Faculty Profiles - OZAKI Toshifumi

Papers - OZAKI Toshifumi

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Bilateral Anterior Cruciate Ligament Tear Combined with Medial Meniscus Posterior Root Tear.

Takaaki Hiranaka, Takayuki Furumatsu, Yoshiki Okazaki, Yusuke Kamatsuki, Shin Masuda, Yuki Okazaki, Shota Takihira, Shinichi Miyazawa, Eiji Nakata, Toshifumi Ozaki

Acta medica Okayama 73 ( 6 ) 523 - 528 2019.12

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

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.

DOI： 10.18926/AMO/57717

The Early Arthroscopic Pullout Repair of Medial Meniscus Posterior Root Tear Is More Effective for Reducing Medial Meniscus Extrusion.

Yusuke Kamatsuki, Takayuki Furumatsu, Shinichi Miyazawa, Yuya Kodama, Tomohito Hino, Yoshiki Okazaki, Shin Masuda, Yuki Okazaki, Tomoyuki Noda, Yasuaki Yamakawa, Tomoko Tetsunaga, Toshifumi Ozaki

Acta medica Okayama 73 ( 6 ) 503 - 510 2019.12

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

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.

DOI： 10.18926/AMO/57714

Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort. International journal

Masahiro Kiyono, Tomoyuki Noda, Hiroshi Nagano, Takashi Maehara, Yasuaki Yamakawa, Yusuke Mochizuki, Takahiko Uchino, Suguru Yokoo, Koji Demiya, Kenta Saiga, Yasunori Shimamura, Toshifumi Ozaki

Journal of orthopaedic surgery and research 14 ( 1 ) 384 - 384 2019.11

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

BACKGROUND: Plate fixation is one of the standard surgical treatments for distal femoral fractures. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method. METHODS: This retrospective study included 71 distal femoral fractures of 70 patients who were treated with the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA). The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of screw holes not inserted around the fracture), and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur). Patient demographics (age), comorbidities (smoking, diabetes, chronic steroid use, dialysis), and injury characteristics (AO type, open fracture, infection) were obtained for all participants. Univariate analysis was performed on them. RESULTS: Of 71 fractures, 26 fractures were simple fractures, 45 fractures were comminuted fractures, and 7 fractures resulted in non-union. Non-union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm. Non-union was founded in simple fractures with bone medial fracture distance exceeding 2 mm, but not significant (p = 0.06). In cases with simple fractures, one non-union case had one empty hole and one non-union case had four empty holes, whereas in cases with comminuted fractures, five non-union cases had two more empty holes. CONCLUSIONS: We concluded that bone fragment distance between fracture fragments is more important than bridge span length of the fracture site and the number of empty holes. Smoking and medial fracture distance are prognostic risk factors of nonunion in distal femoral fractures treated with LCP as bridging plate.

DOI： 10.1186/s13018-019-1401-9

Posttraumatic cartilage degradation progresses following anterior cruciate ligament reconstruction: A second-look arthroscopic evaluation.

Takaaki Hiranaka, Takayuki Furumatsu, Yusuke Kamatsuki, Kazuhisa Sugiu, Yoshiki Okazaki, Shin Masuda, Yuki Okazaki, Shota Takihira, Shinichi Miyazawa, Eiji Nakata, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 24 ( 6 ) 1058 - 1063 2019.11

