佐粧 孝久

OBJECTIVE: To elucidate the time course of magnetic resonance imaging (MRI)-based morphological and qualitative outcomes after an atelocollagen-assisted autologous chondrocyte implantation (ACI) and to analyze the correlation between arthroscopic and MRI-based assessment. DESIGN: We included ACI recipients from a multicenter registration study (CaTCh [Cartilage Treatment in Chiba] study). Morphological (3-dimensional magnetic resonance observation of cartilage repair tissue: 3D-MOCART, MOCART2.0) and qualitative assessment (T2- and T1rho-mapping) by MRI were conducted at 6, 12, and 24 months post-implantation. Global T2 and T1rho indices (T2 and T1rho in repair tissue divided by T2 and T1rho in normal cartilage) were calculated. Arthroscopic second-look assessment was performed in 4 and 15 knees at 12 and 24 months post-implantation, respectively. RESULTS: The 3D-MOCART over 12 months witnessed significant patient improvement, but some presented subchondral bone degeneration as early as 6 months. The MOCART2.0 improved from 57.5 to 71.3 between 6 and 24 months (P = 0.02). The global T2 index decreased from 1.7 to 1.2 between 6 and 24 months (P < 0.001). The global T1rho index decreased from 1.5 to 1.3 between 6 and 24 months (P = 0.004). Normal or nearly normal ICRS-CRA (cartilage repair assessment scale developed by the International Cartilage Repair Society) grades were achieved in 86% and 93% of the lesions at 12 and 24 months, respectively. Better ICRS-CRA grade corresponded to better MOCART2.0, with no trend in the T2 and T1rho values. CONCLUSIONS: Atelocollagen-assisted ACI improved the MRI-based morphological and qualitative outcomes until 24 months post-surgery, and normal or nearly normal grades were achieved in most lesions by arthroscopic assessment. MRI assessment may be an alternative to arthroscopic assessment.

<title>Abstract</title><sec> <title>Background</title> The evaluation of postoperative total knee arthroplasty (TKA) alignment mainly relies on measurement data obtained from plain radiographs. The aim of this retrospective observational study was to document the intra- and inter-observer reliability in assessment of TKA component positioning after surgery using a three-dimensional (3D) computed tomography (CT) image matching system. </sec><sec> <title>Methods</title> Fourteen knees from 14 patients who received primary TKA were included, and images were analyzed by blinded readers not associated with the surgeries. The examiner digitized the reference points according to defined landmarks, and the designated size component was superimposed to the 3D reconstructed CT model for measurement. In addition to the evaluation of implant position against the coronal and sagittal lower limb mechanical axes that were defined based on bony landmarks, implant position against axes connecting implant-based reference points that are easier to indicate was evaluated. </sec><sec> <title>Results</title> The overall intra- and inter-observer reliabilities determined by the intraclass correlation coefficients (ICC) of the implant alignment measurement for both femoral and tibial components were good (ICC &gt; 0.60), except in the direction of femoral flexion and extension, for both mechanical and implant-based axes. The difference between implant alignment measurements according to the traditional mechanical axis and the implant-based axis ranged between means of 0.08^o and 1.70^o and were statistically significantly different. </sec><sec> <title>Conclusions</title> The postoperative evaluation of implant position in the coronal and sagittal planes using 3D-CT image matching is reliable and has good reproducibility except for the sagittal alignment assessment of the femoral component. The measured implant position according to the traditional mechanical axis and the implant-based axis were slightly but significantly different. </sec>

