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1.
J Orthop Surg (Hong Kong) ; 29(3): 23094990211049569, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34775855

RESUMO

Purpose: Medial meniscus (MM) posterior root (PR) tear leads to severe MM posterior extrusion (PE), resulting in rapid knee cartilage degeneration. MMPR repairs are recommended to reduce MMPE, especially during knee flexion. However, the difference in MMPE between different repair techniques remains unknown. This study aimed to investigate preoperative and postoperative MMPE following several pullout repair techniques. We hypothesized that a technique using two simple stitches (TSS) would be more useful than FasT-Fix-dependent modified Mason-Allen suture (F-MMA) to prevent the progression of MMPE in knee extension. Methods: This retrospective study included 35 patients who underwent MMPR repair. To compare MMPE, patients were divided into two groups according to the use of F-MMA while grasping the posterior capsule and TSS without grasping it. Open magnetic resonance imaging was performed at 10° and 90° knee flexion preoperatively, and at 3 and 12 months postoperatively, and the MMPE of both groups was evaluated. Results: A significant difference was observed between preoperative and 3-month postoperative MMPE at 90° knee flexion in both groups (p < .01). A significant difference was observed in 3- and 12-month postoperative MMPE at 10° knee flexion between both groups (p = .04/.02), whereas no significant difference in the preoperative MMPE at 10° knee flexion was observed between them (p = .45). Conclusions: Both repairs were found to be useful to reduce MMPE in knee flexion. Further, F-MMA repair increased MMPE in knee extension, unlike TSS repair. These findings suggest that TSS might have more advantages for load distribution when standing or walking.

2.
Knee Surg Sports Traumatol Arthrosc ; 29(4): 1025-1034, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32451621

RESUMO

PURPOSE: The purpose of this study was to evaluate the influence of tibial tunnel position in pullout repair for a medial meniscus (MM) posterior root tear (MMPRT) on postoperative MM extrusion. METHODS: Thirty patients (median age 63 years, range 35-72 years) who underwent transtibial pullout repairs for MMPRTs were included. Three-dimensional computed tomography images of the tibial surface were evaluated using a rectangular measurement grid for assessment of tibial tunnel position and MM posterior root attachment. Preoperative and postoperative MM medial extrusion (MMME) and posterior extrusion (MMPE) at 10° and 90° knee flexion were measured using open magnetic resonance imaging. RESULTS: Tibial tunnel centers were located more anteriorly and more medially than the anatomic center (median distance 5.8 mm, range 0-9.3 mm). The postoperative MMPE at 90° knee flexion was significantly reduced after pullout repair, although there was no significant reduction in MMME or MMPE at 10° knee flexion after surgery. In the correlation analysis of the displacement between the anatomic center to the tibial tunnel center and improvements in MMME, and MMPE at 10° and 90° knee flexion, there was a significant positive correlation between percentage distance and improvement of MMPE at 90° knee flexion. CONCLUSION: This study demonstrated that the nearer the tibial tunnel position to the anatomic attachment of the MM posterior root, the more effective the reduction in MMPE at 90° knee flexion. Our results emphasize that an anatomic tibial tunnel should be created in the MM posterior root to improve the postoperative MMPE and protect the articular cartilage in a knee flexion position. Placement of an anatomic tibial tunnel significantly improves the MMPE at 90° of knee flexion after MM posterior root pullout repair. LEVEL OF EVIDENCE: IV.


Assuntos
Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Lesões do Menisco Tibial/cirurgia , Adulto , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Imageamento Tridimensional/métodos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Período Pós-Operatório , Amplitude de Movimento Articular , Ruptura/cirurgia , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
3.
J Neurol ; 268(3): 1025-1035, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32979098

RESUMO

BACKGROUND AND PURPOSE: We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke. METHODS: We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement. RESULTS: Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25-17.84, p < 0.001; odds ratio 1.12, 95% CI 1.03-1.20, p = 0.004, respectively). Swallowing reflex delay was detected in 58 (17.0%) patients. Multivariate analysis identified habitual drinking, basal ganglia lesion, and the NIHSS score as independent significant factors for swallowing reflex delay (odds ratio 0.51, 95% CI 0.26-0.99, p = 0.047; odds ratio 1.91, 95% CI 1.09-3.67, p = 0.041; odds ratio 1.12, 95% CI 1.05-1.20, p < 0.001, respectively). Additionally, oral cavity and pharyngeal residues were independently associated with tongue pressure. CONCLUSION: Parietal lobe lesions are associated with aspiration and basal ganglia lesions with swallowing reflex delay.


