記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Postoperative change of the joint line convergence angle (JLCA) is known to be a factor affecting correction error in opening wedge high tibial osteotomy (OWHTO). The purpose of this study was to assess whether preoperative planning that considers change of the JLCA can achieve accurate correction in the standing position after OWHTO. METHODS: OWHTO was performed for 109 knees with osteoarthritis of the knee. The amount of angular correction was planned aiming to achieve mechanical valgus of 5° in 55 knees (conventional planning), and it was adjusted in 54 knees (adjusted planning) according to the preoperative JLCA as follows: not changed with JLCA ≤ 3°; decreased 1° with JLCA 4-6°; decreased 2° with JLCA 7-8°; and decreased 3° with JLCA ≥ 9°. The hip-knee-ankle (HKA) angle, JLCA, and medial proximal tibial angle (MPTA) were measured on standing long-leg radiographs. Correction error ≤ 2º was defined as the acceptable range, and correction error > 2º was defined as an outlier. RESULTS: The conventional planning group had a significantly greater postoperative HKA angle than the adjusted planning group (6.1º and 4.9º, respectively). The mean JLCA decreased from 4.8º to 2.6º in the conventional planning group and from 4.6º to 2.7º in the adjusted planning group. The conventional planning group had significantly greater postoperative MPTA than the adjusted planning group (96.2º and 94.7º, respectively). The rate of outliers with correction error > 2º was significantly lower in the adjusted planning group (9%) than in the conventional planning group (24%). The rate of the MPTA > 95º was significantly lower in the adjusted planning group (30%) than in the conventional planning group (69%). CONCLUSIONS: This study demonstrated that preoperative planning with adjustment of the correction angle according to the preoperative JLCA improved correction accuracy in the standing position after OWHTO.

DOI： 10.1186/s13018-024-05096-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It is well known that increased posterior tilt of the pelvis is an effective strategy for avoiding impingement of the femur with the pelvis during movement. Daily repetitive collisions become mechanical loads, and the more frequently they occur, the more tissue damage and pain they cause. Therefore, reducing the rate of occurrence of impingement is important to avoid aggravation of symptoms. This study aimed to evaluate the effects of changes in posterior pelvic tilt on the risk of impingement between the femur and the anterior inferior iliac spine (AIIS)/subspine in various functional postures. Patients with femoroacetabular impingement syndrome (FAIS) who were candidates for hip arthroscopic osteochondroplasty between October 2013 and June 2020 were included. A three-dimensional reconstructed model was used to simulate the incidence of impingement at 12 hip positions required for activities of daily living. We predicted value of the spatial incidence of impingement assumed that hip motion should exceed 130/30 degrees without impingement. Impingement was measured at three pelvic positions: an anterior tilt of 10°, in the functional pelvic plane and a posterior tilt of 10°. Multivariate linear-mixed models were used to assess the effect of covariate-adjusted posterior pelvic tilt on the impingement incidence in the AIIS region. AIIS type, center-edge angle, acetabular version and femoral version were used as covariates. The impingement rates and locations of the three pelvic tilt postures were assessed. Seventy-eight patients (60 males and 18 females; average age, 46 ± 15.1 years) with FAIS were analyzed. A multivariate linear-mixed model revealed a coefficient of -0.8% (95% confidence interval -0.9 to -0.7%; P < 0.001) for posterior pelvic tilt. Thus, posterior pelvic tilt affects AIIS impingement incidence. After adjusting for anatomical effects, the posterior pelvic tilt should be addressed to avoid impingement.

DOI： 10.1093/jhps/hnae003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Osteoporosis is characterized by weakened bone microstructure and loss of bone mass. Current diagnostic criteria for osteoporosis are based on the T-score, which is a measure of bone mineral density. However, osteoporotic fragility fractures can occur regardless of the T-score, underscoring the need for additional criteria for the early detection of patients at fracture risk. To identify indicators of reduced bone strength, we performed serum proteomic analysis using data-independent acquisition mass spectrometry with serum samples from two patient groups, one with osteoporosis but no fractures and the other with osteopenia and fragility fractures. Collective evaluation of the results identified six serum proteins that changed to a similar extent in both patient groups compared with controls. Of these, extracellular matrix protein 1 (ECM1), which contributes to bone formation, showed the most significant increase in serum levels in both patient groups. An ELISA-based assay suggested that ECM1 could serve as a serum indicator of the need for therapeutic intervention; however, further prospective studies with a larger sample size are necessary to confirm these results. The present findings may contribute to the provision of early and appropriate therapeutic strategies for patients at risk of osteoporotic fractures. SIGNIFICANCE: This study aimed to identify objective serum indicators of the need for therapeutic intervention in individuals at risk of osteoporotic fracture. Comprehensive proteome analyses of serum collected from patients with osteoporosis but no fractures, patients with osteopenia and fragility fractures, and controls were performed by data-independent acquisition mass spectrometry. Collective evaluation of the proteome analysis data and ELISA-based assays identified serum ECM1 as a potential objective marker of the risk of fragility fractures in patients with osteoporosis or osteopenia. The findings are an important step toward the development of appropriate bone health management methods to improve well-being and maintain quality of life.

DOI： 10.1016/j.jprot.2024.105166

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The molecular mechanisms associated with spaceflight-induced biological adaptations that may affect many healthy tissue functions remain poorly understood. In this study, we analyzed temporal changes in the serum proteome of six astronauts during prolonged spaceflight missions using quantitative comprehensive proteome analysis performed with the data-independent acquisition method of mass spectrometry (DIA-MS). All six astronauts participated in a spaceflight mission for approximately 6 months and showed a decreasing trend in T-scores at almost all sites where dual-energy X-ray absorptiometry scans were performed. DIA-MS successfully identified 624 nonredundant proteins in sera and further quantitative analysis for each sampling point provided information on serum protein profiles closely related to several time points before (pre-), during (in-), and after (post-) spaceflight. Changes in serum protein levels between spaceflight and on the ground suggest that abnormalities in bone metabolism are induced in astronauts during spaceflight. Furthermore, changes in the proteomic profile occurring during spaceflight suggest that serum levels of bone metabolism-related proteins, namely ALPL, COL1A1, SPP1, and POSTN, could serve as highly responsive indicators of bone metabolism status in spaceflight missions. This study will allow us to accelerate research to improve our understanding of the molecular mechanisms of biological adaptations associated with prolonged spaceflight.

DOI： 10.1002/pmic.202300328

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Physical inactivity associated with gravity unloading, such as microgravity during spaceflight and hindlimb unloading (HU), can cause various physiological changes. In this study, we attempted to identify serum proteins whose levels fluctuated in response to gravity unloading. First, we quantitatively assessed changes in the serum proteome profiles of spaceflight mice using mass spectrometry with data-independent acquisition. The serum levels of several proteins involved in the responses to estrogen and glucocorticoid, blood vessel maturation, osteoblast differentiation, and ossification were changed by microgravity exposure. Furthermore, a collective evaluation of serum proteomic data from spaceflight and HU mice identified 30 serum proteins, including Mmp2, Igfbp2, Tnc, Cdh5, and Pmel, whose levels varied to a similar extent in both gravity unloading models. These changes in serum levels could be involved in the physiological changes induced by gravity unloading. A collective evaluation of serum, femur, and soleus muscle proteome data of spaceflight mice also showed 24 serum proteins, including Igfbp5, Igfbp3, and Postn, whose levels could be associated with biological changes induced by microgravity. This study examined serum proteome profiles in response to gravity unloading, and may help deepen our understanding of microgravity adaptation mechanisms during prolonged spaceflight missions.

DOI： 10.1002/pmic.202300214

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of the present study was to investigate the association between chondrogenic differentiation and Wnt signal expression in the degenerative process of the human meniscus. Menisci were obtained from patients with and without knee osteoarthritis (OA), and degeneration was histologically assessed using a grading system. Immunohistochemistry, real-time polymerase chain reaction (PCR), and Western blot analysis were performed to examine the expressions of chondrogenic markers and of the components of Wnt signaling. Histological analyses showed that meniscal degeneration involved a transition from a fibroblastic to a chondrogenic phenotype with the upregulation of SOX9, collagen type II, collagen type XI, and aggrecan, which were associated with increased Wnt5a and ROR2 and decreased TCF7 expressions. OA menisci showed significantly higher expressions of Wnt5a and ROR2 and significantly lower expressions of AXIN2 and TCF7 than non-OA menisci on real-time PCR and Western blot analysis. These results potentially demonstrated that increased expression of Wnt5a/ROR2 signaling promoted chondrogenesis with decreased expression in downstream Wnt/β-catenin signaling. This study provides insights into the role of Wnt signaling in the process of meniscal degeneration, shifting to a chondrogenic phenotype. The findings suggested that the increased expression of Wnt5a/ROR2 and decreased expression of the downstream target of Wnt/β-catenin signaling are associated with chondrogenesis in meniscal degeneration.

DOI： 10.1002/jor.25825

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: This study aimed to investigate the anterior-posterior (AP) displacement of the tibial tuberosity (TT) and to assess the difference between closed wedge and opening wedge high tibial osteotomies (OWHTO and CWHTO). METHODS: One hundred consecutive knees with osteoarthritis that underwent OWHTO (50 knees) or CWHTO (50 knees) were investigated retrospectively. The femorotibial angle (FTA) was measured on AP radiographs of the knee. AP displacement of the TT, posterior tibial slope (PTS), the modified Blackburne-Peel index (mBPI), and the modified Caton-Deschamps index (mCDI) were measured on lateral radiographs of the knee. RESULTS: Patients had a mean correction angle of 12.58 ± 2.84° and 18.98 ± 5.14° (P < 0.001), with a mean AP displacement of TT of 0.84 ± 2.66 mm and 7.78 ± 3.41 mm (P < 0.001) in OWHTO and CWHTO, respectively. The AP displacement of the TT per correction of 1° was significantly greater in CWHTO than in OWHTO (P < 0.001). A significant correlation was found between the correction angle and AP displacement of the TT in CWHTO (r = -0.523, P < 0.001), but not in OWHTO. The change of PTS per correction of 1° was significantly greater in OWHTO than in CWHTO (P < 0.001). The changes of mBPI and mCDI per correction of 1° were significantly greater in CWHTO than in OWHTO (P < 0.001 and P < 0.001, respectively). CONCLUSIONS: There was greater anterior displacement of the TT in CWHTO than in OWHTO, which was correlated with the correction angle. The results suggested that CWHTO would be better than OWHTO when a concomitant anteriorization of TT is required.

DOI： 10.1051/sicotj/2024020

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Periprosthetic joint infection (PJI) is one of the most intractable orthopedic diseases, partly because of the difficulty in differentiating septic from aseptic conditions. We aimed to evaluate and consolidate the diagnostic accuracy of the quantitative assessment of serum albumin (Alb), globulin (Glb), and albumin-globulin ratio (AGR), alone or in combination with the inflammatory marker, C-reactive protein (CRP), for PJI. We searched the PubMed, CINAHL, and Cochrane Library databases for studies that quantitatively measured Alb, Glb, or AGR for the diagnosis of PJI up until the 30 April 2023. A total of 2339 patients were included from 10 studies, including 845 patients with a definitive diagnosis of PJI and 1494 with non-PJI. The pooled sensitivity, specificity, and area under the curve (AUC) in the summary receiver-operating characteristic curve were as follows: 0.625, 0.732, and 0.715 for Alb; 0.815, 0.857, and 0.887 for Glb; 0.753, 0.757, and 0.875 for AGR; 0.788, 0.837, and 0.876 for CRP; 0.879, 0.890, and 0.917 for the CRP-Alb ratio; and 0.845, 0.855, and 0.908 for the CRP-AGR ratio. Serum Alb, Glb, and AGR levels are feasible and accurate diagnostic markers for PJI, and the combination of these markers with CRP levels may potentially improve preoperative serum diagnostic accuracy. Future prospective studies are required to verify these findings because of the small numbers of included studies.

DOI： 10.3390/jcm12247512

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Fungal periprosthetic joint infections are one of the most intractable orthopedic disorders. Continuous local antibiotic perfusion allows direct administration of the antifungal agent micafungin into the local infection area at biofilm-disruptive concentrations, while controlling the dead space in addition to conventional treatment. Although the appropriate use of continuous local antibiotic perfusion requires familiarity with the characteristics of local antibiotic perfusion, it is a versatile treatment modality that can improve the clinical outcomes of fungal periprosthetic joint infection in combination with conventional treatment methods.

DOI： 10.1016/j.artd.2023.101245

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI). MATERIALS AND METHODS: Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case-control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I). RESULTS: Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49-0.62) (P < 0.00001), and that of PJI alone (OR 0.53; 95% CI 0.47-0.59) (P < 0.00001). TXA reduced the incidence of overall infection in patients who underwent total hip arthroplasty (THA; OR 0.51; 95% CI: 0.35-0.75) (P = 0.0005) and total knee arthroplasty (TKA; OR 0.55; 95% CI: 0.43-0.71) (P < 0.00001). Intravenous administration of TXA reduced the incidence of overall infection (OR 0.59; 95% CI 0.47-0.75) (P < 0.0001), whereas topical administration did not. CONCLUSIONS: Intravenous administration of TXA reduces the incidence of overall infection in patients undergoing both THA and TKA. LEVEL OF EVIDENCE: Level III.

DOI： 10.1007/s00402-023-04914-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Antibiotic susceptibility is very important for the successful treatment of orthopedic infections, particularly for implant-related infections. While the minimum inhibitory concentrations (MICs) of Staphylococcus species were well investigated for the isolates from the respiratory tract, investigations for orthopedic pathogens are very limited. We investigated the antibiotic MIC values of Staphylococcus species isolated from orthopedic infections and compared them with those of respiratory medicine isolates used as a control. METHODS: The MICs of vancomycin (VCM), arbekacin (ABK), teicoplanin (TEIC), linezolid (LZD), and rifampicin (RFP) of a total of consecutive 259 (89 orthopedic and 170 respiratory) Staphylococcus speciesisolated in our laboratory from January 2013 to July 2016 were retrospectively reviewed. Differences between the MICs of each antibiotic in orthopedic and respiratory samples were determined. RESULTS: The number of methicillin-sensitive Staphylococcus aureus (MSSA) with a VCM MIC of <0.5 μg/mL among respiratory isolates was significantly higher than that among orthopedic isolates, while those with a MIC of 2 μg/mL were significantly lower (P = 0.0078). The proportion of methicillin-resistant coagulase-negative staphylococci (MRCNS) isolates with a VCM MIC of 2 μg/mL was significantly higher in orthopedic samples than that of methicillin-resistant Staphylococcus aureus (MRSA) (P < 0.001) in respiratory isolates. The proportion of MRCNS orthopedic isolates with an RFP MIC of >2 μg/mL was significantly higher (P = 0.0058) than that of other orthopedic staphylococci. CONCLUSIONS: The VCM MICs of Staphylococcus species from orthopedic infections were higher than those of respiratory samples, particularly MRCNS from implant-related samples.

DOI： 10.7759/cureus.49535

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Shelf acetabuloplasty has been performed in patients with developmental dysplasia of the hip (DDH); however, the appropriate position of the shelf has not been determined, particularly with respect to avoiding range of motion (ROM) loss. The aim of this study was to investigate the frequency of ROM inhibition and the influence of 3D position of the shelf following actual shelf acetabuloplasty and virtual surgery using computer simulation analysis. Computed tomography data from 15 patients with DDH who underwent shelf acetabuloplasty were collected between August 2019 and February 2022. The three-dimensional models of a hip joint were constructed using Zed Hip®. Maximal internal rotation (MIR) at 45° and 90° flexion was measured in each patient. The frequency and position of ROM inhibition was determined in a real postoperative model virtually. In addition, a second analysis using virtual acetabuloplasty was performed. Upon placing the shelf, three patterns were provided for the following four parameters: height, coronal inclination, center-edge angle (CEA), and anteroposterior position. The predictors for ROM inhibition were analyzed using a logistic regression model. In the actual postoperative model, a limitation of MIR at 90° and 45° of flexion occurred in 60% and 66.7% of patients, respectively. A higher CEA and anterior position are major factors limiting MIR. The analysis of the virtual shelf acetabuloplasty model revealed that anterior position and CEA were significant factors causing ROM inhibition. As for clinical significance, the results of the current study indicated the optimal location of the shelf to avoid iatrogenic impingement after shelf acetabuloplasty.

