Prediction of graft length by body height in anatomic double-bundle anterior cruciate ligament reconstruction

To investigate the intra-articular graft length and the length of the bone tunnels after anatomic double-bundle (DB) ACL reconstruction with semitendinosus (ST) tendon, and predict the required length of ST tendon, 178 patients who underwent anatomic DB ACL reconstruction with ST tendon were analyzed. The length of the intra-articular graft was measured by CT. A regression analysis was performed to determine the correlation between the intra-articular graft length and patient height. There was a statistically significant correlation between the intra-articular graft length and patient height. Therefore, the required length of ST tendon can be predicted from patient height. Keywords: Anterior cruciate ligament, Anatomic reconstruction, Graft length, Semitendinosus tendo

Three dimensional CT analysis of the change in rotational alignment in double level osteotomy after double level osteotomy performed for varus osteoarthritic knees

Purpose: To analyze the change in rotational alignment caused by double level osteotomy (DLO) based on comparative three-dimensional image analysis of pre- and postoperative CT images. Methods: Pre- and postoperative CT examination of the lower extremities were performed with informed consent for 39 consecutive knees undergoing DLO for varus knee deformity. The DLO procedure consisted of closed wedge distal femoral osteotomy (CWDFO) and open wedge high tibial osteotomy (OWHTO). Among those cases, 20 knees complicated with hinge fracture at the osteotomy site were excluded from the analysis to eliminate a confounding factor affecting the results. Consequently, data obtained from 19 knees were subjected to the study analysis while osteotomies with hinge fractures complications were excluded from the study. In the three-dimensional CT image analysis of axial plane images, femoral torsion (the angle between midline along the femoral neck axis and the tangent of the posterior edges of the medial/lateral femoral condyles) and tibial torsion (the angle between the tangent of the posterior edges of the medial/lateral tibial condyles and the transmalleolar axis) were measured. The torsion angle was measured in each of the femurs and the tibias on both pre- and postoperative CT axial images, and the change induced by the osteotomy was calculated and statistically(using Wilcoxon signed-rank test) compared. Results: The mean pre- and postoperative femoral torsion (anteversion) angles were 29.3° and 31.4° with a significant postoperative increase in internal rotation of the bony segment distal to the osteotomy(P = 0.002). On the tibial side, the mean pre- and postoperative torsion angles were 26.5° and 25.7°, indicating no significant postoperative change(P = 0.199)（NS）. Conclusions: This study showed that the DLO procedure (combining CWDFO and OWHTO) increased torsion (anteversion) of the femur by 2.1° on average while inducing no significant rotational change on the tibial side

Double Threaded Screw Fixation for Bilateral Stress Fracture of the Medial Malleolus

An 18-year-old college basketball player presented with continued ankle pain. A radiographic examination showed bilateral medial malleolus stress fractures. Considering the prolonged history and refractory nature of this injury, surgery was adopted as a treatment option. At surgery, the fracture site was percutaneously fixed using two cannulated double threaded screws. Surgery for each side was sequentially performed two months apart. Prompt bony healing was attained after surgery, and the patient could return to his previous sports level six months after the first surgery without subsequent recurrence

Metastatic colorectal cancer responsive to regorafenib for 2 years: a case report

