Faculty Profiles - OZAKI Toshifumi

Medial meniscus posterior root repair influences sagittal length and coronal inclination of the anterior cruciate ligament: a retrospective study. International journal

Yuki Okazaki, Takayuki Furumatsu, Yuya Kodama, Takaaki Hiranaka, Keisuke Kintaka, Yusuke Kamatsuki, Toshifumi Ozaki

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2022.5

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

PURPOSE: Medial meniscus (MM) posterior root tears (PRTs) lead to abnormal kinematic changes in the knee and may induce pathological external rotation of the tibia during knee flexion. This study aimed to investigate changes in the length and inclination of the anterior cruciate ligament (ACL) after MM posterior root repair using magnetic resonance imaging (MRI). METHODS: This retrospective study included 44 patients who underwent MM posterior root repair between 2016 and 2019. Clinical outcomes were evaluated before and after surgery. MRI examinations were performed at 10°/90° of knee flexion preoperatively and 3 months postoperatively. The ACL length, proximal angle, and distal angle were determined using the sagittal view. MM extrusion and ACL inclination angle were determined using the coronal view. RESULTS: Clinical outcomes significantly improved 1 year after surgery. The postoperative ACL length (29.7 ± 2.4 mm) and proximal angle (47.0 ± 7.4°) at 90° of knee flexion decreased relative to the preoperative values (31.5 ± 2.3 mm and 51.8 ± 8.7°, P < 0.01). The postoperative ACL inclination (64.9 ± 5.6°) at 10° of knee flexion decreased relative to the preoperative value (69.7 ± 5.6°, P < 0.01). CONCLUSION: Pathologically-stretched linear ACL at 90° of knee flexion and a steep ACL inclination at 10° of knee flexion could be reduced after MM posterior root repair. This suggests that pullout repair could restore MM function as a secondary stabilizer, thereby preventing meniscal and cartilage degeneration.

DOI： 10.1007/s00590-022-03285-0

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Current management of giant-cell tumor of bone in the denosumab era International journal

Akihito Nagano, Hiroshi Urakawa, Kazuhiro Tanaka, Toshifumi Ozaki

Japanese Journal of Clinical Oncology 52 ( 5 ) 411 - 416 2022.5

Authorship：Last author Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press (OUP)

Abstract

Giant-cell tumor of bone is a rare, locally aggressive and rarely metastasizing primary bone tumor. The mainstay of treatment remains controversial and is decided by the balance between adequate surgical margin and sufficient adjacent joint function. Although curettage with a high-speed burr and local adjuvants can maintain normal joint function, many reports have revealed a high local recurrence rate. Conversely, en bloc resection and reconstruction with prostheses for highly aggressive lesions have reportedly lower local recurrence rates and poorer functional outcomes. Denosumab—a full human monoclonal antibody that inhibits receptor activator of nuclear factor-kappa β ligand—was approved by the Food and Drug Authority in 2013 for use in surgically unresectable or when resection is likely to result in severe morbidity for skeletally mature adolescents and adults with giant-cell tumor of bone. However, subsequent studies have suggested that the local recurrence rate would be increased by preoperative use of denosumab. In systematic reviews of the local recurrence rate after preoperative use of denosumab, conclusions vary due to the small sample sizes of the studies reviewed. Therefore, controversy regarding the treatment of giant-cell tumor of bone is ongoing. Here, this review elucidates the management of giant-cell tumor of bone, especially with the local adjuvant and neoadjuvant use of denosumab, and presents the current, evidence-based treatment for giant-cell tumor of bone.

DOI： 10.1093/jjco/hyac018

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Increased cleft width during knee flexion is useful for the diagnosis of medial meniscus posterior root tears. International journal

Takaaki Hiranaka, Takayuki Furumatsu, Shinichi Miyazawa, Keisuke Kintaka, Naohiro Higashihara, Masanori Tamura, Ximing Zhang, Haowei Xue, Toshifumi Ozaki

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2022.5

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

PURPOSE: This study aimed to evaluate changes in the cleft width, defined as the distance between the lateral edge of the medial tibial plateau and that of the medial meniscus (MM) posterior root, using open magnetic resonance imaging (MRI) in patients with MM posterior root tear (MMPRT). METHODS: This study included 25 patients (20 women and 5 men; mean age: 65.2 years) who were diagnosed with MMPRT and underwent pullout repair. Upon coronal imaging, the cleft width was evaluated at the 10° and 90° flexed knee positions. The difference in the cleft width (defined as the cleft width at 90° minus the cleft width at 10°) was also calculated. Upon sagittal imaging, the MM posterior extrusion (MMPE) at 90° was also evaluated. Separate univariate linear regression models were used to determine the association between the time from injury to MRI and radiographic measurements. RESULTS: The mean cleft width at 10° and 90° was 4.9 ± 2.6 mm and 7.4 ± 3.7 mm, respectively; the mean difference in cleft width was 2.5 ± 1.5 mm, and the mean MMPE at 90° was 3.7 ± 1.3 mm. There was a significant difference in cleft width at 10° and 90° (p < 0.001). The time from injury to MRI was significantly associated with the cleft width at 10° (R = 0.42; p = 0.023), cleft width at 90° (R = 0.59; p = 0.002), the difference in the cleft width (R = 0.62; p = 0.008), and MMPE at 90° (R = 0.53; p = 0.008). CONCLUSION: This study demonstrates that the cleft width is significantly larger during knee flexion than during knee extension. Increased cleft width during knee flexion ("graben" sign) may help diagnose MMPRT, especially in cases where the cleft sign is unclear during knee extension. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-022-06983-8

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Application of mesh plate for the treatment of an osteochondral fracture of the medial femoral condyle with medial wall fracture: A case report. International journal

Yusuke Mochizuki, Norio Yamamoto, Tomoyuki Noda, Toshifumi Ozaki

Acta orthopaedica et traumatologica turcica 56 ( 3 ) 228 - 231 2022.5

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

Osteochondral fractures of the medial femoral condyle accompanied by medial wall fracture are rare. Surgeons often have difficulty in selecting the most appropriate treatment, especially the plating technique for internal fixation since the available femoral locking plates are made to fit the femoral lateral condyle and there is no anatomical plate for the medial condyle. We, herein, report a case of a 44-year- old female patient who suffered from an osteochondral fracture of the medial femoral condyle accompanied by medial wall fracture treated by a low-profile mesh plate contoured to fit around the fracture site. Bone union was achieved at postoperative week 12 and the patient was able to return to her normal activities. At the 16-month follow-up exam, the patient's functional and clinical outcomes were satisfactory. Her Oxford knee score was 47 points, and the Western Ontario and McMaster Universities Arthritis Index scores were 2 points for pain and 5 points for physical function. We believe that the mesh plate has several advantages. This is the first report of using a mesh plate for the femur, and we were able to achieve good results. We conclude that treatment with a mesh plate can be applied in well- selected patients with medial femoral condyle osteochondral fracture and has the potential to be applied to the treatment of fractures in various regions in the future.

DOI： 10.5152/j.aott.2022.21325

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