佐粧 孝久

The purpose of this study was to clarify the association of locomotive syndrome with present and past physical activities, as well as gait speed. Subjects were recruited from the participants of the specific health checkups in Oamishirasato City. The presence of locomotive syndrome was assessed using the stand-up test, two-step test, and 25-question geriatric locomotive function scale. Present physical activity was measured using the International Physical Activity Questionnaire. Questionnaires were also used to assess past physical activity and usual gait speed. The association of each locomotive syndrome risk test with the physical activities and gait speed was examined using univariate analysis and multiple logistic regression analysis. A total of 172 subjects with a mean age of 67.5 years were enrolled. Sixty-nine（40%）and 13（8%）subjects were classified as having stage 1 and 2 locomotive syndrome, respectively. Among the four groups classified by physical activity level, the proportions of subjects with positive stand-up test were higher in the groups of lowest and highest physical activity（P＝0.048）. Faster gait speed was a significant predictor of the negative two-step test（P＝0.08）, negative 25-question geriatric locomotive function scale（P＜0.001）, and absence of locomotive syndrome（P＝0.002）. The associations remained significant in the multiple regression analysis, after adjusting for age, sex, and body mass index. In conclusion, present physical activity was associated with the stand-up test, whereas self-reported usual gait speed was associated with the two-step test and 25-question geriatric locomotive function scale.

ハイテクニーII人工膝関節を用いて膝蓋骨非置換人工膝関節置換術を行った28例29膝(男性4膝、女性25膝、手術時平均年齢71.4歳)を対象に、術後PF(膝蓋大腿)関節へ中期的に生じるX線学的変化について解析した。術後平均観察期間8.0年の結果、外側傾斜や外側偏位については術前後で有意差はみられず、比較的良好に保たれていた。だが、関節症性変化については硬化像の進行を72.4%、骨棘形成の進行を62.1%、関節裂隙の狭小化の進行を82.8%で認め、全例において何らかの関節症性変化の進行が確認された。

Background: The purposes of this study were to clarify the incidence of anxiety and depression among patients with chronic foot and ankle diseases and to examine the independent association of anxiety and depression with pain and quality of life. Methods: Patients who visited the foot and ankle clinic from April 2015 to November 2016 were recruited. Anxiety and depression in patients were assessed using the Hospital Anxiety and Depression Scale. Pain and quality of life were evaluated using the visual analog scale (VAS) and Self-Administered Foot Evaluation Questionnaire (SAFE-Q), respectively. Furthermore, patient characteristics, including age, sex, body mass index, pain in other body areas, social support, employment, and household income, were surveyed. A multiple regression analysis was performed to examine the independent association of anxiety and depression with pain and quality of life. A total of 250 patients were included in the analysis. Results: The prevalence of anxiety and depression was 30% and 27%, respectively. The VAS and all SAFE-Q subscale scores were significantly worse in patients with anxiety or depression than in patients without the same (median VAS 63 vs 49 for anxiety, P = .005; 68 vs 47 for depression, P < .001). Furthermore, the multiple regression analyses showed that the presence of anxiety (P = .02) and depression (P < .001) was independently associated with increased pain, and it led to low scores on all SAFE-Q subscales (P < .001 for all subscales). Conclusion: About 30% of patients with chronic foot and ankle disease had anxiety or depression. The presence of these psychological symptoms was independently associated with worse pain and impaired quality of life after controlling for patient characteristics. Clinicians need to recognize the possibility of concurrent anxiety and depression to provide a more holistic treatment for chronic foot and ankle disease.

【目的】変形性膝関節症(膝OA)患者における運動療法によるメンタルヘルス改善効果の検討を目的とした。【方法】膝OA患者を(1)「薬物治療群」8例と、(2)薬物治療に加えて運動療法を行う「運動療法群」12例の2群に分け、自記式アンケート調査により3ヵ月間の治療前後の臨床症状(Knee Osteoarthritis Outcome Score;KOOS、Visual Analogue Scale;VAS、36-item Short-Form Health Survey;SF-36)及び睡眠の質(ISI)を検討した。同時に活動量も測定した。【結果】薬物治療群は臨床症状の全項目で治療前後に変化がなかったが、運動療法群ではKOOS(疼痛、activities of daily living;ADL、スポーツ、QOL)と臥位の疼痛VASで有意な改善を認めた。活動量は薬物治療群、運動療法群ともに全項目で治療前後に変化はなかった。【結論】運動療法を行うことで短期的にKOOSやVASの臨床症状を改善したが、メンタルヘルス、活動量は変化しなかった。(著者抄録)

Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43-57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or -2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis.

© 2017, International League of Associations for Rheumatology (ILAR). T1 rho and T2 mapping are magnetic resonance imaging (MRI) techniques to detect early degenerative changes in cartilage. Recent advancements have enabled 3D acquisition for both techniques. The objective of the present study was to examine the correlation of 3D T1 rho and 3D T2 mapping with macroscopic and histological characteristics of knee cartilage. Twenty-one patients who underwent total knee arthroplasty due to osteoarthritis with involvement of the medial compartment but with minimum involvement of the lateral compartment were enrolled. Prior to surgery, five series of MRI were acquired with a 3-T scanner. 3D T1 rho/T2 analyses were performed following determination of regions to be assessed using in-house software that incorporated three series of MRI acquisitions data (3D-MERGE, 3D-SPGR, and 3D-CUBE). During surgery, the cartilage of the lateral compartment was macroscopically assessed with the International Cartilage Research Society (ICRS) articular classification system. The extracted specimens were histologically assessed using the OARSI histology score. Three regions of interest (ROI) were assessed

Background: An intra-articular injection of platelet-rich plasma (PRP) may be an effective treatment for osteoarthritis (OA). However, its efficacy in ankle OA has not been investigated yet. The purpose of this study was to assess the safety and efficacy of an intra-articular injection of PRP in patients with ankle OA during a 24-week period. Methods: Twenty ankles of 20 patients with varus-type ankle OA who received intra-articular injections of PRP were evaluated. PRP was extracted from whole blood by using the double-spin technique. Three injections of 2-mL PRP were administered to the ankle at an interval of 2 weeks under ultrasonographic guidance. Adverse events and efficacy were assessed at 4, 12, and 24 weeks after the last injection. Clinical outcomes were assessed by using the visual analog scale (VAS) for pain, the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results: No serious adverse effects were observed during the follow-up period. The VAS and JSSF scale scores significantly decreased from baseline to 4, 12, and 24 weeks after treatment (P&lt;.001). The mean score in the pain-related subscale of the SAFE-Q significantly improved from baseline to 12 weeks after treatment (P =.04). Overall, the amount of pain reduction was maximal at 12 weeks after the last injection, and the effect was reduced at 24 weeks. The patients with latestage OA had worse scores in all outcomes than those with early-stage OA. Conclusion: Intra-articular injections of PRP resulted in no serious adverse effects and significantly reduced pain in the patients with ankle OA. PRP treatment can be safe and effective and may be an option in the treatment of ankle OA.

Objectives: Circadian rhythm (CR) was identified by RNA sequencing as the most dysregulated pathway in human osteoarthritis (OA) in articular cartilage. This study examined circadian rhythmicity in cultured chondrocytes and the role of the CR genes NR1D1 and BMAL1 in regulating chondrocyte functions. Methods: RNA was extracted from normal and OA-affected human knee cartilage (n = 14 each). Expression levels of NR1D1 and BMAL1 mRNA and protein were assessed by quantitative PCR and immunohistochemistry. Human chondrocytes were synchronized and harvested at regular intervals to examine circadian rhythmicity in RNA and protein expression. Chondrocytes were treated with small interfering RNA (siRNA) for NR1D1 or BMAL1, followed by RNA sequencing and analysis of the effects on the transforming growth factor beta (TGF-beta) pathway. Results: NR1D1 and BMAL1 mRNA and protein levels were significantly reduced in OA compared to normal cartilage. In cultured human chondrocytes, a clear circadian rhythmicity was observed for NR1D1 and BMAL1. Increased BMAL1 expression was observed after knocking down NR1D1, and decreased NR1D1 levels were observed after knocking down BMAL1. Sequencing of RNA from chondrocytes treated with NR1D1 or BMAL1 siRNA identified 330 and 68 significantly different genes, respectively, and this predominantly affected the TGF-beta signaling pathway. Conclusions: The CR pathway is dysregulated in OA cartilage. Interference with circadian rhythmicity in cultured chondrocytes affects TGF-beta signaling, which is a central pathway in cartilage homeostasis. (C) 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Background: The aims of this study were to reveal the characteristics of the meniscal shape at each knee osteoarthritis (OA) severity level and to predict trends or patterns of the meniscal shape change as associated with knee OA progression. Methods: Fifty-one patients diagnosed with knee OA based on X-ray and magnetic resonance (MR) images were evaluated. They were divided into three groups based on the Kellgren-Lawrence (KL) grade: normal group (KL grade of 0 or 1), mild group (KL grade of 2 or 3), and severe group (KL grade of 4). We measured the patients' meniscal size and meniscal extrusion using MR images. In addition, semiquantitative measurement was performed using MR images to determine the arthritic status of the corresponding compartment using a whole-organ magnetic resonance imaging score (WORMS). Results: The longitudinal diameter and posterior wedge angle of the medial meniscus were significantly larger, and the posterior wedge width of the medial meniscus was significantly smaller in the severe group than in the normal group. The WORMS scores for cartilage and osteophytes in the medial region were significantly different among the groups. The WORMS score of each region was strongly correlated with the longitudinal diameter. The WORMS scores of the lateral region were lower than those of the medial region. Conclusion: Our observation of the shape change of the medial meniscus in the posterior region was roughly consistent with that in many previous studies of meniscal degeneration. On the other hand, we saw that the most relevant relation between the progression of the knee OA and the deformation of the meniscus was in the longitudinal direction.

Matrix metalloproteinase 13 (MMP13) and a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5) are thought to play critical roles in cartilage degradation at the early phase of osteoarthritis (OA). The aim of this study is to examine the effect of chemically modified Mmp13 or Adamts5 small interfering RNA (siRNA), alone or in combination, in a mouse OA model. OA pathology was surgically induced in 9-week-old male C57/BL6 mice (n = 64) via destabilization of the medial meniscus (DMM). We used chemically modified siRNA (Accell siRNAsA (R)) for Mmp13 and Adamts5, as well as a non-targeting control and evaluated their combined and individual effects after injection in the DMM model. The control group (n = 16) was injected with non-targeting siRNA and the normal group (n = 16) did not undergo any surgical induction or intra-articular injection. Histological assessment of the articular cartilage was conducted at 4 and 8 weeks post-DMM surgery to evaluate OA progression. Significant improvement in the histological score was observed at 8 weeks after DMM in all three siRNA-treated groups compared to the control siRNA-injected group. The score of the combined group was significantly lower than that of the Adamts5 siRNA-only group. No significant differences were noted between the Mmp13 siRNA-only group and the combined group. Combined intra-articular injection of Mmp13 and Adamts5 siRNA resulted in almost the same inhibitory effects as Mmp13 siRNA alone on cartilage degradation at the early phase of OA.

AIMS: The purposes of this study were to clarify first, the incidence of peroneal tendon dislocation in patients with a fracture of the talus and second the factors associated with peroneal tendon dislocation. PATIENTS AND METHODS: We retrospectively examined 30 patients (30 ankles) with a mean age of 37.5 years, who had undergone internal fixation for a fracture of the talus. Independent examiners assessed for peroneal tendon dislocation using the pre-operative CT images. The medical records were also reviewed for the presence of peroneal tendon dislocation. The associations between the presence of dislocation with the patient characteristics or radiological findings, including age, mechanism of injury, severity of fracture, and fleck sign, were assessed using Fisher's exact tests. RESULTS: The pre-operative CT images showed peroneal tendon dislocation in eight out of 30 patients. Dislocation was found later in one patient whose pre-operative CT image had not shown dislocation. The overall incidence of peroneal tendon dislocation was 30% (9/30). The presence of dislocation was associated with the presence of a fleck sign (p = 0.03). CONCLUSIONS: Surprisingly, approximately one-third of the patients who underwent internal fixation for a fracture of the talus had peroneal tendon dislocation. This was associated with a fleck sign. Cite this article: Bone Joint J 2017;99-B:489-93.

全身新鮮凍結屍体2体4肢を用いて、膝関節屈曲ギャップと重力の関係について検討した。今回、重力の影響も含め後十字靱帯温存/切除(CR/PS)、膝蓋骨整復/反転(PR/PE)など様々な条件下での屈曲ギャップを計測した。その結果、TKAにおける術中屈曲ギャップ計測には関節面張力、CR/PS、PR/PE、大腿部重量のすべてが影響することが示唆された。今回の検討から、術後の歩行、階段昇降などの状態を反映するためには適切な大腿部重量減免処置と十分な関節面張力下での計測を行う必要があると考えられた。

【背景】当院では膝屈筋腱を用いた解剖学的二重束ACL再建術において、再建靱帯の固定材料として大腿骨側、脛骨側ともにTightRopeを用いた新しい術式(STAAR法)を導入している。【目的】STAAR法の短期成績を評価すること。【方法】本術式を施行し、術後1年時点で評価可能であった22例を対象とした。評価項目はpivot shift testの陽性率、脛骨前方移動量の健患側差、one leg hop testにおける健患側比(LSI)、術前および術後1年のKOOSスコアとした。【結果】Pivot shift testは14.3%に陽性であり、脛骨前方移動量の健患側差は平均1.4mm、LSIは平均0.95であった。KOOSは疼痛およびQOLサブスコアにおいて有意な改善がみられていた。【結論】術後短期においてSTAAR法は従来のACL再建法と同等の良好な成績が得られた。(著者抄録)

Magnetic resonance imaging (MRI) can be used to identify most types of meniscal tears; however, meniscocapsular separation of the medial meniscus can be difficult to identify with MRI. Here we present a technical note on the intrasurgical use of ultrasonography for the detection of meniscocapsular separation and confirmation of the beneficial effect of suturing on the stability of this lesion in a representative case of meniscocapsular separation that could be diagnosed with ultrasonography but not MRI preoperatively. Ultrasonography can detect meniscocapsular separation as a vertical low echoic area and be performed together with arthroscopy using the picture-in-picture function of the ultrasonography machine. Ultrasonography is an effective tool for diagnosing meniscocapsular separation and is helpful during arthroscopic surgery.

Bipartite navicular bone is an uncommon condition that can cause midfoot pain in children and adolescents. No treatment methods, other than conservative management, have been reported. We report the cases of 2 adolescent soccer players who underwent internal fixation of the painful bipartite fragments, resulting in nonunion. After failure of conservative management, the patients underwent surgery. Curettage of the junction between the 2 bone fragments was performed, and autologous cancellous bone was grafted. Next, the fragments were fixed with variable-threaded screws. Bone union of the bipartite fragments was once achieved on computed tomography in both cases at 3 and 5 months after surgery, respectively. However, separation of the fragment occurred in both cases after the patients had returned to sports. Although the patients were able to return to sports activities, they still had mild midfoot pain 3 and 2 years after surgery, respectively. Internal fixation using screws and an autologous bone graft for painful bipartite navicular bone in adolescent athletes is not recommended, and other surgeries should be considered to achieve bony union. (C) 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.