Background: Thus far, the clinical results of anterior cruciate ligament (ACL) reconstruction have been observed to be comparable between young and older patients. In contrast, age-related changes in the structural and mechanical properties of tendons used for autografts have been described. However, age-related changes associated with graft maturation remain poorly understood. Hypotheses: The hypotheses of this study were that (1) clinical outcomes after ACL reconstruction would be comparable between younger and relatively older patients and (2) younger patients would show lower signal intensity changes on magnetic resonance imaging scans indicative of graft maturation that would be better than that in relatively older patients. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively evaluated 236 patients who underwent double-bundle ACL reconstruction via the outside-in technique using hamstring autograft between January 2012 and December 2015. The patients were categorized by age into 3 groups: &lt;20 years old, 20 to 39 years old, and ≥40 years old. Clinical outcomes were evaluated using the subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale, Lysholm score, and objective assessment of joint laxity 24 months after surgery. In addition, graft maturation was evaluated using magnetic resonance imaging–derived measures of the signal intensity ratio (SIR) at 3, 6, 12, and 24 months postoperatively. Clinical outcomes and graft maturation were compared among the 3 groups. Results: The SIR of both bundles increased from 3 months to 12 months and decreased by 24 months, showing the same tendency in all groups. No significant difference was found in the SIR among the 3 groups at any time point ( P &gt; .05). The IKDC score was significantly lower in the ≥40-year group than in the &lt;20-year group ( P &lt; .01). In contrast, no significant differences were noted in other clinical outcomes. Conclusion: Patients aged ≥40 years exhibited lower IKDC scores compared with younger patients, although the results of graft maturation were comparable.

BACKGROUND: Abnormal foot morphology in children and adolescents is a possible risk factor for lower extremity pain. Foot posture index-6 (FPI-6) is a valid and reliable tool to assess foot morphology. However, the normative data on the age distribution for FPI-6 in Asian children and adolescents are still minimal. Further, the correlation of FPI-6 with lower extremity pain is poorly understood. We aimed to investigate the normative distribution for FPI-6 and the relationship between FPI-6 scores and knee and heel pain in Japanese children. METHODS: We included 2569 Japanese children, aged 9-15 years, at a single school from 2016 to 2018. We summarized the age distribution of children and their mean bilateral FPI-6 scores. Additionally, we assessed the tenderness at the apophysis or tendon insertions at the knee and heel. We performed a cross-sectional analysis to investigate the correlations between FPI-6 scores and sex, age, and knee and heel pain for the data obtained each year. RESULTS: The mean FPI-6 score was 3.1 ± 2.4, 3.4 ± 2.0, and 3.2 ± 1.9 for the left foot and 3.0 ± 2.4, 3.2 ± 1.9, and 3.1 ± 1.9 for the right foot in 2016, 2017, and 2018, respectively. Boys tended to have higher scores than girls, and the FPI-6 score of the left foot was significantly higher than that of the right foot (p < 0.05). There was no correlation between FPI-6 scores and knee and heel pain. CONCLUSION: Children and adolescents between 9 and 15 years of age have neutral to slightly pronated foot morphology and an average FPI-6 score of 3.0-3.4. In addition, there was no relationship between foot morphology and knee and heel pain. This normative distribution for FPI-6 in Japanese children could serve as a reference value for future research and clinical evaluation.

背景:自家培養軟骨(JACC)移植術の術後中長期成績の報告は少なく、臨床成績や予後に関して不明な点が多い。今回、同術式を行い3年以上経過した症例の術後成績を報告する。対象・方法:2016年以降に千葉大学医学部附属病院にてJACCを用いた軟骨移植術を施行され、術後3年以上経過観察し得た3例3膝を対象とした。平均年齢は37.7歳、診断はすべて外傷性軟骨損傷であった。後療法は4週間免荷もしくはニーブレス装着、滑車部損傷がある場合は可動域制限を設けた。術後評価は患者立脚型評価(KOOS、Lysholm score)、MRI検査(3D-MOCART score、T2 mapping)、再鏡視所見(ICRS-CRA)を用いた。結果:患者立脚型評価は術後1年で改善し、術後3年まで良好な結果を維持した。ICRS-CRAは全例でnearly normalまで改善した。MRI検査による3D-MOCART score、T2 mappingにおいても経時的に改善傾向が認められた。結論:外傷性膝関節軟骨損傷に対するジャック移植術後1年で良好な成績が得られ術後3年まで維持された。(著者抄録)

