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Abstract Background It has been reported that hallux valgus (HV) is associated with axial rotation of the first metatarsal (1MT). However, the association between HV and torsion of the 1MT head with respect to the base has not been previously investigated. The present study examined whether there was a significant difference in 1MT torsion between HV and control groups. Methods Three-dimensional (3D) computed tomography (CT) scans of 39 ft were obtained, and 3D surface models of the 1MT were generated to quantify the torsion of the head with respect to the base. The HV group consisted of 27 ft from 27 women (69.5 ± 7.5 years old). Only the feet of HV patients with an HV angle >20° on weight-bearing radiography were selected for analysis. The control group consisted of 12 ft from 12 women (67.7 ± 7.2 years old). In a virtual 3D space, two unit vectors, which describe the orientation of the 1MT head and base, were calculated. The angle formed by these two unit vectors representing 1MT torsion was compared between the control and hallux valgus groups. Results The mean (± standard deviation) of the torsional angle of the 1MT was 17.6 (± 7.7)° and 4.7 (± 4.0)° in the HV and control groups, respectively, and the difference was significant (p

Abstract Hip fracture is the most severe bone fragility fracture among osteoporotic injuries. Family history is a known risk factor for fracture and now included among criteria for osteoporosis diagnosis and treatment; however, genetic factors underlying family history favoring fracture remain to be elucidated. Here we demonstrate that a missense SNP in the ALDH2 gene, rs671 (ALDH2*2), is significantly associated with hip fracture (odds ratio = 2.48, 95% confidence interval: 1.20–5.10, p = 0.021). The rs671 SNP was also significantly associated with osteoporosis development (odds ratio = 2.04, 95% confidence interval: 1.07–3.88, p = 0.040). For analysis we enrolled 92 hip fracture patients plus 48 control subjects without bone fragility fractures with higher than −2.5 SD bone mineral density. We also recruited 156 osteoporosis patients diagnosed as below −2.5 SD in terms of bone mineral density but without hip fracture. Association of rs671 with hip fracture and osteoporosis was significant even after adjustment for age and body mass index. Our results provide new insight into the pathogenesis of hip fracture.

The TightRope RT (Arthrex, Naples, FL) is a suspensory device for anterior cruciate ligament reconstruction. However, there is a potential risk of the button being pulled too far off the lateral femoral cortex into the soft tissue because the adjustable loop is long. The purpose of this article is to present an easy and safe technique for self-flip. As to the preparation of the graft, we draw the first line in the loop of the TightRope RT at the same length as the femoral tunnel, and we draw the second line 7 mm longer than the length of the femoral tunnel as a self-flip line. Concerning passing of the graft, the side sutures are pulled from the lateral side. We stop pulling the sutures just at the self-flip line by holding the graft at the tibial end. The side suture is inclined to the medial side with strong pulling of the suture at full extension of the knee. Then the surgeon pulls the tibial end of the graft to feel a secure positioning of the button on the lateral femoral cortex. Although it has limitations, the present technique is easy and certainly helps surgeons achieve appropriate positioning of the button.

Discoid lateral meniscus with snapping phenomenon is a rare pathologic condition. The purpose of this article is to present an arthroscopic technique for the treatment of discoid lateral meniscus with snapping phenomenon. The patient is placed in the supine position for confirmation of snapping. As the patient's knee bends, it can be confirmed by arthroscopy that the posterior horn of the discoid lateral meniscus moves posteriorly and the central portion of the discoid lateral meniscus moves anteriorly at the same time with snapping at deep flexion angles. The anterior segment of the discoid lateral meniscus is found to be redundant and is often folded. On the contrary, as the patient's knee extends, the central portion is returned to the original position accompanied by snapping at nearly full extension. After excision of the central portion, the movement of the meniscus is evaluated again and the disappearance of the snapping phenomenon can be confirmed. Although it includes limitations, this application is easy and would certainly help surgeons to treat snapping knee with discoid lateral meniscus.

