CBP Expression Contributes to Neuropathic Pain via CREB and MeCP2 Regulation in the Spared Nerve Injury Rat Model.

Background and Objectives: This study aimed to investigate the relationship between neuropathic pain and CREB-binding protein (CBP) and methyl-CpG-binding protein 2 (MeCP2) expression levels in a rat model with spared nerve injury (SNI). Materials and Methods: Rat (male Sprague-Dawley white rats) models with surgical SNI (n = 6) were prepared, and naive rats (n = 5) were used as controls. The expression levels of CBP and MeCP2 in the spinal cord and dorsal root ganglion (DRG) were compared through immunohistochemistry at 7 and 14 days after surgery. The relationship between neuropathic pain and CBP/MeCP2 was also analyzed through intrathecal siRNA administration. Results: SNI induced a significant increase in the number of CBPs in L4 compared with contralateral DRG as well as with naive rats. The number of MeCP2 cells in the dorsal horn on the ipsilateral side decreased significantly compared with the contralateral dorsal horn and the control group. SNI induced a significant decrease in the number of MeCP2 neurons in the L4 ipsilateral DRG compared with the contralateral DRG and naive rats. The intrathecal injection of CBP siRNA significantly inhibited mechanical allodynia induced by SNI compared with non-targeting siRNA treatment. MeCP2 siRNA injection showed no significant effect on mechanical allodynia. Conclusions: The results suggest that CBP and MeCP2 may play an important role in the generation of neuropathic pain following peripheral nerve injury.

Surgery-related anxiety regarding arthroscopic meniscectomy under general anesthesia: a retrospective observational study.

BACKGROUND: The prevalence of anxiety among patients undergoing arthroscopic surgery and its association with postoperative function has been well documented; however, the level of anxiety and anxiety-related characteristics remain unclear. As such, the present study investigated the characteristics of state anxiety in patients undergoing arthroscopic meniscectomy. METHODS: Data from 75 patients, who underwent arthroscopic partial meniscectomy under general anesthesia and completed an anxiety status questionnaire between April 2021 and March 2022, were retrospectively collected and reviewed. The State-Trait Anxiety Inventory (STAI)-X was used to measure state anxiety; a total score ≥ 52 was defined as clinically meaningful state anxiety. STAI score, main cause of preoperative anxiety, most anxious period, and most helpful factors for reducing perioperative anxiety were investigated. Patients were divided into 2 groups according to the main cause of preoperative anxiety; surgery or anesthesia (group I [n = 47]); and postoperative pain or rehabilitation (group II [n = 28]) Characteristics of state-anxiety between the two groups were compared using independent t-tests. RESULTS: The mean STAI score of the total population was 39.1 points (range, 20-60 points). The mean STAI score was significantly higher in group I than in group II (41.9 vs. 34.4 points, respectively; P < 0.001). The proportion of patients with clinically meaningful state anxiety was significantly higher in group I than in group II (23.4% vs. 3.6%, respectively, P = 0.02). Most patients (66.0% in group I and 50.0% in group II) responded that trust in medical staff was the most helpful factor in overcoming preoperative anxiety. In group I, 63.8% reported that the surgeon's explanation was the most helpful factor in reducing postoperative anxiety, whereas in group II, 71.4% reported that the natural course after surgery was the most helpful factor. CONCLUSIONS: Surgeons should be aware that anxiety related to arthroscopic meniscectomy differs according to patient characteristics, and a preoperative explanation of the postoperative process with the surgeon is important for patients who experience preoperative anxiety regarding anesthesia or the surgery itself.

A Bibliometric Analysis of the Field of Computer-Assisted Orthopedic Surgery during 2002-2021.

Background: This study aimed to investigate the characteristics of research articles and research trends in computer-assisted orthopedic surgery (CAOS) by conducting bibliometric analyses. Methods: CAOS-related research articles published in international journals from 2002 to 2021 were collected using the PubMed database and analyzed using the bibliometric method. Their publication year, journal name, corresponding author's country name, and the number of citations of all collected articles were noted. Contents of the articles were analyzed to evaluate the time point and anatomical site at which the digital technique was applied. Further, the 20-year period was divided into two halves of 10 years each to analyze the research trends. Results: A total of 639 CAOS-related articles were identified. An average of 32.0 CAOS-related articles were published annually, with an average of 20.6 and 43.3 published in the first half and second half, respectively. Of all articles, 47.6% were published in the top 10 journals, and 81.2% were written in the top 10 countries. The total numbers of citations were 11.7 and 6.3 in the first and second halves, respectively, but the average annual number of citations was higher in the second half than in the first one. Articles on application of digital techniques during surgery were 62.3% and those on pre-surgery application were 36.9%. Further, articles in the knee (39.0%), spine (28.5%), and hip and pelvis (21.5%) fields accounted for 89.0% of the total publications. But the increase in publications in the said period was highest in the fields of the hand and wrist (+1,300.0%), ankle (+466.7%), and shoulder (+366.7%). Conclusions: Over the last 20 years, the publication of CAOS-related research articles in international journals has grown steadily. Although the knee, spine, hip, and pelvis fields account for most CAOS-related research, research in new fields is also increasing. This study analyzed the types of articles and trends in CAOS-related research and provided useful information for future research in the field of CAOS.