DOI： 10.1002/jor.25710

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although the microgravity (μ-g) environment that astronauts encounter during spaceflight can cause severe acute bone loss, the molecular mechanism of this bone loss remains unclear. To investigate the gravity-response proteins involved in bone metabolism, it is important to comprehensively determine which proteins exhibit differential abundance associated with mechanical stimuli. However, comprehensive proteomic analysis using small bone samples is difficult because protein extraction in mineralized bone tissue is inefficient. Here, we established a high-sensitivity analysis system for mouse bone proteins using data-independent acquisition mass spectrometry. This system successfully detected 40 proteins in the femoral diaphysis showing differential abundance between mice raised in a μ-g environment, where the bone mass was reduced by gravity unloading, and mice raised in an artificial 1-gravity environment on the International Space Station. Additionally, 22 proteins, including noncollagenous bone matrix proteins, showed similar abundance between the two groups in the mandible, where bone mass was unaltered due to mastication stimuli, suggesting that these proteins are responsive to mechanical stimuli. One of these proteins, SPARCL1, is suggested to promote osteoclastogenesis induced by receptor activator of nuclear factor-κB ligand. We expect these findings to lead to new insights into the mechanisms of bone metabolism induced by mechanical stimuli. SIGNIFICANCE: We aimed to investigate the gravity-response proteins involved in bone metabolism. To this end, we established a comprehensive analysis system for mouse bone proteins using data-independent acquisition mass spectrometry, which is particularly useful in comprehensively analyzing the bone proteome using small sample volumes. In addition, a comprehensive proteomic analysis of the femoral diaphysis and mandible, which exhibit different degrees of bone loss in mice raised on the International Space Station, identified proteins that respond to mechanical stimuli. SPARCL1, a mechanical stimulus-responsive protein, was consequently suggested to be involved in osteoclast differentiation associated with bone remodeling. Our findings represent an important step toward elucidating the molecular mechanism of bone metabolism induced by mechanical stimuli.

DOI： 10.1016/j.jprot.2023.104976

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Gravity-dependent physical processes strongly affect the ability of elderly people to maintain musculoskeletal health by reducing muscle atrophy and increasing bone mineral density, thereby increasing quality of life. A need therefore exists to identify molecules in the musculoskeletal system that are responsive to gravitational loading and to establish an objective indicator for the maintenance of healthy musculoskeletal systems. Here, we performed an integrated assessment of the results of soleus muscle proteomic analyses in three model mouse experiments under different gravity environments (hypergravity, hindlimb unloading, and spaceflight). Myl6b, Gpd1, Fbp2, Pvalb, and Actn3 were shown to be gravity-responsive muscle proteins, and alterations in the levels of these proteins indicated changes in muscle fiber type to slow-twitch type due to gravity loading. In addition, immunoblotting and enzyme-linked immunosorbent assays revealed that Pvalb levels in the sera of hindlimb-unloaded mice and osteoporosis patients were higher than in control subjects, suggesting that Pvalb levels might be useful to objectively evaluate soleus muscle atrophy and bone loss.

DOI： 10.1038/s41598-023-42875-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To evaluate the expected postoperative total leg length change using preoperative radiographs during surgical planning of four different methods of double level osteotomy (DLO). METHODS: This study included 34 patients (44 knees) who underwent DLO for varus knee osteoarthritis. Surgical planning was performed so that the postoperative weight bearing line ratio was 62.5%. In DLO, lateral closed or medial open wedge distal femoral osteotomy (LCWDFO, MOWDFO) was performed so that the postoperative mechanical lateral distal femoral angle was 85°, and residual deformity was corrected with medial open or lateral closed wedge high tibial osteotomy (MOWHTO, LCWHTO). Pre- and surgical planning X-rays in the one-leg standing position were compared to assess the change in leg length, and the factors affecting it, in the various surgical groups. The proportion of cases in which Δ total leg length was greater than 6 mm (symptomatic change) was investigated. RESULTS: The mean postoperative total leg length increased significantly with LCWDFO + MOWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, while it decreased with LCWDFO + LCWHTO. The proportion of cases with a postoperative total leg length change > 6 mm was 72.7%, 2.3%, 100%, and 6.8% in LCWDFO + MOWHTO, LCWDFO + LCWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, respectively. In addition, the preoperative hip-knee-ankle angle correlated negatively with the postoperative total leg length change in LCWDFO + MOWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, but not in LCWDFO + LCWHTO. CONCLUSIONS: MOWDFO + MOWHTO had the largest postoperative leg length change and MOWDFO + LCWHTO had the smallest. Symptomatic leg length change (> 6 mm) should be considered in MOWDFO + MOWHTO and LCWDFO + MOWHTO.

DOI： 10.1186/s43019-023-00198-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To identify factors associated with insufficient range of motion (ROM) improvement after the posterior pelvic tilt change in cam-type femoroacetabular impingement syndrome. METHODS: Preoperative computed tomography images from 71 consecutive patients with femoroacetabular impingement syndrome treated with arthroscopic cam resection were evaluated. Using a dynamic computer simulation program, 3-dimensional models with a 10° posterior pelvic tilt from the supine functional pelvic plane (baseline) were created by computed tomography models. Patients were divided into 2 groups: those who experienced >10° (effective group) and ≤10° (ineffective group) improvements in internal rotation at 90° flexion after a 10° posterior pelvic tilt. Demographic characteristics; preoperative range of internal rotation at 90° flexion; and radiographic parameters, including Tönnis grade, lateral center-edge angle, acetabular roof obliquity angle, central acetabular anteversion, cranial acetabular anteversion, femoral anteversion, and α angle, were compared in the 2 groups. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with insufficient ROM improvement following a 10° posterior pelvic tilt. RESULTS: The 71 patients included 58 men and 13 women, of mean age 41.4 ± 14.6 years. Posterior pelvic tilt was effective in 13 hips and ineffective in 58. Univariate analysis showed that preoperative range of internal rotation at 90°flexion, femoral anteversion, and α angle differed significantly in the 2 groups. Multivariable analysis showed that femoral anteversion <16° (odds ratio 7.4; 95% confidence interval 1.6-35; P = .012) and α angle >65° (odds ratio 6.7; 95% confidence interval 1.2-37; P = .027) were significant factors associated with insufficient ROM improvement after posterior pelvic tilt. CONCLUSIONS: Physical therapy may not be successful for patients with cam-type femoroacetabular impingement syndrome and may result in insufficient hip ROM when femoral anteversion is less than 16° and α-angle is greater than 65°. CLINICAL RELEVANCE: Patients with a prominent cam-type deformity and lower anterior femoral anteversion are at high risk of clinical failure following improvement in pelvic mobility by conservative treatment alone and are likely to benefit from surgery for cam deformity.

DOI： 10.1016/j.arthro.2023.07.012

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Hip resurfacing arthroplasty (HRA) patients require subsequent annual screening for postoperative complications. Ultrasonography may be useful for this purpose but lacks a screening protocol for hips. The purpose of this study was to evaluate the accuracy of ultrasonography for detecting postoperative complications in HRA patients using a screening protocol that specifically targets periprosthetic muscles. METHODS: We enrolled 45 hips from 40 HRA patients with a mean follow-up period of 8.2 years. MRI and ultrasonography scans were simultaneously conducted at follow-up. The ultrasonography assessments were conducted on the anterior part of the hip that targets iliopsoas, sartorius, rectus femoris, lateral with anterior superior and inferior iliac spine (ASIS and AIIS) as bony landmarks, and the lateral and posterior parts that target fascia tensor, short rotators, and gluteus minimus, medius, and maximus with greater trochanter and ischial tuberosity as bony landmarks. The accuracy of diagnosing postoperative abnormalities and the visibility of periprosthetic muscles were compared between these two modalities. RESULTS: Both MRI and ultrasonography detected an abnormal region in eight cases comprising two infections, two pseudotumors, and four patients with greater trochanteric bursitis. Among these cases, four hips required implant removal. The increase in anterior space, measured as the distance between the iliopsoas and resurfacing head, was a good indicator for the abnormal mass in these four HRA cases. In the assessment of periprosthetic muscles, MRI showed a much lower visibility than ultrasonography in the iliopsoas (6.7% vs. 100%), gluteus minimus (6.7% vs. 88.9%), and short rotators (8.8% vs. 71.4%) due to implant halation. CONCLUSIONS: By targeting periprosthetic muscles, ultrasonography can detect postoperative complications as effectively as MRI assessments in HRA patients. Ultrasonography has superior visibility in the periprosthetic muscles of HRA patients, indicating its utility for the screening of small legions in these cases which may not be visible by MRI.

DOI： 10.3390/jcm12082871

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

PURPOSE: To identify the arthroscopic findings associated with deterioration of 10-year clinical outcomes after opening-wedge high tibial osteotomy (OWHTO) in patients with knee osteoarthritis. METHODS: A total of 114 consecutive knees of 91 patients with knee osteoarthritis who underwent OWHTO between 2007 and 2011 were retrospectively reviewed. Of these patients, those who underwent second-look arthroscopy and were followed up for a minimum of 10 years were enrolled. The Knee Society Score (KSS) and hip-knee-ankle angle were assessed. Cartilage status was graded at the time of osteotomy (first look) and plate removal (second look) according to the International Cartilage Repair Society (ICRS) grading system. The KSS knee subscale score and function subscale score were assessed separately, and on the basis of the changes in each of these scores from 1 to 10 years postoperatively and the minimal clinically important difference (MCID), the patients were divided into 2 groups: deteriorated (deterioration of score ≥ MCID) and non-deteriorated (deterioration of score < MCID). RESULTS: Sixty-nine knees were included in this study. The mean knee score improved continuously from 48.7 ± 11.3 preoperatively to 86.8 ± 10.3 at 1 year (P < .001), 87.5 ± 9.9 at 5 years (P < .001), and 86.5 ± 10.5 at 10 years (P < .001) postoperatively. The mean function score also improved continuously from 62.5 ± 12.1 preoperatively to 90.7 ± 12.9 at 1 year (P < .001), 91.6 ± 12.1 at 5 years (P < .001), and 88.5 ± 13.1 at 10 years (P < .001) postoperatively. Three knees underwent conversion to total knee arthroplasty within 10 years postoperatively. The deteriorated KSS group showed significantly progressed ICRS grades in the lateral compartment compared with the non-deteriorated KSS group. The ICRS grade in the lateral compartment at second-look arthroscopy was identified as the only significant factor associated with both knee score deterioration (odds ratio, 4.89; P = .03) and function score deterioration (odds ratio, 3.91; P = .03) on multivariable logistic regression analysis. CONCLUSIONS: The presence of cartilage degeneration of the lateral compartment of the knee at second-look arthroscopy is associated with deterioration of long-term clinical outcomes after OWHTO. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

DOI： 10.1016/j.arthro.2023.03.032

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

This study was designed to test the hypothesis that blockade of vascular endothelial growth factor (VEGF) suppresses degenerative changes in articular cartilage from patients with osteoarthritis (OA).

Methods

Articular cartilage from eight OA patients was subjected to explant culture for 2 days in the presence or absence of 10 ng/ml recombinant interleukin (IL)-1β. The blocking effect of VEGF was examined by the addition of 10 or 100 ng/ml of bevacizumab. The culture media were harvested, and markers for cartilage degradation were measured by sandwich enzyme-linked immunoassay. Total RNA was isolated from cartilage tissues, and gene expressions associated with the anabolic response were examined by the quantitative real-time polymerase chain reaction.

Results

Bevacizumab significantly reduced concentrations of matrix metalloproteinase (MMP)-2, MMP-3, and cartilage oligomeric matrix protein in the culture media with and without IL-1β. Significant suppressive effects of bevacizumab on MMP-9 and MMP-13 were shown only in the presence of IL-1β. Gene expression of Col2a1 was significantly increased by the addition of bevacizumab in the absence of IL-1β.

Conclusion

Bevacizumab inhibits catabolic reactions and stimulates anabolic function in articular cartilage derived from OA patients directly, suggesting a protective effect on articular cartilage from OA progression.

DOI： 10.1186/s13018-023-03512-2

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その他リンク： https://link.springer.com/article/10.1186/s13018-023-03512-2/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Previous work suggested that tenogenic differentiation of tendon stem/progenitor cells (TSPCs) was suppressed by upregulated expression of the angiogenic marker vascular endothelial growth factor (VEGF). The purpose of this study was to test the hypothesis that anti-VEGF antibody, bevacizumab, promotes in vitro tenogenic differentiation and maturation of two distinct types of TSPCs, tendon proper-derived cells (TDCs), and paratenon-derived cells (PDCs) originating from rat Achilles tendon. TDCs and PDCs were isolated from the tendon proper and the paratenon of rat Achilles tendons. TDCs and PDCs were cultured for 3 days on plates with or without VEGF. TDCs and PDCs were also cultured in collagen gel matrix, and the blocking effect of VEGF was examined by the addition of 100 ng/mL of bevacizumab. Effects of bevacizumab on tenogenic differentiation were assessed using real-time PCR, immunofluorescent staining, and western blotting. VEGF significantly attenuated expression of the Tnmd gene in both PDCs and TDCs (P<0.05). Expressions of the Scx, Tnmd, and Col1a1 genes were significantly upregulated by the addition of bevacizumab (P<0.05). Immunofluorescent staining showed that the percentage of tenomodulin-positive PDCs and TDCs was significantly higher with bevacizumab treatment than in control cultures (P<0.05). Western blotting showed that bevacizumab suppressed pVEGFR-2 protein expression in both PDCs and TDCs. Bevacizumab promoted the in vitro tenogenic differentiation and maturation of two distinct TSPCs derived from rat Achilles tendon. Since the previous studies demonstrated that TSPCs have a potential to contribute to tendon repair, attenuating VEGF levels in TSPCs by administration of bevacizumab is a novel candidate therapeutic option for promoting tendon repair.

DOI： 10.1371/journal.pone.0293463

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Double level osteotomy (DLO) has been introduced to prevent increased postoperative joint line obliquity. However, although DLO is planned, knees with postoperative medial proximal tibial angle (MPTA) > 95° in preoperative surgical planning are present. This retrospective study aimed to evaluate risk factors for an MPTA > 95° in preoperative surgical planning for DLO in patients with varus knee osteoarthritis (OA). METHODS: A total of 168 knees that underwent osteotomies around the knee for varus knee OA were enrolled. The hip-knee-ankle angle (HKA), weight-bearing line (WBL) ratio, mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and mechanical medial proximal tibial angle (mMPTA) were measured on preoperative radiographs. The postoperative WBL ratio was planned to be 62.5%. When the postoperative mMPTA was more than 95° in isolated high tibial osteotomy (HTO), (DLO) was planned so that the postoperative mLDFA was 85°, and residual deformity was corrected by HTO. Knees with postoperative mMPTA ≤ 95° and > 95° were classified into the correctable group and uncorrectable group, respectively. RESULTS: DLO was required in 101 knees (60.1%). Among them, 41 knees (40.6%) were classified into the uncorrectable group. Binomial logistic regression analysis showed that preoperative JLCA and mMPTA were independent predictors in the uncorrectable group. CONCLUSIONS: Even with DLO, postoperative mMPTA was more than 95° in approximately 40% of cases. Preoperative increased JLCA and decreased mMPTA were risk factors for a postoperative mMPTA of > 95° after DLO.

