Training Physical and Geometrical Mid-Points for Multi-person Pose Estimation and Human Detection Under Congestion and Low Resolution.

This paper introduces the design and evaluation of NeoPose which is developed for multi-person pose estimation and human detection. The design of NeoPose is targeting the issue of human detection under congested situation and with low resolution in the image. Under such situations, we compared the performance of different versions of NeoPose as well as other existing algorithms in a human detection task. Throughout the task, the usefulness of two kinds of mid-point (physical and geometrical mid-points) and a deconvolution structure was discussed. Experiment results indicated that NeoPose which applied geometrical mid-points and deconvolution structure performed the best in terms of both precision and recall in the evaluation.

Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures: a randomized controlled trial.

PURPOSE: The reduction of periosteal compression through the use of a locking plate may minimize disturbances of bone blood supply and may improve the rate of bone union. A single-centre, assessor blinded randomized controlled trial was conducted to compare the clinical effectiveness of a locking plate and a non-locking plate. METHODS: A total of 52 patients with AO/OTA 44B lateral malleolar fractures were included in this study. All patients underwent surgical fixation using a lag screw and neutralization plate. An identical treatment protocol was used in all patients, with exception of plate selection. The rate of radiographic bone union, defined as the complete disappearance of fracture lines confirmed through anteroposterior, lateral, and internal oblique views was compared at three, six, and 12 months following surgery. In addition, the Medical Outcomes 36-Item Short-Form Health Survey (SF-36) score, the time required for resolution of tenderness at the fracture site and the complication rate were evaluated. RESULTS: Twenty-three patients were randomly assigned to undergo fixation using a locking plate, and 29 patients were assigned to undergo fixation using a non-locking plate. Intention-to-treat analysis showed no difference in the radiographic bone union rate of fibula, SF-36 score, the time for resolution of tenderness at the fracture site and complication rates. CONCLUSION: No differences were observed in patients with AO/OTA 44B lateral malleolar fractures undergoing fixation with a locking versus non-locking neutralization plate.

Intraoperative soft tissue tension and postoperative range of motion in posterior stabilized total knee arthroplasty.

BACKGROUND: Intraoperative soft tissue tension can significantly impact the range of motion following total knee arthroplasty (TKA). However, the level of impact remains unclear. The purpose of this study was to investigate the relationship between intraoperative soft tissue tension and postoperative range of motion. METHODS: This retrospective study included 504 patients operated with posterior stabilized TKA. During surgery, we adjusted the soft tissue tension from 80 to 160 N for both flexion and extension with the tensor/balancer device and torque driver. Patients were grouped into three categories based on intraoperative soft tissue tension and analyzed with the 1-year postoperative range of motion using one-way analysis of variance (ANOVA). In addition, Pearson's correlation coefficients were determined to assess the association between intraoperative soft tissue tension and postoperative range of motion. RESULTS: The absolute tension value at 90° flexion did not affect the postoperative flexion angle (p = 0.61). The absolute tension value at 0° extension did not affect the postoperative extension angle (p = 0.91). Likewise, the difference of tension between flexion and extension did not affect the postoperative flexion angle (p = 0.86). All comparisons did not have the differences in sex, height, weight, body mass index, diagnosis and preoperative range of motion between three groups. No significant correlation was found in each comparison (r = 0.078, r = 0.031, r = -0.052, respectively). CONCLUSIONS: We did not observe a correlation between intraoperative soft tissue tension adjusted from 80 to 160 N and 1-year postoperative range of motion in posterior stabilized TKA.

Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series.

BACKGROUND: Delayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure. METHODS: The authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity. RESULTS: All patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient. CONCLUSIONS: There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction.

PURPOSE: Medial patellofemoral ligament (MPFL) reconstruction has been recognized as a useful treatment method for patella instability. However, the optimal fixation site has not been well investigated, and few reports have examined intraoperative graft length change. The purpose of the study is to evaluate the intraoperative graft length change and femoral drill hole position to find the optimal graft placement. METHODS: The graft length change between the two points on patella and femur was measured using Isotac(®) and Isometric Positioner(®) during passive knee motion in 27 cases of MPFL. The location of Isotac(®) was also evaluated on the 2-directional radiograph. The pre- and postoperative radiographic assessments have been done in order to evaluate the effect of MPFL reconstruction on patellofemoral alignment. RESULTS: There were 10 cases in which the distance between the two points became longer during knee flexion, 8 cases in which it became shorter and the remaining 9 cases in which the distance changed within 2 mm. The femoral drill hole position was assessed assuming that the maximum anterior-posterior (AP) diameter of the femur on the lateral radiograph was defined as 100%. The distance of the femoral tunnel position from the articular surface averaged 50% overall, 46% in the short group, 55% in the longer group and 48% in the isometric group (P < 0.001). Patella height seemingly affected the length change character. The intraoperative length change influenced the early recovery of knee range motion postoperatively. CONCLUSIONS: The femoral tunnel position is reaffirmed to be an essential determinant for the graft length change in the MPFL reconstruction. Both graft length change measurements and intraoperative radiographic assessment are practical for proper graft placement.

Visual analog scale assessment after medial patellofemoral ligament reconstruction: with or without tibial tubercle transfer.