Does spiked tibial cement spacer reduce spacer-related problems in two-stage revision total knee arthroplasty for infection?

PURPOSE: Articulating cement spacers are frequently used in staged approaches for infected total knee arthroplasty (TKA). This study investigated whether a tibial cement spacer (TCS) with spikes could reduce spacer-related problems in two-stage revision TKA (R-TKA). METHODS: A total of 27 patients (27 knees; 10 men and 17 women) who underwent two-stage R-TKA for infected TKA were retrospectively analyzed. Group A comprised 12 patients who used TCS with spikes added to the bottom surface, whereas group B consisted of 15 patients who used conventional TCS with a flat bottom. For each group, plain radiographs were obtained after cement spacer implantation and before R-TKA to measure mediolateral (ML) translation and TCS's tilting angle. Patients' demographic data, ML translation of the TCS, and changes in the TCS's tilting angle between the groups were analyzed. RESULTS: The mean ML translation was significantly lower in group A than that in group B (1.7 mm vs. 5.4 mm, p = 0.04). The mean change in the tilting angle was significantly lower in group A than that in group B (4.5° vs. 19.4°, p = 0.047). CONCLUSION: The spiked TCS in two-stage R-TKA provides superior stability compared to the TCS with a conventional design.

Successful Limb Salvage Using Bone Transport for Complete Loss of Distal Tibia and Talus: A Case Report.

Complex comminuted fractures involving the distal tibia, ankle joint, and talus are often accompanied by bone loss and are highly prone to complications such as soft tissue infection, fixation failure, and posttraumatic arthrosis, with joint reconstruction being difficult in cases with severe joint destruction or bone loss. In this case, bone transport and fusion procedures were performed to treat a patient with an open fracture involving total talar dislocation, talar bone loss, and distal tibial bone loss. Just as in this case, where the surrounding soft tissues remain healthy, limb salvage via segmental bone transport may be a reasonable option in fractures with massive bone loss that include joints.

Does Posterior Tibial Slope Affect Graft Rupture Following Anterior Cruciate Ligament Reconstruction?

PURPOSE: The purpose of this study was to evaluate the association between posterior tibial slope (PTS) and anterior cruciate ligament (ACL) graft rupture in patients who have undergone ACL reconstruction by comparing results in patients who experienced graft rupture and a matched control group. METHODS: The study included 64 knees of 64 patients (58 men and 6 women), of mean age 31 years (range, 18-60 years) who underwent revision ACL reconstruction for ACL graft rupture, as well as a control group without ACL graft rupture matched for age, sex, body mass index (BMI), and left or right side. The mean time to failure in study group was 48.5 months, and after revision surgeries, the mean follow-up period was 37.7 months. The graft used for the primary surgery was autograft in 3 patients (4.7%) and allograft in 49 patients (76.6%). The type of graft could not be confirmed in the remaining 12 patients (18.7%). PTS was measured on plain radiographs and compared in the 2 groups. RESULTS: Mean PTS was significantly higher in patients with (13.2° ± 2.5°; range, 8.5°-18.2°) than without (10.9° ± 3.1°; range, 4.9°-13.6°) rerupture (P < .01). When mean PTS was compared in the 37 patients who underwent primary surgery by the same surgeon, it was significantly higher in patients with (13.5° ± 2.5°; range, 8.5°-18.2°) than without (11.1° ± 2.9°; range, 5.1°-13.6°) rerupture (P < .01). PTS in patients with rerupture was not significantly associated with age, gender, BMI, and right or left side. The odds ratio of ACL graft rupture in knees with PTS ≥12° was 4.52 (P < .001). CONCLUSIONS: This study showed that mean PTS was significantly greater in patients with than without noncontact ACL graft rerupture (13.2° vs 10.9°, P < .01). The failure of ACL reconstruction appears to be associated with increased PTS, with PTS ≥12° a risk factor for the failure of ACL reconstruction. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Minimally Invasive Plate Osteosynthesis Using a Screw Compression Method for Treatment of Humeral Shaft Fractures.