DOI： 10.1186/s12891-022-06101-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study was to evaluate the reproducibility of planned component positioning including tibial rotational alignment in patient-specific instrumentation (PSI) for total knee arthroplasty (TKA). METHODS: A total of 100 knees of 100 patients underwent TKA using PSI (n = 50) or the conventional method (n = 50). Full-length anteroposterior radiographs of the lower limb were taken in the standing position, and the coronal alignments of the femoral and tibial components were measured. Computed tomography (CT) images of the lower limb were obtained preoperatively and postoperatively, and the rotational alignments of the femoral and tibial components were measured. The difference from the preoperative planning in tibial rotational alignment was measured using three-dimensionally merged pre- and postoperative images. The mean values and rates of outliers in each measurement were compared between the PSI group and the conventional group. RESULTS: There were no significant differences in coronal alignment of the femoral and tibial components and rotational alignment of the femoral component between the two groups. With respect to rotational alignment of the tibial component from the preoperatively planned reference axis, the PSI group showed a lower rate of outliers (internal rotation > 10°) than the conventional group (p < 0.05). CONCLUSIONS: This study demonstrated that the difference from the preoperative planning in tibial rotational positioning was accurately evaluated using novel three-dimensional measurement method, and PSI could reduce outliers in rotational alignment of the tibial component (internal rotation > 10°). PSI is a useful technique for improving the reproducibility of the planned tibial rotational positioning in TKA.

DOI： 10.1186/s13018-022-03298-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We evaluated the relationship between the weight-bearing line (WBL) ratio and anatomical femorotibial angle (FTA) by simulated open wedge high tibial osteotomy (OWHTO). This study evaluated the correlation between the ''Fujisawa point'' and FTA, and identified factors which caused deviations between the two measurement methods. We hypothesized that the Fujisawa point corresponded with 170° of the FTA. METHODS: Preoperative antero-posterior full-length lower limb radiographs of 82 patients were obtained for the OWHTO to place the WBL ratio at a target of 62.5% of the width of the tibial plateau (Fujisawa point). The coronal alignment was measured pre- and post-planning. The patients were divided into two groups by the post-planning FTA: a correspondence group (168.5°≦FTA≦171.5°) and a non-correspondence group (FTA < 168.5°, 171.5° < FTA). The relationship between the Fujisawa point and the FTA was analyzed with multivariate regression analysis. RESULTS: The post-planning FTA was 169.8 ± 1.1° and within 170 ± 1.5° in 69 cases (84.1%) when the WBL ratio was 62.5%. The neck shaft angle was 128.1 ± 5.2° in the correspondence group, and 122.3 ± 6.3° in the non-correspondence group. The multivariate linear regression analysis revealed that the neck shaft angle was the only factor that predicted the correspondence of the Fujisawa point with the FTA at 170° (p = 0.006, odd 1.28). CONCLUSIONS: The post-planning FTA converged at 170° when the WBL ratio passed through the Fujisawa point and the neck shaft angle was the only predictor.

DOI： 10.1186/s12891-022-05734-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To evaluate joint orientation angles of the coronal plane in patients with rheumatoid arthritis (RA) in comparison with osteoarthritis (OA). METHODS: In total, 72 patients with RA (90 knees) and 76 patients with OA (90 knees) who underwent total knee arthroplasty were enrolled. The hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative long-leg radiographs in the standing position. Student's t-test was used to assess differences in radiographic data between patients with RA and OA. RESULTS: In knees with RA and OA, the mean HKA was -3.4 ± 9.4° and -10.6 ± 8.0°, the mean mLDFA was 86.6 ± 3.7° and 88.2 ± 2.7°, the mean mMPTA was 85.9 ± 4.0° and 84.3 ± 3.7°, and the mean JLCA was 2.7 ± 4.2° and 6.8 ± 4.1°. All parameters in the knees with RA were more valgus than those with OA. CONCLUSIONS: Knees with RA had a great variability in joint orientation angles on the coronal plane; the whole lower limb alignment and the femur, tibia, and joint were more valgus in knees with RA than with OA.

DOI： 10.1093/mr/roab046

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE PUBLICATIONS INC  

Objective The purpose of this study was to evaluate the mid-term clinical outcomes of osteochondral autograft transplantation (OAT) with concomitant high tibial osteotomy (HTO) in spontaneous osteonecrosis of the knee (SONK) with a large lesion. Design A total of 48 knees of 48 consecutive patients with SONK (lesion size >= 4 cm(2), no age criteria) who underwent opening wedge HTO and concomitant OAT were retrospectively investigated, and those who were followed up postoperatively for at least 5 years were included in this case series study. Clinical outcomes were evaluated using knee and function scores of Knee Society Score, radiographic outcomes were evaluated using the anatomical femorotibial angle (FTA), and these outcomes were compared between patients aged >= 70 years and Results Of the 48 cases, a total of 43 cases were available for review at a minimum of 5 years, and 5 cases were excluded from the analysis. Overall, the mean knee score improved from preoperative 48.8 +/- 13.3 to postoperative 87.9 +/- 8.6 at 1 year (P < 0.05) and 85.0 +/- 10.4 at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). The mean function score also improved from preoperative 60.1 +/- 10.9 to postoperative 87.3 +/- 12.2 at 1 year (P < 0.05) and 84.2 +/- 12.4 at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). The mean standing FTA was corrected significantly from 181.1 degrees +/- 2.7 degrees preoperatively to 169.7 degrees +/- 2.4 degrees at 1 year (P < 0.05) and 169.4 degrees +/- 3.1 degrees at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). There were no significant differences in clinical and radiographic outcomes between patients aged >= 70 years and <70 years. There were 4 cases of lateral hinge fracture around the osteotomy site and 1 case of delayed union. None of the patients underwent revision surgery during the follow-up period (survival rate of 100%). Conclusions Mid-term clinical outcomes of patients with SONK who underwent HTO and OAT with a relatively large lesion were good.

DOI： 10.1177/19476035221126341

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE PUBLICATIONS INC  

Objective The purpose of this study was to evaluate the postoperative status of spontaneous osteonecrosis of the knee (SONK) after high tibial osteotomy (HTO) with concomitant bone marrow stimulation (BMS) using synovial fluid (SF) biomarkers. Design Twenty patients with SONK who underwent opening wedge HTO were enrolled. Paired SF samples from the affected knee were collected at the time of HTO surgery and at the time of plate removal. SF concentrations of interleukin (IL)-6, IL-8, and matrix metalloproteinase (MMP)-13 were measured by enzyme-linked immunosorbent assays. The Knee Society Score (KSS) and hip-knee-ankle (HKA) angle were assessed before and 2 years after HTO. Results The KSS knee and function scores were significantly improved after HTO (mean changes of 33.8 and 29.4, respectively). The mean HKA angle was changed from mechanical varus (-8.6 degrees) to valgus (5.2 degrees). Concentrations of IL-6, IL-8, and MMP-13 were significantly decreased after HTO (mean changes of -73.7%, -32.4%, and -47.9% from preoperative baseline, respectively). Significant correlations were found between lesion size and concentrations of biomarkers, except for preoperative MMP-13. Conclusions SF levels of biomarkers of inflammation and cartilage degradation were reduced after HTO with a concomitant BMS procedure, suggesting a biological improvement in SONK.

DOI： 10.1177/19476035221118171

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To evaluate the difference in surgical planning of osteotomies around the knee between preoperative standing and supine radiographs and to identify risk factors for discrepancies in surgical planning. METHODS: This study included 117 knees of 100 patients who underwent osteotomies around the knee for knee osteoarthritis with genu varum. Surgical planning was performed so that the target point of the postoperative weight-bearing line (WBL) ratio was 62.5% in preoperative standing and supine radiographs. If the opening gap would be > 13 mm in open-wedge high tibial osteotomy (OWHTO), closed-wedge HTO (CWHTO) was planned. If the postoperative mMPTA would be > 95° in isolated HTO, double-level osteotomy (DLO) was planned. In DLO, lateral closed-wedge distal femoral osteotomy was performed so that the postoperative mechanical lateral distal femoral angle (mLDFA) was 85°, and any residual varus deformity was corrected with HTO. RESULTS: Surgical planning differed between standing and supine radiographs in 43.6% of cases. In all knees for which surgical planning differed between standing and supine radiographs, a more invasive type of osteotomy was suggested by standing radiographs than by supine radiographs. The risk factors for discrepancies in surgical planning were a lower WBL ratio in standing radiographs and a lower joint line convergence angle in supine radiographs. CONCLUSIONS: Surgical planning of DLO, CWHTO and OWHTO, in standing radiographs differed from that in supine radiographs in nearly half of the cases. Surgical planning based on standing radiographs leads to more invasive surgical procedures compared to supine radiographs.

DOI： 10.1186/s12891-022-05461-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To evaluate the anterolateral cortex distance between the lateral edge of the flange and hinge point in surgical simulations of biplanar open wedge high tibial osteotomy (OWHTO) using computed tomography (CT) images. METHODS: A total of 110 knees treated with OWHTO for medial knee osteoarthritis with varus malalignment were enrolled. Surgical simulations of biplanar OWHTO, including the transverse and ascending cuts, were performed in the standard manner using preoperative CT images. The distance between the lateral edge of the flange and the hinge point was measured. In addition, another plane of the ascending cut was defined through the hinge point. The angle between these two planes of the ascending cut was measured in the axial plane. RESULTS: The mean anterolateral cortex distance was 9.4 ± 4.6 mm (range, - 1.5 mm - 20.3 mm). In 3 knees, osteotomy of the anterolateral cortex was not needed. The mean value of the angle between the two ascending cut planes was 8.4 ± 3.6° (range, - 2.1° - 14.8°), which meant that osteotomy of anterolateral cortex was not needed when the ascending cut was performed at this angle. Moreover, these two values increased when the flange thickness was changed from one-third to one-fourth of the anteroposterior tibial diameter or the angle between the transverse and ascending cuts was changed from 110° to 120°. CONCLUSIONS: In biplanar OWHTO, anterolateral cortex osteotomy would be required. However, the range of the required anterolateral cortex osteotomy distance varied widely and the required anterolateral cortex osteotomy distance depended on the flange thickness and the angle between the transverse and ascending cuts. In addition, change of the ascending cut plane can change the necessity of anterolateral cortex osteotomy.

DOI： 10.1186/s12891-022-05283-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate whether the frequency of interference between locking screws for the plate fixation and tibial tunnels differs depending on the tibial tunnel positions in a surgical simulation of the transtibial pull-out repair of medial meniscus posterior root tears (MMPRTs) in patients undergoing biplanar open wedge high tibial osteotomy (OWHTO). METHODS: Sixty-five patients (75 knees) who underwent OWHTO with TomoFix small plate (Depuy Synthes, PA, USA) for medial knee osteoarthritis with varus malalignment were enrolled in this study. Surgical simulation of transtibial pull-out repair of MMPRTs was performed using postoperative computed tomography images. The tibial tunnel was created in the anatomical attachment area of the medial meniscus posterior root. Another aperture of the tibial tunnel was created on the anteromedial (AM) tibial cortex, the posteromedial (PM) tibial cortex, and the anterolateral (AL) tibial cortex in the proximal tibial fragment. The frequency of interference between the tibial tunnel and A-D locking screws was compared in the 3 tibial tunnel positions. In each tibial tunnel position, the locking plate position with and without interference between the tibial tunnel and at least one locking screw was compared. RESULTS: For screw A, the frequency of interference with the tibial tunnel in the AL position was higher than that in the AM (P = 0.048) and PM positions (P <  0.001). For screws B and C, the frequency of interference with the tibial tunnel in the AM position was higher than that in the PM (P <  0.001, P = 0.007) and AL positions (P <  0.001, P = 0.001), respectively. For screw D, there was no difference in the frequency of interference with the tibial tunnel among the three positions. The frequency of interference between the tibial tunnel and at least one screw in the AM position was 100%, which was higher than that in the PM (P <  0.001) and AL positions (P <  0.001). In the PM position, the locking plate was placed more posteriorly in the group where the locking screw interfered with the tibial tunnel. In the AL position, the locking plate was placed more parallel to the medial/lateral axis of the tibial plateau in the interference group. CONCLUSION: Making the tibial tunnel in the AM position should be avoided because interference with locking screws was inevitable. When the tibial tunnel is created in the PM position, interference between the tibial tunnel and screw C should be paid attention. Anterior placement of the locking plate could be useful to prevent interference between locking screws and the tibial tunnel in the PM position. In addition, when the tibial tunnel is created in the AL position, interference between the tibial tunnel and especially screw A among screws A-C should be paid attention. Placing the locking plate in an anteromedial direction could be useful to prevent interference between locking screws and the tibial tunnel in the AL position. LEVEL OF EVIDENCE: IV.

DOI： 10.1186/s40634-022-00464-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

The purpose of this study was to evaluate return to sports (RTS) after opening wedge high tibial osteotomy (OWHTO) in elderly patients and associated factors affecting RTS.

Methods

Seventy-four patients (mean age 68 years) who underwent OWHTO were enrolled. Clinical outcomes were evaluated using the Knee Society Score (KSS). Patients were asked regarding types of sports activities and their levels of participation within preoperative 1 year and postoperative 1 year. Levels of participation in sports and recreational activities were examined using the Tegner activity scale. The outcomes were compared between two age groups (≥ 70 years vs. &lt; 70 years).

Results

Of the 74 patients overall, 59 participated in at least one sport preoperatively, and 55 returned to sports postoperatively (RTS 93%). The KSS knee score and function score were significantly improved after surgery in both age groups (P &lt; 0.05), but no significant differences were found between the age groups. The Tegner activity scales for ≥ 70 years and &lt; 70 years were 2.9 ± 1.1 and 4.0 ± 1.9 preoperatively (P &lt; 0.01) and 2.7 ± 1.2 and 3.3 ± 1.4 postoperatively (P = 0.16), respectively. RTS was reported by 24 of 25 (96.0%) in the age &lt; 70 years group and 31 of 34 (91.2%) in the age ≥ 70 years group. Majority of age ≥ 70 years participated in low-impact sports preoperatively and returned to the same impact level postoperatively.

Conclusions

The rate of RTS after OWHTO was high in patients aged 70 years and older with low-impact level. OWHTO is a preferred surgical option for elderly patients who desire RTS.

DOI： 10.1186/s13018-021-02718-6

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その他リンク： https://link.springer.com/article/10.1186/s13018-021-02718-6/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The purpose of this study was to evaluate the area of the osteotomy surface, including the flange and wedge volume, in open wedge high tibial osteotomy (OWHTO), distal tibial tuberosity osteotomy (DTO), and distal tibial tuberosity arc osteotomy (DTAO) using tibial sawbones. It was hypothesized that the area of the osteotomy surface, including the flange, in DTAO was larger than that in OWHTO and DTO and that the wedge volume in DTAO was smaller than that in OWHTO and DTO. METHODS: Fifteen tibial sawbones were divided equally into three groups: OWHTO, DTO, and DTAO. The total area of the osteotomy surface in OWHTO, DTO, and DTAO was compared using image analysis software. The contact area of the flange and the wedge volume at wedge heights of 5, 10, and 15 mm were compared among osteotomy types. One-way repeated-measures analysis of variance was used to compare the total area of the osteotomy surface, the contact area of the flange, and the wedge volume at 5, 10, and 15 mm in OWHTO, DTO, and DTAO. RESULTS: The total area of the osteotomy surface in DTO and DTAO was significantly larger than that in OWHTO (P < 0.05). The contact area of the flange in DTAO was significantly larger than that in OWHTO at each wedge height (P < 0.05). In addition, the contact area of the flange in DTAO was significantly larger than that in DTO at wedge heights of 5 and 15 mm (P < 0.05). The wedge volume in DTAO was significantly smaller than that in DTO at each wedge height (P < 0.05). CONCLUSIONS: This study demonstrated that an increase in the flange contact area and a decrease in the wedge volume in the opening gap were found in DTAO compared to DTO. This would be an advantage for anteroposterior screw insertion from the flange to the distal tibial fragment and bone union at the osteotomy site.