BACKGROUND: We studied the efficacy of medial patellofemoral ligament (MPFL) reconstruction, with or without tibial tubercle (TT) transfer, for recurrent dislocation of the patella, based on subjective functional assessment using the visual analog scale (VAS). METHODS: Forty-two consecutive knees of 40 patients who underwent MPFL reconstruction using a hamstring tendon were followed up for an average of 4.3 years. Twenty-nine knees underwent MPFL reconstruction (MPFL group) and 13 knees underwent MPFL reconstruction combined with medial transfer of TT (TT+MPFL group). Clinical results, including the VAS score at the latest follow-up in both groups, were assessed. RESULTS: An apparent deficit in the range of motion was observed in two cases from the TT+MPFL group. The ratio of negative apprehension test was significantly improved from 3% preoperatively to 79% postoperatively in the MPFL group and from 8% to 69% in the TT+MPFL group. The Lysholm scores were significantly improved from 70 points preoperatively to 92 points postoperatively in the MPFL group and from 72 points to 90 points in the TT+MPFL group. There was no significant difference between the two groups in the ratios of negative apprehension tests and the Lysholm scores after surgery as well as before surgery. In the VAS assessment, the MPFL group scored significantly higher than the TT+MPFL group in "Japanese full sitting" (average score 92 vs 62). The scores of the two groups were not significantly different in any of the other items, although the total average score was significantly higher in the MPFL group (91 vs 81). CONCLUSIONS: MPFL reconstruction without TT transfer achieved satisfactory results including high scores on subjective functional assessments without disadvantage caused by the TT transfer. Isolated MPFL reconstruction has been suggested to be a useful treatment method for recurrent dislocation of the patella.

Isolated anterior cruciate ligament reconstruction in patients with chronic anterior cruciate ligament insufficiency combined with grade II valgus laxity.

BACKGROUND: There is no consensus about whether isolated anterior cruciate ligament reconstruction using multistrand hamstring tendon with nonoperative treatment for chronic medial collateral ligament injury is sufficient. PURPOSE: To assess clinical outcome for patients with chronic anterior cruciate ligament injury and accompanying grade II valgus laxity who received medial hamstring anterior cruciate ligament reconstruction alone. Results were compared with those of patients with isolated chronic anterior cruciate ligament injury without valgus laxity. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Two hundred eighty-nine patients with isolated anterior cruciate ligament injury were compared with 53 patients with accompanying valgus laxity (minimum follow-up, 24 months). The following parameters were compared between the 2 groups at the last follow-up: range of motion, KT-1000 arthrometer value, pivot-shift test result, Lysholm knee scale, knee extensor muscle strength, return to sporting activities, subjective recovery, and International Knee Documentation Committee grade. Differences in clinical outcome were evaluated between those with preoperative International Knee Documentation Committee grade B and grade C and between those with grade A and grade B or C at final evaluation. RESULTS: Postoperative KT-1000 arthrometer value averaged 1.2 mm for those with isolated anterior cruciate ligament injury and 1.6 mm for those with accompanying valgus laxity (not significant, P = .281). There was no significant difference between these 2 groups regarding the other items. In patients with preoperative valgus laxity, KT-1000 arthrometer values at final evaluation between patients with preoperative grade B and C were not significantly different. The value for subjects with grade A at final evaluation was 1.3 mm and for those with grade B or C at final evaluation was 2.7 mm (P = .065). CONCLUSION: There was no clinically significant difference regarding outcome of anterior cruciate ligament multistrand hamstring reconstruction alone for 90% of patients with grade II valgus laxity who regained medial stability with nonoperative management compared with those who underwent the same anterior cruciate ligament reconstruction for an isolated anterior cruciate ligament tear.

Arthroscopic evaluation of the articular cartilage after anterior cruciate ligament reconstruction: a short-term prospective study of 105 patients.

PURPOSE: Several reports have shown the progression of degenerative osteoarthritis after anterior cruciate ligament (ACL) reconstruction. No report has been published about early cartilage change after ACL reconstruction. The purpose of this study was to evaluate the articular cartilage after ACL reconstruction in a short postoperative period by arthroscopy. TYPE OF STUDY: Case series. METHODS: We examined the status of articular cartilage of 105 patients who received ACL reconstruction and second-look arthroscopy. Cartilage lesion was evaluated arthroscopically in the 6 articular surfaces independently, and these features were classified by modified Outerbridge's classification. We compared the articular cartilage at reconstruction and at second-look arthroscopy. RESULTS: A significant worsening of the status of the articular cartilage was seen after ACL reconstruction. This worsening was seen at all articular surfaces except the lateral femoral condyle. Most of the change involved softening or fibrillation. Anterior laxity and meniscal lesion had no correlation with a progression of degenerative change of articular cartilage. Patient's age influenced the progression of articular cartilage damage after reconstruction significantly in our cases. CONCLUSIONS: The status of articular cartilage was significantly worsened after ACL reconstruction. Potent risk factors causing articular cartilage damage include female gender and age of 30 years or older. LEVEL OF EVIDENCE: Level IV.

Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees.

Using a step-by-step procedure, we measured joint gap during surgery using a simple device with a torque meter in 45 osteoarthritis knee joints (43 patients) with varus deformity. The effects of specific cuts or releases of the anatomic portion on joint gaps were investigated. Each cut or release resulted in various increases in the medial gap from 1.2 to 3.8 mm on average. The final gap measurements averaged 24.1 mm medially and 27.6 mm laterally in extension, and 24.6 mm medially and 27.2 mm laterally in flexion. The results of the measurements showed that each step-by-step procedure had a tendency of gap increase. The results led us to measure soft tissue balancing in a step-by-step procedure during total knee arthroplasty.