Association between periodontal disease and malignant soft tissue sarcomas.

OBJECTIVE: Malignant soft tissue sarcoma (MSTS) is a rare disease, but is seen in patients undergoing orthopedic surgery. Although the association of periodontal disease with various cancers occurring in the oral cavity, gastrointestinal tract, lungs, and prostate, has been reported, the association between periodontal disease and MSTS remains unclear. This study investigated the association between periodontal disease and MSTS in patients undergoing orthopedic surgery. SUBJECTS AND METHODS: One hundred fifteen patients who underwent orthopedic surgery between 2017 and 2021 were retrospectively enrolled (mean age = 66.8 ± 10.7 years). The patient background was adjusted by the propensity score (PS). Subsequently, the association of periodontal disease with MSTS was analyzed using PS inverse probability of treatment weighting (IPTW). Periodontal status was determined by evaluating the periodontal inflamed surface area, which was calculated by measuring the periodontal probing pocket depth and detecting bleeding on probing. RESULTS: Multivariate logistic regression analysis after adjustment by the PS showed that severe periodontitis was significantly associated with MSTS (odds ratio 2.81, p = 0.04). Furthermore, IPTW showed that severe periodontitis was significantly associated with MSTS (odds ratio 3.21, p = 0.01). CONCLUSION: The results indicate an association between periodontal inflammation and MSTS.

Benefits of Collaboration Between the Wound, Ostomy, and Continence Nurse and Orthopedic Surgeon When Treating Skin Defects After Soft Tissue Sarcoma Resection: A Retrospective Case-Control Study.

PURPOSE: The purpose of this study was to evaluate the benefits of collaborative management between orthopedic surgery and WOC nurses in patients undergoing resection of subcutaneous sarcomas. DESIGN: Retrospective case-control study. SUBJECTS AND SETTING: The sample comprised 25 patients who underwent wide resection for soft tissue sarcoma, followed by 2-stage split-thickness skin grafting. Data collection occurred between January 2015 and April 2021 in a university hospital based in Kagoshima, Japan. For comparison, we categorized these patients into 2 groups: intervention group participants were managed by an orthopedic surgeon and a WOC nurse; nonintervention group members were managed without WOC nurse participation. METHODS: Patient background and treatment-related information was retrospectively collected from medical records and compared between the WOC nurse intervention group and the nonintervention group, including maximum tumor diameter, surgical time, maximum skin defect diameter, length of hospital stay, and time from surgery to complete wound healing. RESULTS: The average length of hospital stay was significantly shorter in the WOC nurse intervention group compared with the nonintervention group (38.3 days, SD = 8.0 vs 47.1 days, SD = 10.2; P = .023). CONCLUSION: Collaborative wound management with a WOC nurse resulted in a shorter hospital length of stay when compared to traditional management with WOC nurse involvement. Based on these findings, we assert that WOC nurses provide an important bridge between postoperative wound management in patients undergoing resection of subcutaneous sarcomas.

Editorial Commentary: Bone Marrow Stimulation and Losartan Augmentation of Shoulder Rotator Cuff Repair.

Rotator cuff retear rates after repair have been variously reported as ranging from 5% to 40% for small to mediums tears and as high as 40% to 94% for large to massive tears. Thus strategies to enhance structural healing are relevant. In rabbits, combining oral losartan (which has antifibrotic effects by downregulating transforming growth factor-ß1) and bone marrow stimulation (BMS) of the greater tuberosity, showed improved rotator cuff repair pull-out strength and highly organized tendon matrix in a chronic injury model, whereas BMS alone did not improve the mechanical properties. However, clinical studies show that BMS techniques have a positive impact on healing and retear rates. BMS stimulates migration of mesenchymal stem cells from bone marrow to the lesion, and this approach has been widely used to fill cartilage defects by fibrocartilage metaplasia. BMS is a straightforward and cost-effective technique; the use of multiple deeper bone tunnels is recommended.

CDC5L promotes early chondrocyte differentiation and proliferation by modulating pre-mRNA splicing of SOX9, COL2A1, and WEE1.