BACKGROUND: This study aims to compare the surgical outcomes of open reduction and internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) using a screw compression method in simple humeral shaft fractures. METHODS: This retrospective study was performed with 50 patients who had surgical interventions for the treatment of simple humeral shaft fractures and had follow-ups of at least 12 months in Ulsan University Hospital between August 2008 and June 2015. Group 1 included 23 patients treated with ORIF and group 2 included 27 patients treated with the MIPO technique using a locking screw plate. The time to clinical/radiographic union, the joint range of motion (ROM), and function were evaluated. RESULTS: The average time to clinical/radiographic bone union was shorter in group 2 (12.0 ± 3.7 weeks/14.8 ± 2.0 weeks in group 1 and 9.4 ± 1.3 weeks/12.0 ± 3.3 weeks in group 2; p = 0.022/p = 0.034). Shoulder and elbow joint function evaluated by joint ROM and visual analogue scale (VAS), Korean Shoulder Elbow Society (KSS), American Shoulder and Elbow Surgeons (ASES), and the University of California at Los Angeles (UCLA) scores was excellent in both groups. On the average shoulder ROM at 12 months after the operation, group 1 had forward elevation of 160°, external rotation of 30° in adduction and lumbar vertebra 10 level in internal rotation and group 2 had forward elevation of 170°, external rotation of 35° in adduction and lumbar vertebra 9 level in internal rotation. The mean VAS, KSS, ASES, and UCLA scores were 2.8, 87.0 ± 0.9, 89.4 ± 0.9, and 31.0 ± 1.4, respectively, in group 1 and 1.7, 89.1 ± 2.7, 91.0 ± 1.6, and 32.4 ± 3.2, respectively, in group 2. There were statistically significant intergroup differences in VAS score (p = 0.011). There were significantly less postoperative infections in group 2 (three cases, 10.7% in group 1 and 0 case in group 2; p = 0.041) although all of them were superficial infections and well-treated by an average 4-week course of antibiotics (range, 2 to 6 weeks). CONCLUSIONS: MIPO using a screw compression method in simple humeral shaft fractures demonstrated superior efficacy to ORIF in terms of the time to clinical/radiographic union, pain score, and postoperative infection rate.

Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

BACKGROUND: The purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. METHODS: Forty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to group 1 and preemptively underwent blinded SSNB and axillary nerve block of 10 mL 0.25% ropivacaine and received arthroscopically guided SSNB with 10 mL of 0.25% ropivacaine. The other 20 patients were assigned to group 2 and received blinded SSNB with 10 mL of 0.25% ropivacaine. Visual analog scale (VAS) score for pain and patient satisfaction score were assessed 4, 8, 12, 24, 36, and 48 hours postoperatively. RESULTS: The mean VAS score for pain was significantly lower 4, 8, 12, 24, 36, and 48 hours postoperatively in group 1 (group 1 vs. group 2; 5.2 vs. 7.4, 4.1 vs. 6.1, 3.0 vs. 5.1, 2.1 vs. 4.2, 0.9 vs. 3.9, and 1.3 vs. 3.3, respectively). The mean patient satisfaction score was significantly higher at postoperative 4, 8, 12, 24, 36, and 48 hours in group 1 (group 1 vs. group 2; 6.7 vs. 3.9, 7.4 vs. 5.1, 8.8 vs. 5.9, 9.2 vs. 6.7, 9.5 vs. 6.9, and 9.0 vs. 7.2, respectively). CONCLUSIONS: Arthroscopically guided SSNB and blinded axillary nerve block in arthroscopic rotator cuff repair for medium-sized rotator cuff tears provided more improvement in VAS for pain and greater patient satisfaction in the first 48 postoperative hours than blinded SSNB.

The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone.

BACKGROUND: Recurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit. METHODS: Engaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging. RESULTS: The average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II. CONCLUSIONS: Compared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions.

MRI features of calcifying aponeurotic fibroma in the upper arm: a case report and review of the literature.