全身弛緩性と運動器疼痛の関連を示唆する報告が散見されるが,本邦小児における全身弛緩性の陽性率や,成長期に生じる膝・踵部痛との関連は不明である.そこで本研究の目的は小・中学生の全身弛緩性の評価を行い,膝・踵部痛との関連を調査することとした.対象は,2016〜19年度までに学校運動器検診を受けた9〜15歳の小・中学生とした.対象者背景として性別,身長・体重を記録し,膝・踵部痛の有無に加えて全身弛緩性を評価した.膝・踵部痛は膝3 ヶ所,踵1ヶ所の圧痛を左右で確認し,1 ヶ所以上で痛みを認めた場合に膝・踵部痛ありとした.全身弛緩性はBeightonscore(以下,BS)を用い,5点以上を全身弛緩性ありと判定した.年度ごとに各年齢におけるBSの中央値と全身弛緩性の陽性率を集計し,全身弛緩性の有無による膝・踵部痛の有無のオッズ比について解析した.有意水準は5%未満とした.対象者は837〜865 人で性差は1:1,平均BMIは17.5〜17.8 kg/m2であった.膝・踵部痛を有する割合は5〜13%であった.2018年度の9歳児を除くすべての年齢で,BSの中央値は0〜1であった.年度ごとの全身弛緩性陽性率は1.1〜5.0%であった.また,膝・踵部の圧痛と全身弛緩性がともに陽性となった児童生徒は0〜0.2%と非常に少なく,膝・踵部の圧痛の有無と全身弛緩性に明らかな関連を認めなかった(p=0.31〜0.83).小児の全身弛緩性陽性率は,海外では4.0〜18.6%,本邦では7.5%と報告されている.本研究での全身弛緩性陽性率は,1.1〜5.0%と諸家の報告と比較して低い結果となった.全身弛緩性は年齢や人種・性に関連するとされており,対象年齢や人種の相違が影響したと考えられた.加えて,BSのカットオフ値は4〜6と様々であったことも影響したと考えられた.運動器疼痛と全身弛緩性の関連については一定の見解はないものの,本研究では膝・踵部痛と全身弛緩性を同時に有する児童がほとんどおらず,また,膝・踵部痛の有無と全身弛緩性との間に,統計学的に有意な関連はみられなかった.(著者抄録)

<sec><title>Background:</title> Nationwide epidemiologic studies in Scandinavian countries have shown that the incidence of Achilles tendon ruptures (ATRs) has increased, and the rate of surgical treatment has declined markedly in the past decade. However, there is a lack of national-level data on the trend of ATRs and surgical procedures in other regions. </sec><sec><title>Purpose:</title> To clarify the trend in the incidence of ATRs and the proportion of surgery using the nationwide health care database in Japan. </sec><sec><title>Study Design:</title> Descriptive epidemiology study. </sec><sec><title>Methods:</title> Age- and sex-stratified data on the annual number of ATRs and surgical procedures between 2010 and 2017 were obtained from the Japanese national health care database, which includes almost all inpatient and outpatient medical claims nationwide. The Japanese population data were also obtained from the population census. The change in the annual incidence of ATRs per 100,000 people was assessed using a Poisson regression analysis. The trend in the annual proportion of surgeries relative to the occurrence of tendon ruptures was determined using a linear regression analysis. </sec><sec><title>Results:</title> A total of 112,601 ATRs, with men accounting for 67%, were identified over 8 years. Patients aged ≥60 years accounted for 27,106 (24%), while those aged 20 to 39 years and 40 to 59 years accounted for 36,164 (32%) and 49,331 (44%), respectively. The annual incidence of ATR ranged from 12.8/100,000 to 13.9/100,000 (women, 8.2-8.9/100,000; men, 17.2-19.5/100,000), which did not change over the study period ( P = .82). Moreover, the annual incidences did not change across sexes and age categories. The annual proportion of surgery increased significantly, from 67% in 2010 to 72% in 2017 ( P = .003). The annual proportions increased across sexes and age categories except for women aged 40 to 59 years. </sec><sec><title>Conclusion:</title> The incidence of ATR did not change between 2010 and 2017, according to the Japanese nationwide health care database. Furthermore, the proportion of surgical treatment increased during the study period. Overall, 70% of patients underwent surgical treatment. This study suggested that the trend in ATR and surgery differed across regions. </sec>