Ossification of the posterior longitudinal ligament (OPLL) of the spine is a common pathological condition that causes intractable myelopathy and radiculopathy, mainly the result of an endochondral ossification-like process. Our previous genome-wide association study identified six susceptibility loci for OPLL, including the cell division cycle 5-like (CDC5L) gene region. Here, we found CDC5L to be expressed in type II collagen-producing chondrocyte-like fibroblasts in human OPLL specimens, as well as in differentiating ATDC5 chondrocytes. Cdc5l siRNA transfection in murine chondrocytes decreased the expression of the early chondrogenic genes Sox9 and Col2a1, diminished the cartilage matrix production, and enhanced the expression of parathyroid-hormone-related protein (a resting chondrocyte marker). We also showed that Cdc5l shRNA suppressed the growth of cultured murine embryonal metatarsal cartilage rudiments and that Cdc5l knockdown suppressed the growth of ATDC5 cells. Fluorescence-activated cell sorting analysis revealed that the G2/M cell cycle transition was blocked; our data showed that Cdc5l siRNA transfection enhanced expression of Wee1, an inhibitor of the G2/M transition. Cdc5l siRNA also decreased the pre-mRNA splicing efficiency of Sox9 and Col2a1 genes in both ATDC5 cells and primary chondrocytes; conversely, loss of Cdc5l resulted in enhanced splicing of Wee1 pre-mRNA. Finally, an RNA-binding protein immunoprecipitation assay revealed that Cdc5l bound directly to these target gene transcripts. Overall, we conclude that Cdc5l promotes both early chondrogenesis and cartilage growth and may play a role in the etiology of OPLL, at least in part by fine-tuning the pre-mRNA splicing of chondrogenic genes and Wee1, thus initiating the endochondral ossification process.

Crucial role of high-mobility group box 2 in mouse ovarian follicular development through estrogen receptor beta.

High-mobility group box 2 (HMGB2) is a chromatin-associated protein that is an important regulator of gene transcription, recombination, and repair processes. The functional importance of HMGB2 has been reported in various organs, including the testis, heart, and cartilage. However, its role in the ovary is largely unknown. In this study, ovary tissues from wild-type (WT) and HMGB2-knock-out (KO) mice were examined by histopathological staining and immunohistochemistry. The ovary size and weight were significantly lower in HMGB2-KO mice than in age-matched WT littermates. Histopathological analysis revealed ovarian atrophy and progressive fibrosis in 10-month-old HMGB2-KO mouse ovaries. Compared to age-matched WT mice, the numbers of oocytes and developing follicles were significantly decreased at 2 months of age and were completely depleted at 10 months of age in HMGB2-KO mice. Immunohistochemistry revealed the expression of HMGB2 in the granulosa cells of developing follicles, oocytes, some corpora lutea, and stromal cells. Importantly, HMGB2-positive cells were co-localized with estrogen receptor beta (ERß), but not ERα. Estrogen response element-binding activity was demonstrated by southwestern histochemistry, and it was decreased in HMGB2-KO mouse ovaries. Cell proliferation activity was also decreased in HMGB2-KO mouse ovaries in parallel with the decreased folliculogenesis. These results indicated that the depletion of HMGB2 induced ovarian atrophy that was characterized by a decreased ovarian size and weight, progressive fibrosis, as well as decreased oocytes and folliculogenesis. In conclusion, we demonstrated the crucial role of HMGB2 in mouse ovarian folliculogenesis through ERß expression.

Depletion of high-mobility group box 2 causes seminiferous tubule atrophy via aberrant expression of androgen and estrogen receptors in mouse testis†.

