Anatomical rectangular tunnel anterior cruciate ligament reconstruction provides excellent clinical outcomes.

PURPOSE: The purpose of this study was to prospectively evaluate the clinical outcomes following anatomical rectangular tunnel anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BTB) graft using an adjustable-length femoral cortical fixation device with enough patients and a high follow-up rate. METHODS: This study included 125 patients who underwent anatomical rectangular tunnel ACL reconstruction with a BTB graft. A BTB TightRope® was used for femoral graft fixation. Clinical evaluations were performed more than 2 years after surgery using the International Knee Documentation Committee (IKDC) Form. Patients interviewed by telephone were only subjectively evaluated. The side-to-side difference in anterior laxity at a manual maximum force was measured using the KT-2000 Arthrometer®. RESULTS: Among the 125 patients, 99 were ultimately included and 26 were lost to follow-up (follow-up rate: 79%). Eight patients had re-tear (re-tear rate: 8%) and six patients had ACL injuries to the contralateral knee. Three patients did not follow our rehabilitation programme. One patient suffered septic arthritis. These 18 patients were considered ineligible for clinical evaluations. Therefore, clinical evaluations were performed in 81 of the 99 patients (64 were available for direct follow-up and 17 were available for a telephone interview). The follow-up period was 30 ± 10 months (range 24-68 months). According to the IKDC subjective assessment, 48 (59%) and 33 (41%) knees were graded as normal and nearly normal, respectively. A loss of extension (3°-5°) was observed in five patients (8%), whereas one patient (2%) exhibited a loss of flexion (3°-5°). The Lachman test was negative in 63 patients (98%). The pivot shift test was negative in 59 patients (92%). The side-to-side difference in KT value was 0.4 ± 0.7 mm (range - 1-4 mm). CONCLUSION: Anatomical rectangular tunnel ACL reconstruction with a BTB graft using an adjustable-length femoral cortical fixation device provided excellent clinical outcomes both subjectively and objectively more than 2 years after surgery, whereas 8 of the 99 patients had re-tear of the graft. The adjustable-length femoral cortical fixation device could be safely used in anatomical rectangular tunnel ACL reconstruction with a BTB graft. LEVEL OF EVIDENCE: III.

Progressive Bone Destruction in Rapidly Destructive Coxopathy Is Characterized by Elevated Serum Levels of Matrix Metalloprotease-3 and C-Reactive Protein.

OBJECTIVE: Rapidly destructive coxopathy (RDC) is a rare condition characterized by rapid joint space narrowing; however, its pathology remains unclear. This study aimed to clarify the association of laboratory biomarkers with the radiological progression of RDC. METHODS: We examined 34 female and 4 male patients with RDC between October 2010 and April 2018. Patients were divided into 3 groups according to the progressive radiographic staging of RDC. Group 1 patients had progressive obliteration of the joint space without subchondral destruction (n = 11), group 2 had progressed subchondral destruction (n = 18), and group 3 had cessation of bone destruction observed for more than 6 months (n = 9). Clinical evaluation results were assessed using the Japanese Orthopedic Association hip score. Blood test results, including serum matrix metalloproteinase-3 (MMP-3), and C-reactive protein (CRP), were also evaluated. RESULTS: There were no significant differences in patient background or Japanese Orthopedic Association hip scores among the groups. However, there were significant differences in MMP-3 levels among groups, with MMP-3 levels in group 2 being significantly higher than those in group 3 (group 2, 118.4 ± 81.2 ng/mL; group 3, 42.5 ± 15.1 ng/mL, p < 0.001). The CRP levels in group 2 were also significantly higher than those in group 3 (group 2, 0.77 ± 0.92 mg/dL; group 3, 0.13 ± 0.07 mg/dL, p = 0.019), but elevated CRP levels in group 2 decreased back to the reference range. CONCLUSIONS: Matrix metalloproteinase-3 and CRP are the biomarkers of RDC progression but not of its occurrence. Severe inflammatory response may be associated with bone destruction in RDC.

