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Case: An 18-year-old male patient sustained a traumatic injury that resulted in the loss of approximately 50% of the radial head. Subsequently, reconstruction was performed by transplanting an osteochondral plug harvested from the lateral femoral condyle. At the 1-year postoperative follow-up, the patient was pain-free and had a good range of motion. Conclusion: Using a novel technique, an irreparable radial head fracture was reconstructed using an osteochondral plug from the lateral femoral condyle. Reconstruction with osteochondral plugs may be a treatment option for partial loss of the radial head. [ABSTRACT FROM AUTHOR]

Objectives: Ageing and obesity are major risk factors for osteoarthritis (OA), a widespread disease currently lacking efficient treatments. Senescence-accelerated mouse prone 8 (SAMP8) display early onset ageing phenotypes, including OA. This study investigates the impacts of high-fat diet (HFD)-induced obesity on OA development in SAMP8. Methods: SAMP8 at 5 weeks were fed either a normal chow diet or an HFD for 10 weeks to induce obesity. Parameters related to obesity, liver function, and lipid and glucose metabolism were analysed. At 14 weeks of age, knee joint pathology, bone mineral density, and muscle strength were assessed. Immunohistochemistry and TUNEL staining were performed to evaluate markers for cartilage degeneration and chondrocyte apoptosis. Results: At 14 weeks of age, HFD-induced obesity increased liver and adipose tissue inflammation in SAMP8 without further exacerbating diabetes. Histological scoring revealed aggravated cartilage, menisci deterioration, and synovitis, while no further loss of bone mineral density or muscle strength was observed. Increased chondrocyte apoptosis was detected in knee joints following HFD feeding. Conclusions: Ten weeks of HFD feeding promotes spontaneous OA progression in 14-week-old SAMP8, potentially via liver damage that subsequently leads to chondrocyte apoptosis. This ageing-obese mouse model may prove valuable for further exploration of spontaneous OA pathophysiology. [ABSTRACT FROM AUTHOR]

Study Design. A retrospective case-control study. Objective. To differentiate neurodegenerative diseases from compressive cervical myelopathy (CCM) using motor-evoked potentials (MEPs). Summary of Background Data. When considering surgery for CCM, it may be necessary to differentiate the condition from a neurodegenerative disease. Materials and Methods. A total of 30 healthy volunteers, 52 typical CCM patients with single-level compression of the spinal cord at C4-5 or C5-6, 7 patients with amyotrophic lateral sclerosis (ALS), and 12 patients with demyelinating disease of the central nervous system, including 11 patients with multiple sclerosis and 1 patient with neuromyelitis optica spectrum disorder, formed our study population. MEPs were recorded from the bilateral abductor digiti minimi (ADM) and abductor hallucis (AH) muscles using transcranial magnetic stimulation and electrical stimulation of the ulnar and tibial nerves. Central motor conduction time, peripheral conduction time, amplitude of MEPs, and frequency of F waves were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff value for distinguishing between CCM and ALS. Results. Significant differences were observed in the amplitude of MEPs and frequency of F waves evoked by peripheral nerve stimulation between patients with CCM and ALS. The MEP amplitude of AH was more accurate in differentiating between the two diseases compared with ADM (cutoff value, 11.2 mV, sensitivity, 87.5%; specificity, 85.7%). All 7 patients with ALS showed reduced frequency of F waves from ADM or AH, but none of the healthy volunteers or patients with other diseases demonstrated this finding. Moreover, there were no significant differences between CCM and demyelinating disease of the central nervous system in any of the assessments. Conclusion. The amplitude of MEPs and frequency of F waves evoked by peripheral nerve stimulation could be helpful in differentiating ALS from CCM. [ABSTRACT FROM AUTHOR]