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

BACKGROUND: Several studies have demonstrated that posttraumatic knee osteoarthritis progresses even after anterior cruciate ligament reconstruction. Few reports described zone-specific cartilaginous damages after anterior cruciate ligament reconstruction. This study aimed to compare the status of articular cartilage at anterior cruciate ligament reconstruction with that at second-look arthroscopy. METHODS: This study included 20 patients (20 knees, 10 males and 10 females, mean age 22.4 years, Body mass index 24.4 kg/m2) that underwent arthroscopic anatomic double-bundle anterior cruciate ligament reconstruction and second-look arthroscopy. Mean periods from injury to reconstruction and from reconstruction to second-look arthroscopy were 3.4 and 15.3 months, respectively. Cartilage lesions were evaluated arthroscopically in the 6 articular surfaces and 40 articular subcompartments independently, and these features were graded with the International Cartilage Repair Society articular cartilage injury classification; comparisons were made between the grades at reconstruction and at second-look arthroscopy. Furthermore, clinical outcomes were assessed at reconstruction and at second-look arthroscopy, using the Lysholm knee score, Tegner activity scale, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, side-to-side difference of the KT-2000 arthrometer, and pivot shift test. RESULTS: Each compartment showed a deteriorated condition at second-look arthroscopy compared with the pre-reconstruction period. A significant worsening of the articular cartilage was noted in all compartments except the lateral tibial plateau and was also observed in the central region of the medial femoral condyle and trochlea after reconstruction. However, each clinical outcome was significantly improved postoperatively. CONCLUSIONS: Good cartilage conditions were restored in most subcompartments at second-look arthroscopy. Furthermore, posttraumatic osteoarthritic changes in the patellofemoral and medial compartments progressed even in the early postoperative period, although good knee stability and clinical outcomes were obtained. Care is necessary regarding the progression of osteoarthritis and the appearance of knee symptoms in patients undergoing anterior cruciate ligament reconstruction.

DOI： 10.1016/j.jos.2019.08.001

Preliminary diagnosis of medial meniscus posterior root tears using the Rosenberg radiographic view. International journal

Yuya Kodama, Takayuki Furumatsu, Yusuke Kamatsuki, Takaaki Hiranaka, Tomohiro Takahata, Masayuki Sadakane, Haruhiko Ikuta, Masaharu Yasumitsu, Toshifumi Ozaki

Knee surgery & related research 31 ( 1 ) 9 - 9 2019.9

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: To verify the effectiveness of detecting medial meniscus posterior root tears (MMPRTs) using weight-bearing posterior-anterior (PA) radiographs. MATERIALS AND METHODS: Twenty-three patients were diagnosed with an MMPRT using magnetic resonance imaging (Group A), with 23 matched individuals forming the control group (Group B). The distance between medial tibial eminence and the lateral edge of the medial femoral condyle (MTE-MFC distance) and medial joint space (MJS) width were measured on weight-bearing PA radiographs, with the knee flexed at 45° (Rosenberg view). Absolute medial meniscus extrusion (MME) was measured on magnetic resonance images. RESULTS: The MTE-MFC distance was greater and the MJS width was smaller in Group A than Group B (7.7 ± 1.7 mm versus 6.0 ± 1.24 mm and 3.2 ± 0.8 mm versus 4.5 ± 0.7 mm, respectively; P < 0.05). The MTE-MFC distance and MJS width correlated with MME (r = 0.603 and 0.579, respectively; P < 0.05), and the extent of MME was greater in Group A than Group B (4.1 ± 1.1 mm versus 1.8 ± 1.5 mm, respectively; P < 0.05). CONCLUSIONS: MMPRTs increase the MTE-MFC distance and decrease the MJS width, with these measurements correlating to the MME. Therefore, measurement of the MTE-MFC distance and MJS width on the Rosenberg view could be a useful preliminary method for the diagnosis of an MMPRT. LEVEL OF EVIDENCE: IV.

DOI： 10.1186/s43019-019-0011-5

Ten-year follow-up results of perioperative chemotherapy with doxorubicin and ifosfamide for high-grade soft-tissue sarcoma of the extremities: Japan Clinical Oncology Group study JCOG0304. Reviewed

Tanaka K, Mizusawa J, Naka N, Kawai A, Katagiri H, Hiruma T, Matsumoto Y, Tsuchiya H, Nakayama R, Hatano H, Emori M, Watanuki M, Yoshida Y, Okamoto T, Abe S, Asanuma K, Yokoyama R, Hiraga H, Yonemoto T, Morii T, Ae K, Nagano A, Yoshikawa H, Fukuda H, Ozaki T, Iwamoto Y

BMC cancer 19 ( 1 ) 890 2019.9

Language：English Publishing type：Research paper (scientific journal) Publisher：BMC

