AI-driven robotic chemist for autonomous synthesis of organic molecules.

The automation of organic compound synthesis is pivotal for expediting the development of such compounds. In addition, enhancing development efficiency can be achieved by incorporating autonomous functions alongside automation. To achieve this, we developed an autonomous synthesis robot that harnesses the power of artificial intelligence (AI) and robotic technology to establish optimal synthetic recipes. Given a target molecule, our AI initially plans synthetic pathways and defines reaction conditions. It then iteratively refines these plans using feedback from the experimental robot, gradually optimizing the recipe. The system performance was validated by successfully determining synthetic recipes for three organic compounds, yielding that conversion rates that outperform existing references. Notably, this autonomous system is designed around batch reactors, making it accessible and valuable to chemists in standard laboratory settings, thereby streamlining research endeavors.

Lemon Balm and Corn Silk Mixture Alleviates Metabolic Disorders Caused by a High-Fat Diet.

We recently reported that varying combination ratios of lemon balm (Mellissa officinalis L.) and corn silk extracts (Stigma of Zea mays L. fruit) could reduce the obesity caused by a high-fat diet (HFD). The present study investigated the dose-dependent effect of a 1:1 (w:w) mixture of lemon balm and corn silk extracts (M-LB/CS) on HFD-mediated metabolic disorders and compared the effect with metformin. Oral administration of 50-200 mg/kg of M-LB/CS for 84 days significantly inhibited HFD-induced body weight gain, adipocyte hypertrophy, and lipogenic gene induction without affecting food consumption in mice. Biochemical analyses showed that M-LB/CS blocked abnormal lipid accumulation in the blood by escalating fecal lipid excretion. In addition, M-LB/CS prevented HFD-mediated pancreatic atrophy, decreased the number of insulin- and glucagon-immunoreactive cells, and inhibited increases in glycated hemoglobin, glucose, and insulin. Moreover, M-LB/CS also reduced hepatic injury, lipid accumulation, gluconeogenesis, and lipid peroxidation in parallel with the induction of AMP-activated protein kinase and antioxidant enzymes. Furthermore, M-LB/CS protected the kidney by inhibiting tubular vacuolation and reducing serum creatinine and blood urea nitrogen levels. The prophylactic effect of 100 mg/kg M-LB/CS-administration was comparable to that of metformin. Therefore, M-LB/CS may be an alternative option for managing obesity and its related metabolic disorders.

Amlodipine decreases mitral regurgitation volume in dogs over 7 days: A study of 24 dogs with myxomatous mitral valve degeneration.

Background: Amlodipine, a dihydropyridine calcium-channel blocker, is currently being investigated as a treatment for myxomatous mitral valvular degeneration (MMVD). However, the effects of amlodipine on moderate or severe spontaneous MMVD, based on changes in echocardiographic indices, remain unclear. Animals: Client-owned small-breed dogs (n = 24) with naturally occurring MMVD of the American College of Veterinary Internal Medicine (ACVIM) stage B2 or higher. Methods: Basic dog information including previous medication treatments were recorded. All subjects received amlodipine 0.1 mg/kg, administered per os, twice daily for 7 days, in addition to their existing medication. We measured systolic blood pressure, obtained x-ray, echocardiography, blood test data before and after 1 week of amlodipine administration. Results: Left ventricular end-diastolic internal diameter, left atrial diameter and E wave reduced statistically after 1 week of amlodipine treatment (all p < 0.001). No adverse effects were reported. Conclusions: These findings suggest that low-dose amlodipine should be considered as treatment for dogs with ACVIM stage B2‒C MMVD.

Lemon Balm and Corn Silk Extracts Mitigate High-Fat Diet-Induced Obesity in Mice.