Tibial coronal inclination is often recognized in everyday life, but the compensatory kinematic changes to maintain plantigrade of the hindfoot in response to tibial coronal inclination remain unclear. Lower legs and foot specimens obtained from seven human cadavers were loaded vertically with traction of Achilles' tendon in different tibial inclinations: 0° (neutral), 5°, and 10° medial inclination, and 5° and 10° lateral inclination. The orientations of the tibia, talus, and calcaneus were recorded under vertical load by a three-dimensional digitizing stylus. The angular changes of the talocrural and subtalar joints in the tibial inclinations from neutral were analyzed. The heights of the origins of the talus and calcaneus were also recorded. As the tibia was medially inclined from neutral, the talocrural joint was significantly more dorsiflexed. The subtalar joint was significantly more inverted, plantarflexed, and internally rotated. However, such significant changes in the joint angles were not observed when the tibia was laterally inclined. The height of the talus decreased as the tibia was medially inclined, but it was vice versa when laterally inclined. The compensatory motions of the hindfoot to tibial medial inclination involved coupled movement of both the talocrural and subtalar joints; such motions flatten the medial foot by decreasing the height of the talus. However, such compensatory capacities of the hindfoot to tibial lateral inclinations were limited. Tibial medial inclination under axial loading affects the kinematics of the hindfoot, and this is an important factor to consider in the treatment of flatfoot as well as foot orthotic/footwear intervention. [ABSTRACT FROM AUTHOR]

Background: Preserving the hip joint to delay arthroplasty for patients with acetabular dysplasia-associated early-stage osteoarthritis has become more common, and several surgical procedures have demonstrated pain relief and improved hip joint function. Periacetabular osteotomy, one of the joint-preserving surgical procedures of the hip, provides favorable outcomes, although there are no reports of total hip arthroplasty being used to treat pseudoarthrosis of the periacetabular osteotomy segment. Therefore, we report a case of pseudoarthrosis in the osteotomy segment after periacetabular osteotomy. The patient was treated using modified total hip arthroplasty and achieved a favorable short-term outcome.Case Presentation: A 62-year-old Japanese woman was diagnosed with bilateral acetabular dysplasia at the age of 50 years, and underwent right and left periacetabular osteotomy at the ages of 52 and 55 years, respectively. When she was 61-years old, she experienced repeated episodes of left coxalgia during walking, with increasing pain at rest, and subsequently visited our department. Plain radiography and computed tomography of her left hip joint confirmed pseudoarthrosis of the periacetabular osteotomy segment. In addition, narrowing of her left hip joint space was observed, which indicated advanced osteoarthritis of the hip. Therefore, she underwent left total hip arthroplasty when she was 62-years old. During the surgery, fibrous fusion of the periacetabular osteotomy segment was confirmed via fluoroscopy, although no abnormal mobility was observed. Thus, the osteotomy segment was fixed with one absorbable screw and two bone pegs (which were prepared using allogeneic bone), and the acetabular cup was fixed using cement. Her postoperative course was generally favorable and bone fusion of the periacetabular osteotomy segment was confirmed at 3 years and 6 months after surgery. Her modified Harris hip score was 43 before the surgery and had improved to 90 at the final follow-up.Conclusions: Modified total hip arthroplasty was successfully used to treat osteoarthritis of the hip and pseudoarthrosis of the periacetabular osteotomy segment. This procedure achieved pseudoarthrosis region bone fusion and a favorable postoperative outcome. [ABSTRACT FROM AUTHOR]