High-mobility group box 2, a chromatin-associated protein that interacts with deoxyribonucleic acid, is implicated in multiple biological processes, including gene transcription, replication, and repair. High-mobility group box 2 is expressed in several tissues, including the testis; however, its functional role is largely unknown. Here, we elucidated the role of high-mobility group box 2 in spermatogenesis. Paraffin-embedded testicular tissues were obtained from 8-week-old and 1-year-old wild-type and knock-out mice. Testis weight and number of seminiferous tubules were decreased, whereas atrophic tubules were increased in high-mobility group box 2-depleted mice. Immunohistochemistry revealed that atrophic tubules contained Sertoli cells, but not germ cells. Moreover, decreased cell proliferation and increased apoptosis were demonstrated in high-mobility group box 2-depleted mouse testis. To elucidate the cause of tubule atrophy, we examined the expression of androgen and estrogen receptors, and the results indicated aberrant expression of androgen receptor and estrogen receptor alpha in Sertoli and Leydig cells. Southwestern histochemistry detected decreased estrogen response element-binding sites in high-mobility group box 2-depleted mouse testis. High-mobility group box 1, which has highly similar structure and function as high-mobility group box 2, was examined by immunohistochemistry and western blotting, which indicated increased expression in testis. These findings indicate a compensatory increase in high-mobility group box 1 expression in high-mobility group box 2 knock-out mouse testis. In summary, depletion of high-mobility group box 2 induced aberrant expression of androgen receptor and estrogen receptor alpha, leading to decreased germ cell proliferation and increased apoptosis which resulted in focal seminiferous tubule atrophy.

Glenoid bone resorption after Bankart repair: finite element analysis of postoperative stress distribution of the glenoid.

BACKGROUND: There are various modifications of the Bankart repair, and postoperative changes to the glenoid morphology after the repair are reported. Among the various procedures performed, a decrease in the lateral glenoid diameter might be related to the surgery that involves removal of the articular cartilage and repair of the labrum-anterior inferior glenohumeral ligament complex on the glenoid surface. This is in contrast to cases without significant bony Bankart lesions that are not on the edge of the glenoid. Thus, this study aimed to compare glenoid rim stress after Bankart repair using 2 methods of finite element analysis: a method of removing the anteroinferior cartilage and repairing the glenohumeral ligament complex on the glenoid and a method of preserving the cartilage and repairing the glenohumeral ligament complex on the glenoid edge. METHODS: Five preoperative computed tomography scans of patients with traumatic anterior instability who underwent arthroscopic Bankart repair were used. Two models simulating different surgical procedures were created as follows: in model G, a 5-mm-thick cartilage on the glenoid rim was removed between 2 and 7 o'clock, and the glenohumeral ligament complex was repaired on the medial edge of the glenoid bone where the cartilage was removed. In model E, the cartilage on the glenoid rim was not removed, and the glenohumeral ligament complex was repaired on the glenoid edge. The load stresses on the anteroinferior area of the glenoid after Bankart repair with models G and E were measured using finite element analysis. RESULTS: The stress on the glenoid at 3-4 o'clock was 3.16 MPa in model G and 6.42 MPa in model E (P = .043). The stress at 4-5 o'clock was 1.68 MPa in model G and 4.53 MPa in model E (P = .043). The stress at 5-6 o'clock was 2.26 MPa in model G and 3.93 MPa in model E (P = .043). CONCLUSION: Significantly lower load stresses were observed at the anteroinferior rim of the glenoid in model G than in model E.

Neurotensin receptor 1 is a new therapeutic target for human undifferentiated pleomorphic sarcoma growth.

Undifferentiated pleomorphic sarcoma (UPS) is the second most common soft tissue sarcoma. For patients with unresectable or metastatic disease, chemotherapies are considered, but in many cases they are not curative. There is a need to identify specific molecular dysregulations that can be therapeutic targets. We focused on neurotensin receptor 1 (NTSR1), which belongs to the G-protein-coupled receptor. NTSR1 expression was upregulated in specimens from patients with UPS. Real-time polymerase chain reaction showed that expression of NTSR1 messenger RNA was 5- to 7-fold increased in UPS cells compared with myoblasts. Western blot showed a high expression of NTSR1 protein in UPS cell lines. Knockdown of NTSR1 prevented UPS cell proliferation and invasion. We confirmed that SR48692, an inhibitor of NTSR1, exhibited antitumor activities in UPS cells. The combination index showed that SR48692 and standard chemotherapeutic drugs prevented UPS cell proliferation synergistically. Mouse xenograft models showed that SR48692 inhibited extracellular signal-regulated kinase phosphorylation and enhanced the response to standard chemotherapeutic drugs. Inhibition of NTSR1 improved the effect of standard chemotherapeutic drugs for UPS. SR48692 may be a new drug for targeted UPS therapy.