Meta-analysis for the efficacy of bisphosphonates on hip fracture prevention.

The aim of this study was to investigate the effect of bisphosphonates on preventing osteoporotic hip fracture in patients with or without prior major osteoporotic fracture. Randomized controlled trials (RCTs) and observational studies (OSs) based on electronic health records were used to assess bisphosphonate efficacy and were searched using PubMed, Scopus, and the Cochrane Library databases. Eight RCT studies and 14 OSs were extracted from the studies and quantitatively combined by random-effects meta-analysis. The odds ratio (OR) for all hip fractures in RCTs of 0.66, with a 95% confidence interval (CI) of 0.55-0.79, was lower than that in the OSs (OR 0.83; CI 0.74-0.94). The OR in patients with prior fracture was significantly reduced by bisphosphonates in both RCTs and OSs. Conversely, significant fracture reduction was not apparent in patients without prior fracture. A moderate relationship between prior major fracture rates and OR in hip fractures was defined. In patients with an average age of over 80 years, similar results were confirmed. In this meta-analysis, the efficacy of bisphosphonates was significant in patients with prior major fracture, recommending to prescribe for such patients. Their effect in patients without prior fracture, in contrast, remains unclear.

Loop Length Change of an Adjustable-Length Femoral Cortical Suspension Device in Anatomic Rectangular Tunnel Anterior Cruciate Ligament Reconstruction With a Bone-Patellar Tendon-Bone Graft and Associated Clinical Outcomes.

PURPOSE: To evaluate loop length changes of an adjustable femoral cortical suspensory fixation device and assess the clinical results after anatomic rectangular tunnel anterior cruciate ligament (ART-ACL) reconstruction with a bone-tendon-bone (BTB) graft. METHODS: The study included 50 patients who underwent ART-ACL reconstruction with a BTB graft fixed using the adjustable-length device BTB TightRope for femoral fixation between July 2013 and December 2014. Computed tomography examinations were performed at 1 and 12 weeks after the surgery. Loop length was measured in the reconstructed plane just parallel to the femoral tunnel, including the bone plug and the button. Measurement was performed thrice, and the mean value was used. Loop length change was defined as the difference in loop length between 1 and 12 weeks after the surgery. A paired t test was conducted with the effect size for statistical analysis. At 2 years postoperatively, clinical evaluations, including subjective and objective assessments, were performed. RESULTS: The mean loop lengths at 1 and 12 weeks were 25.77 ± 3.88 mm and 25.81 ± 3.89 mm, respectively, with a significant difference (P = .01). However, the effect size was 0.01, suggesting that the difference was not meaningful. The mean individual loop length change was 0.04 ± 0.13 mm. All individual loop length changes were within the measurement error range. At 2 years postoperatively, 49 patients (98%) were graded as normal or nearly normal according to the International Knee Documentation Committee form. The mean side-to-side difference in anterior laxity at manual maximum force was 0.2 ± 0.5 mm. CONCLUSIONS: The loop length change of an adjustable-length femoral cortical suspension device was negligible after ART-ACL reconstruction with a BTB graft. This ART-ACL reconstruction with a BTB graft using an adjustable-length device could safely provide sufficient stability to the operated knee. LEVEL OF EVIDENCE: Level Ⅳ, therapeutic case series.

Immunoglobulin G4-Related Disease of the Hip.

