The prevalence of locomotive syndrome and its associated factors in patients with Type 2 diabetes mellitus.

OBJECTIVES: We investigated the prevalence of locomotive syndrome (LS) and related musculoskeletal diseases [osteoarthritis (OA), lumbar spondylosis, and spinal alignment] in Type 2 diabetes mellitus (DM) patients. METHODS: Clinical data were collected from 101 patients (55 males; 46 females) admitted to our hospital for diabetes education from October 2018 to April 2021. Patients underwent full-spine and whole-legs standing radiography and physical measurements (10-m walking and grip strength tests and three LS risk tests). RESULTS: The estimated prevalence of LS was 86.1% (Stage 1: 44.5%, Stage 2: 41.6%), lumbar spondylosis was 11.9%, and hip, knee, and ankle OA were 16.9%, 51.5%, and 12.9%, respectively. Multiple logistic regression analysis identified grip strength [odds ratio (OR) = 0.89, confidence interval (CI) = 0.83-0.94], diabetic retinopathy (OR = 5.85, CI = 1.64-20.78), knee OA (OR = 3.34, CI = 1.11-10.02), and a sagittal vertical axis >40 mm (OR = 3.42, CI = 1.13-10.39) as significantly associated risk factors for worsening LS in Type 2 DM patients. CONCLUSIONS: This study clarified the epidemiological indicators of LS and associated factors in DM patients. Exercise therapy and DM management are effective strategies to reduce the occurrence and progression of LS.

The effect of gracilis tendon harvesting in addition to semitendinosus tendon harvesting on knee extensor and flexor strength after anterior cruciate ligament reconstruction.

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction using hamstring tendons may involve harvesting of the gracilis tendon in addition to the semitendinosus tendon (ST) depending on the size of the ST graft. However, the effect of gracilis harvesting in addition to ST harvesting on muscle strength, such as the hamstring-to-quadriceps (HQ) ratio, remains unclear. Hence, this study aimed to investigate the effect of gracilis harvesting on subsequent knee muscle strength. MATERIALS AND METHODS: Eighty-two patients who underwent ACL reconstruction were included in this retrospective study. They were divided into the following two groups depending on the tendon graft used for ACL reconstruction: the ST group (41 patients) and the semitendinosus tendon/gracilis tendon (STG) group (41 patients). The isokinetic peak torque of the knee extensor and flexor was measured using a BIODEX dynamometer at a velocity of 60°/s and 180°/s, respectively, 3 and 6 months after ACL reconstruction. The groups were compared in terms of the limb symmetry index (LSI) and HQ ratio. RESULTS: The significant difference in the knee flexor of the LSI at 6 months after ACL reconstruction was as follows: ST group, 120.3 ± 28.3 vs STG group, 105.6 ± 19.0 (p < 0.01) at 60°/s and ST group, 122.9 ± 35.2 vs STG group, 106.2 ± 24.6 (p = 0.02) at 180°/s. There were significant differences in the HQ ratio at 180°/s as follows: ST group, 0.67 ± 0.15 vs STG group, 0.60 ± 0.13 (p < 0.01) at 3 months and ST group, 0.67 ± 0.13 vs STG group, and 0.59 ± 0.12 (p < 0.01) at 6 months after ACL reconstruction. CONCLUSIONS: Gracilis tendon harvesting may contribute to a decrease in knee flexor strength and HQ ratio with fast contraction. Thus, the need for gracilis tendon harvesting in ACL reconstruction should be carefully considered. LEVEL OF EVIDENCE: III.

In vivo microstructural analysis of the humeral greater tuberosity in patients with rotator cuff tears using multidetector row computed tomography.

BACKGROUND: In arthroscopic surgery, the suture anchor technique has become popular for rotator cuff repair. Preoperative evaluation of the bone microstructure is of utmost importance because, especially in elderly patients, osteoporotic changes may cause anchor pullout, which results in failure of rotator cuff repair. Many groups have reported humeral microstructural analysis; however, most studies were experiments using porcine specimens or human cadavers. In this study, we used multidetector row computed tomography to successfully perform in vivo evaluation of the bone microstructure of the humeral greater tuberosity in patients with rotator cuff tears. METHODS: Ten patients were examined. Regions of interest were defined in six quadrants of the greater tuberosity (medial, lateral, and far lateral rows of the anterior and posterior areas). The local bone mineral density and the trabecular microstructural parameters, including the mean bone volume to total volume (BV/TV), trabecular thickness, trabecular separation, and structure model index (SMI), were measured using bone analysis software. RESULTS: The BV/TV of the posteromedial region was highest and the SMI of the posteromedial region was lowest. These findings suggest that the bone quality of the posteromedial portion is the highest within the greater tuberosity. CONCLUSION: Because the bone quality may be correlated with the pullout strength of suture anchors, our method can help to understand the individual and regional variance in bone quality and may lead to the creation of personalized surgical protocols.