Background Soft-tissue sarcomas (STS) are rare malignant tumors those are resistant to chemotherapy. We have previously reported the 3-year follow-up result on the efficacy of perioperative chemotherapy with doxorubicin (DXR) and ifosfamide (IFM) for high-risk STS of the extremities (JCOG0304). In the present study, we analyzed the 10-year follow-up results of JCOG0304. Methods Patients with operable, high-risk STS (T2bN0M0, AJCC 6th edition) of the extremities were treated with 3 courses of preoperative and 2 courses of postoperative chemotherapy, which consisted of 60 mg/m(2) of DXR plus 10 g/m(2) of IFM over a 3-week interval. The primary study endpoint was progression-free survival (PFS) estimated by Kaplan-Meier methods. Prognostic factors were evaluated by univariable and multivariable Cox proportional hazards model. Results A total of 72 patients were enrolled between March 2004 and September 2008, with 70 of these patients being eligible. The median follow-up period was 10.0 years for all eligible patients. Local recurrence and distant metastasis were observed in 5 and 19 patients, respectively. The 10-year PFS was 65.7% (95% CI: 53.4-75.5%) with no PFS events being detected during the last 5 years of follow-up. The 10-year overall survival was 78.1% (95% CI: 66.3-86.2%). Secondary malignancy was detected in 6 patients. The subgroup analysis demonstrated that there was significant difference in survival with regard to primary tumor size. Conclusions Only a few long-term results of clinical trials for perioperative chemotherapy treatment of STS have been reported. Our results demonstrate that the 10-year outcome of JCOG0304 for patients with operable, high-risk STS of the extremities was stable and remained favorable during the last 5 years of follow-up.

DOI： 10.1186/s12885-019-6114-2

The accuracy of a newly developed guide system in medial meniscus posterior root repair: a comparison between two aiming guides. International journal

Takayuki Furumatsu, Yuki Okazaki, Yuya Kodama, Yoshiki Okazaki, Yusuke Kamatsuki, Shin Masuda, Takaaki Hiranaka, Toshifumi Ozaki

Knee surgery & related research 31 ( 1 ) 7 - 7 2019.8

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: Posterior root repair of the medial meniscus (MM) can prevent rapid progression of knee osteoarthritis in patients with a MM posterior root tear (MMPRT). The anatomic reattachment of the MM posterior root is considered to be critical in a transtibial pullout repair. However, tibial tunnel creation at the anatomic attachment is technically difficult. We hypothesized that a newly developed point-contact aiming guide [Unicorn Meniscal Root (UMR) guide] can create the tibial tunnel at a better position rather than a previously designed MMPRT guide. The aim of this study was to compare the position of the created tibial tunnel between the two meniscal root repair guides. MATERIALS AND METHODS: Thirty-eight patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the UMR guide (19 cases) or MMPRT guide (19 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada's measurement method postoperatively. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines referring to three anatomic bony landmarks (anterior border of the posterior cruciate ligament, lateral margin of the medial tibial plateau, and retro-eminence ridge). The expected anatomic center and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. The distance between the anatomic center and tunnel center was calculated. RESULTS: The anatomic center of the MM posterior root footprint was located at a position of 79.2% posterior and 39.5% lateral. The mean of the tunnel center in the UMR guide was similar to that in the MMPRT guide (posterior direction, P = 0.096; lateral direction, P = 0.280). The mean distances between the tunnel center and the anatomic center were 4.06 and 3.99 mm in the UMR and MMPRT guide group, respectively (P = 0.455). CONCLUSIONS: The UMR guide, as well as the MMPRT guide, is a useful device to create favorable tibial tunnels at the MM posterior root attachment for pullout repairs in patients with MMPRTs. LEVEL OF EVIDENCE: IV.

DOI： 10.1186/s43019-019-0007-1

Tuberosity-overlapping Fixation of the Humeral Shaft in Humeral Head Replacement Surgery.