Lemon balm and corn silk are valuable medicinal herbs, which exhibit variety of beneficial effects for human health. The present study explored the anti-obesity effects of a mixture of lemon balm and corn silk extracts (M-LB/CS) by comparison with the effects of single herbal extracts in high-fat diet (HFD)-induced obesity in mice. HFD supplementation for 84 days increased the body weight, the fat mass density, the mean diameter of adipocytes, and the thickness of fat pads. However, oral administration of M-LB/CS significantly alleviated the HFD-mediated weight gain and adipocyte hypertrophy without affecting food consumption. Of the various combination ratios of M-LB/CS tested, the magnitude of the decreases in weight gain and adipocyte hypertrophy by administration of 1:1, 1:2, 2:1, and 4:1 (w/w) M-LB/CS was more potent than that by single herbal extracts alone. In addition, M-LB/CS reduced the HFD-mediated increases in serum cholesterol, triglyceride, and low-density lipoprotein, prevented the reduction in serum high-density lipoprotein, and facilitated fecal excretion of cholesterol and triglyceride. Moreover, M-LB/CS mitigated the abnormal changes in specific mRNAs associated with lipogenesis and lipolysis in the adipose tissue. Furthermore, M-LB/CS reduced lipid peroxidation by inhibiting the HFD-mediated reduction in glutathione, catalase, and superoxide dismutase. Therefore, M-LB/CS is a promising herbal mixture for preventing obesity.

Volumetric change of the latissimus dorsi muscle after postoperative chemotherapy and radiotherapy in immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap: final results from serial studies.

BACKGROUND: Breast reconstruction using an extended latissimus dorsi (eLD) flap can supplement more volume than reconstruction using various local flaps after partial mastectomy, and it is a valuable surgical method since the reconstruction area is not limited. However, when performing reconstruction, the surgeon should consider latissimus dorsi (LD) volume reduction due to postoperative chemotherapy (POCTx) and postoperative radiotherapy (PORTx). To evaluate the effect of POCTx and PORTx on LD volume reduction, the effects of each therapy-both separately and jointly-need to be demonstrated. The present study quantified LD volume reduction in patients who underwent POCTx and PORTx after receiving breast-conserving surgery (BCS) with an eLD flap. METHODS: This study included 48 patients who received immediate breast reconstruction using an eLD flap from January 2013 to March 2017, had chest computed tomography (CT) 7-10 days after surgery and 10-14 months after radiotherapy completion, and were observed for more than 3 years postoperatively. One surgeon performed the breast reconstruction procedures, and measurements of breast volume were obtained from axial CT views, using a picture archiving and communication system. A P-value <0.05 was the threshold for statistical significance. RESULTS: The average volume reduction of LD at 10-14 months after completing POCTx and PORTx was 64.5% (range, 42.8%-81.4%) in comparison to the volume measured 7-10 days after surgery. This change was statistically significant (P<0.05). CONCLUSIONS: Based on the findings of this study, when harvesting an eLD flap, surgeons should anticipate an average LD volume reduction of 64.5% if chemotherapy and radiotherapy are scheduled after BCS with an eLD flap.

Comparison of breast volume change between oncoplastic breast-conserving surgery with radiation therapy and a simultaneous contralateral balancing procedure through the inverted-T scar technique.

BACKGROUND: Reduction mammoplasty or mastopexy is performed as an additional balancing procedure in patients with large or ptotic breasts who undergo breast-conserving surgery (BCS). Radiation therapy on breasts that have undergone surgery may result in changes in the volume. This study presents a comparative analysis of patients who received post-BCS balancing procedures to determine whether volume changes were larger in breasts that received radiation therapy than on the contralateral side. METHODS: Thirty-six participants were selected among patients who received BCS using the inverted-T scar technique between September 2012 and July 2017, were followed up for 2 or more years, and had pre-radiation therapy computed tomography images and post-radiation therapy images taken between 12 and 18 months after completion. The average age of the participants was 53.5 years, their average body mass index was 26.62 kg/m2. RESULTS: The pre- and post-radiation therapy volumes of the breasts receiving BCS were 666.08±147.48 mL and 649.33±130.35 mL, respectively. In the contralateral breasts, the volume before radiation therapy was 637.69±145.72 mL, which decreased to 628.14±166.41 mL after therapy. The volume ratio of the affected to the contralateral breasts was 1.05±0.10 before radiation therapy and 1.06±0.12 after radiation therapy. CONCLUSIONS: The ratio of the volume between the two breasts immediately after surgery and at roughly 18 months postoperatively was not significantly different (P=0.98). For these reasons, we recommend a simultaneous single-stage balancing procedure as a reasonable option for patients who require radiation therapy after BCS without concerns regarding volume change.