BACKGROUND: When treating cancer patients, the progression of symptoms is accompanied by the deterioration of systemic conditions and motor function. From a risk-benefit perspective, a certain level of physical function must be maintained to continue cancer treatment. Recently, outpatient cancer treatment has become more common. Motor function is important to determine the feasibility of continuing cancer treatment. The study aimed to evaluate the motor function of patients with visceral cancer using locomo tests established by Japanese Orthopaedic Association. METHODS: Locomo tests were performed, and the results were compared with data from non-cancer individuals. Background data were matched by propensity score matching. Data from 53 cancer patients (group C) were compared with that of 75 non-cancer patients (group N). RESULTS: The average score in the two-step test of group C was lower than that of group N (1.27: 1.37, p = 0.004). The average function in the stand-up test of group C was worse than that of group N (p = 0.001). The average score in the 25-question geriatric locomotive function scale (GLFS) of group C was significantly higher than that of group N (19.92: 5.29, SE 2.21, p < 0.001). Higher 25-question GLFS scores indicate reduced mobility. The proportion of the locomo stage 2 in group C was significantly higher than in group N (51%: 13%, p < 0.001). The results of the two field tests revealed a clinically minimal difference between the two groups, but a statistically significant difference. Locomo tests may be detect potential motor dysfunction in outpatient cancer patients with apparently maintained motor function. CONCLUSIONS: Even in cancer patients who attend outpatient clinics, their motor functions could be potentially impaired. Therapeutic interventions to maintain and enhance motor function for cancer patients could be useful for continuing cancer treatment, and furthermore, improving prognosis.

INTRODUCTION: Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are established treatments for medial compartment osteoarthritis (OA) or osteonecrosis (ON) of the knee joint, and the predominance of either procedure is inconclusive. We compared the awareness of the knee after UKA and HTO using the Forgotten joint score-12 (FJS). MATERIALS AND METHODS: This was a retrospective, multicenter study. Ninety-six knees of 90 patients who received UKA or HTO and were followed-up for at least 1 year were analyzed. Postoperative FJS was compared between the two groups and evaluated for the effect of patient-related factors and clinical outcomes. Multiple linear regression analysis was performed to predict FJS. RESULTS: There was no significant difference in the FJS between the UKA and HTO groups (p = 0.24). FJS did not correlate with any of the patient-related factors. There was a correlation between the FJS and each item of the Knee Injury and Osteoarthritis Outcome Scores (KOOS) and Lysholm Knee Scoring Scale (LKS). In multiple linear regression analysis, lower BMI, the diagnosis of OA Kellgren-Lawrence (KL) grade ≥ 3, and ON were significant predictors of better FJS. In both groups, FJS was correlated with each item of the KOOS and LKS. Internal consistency in terms of Cronbach's alpha was excellent. CONCLUSIONS: There was no significant difference in FJS between patients who underwent UKA and HTO. Lower BMI, the diagnosis of OA KL grade ≥ 3, and ON were significant predictors of better FJS.