The histone deacetylase inhibitor LBH589 inhibits undifferentiated pleomorphic sarcoma growth via downregulation of FOS-like antigen 1.

Undifferentiated pleomorphic sarcoma (UPS) is the second most frequent soft tissue sarcoma. Because of its resistance to chemotherapy, UPS patients are treated with surgical resection and complementary radiotherapy. However, since standard chemotherapy has not been established, unresectable or metastatic cases result in a poor prognosis. Therefore, the identification of a more effective therapy for UPS patients is needed. The development and progression of malignant tumors involve epigenetic alterations, and histone deacetylases (HDAC) have become a promising chemotherapeutic target. In this study, we investigated the potential effects and mechanisms of an HDAC inhibitor, LBH589, in UPS cells. We confirmed that LBH589 exhibits potent antitumor activities in four human UPS cell lines (GBS-1, TNMY-1, Nara-F, and Nara-H) and IC50 values ranged from 7 to 13 nM. A mouse xenograft model showed that LBH589 treatment effectively suppressed tumor growth. FACS analysis showed that LBH589 induced apoptosis and G2/M cell cycle arrest. Among apoptosis-related proteins, the expressions of Bcl-2 and Bcl-xL were decreased and the expression of Bak and Bim increased. Among cell cycle-related proteins, reductions of CDK1, p-CDK1, cyclin B1, Aurora A, and Aurora B were observed after LBH589 treatment. RNA microarray identified the FOS-like antigen 1 (FOSL1) gene as a downregulated gene in response to LBH589 in UPS cells. While knockdown of FOSL1 decreased UPS cell proliferation, overexpression induced cell proliferation. Our results show that LBH589 could be a promising chemotherapeutic agent in the treatment of UPS and downregulation of the FOSL1 gene could be the new molecular target of UPS treatment.

PEG10 counteracts signaling pathways of TGF-ß and BMP to regulate growth, motility and invasion of SW1353 chondrosarcoma cells.

Recently, we reported highly active transforming growth factor (TGF)-ß and bone morphogenetic protein (BMP) signaling in human chondrosarcoma samples and concurrent downregulation of paternally expressed gene 10 (PEG10). PEG10 expression was suppressed by TGF-ß signaling, and PEG10 interfered with the TGF-ß and BMP-SMAD pathways in chondrosarcoma cells. However, the roles of PEG10 in bone tumors, including chondrosarcoma, remain unknown. Here, we report that PEG10 promotes SW1353 chondrosarcoma cell growth by preventing TGF-ß1-mediated suppression. In contrast, PEG10 knockdown augments the TGF-ß1-induced motility of SW1353 cells. Individually, TGF-ß1 and PEG10 siRNA increase AKT phosphorylation, whereas an AKT inhibitor, MK2206, mitigates the effect of PEG10 silencing on cell migration. SW1353 cell invasion was enhanced by BMP-6, which was further increased by PEG10 silencing. The effect of siPEG10 was suppressed by inhibitors of matrix metalloproteinase (MMP). BMP-6 induced expression of MMP-1, -3, and -13, and PEG10 lentivirus or PEG10 siRNA downregulated or further upregulated these MMPs, respectively. PEG10 siRNA increased BMP-6-induced phosphorylation of p38 MAPK and AKT, whereas the p38 inhibitor SB203580 and MK2206 diminished SW1353 cell invasion by PEG10 siRNA. SB203580 and MK2206 impeded the enhancing effect of PEG10 siRNA on the BMP-6-induced expression of MMP-1, -3, and -13. Our findings suggest dual functions for PEG10: accelerating cell growth by suppressing TGF-ß signaling and inhibiting cell motility and invasion by interfering with TGF-ß and BMP signaling via the AKT and p38 pathways, respectively. Thus, PEG10 might be a molecular target for suppressing the aggressive phenotypes of chondrosarcoma cells.