Takaaki Hiranaka, Keiichiro Nishida, Taizo Konishiike, Toshifumi Ozaki, Motohiko Mikasa

Acta medica Okayama 73 ( 4 ) 299 - 305 2019.8

Language：English Publishing type：Research paper (scientific journal)

The fixation technique of bony fragments is crucial for the bone union of the tuberosities after humeral head replacement (HHR) for a comminuted fracture of the proximal humerus. To increase the bone union rate, we reduce tuberosities to overlap on the humeral shaft by approx. 1 cm and fix them with cable wire. Herein, we retrospectively investigated the clinical and radiographic outcomes of our procedure. Twenty-six patients who underwent cementless HHR for the treatment of comminuted fractures of the proximal humerus were investigated. The Constant-Murley score, active shoulder mobility, and bone union rate were evaluated. The mean duration of follow-up was 56.3 months (range 24-197). At the final follow-up, the average Constant-Murley score was 58 (range 40-76). Forward elevation was 126° on average (range 35°-180°). Twenty-three cases (88%) showed bone union between the tuberosities and the shaft at an average follow-up of 4.1 months (range 4-5 months) after surgery. Non-union was noted in 1 case, and bone resorption was noted in 2 cases. The bone union rate and the clinical outcome of our procedure were relatively favorable.

DOI： 10.18926/AMO/56931

Possible reparative effect of low-intensity pulsed ultrasound (LIPUS) on injured meniscus. Reviewed International journal

Kamatsuki Y, Aoyama E, Furumatsu T, Miyazawa S, Maehara A, Yamanaka N, Nishida T, Kubota S, Ozaki T, Takigawa M

Journal of cell communication and signaling 13 ( 2 ) 193 - 207 2019.6

Language：English Publishing type：Research paper (scientific journal)

Menisci are a pair of crescent-shaped fibrocartilages, particularly of which their inner region of meniscus is an avascular tissue. It has characteristics similar to those of articular cartilage, and hence is inferior in healing. We previously reported that low-intensity pulsed ultrasound (LIPUS) treatment stimulates the production of CCN2/CTGF, a protein involved in repairing articular cartilage, and the gene expression of major cartilage matrices such as type II collagen and aggrecan in cultured chondrocytes. Therefore, in this present study, we investigated whether LIPUS has also favorable effect on meniscus cells and tissues. LIPUS applied with a 60 mW/cm2 intensity for 20 min stimulated the gene expression and protein production of CCN2 via ERK and p38 signaling pathways, as well as gene expression of SOX9, aggrecan, and collagen type II in human inner meniscus cells in culture, and slightly stimulated the gene expression of CCN2 and promoted the migration in human outer meniscus cells in culture. LIPUS also induced the expression of Ccn2, Sox9, Col2a1, and Vegf in rat intact meniscus. Furthermore, histological evaluations showed that LIPUS treatment for 1 to 4 weeks promoted healing of rat injured lateral meniscus, as evidenced by better and earlier angiogenesis and extracellular matrix synthesis. The data presented indicate that LIPUS treatment might prevent meniscus from degenerative change and exert a reparative effect on injured meniscus via up-regulation of repairing factors such as CCN2 and that it might thus be useful for treatment of an injured meniscus as a non-invasive therapy.

DOI： 10.1007/s12079-018-0496-9

Post-traumatic Articular Cartilage Lesions Increase at Second-look Arthroscopy Following Primary Anterior Cruciate Ligament Reconstruction.

Kazuhisa Sugiu, Takayuki Furumatsu, Yuya Kodama, Yusuke Kamatsuki, Yoshiki Okazaki, Yuki Okazaki, Takaaki Hiranaka, Toshifumi Ozaki

Acta medica Okayama 73 ( 3 ) 223 - 228 2019.6

Language：English Publishing type：Research paper (scientific journal)

