Osteoarthritis of the patella, lateral femoral condyle and posterior medial femoral condyle correlate with range of motion.

PURPOSE: The type of osteoarthritis and the degree of severity which causes restriction of knee range of motion (ROM) is still largely unknown. The objective of this study was to analyse the location and the degree of cartilage degeneration that affect knee range of motion and the connection, if any, between femorotibial angle (FTA) and knee ROM restriction. METHODS: Four hundreds and fifty-six knees in 230 subjects with knee osteoarthritis undergoing knee arthroplasty were included. Articular surface was divided into eight sections, and cartilage degeneration was evaluated macroscopically during the operation. Cartilage degeneration was classified into four grades based on the degree of exposure of subchondral bone. A Pearson correlation was conducted between FTA and knee flexion angle to determine whether high a degree of FTA caused knee flexion restriction. A logistic regression analysis was also conducted to detect the locations and levels of cartilage degeneration causing knee flexion restriction. RESULTS: No correlation was found between FTA and flexion angle (r = -0.08). Flexion angle was not restricted with increasing FTA. Logistic regression analysis showed significant correlation between restricted knee ROM and levels of knee cartilage degeneration in the patella (odds ratio (OR) = 1.77; P = 0.01), the lateral femoral condyle (OR = 1.62; P = 0.03) and the posterior medial femoral condyle (OR = 1.80; P = 0.03). CONCLUSION: For clinical relevance, soft tissue release and osteophyte resection around the patella, lateral femoral condyle and posterior medial femoral condyle might be indicated to obtain a higher degree of knee flexion angle.

Previous fracture surgery is a major risk factor of infection after total knee arthroplasty.

PURPOSE: Total knee arthroplasty (TKA) has been proven to be the most effective treatment for patients with severe joint disease. Although infection is not a frequent complication, it is certainly one of the most dreaded. The purpose of this study was to identify factors associated with infection after TKA. METHODS: Between 1995 and 2006, 2,022 primary TKAs in 1,146 patients were evaluated. Flexible Nichidai Knee (FNK) was used as a prothesis in all subjects. Twenty-four patient-specific data items were collected via chart review for each patient. Revision arthroplasty procedures and infected knees were excluded. The medical records were reviewed to extract the following information: age, gender, body mass index (BMI), preoperative C-reactive protein (CRP), preoperative erythrocyte sedimentation rate (ESR), preoperative total protein (TP), duration of surgery, operative blood loss, total blood loss, duration of surgical drain, duration of antibiotic prophylaxis, primary diagnoses, smoking, diabetes mellitus, steroid or disease modifying anti-rheumatic drugs (DMARDs) therapy, previous operation around the knee joint, previous arthroscopic surgery, previous non-arthroscopic surgery, previous high tibial osteotomy (HTO) or open reduction internal fixation (ORIF), remnants of previous internal fixation material, bone graft, patella replacement, and bone cement. RESULTS: The median age of the patients at the time of primary TKA was 72 (range, 26-91) years. The median follow-up period after primary TKA was 42 (range, 6-145) months. During the study period, 17 infected knee arthroplasties in 17 patients were identified. Previous history of ORIF, male gender, remnants of previous internal fixation material, and BMI showed significant correlation with postoperative infection. CONCLUSION: This study identified previous history of fracture and remnants of internal fixation as major risk factors of infection after TKA. For clinical relevance, surgeons should be aware of potential infection when performing TKA in patients with these risk factors and patients should be informed of the potential risks.

Association between intercondylar notch narrowing and bilateral anterior cruciate ligament injuries in athletes.

