Lateral Collateral Ligament Repair for Hallux Metatarsophalangeal Joint Instability in a Collegiate Sumo Wrestler: A Case Report.

Although sprains of the hallux metatarsophalangeal (MTP) joint ligaments occur in barefooted martial arts athletes, few studies discuss the surgical treatments for lateral collateral ligament damage. We report herein a case of lateral collateral ligament repair for chronic hallux MTP joint instability. A 21-year-old male collegiate sumo wrestler injured his left hallux by snagging it on a sumo straw bale at 14 years of age. After entering university (4 years after the injury), he could no longer put weight on his foot at the left hallux; his athletic performance deteriorated, and he was referred to our department by his doctor. He had instability in the MTP joint of the left hallux, and magnetic resonance imaging revealed a tear in the attachment of the lateral collateral ligament to the metatarsal bone. Conservative treatment, such as taping, did not improve the symptoms; thus, surgery was performed, which consisted of passing a strong suture attached to the capsular ligament through a burr hole made in the metatarsal bone and fixing it to the burr-hole wall using an anchor. Postoperatively, the patient's joint instability improved, and he returned to competitive wrestling 4 months after surgery. He was able to put weight on his left hallux, and his athletic performance improved. The follow-up period after surgery was 2 years. In competitive sumo wrestling, hallux weakness and joint instability lead to a significant reduction in performance. Thus, ligament repair is an effective treatment for hallux MTP joint instability that cannot be treated by conservative means.

Second Anterior Cruciate Ligament Injuries After Anterior Cruciate Ligament Reconstruction in Professional Sumo Wrestlers: A Case Series.

BACKGROUND: Anterior cruciate ligament (ACL) injury is one of the most common traumatic injuries in professional sumo wrestlers. Further, ipsilateral reinjuries or contralateral ACL injuries after ACL reconstruction can occur in sumo wrestlers. The incidence of ipsilateral reinjury and contralateral ACL injury after ACL reconstruction ranges from 3% to 13% in a healthy athletic population. PURPOSE: To investigate the current status of second ACL injuries after ACL reconstruction in sumo wrestlers. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1988 and 2015, a total of 139 primary ACL reconstructions were performed in professional sumo wrestlers at our hospital. After exclusion of cases of multiple ligament knee reconstruction and patients in whom the contralateral ACL had been injured previously, 110 cases were included in this study. We investigated the number of second injuries, time from primary reconstruction to second injury, treatment method, and change in official sumo ranking after second injuries. The chi-square test, Student t test, and Fisher exact text were used for statistical analysis. RESULTS: Among 110 wrestlers who underwent ACL reconstruction, second injuries after primary ACL reconstruction occurred in 22 cases (20.0%). Among them, 14 cases (12.7%) entailed ipsilateral reinjury, 11 (10.0%) entailed contralateral injury, and 3 involved combined rerupture and contralateral injury. As for surgical treatment, 5 revision ACL reconstructions were performed for ipsilateral reinjury (35.7%), and 7 ACL reconstructions were performed for contralateral injury (63.6%). Surgical treatment was not performed for the remaining cases. Wrestlers who were treated by revision or contralateral ACL reconstruction after the second injury were demoted in rank for 3 to 4 tournaments but overtook the nonoperative treatment group in ranking by 2 years postoperatively; all athletes initially were demoted in rank after the second injury. CONCLUSION: This study is the first to investigate instances of ipsilateral reinjuries and contralateral ACL injuries after ACL reconstruction in professional athletes in heavyweight combat sports. The incidences of ipsilateral reinjury and contralateral ACL injury after ACL reconstruction in professional sumo wrestlers were relatively higher than those reported in previous studies.

Jones Fractures in Sumo Wrestlers: Three Case Reports.