A new scale measuring translation of the humeral head as a prognostic factor for the treatment of large and massive rotator cuff tears.

BACKGROUND: Failure rates after rotator cuff repair remain high in patients with massive tears. Although superior translation of the humeral head has been used to assess the severity of rotator cuff tears, the relevance of anterior migration of the humeral head to clinical outcomes has not been established. The purpose of this study was to investigate the potential role of the T-scale, a measure of the anterolateral translation of the humeral head, as a prognostic factor for rotator cuff repair. METHODS: One hundred twenty consecutive patients with full-thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale and acromiohumeral interval (AHI) were measured preoperatively on axial computed tomography scans and radiographs, respectively. The correlations of the T-scale and AHI with previously published scores and active forward elevation (FE) were investigated. The outcome of rotator cuff repairs was compared between patients with positive and patients with negative preoperative T-scale values. RESULTS: The preoperative T-scale but not AHI correlated significantly with postoperative FE and clinical scores in patients with large to massive tears but not in those with small to medium tears. Postoperative FE and clinical scores were significantly higher in patients with positive T-scale values than in those with negative T-scale values. The relative risk of retear was 2.0 to 7.9 times greater in patients with negative T-scale values. CONCLUSION: Patients with large to massive tears and negative T-scale values had poorer clinical outcomes and higher retear rates. A negative T-scale value represents a useful prognostic factor for considering reverse shoulder arthroplasty in patients at greater risk of retear after rotator cuff repair.

Hemoglobin stimulates the expression of ADAMTS-5 and ADAMTS-9 by synovial cells: a possible cause of articular cartilage damage after intra-articular hemorrhage.

BACKGROUND: ADAMTS (a disintegrin and metalloprotease with thrombospondin motifs) proteins play an important pathological role in matrix degeneration. Aggrecan degradation is a significant and critical event in early-stage osteoarthritis. To determine the effect of hemoglobin (Hb) on the ability of synovial tissues to produce ADAMTS family members, we examined the influence of Hb by synovial cells in an in vitro experimental system. METHODS: Synovial tissues were obtained from five young patients with meniscal injury under arthroscopic surgery. Primary cultures of human knee synovial cells were treated with different doses of human Hb (0, 25, 50, 100 µg/ml). The culture media were collected 24 h after Hb-treatment. In the time-course studies, cells were treated with and without 100 µg/ml Hb, and culture media were taken at 6, 12, and 24 h. To identify the proteins responsible for aggrecanase activity, Western blot analysis using antibodies against human ADAMTS-5, -8, -9, and -10; enzyme-linked immunosorbent assay (ELISA); and gene expression for ADAMTS-5 and -9 were examined. Statistical comparisons between each group were performed using paired t-tests. RESULTS: Western blot analysis revealed that Hb-treatment resulted in the expression of ADAMTS-5 and -9. Neither control group nor Hb-treated medium showed immunoreactivity against ADAMTS-8 or -10. In a dose-dependency study, the Hb-treated group showed significantly higher levels of ADAMTS-5 and -9 compared with the control (p < 0.05). There was no significant difference between 25, 50, and 100 µg/ml Hb-treated groups. In a time-course study, the ADAMTS-5 and -9 levels in the conditioned medium had significantly increased expression at 6, 12, and 24 h in the Hb-treated group (p < 0.05). Hb evoked significant expression of ADAMTS-9 mRNA at 12 and 24 h (p < 0.05). CONCLUSIONS: These findings indicate that Hb induces the expression of ADAMTS-5 and -9 by synovial cells at low doses, even at an acute phase, and suggests a possible role for Hb in cartilage damage after intra-articular hemorrhage. The results also suggest a new potential therapeutic target by inhibiting the activities of ADAMTS-5 and -9 to prevent cartilage damage after intra-articular hemorrhage.