BACKGROUND: Intercondylar notch narrowing is a risk factor for anterior cruciate ligament (ACL) injuries, but it is unclear whether a narrow intercondylar notch correlates with bilateral ACL injuries. PURPOSE: To determine whether a narrow intercondylar notch is associated with bilateral ACL knee injuries in athletes, using magnetic resonance imaging (MRI) and radiography to investigate the notch size. STUDY DESIGN: A retrospective case-control study. METHODS: This was a comparative cohort study on 50 subjects of which 25 patients with sport trauma-associated bilateral ACL injuries, 30 with unilateral ACL injuries, and 20 healthy subjects. The notch width index (NWI) was measured as the ratio of the width of the intercondylar notch to the femoral condylar width on radiography and the MRI slice containing the region near the ACL attachment site on the femoral side (NWI-A) and on the following posterior slice (NWI-P). RESULTS: The mean NWI values on radiography were 0.257 (SD 0.040), 0.332 (SD 0.036), and 0.341 (SD 0.027) in the bilateral, unilateral, and control groups, respectively, with significant differences between the bilateral and unilateral groups and the bilateral and healthy groups. On MRI, the mean NWI-A values were 0.236 (SD 0.025), 0.243 (SD 0.048), and 0.266 (SD 0.030), respectively, with a significant difference between the bilateral and healthy groups. The mean NWI-P values were 0.239 (SD 0.021), 0.258 (SD 0.038), and 0.273 (SD 0.033), respectively, with significant differences between the bilateral and unilateral groups and the unilateral and healthy groups. A cutoff value of 0.25 for NWI-P gave an odds ratio of 22.667 for the risk of developing bilateral ACL knee injuries. CONCLUSIONS: The intercondylar notch was significantly narrower in subjects with bilateral ACL injuries than in healthy subjects. NWI measurement using coronal MRI is useful for judging intercondylar notch narrowing. The risk for ACL injuries is very high when NWI is ≤0.25. Preventive measures for the unaffected knee are required for patients with a narrow intercondylar notch.

Intensity of physiotherapy after anterior cruciate ligament reconstruction: a comparison of two rehabilitation regimen.

BACKGROUND: Rehabilitation is one of the most critical points after anterior cruciate ligament (ACL) reconstruction. However, the recent trend of low-cost, short-term hospitalization makes sufficient rehabilitation after ACL reconstruction difficult. LEVEL OF EVIDENCE III: 34 patients who underwent non-anatomical single bundle ACL reconstruction using a hamstring auto graft were evaluated. Twenty patients (12 males and 8 females) were transferred to a special rehabilitation hospital (RH hospital group) after operation and concentrated rehabilitation was performed up to 4 h per day. Fourteen (9 males and 5 females) patients performed clinic-based rehabilitation at a university hospital three times per week (clinic group). Strength of quadriceps and knee flexion muscles was assessed at 60 degrees /s using a Cybex II dynamometer (Lumex, Ronkonkoma, NY, USA) at 3, 6 and 9 months after ACL reconstruction. Anterior tibial translation (ATT) and pivot shift test were also evaluated. RESULTS: No significant difference in muscle recovery in the lower extremity was observed at any time point after ACL reconstruction between the clinic group and the RH hospital group. However, 3 months after operation, the average muscle strength of the RH hospital group tended to be higher than that of the clinic group. There was no significant difference in ATT or pivot shift (each group included 4 positive pivot shift subjects) in the patients who were tested between the clinic group and the RH hospital group. CONCLUSION: Concentrated rehabilitation at a rehabilitation hospital after ACL reconstruction has the potential to improve muscle strength in the lower extremities more dramatically in the early stages of post operation. However, the initial benefits of intensive physiotherapy disappear after 6 months.

The prevalence of restless legs syndrome among pregnant women in Japan and the relationship between restless legs syndrome and sleep problems.

STUDY OBJECTIVES: To clarify the prevalence of restless legs syndrome (RLS) in pregnant women living in Japan and to analyze the relationship between sleep problems and RLS, in order to discuss ways for pregnant women to obtain comfortable sleep and to improve the health of both the mother and child. DESIGN: A cross-sectional questionnaire survey. SETTING: 500 clinical institutions with maternity services were randomly sampled from a list of organizations identified in a survey by the Japan Association of Obstetricians and Gynecologists. Of these 500 institutions, 260 participated in the survey. PARTICIPANTS: 16,528 pregnant women living in Japan. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In this survey of pregnant women, the prevalence of RLS was found to be 19.9%. An analysis was conducted on the relationship between RLS and other factors such as subjective evaluation of sleep, difficulty initiating sleep, difficulty maintaining sleep, early morning awaking, and excessive daytime sleepiness. The result of this analysis suggested that women with these sleep-related problems were more likely to have RLS than those without. In addition, RLS was more prevalent in the later stages of pregnancy. CONCLUSION: In the pregnant women in our survey, the prevalence of RLS was found to be 19.9%, which is higher than the prevalence of RLS that has been found in the general public in a previous study. This suggests that RLS-related sleep problems may be an important public health issue among pregnant women in Japan. This finding may have implications for attempts to improve sleep hygiene in this group.