Anterior cruciate ligament (ACL) reconstruction (ACLR) after ACL rupture improves the instability of the knee joint and decreases mechanical stress to the meniscus and articular cartilage. However, there are reports that post-traumatic osteoarthritis (PTOA) is observed over time following ACLR. In this study, we assessed changes in cartilage lesions by arthroscopic findings following anatomical double-bundle ACLR and at post-operative second-look arthroscopy about 14 months later. We retrospectively evaluated 37 knees in cases with patients <40 years of age who had undergone an anatomical double-bundle ACL reconstruction <1 year after ACL rupture injury from March 2012 to December 2016. Clinical results and arthroscopic cartilage/meniscal lesion were evaluated and compared between a cartilage lesion-detected group and intact-cartilage group. Surgery improved anteroposterior laxity and other clinical measures; however, cartilage lesions were detected at 11 sites during ACLR and at 54 sites at second-look arthroscopy. The periods from injury to second-look arthroscopy and from ACLR to second-look arthroscopy were significantly longer in the cartilage-lesion group (n=23) than in the intact-cartilage group (n=14). Conversely, 96% of meniscal damage observed during ACLR was cured at the time of second-look arthroscopy. Knee articular cartilage lesions after ACL rupture cannot be completely suppressed, even using the anatomical ACL reconstruction technique. This study suggested that articular cartilage lesions can progress to a level that can be confirmed arthroscopically at approximately 17 months after ACL injury. Therefore, in ACLR patients, the possibility of developing knee articular cartilage lesions and PTOA should be considered.

DOI： 10.18926/AMO/56864

Prevalence of and Risk Factors for the Progression of Upper Cervical Lesions in Patients with Rheumatoid Arthritis.

Masahiro Horita, Keiichiro Nishida, Kenzo Hashizume, Yoshihisa Sugimoto, Yoshihisa Nasu, Ryuichi Nakahara, Ryozo Harada, Toshifumi Ozaki

Acta medica Okayama 73 ( 3 ) 235 - 240 2019.6

Language：English Publishing type：Research paper (scientific journal)

We investigated the prevalence of and risk factors for the progression of upper cervical lesions (UCLs) in patients with rheumatoid arthritis (RA). A retrospective analysis of 49 patients with RA (4 males, 45 females) was conducted. The UCLs included atlanto-axial subluxation and vertical subluxation. We investigated the clinical factors including the Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and the modified Health Assessment Questionnaire-Disability Index as well as radiographic changes between the baseline (at May 2010 to April 2013) and final follow-up. Forty patients (81.6%) were classified as the non-progressive group, and the other 9 patients (18.4%) comprised the progressive group. The progressive group's final CRP values, baseline or final MMP-3 levels, DAS28-CRP, and rate of pre-existing lesions at baseline were all significantly higher than those of the non-progressive group (p=0.017, p=0.043, p=0.002, p=0.008, p<0.001, and p=0.008 respectively). A multivariate logistic regression analysis demonstrated that DAS28-CRP at baseline was a risk factor for radiographic progression (p=0.018, odds ratio: 2.54, 95% confidence interval: 1.17-5.51). Our findings indicate that higher disease activity might influence the progression of UCLs in patients with RA.

DOI： 10.18926/AMO/56866

10-year follow-up results of perioperative chemotherapy with doxorubicin (DXR) and ifosfamide (IFM) for high-grade soft tissue sarcomas (STS) in the extremities: Japan Clinical Oncology Group study JCOG0304.

Kazuhiro Tanaka, Junki Mizusawa, Norifumi Naka, Akira Kawai, Hirohisa Katagiri, Toru Hiruma, Yoshihiro Matsumoto, Hiroyuki Tsuchiya, Robert Nakayama, Hiroshi Hatano, Makoto Emori, Masami Hosaka, Yukihiro Yoshida, Takeshi Okamoto, Satoshi Abe, Kunihiro Asanuma, Ryohei Yokoyama, Haruhiko Fukuda, Toshifumi Ozaki, Yukihide Iwamoto

JOURNAL OF CLINICAL ONCOLOGY 37 ( 15 ) 2019.5

Osteosarcoma in patients over 50 years of age: Multi-institutional retrospective analysis of 104 patients. Reviewed

Nagano A, Matsumoto S, Kawai A, Okuma T, Hiraga H, Matsumoto Y, Nishida Y, Yonemoto T, Hosaka M, Takahashi M, Yoshikawa H, Kunisada T, Asanuma K, Naka N, Emori M, Kubo T, Kawashima H, Kawamoto T, Yokoyama R, Tsukushi S, Sato K, Okamoto T, Hiraoka K, Morioka H, Tanaka K, Takagi T, Iwamoto Y, Ozaki T