DOI： 10.1007/s00167-020-06296-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Chronic myeloid leukemia (CML) is a form of myeloproliferative neoplasm caused by the oncogenic tyrosine kinase BCR-ABL. Although tyrosine kinase inhibitors have dramatically improved the prognosis of patients with CML, several problems such as resistance and recurrence still exist. Immunological control may contribute to solving these problems, and it is important to understand why CML patients fail to spontaneously develop anti-tumor immunity. Here, we show that differentiation of conventional dendritic cells (cDCs), which are vital for anti-tumor immunity, is restricted from an early stage of hematopoiesis in CML. In addition, we found that monocytes and basophils, which are increased in CML patients, express high levels of PD-L1, an immune checkpoint molecule that inhibits T cell responses. Moreover, RNA-sequencing analysis revealed that basophils express genes related to poor prognosis in CML. Our data suggest that BCR-ABL not only disrupts the "accelerator" (i.e., cDCs) but also applies the "brake" (i.e., monocytes and basophils) of anti-tumor immunity, compromising the defense against CML cells.

DOI： 10.1038/s41598-021-97371-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study aimed to investigate the prevalence of patients with rheumatoid arthritis (RA) at a high risk of major osteoporosis (OP)-related fractures and the status of OP-related medical treatment for these patients. METHODS: We enrolled 120 patients aged ≥40 years (average, 69.1 years) with RA. The Fracture Risk Assessment Tool (FRAX®) was used to evaluate the fracture risk. Of the 120 patients, the femoral neck bone mineral density (BMD) was evaluated in 102 patients, and their FRAX® scores were calculated alongside the BMD values. Patients observed to be at a high risk of a major OP-related fracture (10-year probability >20% or hip fracture risk >3%), according to FRAX®, were identified as those requiring OP treatment; medication ratio for OP (percentage of patients actually receiving medication among patients requiring OP treatment) was assessed. RESULTS: OP treatment was indicated in 75 (63%) patients; the medication ratio for OP was 49%. The use of biological disease-modifying anti-rheumatic drugs and corticosteroids showed a positive effect; however, the use of methotrexate showed a negative effect on the medication ratio. CONCLUSION: The number of potential patients requiring OP treatment is underestimated. All patients with RA should be assessed to determine their eligibility for OP treatment.

DOI： 10.1080/14397595.2020.1847752

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To determine whether medialization of the proximal tibia due to a varus deformity is related to lateralization of the tibial tuberosity in varus knee osteoarthritis (OA). METHODS: A total of 120 knees that underwent osteotomies around the knee for varus knee OA were enrolled. Mechanical medial proximal tibial angle (mMPTA) was measured on radiographs. The angle between the mechanical and anatomical axes of the tibia (angle MA) and the distance between the centre of the tibial plateau and the anatomical axis (distance MA) were measured in the coronal plane on computed tomography images. The tibial tuberosity-posterior cruciate ligament (TT-PCL) distance, the distance between the midpoint of the tibial tuberosity and the centre of the tibial plateau (TT-centre distance), and the angle between the line through the midpoint of the tibial tuberosity and the centre of the tibial plateau and the anteroposterior axis (TT-centre angle) were measured in the axial plane. The correlations of these parameters were evaluated. RESULTS: mMPTA correlated negatively with angle MA (r = -0.37, P < 0.01) and distance MA (r = -0.55, P < 0.01). Angle MA and distance MA correlated with TT-PCL distance (r = 0.39, P < 0.01, r = 0.42, P < 0.01), TT-centre distance (r = 0.35, P < 0.01, r = 0.38, P < 0.01) and TT-centre angle (r = 0.36, P < 0.01, r = 0.36, P < 0.01). CONCLUSIONS: Medialization of the proximal tibia due to a varus deformity may induce lateralization of the tibial tuberosity.

DOI： 10.1016/j.knee.2021.03.023

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

Purpose:

The aim of this study was to assess differences in clinical outcomes and postoperative cartilage repair between opening wedge high tibial osteotomy (OWHTO) and closed wedge HTO (CWHTO) for medial osteoarthritis (OA) of the knee.

Methods:

A total of 90 knees of 76 patients who underwent OWHTO (45 knees of 40 patients) and CWHTO (45 knees of 36 patients) was followed-up for 2 years. Cartilage repair at the medial compartment was arthroscopically classified into the following stages: Stage 1 (no reparative change); Stage 2 (partial coverage with white cartilaginous tissue); and Stage 3 (full coverage with white cartilaginous tissue). Clinical outcomes were assessed using Knee Society scores, and radiographic assessment was carried out by anatomical femorotibial angle (aFTA).

Results:

Regarding preoperative OA grade, varus alignment, and function score, CWHTO patients showed more advanced OA status than OWHTO patients. Knee scores and function scores were significantly improved after surgery with both HTO procedures (P &lt; 0.05), with no significant difference between the two procedures. Cartilage repair of stage 2 or 3 was found in more than 80% of the subjects in the medial femoral condyle and more than 60% in the medial tibial condyle. However, there were no significant differences between the two HTO procedures. Multivariate logistic regression analysis showed that preoperative International Cartilage Repair Society (ICRS) grade was the only factor affecting cartilage repair.

Conclusions:

CWHTO improved clinical outcomes and cartilage status as much as OWHTO. Although the effects of cartilage repair on clinical outcomes are unknown, HTO is an effective treatment option even for severe medial OA of the knee.

DOI： 10.1177/23094990211020366

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その他リンク： http://journals.sagepub.com/doi/full-xml/10.1177/23094990211020366

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This study investigated the relationship between femoral shaft bowing and the orientation of the surgical transepicondylar axis (TEA) in the coronal plane in varus knee osteoarthritis (OA). METHODS: A total of 82 knees scheduled to undergo total knee arthroplasty (TKA) for the treatment of varus knee OA were enrolled. The hip-knee-ankle angle (HKA) was measured preoperatively on anteroposterior whole-leg standing radiographs. The lateral angle between the TEA and the mechanical axis of the femur (MA-TEA) was measured in the coronal plane from preoperative computed tomography (CT) images. Femoral shaft bowing was measured on CT images. Pearson's correlation coefficient was used to examine the correlation of the MA-TEA with the HKA and femoral shaft bowing. RESULTS: The MA-TEA correlated negatively with the HKA (r = - 0.321, P < 0.01) and positively with femoral shaft bowing (r = 0.415, P < 0.01). CONCLUSIONS: The TEA changed to varus as femoral shaft bowing increased in patients with varus knee OA. This suggests that the TEA is not always the centre of the rotational axis of the femur after TKA. In addition, the TEA may not be useful as a consistent parameter in the coronal plane in patients with increasing femoral shaft bowing. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-020-06025-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The aim of this study was to investigate whether the tibial tuberosity-trochlear groove (TT-TG) distance and lateral patellar tilt, which induce patellofemoral osteoarthritis (OA), are related to the coronal deformity of the lower limb in varus knee OA. It was hypothesized that varus inclination of the tibia was negatively correlated with the TT-TG distance and lateral patellar tilt in Japanese female patients with moderate knee OA. METHODS: A total of 104 female patients (139 knees) scheduled to undergo knee osteotomy for varus knee OA were enrolled. The coronal lower limb alignment was measured on anteroposterior whole-leg radiographs. The TT-TG distance, patellar tilt angle, and the patellofemoral joint space were measured both medially and laterally on computed tomography images. The correlations between coronal lower limb alignment and the TT-TG distance or patellar tilt angle, and the correlations between the TT-TG distance or patellar tilt angle and patellofemoral joint space were evaluated. RESULTS: The medial proximal tibial angle was negatively correlated with the TT-TG distance (r =  - 0.383, P < 0.01) and patellar tilt angle (r =  - 0.34, P < 0.01). Lateral patellofemoral joint space was negatively correlated with the TT-TG distance (r =  - 0.256, P = 0.002) and patellar tilt angle (r =  - 0.205, P = 0.016). CONCLUSIONS: Varus inclination of the proximal tibia may induce lateralization of the tibial tuberosity and lateral patellar tilt. The tibial tuberosity lateralization and lateral patellar tilt may induce lateral patellofemoral OA in patients with varus knee OA. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-020-06000-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study was to investigate the correction error associated with soft tissue balance in high tibial osteotomy (HTO) and the difference between opening wedge HTO (OWHTO) and closed wedge HTO (CWHTO). METHODS: A total of 170 knees of 130 patients (85 knees of 68 patients in OWHTO and 85 knees of 62 patients in CWHTO) were evaluated. Anteroposterior radiographs of the knee and full-length leg were taken preoperatively, immediately under general anesthesia postoperatively, 2 days, and 1 and 12 months postoperatively. The femorotibial angle (FTA), joint line convergence angle (JLCA), and medial proximal tibial angle (MPTA) were measured. RESULTS: The postoperative FTA was decreased from 170.5 ± 2.1° at 0 day to 168.6 ± 2.2° at 2 days in OWHTO (P < 0.05), whereas it was not changed from 168.7 ± 2.4° at 0 day to 168.1 ± 2.8° at 2 days in CWHTO. The JLCA was 4.8 ± 1.8° preoperatively, 4.2 ± 1.9° at 0 day, 2.2 ± 1.8° at 2 days (P < 0.05 vs 0 day), 2.6 ± 1.7° at 1 month, and 2.7 ± 1.6° at 12 months in OWHTO, and 7.1 ± 3.2° preoperatively, 4.1 ± 2.4° at 0 day (P < 0.05 vs preoperative), 3.4 ± 2.5° at 2 days, 3.9 ± 2.3° at 1 month, and 4.2 ± 2.6° at 12 months in CWHTO. Multiple regression analysis showed that preoperative factors affecting change of the JLCA from preoperative to postoperative 1 month were the correction angle in OWHTO (P = 0.001) and the preoperative standing JLCA in OWHTO (P < 0.001) and CWHTO (P < 0.001). CONCLUSIONS: A significant decrease of the JLCA occurred immediately after osteotomy under anesthesia in CWHTO, whereas in OWHTO there was no decrease under anesthesia, but it decreased several days postoperatively.

DOI： 10.1186/s13018-021-02214-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The purpose of this study was to assess early postoperative loss of achieved correction and associated factors after opening wedge high tibial osteotomy (OWHTO). MATERIALS AND METHODS: OWHTO was performed in 121 patients with osteoarthritis of the knee (mean age 66 years, 154 knees). Anteroposterior radiographs of the knee and full-length leg, and varus and valgus stress radiographs of the knee were taken, and the femorotibial angle (FTA), joint line convergence angle (JLCA), and medial proximal tibial angle (MPTA) were measured. The changes in the FTA, JLCA, and MPTA were defined as ΔFTA, ΔJLCA, and ΔMPTA. RESULTS: The ΔFTA and ΔJLCA at postoperative 0-2 days were - 1.8 ± 1.2° and - 1.9 ± 1.4°, respectively. The ΔFTA, ΔJLCA and ΔMPTA at postoperative 1-12 months were 0.9 ± 1.3°, 0.2 ± 1.2° and - 0.8 ± 0.8°, respectively. A positive correlation was found between ΔFTA and ΔJLCA at postoperative 0-2 days (ρ = 0.642, P < 0.001) and at postoperative 1-12 months (ρ = 0.402, P < 0.001). A negative correlation was found between ΔFTA and ΔMPTA at postoperative 1-12 months (ρ = - 0.534, P < 0.001). A discrepancy in alignment represented by the FTA occurred in the supine radiographs between the day of surgery and postoperative 2 days. Multiple regression analysis suggested that postoperative JLCA on the day of surgery was the factor related to early postoperative change of the FTA. CONCLUSIONS: This study demonstrated the early loss of achieved correction after OWHTO due to change of the JLCA, even if the accurate alignment is obtained intraoperatively.

DOI： 10.1007/s00402-020-03419-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The present study is aimed at assessing the changes in tibial rotation at the osteotomy site after an open-wedge, high-tibial osteotomy (OWHTO) and analysing the factors that affect rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the same site. This study involved 53 patients (60 knees; 16 males and 37 females) with medial osteoarthritis (OA) who underwent OWHTO and preoperative and 3-month postoperative computed tomography (CT) scans. Rotational angles of the distal tibia were measured using Stryker OrthoMap 3D by comparing preoperative and postoperative CTs. The mean rotational angle yielded an external rotation of 2.9° ± 4.8°. There were 17 knees with internal rotations, 37 knees with external rotations, and one knee with no rotation. The rotational angle significantly correlated with the resultant change in the femorotibial angle (correction angle) and the angle between the ascending and transverse osteotomy lines on the anterior osteotomised surface on which a flange was formed with the distal tibial osteotomised surface (flange angle). The flange angle affected the rotation, but it may have been affected by our surgical technique. The rotational angle did not significantly correlate with the change in the angle of the posterior tibial slope or body mass index. There were significant correlations between the rotational angle and correction angle (r = 0.42, p < 0.05). Additionally, the rotational angle correlated with the flange angle (r = -0.41, p < 0.05).

DOI： 10.1155/2021/6357109

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: This study evaluated the effect of surgical intervention on disease activity and factors associated with postoperative disease activity in patients with rheumatoid arthritis (RA).Methods: One hundred and seventy-five patients with RA who underwent a single orthopaedic surgical procedure with 1 year of follow-up were retrospectively reviewed to assess postoperative changes in disease activity using disease activity score in 28 Joints calculated with C-reactive protein (DAS28-CRP). European League against Rheumatology (EULAR) response criteria were used to assess the response to surgical intervention.Results: Overall disease activity was significantly improved after surgery. Therapeutic regimens including biological/targeted-synthetic (b/ts) disease-modifying anti-rheumatic drugs (DMARDs), methotrexate (MTX), and prednisolone (PSL) were not significantly changed 1 year after surgery. Shorter disease duration, surgery of large joints, higher baseline DAS28-CRP, and no use of b/tsDMARDs affected postoperative improvement of disease activity. Multivariate logistic regression analysis revealed that large joint surgery and no preoperative use of b/tsDMARDs were independent factors leading to good response to EULAR criteria after surgery (OR = 2.70; 95% CI, 1.03-7.06; p < .05, OR = 4.09; 95% CI, 1.50-11.14; p < .01, respectively).Conclusion: Significant improvement of disease activity after surgical intervention may be expected in patients with RA with large joint surgeries or no preoperative use of b/tsDMARDs.

DOI： 10.1080/14397595.2019.1702252

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). METHODS: A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. RESULTS: CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P <  0.05), and a greater soft tissue correction than OWHTO (P <  0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P <  0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. CONCLUSIONS: The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.

DOI： 10.1186/s12891-020-03703-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To investigate the relationship between femoral or tibial torsion and hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), or mechanical medial proximal tibial angle (mMPTA) in patients with medial knee osteoarthritis (OA). METHODS: A total of 75 knees were enrolled. Femoral and tibial torsions were measured by superimposing the axial planes of computed tomography images. The relationship between femoral or tibial torsion and HKA, mLDFA, or mMPTA on radiographs was examined. RESULTS: The mean femoral torsion was 12.2 ± 8.5° internally; femoral internal and external torsions were observed in 70 and 5 knees, respectively. The mean tibial external torsion was 18.0 ± 7.4° externally; tibial external torsion was observed in all 75 knees. Femoral internal and tibial external torsions increased with lower mMPTA (r = 0.33, P = 0.003; r = - 0.32, P = 0.005, respectively) but were not related to HKA or mLDFA. CONCLUSION: Femoral and tibial torsions were correlated with varus inclination of the proximal tibia in patients with medial knee OA.

DOI： 10.1186/s12891-020-03286-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study was to investigate the healing process of synthetic bone grafts in opening wedge high tibial osteotomy (OWHTO) and to identify the factors that affect bone healing in OWHTO. It was hypothesized that lateral hinge fracture (LHF) is associated with delayed bone healing after OWHTO with synthetic bone grafting. METHODS: The subjects included 350 knees of 283 patients who underwent OWHTO using two wedged blocks of beta-tricalcium phosphate (β-TCP) with 60% porosity. The healing of the osteotomy gap using a radiologic rating system for OWHTO with synthetic bone grafts and the presence of an LHF were assessed up to postoperative 24 months. RESULTS: LHFs were found in 49 knees (14%). The osteotomy gap showed slower progression of radiographic healing with an LHF than without an LHF (P < .05). In the knees with LHFs, initial radiographic change in the osteotomy gap was observed almost at the same time as healing of the LHF. Multivariate logistic regression analysis identified LHF as the factor preventing the progression of bone healing (OR = 46.78, P < .05). CONCLUSIONS: LHF is associated with delayed bone healing after OWHTO with synthetic bone grafting.