Assuntos
Transtornos de Deglutição , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Feminino , Fluoroscopia , Humanos , Pessoa de Meia-Idade , Pressão , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Língua/diagnóstico por imagem
4.
J Stroke Cerebrovasc Dis ; 29(12): 105303, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33039771

RESUMO

BACKGROUND AND PURPOSE: Dysphagia in the acute phase of stroke contributes significantly to poor outcomes and is associated with the development of aspiration pneumonia and malnutrition. Therefore, an accurate evaluation of swallowing is necessary before initiating oral food intake. The modified water swallow test (MWST) and the repetitive saliva swallow test (RSST) are commonly used as bedside screening methods for swallowing dysfunction, but it is unclear whether other factors contribute to dysphagia and consequent aspiration. The purpose of this study was to identify characteristics that might be overlooked in screening tests. METHODS: Participants were prospectively selected from patients hospitalized for stroke at the Suiseikai Kajikawa Hospital between August 1, 2016 and June 30, 2018. Inclusion criteria were conscious and stable medical condition, and patients who were diagnosed with dementia were excluded. A videofluoroscopic (VF) swallowing study was carried out on all patients who met the inclusion/exclusion criteria and who passed both the MWST and the RSST. RESULTS: Aspiration was observed in 16 of 172 patients (9.3%) when swallowing 3 ml of water. These aspirated patients showed significantly delayed swallowing reflex on VF. CONCLUSIONS: Swallowing evaluation using a combination of the MWST and the RSST is reasonably effective. However, patients who show a delayed swallowing reflex might be overlooked by this screening procedure.


Assuntos
Transtornos de Deglutição/diagnóstico , Deglutição , Testes Imediatos , Tempo de Reação , Reflexo , Acidente Vascular Cerebral/diagnóstico , Gravação em Vídeo , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
5.
Auris Nasus Larynx ; 47(6): 938-942, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32553771

RESUMO

OBJECTIVE: Hearing loss caused by GJB2 mutations is inherited in an autosomal recessive manner (DFNB1); thus siblings of an affected child have a 25% chance of also being affected. Hearing loss among subsequent siblings carrying the same GJB2 mutation is a concern for parents and a frequent topic of enquiry during genetic counseling. Evidence exists for genotype-phenotype correlations of GJB2 mutations; however, no analysis of differences in hearing among siblings, in whom the common genetic background may decrease variation, has been reported. The purpose of the present study was to investigate hearing differences between siblings with identical GJB2 mutations. METHODS: We examined the hearing levels of 12 pairs of siblings; each pair had the same pathogenic GJB2 mutations. Differences in hearing acuity between sibling pairs detected by auditory evaluation. RESULTS: No significant correlation was detected between the average hearing levels of first and second affected siblings. Average differences in acoustic threshold >30 dB were observed between four pairs of siblings, whereas the remaining eight pairs had average threshold values within 20 dB of one another. CONCLUSION: Our results indicate that auditory acuity would be expected to approximate that found in the first child in approximately 70% of subsequent children with GJB2-mediated hearing loss, whereas 30% of subsequent siblings would have average differences of >30 dB.