Context: Tennis is a noncontact sport playable at an individual's own pace. Thus, it is popular among the older adults. It is known that older adults often suffer from rotator cuff tears (RCTs), which may affect tennis activity. However, the prevalence and influence of RCTs on tennis play among older players are not well-known. This study aimed to evaluate the prevalence of RCTs in older tennis players and its impact on physical findings and shoulder function. Design: A cross-sectional study. Methods: Fifty-three tennis players (mean age: 70.7 y; range: 60-83 y) participating in a recreational-level tennis tournament were examined in this study. An ultrasonographic examination of both shoulders was performed to detect RCTs. Relationships between RCTs of the dominant shoulder and clinical findings, shoulder pain, and shoulder function including range of motion, shoulder strength, and Single Assessment Numeric Evaluation score, and Disability of the Ann, Shoulder and Hand--Sports Module score were assessed. Results: RCTs were detected in 19 (36%) dominant shoulders and 6 (11%) nondominant shoulders. Asymptomatic RCTs were detected in 11 (58%) dominant shoulders and 5 (83%) nondominant shoulders. Increased crepitus and more positive results in the empty can test, and infraspinatus test were observed in the dominant shoulders with RCTs than in those without; however, there was no difference in shoulder pain, range of motion; strength; Single Assessment Numeric Evaluation score; and Disability of the Arm, Shoulder and Hand--Sports Module score between the players with and without RCTs. Conclusions: One-third of the older tennis players in this study had RCTs in the dominant shoulder with some positive physical sign of an RCT. However, shoulder pain and shoulder function did not differ between the players with and without RCTs, suggesting that RCTs had a minor impact on the tennis performance in the participants of this study. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the microstructural changes of subchondral trabecular bone in patients with osteonecrosis of the femoral head (ONFH) using multi-detector row computed tomography (MDCT). Methods: We retrospectively investigated 76 hips in 50 patients diagnosed with ONFH between 2017 and 2021. Groups 1, 2, 3, and 4 comprised hips without ONFH, ONFH without femoral head collapse (FHC), ONFH with mild collapse (<2 mm), and ONFH with severe collapse (>2 mm), respectively. All patients underwent MDCT, and the subchondral trabecular bone microstructure was assessed. Regions of interests were set at the lateral boundary of the femoral head necrotic lesion and centre of the acetabular weight-bearing portion. Results: In both the femoral head and the acetabular regions, there were significant differences in Groups 2 and 3 compared to Group 1, with increased volumetric bone mineral density and apparent bone volume fraction, and more plate-like with increased connectivity, indicating that osteosclerotic changes were occurring. Conclusions: In both the femoral head and the acetabular regions, osteosclerotic changes of subchondral trabecular bone microstructure were present before FHC. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Purpose: The present study aimed to examine the characteristics of physical signs in elderly patients with cervical myelopathy (CM) and to compare the findings in three different age groups. Overview of Literature: As the global population ages, the incidence of CM in elderly patients is increasing. Methods: We evaluated 100 consecutive surgical patients with CM and divided them into the following groups: 80s (34 patients; mean age, 83.9 years), 70s (33 patients; mean age, 73.9 years), and 69 or younger (33 patients; mean age, 60.9 years). The clinical symptoms and physical signs were evaluated and recorded. Results: Although the recovery rate decreased with increasing age, all groups demonstrated a significant improvement in clinical symptoms relative to preoperative values. The Hoffman sign and hyperreflexia of the triceps tendon were, respectively, present in 82% and 88% of patients in the 80s group, 74% and 64% of those in the 70s group, and 69% and 82% of those in the 69 or younger group, with no significant difference among the groups. In contrast, the rates of hyperreflexia of the patellar and Achilles tendons were, respectively, 59% and 32% in the 80s group, 85% and 48% in the 70s group, and 91% and 70% in the 69 or younger group, with significant differences. Conclusions: The positivity rate of the lower extremity hyperreflexia decreased significantly with increasing age in patients with CM. The absence of hyperreflexia, particularly lower extremity, is not uncommon in elderly patients with suspected CM. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study. Purpose: This research aimed to assess the clinical outcomes of patients with traumatic cervical spine dislocation who underwent closed reduction employing our approach. Overview of Literature: Bedside closed reduction is the quickest procedure for repairing traumatic cervical spine dislocations; nevertheless, it also possesses the risk of neurological deterioration. Methods: For closed reduction, the patient's head was elevated on a motorized bed, the cervical spine was placed at the midline, traction of 10 kg was applied, the motorized bed was gradually returned to a flat position, the head was lifted off the bed, and the cervical spine was slowly adjusted to a flexed position. The weight of traction was elevated by 5-kg increments until the positional shift was attained. Subsequently, the bed was gradually tilted while traction was applied again to return the cervical spine to the midline position. Results: Of the 43 cases of cervical spine dislocation, closed reduction was carried out in 40 cases, of which 36 were successful. During repositioning, three patients experienced a temporary worsening of their neck pain and neurological symptoms that enhanced when the cervical spine was flexed. Closed reduction was conducted while the patient was awake; nevertheless, sedation was needed in three cases. Among the 24 patients whose pretreatment paralysis had been characterized by American Spinal Injury Association Impairment Scale (AIS) grades A--C, seven patients (29.2%) demonstrated an enhancement of two or more AIS grades at the last observation. Conclusions: Our closed reduction approach safely repaired traumatic cervical spine dislocations. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective cohort study. Purpose: We aimed to investigate the surgical results of foramen magnum decompression (FMD) to identify the potential factors associated with syrinx reduction in Chiari malformation type I (CMI). Overview of Literature: The predictive value of preoperative factors for syrinx reduction in patients with CMI remains debatable. Methods: We enrolled patients who underwent microscopic FMD with outer dural layer resection for CMI. The distance from the tip of the cerebellar tonsil to the C2 vertebral endplate on sagittal magnetic resonance imaging (MRI) was defined as the tonsillar distance (TD). Patients who showed a >20% syrinx diameter reduction on the 1-year follow-up MRI were defined as the syrinx reduction group while the others were categorized in the syrinx nonreduction group. Patients with syringomyelia were categorized into the clinically improved and unimproved groups using the Chicago Chiari Outcome Scale. The imaging and clinical parameters were evaluated pre- and postoperatively. Results: This study included 25 patients of whom 19 (76.0%) had syringomyelia. At the 1-year follow-up, the syrinx diameter had decreased in 11 patients (57.8%). The increased TD significantly differed between the syrinx reduction and nonreduction groups. At the 1-year follow-up, 12 and seven patients with syringomyelia were categorized into the clinically improved and unimproved groups, respectively. The clinically improved and unimproved groups showed significant differences in the mean age and increased TD. Conclusions: Postoperative syrinx reduction was significantly correlated with the upward shifting of the cerebellar tonsil in patients with CMI. Our quantitative evaluation of the alterations in hindbrain position after FMD was easily performed and reflects the clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Substance P (SP) modulates NK1 and has various functions such as regulation of pain response, bone metabolism, and angiogenesis, which are recognized as important factors in osteoarthritis (OA). We aimed to evaluate the therapeutic effect of targeting SP on OA progression. Methods: SP expression patterns were analysed histologically in articular cartilage and subchondral bone of human knees from OA patients and autopsy donors as non-OA samples and in mouse articular cartilage. Moreover, to examine the effect of SP on the progression of OA, we administered drugs to mice following the surgical destabilization of the medial meniscus: Phosphate-buffered saline (PBS), septide (NK1 receptor agonist), or aprepitant (NK1 receptor antagonist). Histological analysis and bone morphologic analysis using micro-computed tomography were performed. Results: In human analysis, the expression of SP in mild OA samples was significantly higher than that in severe OA, and that in healthy cartilage was significantly higher than that in OA. In mouse analysis, Osteoarthritis Research Society International scores in the septide group were significantly lower than those in the control group. Computed tomography analysis showed that the subchondral bone's epiphysis in the control group had sclerotic change, not observed in the septide group. Conclusions: The administration of septide ameliorates OA progression through preventing subchondral bone sclerosis. [ABSTRACT FROM AUTHOR]