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 25 ( 2 ) 319 - 323 2019.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Primary osteosarcoma in elderly patients are rare malignant tumors. Its optimal treatment has not yet been determined. METHODS: This retrospective study included 104 patients aged >50 years with resectable, non-metastatic osteosarcoma treated by the members of the Bone and Soft Tissue Tumor Study Group of the Japan Clinical Oncology Group. The effects of adjuvant chemotherapy were estimated by comparing outcomes in patients who received surgery plus chemotherapy with those who underwent surgery alone. RESULTS: Median age at presentation was 59 years. Neoadjuvant and adjuvant chemotherapy was administered to 83 (79.8%) patients. Patients who underwent surgery plus chemotherapy and those who underwent surgery alone had 5-year overall survival (OS) rates of 68.6% and 71.7%, respectively (p = 0.780), and 5-year relapse free survival (RFS) rates of 48.2% and 43.6%, respectively (p = 0.64). Univariate analysis showed that resection with wide margins was significantly correlated with better prognosis. CONCLUSIONS: The addition of chemotherapy to surgery did not improve OS or RFS in patients aged >50 years with resectable, non-metastatic osteosarcoma. Surgery with wide margins was only significantly prognostic of improved survival. The effect of chemotherapy in elderly osteosarcoma patients was unclear.

DOI： 10.1016/j.jos.2019.04.008

Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair. International journal

Takayuki Furumatsu, Shinichi Miyazawa, Masataka Fujii, Takaaki Tanaka, Yuya Kodama, Toshifumi Ozaki

International orthopaedics 43 ( 5 ) 1239 - 1245 2019.5

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: Medial meniscus posterior root tear (MMPRT) leads to a rapid degradation of articular cartilage. In the treatment of MMPRT, transtibial pullout repair demonstrates a high clinical survival rate. However, there is no reliable method to evaluate the meniscal healing after surgery. We propose an arthroscopic scoring system for evaluating the meniscal healing status. The aim of this study was to investigate the correlations between second-look arthroscopic scores and clinical outcomes after transtibial pullout repair. METHODS: Twenty patients who had MMPRTs underwent transtibial pullout repairs. Clinical outcomes were assessed using the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS) and pain score evaluated by visual analogue scale at preoperatively and 1 year postoperatively. The healing status of repaired MM was assessed at one year post-operatively using a semi-quantitative arthroscopic scoring system (total, 10 points) composed of three evaluation criteria: (i) anteroposterior width of bridging tissues, (ii) stability of the MM posterior root, and (iii) synovial coverage of the sutures. Linear regression analysis was used to assess the correlation between second-look arthroscopic scores and clinical outcomes. RESULTS: Transtibial pullout repairs of MMPRTs significantly improved clinical evaluation scores at one year post-operatively. A median of second-look arthroscopic scores was 6.5 (5.75-8). A good correlation was observed between the arthroscopic score and KOOS quality of life (QOL) subscale. A moderate negative correlation between the arthroscopic score and pain score was observed. CONCLUSIONS: This study demonstrated that our semi-quantitative scoring system of meniscal healing correlated with the KOOS QOL subscale following MMPRT transtibial pullout repair. Our results suggest that the second-look arthroscopic score using this system may be a useful scale to determine and compare the healing status of the MM posterior root.

DOI： 10.1007/s00264-018-4071-z

Very rare solitary primary peripheral nerve onset cytotoxic molecule-positive peripheral T-cell lymphoma (PTCL)

Namiko Matsumoto, Kota Sato, Yoshiaki Takahashi, Yuko Kawahara, Taijun Yunoki, Jingwei Shang, Mami Takemoto, Nozomi Hishikawa, Yasuyuki Ohta, Toru Yamashita, Maiko Sakamoto, Eisei Kondou, Rei Shibata, Tadashi Yoshino, Toshifumi Ozaki, Koji Abe

NEUROLOGY AND CLINICAL NEUROSCIENCE 7 ( 3 ) 146 - 149 2019.5

Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY

Here we present the first report of solitary primary peripheral nerve onset cytotoxic molecule (CM)-positive peripheral T-cell lymphoma (PTCL) diagnosed after nerve biopsy. An 84-year-old female with rheumatoid arthritis (RA) complained of asymmetric severe tenderness in her upper limbs. The biopsy pathology revealed a direct invasion of CM-positive PTCL. When RA patients complain of numbness, tenderness, or weakness, lymphomatic peripheral nerve invasion should be considered.