Jones fractures sometimes occur in athletes and are known to have complications, such as nonunion, delayed union, and recurrence, even with treatment. We describe three cases of Jones fractures in sumo wrestlers with treatment-related difficulties. All patients discontinued treatment at their own discretion. The two conservative cases had nonunion or delayed union, and the operative case had a broken screw. However, all patients continued sumo wrestling, with little impact on their careers. The risk factors of Jones fractures in sumo wrestling may be heavy weight, and training or competition characteristics unique to sumo wrestling. In cases of a complete Jones fracture, operative treatment is most commonly selected, as the risk for nonunion or refractures is less than that for conservative treatment. However, in the case of sumo wrestlers, there are risks of infection and problems with treatment compliance. As taking a rest may result in a lowered rank, completing a sufficient duration of treatment is difficult. Treatment is difficult and controversial in sumo wrestlers; all three patients discontinued treatment of their own accord. These cases suggest that it is important to thoroughly inform sumo wrestlers of the treatment options, and to decide the most appropriate treatment method for each patient.

Treatment of Incomplete Jones Fractures With Low-Intensity Pulsed Ultrasound (LIPUS).

OBJECTIVE: Stress fractures of the proximal epiphysis of the fifth metatarsal bone (termed Jones fracture) frequently occur in both senior high-school-age and older contestant-level soccer players, and its incidence in Japanese soccer players is higher than that in European players. Surgery is most commonly indicated for a complete fracture, and about 3 months are required before the patient is able to return to the sport. We have performed a "Jones fracture screening" to reduce the incidence of these fractures. While surveying its frequency and promoting education on its prevalence and symptoms, we tried to discover incomplete fractures early and treat them using LIPUS without limiting their soccer practice. SUBJECTS AND METHODS: The subjects were 341 students (682 feet) from 3 senior high schools and university soccer clubs. Primary screening for tenderness and by diagnostic ultrasound imaging was performed as a Jones fracture screening. Fifty subjects (50 feet) were positive on the ultrasonic diagnosis, and secondary screening was recommended. Forty subjects underwent radiography (secondary screening rate: 80%), and 5 subjects (5 feet) were diagnosed with incomplete Jones fractures. Conservative treatment centering on LIPUS was performed in these 5 players who still continued to participate in all soccer practices. RESULTS: Bone union was achieved in 2 subjects (2 feet) after about 6 months without taking a break from soccer practice. The other 3 subjects (3 feet) are at 2 months after the diagnosis and are being followed without taking a break from soccer practice. DISCUSSION: Incomplete Jones fractures that are discovered early by an ultrasonic check-up for bone expansion with subsequent early treatment with LIPUS may heal without taking a break from practice. No preventive method has been established for Jones fractures. This check-up may serve as a useful preventative approach, and we will make an effort to suggest it as a common practice.

Outcome of Low-Intensity Pulsed Ultrasound (LIPUS) for Opening Wedge High Tibial Osteotomy.

OBJECTIVE: Opening Wedge High Tibial Osteotomy (OWHTO) for knee osteoarthritis and for osteonecrosis has reported good results. Use of low intensity pulsed ultrasound (LIPUS) after OWHTO had become an option for the treatment of OWHTO since April 2016. The purpose of this study was to examine whether LIPUS has an accelerating effect on synostosis after OWHTO. MATERIALS AND METHODS: The control subjects were 24 patients with a total of 26 knees (9 male with knees and 15 female with 17 knees treated) treated with OWHTO only. OWHTO was performed from April 2015 to March 2016 (non-LIPUS control group). The average age of the patients was 61 years. The test subjects were 25 patients with a total of 27 knees (8 male with 9 knees and 17 female with 18 knees treated) treated with OWHTO and LIPUS. OWHTO was performed from April 2016 until the present. LIPUS was started after the surgery (LIPUS + group). The average age was 64.6 years. FTA, ROM, intraoperative open angle, and the time to bone union were examined. RESULTS: There was no difference between the 2 groups in FTA, ROM, and open angle. Synostosis was obtained in 18 knees in the control group (no LIPUS) with an average duration of 8.4 months. The LIPUS + group had a short observation period with none of the patients experiencing bone union. DISCUSSION: The synostosis promoting effect of LIPUS is expected. In this study, there were no bone union cases because of the short observation period. It is necessary to extend the follow-up period, and clarify the utility of LIPUS.

Reliability, validity, and responsiveness of the Japanese version of the patient-rated elbow evaluation.