Background: No definite consensus has been reached regarding the optimal technique for graft fixation to the femur in an anterior cruciate ligament reconstruction. The purpose of this study was to evaluate the mechanical strength of two cortical suspension devices which were the TightRope (TR), a new adjustable-length loop device, and the EndoButton (EB), a well-established fixed-length loop device. Methods: The devices were tested under cyclic and pull-to-failure loading conditions in both an isolated device setup and a specimen setup using porcine femora and bovine flexor tendons. In particular, we examined the influence of tendon and device lengths, whereby the total length of the bone tunnel was fixed to 35 mm and an effective length of tendon in the bone tunnel was adjusted. Results: In the isolated device testing, the EB showed significantly higher ultimate tensile strength than the TR. The displacement after preloading for the EB was statistically lower than that for the TR, and retained a significant difference after the cyclic load. In contrast, specimen testing showed no statistical difference in the displacement among the EB group and TR groups. Conclusion: This study indicated that the EB provides greater mechanical strength than the TR. An important new finding was the measurement of initial displacement from the initiation of fixation until loading began using 50 N of tension. In isolated device testing, the TR induced significantly more displacement than the EB during preloading, which could reflect the TR loop's stretching capacity until a certain amount of tension is applied. [ABSTRACT FROM AUTHOR]

The therapeutic potential of mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) for various diseases and tissue repair is attracting attention. Here, EVs from conditioned medium of human bone marrow MSCs at passage 5 (P5) and passage 12 (P12) were analysed using mouse Achilles tendon rupture model and lectin microarray. P5 MSC-EVs accelerated Achilles tendon healing compared with P12MSC-EVs. Fucose-specific lectin TJA-II was indicated as a glycan marker for therapeutic MSC-EVs. The present study demonstrated that early passagedMSC- EVs promote Achilles tendon healing compared with senescentMSCEVs. Glycans on MSC-EVs might provide useful tools to establish a quality control and isolation system for therapeutic MSC-EVs in regenerative medicine. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional study. Purpose: We aimed to quantitatively assess bone marrow edema (BME) on magnetic resonance imaging (MRI) for patients with degenerative lumbar diseases. Overview of Literature: BME adjacent to a sclerotic endplate of the lumbar spine, detected using T2-weighted fat-saturated MRI, is closely associated with low back pain in patients with degenerative lumbar diseases. However, currently, there no quantitative evaluation methods for BME adjacent to the vertebral endplate. Methods: Patients with degenerative lumbar diseases, whose MRIs detected BME, were enrolled. On a T2-weighted fat-saturated MRI, BME appeared as a high-intensity region adjacent to the vertebral endplate. We calculated the contrast ratios (CRs) of BME and normal bone marrow using the signal intensities of BME, normal bone marrow, and the spinal cord. On computed tomography, we calculated Hounsfield unit (HU) values in the same area as BME, the sclerotic endplate, and normal bone marrow to assess bone density. Results: There were 16 men and 14 women, with an average age of 73.5 years. The mean CRs of BME and normal bone marrow were -0.015±0.056 and -0.407±0.023, respectively. BME's CR was significantly higher than that of normal bone marrow (p <0.01). The HU values in the same area as BME, the sclerotic endplate, and normal bone marrow were 251.9±24.6, 828.3±35.6, and 98.1±9.3, respectively; these values were significantly different from each other (p <0.01). Conclusions: The CR on MRI is a useful quantitative assessment tool for BME in patients with degenerative lumbar diseases. [ABSTRACT FROM AUTHOR]

Purpose: A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA. Materials and methods: A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PSTKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination. Results: The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158). Conclusions: The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component. [ABSTRACT FROM AUTHOR]