DOI： 10.1111/ncn3.12280

Histological alterations to the hamstring tendon caused by cleaning during autograft preparation Reviewed International journal

Okazaki Y, Furumatsu T, Maehara A, Miyazawa S, Kamatsuki Y, Hino T, Ozaki T

Muscles, Ligaments and Tendons Journal 9 ( 2 ) 217 - 224 2019.4

Nonunion fragility fracture of the pelvis with complication from bladder rupture: A case report. Reviewed International journal

Yamakawa Y, Noda T, Saito T, Saiga K, Nakahara R, Shimamura Y, Ozaki T

Trauma case reports 20 100169 - 100169 2019.4

Language：English

The incidence rate of bladder rupture associated with pelvic ring fractures is reported to be about 5-10%, mostly occurring at the time of injury. Fragility pelvic ring fractures are reported to increase fracture displacement or become nonunion if they are treated inadequately. Few case reports on bladder rupture associated with fragility pelvic ring fracture have been published. We report a rare case of delayed bladder rupture associated with a fragility fracture of the pelvis. A 65-year-old female felt right hip pain without sustaining any trauma. She was diagnosed with a right pubic rami fracture. However, her pain deteriorated, and a sacral fracture was identified one month later. She was prescribed teriparatide, but her pain worsened and she was referred to our hospital. She was diagnosed with fragility fracture of the pelvis (Rommens classification type IVb) and was treated operatively. During the surgery, her thin bladder wall, which was compressed by a displaced pubic fragment, was torn and repaired. This is the first report describing a fragility fracture of the pelvis associated with a bladder rupture. Our treatment led to a successful result.

DOI： 10.1016/j.tcr.2019.100169

Temporary External Fixation Can Stabilize Hip Transposition Arthroplasty After Resection of Malignant Periacetabular Bone Tumors. Reviewed International journal

Kunisada T, Fujiwara T, Hasei J, Nakata E, Senda M, Ozaki T

Clinical orthopaedics and related research 477 ( 8 ) 1892 - 1901 2019.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The choice of reconstructive procedure to restore limb function is challenging after internal hemipelvectomy. Hip transposition arthroplasty, also known as resection arthroplasty, removes a malignant or aggressive tumor of the pelvis and acetabulum after which the remaining femoral head is moved proximally to the lateral surface side of the sacrum or the underside of the resected ilium after internal hemipelvectomy. It may provide reasonable functional results and have some advantages such as lowering the risk of an infected implant compared with other reconstructions because no foreign implants are used. Hip transposition is generally managed with prolonged bed rest or immobilization postoperatively to stabilize the soft tissue surrounding the remaining femur. Because enabling patients to be mobile while the soft tissues heal might be advantageous, we reviewed our experience with an external fixation for this procedure. QUESTIONS/PURPOSES: (1) Does temporary external fixation facilitate postoperative physiotherapy in patients who undergo hip transposition arthroplasty? (2) What functional Musculoskeletal Tumor Society (MSTS) scores were achieved at short term in a small series of patients treated with hip transposition and temporary external fixation? (3) What were the complications of using external fixation in a small series of patients who received it for malignant tumors? METHODS: Between 2008 and 2012, we treated seven patients (three men and four women; median age, 37 years; age range, 18-53 years) with acetabular resection for malignant bone tumors; all were managed with a hip transposition, initially stabilized using external fixation. No other types of procedures were used for this indication in this period. Minimum followup in this retrospective study was 45 months, except for one patient who died at 18 months (range of followup duration, 18-90 months; median followup, 57 months), and no patients were lost to followup. The pins for external fixation were inserted into the affected side of the femur and the healthy contralateral ilium. External fixation was removed 6 weeks postoperatively and weightbearing was started at that time. Preoperative chemotherapy was administrated in four patients, but postoperative chemotherapy was delayed since it was given after external fixation removal in three patients. The postoperative rehabilitation course and functional results were assessed by chart review, functional results were determined using MSTS scores, tallied by physiotherapists who were not part of the surgical team, and complications were ascertained through chart review. Major complications were defined as complications that were treated with additional operations, such as deep infection, or ones that could cause severe postoperative dysfunction, such as nerve injury. RESULTS: With temporary external fixation, standing next to a bed was achieved in median 7 days (range, 6-9 days) postoperatively, transferring to a wheel chair in median 8 days (range, 6-28 days), and gait training using parallel bars in median 15 days (range, 7-48 days). At most recent followup, three patients could walk without a crutch or cane, three could walk with a cane, and one could walk with a crutch. The median MSTS score at most recent followup (median, 57 months) was 63%. Two patients had complications that resulted in reoperations; one had a wound dehiscence, and one had an abdominal herniation that gradually developed, and which was reconstructed using polypropylene mesh 2 years after pelvic resection. Two patients had nerve palsies that recovered by the end of the first year. All patients had pin tract infections that resolved with nonsurgical approaches. CONCLUSIONS: Hip transposition with temporary external fixation can stabilize the bone soft tissue after pelvic resection. Although we did not have a comparison group of patients, we believe that external fixation facilitates early postoperative physiotherapy and rehabilitation and provides good functional results without major surgical complications. Because it delays the resumption of chemotherapy, more patients with longer followup are needed to determine whether this will be associated with poorer oncologic results. LEVEL OF EVIDENCE: Level IV, therapeutic study.