Assuntos
Limiar Auditivo , Conexina 26/genética , Perda Auditiva/fisiopatologia , Mutação , Irmãos , Audiometria , Criança , Pré-Escolar , Surdez/genética , Surdez/fisiopatologia , Feminino , Genótipo , Perda Auditiva/genética , Humanos , Lactente , Masculino
6.
Knee ; 27(3): 701-708, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563426

RESUMO

BACKGROUND: Transtibial pullout repair of a medial meniscus posterior root tear (MMPRT) is a commonly used procedure, and several techniques have been reported. We hypothesised that pull-out repairs using two simple stitches (TSS) would have similar postoperative outcomes as those using the modified Mason-Allen suture with FasT-Fix (F-MMA). We aimed to investigate the clinical outcomes of these techniques, including the meniscal healing status and osteoarthritic change. METHODS: The data of 68 patients who underwent transtibial pull-out repair were retrospectively investigated. The patients were divided into two groups of 41 and 27 patients using F-MMA and TSS, respectively. The clinical outcomes were assessed preoperatively and at second-look arthroscopy (the mean period from surgery was one year) using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status, evaluated at second-look arthroscopy, was compared between the two groups. The cartilage damage was graded as per the classification of the International Cartilage Repair Society and compared at the primary surgery and second-look arthroscopy. RESULTS: Both groups showed significant improvement in each clinical score. No significant difference was seen in the clinical outcome scores and the meniscal healing status between the two groups at second-look arthroscopy. Moreover, no significant progression of cartilage damage was observed in both groups. Fourteen patients in the F-MMA group developed a complication of suture bar failures postoperatively; however, there were no complications in the TSS group. CONCLUSIONS: The TSS and F-MMA techniques showed favourable clinical outcomes and would be established as clinically useful techniques for the MMPRT treatment.


Assuntos
Artroscopia/métodos , Meniscos Tibiais/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Ruptura , Cirurgia de Second-Look , Lesões do Menisco Tibial/diagnóstico
7.
Knee ; 27(3): 899-905, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32249020

RESUMO

BACKGROUND: To investigate the relationship between tibial tunnel aperture location and postoperative meniscal healing. METHODS: We enrolled 25 patients (20 women and five men, mean age: 62.5 years) who underwent transtibial pullout repair for medial meniscus (MM) posterior root repair. The expected MM posterior root attachment center (AC) and tibial tunnel center (TC) were identified using three-dimensional computed tomography, and the minimum AC-TC distance was calculated. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period: 15 months) using a previously reported scoring system (meniscal healing score; range: 0-10). The association between AC-TC distance and meniscal healing score was investigated using univariate linear regression models. The optimal AC-TC distance cut-off for improved MM healing score (≥7) was determined using receiver operating characteristic analysis. RESULTS: The AC-TC distance and meniscal healing score were significantly associated (y = -0.42x + 9.48, R2 = 0.342; P = 0.002), with the optimum AC-TC distance being 5.8 mm. This cut-off had a sensitivity of 100% and specificity of 53%. CONCLUSIONS: This study demonstrates that AC-TC distance is significantly correlated with postoperative meniscal healing. Anatomical repair within 5.8 mm of the AC may result in improved meniscal healing.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Artroscopia , Feminino , Humanos , Imageamento Tridimensional , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Dispositivos de Fixação Ortopédica , Estudos Retrospectivos , Cirurgia de Second-Look , Técnicas de Sutura
8.
Orthop Traumatol Surg Res ; 106(3): 469-473, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32278734

RESUMO

BACKGROUND: Lateral meniscus (LM) posterior root tear (PRT) is often associated with anterior cruciate ligament (ACL) injury and can result in rotational instability, joint overloading, and degenerative changes in the knee. Improved rotational stability and kinematics have been reported after LMPRT repair. However, it is unclear what repair technique can achieve the greatest reduction in LM extrusion (LME). HYPOTHESIS: We hypothesized that transtibial pullout repair would decrease LME to a greater extent than other repair techniques. PATIENTS AND METHODS: Seventeen patients with ACL injury and complete LMPRT were evaluated. Nine underwent ACL reconstruction (ACLR) and transtibial pullout repair, and eight underwent ACLR and other repairs such as inside-out suturing. Double-bundle ACLR was performed using hamstring tendons, and LMPRT pullout repair was performed through the bone tunnel for the posterolateral bundle. Magnetic resonance imaging was performed immediately preoperatively and at>6 months postoperatively, and LME was measured from coronal images only. RESULTS: A significantly greater decrease in the value of LME from pre- to postoperative measurement was observed in the transtibial pullout repair group (-0.5±0.7mm) than in the other-repair group (1.0±0.9mm, p<0.01). Pre- and postoperative LME measurements were not significantly different between the two groups. DISCUSSION: The most important finding of this study was that transtibial pullout repair resulted in a greater decrease in LME than other repair techniques in patients with ACL injury and LMPRT. This technique might be useful for restoring hoop tension by decreasing LME. LEVEL OF EVIDENCE: III, comparative retrospective study.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Menisco Tibial , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia
9.
Eur J Orthop Surg Traumatol ; 30(5): 901-908, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32157399