Protective effects of fermented rice extract on ulcerative colitis induced by dextran sodium sulfate in mice.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD), characterized by the gut mucosal ulceration. Growing evidence indicates that dysregulation of immune response to the commensal microbiota involves the pathogenesis of IBD. Previous studies have demonstrated the favorable probiotic effects of fermented rice extracts through triple fermentation with Saccharomyces cerevisiae and Weissella cibaria (FRe). Thus, the therapeutic potential of FRe for UC was examined. Dextran sodium sulfate UC mice model was orally administered distilled water as a control, sulfasalazine, or FRe at 300, 200, and 100 mg/kg, once a day for a week. The UC control exhibited body weight loss, bloody stools, and colonic shortening. However, the FRe, especially at 300 mg/kg, led to a reduction in weight loss, disease activity index scores, and colon weight, and an increase in colorectal length. The histopathological analyses revealed mild changes involved in the colonic crypt and mucosal damages in the FRe groups, along with inhibited inflammation. Indeed, the FRe reduced neutrophil infiltration and production of proinflammatory cytokines (i.e., tumor necrosis factor-α, interleukin-6/-8). This was accompanied by the down-regulation of nuclear factor-kappa B. The gene expression responsible for the intestinal barrier integrity (i.e., Zonna occludens-1/-2, Claudin-1, Occludin, Mucin-1/-2) was up-regulated in the FRe groups. In addition, the FRe reduced lipid peroxidation and enhanced antioxidant activity. Interestingly, the microbiota dysbiosis was attenuated in the FRe groups, and the number of beneficial bacteria, Lactobacilli and Bifidobacteria, was increased. It suggests that the FRe potently ameliorate UC as a functional food.

Anti-Photoaging Effects of Low Molecular-Weight Fucoidan on Ultraviolet B-Irradiated Mice.

Ultraviolet (UV) B exposure induces DNA damage and production of reactive oxygen species (ROS), which causes skin photoaging through signaling pathways of inflammation and modulation of extracellular matrix remodeling proteins, collagens, and matrix metalloproteinase (MMP). As low molecular-weight fucoidan (LMF) has potential antioxidant and anti-inflammatory properties, we examined the protective effects of LMF against UVB-induced photoaging. A UVB-irradiated mouse model was topically treated with myricetin or LMF at 2.0, 1.0 and 0.2 mg/cm² (LMF2.0, LMF1.0 and LMF0.2, respectively) once a day for 15 weeks. Wrinkle formation, inflammation, oxidative stress, MMP expression, and apoptosis in the treated regions were compared with those in a distilled water-treated photoaging model (UVB control). LMF treatments, particularly LMF2.0 and LMF1.0, significantly inhibited the wrinkle formation, skin edema, and neutrophil recruitment into the photo-damaged lesions, compared with those in the UVB control. While LMF decreased interleukin (IL)-1ß release, it increased IL-10. The LMF treatment inhibited the oxidative stresses (malondialdehyde and superoxide anion) and enhanced endogenous antioxidants (glutathione). Additionally, LMF reduced the mRNA expression of MMP-1, 9, and 13. The histopathological analyses revealed the anti-photoaging effects of LMF exerted via its antioxidant, anti-apoptotic, and MMP-9-inhibiting effects. These suggest that LMF can be used as a skin-protective remedy for photoaging.

Posterior Shift of Contact Point between Femoral Component and Polyethylene in the LCS Rotating Platform Implant under Weight Bearing Condition.