DOI： 10.1097/CORR.0000000000000764

Involvement of ADAM12 in Chondrocyte Differentiation by Regulation of TGF-β1-Induced IGF-1 and RUNX-2 Expressions. Reviewed International journal

Horita M, Nishida K, Hasei J, Furumatsu T, Sakurai M, Onodera Y, Fukuda K, Salter DM, Ozaki T

Calcified tissue international 105 ( 1 ) 97 - 106 2019.4

Language：English Publishing type：Research paper (scientific journal)

A disintegrin and metalloproteinase 12 (ADAM12) is known to be involved in chondrocyte proliferation and maturation; however, the mechanisms are not fully understood. In this study, expression and localization of ADAM12 during chondrocyte differentiation were examined in the mouse growth plate by immunohistochemistry. Adam12 expression during ATDC5 chondrogenic differentiation was examined by real-time PCR and compared with the expression pattern of type X collagen. The clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 system was used to generate Adam12-knockout (KO) ATDC5 cells. Adam12-KO and Adam12 overexpressing cells were used for analyses of ADAM12 expression with or without TGF-β1 stimulation. ADAM12 was identified predominantly in chondrocytes of the proliferative zone in mouse growth plates by immunohistochemistry. Adam12 was upregulated prior to Col10a1 during chondrogenic differentiation in wild-type ATDC5 cells. In Adam12-KO ATDC5 cells, following initiation of chondrogenic differentiation, we observed a reduction in Igf-1 expression along with an upregulation of hypertrophy-associated Runx2, Col10a1, and type X collagen protein expressions. In ATDC5 wild-type cells, stimulation with TGF-β1 upregulated the expressions of Adam12 and Igf-1 and downregulated the expression of Runx2. In contrast, in Adam12-KO ATDC5 cells, these TGF-β1-induced changes were suppressed. Adam12 overexpression resulted in an upregulation of Igf-1 and downregulation of Runx2 expression in ATDC5 cells. The findings suggest that ADAM12 has important role in the regulation of chondrocyte differentiation, potentially by regulation of TGF-β1-dependent signaling and that targeting of ADAM12 may have a role in management of abnormal chondrocyte differentiation.

DOI： 10.1007/s00223-019-00549-6

Posteromedial vertical capsulotomy selectively increases the extension gap in posterior stabilized total knee arthroplasty. Reviewed International journal

Masuda S, Miyazawa S, Yuya K, Kamatski Y, Tomohito H, Yoshiki O, Yuki O, Furumatsu T, Ozaki T

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 28 ( 5 ) 1419 - 1424 2019.4

Language：English Publishing type：Research paper (scientific journal)

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.

DOI： 10.1007/s00167-019-05511-5

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