Superficial blood flow of the superior labrum associated with rotator cuff tear using laser Doppler flowmeter.

INTRODUCTION: Superior labrum anterior and posterior (SLAP) lesions due to overuse by repeated pitching motion and trauma are often noted and usually. However, shoulder disorders with a chronic course are often accompanied by SLAP lesions. SLAP lesions are frequently observed during arthroscopic surgery of the shoulder joint for rotator cuff tear in middle-aged and elderly individuals, suggesting the involvement of factors other than pitching motion and traumatic events in the pathogenesis. We considered that blood flow in the labrum is altered. The purpose of this study was to clarify the superficial blood flow in the superior labrum during arthroscopic surgery of the rotator cuff tear and investigate whether it is altered with labrum injury. MATERIALS AND METHODS: We evaluated 33 subjects with a mean age of 55.1 years who underwent arthroscopic surgery for partial or complete rotator cuff tears. The blood flow measurement site for the superior labrum was set at the supraglenoid tubercle attachment site, and blood flow was measured twice using laser Doppler flowmeter. The mean was calculated and compared among the normal labrum and type 1 SLAP lesions. RESULTS: The morphology of the labrum was normal in 16 subjects, and 17 subjects had type 1 SLAP lesions. The mean blood flow was 1.75 ml/min/100 g in subjects with a normal labrum; however, in subjects with type 1 SLAP lesions, blood flow was 1.32 ml/min/100 g, showing significant differences (P < 0.01). CONCLUSION: Superficial blood flow in the superior labrum of the shoulder with rotator cuff tear was measured using laser Doppler flowmetry. The blood flow in type 1 SLAP lesions was lower than that in the normal labrum.

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.

Safety and Efficacy of Early Rehabilitation With Assistance From a Single-Joint Hybrid Assistive Limb in Patients With Total Knee Arthroplasty: A Randomized Controlled Clinical Pilot Study.

Background This study aimed to evaluate the safety and effectiveness of knee exercise within four hours after total knee arthroplasty (TKA) using a single-joint hybrid assistive limb (HAL-SJ). Materials and methods This pilot single-blind randomized controlled trial included participants who underwent TKA for osteoarthritis and were randomly allocated to the early rehabilitation (n = 14) or control rehabilitation (n = 16) group. Knee rehabilitation exercises using the HAL-SJ began within four hours postoperatively in the early group and seven days after surgery in the control group. Knee circumference, range of motion (ROM), pain, muscle strength, and extension lag were assessed before and one and two weeks after surgery. Results Circumferences at 1 and 10 cm from the upper edge of the patella did not differ between the groups before surgery or one week postoperatively. The extension lag and knee flexion ROM after one week were significantly better in the early intervention group than in the control group. However, the quadriceps and hamstring isometric knee strength and pain scores did not differ between the groups at one and two weeks postoperatively. HAL-SJ-related complications were not reported. Conclusion Rehabilitation knee exercises using the HAL-SJ within four hours after TKA improved extension lag and knee flexion ROM without exacerbating knee swelling and pain.

Ultrasound-guided arthroscope insertion and decompression of a supraspinous fossa cyst.

A cyst arising in the scapular supraspinous fossa may cause shoulder pain; subsequently, enlargement of the cyst may result in severe compression of the adjacent suprascapular nerve, leading to muscle weakness and sensory disorder. Decompression of the nerve through cyst removal is effective in resolving these symptoms. However, treatment can also be performed less invasively through arthroscopy. Insertion of an arthroscope without visual guidance could cause tissue damage and, consequently, would become an invasive procedure itself. The use of ultrasonography to guide the scope to the cyst decreases the invasiveness of the procedure. Here, we present the case of a patient with a cyst arising in the scapular supraspinous fossa, in whom we could relatively readily and safely observe the cyst by advancing an arthroscope under ultrasonographic guidance. The suprascapular nerve was decompressed via cyst removal.