RESUMO

BACKGROUND: Two types of repair techniques, FasT-Fix modified Mason-Allen (F-MMA) and two simple stitches (TSS), for the treatment of a medial meniscus posterior root tear (MMPRT) were previously reported. However, whether these techniques could prevent postoperative medial meniscus extrusion (MME) progression is unknown. This study investigated and compared postoperative MME of the two repair techniques. METHODS: Forty-seven knees that had undergone pullout repair for MMPRT were retrospectively reviewed. These knees were divided into two groups as follows: In 26 knees, MMPRT was treated using the F-MMA technique and fixed with the knee flexed at 45° and 20 N of tension [F-MMA (45°-20 N) group], and in 21 knees, MMPRT was treated using the TSS technique and fixed with the knee flexed at 20° and 30 N of tension [TSS (20°-30 N) group]. The medial meniscus body width (MMBW), absolute MME (aMME), and relative MME (rMME = absolute MME/MMBW) were measured and compared using magnetic resonance imaging 3 months postoperatively. The Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for clinical outcomes were compared between the two groups at 6 months postoperatively. RESULTS: At 3 months postoperatively, the aMME and rMME significantly decreased in the TSS (20°-30 N) compared to the F-MMA (45°-20 N) group. The TSS (20°-30 N) group had better KOOS subscale scores than the F-MMA (45°-20 N) group at 6 months postoperatively. CONCLUSIONS: The TSS technique with appropriate tibial fixation can decrease MME soon after surgery. This may prevent osteoarthritis progression and improve clinical outcomes.


Assuntos
Procedimentos Ortopédicos/métodos , Técnicas de Sutura , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Artigo em Inglês | MEDLINE | ID: mdl-32042596

RESUMO

Background: Meniscal tears are commonly observed in patients with anterior cruciate ligament (ACL) injuries. Meniscal repair has become a common procedure for the injured meniscus, and good clinical outcomes have been reported in such cases when used concurrently with ACL reconstruction. However, it is unclear whether early chondral damage progression can be prevented following meniscal repair with ACL reconstruction, as meniscal damage is a potential risk factor for the development of osteoarthritis. The purpose of this study was to evaluate the zone-specific chondral damage that occurs after arthroscopic meniscal repair with concomitant ACL reconstruction. Our hypothesis was that meniscal repair with ACL reconstruction would not decrease the rate of progression of chondral damage compared to that observed in isolated ACL reconstruction with intact menisci. Methods: This study included 40 patients who underwent anatomic double-bundle ACL reconstruction. We divided the patients into the following two groups: Group A with an intact meniscus (20 knees) and Group M requiring meniscal repair (20 knees). Chondral damage was evaluated arthroscopically in six compartments and 40 sub-compartments, and these features were graded using the International Cartilage Repair Society lesion classification. The cartilage damage in each sub-compartment and compartment was compared between the two groups both at reconstruction and at second-look arthroscopy (average 16 months postoperatively). At the latest follow-up examination (average 37 months postoperatively), the International Knee Documentation Committee (IKDC) score was compared between the two groups. Results: Group M had a significantly worse cartilage status than Group A in five sub-compartments (mainly in the medial compartment) at reconstruction and in nine sub-compartments (mainly in the bilateral compartments) at second-look arthroscopy. The mean IKDC score was better in Group A than in Group M (Group A; 90 vs. Group M; 86). The overall success rate of meniscal repairs was 92% (23 of 25 menisci) at second-look arthroscopy. Conclusion: The progression of post-traumatic chondral damage may occur at a faster rate in patients who require ACL reconstruction and meniscal repair than in patients with intact menisci.

