Journal of Orthopaedic Science最新文献

Background: In Japan, the Japanese Orthopedic Association (JOA) score is widely used as a clinician-reported outcome after shoulder surgery. However, Shoulder36 is positioned as a general patient-reported outcome measure. This study aimed to determine the correlations between the JOA score and scores in the domains of the Shoulder36 and their minimal clinically important differences (MCIDs) and cutoff values for the patient-acceptable symptom state (PASS) after unilateral arthroscopic rotator cuff repair (ARCR).

Methods: We evaluated 145 patients using the JOA score and Shoulder36 before and 1 year after surgery. The MCID and PASS cutoff values were determined by patients' responses to the following anchor item: A, none ("no good at all"); B, poor ("some effect but unsatisfactory"); C, good ("satisfactory effect with occasional episodes of pain or stiffness"); D, excellent ("ideal response, virtually pain-free"). The correlations between the JOA score and the domains of the Shoulder36 were statistically calculated. The border between B and C was defined as the threshold for PASS.

Results: There were significant correlations between the JOA score and the Shoulder36 domains. The responses to the anchor item were as follows: A (n = 0), B (n = 21), C (n = 76), and D (n = 48). The MCID for the JOA score was 19.5 points and the MCIDs for Shoulder36 were 0.5 points for pain, 0.667 for range of motion, 0.67 for muscle strength, 0.3 for general health, 0.571 for activities of daily living, and 1.0 for sports ability. The PASS cutoff value was 89.0 points for the JOA score and 3.8 points for pain, 3.667 for range of motion, 3.0 for muscle strength, 3.7 for general health, 3.7 for activities of daily living, and 3.0 for sports ability in the Shoulder36.

Conclusions: The MCID and cutoff PASS values for the JOA score and Shoulder36 identified in this study will help to determine the effectiveness of multidisciplinary management after ARCR.

Background: Spontaneous anterior interosseous nerve (AIN) palsy is characterized by the sudden onset of upper limb pain followed by weakness of muscles mainly innervated by the AIN. Although this palsy is conventionally treated conservatively, interfascicular neurolysis to release hourglass-like fascicular constrictions has been recommended. The present study aimed to establish the clinical characteristics and treatment strategy for this condition.

Methods: One hundred limbs with spontaneous AIN palsy from 24 Japanese institutions were treated either conservatively or with interfascicular neurolysis according to the patient's intention. Patients were followed periodically from 3 months to either recovery or ≥36 months after onset. Limbs recovering to manual muscle testing grade 4 or better in both the flexor pollicis longus and flexor digitorum profundus of the index finger were rated as Good recovery, with all other results classified as Poor recovery. We performed logistic regression analysis to determine the independent factors associated with Good recovery.

Results: Good recovery was achieved in 39 of 49 limbs treated conservatively and 44 of 51 limbs by interfascicular neurolysis. All 26 limbs with conservative treatment displaying ≥1 grade of manual muscle testing improvement within 6 months after onset achieved Good recovery. All 23 limbs with Group I palsy, in which weakness was recognized only in muscles innervated by the AIN, obtained Good recovery with interfascicular neurolysis regardless of when it was performed. In the 59 limbs with no recovery at 6 months by conservative treatment, Good recovery was achieved in 30 of 36 limbs by subsequent interfascicular neurolysis and 13 of 23 limbs continuing conservative treatment. In these 59 limbs, interfascicular neurolysis and Group I palsy were significantly associated with Good recovery.

Conclusions: Conservative treatment is recommended within 6 months following symptom onset, after which time interfascicular neurolysis is advisable for cases of no improvement.

Background: Long bone fractures may exhibit nonunion/delayed union and the precise mechanism underlying this devastating condition remain unknown. More recently, a series of meta-analyses have examined the effect of local administration of platelet-rich plasma (PRP) in patients suffering from nonunion/delayed union fractures; however, the conclusions of available meta-analyses have remained debatable. This umbrella meta-analysis was performed to synthesize and recalculate available evidence to assess the certainty of the effect of PRP on nonunion/delayed union fractures.

