Journal of Orthopaedic Science最新文献

Background: Various conservative treatments have been reported for refractory calcific tendinitis of the shoulder. This study aimed to evaluate the clinical outcomes of a combined therapy of focused shock wave (FSW) and ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT).

Methods: A total of 229 patients (246 shoulders) who experienced shoulder pain for over six months due to calcific tendinitis were included. The mean age of the patients was 55.0 years, and the mean disease duration was 30.0 months. FSW was performed monthly with ultrasonography. US-PICT was performed before FSW until the symptoms or calcium deposits disappeared. The resorption rate, number of treatments, and clinical scores (the University of California at Los Angeles [UCLA] and Constant scores) were evaluated at the final follow-up. Radiological characteristics of the calcium deposits before treatment were evaluated using the Molé classification. Clinical outcomes were compared between the complete resorption and residual groups.

Results: Complete resorption occurred in 82.9 % of the 204 shoulders. Partial resorption was observed in 38 shoulders, and no change was noted in 4 shoulders. The mean number of FSW and US-PICT treatments was 4.0 and 2.4, respectively. The UCLA and Constant scores considerably improved from 18.7 to 33.0 and from 68.9 to 95.0, respectively. The number of treatments was markedly higher in Molé classification type B. The complete resorption group exhibited better UCLA and Constant scores and required fewer treatments. Additionally, Molé classification type B had a higher proportion of patients in the residual group.

Conclusions: The combined FSW and US-PICT therapy showed good clinical outcomes with a high resorption rate for refractory calcific tendinitis of the shoulder. Patients in the complete resorption group had better clinical outcomes and required fewer treatment sessions. Furthermore, attention should be paid to the refractory radiological characteristics of patients with Molé classification type B.

Background: A walking support orthosis known as the e-foot®, a rubber orthotic worn from the hip to the forefoot to enhance joint flexibility and movement, has been developed to assist elderly people and individuals with walking impairments. Despite its widespread acceptance and positive reception in some care settings, the precise impact of this device on gait dynamics remains unexplored. This study aims to bridge this gap by comparing the walking speeds of healthy volunteers using the e-foot® against their normal walking speeds. Furthermore, it seeks to elucidate the biomechanical alterations induced by the e-foot® on their gait patterns.

Methods: In this intervention study, 51 healthy volunteers underwent a 10-m walk test, both with and without the e-foot®, to measure its effect on walking speed. Gait changes were biomechanically compared by analyzing marker positions and accelerations of the lower extremities during the walk tests.

Results: The e-foot® orthotic device significantly improved walking times for both men and women in the 10-m walk test. Biomechanical testing showed a consistent trend of higher marker positions of the knees, heels, and toes when participants were using the e-foot®. Additionally, marker acceleration during the first half of the swing phase was greater with the e-foot®, indicating a faster gait initiation.

Conclusions: The e-foot® increased the walking speed of healthy volunteers. Also, there were changes to knee, heel and toe positions during gait, and comparative increase in acceleration was recorded in these three parts during swinging gait.

Purpose: A finite element analysis was performed to simulate the biomechanical differences between anterior-posterior (AP) direction and posterior-anterior (PA) direction placement of two cannulated screws in Hoffa fractures.

Methods: Computed tomography images of an healthy male volunteer were used to simulate Letenneur Ⅰ, Ⅱa, Ⅱb, Ⅱc, Ⅲ Hoffa fractures, and two groups of screw internal fixation models were constructed. Two 6.5 mm cannulated screws were implanted parallel in the AP direction or the PA direction. The biomechanical test was performed to determine the displacement, stress distribution, and peaks in the distal femur and cannulated screws in 10 models.

Results: The displacement distribution and peak values of the distal femur and cannulated screws in both groups were similar, and displacement increasing as the load increased. The stress distribution in the distal femur was similar between the two groups, with stress mainly concentrated on both sides of the fracture line, the posterolateral and anterior aspects of the femoral shaft. The peak stress in the PA group of the Letenneur type Ⅱb was significantly higher than that in the AP group, and the stress in the distal femur increased with increasing load. The stress distribution in the cannulated screws of Letenneur Ⅰ, Ⅱa, Ⅱb, and Ⅲ, was similar, but differences are observed between the two groups in type Ⅱc. The stress in the cannulated screws increased with increasing load, and the peak values in the PA group are significantly higher than those in the AP group.

Conclusion: The mechanical stability of the two screw insertion methods is similar. Inserting screws from anterior to posterior can reduce the stress on the distal femur and cannulated screws, and also minimize the dissection of the posterior soft tissues. Therefore, inserting screws from anterior to posterior is a more recommended surgical approach for Hoffa fractures.

Backgroud: Medial humeral epicondyle fracture is a prevalent type of upper limb fractures in pediatric patients. This study aims to compare the follow-up clinical results and complications in 30 children with medial epicondyle fractures who were treated with either metal screws or absorbable screws at our hospital.