DOI： 10.1016/j.knee.2019.10.027

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It is known that Wnt/β-catenin signaling induces endochondral ossification and plays a significant role in the pathophysiology of osteoarthritis (OA). Sclerostin is a potent inhibitor of the Wnt/β-catenin signaling pathway. This study investigated the role of sclerostin in the endochondral differentiation under an OA-like condition induced by proinflammatory cytokines. ATDC5 cells were used to investigate chondrogenic differentiation and terminal calcification, and 10 ng/ml IL-1β and/or 200 ng/ml sclerostin were added to the culture medium. IL-1β impaired early chondrogenesis from undifferentiated state into proliferative chondrocytes, and it was not altered by sclerostin. IL-1β induced progression of chondrogenic differentiation in the late stage and promoted terminal calcification. These processes were inhibited by sclerostin and chondrogenic phenotype was restored. In addition, sclerostin restored IL-1β-induced upregulation of Wnt/β-catenin signaling in the late stage. This study provides insights into the possible role of sclerostin in the chondrogenic differentiation under the IL-1β-induced OA-like environment. Suppression of Wnt signaling by an antagonist may play a key role in the maintenance of articular homeostasis and has a potential to prevent the progression of OA. Thus, sclerostin is a candidate treatment option for OA.

DOI： 10.1371/journal.pone.0239651

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications Inc.  

Background: Platelet-rich plasma (PRP) is a treatment option for tendon injury because of its effective tendon-healing properties. At the early stage of tendon repair, paratenon-derived cells (PDCs) are thought to play a more important role than tendon proper–derived cells (TDCs). However, there has been no study investigating the effects of PRP on PDCs. Hypothesis: PRP promotes the migration, proliferation, and differentiation of PDCs in vitro. Study Design: Controlled laboratory study. Methods: TDCs and PDCs were isolated from the tendon proper and paratenon of rat Achilles tendons and were cultured to the third passage. PRP was prepared from the rats using the double-spin method. Third-passage TDCs and PDCs were cultured in Dulbecco’s modified Eagle medium with 2% fetal bovine serum (control group) or 2% fetal bovine serum plus 5% PRP (PRP group), and cell migration, proliferation, and differentiation were evaluated. The relative mRNA expression levels of scleraxis (Scx), tenomodulin (Tnmd), collagen type I alpha 1 (Col1a1), collagen type III alpha 1 (Col3a1), and vascular endothelial growth factor A (VEGF) were examined by quantitative real-time reverse transcription polymerase chain reaction. Results: The cell migration rate was significantly higher in the PDCs of the PRP group than in the control group (1.4-fold increase
P = 0.02). Cell proliferation was significantly higher in the PDCs of the PRP group (2.2-fold increase
P &lt
0.01). In the PDCs, the gene expression levels of Scx, Col1a1, and VEGF were significantly increased by PRP (Scx: 2.0-fold increase, P = 0.01
Col1a1: 5.3-fold increase, P = 0.01
VEGF: 7.8-fold increase, P = 0.01), but the gene expression level of Tnmd, a factor for tendon maturation, was significantly reduced by PRP (0.11-fold decrease
P = 0.02). Conclusion: In vitro PRP promoted migration, proliferation, and tenogenic differentiation with the upregulation of Scx in PDCs. PRP also upregulated the expression of the angiogenic marker VEGF. Clinical Relevance: Our results suggest that PRP treatment in vitro may enhance the tendon-healing properties of PDCs at the initial stage of tendon repair.

DOI： 10.1177/1941738118807479

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1371/journal.pone.0201839

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W.B. Saunders  

Purpose: To assess whether the increased inclination of the tibial plateau on the coronal view after opening-wedge high tibial osteotomy affects radiographic coronal alignment, clinical outcomes, and cartilage findings. Methods: After adjustment for the preoperative medial proximal tibial angle (MPTA), patients who underwent opening-wedge high tibial osteotomy were retrospectively divided into those with postoperative MPTA values of 95° or less (normal group) and greater than 95° (increased group), with each group containing 43 knees. The 2 groups were compared regarding their arthroscopic cartilage findings at 1 year postoperatively and radiographic coronal alignment and clinical outcomes at 2 years postoperatively. Cartilage regeneration in the medial condyles and cartilage deterioration in the lateral condyles were evaluated at the time of second-look arthroscopy. Clinical outcomes were evaluated by the American Knee Society knee and function scores, Lysholm knee scoring scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: The postoperative anatomic femorotibial angle in the increased group was lower than that in the normal group (P &lt
.001), and the amount of overcorrection in the increased group was higher than that in the normal group (P &lt
.001). The postoperative joint line obliquity in the increased group was higher than that in the normal group (P &lt
.001). Cartilage regeneration in the medial condyles and deterioration in the lateral condyles did not differ significantly on the femoral and tibial sides between the groups. The postoperative American Knee Society knee score and KOOS sports and recreational function subscale score in the normal group were higher than those in the increased group (both P &lt
.001). Conclusions: There were no significant differences in the changes in the appearance of the articular surfaces between the 2 groups at 1 year postoperatively. Patients with a postoperative MPTA greater than 95° had more valgus alignment and higher joint line obliquity and had a lower KOOS sports and recreational function subscale score than patients with a postoperative MPTA of 95° or less at 2 years postoperatively. Level of Evidence: Level III, retrospective comparative study.

DOI： 10.1016/j.arthro.2018.01.055

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Verlag  

Introduction: Rotational malpositioning of the tibial component can lead to poor functional outcome in TKA. Although various surgical techniques have been proposed, precise rotational placement of the tibial component was difficult to accomplish even with the use of a navigation system. The purpose of this study is to assess whether combined CT-based and image-free navigation systems replicate accurately the rotational alignment of tibial component that was preoperatively planned on CT, compared with the conventional method. Materials and methods: We compared the number of outliers for rotational alignment of the tibial component using combined CT-based and image-free navigation systems (navigated group) with those of conventional method (conventional group). Seventy-two TKAs were performed between May 2012 and December 2014. In the navigated group, the anteroposterior axis was prepared using CT-based navigation system and the tibial component was positioned under control of the navigation. In the conventional group, the tibial component was placed with reference to the Akagi line that was determined visually. Fisher’s exact probability test was performed to evaluate the results. Results: There was a significant difference between the two groups with regard to the number of outliers: 3 outliers in the navigated group compared with 12 outliers in the conventional group (P &lt
0.01). Conclusions: We concluded that combined CT-based and image-free navigation systems decreased the number of rotational outliers of tibial component, and was helpful for the replication of the accurate rotational alignment of the tibial component that was preoperatively planned.

DOI： 10.1007/s00402-017-2837-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W.B. Saunders  

Purpose: To evaluate the effects of osteochondral autograft transplantation (OAT) mosaicplasty as a concomitant procedure with opening-wedge valgus high tibial osteotomy (HTO) for spontaneous osteonecrosis of the medial femoral condyle (MFC) on clinical outcomes and cartilage status in comparison with bone marrow stimulation (BMS) by drilling, and to assess the relation between lesion size and postoperative cartilage status. Methods: Fifty-eight patients with spontaneous osteonecrosis of the MFC were treated with opening-wedge HTO and a concomitant procedure of BMS (28 patients) or OAT (30 patients). Clinical evaluation was carried out using the Knee Society Score at postoperative 2 years. Postoperative status of articular cartilage was assessed by arthroscopy according to the International Cartilage Repair Society (ICRS) grade at the time of plate removal. Results: The Knee Society Score objective score and function score were improved at postoperative 2 years compared with preoperative value in both groups, but no significant difference was found between the 2 groups. According to the ICRS overall repair grade, cartilage status was rated as normal or nearly normal (ICRS overall score ≥8) in 41% of the BMS group and 90% of the OAT group. The results suggested that cartilage repair in OAT was significantly better than that in BMS (P =.0015). Furthermore, the BMS group revealed that repair with normal or nearly normal was observed in all less than 4 cm2 of lesion size, whereas the OAT group exhibited that repair with normal or nearly normal was independent of lesion size. Conclusions: This study suggested that OAT is superior to BMS as a concomitant procedure with opening-wedge valgus HTO for spontaneous osteonecrosis of the MFC in the success of cartilage repair. However, clinical outcomes were not significantly different between these 2 procedures. When treating the lesion larger than 4 cm2 by joint-preserving surgery, OAT mosaicplasty is recommended as a concomitant procedure with HTO. Level of Evidence: Level III, therapeutic case-control study.

DOI： 10.1016/j.arthro.2017.08.244

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier B.V.  

Background We evaluated bone union and remodelling in patients undergoing opening-wedge high tibial osteotomy (OWHTO) with bone gaps filled with beta-tricalcium phosphate. We examined the effectiveness of radiography and computed tomography (CT) for the evaluation of bone union and remodelling, and investigated whether lateral hinge fractures affected bone union. Methods Sixty-six cases underwent OWHTO with a combination of a TomoFix plate and a bone substitute. Bone union and remodelling were assessed using the rating system for OWHTO at three and six months, postoperatively. Results Radiographic evaluation showed that bone union of the lateral hinge was 85% and 100% at three and six months, respectively. Based on CT evaluation, bone union of the lateral hinge and the flange was achieved in all cases at six months, and the bone union of the posterior cortex reached Zone 3 in 83% at six months. Based on radiographic evaluation, bone remodelling phases of bone substitute had progressed in each zone in six months compared with three months. Radiographic and CT analyses identified a Takeuchi type I hinge fracture in fourteen (21.2%) and five (7.6%) knees at two weeks postoperatively, respectively. There were no differences in bone union with and without the lateral hinge fracture. Conclusions The use of CT enabled us to evaluate the bone union of the flange and the extent of the bone union of the posterior cortex. Plain radiographs are useful to evaluate bone union of the lateral hinge similar to CT analysis. The presence of a Takeuchi type I hinge fracture did not affect bone union.

DOI： 10.1016/j.knee.2017.06.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Verlag  

Purpose: This study aimed to investigate the incidence of venous thromboembolism (VTE) after medial opening-wedge high tibial osteotomy (OWHTO) and evaluate the efficacy and safety of edoxaban for the prevention of VTE in patients undergoing OWHTO. Methods: A total of 139 patients with osteoarthritis or osteonecrosis undergoing OWHTO were enrolled in this prospective, randomized study. Four patients were excluded because of preoperatively diagnosed VTE, and 135 patients were divided into two groups—an edoxaban group and a non-edoxaban group—and underwent computed tomography venography on day 7 to check for postoperative VTE. Blood samples were taken on the day before OWHTO and on postoperative days 1, 3, 7, and 14. Results: Treatment with edoxaban reduced the incidence of VTE after OWHTO
however, there was no statistically significant difference between the two groups. No major bleeding was noted in the edoxaban group. There were significant differences in the D-dimer level, prothrombin time, fibrinogen level, and thrombin antithrombin complex levels between the groups. Conclusions: Edoxaban is an oral, once-daily, selective, direct factor Xa inhibitor that is safe and easy to handle. It may offer a new option for preventing VTE after OWHTO. Level of evidence: I.

DOI： 10.1007/s00167-016-4065-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: This study evaluated the effect of TKA with capsulosynovectomy on disease activity and knee function in patients with RA. METHODS: Seventy-six RA patients who underwent primary TKA with more than two years of follow-up were retrospectively reviewed to assess postoperative knee function and disease activity. RESULTS: Postoperative knee function was significantly improved in all clinical scores, and maintained up to 24 months after surgery. RA disease activity was significantly decreased in DAS28-CRP, CDAI, and serum CRP level, and maintained up to 24 months after surgery. Postoperative knee function was negatively correlated with RA disease activity. CONCLUSIONS: TKA improves both knee function and disease activity in patients with rheumatoid arthritis.

DOI： 10.1080/14397595.2016.1265705

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

For opening wedge high tibial osteotomy (OWHTO), it is recommended that the osteotomy line is parallel to the medial tibial posterior slope (TPS) in the sagittal view and that the alignments are simultaneously controlled in the coronal and sagittal views. Here combined computed tomography (CT)-based and image-free navigation systems were used for intraoperative reference during OWHTO. Using the CT-based navigation, 2 entry points for insertion of Kirschner wires were preoperatively set up and an accurate osteotomy plane was intraoperatively duplicated. Preoperative planning anticipated a femorotibial angle of 170°, representing a weight-bearing ratio of 62.5%, on the whole-leg radiograph. The original TPS in the sagittal view was aimed to be preserved postoperatively. The hip-knee-ankle (HKA) correction angle was preoperatively measured on the whole-leg radiograph, and the HKA angle and flexion angle were intraoperatively monitored in real time using the image-free navigation. We have introduced an operative technique for OWHTO using CT-based and image-free navigation systems. We expect that this method, with the osteotomy plane parallel to the tibial plateau plane in the sagittal view and simultaneous control of coronal and sagittal alignments, will enable actuation of accurate alignment in the 2 planes and lead to improvements in patient activity in future.

DOI： 10.1016/j.eats.2017.03.036

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We have previously demonstrated that LIPUS stimulates endochondral ossification with decreased expression of sclerostin. The Wnt signaling pathway was examined in vitro to further address the effect of LIPUS on endochondral ossification. MATERIALS AND METHODS: ATDC5 cells were plated at an initial density of 6 × 10 cells/well in a 6-multiwell plate and cultured in the presence of 5% FBS plus ITS. The bottom of the culture plate was treated every day with LIPUS for 20 minutes. The level of calcification and the expression of Wnt signaling were investigated. RESULTS: The area of calcified nodules in the LIPUS-treated group was significantly greater than in the control group. The expression of Wnt was significantly elevated by LIPUS exposure. Markers associated with endochondral ossification were increased in the LIPUS-treated group. When sclerostin was added to the culture media, calcified nodule formation and the expression of Wnt were inhibited in both the LIPUS-treated group and the control group. DISCUSSION: This study suggests that endochondral ossification was stimulated by LIPUS via the Wnt signaling pathway.

DOI： 10.1097/01.bot.0000520898.92470.94

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This study documented the healing potential of degenerated articular cartilage after opening-wedge valgus high tibial osteotomy (HTO) in patients with osteoarthritis of the knee. It was hypothesized that regeneration of articular cartilage is affected by several factors, including preoperative cartilage degeneration grade, difference between the medial femoral condyle (MFC) and the medial tibial condyle (MTC), and postoperative knee alignment. METHODS: Medial opening-wedge valgus HTO was performed in 131 knees of 100 patients (mean age 66 ± 7.7 years). Initial arthroscopy was performed at the time of HTO, and a second-look arthroscopy was performed at the time of plate removal (20.8 ± 6.5 months after HTO). Status of articular cartilage was assessed according to the ICRS grade. Cartilage regeneration was also evaluated by the presence of newly formed cartilaginous tissue. All subjects were followed up postoperatively at 2 years for assessment of clinical and radiographic outcomes. RESULTS: The number of subjects in ICRS grade 1/2/3/4 was significantly altered from 0/11/53/67 preoperatively to 14/21/56/40 postoperatively in the MFC (P < 0.05) and 0/12/62/57 preoperatively to 9/24/64/34 postoperatively in the MTC (P < 0.05). Newly formed cartilaginous tissue was found in 71 % of MFCs and 51 % of MTCs. Incidence of cartilage regeneration was significantly higher in lower BMI cases, MFC, preoperatively advanced ICRS grade and overcorrected knees. Age, gender and clinical outcomes did not affect cartilage regeneration. CONCLUSION: Cartilage regeneration in degenerated articular cartilage is induced after opening-wedge valgus HTO, which is affected by BMI, the difference between the MFC and MTC, preoperative cartilage degeneration grade, and postoperative limb alignment. Therefore, patient selection by BMI rather than age, and surgical techniques maintaining valgus knee alignment should be considered for cartilage regeneration. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

DOI： 10.1007/s00167-016-4096-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The coronal subluxation of the proximal tibia relative to the distal femur is a common radiological finding in patients with knee osteoarthritis. The purpose was to evaluate whether the coronal subluxation was corrected after opening wedge high tibial osteotomy (OWHTO), and whether this subluxation was one cause of inconsistency between the actual and predicted alignments (correction loss). METHODS: Fifty-one patients (55 knees) were treated with OWHTO. The change of location between the intersection points of the femoral and tibial axes on the tibial plateau (subluxation-C), the change of location between the lines through the most lateral points of the lateral femoral and tibial condyles (subluxation-L), and joint space angle (JSA) were compared in standing knee radiographs before and one year after OWHTO. The subluxation-C and subluxation-L were converted to a percentage of the tibial plateau width. RESULTS: The mean subluxation-C of 6.5% before OWHTO significantly increased to a mean subluxation-C of 7.3% one year after OWHTO. The mean subluxation-L of 6.3% and JSA of 4.5° before OWHTO significantly decreased to a subluxation-L of 1.8% and JSA of 3.3° one year after OWHTO. The change in subluxation-L correlated with the change in femorotibial angle and correction loss (r=0.634, P<0.001 and r=0.463, P<0.001, respectively). CONCLUSION: The proximal tibia shifted medially relative to the distal femur after OWHTO. This medial shift correlated with the correction loss. The coronal subluxation might be one cause of correction loss.