11.
Sci Rep ; 10(1): 3662, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32107406

RESUMO

Variants in the EYA4 gene are known to lead to autosomal dominant non-syndromic hereditary hearing loss, DFNA10. To date, 30 variants have been shown to be responsible for hearing loss in a diverse set of nationalities. To better understand the clinical characteristics and prevalence of DFNA10, we performed genetic screening for EYA4 mutations in a large cohort of Japanese hearing loss patients. We selected 1,336 autosomal dominant hearing loss patients among 7,408 unrelated Japanese hearing loss probands and performed targeted genome enrichment and massively parallel sequencing of 68 target genes for all patients. Clinical information of cases with mutations in EYA4 was gathered and analyzed from medical charts. Eleven novel EYA4 variants (three frameshift variants, three missense variants, two nonsense variants, one splicing variant, and two single-copy number losses) and two previously reported variants were found in 12 probands (0.90%) among the 1,336 autosomal dominant hearing loss families. The audiometric configuration of truncating variants tends to deteriorate for all frequencies, whereas that of non-truncating variants tends to show high-frequency hearing loss, suggesting a new correlation between genotype and phenotype in DFNA10. The rate of hearing loss progression caused by EYA4 variants was considered to be 0.63 dB/year, as found in this study and previous reports.


Assuntos
Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/genética , Mutação , Transativadores/genética , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Masculino , Prevalência
12.
Knee ; 27(1): 132-139, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31882388

RESUMO

BACKGROUND: Medial meniscus (MM) medial extrusion in the coronal plane does not always improve, even after repair. This study aimed to determine the extent of posteromedial extrusion of the MM during knee flexion before and after MM pullout repair using three-dimensional magnetic resonance imaging (MRI). METHODS: Data from 14 patients (mean age, 63.4 years; 86% female) who had undergone MM pullout repair at the current institution between August 2017 and October 2018 were retrospectively reviewed. The MRIs were performed pre-operatively and ≥3 months postoperatively. Three-dimensional MRIs of the tibial surface and MM were evaluated using Tsukada's measurement method before and after pullout repair. The expected center of MM posterior root attachment (point A), the point on the extruded edge of the MM farthest away from point A (point E), and the point of intersection of a line through the posteromedial corner of the medial tibial plateau and a line connecting points A and E (point I) were identified. Subsequently, the pre-operative and postoperative AE and IE distances were calculated and compared. RESULTS: Point E was laterally shifted by the pullout repair, whereas point I showed no significant change. The postoperative IE distance (6.7 mm) was significantly shorter than the pre-operative one (9.1 mm, P < 0.01). The postoperative AE distance (29.3 mm) was significantly shorter than the pre-operative one (31.5 mm, P < 0.01). CONCLUSIONS: The AE and IE distances significantly decreased after MM posterior root repair, suggesting that transtibial pullout repair may be useful in reducing posteromedial extrusion of the MM.


Assuntos
Articulação do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Imageamento Tridimensional , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Lesões do Menisco Tibial/classificação , Lesões do Menisco Tibial/diagnóstico por imagem
13.
Knee Surg Sports Traumatol Arthrosc ; 28(11): 3416-3425, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31781798