Methods: A retrospective review was conducted on 30 children with medial humeral epicondyle fractures, who were divided into two groups: Metal group (18 children) underwent fixation using metal screws, while Absorbable group (12 children) received absorbable screws between January 2016 and June 2024. We collected the operation time and the length of incision of each patient. All the patients were followed up for over 20 months. Clinical outcomes were assessed and compared using elbow range of motion (ROM), mayo elbow performance score (MEPS) and range of rotation (ROR) during the last follow-up visit. Additionally, pain levels measured by a 10-point visual analog scale (VAS) and complications were duly documented.

Results: In terms of operative time, length of incision, and VAS scores, no significant differences were observed (p > 0.05). The patients were followed up at an average of 33.1 months (range, 22-49 months). The mean MEPS were 89.44 ± 3.79 and 89.58 ± 3.34 (p = 0.89), the mean ROM were 122.28 ± 5.87 and 125.1 ± 5.83 (p = 0.27), and the mean ROR were 153.33 ± 5.94 and 155.83 ± 5.15 (p = 0.26) in groups A and B, respectively. In addition, two children in Metal group experienced symptoms of screw stimulation, while Absorbable group did not.

Conclusion: The use of absorbable screws in treating pediatric medial epicondyle fractures can yield equivalent therapeutic outcomes to traditional metal screws, obviating the need for subsequent surgical interventions and mitigating complications associated with screw irritation resulting from non-degradable metallic implants.

Background: Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms.

Methods: A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness.

Results: The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL.

Conclusions: The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly.

Level of evidence: II, prospective cohort study.

Backgrounds: Evaluation of gait posture using a three-dimensional motion analysis system (3DMAS) revealed that elderly patients with adult spinal deformity (ASD) experience pelvic anteversion while walking. The purpose of this study was to investigate the influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with ASD.

Methods: Fifty-four patients with ASD aged 50 years or older who were admitted to our hospital between March 2016 and December 2021 were included in the study. The 6-min walking distance (6MWD) was used to evaluate walking ability, and trunk and hip extensor strength were measured to evaluate physical function in the subjects. The 3DMAS was used to measure the subject's changes in pelvic anteversion during gait. After measuring the changes in pelvic anteversion, the median value of the study subjects was calculated, according to which the subjects were divided into two groups (small anteversion [S] group, large anteversion [L] group). Walking ability and physical function were compared between the two groups.

Results: The number of subjects in each group was 27. Comparisons of walking ability and physical function between the groups revealed significant differences in 6MWD (S group, 333.6 ± 111.2 m; L group, 238.0 ± 106.3 m) and hip extensor strength (S group, 15.8 ± 3.8 kgf; L group, 13.4 ± 4.4 kgf). No significant differences regarding trunk extensor strength were observed between the groups (S group, 15.2 ± 4.0 kgf; L group, 12.9 ± 4.8 kgf).

Conclusion: The results of the present study revealed that ASD patients with greater pelvic anteversion associated with walking have lower walking ability and physical function. These results suggest the importance of evaluating the posture of ASD patients not only by using radiographic findings but also by assessing movement, such as gait posture.

Background: Previous studies have associated diabetes with reduced shoulder motion, increased pain, and higher postoperative retear risk after arthroscopic rotator cuff repair (ARCR). However, the impact of glycemic control, measured by hemoglobin A1c (HbA1c) levels, on retear and revision rates after ARCR in diabetic patients remains unclear.

Methods: This systematic review was conducted using the PubMed, Cochrane Library, Web of Science, and Embase databases according to the preferred reporting conventions for systematic reviews and meta-analyses. Only studies that compared retears and revisions in ARCR patients with documented HbA1c levels between controlled and uncontrolled diabetes groups were included. Relevant data were extracted and analyzed using STATA software. The methodological index for nonrandomized studies was employed to assess the risk of bias in the selected studies. Additionally, heterogeneity tests and sensitivity analyses were conducted to evaluate potential heterogeneity within the samples, and publication bias was also detected.

Results: Six studies (4395 patients), including five retrospective cohort studies and one case‒control study, were included. Four of these studies assessed retears involving 253 patients. Lower HbA1c levels, indicating better glycemic control, were significantly associated with reduced retear rates after ARCR in diabetic patients (P = 0.000; odds ratio = 0.242, 95 % confidence interval: 0.128-0.454; I² = 25 %). For revision evaluations, two studies, with a total of 4142 patients, found no significant difference in rates between controlled and uncontrolled diabetes groups, and no publication bias was detected.

Conclusion: Following ARCR in diabetic patients, effective glycemic control significantly reduces retear rates without affecting revisions, and maintaining glycemic control in the postoperative period may contribute to rotator cuff healing.

Background and aims: Pain and muscle fatigue in the low back and lower extremity associated with adult spinal deformity (ASD) markedly limit daily activities and affect quality of life. This study aimed to clarify if spinal correction surgery decreases the muscle activity requirements in relation to alignment and balance parameters.