DOI： 10.1016/j.knee.2016.09.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W.B. Saunders  

Purpose To assess whether a combined computed tomography (CT)–based and image-free navigation system results in better coronal and sagittal alignment than the conventional method for performing opening-wedge high tibial osteotomy (OWHTO) and whether CT-based navigation results in acquisition of an accurate osteotomy plane. Methods Sixty-two consecutive knees were randomly divided into navigated and conventional groups. The intraoperative correction angle was determined by the change in hip-knee-ankle angle in the navigated group and by the predicted medial opening width in the conventional group. Outliers of femorotibial angle (FTA) and tibial posterior slope (TPS) were defined as angles of &gt
175° or &lt
165° and angles of &gt
2.5° or &lt
−2.5°, respectively. Radiographic and clinical data were compared between the 2 groups at 2 years postoperatively. Results Mean postoperative FTAs were 168.5° in the navigated group and 168.1° in the conventional group. Mean change in TPS of −0.2° in the navigated group was significantly lower than that of 1.6° in the conventional group (P =.005). On postoperative CT, mean angle between the tibial plateau and osteotomy planes in the sagittal plane showed a significantly higher anterior opening of 12° in the conventional than in the navigated group (P &lt
.001). There was a significantly greater proportion of TPS outliers in the conventional (51.6%) than in the navigated group (12.9%) (P =.001), and a significantly greater proportion within the normal range in both planes in the navigated (74.2%) than in the conventional group (48.4%) (P =.037). Conclusions Combined CT-based and image-free navigation in OWHTO better preserves the original TPS and more frequently restores normal coronal and sagittal plane knee joint alignment. CT-based navigation also enabled acquisition of our target osteotomy plane in the sagittal plan. The navigation system in OWHTO was helpful for simultaneous control of the alignment in 2 planes. Level of Evidence Level II, lesser-quality prospective randomized trial.

DOI： 10.1016/j.arthro.2016.02.018

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To show the differences in lateral and anterior femoral shaft bowing (FSB) between radiographic and computed tomography (CT) images and to assess whether FSB is associated with various predictive factors in women with knee osteoarthritis (OA) using CT images. METHODS: We enrolled 135 Japanese women with medial compartment knee OA. Lateral and anterior FSB were measured by radiography and reconstructed CT. Age, body mass index (BMI), femorotibial angle (FTA), femoral length, and lumbar spine and femoral neck bone mineral density (BMD) were set as predictive factors for progression of knee OA. We compared predictive factors in the lateral FSB group having lateral angulations of >5° with those in the nonbowing group and compared predictive factors in the anterior FSB group having anterior angulations of >11° with those in the nonbowing group. Binomial logistic regression modeling was applied to determine independent predictors of both FSB. RESULTS: There were significant differences in both FSB between the radiographic and reconstructed CT images (P = 0.005 and P = 0.047, respectively). In binomial logistic regression analyses for lateral FSB on CT, age, BMI, and lumbar spine BMD were significant predictors, with odds ratios of 1.16, 1.22, and 0.03, respectively; for anterior FSB on CT, age was a significant predictor, with an odds ratio of 1.06. CONCLUSIONS: It is preferable to measure both FSB on reconstructed CT when planning reconstructive knee surgeries. Age, BMI, and lumbar spine BMD were predictors of lateral FSB progression, and age was a predictor of anterior FSB progression. Level of evidence Level III.

DOI： 10.1007/s00402-016-2519-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Unicompartmental knee prostheses with screw fixation into the proximal tibia were employed and postoperative clinical results for osteoarthritis of the knee, especially regarding relief of pain, range of motion and satisfactory limb alignment are reported and discussed. METHODS: A total of 140 knees (131 medial and 9 lateral) of 85 patients (21 men and 64 women) were followed up for two to 17 years with an average of 7.0 ± 3.0 years. RESULTS: In spite of loss to follow-up in three knees of two patients and revision to total knee arthroplasty in one knee of one patient, in the remaining 136 knees (82 patients) the mean knee score of the Knee Society Clinical Rating System was 41.0 ± 14.7 pre-operatively, which improved to 93.1 ± 5.7 at follow-up, while the mean functional score similarly improved from 36.9 ± 8.1 to 88.5 ± 6.3 (p < 0.001 respectively). One knee developed a fracture in the medial proximal part of the tibia, but no knee developed loosening of the prosthesis or infection. The mean pre-operative knee flexion was 122.6 ± 15.9°, which improved to 132.9 ± 13.4° (p < 0.001) at follow-up. The limb alignment showed 4.8 ± 4.5° anatomical varus angulation pre-operatively, which was corrected to 5.8 ± 3.3° valgus at follow-up in the medial unicompartmental replacement group (127 knees), and 19 ± 6.1° valgus pre-operatively, which was corrected to 6.7 ± 3.0° valgus at follow-up in the lateral unicompartmental replacement group (nine knees). CONCLUSIONS: The clinical results of arthroplasty with screw fixation were concluded to be promising.

DOI： 10.1007/s00264-014-2564-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The changes in synovial fluid biomarkers after intra-articular injection of hyarulonic acid (IA HA) remain controversial. We investigate the changes in the properties of synovial fluid (SF) and clinical symptoms before the first and fifth IA HA. METHODS: A total of 73 patients (73 knees) with symptomatic knee osteoarthritis were treated with five weekly intra-articular injections of HA and 55 patients (55 knees) were analyzed. The SF total volume, viscosity, and levels of HA, chondroitin 4-sulfate (C4S), chondroitin 6-sulfate (C6S), keratin sulfate, and interleukin (IL)-6 were measured before the first and fifth injections. Clinical evaluations were performed using the American Knee Society score for physician-based outcome measurements and Knee injury and Osteoarthritis Outcome Score for patient-based outcome measurements before the first and fifth injections. RESULTS: The SF viscosity and levels of HA were significantly increased, and the total SF volume and levels of chondroitin 4-sulfate, chondroitin 6-sulfate, and interleukin-6 were significantly decreased. The physician-based and patient-based outcome scores were improved. CONCLUSIONS: Our findings speculate that HA injections significantly modulate levels of intra articular biomarkers which may indicate beneficial effect for articular cartilage and synovium membrane.

DOI： 10.1186/s40634-014-0016-7

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掲載種別：研究論文（学術雑誌）  

Background: Treatment of articular cartilage injuries remains a difficult challenge due to the limited capacity for intrinsic repair. Mesenchymal stem cells (MSCs) can differentiate into chondrocytes under certain culture conditions. This study focused on the modulatory effects of parathyroid hormone (PTH) on chondrogenic differentiation from MSCs.Methods: MSCs were treated with various concentrations of PTH under chondrogenic pellet culture condition. RNA was isolated for real-time polymerase chain reaction (PCR) and gene expressions of collagen type II α1 chain (Col2a1), collagen type X α1 chain, collagen type I α1 chain, SRY-box9 (Sox9), and type 1 PTH/PTHrP receptor (PTH1R) were examined. Chondrogenic differentiation was also evaluated by histological findings.Results: PTH had opposite effects on chondrogenesis, depending on the concentration. A low to moderate concentration of PTH promoted chondrogenic differentiation of MSCs with increased expression of Sox9, Col2a1, and PTH1R, whereas chondrogenesis of MSCs was inhibited rather than stimulated with a higher concentration of PTH.Conclusion: This study provides insights into the modulatory effect of PTH on chondrogenic differentiation from MSCs and the therapeutic potential for cartilage regeneration. Based on clinical experience regarding the efficacy and safety of PTH for bone metabolism, PTH may also be useful clinically for cartilage repair.

DOI： 10.1186/s13018-014-0068-5

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掲載種別：研究論文（学術雑誌）  

Between 2003 and 2007, 99 knees in 77 patients underwent opening wedge high tibial osteotomy. We evaluated the effect of initial stable fixation combined with an artificial bone substitute on the mid- to long-term outcome after medial opening-wedge high tibial osteotomy (HTO) for medial compartmental osteoarthritis or spontaneous osteonecrosis of the knee in 78 knees in 64 patients available for review at a minimum of five years (mean age 68 years; 49 to 82). The mean follow-up was 6.5 years (5 to 10). The mean Knee Society knee score and function score improved from 49.6 (SD 11.4, 26 to 72) and 56.6 (SD 15.6, 5 to 100) before surgery to 88.1 (SD 12.5, 14 to 100) and 89.4 (SD 15.6, 5 to 100) at final follow-up (p < 0.001) respectively. There were no significant differences between patients aged ≥ 70 and < 70 years. The mean standing femorotibial angle was corrected significantly from 181.7° (SD 2.7°, 175° to 185°) pre-operatively to 169.7° (SD 2.4°, 164° to 175°) at one year's follow-up (p < 0.001) and 169.6° (SD 3.0°, 157° to 179°) at the final follow-up (p = 0.69 vs one year). Opening-wedge HTO using a stable plate fixation system combined with a bone substitute is a reliable procedure that provides excellent results. Although this treatment might seem challenging for older patients, our results strongly suggest that the results are equally good. © 2014 The British Editorial Society of Bone & Joint Surgery.

DOI： 10.1302/0301-620X.96B3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease of which the pathogenetic mechanisms are not fully understood. Semaphorin3A (Sema3A) has an immune regulatory role. Neuropilin1 (NRP1), the primary receptor for Sema3A, is also a receptor for vascular endothelial growth factor 165 (VEGF 165). It has been shown that Sema3A competitively antagonizes VEGF 165 signaling. This study investigated whether Sema3A is expressed in synovial tissues, and is associated with disease activity and the histological features of synovial tissues from RA patients. METHODS: Human synovial tissues samples were obtained from RA and osteoarthritis (OA) patients. Disease activity of RA patients was calculated using the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP). The histological features of RA synovial tissues were evaluated using Rooney's inflammation scoring system. The localization of Sema3A, VEGF 165 and NRP1 positive cells was immunohistochemically determined in synovial tissues. Expression levels of Sema3A, VEGF-A and NRP1 mRNA were determined using quantitative real-time polymerase chain reaction (qPCR). RESULTS: In OA specimens, Sema3A, VEGF 165 and NRP1 proteins were expressed in the synovial lining and inflammatory cells beneath the lining. Immunohistochemistry revealed the protein expression of Sema3A in synovial lining cells was decreased in RA tissues compared with OA samples. qPCR analysis demonstrated a significant reduction of Sema3A mRNA levels in RA synovial tissue samples than in OA and a significant correlation of the ratio of Sema3A/VEGF-A mRNA expression levels with DAS28-CRP (R = -0.449, p = 0.013). Sema3A mRNA levels also correlated with Rooney's inflammation score, especially in perivascular infiltrates of lymphocytes (R = -0.506, p = 0.004), focal aggregates of lymphocytes (R = -0.501, p = 0.005) and diffuse infiltrates of lymphocytes (R = -0.536, p = 0.002). CONCLUSIONS: Reduction of Sema3A expression in RA synovial tissues may contribute to pathogenesis of RA.

DOI： 10.1186/1471-2474-14-40

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Degeneration in cruciate ligaments results from abnormal biomechanical stress and the aging process. Such degeneration is a common outcome in patients with osteoarthritis (OA) of the knee and contributes to the progression of OA. However, to date, there are no specific markers that can predict the extent of ligament degeneration. We hypothesized that the extent of degeneration has correlations to increased chondrogenic potential. METHODS: Twenty anterior cruciate ligaments (ACLs) and 30 posterior cruciate ligaments (PCLs) from 30 knees of 28 adult patients with OA at the time of total knee arthroplasty were used for the study. Degeneration was histologically assessed using a grading system. Expressions of Scleraxis (as a ligament cell marker) and Sry-type HMG box 9 (SOX9) (as a chondrogenic marker) were immunohistochemically assessed in each grade. RESULTS: We found the opposite expression pattern between Scleraxis and SOX9 according to the grade. The percentage of Scleraxis-positive cells decreased significantly by grade (60.9±23.7 in grade 1, 39.7±30.5 in grade 2, and 13.9±27.1 in grade 3, P<0.0001). In contrast, the percentage of SOX9-positive cells increased significantly by grade (2.5±4.9 in grade 1, 17.5±13.4 in grade 2, and 50.9±27.1 in grade 3, P<0.0001). Furthermore, co-localized expression of both Scleraxis and SOX9 was demonstrated in chondrocyte-like cells. CONCLUSIONS: This study indicates that chondrogenic differentiation is associated with the progression of degeneration in human ligaments. Our results suggest that the expression of SOX9 as a chondrogenic marker could be an indicator for the extent of degeneration in human ligaments. It remains to be elucidated whether suppression of chondrogenic differentiation can prevent progression of the degenerative process of cruciate ligaments in patients with OA.

DOI： 10.1016/j.joca.2012.07.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We investigated the effect of low-intensity pulsed ultrasound (LIPUS) on the homing of circulating osteogenic progenitors to the fracture site. Parabiotic animals were formed by surgically conjoining a green fluorescent protein (GFP) mouse and a syngeneic wild-type mouse. A transverse femoral fracture was made in the contralateral hind limb of the wild-type partner. The fracture site was exposed to daily LIPUS in the treatment group. Animals without LIPUS treatment served as the control group. Radiological assessment showed that the hard callus area was significantly greater in the LIPUS group than in the control group at 2 and 4 weeks post-fracture. Histomorphometric analysis at the fracture site showed a significant increase of GFP cells in the LIPUS group after 2 weeks (7.5%), compared to the control group (2.4%) (p < 0.05). The LIPUS group exhibited a significantly higher percentage of GFP cells expressing alkaline phosphatase (GFP/AP) than the control group at 2 weeks post-fracture (5.9%, 0.3%, respectively, p < 0.05). There was no significant difference in the percentage of GFP/AP cells between the LIPUS group (2.0%) and the control group (1.4%) at 4 weeks post-fracture. Stromal cell derived factor-1 and CXCR4 were immunohistochemically identified at the fracture site in the LIPUS group. These data indicate that LIPUS induced the homing of circulating osteogenic progenitors to the fracture site for possible contribution to new bone formation.