PURPOSE: To analyze the contact mechanics of the femoral component and polyethylene of the Low Contact Stress rotating platform (LCS-RP) in nonweight bearing and weight bearing conditions using full flexion lateral radiographs. MATERIALS AND METHODS: From May 2009 to December 2013, 58 knees in 41 patients diagnosed with osteoarthritis and treated with total knee arthroplasty (TKA) were included in this study. TKA was performed using an LCS-RP knee prosthesis. Full flexion lateral radiographs in both weight bearing and nonweight bearing condition were taken at least one month postoperatively (average, 28.8 months). Translation of femoral component was determined by the contact point between the femoral component and polyethylene. Maximum flexion was measured as the angle between the lines drawn at the midpoint of the femur and tibia. RESULTS: Posterior shift of the contact point in LCS-RP TKA was observed under weight bearing condition, which resulted in deeper flexion compared to LCS-RP TKA under nonweight bearing condition. CONCLUSIONS: In the LCS-RP TKA, the contact point between the femoral component and polyethylene moved posteriorly under weight bearing condition, and the joint was more congruent and maximum flexion increased with weight bearing.

Open-Wedge High Tibial Osteotomy Using a Protective Cutting System: Technical Advancement for the Accuracy of the Osteotomy and Avoiding Intraoperative Complications.

Open-wedge high tibial osteotomy for medial unicompartmental arthritis of the knee joint is a successful treatment option but is associated with potential intraoperative complications such as tibial plateau fracture, dislocation of the osteotomy hinge, under- or over-correction of the posterior slope, and neurovascular injury. Therefore we devised a protective cutting system and describe our method for the prevention of these complications. The potential advantages of this system are protection of the posterior neurovascular structures using a curved protector, bone cutting along the natural tibial slope using a superior surface aligning with the natural tibial slope, and complete 1-plane sawing of the posterior wall before the lateral hinge.

Effect of the Osteotomy Length on the Change of the Posterior Tibial Slope With a Simple Distraction of the Posterior Gap in the Uni- and Biplanar Open-Wedge High Tibial Osteotomy.

PURPOSE: To (1) determine the length of the osteotomy at the anterior and posterior cortex, (2) compare between uni- and biplanar osteotomy, and (3) evaluate the relationship between the extent of the osteotomy and change of the posterior tibial slope. METHODS: A prospective comparative study of 24 uniplanar and 30 biplanar osteotomies was performed. To evaluate the length of osteotomy, osteotomy lines of the anterior and posterior cortex were analyzed in the 3-dimensional surface models. For slope measurement, the intramedullary axis of the proximal tibia (slope P), posterior cortical line of the proximal tibia (slope C), and anterior cortical line of the proximal fibula (slope F) were used. An analysis of the changes in the posterior tibial slope was performed independently using a pre- and postoperative lateral plane radiograph. RESULTS: In the uniplanar osteotomy, ratios of the osteotomized length to the total cortical length aligned with the osteotomized plane were larger in the anterior cortex (0.91 in uniplanar v 0.46 in biplanar; P = 0) and posterior cortex (0.97 in uniplanar v 0.79 ratio in biplanar; P = 0). Furthermore, the posterior tibial slope was maintained in both groups and the ratios between the anterior and posterior gap in both groups were 0.57 and 0.63, respectively. The maintenance of the slope was not related to any specific variables. Additionally, these phenomena did not differ between those patients who underwent uni- and those who underwent biplanar osteotomy. CONCLUSIONS: Increase in the posterior tibial slope was prevented with appropriate uni- or biplanar osteotomy with a simple distraction at the most posterior gap. However, in the uniplanar osteotomy, the ratio of the osteotomized length to the total cortical length was larger in both the anterior and posterior cortex.

Changes in patellofemoral alignment do not cause clinical impact after open-wedge high tibial osteotomy.