Methods: Integrated electromyogram (I-EMG) studies of the low back and lower extremity in addition to whole body alignment, body sway, and health-related quality of life (HRQOL) were evaluated in 16 patients with ASD before and after surgery. Sixteen healthy volunteers were included as control subjects. Muscle activities of the bilateral lumbar paravertebral, biceps femoris, rectus femoris, gastrocnemius, and tibialis anterior were measured using surface electromyogram in both resting and working standing positions. Surgical outcomes were based on improvements in muscle fatigue using the sum of the whole muscle I-EMGs and body sway. HRQOL was evaluated by SRS-22r, which measures 4 domains (function, pain, self-image, mental health) and subtotal scores.

Results: In controls, the sum of the 10 whole I-EMGs (mVms; mean ± SD) was 3316 ± 1247 in the resting standing position and 5625 ± 2065 in the working standing position. The I-EMG values were higher in ASD patients than in healthy subjects; in the resting standing position, the sum of the whole 10 I-EMGs significantly decreased from baseline (9125 ± 3529) to 3 (6088 ± 1793) and 6 (6381 ± 1776) months postoperatively (p < 0.01). In the working standing position, the sum in ASD patients also significantly decreased from baseline (14,160 ± 5474) to 3 (8085 ± 2540) and 6 (8557 ± 3025) months postoperatively (p < 0.01). I-EMG values did not differ significantly between the 3- and 6-month time points in either condition. Body sway was also improved postoperatively at 3 months and maintained at 6 months along with the amelioration of whole-body sagittal alignment, and 4 domains and subtotal SRS-22r scores significantly increased postoperatively.

Conclusion: Following spinopelvic correction surgery, whole body sagittal alignment was improved, and muscle activity based on I-EMG and body sway were significantly decreased. The SRS-22r scores after surgery also indicated significant improvement, suggesting that muscle fatigue in the standing position was ameliorated, i.e., the "cone of economy" was normalized.

Background: The adductor canal block is a well-known procedure for controlling postoperative pain after medial malleolus fracture surgery. Continuous nerve block is a viable option for blocking pain for a longer period although the literature on this subject is scarce. Therefore, this study aimed to compare continuous adductor canal block (cACB) group to single-injection adductor canal block (sACB) group in those with bimalleolar or trimalleolar ankle fractures. The procedure was performed in addition to a continuous sciatic nerve block for postoperative pain relief and patient satisfaction.

Methods: The study included 57 patients who had bimalleolar or trimalleolar ankle fractures and underwent open reduction and internal fixation between August 2016 and June 2018. Each patient received a continuous sciatic nerve block and was divided into two groups: those who received cACB and those who received sACB. Each postoperative pain was scored at 4, 8, 12, 24, 48, and 72 h after surgery. Additionally, the consumption of rescue medications and patient satisfaction were evaluated.

Results: The two groups displayed no disparity in medial side ankle pain at 4 h and 8 h after surgery, but significantly higher pain in the sACB group at 12, 24, 48, and 72 h after surgery. However, there was no difference in the pain at the lateral side of ankle and consumption of rescue medication. In addition, the cACB group showed more satisfaction than the sACB group did.

Conclusion: CACB is better than sACB in terms of postoperative pain control and patient satisfaction. cACB can be used for postoperative pain control in ankle fractures involving the medial malleolus.

Level of evidence: Prospective Randomized Controlled Trial, Level 2.

Background: This study aimed to demonstrate the effectiveness of our new diagnostic chart using point of care ultrasound combined with CTS-6 for diagnosing idiopathic carpal tunnel syndrome.

Methods: We conducted a retrospective analysis of the data of patients who visited our department and received point of care ultrasound combined with CTS-6 from 2020 to 2023. Data regarding age, sex, initial and final diagnosis, cross-sectional area of the median nerve, CTS-6 score, and electrodiagnostic severity were obtained and statistically analyzed.

Results: Of the 177 wrists included in our study, 138 (78 %) were diagnosed with carpal tunnel syndrome, while 39 (22 %) were not (non-carpal tunnel syndrome). With our diagnostic method, 127 wrists (72 %) were diagnosed initially with carpal tunnel syndrome, 23 wrists (13 %) with non-carpal tunnel syndrome, and the rest 27 wrists (15 %) as borderline. Our initial diagnoses of carpal tunnel syndrome and non-carpal tunnel syndrome were maintained in all cases except for two. Cross-sectional area, CTS-6 score, and electrodiagnostic severity showed a positive correlation. A post hoc analysis showed that the new scoring system (CTS-6 score + 2 × cross-sectional area) with a cutoff value of 31.25 points showed a sensitivity as high as 95 % and a specificity of 100 %.

Conclusions: Our findings suggest that most suspected idiopathic carpal tunnel syndrome cases can be diagnosed correctly using the diagnostic chart. Although additional tools, including electrodiagnostic studies, may be needed for borderline cases, the use of point of care ultrasound combined with CTS-6 may be a recommendable first-line confirmatory test because point of care ultrasound and CTS-6 could be complementary tools, and this chart may be especially beneficial for atypical or outlier cases.

Level of evidence: Diagnostic III.