Abstract Background Regorafenib is an oral multikinase inhibitor that has been demonstrated as clinically effective in patients with metastatic colorectal cancer in phase III studies. Although disease control was achieved in 40% of the pretreated patients with metastatic colorectal cancer in the pivotal studies, radiological response has rarely been reported. Severe adverse events associated with regorafenib are known to occur during the first and second courses of treatment. We present a case of a 62-year-old Japanese patient whose metastatic colorectal cancer has been responding to treatment with regorafenib for 2 years. Case presentation A 54-year-old Japanese man visited our institute exhibiting general malaise, and he was diagnosed with ascending colon cancer in April 2006. He underwent right hemicolectomy, and the final staging was T3N0M0, stage II. After 19 months, pulmonary metastasis and anastomotic recurrences were detected, and a series of operations were performed to resect both metastatic lesions. After that, liver metastasis, a duodenal metastasis with right renal invasion, right adrenal metastasis, and para-aortic lymph node metastases were observed during follow-up, and chemotherapy and resection were performed. The patient had metastatic para-aortic lymph nodes after the fifth tumor resection and underwent multiple lines of chemotherapy in April 2014. Regorafenib monotherapy was started at 80 mg/day. Then, regorafenib was increased to 120 mg/day in the second cycle. Regorafenib monotherapy led to 60% tumor shrinkage within the initial 2 months, and the tumor further decreased in size over 4 months until it became unrecognizable on imaging studies. The clinical effects of regorafenib monotherapy have shown a partial response according to Response Evaluation Criteria in Solid Tumors criteria. No severe adverse events were observed, except for mild fatigue and hand-foot syndrome. The patient has received 24 courses of regorafenib over 2 years without exhibiting tumor progression. Conclusions To the best of our knowledge, this is the longest treatment with regorafenib without tumor progression ever reported. A reduced dosage of regorafenib at induction may ameliorate the cutaneous and hepatic toxicity associated with its use

Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

Abstract Purpose The purpose of this study was to examine the relationship between preoperative Ahlbäck radiographic classification grade and the clinical outcomes of double level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity. Methods The study population comprised a consecutive series of 99 knees (68 patients) for which DLO was performed and follow‐up results for a minimum of two years were available. The Ahlbäck radiographic classification system was used to determine the osteoarthritic grade. The following radiological parameters for alignment and bone geometry were measured: mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint‐line convergence angle (JLCA), and mechanical tibiofemoral angle (mTFA). Clinical results were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) subjective score preoperatively and at 2 years after surgery. Difference between preoperative and postoperative measurements as well as relationship between Ahlbäck grade and radiological/clinical results were statistically assessed. Results The average age of the study participants was 60.9 ± 6.2 years and the mean follow‐up period was 45.4 ± 15.2 months. Each of the radiological parameters exhibited preoperative abnormal values. Knees with Ahlbäck grade 3 and 4 osteoarthritis exhibited significantly greater JLCA and mTFA than grade 1 knees. Two years post‐surgery, all radiological parameter values measured within a normal range. Clinical evaluation showed significant improvement in KOOS after surgery. Analysis of the relationship between Ahlbäck grade and clinical score showed that the 2‐year postoperative KOOS scores in grade 3 and 4 osteoarthritic knees were significantly lower than grade 1 knees (with the mean 2‐year KOOS scores of 350.0 ± 79.9, 317.9 ± 78.3, and 420.2 ± 42.9, respectively). Conclusions While DLO may produce significant radiological and clinical improvement in knees with joint space obliteration, Ahlbäck grade 3 and 4 osteoarthritic knees associated with larger JLCA and mTFA showed less satisfactory clinical results compared to grade 1 knees. Level of Evidence: IV case series

Clinical outcome of meniscus repair for isolated meniscus tear in athletes

Objective: To examine the clinical and functional outcomes for a series of patients who underwent meniscal repair for isolated meniscal tears focusing the study population on athletes. Methods: This study represents a case series of 46 athletes who underwent repair of isolated meniscal lesions of the knee from 2010 to 2015. Cases of discoid meniscal lesions and combined ligament injuries were excluded. The mean age of the patients was 22.9 years ranging from 12 to 50 years. Arthroscopic inside-out repair was primarily a procedure of option. For repair of tears with degeneration and inferior vascularity, autogenous fibrin clot was implanted to the repair site for healing enhancement. The mean follow-up period of all patients was 19.8 ± 6.8 months (range; 12 months–33 months). Results: In total, 37 of 46 patients (80%) could go back to their original sports activities. During the follow-up period, re-tear was encountered in 4 of 46 knees (8.7%). No significant differences in clinical/functional outcomes and re-tear rate were detected between the medial and lateral meniscal repairs. Conclusion: In our expanded repair indication for isolated meniscus repair for athletes, the rate of satisfactory return to sports was 91.3% in total (88.9% for the medial meniscus group; 92.9% for the lateral meniscus group). During the follow-up period ranging from 12 to 33 months (mean, 19.8 months), re-tear of the repaired site was encountered in 4 of the 46 knees (8.7%)