Introduction It has been well documented that labral tear is frequently associated with femoroacetabular impingement and dysplasia of the hip; however, there have been few reported cases of labral tear associated with idiopathic osteonecrosis of the hip. Here we report the case of a patient with labral tear associated with idiopathic osteonecrosis of the femoral head who was treated by hip arthroscopy, with a favorable short-term outcome. Case presentation Under the diagnosis of systemic lupus erythematosus, a 28-year-old Japanese woman was treated with the oral administration of steroid in 2007. A year after the treatment, she developed right hip joint pain and was diagnosed with idiopathic osteonecrosis of the femoral head at our institution. In November of 2011, she revisited our hospital when her right hip joint pain exacerbated and she became unable to walk. On the visit, the anterior impingement sign and Patrick test were positive. Radiography and magnetic resonance imaging in 2011 demonstrated neither spreading of the osteonecrosis area nor collapse of the femoral head in the right joint; however, magnetic resonance imaging showed a high-intensity area in the articular labrum in a T2-weighted image, leading to a diagnosis of labral tear. She underwent labral repair with hip arthroscopy in August of 2012. Now, 1 year after surgery, she does not feel any pain during walking and her modified Harris hip score has improved from 20 prior to surgery to 85. Conclusion The case indicated that it is important to be aware of the possibility of labral tear in patients with idiopathic osteonecrosis of the femoral head, when spreading of the osteonecrosis area or collapse of the femoral head has not been seen on magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Background: The definition of flatfoot remains analytically vague. Toward the purpose of establishing the standard values of the foot length and arch height in childhood and adolescence, large-scale measurement and investigation of the foot arch were conducted using a three-dimensional foot-measuring device. Methods: Measurements of foot structure were performed on 5311 boys and 4844 girls, for a total of 20,310 ft. of 10,155 children aged from 6 to 18 years during the 2006-2008 year period. The foot length (FL) and the navicular height (NH) were measured, and the arch height ratio (AHR (%) = NH × 100/FL) was calculated. Results: The FL in boys showed an extension from the age of 6 to 14 and nearly reached a plateau at 14 years old. In girls, the extension was observed from the age of 6 to 13, and the FL came to a plateau at 13 years old. The NH in boys increased from the age of 6 to 13. In girls, the NH increased from the age of 8 to 13. The AHR, presented a normal distribution, and no differences were observed in the distribution for all ages in boys and girls. In boys, the AHR was almost flat until 11 years old, but elevated in the 11-13 year age period. In girls, the AHR was almost flat until 10 years old, but elevated in the 10-12 year age period. Conclusions: We are certain that the data demonstrating the normal growth of the foot contribute to the diagnosis and treatment of the failure of the foot to thrive. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the feasibility of T2*-weighted imaging (T2*WI) gradient-echo MRI to reflect actual function of the graft after anatomic double-bundle ACL reconstruction. T2*WI and proton density-weighted imaging (PDWI) were compared in the assessment of ACL grafts. Method: Sixty-one patients underwent T2*WI and PDWI at 3,6, and 12 months postoperatively. Signal intensity of the anteromedial bundle (AMB) or posterolateral bundle (PLB) graft standardized to the intensity of the PCL was defined as signal intensity ratio (SIR). Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. The diagnostic efficacy of T2*WI sequence to detect poorly functioning knee with anteroposterior translation >4 mm was assessed. Results: Significant correlations were observed between SIR and KT values for both AMB and PLB at 12 months on T2*WI (r=0.39 and 0.53, respectively), but not on PDWI. Notably, 9 of 10 patients with poorly functioning graft showing anteroposterior translation >4 mm at 12 months formed an isolated group with high T2*WI-SIR. Six of the 10 patients displayed an increase in SIR from 6 to 12 months. Defining anteroposterior translation >4 mm at 12 months as the diagnostic standard for poorly functioning graft, increasing T2*WI-SIR offered 60% sensitivity and >90% specificity. Conclusions: ACL graft intensity on T2*WI is more strongly associated with actual function of the graft than that on PDWI. An increasing trend in T2*WI-SIR from 6 to 12 months postoperatively represents a possible surrogate indicator for poorly functioning grafts. [ABSTRACT FROM AUTHOR]

We present a case of an 8-year-old boy diagnosed with melorheostosis who was suffering from severe genu valgum, permanent dislocation of the patella, knee flexion contracture and leg length shortening. Soft tissue contracture of the limb and subsequent joint deformities were reported to represent clinical manifestations of pediatric melorheostosis. As the epiphyseal plate had not closed, patellar reduction was achieved by soft tissue surgical stabilization, including lateral retinacular release, medial retinaculum plication, and transfer of the lateral half of the patellar tendon. At 4 years postoperatively, as a result of improved limb alignment and knee flexion contracture, the leg length shortening has improved, and the patient does not limp and participates in sports activities. Surgical intervention should be performed as early as possible, because genu valgum and external rotation of the tibia may deteriorate with age, rendering the patellar dislocation irreversible in patients with melorheostosis before epiphyseal closure. [ABSTRACT FROM AUTHOR]

Lateral retinacular release is still being performed in patients with recurrent patellar dislocation as an additional procedure with distal realignment or medial patellofemoral ligament (MPFL) reconstruction. However, consensus remains lacking regarding suitable indications for lateral retinacular release. A 20-year-oldwoman presented with patellar instability in both medial and lateral directions after undergoing lateral retinacular release with MPFL reconstruction. She displayed inherent systemic joint laxity meeting all seven Carter-Wilkinson criteria. Simultaneous MPFL revision and lateral retinaculum reconstruction successfully improved patellar instability in both directions. This case provides an example of iatrogenic medial patellar instability after failed lateral retinacular release. [ABSTRACT FROM AUTHOR]