Methods: Relevant meta-analyses and individual studies investigating the effect of PRP therapy on nonunion/delayed union fractures were obtained through a systematic search in PubMed, Web of Knowledge, and Scopus up to November 2023. Meta-analyses were re-conducted for healing rate and healing time using a random effects model. The methodology quality of the included meta-analyses and the quality of evidence was assessed using the AMSTAR2 and GRADE criteria, respectively.

Results: A total of 5 meta-analyses with 13 individual studies, comprising 1362 patients, were included. The analysis revealed a significant improvement in both healing rate (relative risk (RR) = 1.30, 95%CI: 1.06 to 1.60) and healing time (mean difference (MD): -1.25, 95 % CI: -2.09 to -0.42) of nonunion/delayed union fractures. However, when individual studies were pooled, PRP was not effective in increasing the healing rate, while it was effective in reducing healing time (MD = -2.15, 95 % CI = -3.17 to -1.13). PRP therapy had no significant effect on pain improvement and the Excellent/Good Posttreatment Limb Function. The risk of the adverse side effects was not significant.

Conclusion: This umbrella meta-analysis revealed that PRP may reduce healing time in patients with nonunion/delayed union fractures, with no potential side effects. This finding is needed to be confirmed by further studies.

Background: Popliteal artery injury (PAI) is sometimes accompanied by proximal tibial fracture or knee dislocation. We hypothesized that revascularisation approach should be selected depending on the associated injury. The purpose of this study is to propose revascularisation approach that does not interfere with definitive surgery.

Methods: Patients with PAI who were treated between 2013 and 2023 were included. Associated injuries, revascularisation approach, and skin incision for the definitive surgery were investigated. We investigated whether varus-valgus instability remained as an outcome.

Results: 21 limbs with PAI were included. There were 6 cases with proximal tibial fracture. Medial incision was used in 2 cases and crank shaped incision in 4 cases. In 4 cases of crank shaped incision, osteosynthesis was performed through a crank shaped incision. There were 8 cases with knee dislocation. Medial incision was used in 1 case, S shaped incision in 4 cases, and crank shaped incision in 3 cases. In cases of S shaped incision, extra-articular ligament was repaired through independent incisions. In three cases of crank shaped incision, it was not possible to repair extra-articular ligament because of interfere with the initial incision. As a result, knee joint instability remained. There were 7 cases without proximal tibial fracture or knee dislocation. Medial incision was used in 1 case, S shaped incision in 3 cases, and crank shaped incision in 3 cases. There was no interference between the incisions for revascularisation and for definitive surgery.

Conclusion: For PAI, revascularisation approaches should be selected depending on the associated injury.

Background: Osteosarcoma (OS) is the most common primary malignant bone tumor. Despite advances in multimodal chemotherapy, prognosis for metastatic or recurrent OS remains poor. Next-generation sequencing (NGS) can uncover new therapeutic options by identifying potentially targetable alterations. This study analyzed NGS data from the Center for Cancer Genomics and Advanced Therapeutics (C-CAT) database in Japan, comparing findings with the Memorial Sloan-Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) data from the United States.

Methods: We sequenced tumor and/or germline DNA from 223 high-grade OS samples using the FoundationOne® CDx or OncoGuideTM NCC Oncopanel System, and the FoundationOne® Liquid CDx for multigene panel testing (2019-2023). Genomic alterations were interpreted using the Cancer Knowledge Database (CKDB), with potentially actionable genetic events categorized into A-F levels.

Results: Analysis of 223 high-grade OS samples revealed 1684 somatic mutations in 167 genes and 1114 copy number alterations in 89 genes. Potentially actionable alterations were identified in 94 patients (42.2 %) at CKDB Levels A-C. These included 2 cases with NTRK fusions (0.9 %; Level A), one case with TMB-high (0.4 %; Level A), 3 with ERBB amplifications (1.3 %; Level B), and 88 cases (39.5 %) with alterations such as CDK4 amplification, PTEN deletion/mutation, and others (Level C). Co-occurring amplifications of KIT, KDR, and PDGFRA at the 4q12 locus were found in 8 cases (3.6 %), while VEGFA and CCND3 co-amplifications at the 6p12-21 locus were seen in 33 cases (14.8 %). These gene amplifications, also reported in US studies, are targetable by multi-kinase inhibitors, although the C-CAT cohort's profiles differed from US cohorts like MSK-IMPACT.