Translation of the humeral head scale is associated with success of rotator cuff repair for large-massive tears.

BACKGROUND: Although a loss of rotator cuff integrity leads to the superior migration of the humeral head, the parameters that characterize the anterolateral migration of the humeral head have not been established. The purpose of this study was to investigate the correlation between the translation of the humeral head scale (T-scale) and clinical outcomes of rotator cuff repair, as well as the correlation between the T-scale and radiologic parameters. METHODS: One hundred thirty-five consecutive patients with full-thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale, which indicates the distance from the center of the humeral head to the lateral coracoacromial arch, was measured on axial computed tomography scans, and the acromiohumeral interval (AHI) was measured radiographically. The correlation of the two parameters with the clinical scores of the Japanese Orthopaedic Association and University of California-Los Angeles scores and active forward elevation (FE) were evaluated at the preoperative and postoperative stages, respectively. RESULTS: The postoperative T-scale and AHI correlated well with the postoperative FE and clinical scores in the patients with large-massive tears but not in those patients with small-medium tears and preoperative large-massive tears. A significant correlation was observed between the postoperative T-scale and AHI. The T-scale was subject to cuff repair integrity. CONCLUSIONS: We demonstrated that the postoperative T-scale was well correlated with the clinical results and postoperative AHI after rotator cuff repair for large-massive tears, indicating that poor outcomes are associated with combined superior and anterolateral migration of the humeral head following retears.

Humeral bone resorption after anatomic shoulder arthroplasty using an uncemented stem.

BACKGROUND: Bone resorption around the femoral stem after total hip arthroplasty is a well-known phenomenon. However, only a few studies have evaluated bone resorption after shoulder arthroplasty. This study investigated the prevalence of humeral bone resorption after different shoulder arthroplasty procedures. METHODS: The study included 147 shoulders that underwent total shoulder arthroplasty (TSA) or humeral head replacement (HHR) with an uncemented humeral stem from November 2008 to May 2015 and were monitored for more than 1 year. The prevalence of humeral bone resorption and risk factors were investigated. RESULTS: The most advanced grade of bone resorption, grade 0, occurred in 21 shoulders (14.3%). Grade 1 bone resorption occurred in 10 (6.8%), grade 2 in 28 (19.0%), grade 3 in 61 (41.5%), and grade 4 in 27 (18.4%). High occurrence of bone absorption was observed in zones 1, 2, and 7. Grade 4 bone resorption did not occur in zones 3 and 5. HHR, on-growth type stem coating, and occupation ratio were significant independent risk factors for grade ≥3 bone resorption, whereas female sex and HHR were significant independent risk factors for grade 4. CONCLUSION: Bone resorption was observed in 126 shoulders (85.7%), and full-thickness cortical bone resorption occurred in 27 shoulders (18.4%). Bone resorption was frequently observed at the greater tuberosity, lateral diaphysis, and calcar region (zones 1, 2, and 7). Significant risk factors included female sex, HHR with rotator cuff reconstruction, on-growth type stem coating, and high occupation ratio of the implant.

Pseudoaneurysm as a complication of shoulder arthroscopy.

A case of pseudoaneurysm that is a rare complication of shoulder arthroscopy is reported. A 73-year-old man with rotator cuff tear underwent arthroscopic rotator cuff repair. On post-operative day 3, a pulsating mass (diameter 5 mm) was detected near the anterior portal. Then, the mass gradually enlarged, which was diagnosed as pseudoaneurysm. After the consultation with vascular surgeons, the mass was surgically excised following ligation of feeding artery 6 weeks after the arthroscopic surgery. Thus far, no recurrence has been observed. Level of evidence V.

Bone marrow stimulation at the footprint of arthroscopic surface-holding repair advances cuff repair integrity.