RESUMO

PURPOSE: To investigate changes in meniscal extrusion during knee flexion before and after pullout fixation for medial meniscus posterior root tear (MMPRT) and determine whether these changes correlate with articular cartilage degeneration and short-term clinical outcomes. METHODS: Twenty-two patients (mean age 58.4 ± 8.2 years) diagnosed with type II MMPRT underwent open magnetic resonance imaging preoperatively, 3 months after transtibial fixation and at 12 months after surgery, when second-look arthroscopy was also performed. The medial meniscus medial extrusion (MMME) and the medial meniscus posterior extrusion (MMPE) were measured at knee 10° and 90° flexion at which medial meniscus (MM) posterior translation was also calculated. Articular cartilage degeneration was assessed using International Cartilage Research Society grade at primary surgery and second-look arthroscopy. Clinical evaluations included Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee subjective knee evaluation form, Lysholm score, Tegner activity level scale, and pain visual analogue scale. RESULTS: MMPE at 10° knee flexion was higher 12 months postoperatively than preoperatively (4.8 ± 1.5 vs. 3.5 ± 1.2, p = 0.01). MMPE at 90° knee flexion and MM posterior translation were smaller 12 months postoperatively than preoperatively (3.5 ± 1.1 vs. 4.6 ± 1.3, 7.2 ± 1.7 vs. 8.9 ± 2.0, p < 0.01). Articular cartilage degeneration of medial femoral condyle correlated with MMME in knee extension (r = 0.5, p = 0.04). All clinical scores significantly improved 12 months postoperatively. However, correlations of all clinical scores against decreased MMPE and increased MMME were not detected. CONCLUSIONS: MMPRT transtibial fixation suppressed the progression of MMPE and cartilage degeneration and progressed MMME minimally in knee flexion position at 1 year. However, in the knee extension position, MMME progressed and correlated with cartilage degeneration of medial femoral condyle. MMPRT transtibial fixation contributes to the dynamic stability of the MM in the knee flexion position. LEVEL OF EVIDENCE: IV.


Assuntos
Traumatismos do Joelho/cirurgia , Meniscos Tibiais/fisiopatologia , Lesões do Menisco Tibial/cirurgia , Idoso , Artroscopia/métodos , Doenças das Cartilagens/fisiopatologia , Doenças das Cartilagens/cirurgia , Feminino , Humanos , Traumatismos do Joelho/complicações , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/cirurgia , Período Pós-Operatório , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Ruptura/cirurgia , Cirurgia de Second-Look/métodos , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/fisiopatologia
14.
Knee Surg Sports Traumatol Arthrosc ; 28(11): 3405-3415, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31243505

RESUMO

PURPOSE: This study aimed to clarify the advantages of three-dimensional (3D) magnetic resonance imaging (MRI) over two-dimensional (2D) MRI in measuring the size of the medial meniscus (MM) and to analyse the volumes of MM and the extruded meniscus in patients with MM posterior root tear (MMPRT), at 10° and 90° knee flexion. METHODS: This study included 17 patients with MMPRTs and 15 volunteers with uninjured knees. The MMs were manually segmented for 3D reconstruction; thereafter, the extruded part separated from the tibial edge was determined. The length, width, height, and extrusion of MM were measured by the 2D and 3D methods, and compared. The MM volume, extruded meniscus volume, and their ratio were also calculated using 3D analysis software in the two groups. RESULTS: The estimated length and posterior height of MM were larger with 3D MRI than with 2D MRI measurements. The MM volume was significantly greater in MMPRT knees than in normal knees, with increasing MM height. In MMPRT knees, the mean volume of the extruded meniscus and its ratio significantly increased by 304 mm3 (p = 0.02) and 9.1% (p < 0.01), respectively, during knee flexion. CONCLUSIONS: This study demonstrated that 3D MRI could estimate the precise MM size and that MMPRT caused swelling of the meniscus due to the increased thickness in the posteromedial part. The clinical significance of this study lies in its 3D evaluation of MM volume, which should help the surgeon understand the biomechanical failure of MM function and improve MMPRT repair technique. LEVEL OF EVIDENCE: III.