DOI： 10.1002/jor.22103

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掲載種別：研究論文（学術雑誌）  

The purpose of this study was to determine the frequency of lateral hinge fractures after opening-wedge high tibial osteotomy and investigate the patterns of fracture and their clinical outcome. We analyzed 104 knees in 93 patients with a mean age of 68 ± 7 years. Of the knees, 74 were diagnosed as having primary osteoarthritis and 30 with osteonecrosis. The mean follow-up period was 41 months. Lateral hinge fractures were classified as follows: type I, the fracture reaches just proximal to or within the tibiofibular joint; type II, the fracture reaches the distal portion of the proximal tibiofibular joint; and type III, a lateral plateau fracture. A standard postoperative rehabilitation protocol was used for type I fractures, 3 of 5 patients with type II fractures were treated with nonweight bearing, and type III fractures were treated with nonweight bearing until visible callus formation. The Knee Society scores for the knee and for function showed improvement from 49 ± 11 to 91 ± 7.7 points and from 62 ± 13 to 95 ± 8.2 points, respectively. Lateral cortex fractures were observed in 26 knees (25%): 19 type I, 5 type II, and 2 type III. In the type II fracture group, 2 of 5 patients were judged to have a delayed bone union. There were 2 cases of infection (2%) and 1 case of traumatic neuroma (1%) but no instances of implant failure, nonunion, or deep vein thrombosis among our patient cohort. High tibial osteotomy patients treated with a combination of TomoFix (Synthes, Bettlach, Switzerland) and bone substitute were able to walk with full weight bearing 2 weeks after surgery. No complications were seen in 19 patients with type I fractures. Of 5 patients with type II fractures, 2 had delayed unions with a correction loss of 3°and 7°, respectively. Level IV, therapeutic case series.

DOI： 10.1016/j.arthro.2011.06.034

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Homing of osteogenic cells through the systemic circulation represents an alternative to traditional orthopedic tissue engineering approaches that focus on local cell populations. We hypothesize that expression of the chemokine, stromal cell-derived factor-1 (SDF-1) or monocyte chemotactic protein-3 (MCP-3) may enhance homing of osteogenic cells into sites of fracture repair, as both have demonstrated promise in recruitment of marrow stromal cells (MSCs). This hypothesis was tested by transplantation of culture expanded MSCs expressing these factors adjacent to a fracture site on a collagen scaffold. One green fluorescent protein positive (GFP+) and one wild-type mouse were surgically conjoined as parabiots at 7-8 weeks of age. Fibular osteotomy was performed 4 weeks after parabiosis on the hind limb of the wild-type mouse. Mice were randomly allocated to receive one of the following five treatments: control (no scaffold), empty scaffold (no cells), or scaffold containing MSCs, scaffold containing MSCs expressing SDF-1, or scaffold containing MSCs expressing MCP-3. Fracture callus was harvested 2 weeks after injury, and analyzed with confocal microscopy and cell-counting software. When compared to fracture callus treated with nontransfected MSCs, the fracture callus of mice treated with both SDF-1 and MCP-3 secreting MSCs demonstrated a significant increase in the number of both GFP+ cells (p = 0.0003, p = 0.02) and GFP+ /AP+ cells (p = 0.0005, p = 0.01). These data suggest that homing of osteogenic cells from systemic circulation participate in fracture repair and that homing pathways might be modulated to enhance the contribution of circulating progenitors at the site of skeletal injury.

DOI： 10.1002/jor.21374

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The choice of surgical treatments for unicompartmental osteoarthritis (OA) of the knee is still somewhat controversial. Midterm results from cases treated using unicompartmental knee arthroplasty (UKA) or open wedge high tibial osteotomy (OWHTO) were evaluated retrospectively. METHODS: Twenty-seven knees of 24 patients with varus deformities underwent OWHTO and 30 knees of 18 patients underwent UKA surgeries for the treatment of medial compartmental osteoarthritis (OA). The KSS score, FTA, range of motion and complications were evaluated before and after surgery. RESULTS: The preoperative mean KSS scores were 49 points in the OWHTO group and 62 in the UKA group which improved postoperatively to 89 (excellent; 19 knees, good; 8 knees), and 88 (excellent; 25, good; 4, fair; 1), respectively. There was no significant difference between the OWHTO and UKA scores. Seventeen patients in the OWHTO group could sit comfortably in the formal Japanese style after surgery. The preoperative mean FTA values for the OWHTO and UKA groups were 182 degrees and 184, and at follow-up measured 169 and 170, respectively. In the UKA group, the femoral component and the polyethylene insertion in one patient was exchanged at 5 years post-surgery and revision TKAs were performed in 2 cases. In the OWHTO group, one tibial plateau fracture and one subcutaneous tissue infection were noted. CONCLUSIONS: Treatment options should be carefully considered for each OA patient in accordance with their activity levels, grade of advanced OA, age, and range of motion of the knee. OWHTO shows an improved indication for active patients with a good range of motion of the knee.

DOI： 10.1186/1749-799X-5-65

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In the current study, we evaluated changes in the patellofemoral joint indices in 49 knees from 39 patients (11 men and 28 women with a median age of 64 years; range 53-79) who had undergone an opening wedge high tibial osteotomy (OWHTO). Osteoarthritis had been diagnosed in 39 knees and osteonecrosis in the other 10 knees in this patient cohort. Radiographs showing anteroposterior and true lateral views of the knee joints while standing, and also skyline views while standing with a 30 degrees flexion, were taken both pre- and postoperatively. Radiographic assessments were then performed using the following five parameters: femorotibial angle (FTA), modified Blackburne-Peel ratio (mBP), tibial slope (TS), lateral patellar tilt (LPT), and lateral patellar shift (LPS). The average LPT decreased significantly from 7.4 degrees + or - 3.7 degrees to 5.2 degrees + or - 3.6 degrees (P < 0.01). Patients treated with a greater than 15 degrees correction showed a significantly bigger change in their LPT than those with corrections of 15 degrees or less. No statistical differences were found between the preoperative (10.2 + or - 4.5%) and postoperative (10.2 + or - 4.7%) LPS measurements. Changes in the radiographic parameters were also observed in the patellofemoral joint after OWHTO. It is unclear to what extent the postoperative patellar shift and tilt affects the long-term clinical outcomes but our current results suggest that OWHTO negatively affects the congruency of the patellofemoral joint and should not exceed a correction of 15 degrees .

DOI： 10.1007/s00167-010-1077-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Obtaining a correct postoperative limb alignment is an important factor in achieving a successful clinical outcome after an opening-wedge high tibial osteotomy (OWHTO). To better predict some of the aspects that impact upon the clinical outcomes following this procedure, including postoperative correction loss and over correction, we examined the changes in the frontal plane of the lower limb in a cohort of patients who had undergone OWHTO using radiography. Forty-two knees from 33 patients (23 cases of osteoarthritis and 10 of osteonecrosis) underwent a valgus realignment OWHTO procedure and were radiographically assessed for changes that occurred pre- and post-surgery. The mean femorotibial angle (FTA) was found to be 182.1 +/- 2.0 degrees (12 +/- 2.0 anatomical varus angulation) preoperatively and 169.6 +/- 2.4 degrees (10.4 +/- 2.4 anatomical valgus angulation) postoperatively. These measurements thus revealed significant changes in the weight bearing line ratio (WBL), femoral axis angle (FA), tibial axis angle (TA), tibia plateau angle (TP), tibia vara angle (TV) and talar tilt angle (TT) following OWHTO. In contrast, no significant change was found in the weight bearing line angle (WBLA) after these treatments. To assess the relationship between the correction angle and these indexes, 42 knees were divided into the following three groups according to the postoperative FTA; a normal correction group (168 degrees < or = FTA < or = 172 degrees ), an over-correction group (FTA < 168 degrees ), and an under-correction group (FTA > 172 degrees ). There were significant differences in the delta angle [DA; calculated as (pre FTA - post FTA) - (pre TV - post TV)] among each group of patients. Our results thus indicate a negative correlation between the DA and preoperative TA (R(2) = 0.148, p < 0.05). Hence, given that the correction errors in our patients appear to negatively correlate with the preoperative TA, postoperative malalignments are likely to be predictable prior to surgery.

DOI： 10.1007/s00167-008-0706-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We evaluated the clinical outcomes, in terms of early weight bearing, of using opening wedge high tibial osteotomy (OWHTO) to treat spontaneous osteonecrosis of the medial femoral condyle of the knee (SONK) using TomoFix and artificial bone substitute. Damaged cartilage tissue was removed and drilling of the necrotic area followed by OWHTO was performed in 30 knees from 30 patients with an average age of 71 years (range 58-82) at the time of operation. Patients were allowed to undertake partial weight-bearing exercises 1 week after the osteotomy procedure, with all patients performing full weight-bearing exercise at 2 weeks post-surgery. The mean follow-up period was 40 months (range 24-62). All of the SONK patients could walk with a full weight-bearing load, using only a T-cane, at 2 weeks after undergoing OWHTO. Clinical assays, including the mean American Knee Society Score and Function Score, showed significant improvements from 51 to 93 points, and 58 to 93 points, respectively. Prior to surgery, the average femoro-tibial angle (FTA) during standing was 181 (1 degree anatomical varus) and had significantly changed to 170 (10 degrees valgus) at the time of follow-up. There were no cases of non-union, or implant failure in any of our patients. In addition, none of the patients could sit in the Japanese style prior to surgery, but 21 of 30 patients (70%) could do so after treatment. Arthroscopic findings could be observed in 24 out of 30 cases at implant removal. Necrotic area in each case was covered with fibrous cartilage-like tissue completely. Drilling of the necrotic area followed by OWHTO with TomoFix and artificial bone substitute is an effective treatment for SONK as it results in pain alleviation and regeneration of the fibrous cartilage tissue over the necrotic legion. In addition, an early weight-bearing exercise program is possible after this procedure and full weight-bearing can be achieved at two weeks after surgery.

DOI： 10.1007/s00167-008-0698-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: We performed clinical and radiographic evaluation of patients with medial compartment osteoarthritis of the knee who had undergone treatment with opening wedge high tibial osteotomy (OWHTO) followed by early full weight bearing. OWHTO procedures were performed by use of TomoFix (Synthes, Bettlach, Switzerland) and bone substitute materials. METHODS: OWHTO was performed in 57 knees in 52 patients with a mean age of 69 years (range, 54 to 82 years) at the time of operation. The diagnosis was primary osteoarthritis in 34 knees in 29 patients and osteonecrosis in a further 23 knees in 23 patients. We established an early weight-bearing exercise program during which these patients were permitted partial weight-bearing exercise 1 week after their osteotomy procedure. All patients performed full weight-bearing exercises at 2 weeks after surgery. The mean follow-up period was 40 months (range, 24 to 62 months). RESULTS: The American Knee Society Score and Function Score showed significant improvement from 50.9 +/- 12.3 to 91.7 +/- 6.9 points and 59.3 +/- 13.1 to 94.1 +/- 8.8 points, respectively. Before surgery, the mean femorotibial angle during standing was 181.3 degrees +/- 2.4 degrees (1.3 degrees anatomic varus), but it measured 169.6 degrees +/- 2.3 degrees (10.4 degrees valgus) at the time of follow-up. There were no instances of nonunion or implant failure in any of our patients. CONCLUSIONS: We have shown that an early weight-bearing exercise program enables full weight bearing at 2 weeks after OWHTO with TomoFix and artificial bone wedges. Overall, this combination was a highly successful course of treatment for correcting knee malalignment in patients with medial compartment osteoarthritis. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

DOI： 10.1016/j.arthro.2008.08.015

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Simultaneous bilateral opening-wedge high tibial osteotomies (OWHTOs), using the TomoFix fixation device and artificial bone wedges (beta-TCP) were performed on 20 knees of 10 patients with an average age of 67 years (range 53-75) at the time of the operation. We established an early weight-bearing exercise program during which patients were permitted partial weight-bearing exercise 1 week after osteotomy, with all patients performing full weight-bearing exercise at 3 weeks. The follow-up period was an average of 15 months (range 6-39). The American Knee Society Score and the Function Score were improved significantly from 46 +/- 8.1 to 92 +/- 6.8 points and 67 +/- 7.9 to 95 +/- 7.9 points, respectively. Prior to surgery, the average lateral femoro-tibial angle (FTA) during standing was 182 +/- 2.3 degrees (2 degrees anatomical varus) and significantly changed to 170 +/- 2.5 degrees (10 degrees valgus) at the time of follow-up. There were no cases of infection, non-union, or implant failure. Overall, this procedure was highly successfully in correcting knee malalignment in patients with medial compartmental osteoarthritis. In our study also, there was no evidence of correction loss, implant failure, collapse of the artificial bone wedges, or screw loosening. Simultaneous treatment of bilateral OWHTOs under a single administration of anesthesia appears to be superior to separate procedures of unilateral surgical procedures in providing the potential benefits of minimizing hospitalization, reducing costs and maximizing clinical outcomes for patients and institutions.

DOI： 10.1007/s00167-008-0609-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Tissue engineering seeks to translate scientific knowledge into tangible products to advance the repair, replacement, or regeneration of organs and tissues. Current tissue engineering strategies have progressed recently from a historical approach that is based primarily on biomaterials to a cell and tissue-based approach that includes understanding of cell-sourcing and bioactive stimuli. New options include methods for harvest and transplantation of tissue-forming cells, bioactive matrix materials that act as tissue scaffolds, and delivery of bioactive molecules within scaffolds. These strategies are already benefiting patients, and they place increasing demands on orthopaedic surgeons to have a solid foundation in the contemporary concepts and principles of cell-based tissue engineering. Essentially all orthopaedic tissue engineering strategies can be distilled to a strategy or combination of strategies that seek to increase the number or relative performance of bone-forming cells. The global term connective tissue progenitors has been used to define the heterogeneous populations of stem and progenitor cells that are found in native tissue and that are capable of differentiating into one or more connective tissue phenotypes. These stem or progenitor populations are found in various tissue sources, with varying degrees of ability to differentiate along connective tissue lineages. Available cell-based strategies include targeting local cells with use of scaffolds or bioactive factors, or transplantation of autogenous connective tissue progenitor cells derived from bone marrow or other tissues, with or without processing to change their concentration or prevalence. The future may include means of homing circulating connective tissue progenitor cells with use of intrinsic chemokine systems, or modifying the biological performance of connective tissue progenitor cells by means of genetic modifications.

DOI： 10.2106/JBJS.G.01572

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Based on the accumulating evidence of osteogenic cells present in the systemic circulation, we hypothesized that circulating osteogenic connective tissue progenitors (CTPs) home to fracture site and contribute to skeletal repair. Parabiotic animals were formed by surgically conjoining transgenic mice constitutively expressing green fluorescent protein (GFP) in no erythroid tissue and syngeneic wild-type mice. After 3 weeks parabionts, equilibrium in blood chimerism between partners was established. A transverse fibular fracture was made in the contralateral hind limb of the conjoined wild-type partner. The contribution of circulating cells to the fracture callus was assessed based on analysis of GFP+ cells and co-localization of alkaline phosphatase (AP) staining nonfracture and at 1, 2, 3, and 4 weeks after fracture. Histomorphometric analysis at the fracture site showed significant increase of GFP+ cells after 2 (5.4%) and 3 (5.6%) weeks compared to nonfractured controls (1.7%). Of the GFP+ cells, percentage of the cells expressing AP activity at 1 (37.4%) and 2 (85.3%) weeks postfracture time was statistically higher than that in nonfractured controls (10.8%). The rate of mobilization of circulating osteogenic CTPs to fracture callus was also examined using 1 week parabionts at week 0-1 and week 1-2 postfracture. There was significant increase of GFP+/AP+ cells from week 0-1 (0.1%) and week 1-2 (1.8%). These data indicate that circulating osteogenic CTPs are mobilized to fracture site and contribute to osteogenesis in the early stage of fracture healing.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The effect of low-intensity pulsed ultrasound (LIPUS) on cell growth was examined in three-dimensional-cultured chondrocytes with a collagen sponge. To elucidate the mechanisms underlying the mechanical activation of chondrocytes, intracellular signaling pathways through the Ras/mitogen-activated protein kinase (MAPK) and the integrin/phosphatidylinositol 3 kinase (PI3K)/Akt pathways as well as proteins involved in proliferation of chondrocytes were examined in LIPUS-treated chondrocytes. METHODS: Articular cartilage tissue was obtained from the metatarso-phalangeal joints of freshly sacrificed pigs. Isolated chondrocytes mixed with collagen gel and culture medium composites were added to type-I collagen honeycomb sponges. Experimental cells were cultured with daily 20-minute exposures to LIPUS. The chondrocytes proliferated and a collagenous matrix was formed on the surface of the sponge. Cell counting, histological examinations, immunohistochemical analyses and western blotting analysis were performed. RESULTS: The rate of chondrocyte proliferation was slightly but significantly higher in the LIPUS group in comparison with the control group during the 2-week culture period. Western blot analysis showed intense staining of type-IX collagen, cyclin B1 and cyclin D1, phosphorylated focal adhesion kinase, and phosphorylated Akt in the LIPUS group in comparison with the control group. No differences were detected, however, in the MAPK, phosphorylated MAPK and type-II collagen levels. CONCLUSION: LIPUS promoted the proliferation of cultured chondrocytes and the production of type-IX collagen in a three-dimensional culture using a collagen sponge. In addition, the anabolic LIPUS signal transduction to the nucleus via the integrin/phosphatidylinositol 3-OH kinase/Akt pathway rather than the integrin/MAPK pathway was generally associated with cell proliferation.