Calcifying aponeurotic fibroma is a rare soft tissue tumor that occurs in the distal extremities of children and adolescents. We report a case of pathologically proven calcifying aponeurotic fibroma in the left upper arm of a 23-year-old female. Radiographs revealed increased soft tissue density with multiple stippled calcifications in the mid-portion of the patient's left upper arm. Magnetic resonance imaging (MRI) showed a well-defined soft tissue mass with low to intermediate signal intensity on T1-weighted images, heterogeneously low signal intensity on T2-weighted images, and heterogeneous enhancement on fat-suppressed, contrast-enhanced T1-weighted images. Histologically, spindle cell proliferation with scattered calcifications and hyalinization was present. Seven years after surgery, there was no evidence of local recurrence. This is the first report of MRI findings of calcifying aponeurotic fibroma in the upper arm. We also summarize the MRI findings of 16 previously reported cases of calcifying aponeurotic fibroma originating in the upper or lower extremities.

Symptomatic mucoid degeneration of the anterior cruciate ligament.

PURPOSE: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. The aim of this study was to detail the clinical, radiological, arthroscopic and pathological findings of this condition and to report clinical outcomes following arthroscopic partial excision of the ACL. METHODS: Between 1999 and 2009, 80 knees in 78 patients were diagnosed as having mucoid degeneration of the ACL based on MRI and clinical findings, and subsequently underwent arthroscopic treatment. Of these, 68 knees in 66 patients, with a median age of 51 years (range, 35-75 years), were followed-up for at least one year. RESULTS: All patients had insidious onset of knee pain, while 56 knees (82 %) had associated extension deficits and 36 knees (53 %) had restricted flexion. MRI findings typically showed diffuse thickening and increased signal intensity of the ACL. Arthroscopic examination revealed notch impingement and bulging of hypertrophied ACL into lateral compartments. Associated lesions included meniscal tears in 33 knees and chondral lesions of at least Outerbridge grade 2 in 56 knees. All knees underwent arthroscopic partial excision of the hypertrophied ACL, with three undergoing preoperative and 30 undergoing concomitant meniscectomies. Pain relief was achieved in 58 of 62 knees (94 %) following partial excision of the ACL. Extension deficits were normalized in 49 of 56 knees (88 %), and restricted flexion was normalized in 33 of 36 affected knees (92 %). Four knees of four patients had postoperative symptoms of anterior instability. CONCLUSIONS: Pain and limitation of motion due to mucoid degeneration of the ACL can be improved by arthroscopic partial excision of the ACL with or without notchplasty. However, one potential complication is the development of postoperative symptoms of anterior instability. LEVEL OF EVIDENCE: Retrospective study, Level IV.

Mucoid degeneration of both ACL and PCL.

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient's magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.

Arthroscopic single-row supraspinatus tendon repair with a modified mattress locking stitch: a prospective, randomized controlled comparison with a simple stitch.

PURPOSE: Our purpose was to compare the clinical results and failure rates of arthroscopic rotator cuff repair by use of a modified mattress locking stitch (MMLS) repair versus a simple stitch repair. METHODS: Between December 2004 and January 2006, 78 cases of arthroscopically repaired full-thickness rotator cuff tears were evaluated prospectively. All tears were between 1.5 and 3 cm in size. The mean age of the patients was 53.4 years (range, 39 to 68 years), and the mean follow-up duration was 31.1 months (range, 24 to 37 months). Thirty-nine individuals underwent arthroscopic repair by use of an MMLS (group I). Thirty-nine individuals underwent arthroscopic repair by use of a simple stitch (group II). Postoperative visual analog scale scores for pain, scores for activities of daily living, and University of California, Los Angeles (UCLA) scores were obtained at a mean of 12 months (range, 6 to 36 months). We compared the results statistically by Mann-Whitney U test. In both groups magnetic resonance imaging scans were obtained at 6 to 36 months after repair. RESULTS: Between groups, the visual analog scale scores for pain, scores for activities of daily living, and University of California, Los Angeles scores were not significantly different (P > .05 for all). Of the patients, 92.3% in group I and 89.7% in group II showed excellent or good results at the final follow-up (P > .05). The satisfaction rate was 94.9% (37 cases) in group I and 89.7% (34 cases) in group II (P < .05). Radiographic failure was seen in 6 of 36 cases in group I (16.7%) and 9 of 30 cases in group II (27.4%) (P < .05). CONCLUSIONS: Arthroscopic repair of medium-sized (1.5- to 3-cm) full-thickness rotator cuff tears by use of an MMLS improves patient satisfaction rates and radiographic repair integrity in comparison to simple stitch repair. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial.