Long-term Stress Distribution Patterns Across the Ankle Joint in Soccer Players : A Computed Tomography Osteoabsorptiometry Study

Background: The distribution pattern of subchondral bone density is considered to accurately reflect the stress distribution over a joint under long-term physiologic loading. The biomechanical characteristics of the surface of the ankle joint in soccer players can be determined by measuring this distribution pattern under long-term loading. Purpose: To evaluate the distribution of subchondral bone density across the ankle joint in soccer players and to determine the effects of soccer activities, including kicking motion, on the ankle joint surface under long-term loading conditions by computed tomography (CT) osteoabsorptiometry (CTOAM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: CT imaging data were obtained from both ankles of 10 soccer players (soccer group) and 10 nonathletic volunteers (control group). The distribution patterns of subchondral bone density across the articular surface of the ankle joints were assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the ankle joint differed between the soccer players and controls. In the soccer players, the high-density areas were found in the anterior part of the distal tibia and proximal talus as well as the distal fibula. The percentages of high-density areas were greater in the soccer players compared with controls (P < .0001). Conclusion: Stress distribution over the articular surface of the ankle joint was affected by soccer activities. A high stress concentration was seen in soccer players in the anterior part of the tibia and talus and in the fibula; such excessive stress may lead to anterior impingement

Changes in wrist joint contact area following radial shortening osteotomy for Kienbock's disease

We hypothesized that the contact area of the articular surface of the wrist joint could be evaluated using a custom-designed analytical program. The aim of the study was to compare the articular contact area of the wrist joint before and after radial shortening osteotomy for Kienbock's disease. Nine wrists of 9 patients underwent radial shortening osteotomy for Kienbock's disease. Computed tomography (CT) images of the wrist joint were reconstructed using a 3D reconstruction software package. Radioscaphoid and radiolunate joint contact areas and translation of the joint contact area from preoperative to postoperative were calculated using customized software. The mean Modified Mayo Wrist Score was significantly improved from 50.6 preoperatively to 83.3 at final follow-up (p < .001). Preoperatively, the pain was reported as severe in five wrists and moderate in four wrists, while at final follow-up, five patients were free from pain and four patients had mild pain with vigorous activity. The preoperative radioscaphoid joint contact area was 133.4 +/- 49.5 mm(2) and the postoperative radioscaphoid joint contact area was 156.4 +/- 73.1 mm(2). The preoperative radiolunate joint contact area was 194.8 +/- 92.1 mm(2) and the postoperative radiolunate joint contact area was 148.3 +/- 97.9 mm(2). The radial translation distance was 0.4 +/- 1.2 mm, the dorsal translation distance was 0.6 +/- 1.2 mm, and the proximal translation distance was 0.2 +/- 0.4 mm. CT-based analysis revealed that the center of the contact area translated radially following radial shortening

Residual remnant preserving anatomic double-bundle anterior cruciate ligament reconstruction using hamstring tendon autografts

Residual remnant tissue preservation of the anterior cruciate ligament (ACL) has attracted notice in ACL reconstruction. There is a possibility that residual remnant tissue preserving technique has several potential advantages to accelerate the graft remodeling, such as improved anterior knee laxity, accelerated cell infiltration and revascularization, increased mechanoreceptors, and reduction of bone tunnel enlargement. Recently, the authors reported a new remnant tissue preserved procedure for anatomic double-bundle (DB) ACL reconstruction using the transtibial tunnel technique. The anterior and rotational knee laxities were significantly less in the remnant-preserved group than in the remnant-resected group. The 2nd look observation showed that the remnant-preserved group was significantly better than the remnant-resected group. In this article, the authors described the surgical technique and clinical outcomes of the residual remnant preserving DB ACL reconstruction