BACKGROUND: The patient-rated elbow evaluation (PREE) is a joint-specific, self-administered questionnaire consisting of a pain scale (PREE-P) and a functional scale (PREE-F), the latter consisting of specific function (PREE-SF) and usual function (PREE-UF). The purpose of this study was to cross-culturally adapt the PREE into Japanese (PREE-J) and to test its reliability, validity, and responsiveness. METHODS: A consecutive series of 74 patients with elbow disorder completed the PREE-J, the Japanese version of the disabilities of the arm, shoulder, and hand (DASH-JSSH) questionnaire, and the official Japanese version of the 36-Item Short-Form Health Survey (SF-36). Of the 74 patients, 53 were reassessed for test-retest reliability 1 or 2 weeks later. Reliability was investigated in terms of reproducibility and internal consistency. The validity of the PREE-J was examined by factor analysis, and correlation coefficients were obtained using the PREE-J, DASH-JSSH, and SF-36. Responsiveness was examined by calculating the standardized response mean (SRM) and effect size after elbow surgery in 53 patients. RESULTS: Cronbach's α coefficients for PREE-P, PREE-F, and PREE were 0.92, 0.97, and 0.97, respectively, and the corresponding intraclass correlation coefficients were 0.92, 0.93, and 0.94, respectively. Unidimensionality of PREE-P and PREE-F was confirmed by factor analysis. The coefficients of correlation between PREE-P and PREE-F or DASH-JSSH were 0.81 and 0.74, respectively; that between PREE-F and DASH-JSSH was 0.86, and those between DASH-JSSH and PREE-SF or PREE-UF were 0.85 and 0.82, respectively. Moderate correlation was observed in "physical functioning" for SF-36 and PREE-F (r = -0.69) or PREE (r = -0.68). The SRMs/effect sizes of PREE-P (1.31/1.32) or PREE (1.28/1.12) were more responsive than the DASH-JSSH (0.99/0.85), "bodily pain" (-1.15/-1.43), and "physical functioning" (-0.70/-0.44) in SF-36. CONCLUSION: The PREE-J represents a reliable, valid, and responsive instrument and has evaluation capacities equivalent to those of the original PREE.

Repair of olecranon fractures using fiberWire without metallic implants: report of two cases.

Olecranon fractures are a common injury in fractures. The tension band technique for olecranon fractures yields good clinical outcomes; however, it is associated with significant complications. In many patients, implants irritate overlying soft tissues and cause pain. This is mostly due to protrusion of the proximal ends of the K-wires or by the twisted knots of the metal wire tension band. Below we described 2 cases of olecranon fractures treated with a unique technique using FiberWire without any metallic implants. Technically, the fragment was reduced, and two K-wires were inserted from the dorsal cortex of the distal segment to the tip of the olecranon. K-wire was exchanged for a suture retriever, and 2 strands of FiberWire were retrieved twice. Each of the two FiberWires was manually tensioned and knotted on the posterior surface of the olecranon. Bony unions could be achieved, and patients had no complaint of pain and skin irritation. There was only a small loss of flexion and extension in comparison with that of the contralateral side, and the patient did not feel inconvenienced in his daily life. Using the method described, difficulty due to K-wire or other metallic implants was avoided.

Prediction of primary reparability of massive tears of the rotator cuff on preoperative magnetic resonance imaging.

We studied magnetic resonance images of rotator cuff tears to determine whether it was possible to establish preoperatively the feasibility or infeasibility of primary repair. The study comprised 27 shoulders in 26 patients who underwent magnetic resonance imaging before surgery because of complete tears of the rotator cuff and who were treated with primary repair or by the patch graft technique because primary repair was not feasible. The length and width of each tear, the thickness of the supraspinatus muscle at the superior margin of the glenoid, and the presence or absence of a high signal intensity in the infraspinatus muscle were statistically analyzed. Primary repair was often not feasible when both the length and width of the tear exceeded 40 mm on a preoperative magnetic resonance image, when the supraspinatus muscle was thin at the superior margin of the glenoid, and when a high signal intensity was observed in the infraspinatus muscle.