Objectives: Transgender issues have become increasingly prominent in sports. However, knowledge of and experience with supporting transgender players across soccer team staff remain unclear. The objectives of this questionnaire-based study were to 1) clarify staff knowledge of transgender-related terminology; and 2) explore soccer team staff's awareness and experience with supporting transgender players.Methods: A questionnaire was distributed to coaches, physicians, and physical trainers affiliated with soccer teams between 2018 and 2019 to capture 1) participant characteristics (e.g. gender, age, certified license, team categories); 2) their understanding of transgender-related terms, including lesbian, gay, bisexual, and transgender (LGBT) and of the IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism in 2015; 3) their awareness of transgender players; and 4) their experience supporting transgender players. Participants were categorized by age, gender, profession, qualifications, and category of involvement; their understanding and experience were investigated statistically using univariate and multivariate analysis.Results: The 478 respondents included 30 women and 448 men with a mean age of 38 ± 10 years. Of these, 83% understood the term transgender, 75% understood the term LGBT, while only 7% were familiar with the 2015 IOC Consensus Meeting. Physicians reflected more knowledge than coaches and physical trainers (p < 0.01). Altogether, 15% had identified transgender players and 1% had experience supporting them. Respondents with certified licenses who worked with women's teams were more likely to recognize transgender players (p < 0.01). Four participants (1%) had witnessed transgender players receiving transgender hormone therapy.Conclusion: Although most soccer support staff were familiar with transgender terms, many did not have sufficient knowledge of or experience with transgender athletes.

OBJECTIVE: Cartilage lesions in the knee joint can lead to joint mechanics changes and cause knee pain. Bone marrow stimulation (BMS) promotes cartilage regeneration by perforating the subchondral bone just below the injury and inducing bone marrow cells. This study aimed to investigate whether systemic administration of granulocyte colony-stimulating factor (G-CSF) with BMS improves repair of chronic partial-thickness cartilage defects (PTCDs). DESIGN: Eighteen 6-month-old New Zealand white rabbits were divided into 3 groups: control (C, n = 6), BMS alone (n = 6), and BMS + G-CSF (n = 6). Partial cartilage defects with 5 mm diameter were created in the trochlear region of both knees; after 4 weeks, the BMS alone and BMS + G-CSF groups underwent BMS; G-CSF (50 µg/kg) or saline was administered subcutaneously for 5 days starting from 3 days before BMS. At 8 and 16 weeks after cartilage defect creation, the area of cartilage defects was macroscopically and histologically evaluated. RESULTS: International Cartilage Repair Society (ICRS) grades for macroscopic assessment were 0, 0.7, and 0.7 at 8 weeks and 0, 1.2, and 1.3 at 16 weeks in the C, BMS, and BMS + G-CSF groups, respectively. Wakitani scores for histological assessment were 9.8, 8.7, and 8.2 at 8 weeks and 9.5, 9, and 8.2 at 16 weeks in the C, BMS, and BMS + G-CSF groups, respectively. The BMS + G-CSF group showed significantly more repair than the C group, but there was no difference from the BMS group. CONCLUSIONS: The effect of BMS and G-CSF on chronic PTCDs in mature rabbit knees was limited.

BACKGROUND: Evaluation over time is important in assessing the reduction of the syndesmosis after suture-button fixation for ankle malleolar fractures. The purposes of this study were to evaluate time-dependent change in the syndesmotic reduction immediately after suture-button fixation for ankle malleolus fractures and 1 year after surgery using computed tomography, and to investigate the reliability of the measurement values to evaluate the reduction of syndesmosis. METHODS: We assessed 28 patients who underwent suture-button fixation for ankle fractures. Syndesmotic reduction was assessed within 2 weeks of the fracture surgery and 1 year after surgery using axial computer tomographic images. Side-to-side differences in the anterior, central, and posterior tibiofibular distances, anteroposterior fibular translation, fibular rotation, and syndesmosis area were measured. RESULTS: The mean anterior tibiofibular distance and anteroposterior fibular translation were 1.8 mm and 1.5 mm, respectively, after syndesmotic fixation. They decreased to 1.2 mm and 0.6 mm, respectively, at 1 year after surgery (P = .03 and P = .01, respectively). The other measurement values did not change over time. The minimum detectable change in the distance of measurements was 1 mm or less. CONCLUSION: The anterior tibiofibular distance and anteroposterior fibular translation had decreased 1 year after fixation in ankle malleolar fractures with syndesmotic suture button. Even if the fibula is posteriorly malreduced by the time computed tomography is performed immediately after surgery, the fibula may return to a good position 1 year after surgery. LEVEL OF EVIDENCE: Level IV, case series.