BACKGROUND: Bone marrow stimulation (BMS) at the footprint of arthroscopic rotator cuff repair has not been fully evaluated according to the preoperative tear size and surgical technique. In this study, we investigated the effect of BMS on cuff repair integrity after an arthroscopic surface-holding (ASH) repair. MATERIALS AND METHODS: A total of 111 patients (mean age, 64.5 years) with chronic rotator cuff tears who underwent treatment by the ASH method with BMS by drilling of multiple holes at the footprint (67 shoulders) or without BMS (44 shoulders) were studied, and all patients were observed prospectively. Sugaya's classification was used to evaluate cuff integrity by postoperative magnetic resonance imaging, with types IV and V classified as rotator cuff retears. RESULTS: The mean scores for cuff integrity were 2.2 ± 0.2 and 1.7 ± 0.2 in the non-BMS and BMS groups, respectively. The mean scores were similar between the 2 groups for medium tears; however, scores for large-massive tears were significantly lower in the BMS group. The overall retear rate was 23.9% in the non-BMS group and 9.1% in the BMS group, and the distribution of repair types differed significantly. For large-massive tears, the retear rate was much higher in the non-BMS group (28.6%) than in the BMS group (4.5%), although the rates for medium tears were comparable between the 2 groups. CONCLUSIONS: These findings demonstrate that applying BMS to the footprint during ASH repair results in improved cuff repair integrity, particularly in large-massive tears, and suggest the importance of biologic treatment for rotator cuff healing after arthroscopic rotator cuff repair.

Surface-holding repair: an original arthroscopic rotator cuff repair technique.

BACKGROUND: Arthroscopic rotator cuff repair provides satisfactory results; however, there is still a high rate of re-tear. The objective of this study was to present a surface-holding technique that we recently developed for arthroscopic rotator cuff repair in detail and to evaluate the clinical outcome as well as cuff repair integrity with this new method. MATERIALS AND METHODS: A consecutive series of 116 patients with full-thickness rotator cuff tears underwent arthroscopic surface-holding repair and were monitored with the Japanese Orthopaedic Association, Constant-Murley, and University of California-Los Angeles scores to assess the clinical outcome. The mean follow-up period was 17.9 months (range, 12-40 months). Cuff repair integrity was evaluated by magnetic resonance imaging. RESULTS: All 3 rating systems at the time of final follow-up reflected a significant improvement in functional recovery of the shoulder compared with the preoperative scores. The overall rate of rotator cuff retear was 19.0% (22 of 116 shoulders), and the rates were 13.6% (9 of 66 shoulders) for small and medium-sized tears and 26% (13 of 50 shoulders) for large and massive tears. The rate for large and massive tears was much higher in patients older than 70 years (58.3%) compared with those younger than 70 years (36.3%), whereas the retear rates were similar in these 2 groups (22.2% and 17.5%, respectively). CONCLUSIONS: Arthroscopic surface-holding repair technique with medial suture and transosseous fixation improved rotator cuff healing. This method may be useful both for young patients and for elderly patients, who frequently have chronic large and massive tears, including osteoporotic bones.

Suprascapular notch variations: a 3DCT study.

BACKGROUND: Although cadaveric studies have revealed suprascapular notch shape variations, few have investigated the association between suprascapular notch variation and age or gender. The purpose of this study was to investigate suprascapular notch shape variations by use of three-dimensional computed tomography (3DCT) and to determine if there was any association with age or gender. METHODS: Three-dimensional CT images of 762 shoulders of 762 patients were analyzed in this study. Participants comprised 404 men and 358 women, with an average age of 58.2 ± 19.1 years. Suprascapular notch shape variations were classified into six types on the basis of Rengachary's classification. RESULTS: Of the total study population, 11.4% were classified as type I, 23.5% as type II, 30.1% as type III, 14.8% as type IV, 15.9% as type V, and 4.3% as type VI. Average age was 56.5 ± 20.5 years for type I, 57.0 ± 19.5 years for type II, 55.5 ± 20.0 years for type III, 56.4 ± 18.5 years for type IV, 65.5 ± 14.4 years for type V, and 68.0 ± 13.4 years for type VI. Statistically significant age differences were found between types I-IV and V, between types I-IV and VI, and between the non-ossification group (types I-IV) and the ossification group (types V and VI). Male-to-female ratio among each type, and between the non-ossification group and the ossification group, were not statistically significantly different. CONCLUSIONS: Our results suggest that transverse scapular ligament ossification is associated with aging whereas individual variation explains differences among types I, II, III, and IV. Three-dimensional CT provides useful information for arthroscopic resection of the transverse scapular ligament, when the wide variety of suprascapular notch shape variations is considered. LEVEL OF EVIDENCE: Level IV.