PURPOSE: The objectives of this study were (1) to evaluate the clinical and radiologic outcomes of open-wedge high tibial osteotomy focusing on patellofemoral alignment and (2) to search for correlation between variables and patellofemoral malalignment. METHODS: A total of 46 knees (46 patients) from 32 females and 14 males who underwent open-wedge high tibial osteotomy were included in this retrospective case series. Outcomes were evaluated using clinical scales and radiologic parameters at the last follow-up. Pre-operative and final follow-up values were compared for the outcome analysis. For the focused analysis of the patellofemoral joint, correlation analyses between patellofemoral variables and pre- and post-operative weight-bearing line (WBL), clinical score, posterior slope, Blackburn Peel ratio, lateral patellar tilt, lateral patellar shift, and congruence angle were performed. RESULTS: The minimum follow-up period was 2 years and median follow-up period was 44 months (range 24-88 months). The percentage of weight-bearing line was shifted from 17.2 ± 11.1 to 56.7 ± 12.7%, and it was statistically significant (p < 0.01). Regarding the clinical results, statistical significance was observed using all scores (p < 0.01). In the radiologic evaluation, patellar descent was observed with statistical significance (p < 0.01). Last follow-up lateral patellar tilt was decreased with statistical significance (p < 0.01). In correlation analysis between variables of patellofemoral malalignment, the pre-operative weight-bearing line showed an association with the change in lateral patellar tilt and lateral patellar shift (correlation coefficient: 0.3). CONCLUSION: After open-wedge high tibial osteotomy, clinical results showed improvement, compared to pre-operative values. The patellar tilt and lateral patellar shift were not changed; however, descent of the patella was observed. Therefore, mild patellofemoral problems should not be a contraindication of the open-wedge high tibial osteotomy. LEVEL OF EVIDENCE: Case series, Level IV.

Restoration of the anatomic position during a meniscal allograft transplantation using pre-existing landmarks.

INTRODUCTION: Accurate sizing and positioning of a meniscal allograft is an important factor for successful outcomes of meniscal allograft transplantation. The objectives of this study were (1) to search a proper rotational landmark, (2) to determine the sagittal slope of meniscus, and, thus (3) to determine the meniscal positioning. MATERIALS AND METHODS: A total of 121 consecutive patients who underwent magnetic resonance imaging in the 3 months prior to the beginning of the study were selected. To assess the meniscal rotation, rotation 0° line of the meniscus was defined as a line connecting the center of the anterior and the posterior horn of the medial and lateral meniscus, respectively. At this level, four possible reference lines were compared: Akagi line, line perpendicular to the largest mediolateral dimension (LMLD), line between the medial border of the patellar tendon and the apex of the medial tibial spine (PTMS), and line between the lateral border of the patellar tendon and the apex of the lateral tibial spine. To assess the meniscal slope, the slope of the insertional area, meniscal and bony slopes at the mid-plateau area were compared. RESULTS: Akagi line was significantly different with a true meniscal rotation (line connecting between centers of the anterior and posterior horns) in both medial and lateral meniscus (p < 0.01 and p < 0.01). LMLD was significantly different in the lateral meniscus (p < 0.01), however, no statistical difference was observed in the medial meniscus (n.s.). PTMS was not different in the medial meniscus (n.s.), however, it was different in the lateral meniscus (p < 0.01). On the medial side, significant statistical difference was observed between insertional and bony slope (p < 0.01) and between meniscal and bony slope (p < 0.01). On the lateral side, comparison of three slopes showed significant statistical differences (p < 0.01-p = 0.03). CONCLUSION: Line between patellar tendon and tibial spine was a good reference line for a meniscal rotation in the medial meniscus. Among previously introduced reference lines, LMLD showed approximity with a true meniscal rotation. The slope between tibial insertion and mid-portion was significantly different in the lateral meniscus.

Change of the tunnel configuration in the non-anatomic trans-tibial double bundle ACL reconstruction.

BACKGROUND: The objectives of this study were to evaluate tunnel widening and morphologic change at the tunnel aperture. METHODS: A prospective study that included 17 trans-tibial double bundle anterior cruciate ligament (ACL) patients was conducted for the evaluation of serial computed tomography (CT) scan. The OsiriX was used for remodeling of CT images with a tunnel direction. Tunnel widening and change of the aperture morphology were assessed. RESULTS: With regard to the comparison of tunnel widening of the anteromedial (AM) tunnel, the entrance (p=0.01) and mid (p=0.02) of the coronal image, and the entrance (p < 0.01) and mid (p < 0.01) of the sagittal image showed statistically significant differences. The entrance (p=0.01) of the sagittal image only showed statistical significance in the posterolateral (PL) tunnel. With regard to the comparison between the AM and PL tunnels, the mid-portion (p = 0.04) of the sagittal image showed statistical differences, and the AM tunnel showed larger widening than the PL tunnel. Change of tunnel aperture was observed in the posterior, medial, and lateral portions of the AM tunnel and the anterior, posterior, and lateral portions of the PL tunnel. CONCLUSIONS: In some aspects, occurrence of tunnel widening was observed in most sites. Widening occurred mainly at the entrance and mid-portions of the AM tunnel and the entrance of the PL tunnel. Change of tunnel aperture was observed at most directions in both tunnels. This is a non-anatomic ACL reconstruction and similar study with anatomic ACL reconstruction would be required in the future.