Conclusions: Precision medicine for rare tumors still poses challenges. In this Japanese cohort, 42.2 % of high-grade OSs had potentially actionable alterations per CKDB. Concurrent gene amplifications of KIT, KDR, and PDGFRA at 4q12, and VEGFA and CCND3 at 6p12-21, might offer promising therapeutic options for patients with recurrent/metastatic OS resistant to conventional chemotherapy.

Background: Discontinuity at the site of osteotomy is a complication after periacetabular osteotomy. The objectives of this study were to assess whether discontinuity is owed to delayed union or non-union and to clarify the risk factors associated with discontinuity >1 year after periacetabular osteotomy.

Methods: We performed a retrospective review of 104 hips in 95 consecutive patients who underwent periacetabular osteotomy between 2017 and 2021. Pre- and post-periacetabular osteotomy radiographs of 97 hips in 89 patients were finally evaluated. Radiographic evaluations included the occurrence of stress fractures in the inferior pubic ramus and posterior column, incidence of discontinuity at osteotomy sites and stress-fractured bones, centre-edge angle, acetabular roof obliquity, and Tönnis grade. Clinical evaluations included the age at surgery, body mass index, and Harris hip score.

Results: The incidence of discontinuity at the pubic osteotomy site and stress-fractured posterior column improved from 16.5 % to 2.1 % at 1 year postoperatively to 5.2 % and 0 % at the final follow-up, respectively. Multivariate analysis revealed that postoperative stress fracture in the inferior pubic ramus was significantly more common in patients with discontinuity of the stress-fractured inferior pubic ramus at the final follow-up.

Conclusions: The present study demonstrated that even if discontinuity is present at the osteotomy site or stress-fractured inferior pubic ramus and posterior column 1 year post-periacetabular osteotomy, continuity can subsequently occur at these sites. The findings suggest that discontinuity 1 year postoperatively should be defined as delayed union rather than non-union. We also identified postoperative stress fracture in the inferior pubic ramus as a risk factor for discontinuity at the pubic osteotomy site at a mean time of 3.2 years after periacetabular osteotomy.

Background: The initial fixation strength of the ulnar collateral ligament (UCL) reconstruction is increased by combining a suture augmentation (SA). However, no reports have investigated the stability of UCL reconstruction with SA across multiple elbow flexion angles and the influence of SA on the stability and failure strength of the anchor and bone tunnel methods. This study aimed to compare the displacement against a valgus load at multiple elbow flexion angles of the anchor and bone tunnel methods between with and without SA, and to compare the failure strength between these methods with SA. We hypothesized that the combination of SA reduced the displacement, and the failure strength was comparable between the anchor and Ito methods with SA.

Methods: Eight fresh-frozen cadaveric upper extremities were used. To evaluate the displacement against valgus load, the valgus stability tests at multiple flexion angles were performed for four UCL reconstruction methods: anchor method, anchor with SA, bone tunnel, and bone tunnel with SA. The load-to-failure test was performed to evaluate the failure strength of the anchor and bone tunnel methods with SA. P < 0.05 was considered significant in tests of statistical inference.

Results: The displacements of the anchor method with SA at 30°, 60°, and 90° of flexion were significantly smaller than those without SA. Regarding comparing the bone tunnel method with and without SA, a significant difference was observed at only 30° of flexion. There was no significant difference in the failure strength between the anchor and bone tunnel methods with SA.

Conclusion: The combination of SA reduced the displacement against a valgus load at multiple flexion angles, and the failure strength was comparable between the anchor and bone tunnel methods with SA. Combining SA may increase the initial fixation strength in both the anchor and bone tunnel methods.