Assuntos
Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Lesões do Menisco Tibial/diagnóstico por imagem , Idoso , Edema/diagnóstico por imagem , Feminino , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/fisiopatologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Ruptura/diagnóstico por imagem , Ruptura/fisiopatologia , Lesões do Menisco Tibial/fisiopatologia
15.
Connect Tissue Res ; 61(6): 546-553, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-31181971

RESUMO

Purpose/Aim of the study: Posterior root injury of the medial meniscus often leads to articular cartilage degeneration due to altered biomechanics. To avoid dysfunction, the attachment must be repaired using the transtibial pullout technique. To guide appropriate placement of the tibial tunnel, additional details on the normal anatomy of the meniscus insertion are needed. Therefore, we performed a histological analysis of a tibial bone slice with the medial meniscus posterior insertion obtained during total knee arthroplasty surgery. Materials and methods: Horizontal slices of the proximal tibia were obtained from 7 patients with osteoarthritis who underwent total knee arthroplasty. After decalcification, the region of the posterior horn was cut out and segmented into four pieces (2.0 mm thickness; medial to lateral). Sagittal sections were evaluated by safranin O staining or immunohistochemistry with anti-type collagen antibody. Results: Safranin O staining showed that the insertion of the posterior root consisted primarily of fibrocartilaginous layers in segment 2. Anatomically, segment 2 corresponded to the sagittal plane passing through the peak of the medial intercondylar tubercle. In this section, safranin O staining and immunohistochemistry revealed that the anterior one-third of the posterior root insertion was richer in proteoglycans and type II collagen than the central and posterior one-third. Conclusions: Anatomical insertion of the posterior root of the medial meniscus was located at the sagittal plane passing through the peak of the medial intercondylar tubercle. The structure of the medial meniscus posterior insertion was mainly localized in the anterior one-third.


Assuntos
Meniscos Tibiais/patologia , Tíbia/patologia , Idoso , Idoso de 80 Anos ou mais , Colágeno Tipo II/metabolismo , Feminino , Humanos , Masculino , Meniscos Tibiais/metabolismo , Coloração e Rotulagem , Tíbia/metabolismo
16.
Knee Surg Sports Traumatol Arthrosc ; 28(5): 1419-1424, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31025058

RESUMO

PURPOSE: In total knee arthroplasty (TKA), it is important to obtain an appropriate flexion-extension gap. The extension gap is expanded by posteromedial vertical capsulotomy (PMVC). This study aimed to evaluate the increase in the extension gap by PMVC using a navigation system. METHODS: In posterior stabilized (PS)-type TKA, PMVC was performed in 37 knees. The medial extension gap at 0° and flexion gap at 90° flexion of the knee joint using the navigation system before and after PMVC were measured. RESULTS: The extension gap before the PMVC was 5.3 ± 2.9 mm. After PMVC, the extension gap had significantly increased to 8.0 ± 2.8 mm (p < 0.001). In addition, the flexion gap was 8.1 ± 2.7 mm before the PMVC, but it was 8.7 ± 2.8 mm after the PMVC, and the flexion gap was not enlarged (n.s.). CONCLUSION: In PS-type TKA, it is possible to obtain selective expansion of about 2.7 mm of the extension gap by PMVC. Therefore, gap balance can be acquired by soft-tissue treatment while preserving the bone. The PMVC was a useful method for acquiring gap balance and preserving the bone stock. LEVEL OF EVIDENCE: IV.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Amplitude de Movimento Articular
17.
Acta Med Okayama ; 73(6): 495-501, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31871331

RESUMO

Medial meniscus posterior root tear causes rapid knee cartilage degradation by inducing posteromedial displacement of the medial meniscus. We evaluated medial meniscus posterior extrusion before and after pullout repair for medial meniscus posterior root tear using magnetic resonance images. Twenty-eight patients with symptomatic medial meniscus posterior root tear were included. The inclusion criteria were: acute (< 3 months) or chronic (≥3 months) medial meniscus posterior root tear after painful popping events. The exclusion criteria were: other meniscus and anterior cruciate ligament injuries. We measured medial meniscus posterior extrusion and medial meniscus anteroposterior interval at knee flexion angles of 10° and 90° preoperatively and at 3 months postoperatively. The posterior extrusion at 90° knee flexion decreased from 4.42±1.38 mm preoperatively to 3.09±1.06 mm (p<0.001) postoperatively, while at 10° knee flexion it was -4.17±1.63 mm preoperatively and -3.77±1.72mm postoperatively, showing no significant change. The anteroposterior interval at 10° knee flexion increased from 19.74±4.27 mm preoperatively to 22.15±5.10 mm postoperatively (p<0.001); at 90° knee flexion, it increased from 16.81±4.51 mm preoperatively to 19.20±4.30 mm postoperatively (p<0.001). Medial meniscus posterior extrusion and movement decreased after pullout repair. Pullout repair for medial meniscus posterior root tear improves medial meniscus posterior extrusion, especially at 90° knee flexion.