[Relationships between finding of calcaneal quantitative ultrasound and lifestyle in Japanese college students].

PURPOSE: The actual situation regarding the lifestyle of college students in Japan cannot be said to be healthy and future reduction of bone mass is a possible matter for concern. However, there have been only a few reports about the relationship between lifestyle during this period and bone mass, and especially none focusing on males not affected by female hormones. The purpose of this study was thus to investigate the relationship between bone mass and lifestyle in college students of both sexes. METHODS: Seven hundred and sixty-six college students of both genders were enrolled in this study as subjects and underwent calcaneal quantitative ultrasound with an AOS-100 device (ALOKA). At the same time physical factors, lifestyle and nutrition were also examined with laboratory findings. RESULTS: Physical factors such as stature, weight, body mass index (BMI), percentage body fat and gripping power were more strongly related to calcaneal quantitative ultrasound among females than in male students. Multiple regression analysis using calcaneal Osteo Sono-Assessment Index (OSI) as the dependent variable, and physical factors, lifestyle and nutrition, and laboratory findings as the independent variables, indicated that regular physical activity was strongly related to OSI in both sexes. The OSI in the alcohol-consuming group was significantly higher than that in the non alcohol-consuming group in males, and demonstrated a significant negative correlation with liver function markers, i.e. ALT (GPT) IU/l. CONCLUSION: It is very necessary to undertake daily physical activity for primary prevention of osteoporosis in both males and females. Bone mass in the alcohol-consuming group was here found to be significantly higher than that in the non alcohol-consuming group, but the study suggested that if the amount of alcohol consumed reaches an extent where liver function markers are affected, bone mass may decrease.

[An epidemiological study of sleep problems among the Japanese pregnant women].

OBJECTIVE: The objective of the study was to identify: 1) what kinds of sleep problems that pregnant women experience in Japan; and 2) the relationships between sleep problems and month of pregnancy, sleep problems and the number of pregnancies, and sleeping hours, by means of a questionnaire given to pregnant women in Japan. Conditions to assure good quality sleep were studied. METHODS: Of 500 obstetric facilities which were randomly selected from areas surveyed by the Japan Association of Obstetricians and Gynecologists, 260 finally agreed to participate in this study. Women who had their pregnancy confirmed and were on a revisit to the 260 obstetric facilities were enrolled. These pregnant women completed anonymous self-administered questionnaires during the waiting time for treatment and submitted them to the obstetric facilities in sealed envelopes. The questionnaire covered personal attributes such as age and highest level of education, pregnancy status, working status, and patterns of smoking and alcohol drinking. Sleep-related items such as 1) subjective sleep quality, 2) difficulty in getting to sleep, 3) frequent awakenings, 4) waking up too early, 5) sleeping hours and 6) daytime drowsiness were also included. RESULTS: The month of pregnancy was significantly related to four sleep-related items, including difficulty in getting to sleep and waking up too early. With respect to the relationship between the number of pregnancies and sleep problems, significance was found for five sleep-related items, including subjective sleep quality and waking up too early. Poor subjective sleep quality was significantly related to sleeping less than seven hours and whether or not pregnant women had a regular job. It was also suggested that the greater the number of pregnancies, the shorter the sleeping hours. When responses to each sleep-related item were compared between pregnant women and the general population, the former were more likely to have sleep problems. CONCLUSION: These findings suggest that as well as the number of pregnancies and month of pregnancy with sleeping hours may be factor intimately related to sleep problems during pregnancy. A good quality sleep during pregnancy is vital for normal maternal health and fetal growth and sufficient sleeping hours are therefore needed. Attention should therefore be paid to the finding that pregnant women were more likely to have sleep problems than the general population.