Background: Osteosarcoma is the most familiar primary malignant tumor occurred in bone in young people and is featured by complicated genetic changes. CD93 has been affirmed to exhibit the facilitative roles in multiple cancers.

Methods: But, the detailed impacts and related regulatory pathway of CD93 in osteosarcoma progression maintain unclear.

Results: In this study, the elevated expression of CD93 was verified in osteosarcoma tissues from GEO database. Additionally, it was illustrated that CD93 existed the aggrandized mRNA and protein expressions in osteosarcoma cell lines. Moreover, suppression of CD93 restrained cell proliferation and angiogenesis in osteosarcoma. It was demonstrated that inhibition of CD93 retarded immune escape in osteosarcoma. Furthermore, CD93 triggered the PI3K/AKT pathway to aggravate the progression of osteosarcoma. At last, it was discovered that knockdown of CD93 attenuated tumor growth in vivo.

Conclusions: In conclusion, this study disclosed that CD93 aggravated cell proliferation, angiogenesis and immune escape in osteosarcoma through triggering the PI3K/AKT pathway. This work may supply useful opinions of CD93 on the cure of osteosarcoma.

Background: 40-45 % of the population presents with enlarged external occipital protuberances (EEOPs), which can lead to pain. EEOP occurrence is higher in younger males; however, the reason is debated. We used plane lateral radiographs to investigate how anthropometrics, age, biological sex, head and neck kinematics, and neck strength differ between those with and without an EEOP.

Methods: Data was compiled across four study samples, which included lateral radiographs taken in a neutral neck posture (n = 102, 50% females). An enlarged EOP was defined as being longer than 10 mm, and this threshold was used to classify participants as having a presence or absence of an EEOP. Statistical analyses were used to compare outcome measures between those with and without an EEOP presence for age, biological sex, skull angle, intervertebral joint angle (C1-C2 through C6-C7), and neck strength (flexion and extension).

Results: Twenty-four percent of participants (19 males and five females, p = 00.002 for biological sex differences) presented with an EEOP; only one was over 30 years old. There were no significant main effects on the skull and intervertebral joint angles, participant anthropometrics, or neck strength.

Conclusions: This study confirmed that enlarged EOPs are more prevalent in males; however, neck posture and other anthropometrics do not differ with the presence or absence of an EEOP.

Introduction: Laminoplasty is a widely used surgical procedure to decompress the cervical spinal cord. Recently, titanium plates (TPs) have been used instead of conventional hydroxyapatite block (HA) spacers to prevent laminar reclosure. However, no study has compared the cost-effectiveness of TP and HA. Therefore, this study aimed to compare the cost-effectiveness and postoperative outcomes of laminoplasty using TP or HA.

Methods: A total of 167 patients who underwent cervical laminoplasty at our institution were included in this study. Patients with cervical spinal cord injury, epidural hematoma, or follow-up of <1 year were excluded. Of the 167 patients, 69 underwent laminoplasty using TP (the TP group), and 98 underwent laminoplasty using HA (the HA group). The surgical costs and incremental cost-effectiveness ratio (ICER) were compared between the two groups. Additionally, the operation time, complications, Japanese Orthopaedic Association score, Hirabayashi recovery rate, and pre and postoperative cervical alignment on X-ray images were investigated.

Results: The surgical costs were significantly higher in the TP group than in the HA group (HA, 7255 ± 1504 USD vs. TP, 11,642 ± 2492 USD, p < 0.01). The ICER was 21,935 USD per quality-adjusted life year in the TP group. The operation time was shorter in the TP group than in the HA group (HA, 70.0 ± 22.5 min vs. TP, 63.6 ± 19.3 min, p = 0.06). The Hirabayashi recovery rate and radiographic parameters were similar between the two groups. Implant displacements were significantly more common in the HA group than in the TP group (HA, 11.2 % vs. TP, 0 %, p < 0.01).

Conclusions: The surgical costs and ICER with TPs were higher than those with HA spacers. However, no difference in the Hirabayashi recovery rate and postoperative radiological parameters was observed between the two groups, although the HA group had more implant displacements.