Prevalence of low skeletal muscle quantity and quality and their associated factors in patients before allogeneic hematopoietic stem cell transplantation.

Both quality and quantity of skeletal muscle are considered important for prognostic factors and clinical outcomes in solid cancers. However, few studies have examined both quality and quantity of skeletal muscle in patients with hematological malignancies. The aim of the present study was to clarify the prevalence of low skeletal muscle quantity and quality and their associated factors in patients before allogeneic hematopoietic stem cell transplantation (allo-HSCT). Pretransplant plain CT imaging at the third lumber vertebra level was used to measure the psoas muscle mass index (PMI) and the intramuscular adipose tissue content (IMAC) in 113 adult patients (age 47.1 ± 14.6 years) before HSCT. We analyzed the factors associated with PMI and IMAC, respectively. Although 62.8% of all patients had low skeletal muscle mass, only 8% had poor skeletal muscle quality. Multivariable logistic analysis showed that older age [odds ratio (OR) = 2.45, confidence interval (CI) = 1.04-5.76, P = 0.04], male (OR = 4.35, CI = 0.05-0.97, P = 0.04), and low BMI (OR = 0.83, CI = 0.71-0.97, P = 0.02) were independent risk factors for low PMI before HSCT. Only age (≤ 50 years) was significantly associated with muscle quality (modified OR = 0.07, CI = 0.00-0.43, P < 0.01) in univariate analysis. Most patients already showed low skeletal muscle mass before allo-HSCT although skeletal muscle quality was relatively preserved. These results may be indicative of pre-cachexia and may be useful for its long-term management in allo-HSCT patients.

Anterior cruciate ligament reconstruction with ultrasound-guided femoral nerve block does not adversely affect knee extensor strength beyond that seen with intravenous patient-controlled analgesia at 3 and 6 months postoperatively.

BACKGROUND: This study aimed to investigate the effect of anterior cruciate ligament (ACL) reconstruction with an ultrasound-guided femoral nerve block (FNB) on knee extensor strength weakness 3 and 6 months, and graft rupture in the 1 year following ACL reconstruction. METHODS: One hundred and seven patients who underwent ACL reconstruction were included in this retrospective study. The patients were divided into two groups stratified by the method of postoperative pain management. The FNB group included 66 patients, and there were 41 patients in the intravenous patient-controlled analgesia (iv-PCA) group. The isokinetic peak torque of knee flexor and extensor was measured preoperative, 3 and 6 months after ACL reconstruction. Muscle strength measurements were performed using the BIODEX dynamometer at a velocity of 60°/s and 180°/s. Peak torque of knee extensor and flexor strength, estimated pre-injury capacity (EPIC), body weight ratio (BW), and graft rupture incidence were compared between the two groups. RESULTS: There were no statistically significant differences in the knee extensor and flexor strength for all items at 3 and 6 months after ACL reconstruction. There was also not a statistically significant difference in the graft rupture incidence between the two groups: FNB group was two patients, 3.0% vs. iv-PCA group was one patient, 2.4% (p = 0.86). CONCLUSION: ACL reconstruction with ultrasound-guided FNB does not affect knee extensor strength at 6 months, nor graft rupture at 1 year postoperatively.

Accuracy of the biceps tendon sheath injection: ultrasound-guided or unguided injection? A randomized controlled trial.

BACKGROUND: Patients often localize pain in the anterior shoulder; however, this patient-localized pain does not necessarily correlate to the location of disease. Unguided shoulder injections are common in clinical practice. The accuracy of unguided biceps tendon sheath injections has not been studied. Patient management may be aided by the knowledge of injection accuracy. This study compared the accuracy of ultrasound-guided biceps tendon sheath injection with unguided injection. MATERIALS AND METHODS: The study comprised 30 patients (30 shoulders) with reported anterior shoulder pain who had a primary diagnosis of tenosynovitis or tendinitis of the biceps tendon, or both. Shoulders were randomly allocated into ultrasound-guided and unguided injection groups. Computed tomography (CT) imaging was performed immediately after a contrast agent was injected into the biceps tendon sheath. The locations of contrast seen on CT scan were classified into 3 types: only within the tendon sheath (type 1); inside the tendon, tendon sheath, and surrounding area (type 2); and only the area outside the tendon sheath (type 3). RESULTS: Ultrasound-guided injections resulted in 86.7% type 1 and 13.3% type 2 locations. Unguided injections resulted in 26.7% type 1, 40.0% type 2, and 33.3% type 3 locations. The difference for each location type was significant (P < .05). CONCLUSION: Injection into the tendon sheath of the long head of the biceps brachii can be more accurately performed using ultrasound guidance than by the blind method.