Lateral tibial bone mineral density around the level of the proximal tibiofibular joint.

PURPOSE: During open-wedge high tibial osteotomy, fracture occurring in the insufficient osteotomy before distraction of the osteotomy gap is an important complication. The objective of this study was to evaluate bone mineral density (BMD) around the proximal tibiofibular joint (PTFJ) and the osteotomy hinge. The hypotheses of this study were (1) BMD would be higher in the level of PTFJ, compared with that of above--or below--the level of PTFJ, (2) BMD of the posterolateral side of the hinge would be higher than that of the anterior or lateral side. METHODS: Computed tomography was used to determine the BMD of the lateral aspect of the proximal tibia around the PTFJ and the osteotomy hinge. The means and standard deviations of the regions of interest were measured. To verify the first hypothesis, a coronal reconstructed image showing the beginning of the fibula head was used and an axial reconstructed image showing the beginning of the fibula head was used for verification of the second hypothesis. RESULTS: BMD of the lateral aspect of the proximal tibia at the level of the PTFJ was significantly higher, compared with that of above (P = 0.04)-or below (P < 0.01)--the level of the PTFJ in male patients. In addition, it was also significantly higher, compared with that of below the level of the PTFJ (P < 0.01). BMD of the posterolateral area of the proximal tibia was significantly higher than that of the anterior or lateral area in both male and female patients (P < 0.01). CONCLUSION: BMD of the level of the PTFJ was higher, compared with that of above-or below-the level of the PTFJ and that of the posterolateral area of the proximal tibia was significantly higher, compared with that of the anterior or lateral area.

Comparison of femoral tunnel widening between outside-in and trans-tibial double-bundle ACL reconstruction.

PURPOSE: The objectives of this study were to compare (1) the degree of widening by comparing the diameter at the most widened area and the site of widening by measuring the distance from the tunnel entrance to the most widened area in two femoral tunnels (anteromedial and posterolateral), and (2) the morphologic change at the tunnel entrance between outside-in and trans-tibial double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: A retrospective study that included 17 trans-tibial and 19 outside-in double-bundle ACL reconstructed patients was conducted for evaluation of serial computed tomography (CT) scan (immediate post-operation and post-operative 1 year). Digital image communication in medicine (DICOM) data was extracted from the PiViewSTAR and imported into OsiriX, which was installed on a Macbook Pro laptop computer. Diameter of the most widened area and distance from the entrance to this point were measured from each of two perpendicular (sagittal and coronal) planes that were accurately realigned parallel to the tunnel direction. Change in the morphology of the tunnel entrance between immediate post-operation and 1-year post-operation was evaluated. RESULTS: Widening was observed in both planes of both tunnels in the two techniques. However, no statistical significances in the diameter of most widened area and distance from the tunnel entrance to the most widened point were observed between the both techniques (n.s.). Distances from the centre point to each four sections showed an increase in all four sections of all both tunnels in both techniques. However, no statistical significance was observed between the two techniques (n.s.). CONCLUSION: Widening was observed in all tunnels using both techniques and degrees, and sites of the widening did not differ between groups. Morphologic change at the tunnel entrance was not limited to the specific direction and occurred in all directions without significant difference between groups. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Analysis of tunnel widening after double-bundle ACL reconstruction.