Study Design: Prospective cohort study. Purpose: To quantitatively evaluate bone marrow edema (BME) in the pedicle on magnetic resonance imaging (MRI) for adolescent athlete patients with spondylolysis. Overview of Literature: Spondylolysis, a stress fracture of the pars interarticularis, is a common occurrence in adolescent athletes with low back pain. T2-weighed fat-saturated MRI is reportedly useful for the detection of BME in the pedicle in the early stage of spondylolysis; however, to our knowledge, the quantitative assessment of BME in spondylolysis has not been reported. Methods: Adolescent athletes with spondylolysis, including those with symptoms of low back pain, were enrolled. The sporting activity of the patients was restricted, and a hard brace was attached to the spine. The BME range of interest was taken on T2-weighed fat-saturated MRI, and the signal intensity (SI) of the BME (SIedema) was measured. The contrast ratio (CR) between the SI of the BME and SI of the spinal cord (SIcord) was calculated per the following formulae: CRedema=(SIedema-SIcord)/(SIedema+SIcord). The CR of the normal pedicle was measured as a control per the following formulae: CRcontrol=(SIcontrol-SIcord)/(SIcontrol+SIcord). Results: The study enrolled 32 men and one woman; the mean patient age was 15.2 years (range, 12-18 years). The average CR of the edema and normal pedicle at the first visit was 0.506 (range, 0.097-0.804) and 0.137 (range, -0.741 to 0.572), respectively. The CR of the edema was significantly higher as compared to that of the normal pedicle (p <0.01). MRI that was performed 1 month after the first visit showed that the CR of the edema had decreased to 0.204 (range, -0.152 to 0.517). The CR of the edema 1 month thereafter was significantly lower than that at the first visit (p <0.01). Conclusions: Quantitative assessment of BME using CR on MRI is useful in the evaluation of the healing process of spondylolysis. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of our devised hybrid physiotherapy regime using an anti-gravity treadmill and a low-frequency electrical stimulation device, as measured in patients with hip osteoarthritis after total hip arthroplasty (THA). Methods The outcomes of the postoperative rehabilitation in 44 patients who underwent THA for hip osteoarthritis were retrospectively examined. The conventional group (n=22) underwent the postoperative rehabilitation according to our protocol, while the hybrid group (n=22) underwent the same training, along with training on an anti-gravity treadmill and training using a low-frequency therapeutic device. The outcome measures were recorded and reviewed with the Numerical Rating Scale for pain, which rates pain on an 11-point scale from 0 to 10, surgical side knee joint extension force, 10-m walking test, Timed Up and Go test, and the 6-minute walking distance (6MD). The outcome measurement was taken 2 weeks after conducting pre-operation and antigravity treadmill training and electrical muscle stimulation, and compared the respective results. Results At the timeframe of 2 weeks from the surgery after conducting a devised hybrid physiotherapy, the values of knee extension muscle strength and 6MD were not worse in the hybrid group than conventional group. In the evaluation at 2 weeks after surgery, the knee extension muscle strength and 6MD values significantly decreased compared with the preoperative values only in the conventional group. Conclusion Lower limb muscular strength and endurance were maintained in the hybrid group, which suggested that hybrid physiotherapy could maintain physical functions early after THA operation. [ABSTRACT FROM AUTHOR]

Study Design: Prospective observational study. Purpose: This prospective analysis aimed to evaluate the efficacy and bone-bonding rate of hybrid hydroxyapatite (HA) spacers in expansive laminoplasty. Overview of Literature: Various types of spacers or plates have been developed for expansive laminoplasty. Methods: Expansive open-door laminoplasty was performed in 146 patients with cervical myelopathy; 450 hybrid HA spacers and 41 autogenous bone spacers harvested from the spinous processes were grafted into the opened side of each lamina. The patients were followed up using computed tomography (CT), and their bone-bonding rates for hybrid HA and autogenous spacers, bone-fusion rates of the hinges of the laminae, and complications associated with the implants were then examined. Results: Clinical symptoms significantly improved in all patients, and no major complications related to the procedure were noted. The hybrid HA spacers exhibited sufficient bone bonding on postoperative CT. The hinges completely fused in over 95% patients within 1 year of the procedure. Only 4 spacers (0.9%) developed lamina sinking, and most expanded laminae maintained their