Comparative survey of pain-alleviating effects between ultrasound-guided injection and blind injection of lidocaine alone in patients with painful shoulder.

BACKGROUND: Complaints of shoulder pain are very frequent in clinical practice. To relieve this type of pain, intra-subacromial bursa (SAB) injection therapy is commonly employed. Injection procedures include blind and ultrasound-guided injection. In clinical practice, blind injection is routinely performed. However, the SAB is a very thin tissue. Poor response to blind injection may be due to a misplaced injection. It is assumed that ultrasound-guided injections are more effective than blind injections. The purpose of this study was to compare pain-alleviating effects between ultrasound-guided injection and blind injection with lidocaine alone. MATERIALS AND METHODS: The subjects were 16 patients (20 shoulders) in whom pain was possibly derived from inflammation of the SAB. Initially, ultrasound-guided injection was performed with 2 ml of 1% lidocaine. After 1 week, blind injection was conducted in the same patient. They subjectively expressed the grade of pain at each time point (before and 1, 5, 10, 15, 20, 25, and 30 min after injection) as pain scores. We calculated the amelioration rate by dividing differences between the scores at each time point and before injection by the pre-injection score. RESULTS: Pain scores of ultrasound-guided injection were lower than blind injection. Ultrasound-guided injection achieved higher mean amelioration rates compared to blind injection, showing significant differences at all time points (P < 0.01). CONCLUSIONS: Ultrasound-guided technique achieved higher effectiveness compared to blind technique.

Risk factors for noncontact anterior cruciate ligament injury in female high school basketball and handball players: A prospective 3-year cohort study.

INTRODUCTION: The risk factors of noncontact anterior cruciate ligament (ACL) injury remain an enigma. The purpose of this study was to prospectively evaluate the risk factors for noncontact ACL injury in female high school basketball and handball players. MATERIALS AND METHODS: We conducted a 3-year prospective cohort study between 2009 and 2014, and it included 317 female high school athletes aged 15 years. At baseline, they underwent detailed examinations for various parameters that were documented during their first year of high school. The parameters assessed were height (cm), weight (kg), general joint laxity (points), navicular drop (mm), anterior laxity of the knee using the KT-1000 Knee Ligament Arthrometer (mm), angle of femoral anteversion (º), knee extensor/flexor muscle strength (Nm/kg), and hip abductor strength (Nm/kg). All ACL injuries that occurred during these 3 years were recorded. RESULTS: Of 317 players, 27 were excluded because they either had a history of ACL injury or could not complete the study. Thirty ACL tears occurred. Three of the ACL injuries were contact injuries, whereas the remaining 27 were noncontact injuries. Greater body weight (95% confidence interval [CI], 1.030-1.174; P = 0.004), a high hip abductor strength (95% CI, 1.462-4.827; P = 0.001), and small femoral anteversion (95% CI, 0.746-0.982; P = 0.027) were found to be risk factors in logistic regression analysis. CONCLUSION: Greater body weight, a high hip abductor strength, and small femoral anteversion were risk factors for noncontact ACL injury in female high school basketball and handball players.

Assessing the efficacy of famotidine and rebamipide in the treatment of gastric mucosal lesions in patients receiving long-term NSAID therapy (FORCE--famotidine or rebamipide in comparison by endoscopy).

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are major causes of gastric mucosal lesions. In Japan, histamine-2 receptor antagonists are frequently prescribed, but the literature regarding their efficacy is limited. In this study, we compare the effects of famotidine and rebamipide on NSAID-associated gastric mucosal lesions using upper gastrointestinal endoscopy. METHODS: This study examined 112 patients taking NSAIDs for either gastric hemorrhage or erosion. Before treatment, the patients were assessed by endoscopy. Using blind randomization, patients were divided into two groups: group F (famotidine, 20 mg/day) and group R (rebamipide, 300 mg/day). Efficacy was examined 4 weeks later using endoscopy. RESULTS: After treatment, the Lanza score decreased significantly in group F (P < 0.001) but not in group R (P = 0.478). The change in the Lanza score in group F was significantly greater (P = 0.002) than that in group R. CONCLUSIONS: Famotidine was superior to rebamipide in treating NSAID-associated mucosal lesions.