PURPOSE: The purpose of this study was to evaluate the tunnel widening using a multi-planar reformation of MRI (Magnetic Resonance Imaging) in the orientation of the tunnel. The hypotheses of this study were as follows: (1) tunnel widening would be reduced with the above-mentioned technique, (2) the degree of tunnel widening would be different at the site of the tunnels, and (3) the time interval from surgery to MRI acquisition would affect the magnitude of tunnel widening. METHODS: Forty double-bundle ACL reconstructed patients who underwent postoperative MRI were enrolled in this study. The postoperative MRI was performed at 26.7 ± 7.4 months in terms of time. The tunnel widening was examined using a multi-planar reformation of MRI in the orientation of the tunnel. Site-specific analysis was performed according to the depth (the entrance, mid, and exit portion) and wall (anterior, posterior, medial, and lateral walls). The correlation between MRI and widening was also evaluated. RESULTS: The mean tunnel widening of the femoral AM (Anteromedial), femoral PL (Posterolateral), tibial AM, and tibial PL in terms of the most widened diameter was 1.9 (25.4), 2.1 (30.8), 2.5 (32.8), and 3.2 mm (44.5%), respectively. The tibial PL tunnel showed significant widening than the other tunnels. At the entrance, tunnel widening occurred mostly, followed by the order of the mid and exit portion. Correlation analysis of the time interval of MRI acquisition and tunnel widening showed little association. CONCLUSIONS: Tunnel widening after a double-bundle ACL reconstruction using an outside-in technique with press-fitting of the graft was acceptable compared to previously published studies. The tibial PL tunnel showed the most widening among the 4 tunnels examined with the tunnel entrance being most widened area. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.

Long-term outcomes of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome: at least 5-years follow-up.

BACKGROUND: There have been few outcomes studies with follow-up after performing ulnar shortening osteotomy for ulnar impaction syndrome. We investigated the long-term clinical and radiological outcomes of ulnar shortening osteotomy for the treatment of idiopathic ulnar impaction syndrome. METHODS: We retrospectively reviewed 36 patients who had undergone ulnar shortening osteotomy for idiopathic ulnar impaction syndrome for a mean follow-up of 79.1 months (range, 62 to 132 months). The modified Gartland and Werley scores were measured pre- and postoperatively. The radiographic parameters for the assessment of the distal radioulnar joint (DRUJ) as well as the relationship between these radiographic parameters and the clinical and radiological outcomes were determined. RESULTS: The average modified Gartland and Werley wrist score improved from 65.5 ± 8.1 preoperatively to 93.4 ± 5.8 at the last follow-up visit. The average preoperative ulnar variance of 4.7 ± 2.0 mm was reduced to an average of -0.6 ± 1.4 mm postoperatively. Osteoarthritic changes of the DRUJ were first seen at 34.8 ± 11.1 months follow-up in 6 of 36 wrists (16.7%). Those who had osteoarthritic changes in the DRUJ had significantly wider preoperative ulnar variance, a longer distal radioulnar distance and a greater length of ulnar shortening, but the wrist scores of the patients who had osteoarthritic changes in the DRUJ were comparable to those who did not have osteoarthritic changes in the DRUJ. CONCLUSIONS: The clinical outcomes are satisfactory for even more than 5 years after ulnar shortening osteotomy for treating idiopathic ulnar impaction syndrome despite the osteoarthritic changes of the DRUJ. The patients who need a larger degree of ulnar shortening may develop DRUJ arthritis.

Effect of passive stretching on simple camptodactyly in children younger than three years of age.

PURPOSE: To present the effectiveness of passive stretching as a treatment for camptodactyly, without any other form of physiotherapy or splinting. METHODS: From May 2003 to August 2008, 61 digits of 22 patients were treated conservatively using passive stretching exercises. All children were less than 3 years old and had no other anomalies. Flexion contractures before and after treatment in mild, moderate, and severe groups were measured and changes were analyzed statistically. The correlations between various clinical factors and treatment outcome were also analyzed statistically. The average follow-up period was 26 months (range, 12-47 mo). RESULTS: Mean flexion contracture improved from 20° to 1° in the mild group (p < .001), from 39° to 12° in the moderate group (p < .001), and from 75° to 28° in the severe group (p < .001). Of the clinical factors examined, only initial flexion contracture was found to be significantly correlated with treatment outcome (r = -0.287, p = .0025). CONCLUSIONS: Passive stretching can effectively improve flexion deformity in camptodactyly in infants and young children. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.