The authors report a case of immunoglobulin G4-related disease (IgG4-RD) of the hip. A 60-year-old man diagnosed with osteoarthritis of the right hip was referred to the authors' outpatient clinic for surgical intervention. Laboratory test results revealed elevated C-reactive protein and serum IgG levels. A subsequent laboratory test revealed an IgG4 level of 318 mg/dL. Magnetic resonance imaging revealed an abnormal mass in the right hip joint. The authors suspected IgG4-RD of the hip. The mass was resected during total hip arthroplasty. Immunohistochemical analysis for IgG revealed positive staining of many plasma cells. Most of the IgG-positive plasma cells were positive for IgG4, and the ratio of IgG4/IgG-positive cells was 51%. This case met all criteria for IgG4-RD; thus, the authors made a definitive diagnosis of IgG4-RD of the hip. The C-reactive protein level decreased to a negative value, and the IgG level decreased to a normal range at 3 weeks postoperatively. The IgG4 level gradually decreased to 152 mg/dL at 5 months postoperatively. This is the first reported case of IgG4-RD of the hip joint. [Orthopedics. 2018; 41(6):e876-e879.].

Artificial neural networks to predict future bone mineral density and bone loss rate in Japanese postmenopausal women.

OBJECTIVE: Predictions of the future bone mineral density and bone loss rate are important to tailor medicine for women with osteoporosis, because of the possible presence of personal risk factors affecting the severity of osteoporosis in the future. We investigated whether it was possible to predict bone mineral density and bone loss rate in the future using artificial neural networks. RESULTS: A total of 135 women over 50 years old residing in T town of Wakayama Prefecture, Japan were analyzed to establish a statistical model. Artificial neural networks models were constructed using the two variables of bone mineral density and bone loss rate. The multiple correlation coefficients between the actual and measured values for lumbar and femoral bone mineral densities in 2003 showed R2 = 0.929 and R2 = 0.880, respectively, by linear regression analyses, while the values for bone loss rates in lumbar and femoral bone mineral densities were R2 = 0.694 and R2 = 0.609, respectively. Statistical models by artificial neural networks were superior to those by multiple regression analyses. The prediction of future bone mineral density values estimated by artificial neural networks was considered to be useful as a tool to tailor medicine for the early diagnosis of and intervention for women osteoporosis with women.

Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature.

Fragility fractures in the elderly is an ongoing concern for orthopaedic surgeons. A 50-year-old woman has a 40% chance of having a vertebral compression fracture in her lifetime. The incidence of vertebral fractures, reported to be more than 10 times higher than that of femoral fractures, is estimated as 1-1.5 million per year in Japan. Vertebral fractures often occur without a fall, whereas the majority of nonvertebral fractures are the consequence of falls; the site of the nonvertebral fracture appears to be dictated by the type of fall. Distal radial fractures commonly occur as a consequence of hand protection during the fall. In older patients, falling load tends to directly affect shoulder and hip joints and lead to proximal humeral and femoral fractures. The incidence of vertebral fractures is increased in women over 50 yr of age, following the same trend as osteoporosis prevalence. Conversely, the mean age for proximal femoral fractures is around 80 yr, and more than 75% of femoral fractures occur in individuals over the age of 75. The prognostic risk of aging is 11-fold greater than that of reduced bone mineral density, and age is another risk factor for femoral fractures. Prophylactic therapy for osteoporosis and femoral fractures was shown to more effective in women in their 70s than in those over the age of 80. Although several approaches, including exercise therapy, vitamin D administration, and environmental adjustment at home, have been reported to be effective in fall prevention, effective fracture prevention approaches in frail elderly individuals have not yet been well established.

Synthesis and properties of green sustainable carbonate-type nonionics containing polyoxyethylene chains.

A series of polyoxyethylene surfactants containing carbonate linkages as biodegradable and chemically recyclable segments was designed and synthesized by a green process. A two-step carbonate exchange reaction was used: dimethyl or diphenyl carbonate was reacted with 1-alkanol, and the product was reacted with poly (ethylene) glycol in the presence of a lipase or chemical catalyst. The obtained carbonate-type nonionics exhibited good surface-active properties such as a low critical micelle concentration value and a surface tension lowering action. They were readily biodegraded by activated sludge, furthermore, could be chemical recycled using a lipase.