DOI： 10.1186/ar2451

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Osteogenic Protein-1 (OP-1, BMP-7) acts locally on connective tissue progenitors (CTPs) to induce bone formation. The response to OP-1 and similar agents is potentially limited by the number of local CTPs. This study tested the hypothesis that supplementing local CTPs using autogenous bone marrow will enhance bone formation at an OP-1 implant. Four 1.0-cm diameter unicortical cylindrical defects in the left proximal femur were grafted in each of seven dogs. Radial ingrowth of new bone formation was assessed at 4 weeks using micro CT. The OP-1 (3.5 mg rhOP-1 in 1 g bovine collagen I matrix) was implanted in each site combined with either clotted blood or aspirated bone marrow (BM). Bone formation was increased in the group augmented with transplanted marrow. These data suggest that increasing the local population of cells and CTPs using aspirated bone marrow can enhance the performance of OP-1, but may not eliminate the effects of site variation on the response to OP-1 and similar agents. The canine multiple femoral defect model defined in this study is well suited to quantitatively evaluate strategies for augmenting bone repair using local cell targeting and cell transplantation strategies.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study investigated the stimulatory effect of bone healing on cartilage regeneration. Full-thickness osteochondral defects, 5 mm wide x 3 mm deep, were created in the patellar groove of the right distal end of the femur in 60 mature Japanese white rabbits. The bone defect was made in the medial condyle of the ipsilateral tibia in the experimental group. The control group had only a chondral defect in the patellar groove. At 4, 8, and 12 weeks after surgery, cartilage repair was evaluated macroscopically and histologically using a semiquantitative grading scale. The mean scores of the gross and histological evaluation grade in the experimental group were significantly superior to those in the control group at 8 and 12 weeks ( P << 0.05). These findings suggested that regeneration of articular cartilage defects might be promoted by creation of a periarticular bony defect.

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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記述言語：英語   出版者・発行元：SPRINGER  

To assess potentially predictive factors that were evaluated 1 year after the onset of symptoms in patients with spontaneous osteonecrosis of the knee (SONK) and to determine receiver operating characteristic (ROC) curve cut-off values.
Within 1 year of symptom onset, patients with SONK-selected treatment options, mainly based on severity of pain, chose either conservative treatment (n = 27 knees) or operative treatment (n = 27 knees). Knee and whole-leg radiographs, knee MRIs and bone mineral density scans of the lumbar spine, femoral neck and femoral condyles were obtained. The parameters measured were: (1) anatomical angle on whole-leg radiograph and (2) lesion size and medial meniscus extrusion on MRI.
The anatomical angle and lesion size in the sagittal section (depth) on MRI were markedly larger in the operative treatment group than those in the conservative treatment group. The anatomical angle and depth on MRI of SONK at Stages 1-3 were significantly different between groups, with odds ratios (95 % confidence intervals) of 1.16 (1.18-2.34) and 1.11 (1.01-1.23). One year after symptom onset, ROC curve cut-off value for anatomical angle was 180A degrees and depth on MRI was 20 mm.
An anatomical angle &gt; 180A degrees and depth &gt; 20 mm on MRI were predictive factors for a poorer prognosis 1 year after symptom onset in patients with SONK. Our results on radiographs and MRI provided a predictive prognosis for patients with SONK at the initial visit to their orthopaedic surgeons.
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DOI： 10.1007/s00167-015-3839-6

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：リウマチの外科研究会  

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記述言語：英語   出版者・発行元：SPRINGER  

Purpose Unicompartmental knee prostheses with screw fixation into the proximal tibia were employed and postoperative clinical results for osteoarthritis of the knee, especially regarding relief of pain, range of motion and satisfactory limb alignment are reported and discussed.
Methods A total of 140 knees (131 medial and 9 lateral) of 85 patients (21 men and 64 women) were followed up for two to 17 years with an average of 7.0 +/- 3.0 years.
Results In spite of loss to follow-up in three knees of two patients and revision to total knee arthroplasty in one knee of one patient, in the remaining 136 knees (82 patients) the mean knee score of the Knee Society Clinical Rating System was 41.0 +/- 14.7 pre-operatively, which improved to 93.1 +/- 5.7 at follow-up, while the mean functional score similarly improved from 36.9 +/- 8.1 to 88.5 +/- 6.3 (p &lt; 0.001 respectively). One knee developed a fracture in the medial proximal part of the tibia, but no knee developed loosening of the prosthesis or infection. The mean pre-operative knee flexion was 122.6 +/- 15.9A degrees, which improved to 132.9 A +/- 13.4A degrees (p &lt; 0.001) at follow-up. The limb alignment showed 4.8 A +/- 4.5A degrees anatomical varus angulation pre-operatively, which was corrected to 5.8 A +/- 3.3A degrees valgus at follow-up in the medial unicompartmental replacement group (127 knees), and 19 A +/- 6.1A degrees valgus pre-operatively, which was corrected to 6.7 A +/- 3.0A degrees valgus at follow-up in the lateral unicompartmental replacement group (nine knees).
Conclusions The clinical results of arthroplasty with screw fixation were concluded to be promising.

DOI： 10.1007/s00264-014-2564-y

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記述言語：英語   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

The relationship between the surgical epicondylar axis (SEA) and the rotational axis of the distal femur remains unclear. We investigated the relationship between the SEA and the distal femur and whether the SEA can be used as the rotational axis of the knee. Angular and linear measurements of 70 femora at 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 120 degrees of flexion were recorded. Results showed that the SEA was a logical and appropriate parameter as a principal axis for knee flexion at least between 0 degrees and 60 degrees of flexion. The study has important implications for the design and positioning of femoral components in total knee arthroplasty. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.arth.2014.10.024

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記述言語：英語   出版者・発行元：SPRINGER  

Various rotational landmarks including the surgical epicondylar axis (SEA) are used for preoperative planning and intra-operative reference of total knee arthroplasty (TKA) in the axial plane. The aim of the study was to elucidate the relationships between the SEA and other femoral anatomical landmarks, including the mechanical axis, distal and posterior knee joints, the trochlear groove, and the anterior femoral condyle, in both the coronal and axial planes.
Angular and linear measurements were taken of sixty femora using Orthomap3D, which has a tool to analyse computed tomography image data that makes it possible to measure three-dimensional distances and angles precisely. The inter- and intra-observer reliabilities of these measurements were evaluated. Comparisons were made according to height, weight, body mass index, and gender.
The angle between the mechanical axis and the SEA was 90.2A degrees (95 % CI 90.0A degrees-90.4A degrees). There was a significant correlation for each linear measurement between the SEA and the distal/posterior knee joint line and for each linear measurement between the SEA and the anterior medial/lateral femoral condyle. A significant difference was observed between genders in the linear measurements. Significant correlations were found between height and weight and linear parameters.
Knowledge of the relationships between the SEA and other femoral anatomical landmarks is useful in preoperative planning, intra-operative landmark, and postoperative assessment of TKA. The SEA is a consistent parameter of femoral alignment in the coronal plane and a stable reference for femoral rotation in the axial plane.
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DOI： 10.1007/s00167-014-2867-y

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記述言語：英語   出版者・発行元：BIOMED CENTRAL LTD  

Background: Treatment of articular cartilage injuries remains a difficult challenge due to the limited capacity for intrinsic repair. Mesenchymal stem cells (MSCs) can differentiate into chondrocytes under certain culture conditions. This study focused on the modulatory effects of parathyroid hormone (PTH) on chondrogenic differentiation from MSCs.
Methods: MSCs were treated with various concentrations of PTH under chondrogenic pellet culture condition. RNA was isolated for real-time polymerase chain reaction (PCR) and gene expressions of collagen type II alpha 1 chain (Col2a1), collagen type X alpha 1 chain, collagen type I alpha 1 chain, SRY-box9 (Sox9), and type 1 PTH/PTHrP receptor (PTH1R) were examined. Chondrogenic differentiation was also evaluated by histological findings.
Results: PTH had opposite effects on chondrogenesis, depending on the concentration. A low to moderate concentration of PTH promoted chondrogenic differentiation of MSCs with increased expression of Sox9, Col2a1, and PTH1R, whereas chondrogenesis of MSCs was inhibited rather than stimulated with a higher concentration of PTH.
Conclusion: This study provides insights into the modulatory effect of PTH on chondrogenic differentiation from MSCs and the therapeutic potential for cartilage regeneration. Based on clinical experience regarding the efficacy and safety of PTH for bone metabolism, PTH may also be useful clinically for cartilage repair.

DOI： 10.1186/s13018-014-0068-5

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記述言語：英語   出版者・発行元：British Editorial Society of Bone and Joint Surgery  

Between 2003 and 2007, 99 knees in 77 patients underwent opening wedge high tibial osteotomy. We evaluated the effect of initial stable fixation combined with an artificial bone substitute on the mid- to long-term outcome after medial opening-wedge high tibial osteotomy (HTO) for medial compartmental osteoarthritis or spontaneous osteonecrosis of the knee in 78 knees in 64 patients available for review at a minimum of five years (mean age 68 years
49 to 82). The mean follow-up was 6.5 years (5 to 10). The mean Knee Society knee score and function score improved from 49.6 (SD 11.4, 26 to 72) and 56.6 (SD 15.6, 5 to 100) before surgery to 88.1 (SD 12.5, 14 to 100) and 89.4 (SD 15.6, 5 to 100) at final follow-up (p &lt
0.001) respectively. There were no significant differences between patients aged ≥ 70 and &lt
70 years. The mean standing femorotibial angle was corrected significantly from 181.7° (SD 2.7°, 175° to 185°) pre-operatively to 169.7° (SD 2.4°, 164° to 175°) at one year's follow-up (p &lt
0.001) and 169.6° (SD 3.0°, 157° to 179°) at the final follow-up (p = 0.69 vs one year). Opening-wedge HTO using a stable plate fixation system combined with a bone substitute is a reliable procedure that provides excellent results. Although this treatment might seem challenging for older patients, our results strongly suggest that the results are equally good. © 2014 The British Editorial Society of Bone &amp
Joint Surgery.

DOI： 10.1302/0301-620X.96B3

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

Objective: Degeneration in cruciate ligaments results from abnormal biomechanical stress and the aging process. Such degeneration is a common outcome in patients with osteoarthritis (OA) of the knee and contributes to the progression of OA. However, to date, there are no specific markers that can predict the extent of ligament degeneration. We hypothesized that the extent of degeneration has correlations to increased chondrogenic potential.
Methods: Twenty anterior cruciate ligaments (ACLs) and 30 posterior cruciate ligaments (PCLs) from 30 knees of 28 adult patients with OA at the time of total knee arthroplasty were used for the study. Degeneration was histologically assessed using a grading system. Expressions of Scleraxis (as a ligament cell marker) and Sty-type HMG box 9 (SOX9) (as a chondrogenic marker) were immunohistochemically assessed in each grade.
Results: We found the opposite expression pattern between Scleraxis and SOX9 according to the grade. The percentage of Scleraxis-positive cells decreased significantly by grade (60.9 +/- 23.7 in grade 1, 39.7 +/- 30.5 in grade 2, and 13.9 +/- 27.1 in grade 3, P &lt; 0.0001). In contrast, the percentage of SOX9-positive cells increased significantly by grade (2.5 +/- 4.9 in grade 1, 17.5 +/- 13.4 in grade 2, and 50.9 +/- 27.1 in grade 3, P &lt; 0.0001). Furthermore, co-localized expression of both Scleraxis and SOX9 was demonstrated in chondrocyte-like cells.
Conclusions: This study indicates that chondrogenic differentiation is associated with the progression of degeneration in human ligaments. Our results suggest that the expression of SOX9 as a chondrogenic marker could be an indicator for the extent of degeneration in human ligaments. It remains to be elucidated whether suppression of chondrogenic differentiation can prevent progression of the degenerative process of cruciate ligaments in patients with OA. (C) 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.joca.2012.07.013

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL  

We investigated the effect of low-intensity pulsed ultrasound (LIPUS) on the homing of circulating osteogenic progenitors to the fracture site. Parabiotic animals were formed by surgically conjoining a green fluorescent protein (GFP) mouse and a syngeneic wild-type mouse. A transverse femoral fracture was made in the contralateral hind limb of the wild-type partner. The fracture site was exposed to daily LIPUS in the treatment group. Animals without LIPUS treatment served as the control group. Radiological assessment showed that the hard callus area was significantly greater in the LIPUS group than in the control group at 2 and 4 weeks post-fracture. Histomorphometric analysis at the fracture site showed a significant increase of GFP cells in the LIPUS group after 2 weeks (7.5%), compared to the control group (2.4%) (p?&lt;?0.05). The LIPUS group exhibited a significantly higher percentage of GFP cells expressing alkaline phosphatase (GFP/AP) than the control group at 2 weeks post-fracture (5.9%, 0.3%, respectively, p?&lt;?0.05). There was no significant difference in the percentage of GFP/AP cells between the LIPUS group (2.0%) and the control group (1.4%) at 4 weeks post-fracture. Stromal cell derived factor-1 and CXCR4 were immunohistochemically identified at the fracture site in the LIPUS group. These data indicate that LIPUS induced the homing of circulating osteogenic progenitors to the fracture site for possible contribution to new bone formation. (C) 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:15161521, 2012

DOI： 10.1002/jor.22103

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記述言語：英語   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Purpose: The purpose of this study was to determine the frequency of lateral hinge fractures after opening-wedge high tibial osteotomy and investigate the patterns of fracture and their clinical outcome. Methods: We analyzed 104 knees in 93 patients with a mean age of 68 +/- 7 years. Of the knees, 74 were diagnosed as having primary osteoarthritis and 30 with osteonecrosis. The mean follow-up period was 41 months. Lateral hinge fractures were classified as follows: type I, the fracture reaches just proximal to or within the tibiofibular joint; type II, the fracture reaches the distal portion of the proximal tibiofibular joint; and type III, a lateral plateau fracture. A standard postoperative rehabilitation protocol was used for type I fractures, 3 of 5 patients with type II fractures were treated with non-weight bearing, and type III fractures were treated with non-weight bearing until visible callus formation. Results: The Knee Society scores for the knee and for function showed improvement from 49 +/- 11 to 91 +/- 7.7 points and from 62 +/- 13 to 95 +/- 8.2 points, respectively. Lateral cortex fractures were observed in 26 knees (25%): 19 type I, 5 type II, and 2 type III. In the type II fracture group, 2 of 5 patients were judged to have a delayed bone union. There were 2 cases of infection (2%) and 1 case of traumatic neuroma (1%) but no instances of implant failure, nonunion, or deep vein thrombosis among our patient cohort. Conclusions: High tibial osteotomy patients treated with a combination of TomoFix (Synthes, Bettlach, Switzerland) and bone substitute were able to walk with full weight bearing 2 weeks after surgery. No complications were seen in 19 patients with type I fractures. Of 5 patients with type II fractures, 2 had delayed unions with a correction loss of 3 and 7, respectively. Level of Evidence: Level IV, therapeutic case series.

DOI： 10.1016/j.arthro.2011.06.034

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：日本語   出版者・発行元：日本リウマチの外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本リウマチ学会  

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