Assuntos
Traumatismos do Joelho/cirurgia , Meniscos Tibiais/patologia , Meniscos Tibiais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões do Menisco Tibial/cirurgia , Idoso , Lesões do Ligamento Cruzado Anterior , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade
18.
Acta Med Okayama ; 73(6): 503-510, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31871332

RESUMO

Clinical studies have demonstrated that transtibial pullout repair led to favorable midterm outcomes in patients with medial meniscus posterior root tears (MMPRTs) although medial meniscal extrusion (MME) continued to be present. It has been unclear whether these residual postoperative MMEs existed after the pullout repair or had progressed at the very short-term evaluation after surgery. We sought to determine which characteristics of patients with MMPRTs influence the incidence of postoperative MME. The cases of 23 patients whose date of injury was known were analyzed. All patients underwent MMPRT pullout fixation. Preoperative and 3-month postoperative magnetic resonance imaging (MRI) examinations were performed. MME was retrospectively assessed on the mid-coronal plane of MRI scans. The preoperative and postoperative MME values were 4.2±1.2 mm and 4.3±1.5 mm, respectively (p=0.559). Pullout repair surgery was performed significantly earlier after the MMPRT-specific injury in patients whose postoperative MME improved compared to the patients whose MME did not improve (p<0.001). Our findings demonstrated that an early transtibial pullout repair of an MMPRT was more effective in reducing MME than a late repair. Surgeons should not miss the optimal timing for the pullout repair of an MMPRT, considering the period from the injury and the preoperative MME.


Assuntos
Artroscopia/métodos , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Feminino , Humanos , Masculino , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia
19.
Acta Med Okayama ; 73(6): 523-528, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31871335

RESUMO

The case of an individual with a bilateral anterior cruciate ligament (ACL) tear combined with a medial meniscus (MM) posterior root tear is described. A 34-year-old Japanese man with bilateral ACL rupture that occurred > 10 years earlier was diagnosed with bilateral ACL tear combined with MM posterior root tear (MMPRT). We performed a transtibial pullout repair of the MMPRT with ACL reconstruction. The tibial tunnels for the MM posterior root repair and ACL reconstruction were created separately. Postoperatively, a good clinical outcome and meniscal healing were obtained. Our surgical technique may thus contribute to anatomical MM posterior root repair and ACL reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Adulto , Lesões do Ligamento Cruzado Anterior/patologia , Reconstrução do Ligamento Cruzado Anterior , Humanos , Instabilidade Articular , Traumatismos do Joelho/patologia , Masculino , Meniscos Tibiais/patologia , Lesões do Menisco Tibial/cirurgia
20.
Sci Rep ; 9(1): 16548, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31719594

RESUMO

Photonic-integrated circuits (PICs) using ferroelectric materials are expected to be used in many applications because of its unique optical properties such as large electro-optic coefficients. In this study, a novel PIC based on a ferroelectric thin-film platform was designed and fabricated, where high-speed optical modulator, spot-size converters (SSCs), and a variable optical attenuator (VOA) were successfully integrated. A ferroelectric lanthanum-modified lead zirconate titanate (PLZT) thin film was epitaxially-grown by using a modified sol-gel method, and it exhibits large electro-optic coefficients (>120 pm/V) and low propagation loss (1.1 dB/cm). The optical modulator, a Mach-Zehnder type, exhibited a half-wave voltage (Vπ) of 6.0 V (VπL = 4.5 Vcm) and optical modulation up to 56 Gb/s. Also, the VOA (with attenuation range of more than 26 dB) was successfully integrated with the modulator. As a result, it is concluded that the developed ferroelectric platform can pave the way for photonic integration.

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