positions without sinking or floating throughout the follow-up period. Conclusions: Hybrid HA spacers contributed to high bone-fusion rates of the spacers and hinges of the laminae, and no complications were associated with their use. Cervical laminoplasty with these spacers is safe and simple, and it yields sufficient fixation strength while ensuring sufficient bone bonding during the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective case-control study. Purpose: To evaluate the primary outcomes and radiographic results of percutaneous vertebroplasty (PVP) in patients with singlelevel osteoporotic vertebral fracture (OVF) with intravertebral cleft (IVC) to identify the risk factors for cement loosening after PVP. Overview of Literature: PVP is a widely accepted method for managing painful OVF; however, cement loosening occasionally occurs with poor outcomes. Methods: This retrospective study involved 195 patients treated with PVP for single-level OVF with IVC. Six months thereafter, the primary outcomes were evaluated using the Visual Analog Scale (VAS) for back pain and the modified Oswestry Disability Index. Computed tomography was conducted to detect cement loosening. Possible risk factors, such as age, sex, wedging angle, intravertebral instability, Parkinson's disease, spinous process fracture, ankylosing spinal hyperostosis, split vertebrae, and adjacent intervertebral vacuum, were assessed. Results: Forty-nine patients (25%) experienced cement loosening 6 months after PVP. The mean VAS scores were significantly higher in patients with cement loosening than in those without (50 vs. 26 mm, respectively; p <0.01). Cement loosening was closely associated with intravertebral instability (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04-1.40; p =0.015), Parkinson's disease (OR, 54.31; 95% CI, 4.47-659.53; p =0.002), spinous process fracture (OR, 7.11; 95% CI, 1.65-30.60; p =0.009), and split vertebrae (OR, 11.59; 95% CI, 1.64-82.02; p =0.014). Conclusions: Patients with cement loosening experienced worse back pain than those without cement loosening. The important risk factors that influenced cement loosening after PVP were high intravertebral instability, Parkinson's disease, spinous process fracture, and split vertebrae. [ABSTRACT FROM AUTHOR]

Background: Hip dysplasia is a common cause of secondary osteoarthritis. To prevent the early onset of secondary osteoarthritis, rotational acetabular osteotomy has been proposed. Description: The approach combines the anterior iliofemoral and posterior approaches through a single skin incision. The pubic bone is cut independently, and the ilium and ischium are cut in continuity. The rotation of the acetabulum provides a more horizontal weight-bearing area and, at the same time, returns the superiorly subluxated femoral head to a more normal position. Alternatives: The Ganz periacetabular osteotomy involves the same concept as a rotational acetabular osteotomy with a different surgical approach. The rate of major complications, such as intra-articular osteotomy, nerve palsy, loss of fixation, malreduction, and symptomatic heterotopic ossification, is lower in rotational acetabular osteotomy (0% to 18%) than in periacetabular osteotomy (6% to 37%). Because of a wide surgical exposure, osteotomy can be performed under direct vision in rotational acetabular osteotomy. Rationale: Rotational acetabular osteotomy for osteoarthritis secondary to hip dysplasia can alter the position of the acetabulum en bloc and cover the femoral head with cartilage. For the unstable hip with dysplasia, the surgical procedure is needed for the prevention of osteoarthritis. [ABSTRACT FROM AUTHOR]

This study evaluated factors affecting sensory restoration after thumb reconstruction using a wrap-around flap in 21 thumbs in patients aged 11 to 50 years old. The patients were followed from 12 to 94 months after surgery. Static and moving 2-point discrimination of the reconstructed pulp was measured and analysed using multiple regression analysis. According to the univariate and multivariate analyses, the preoperative period, the number of nerve coaptations, and the duration of follow-up all significantly affected sensory recovery. Sensory recovery with more than three coaptations was significantly better than those with less than three coaptations, and the number of nerve coaptations was one of the primary factors influencing sensory recovery. We conclude from this study that the wrap-around flap should be performed soon after injury and that surgeons should try to coaptate three or more nerves to enhance sensory recovery. Level of evidence: IV.