Impact of preoperative echocardiographic delay on timing of hip fracture surgery in elderly patients.

Objectives: Early surgery is recommended for hip fractures in elderly patients. This study was performed to evaluate factors contributing to delayed surgery and associated outcomes in a secondary hospital in Japan with a rehabilitation centre. Methods: We retrospectively reviewed the records of 895 patients aged >50 years [median age, 86 (81-91) years] treated for hip fractures at our institution from 2016 to 2020. We defined surgical delay as surgery performed >48 h after admission. We evaluated several risk factors for surgical delay and associated outcomes: mortality, length of hospital stay and walking status. Results: Binomial logistic regression analysis showed that several factors, including preoperative echocardiographic delay (odds ratio, 9.38; 95% confidence interval, 5.95-15.28), were risk factors for surgical delay. In the multiple regression analyses, surgical delay was a significant risk factor for a longer hospital stay (partial regression coefficient, 6.99; 95% confidence interval, 3.67-10.31). Conclusions: Our findings indicated that preoperative echocardiographic delay was one of the risk factors for surgical delay of hip fractures in elderly patients. Surgical delay was a risk factor for a longer hospital stay, including rehabilitation.

Incidence and Risk Factors for Hyponatremia in Postoperative Spinal Surgery Patients.

Introduction: The incidence of hyponatremia after orthopedic surgery is high. Hyponatremia may prolong hospitalization and increase mortality, but few reports have identified risk factors for hyponatremia after spinal surgery. This study aims to determine the incidence and risk factors for hyponatremia after spinal surgery. Methods: A total of 200 patients aged 20 years or older who underwent spinal surgery at our hospital from 2020-2021 were recruited. Data on age, sex, height, weight, body mass index, operation duration, blood loss, albumin level, the geriatric nutritional risk index (GNRI), potassium level, the estimated glomerular filtration rate (eGFR), sodium level, length of hospital stay, history of hypertension, dialysis status, the occurrence of delirium during hospital stay, and oral medication use were collected. Comparisons between the postoperative hyponatremia group and the postoperative normonatremia group were conducted to evaluate the impact of hyponatremia on clinical outcomes. Results: Postoperative hyponatremia was observed in 56 (28%) of the 200 patients after spinal surgery. Comparison between the postoperative hyponatremia group with the postoperative normonatremia group revealed that the patients in the postoperative hyponatremia group were significantly older (72 versus 68.5 years, p<0.01). Postoperative hyponatremia was significantly associated with low GNRI values (100.8 versus 109.3, p<0.01), low eGFR values (59.2 versus 70.8 mL/min/1.73 m2, p<0.01), preoperative hyponatremia (138.5 vs. 141 mEq/L, p<0.01), and a high incidence of delirium (12.5% versus 2.7%, p=0.01). Older age (odds ratio=1.04, p=0.01) and preoperative hyponatremia (odds ratio=0.66, p value<0.01) were risk factors for postoperative hyponatremia. Conclusions: In addition to older age and preoperative hyponatremia, the study identified new risk factors for postoperative hyponatremia, which are preoperative undernutrition and impaired renal function. The incidence of delirium was significantly higher in the postoperative hyponatremia group, suggesting that correcting preoperative hyponatremia and ensuring good nutrition may prevent delirium and thereby shorten hospital stays.