Background: To investigate in vivo kinematics of total knee arthroplasty (TKA) with the introduction of a mildly constrained (MC) type of polyethylene (PE). We compared the knee kinematics with a reported pattern after surgery using the same component with a conventionally constrained (CC) type of PE. Methods: Finite element analysis (FEA) was performed to examine different peak stress distribution of both types of PE. For in vivo study, patients who underwent cruciate-retaining TKA using a total knee system with MC-PE were included. Fluoroscopic surveillance was used to measure the weight-bearing deep knee bend (squatting) using a two-dimensional/three-dimensional (2-D/3-D) registration technique. Results: FEA analysis revealed the edge loading of the femoral component on PE in CC but not in MC. During the study period, 42 patients underwent TKA with MC-PE. Among them, 13 agreed to participate in the present study. In vivo kinematics analysis found that starting from an average external rotation of femur being 7.1° at 0° of flexion, the rotation slightly decreased to 6.8° at 10° of flexion, then increased with increasing knee flexion until it reached 10.8° at 80° of flexion, and finally decreased to 9.8° at 100° of knee flexion. The results indicate a modest medial pivot pattern. Although the overall pattern was similar for both MC-PE and CC-PE, a slight difference was observed. MC-PE showed a slight internal rotation of 0.3° from 0 to 10° of knee flexion, whereas CC-PE showed a gradual increase of external rotation in this range. Conclusions: Change of configuration from CC to MC did not substantially affect in vivo kinematics of knees after TKA. Considering the theoretical wider range of allowance of rotation, MC-PE is easier for knee surgeons to use.

BACKGROUND: The purpose of this study was to clarify the incidence rate and the risk factors for the progression of the hallux valgus deformity. METHODS: Patients who had weight-bearing radiographs of the foot taken twice or more, with a ≥2-year interval, were retrospectively analyzed. Progression of the deformity was defined as an increase in the hallux valgus angle of ≥5° during the follow-up. The association of hallux valgus progression with patient characteristics and radiographic measurements at baseline was determined using univariate and multivariate analyses. RESULTS: Totally, 268 patients (217 women and 51 men; median age, 64 years) were analyzed. An increase in the hallux valgus angle of ≥5° occurred in 44 (17%) patients in a median follow-up of 49 months. Large hallux valgus angle (odds ratio, 1.07) on the dorsoplantar radiograph at baseline were independent risk factors for the progression of the deformity. CONCLUSION: Progression of the hallux valgus deformity occurred in one of six patients. Furthermore, large hallux valgus angle was the risk factor for subsequent deformity progression. Patients with large hallux valgus angle should be informed about the possible progression of the deformity.

BACKGROUND: The purpose of this study was to compare physical activity levels and the proportion of patients who met physical activity recommendations in patients with ankle osteoarthritis and controls. METHODS: Ankle osteoarthritis patients (n = 50) and controls (n = 50) were recruited. physical activity was measured using an accelerometer-based monitor. Physical activity parameters, including the step count/day, the proportion of patients who met physical activity recommendations of ≥7000 steps/day, and moderate to vigorous physical activity minutes/day, were compared between the patient groups. RESULTS: The patients with ankle osteoarthritis walked 3998 steps/day, while the controls walked 6531 steps/day (P < .001). Only 7 (14%) ankle osteoarthritis patients and 17 (34%) controls met the physical activity recommendations of ≥7000 steps/day (P =  .01). Time spent performing moderate to vigorous physical activity was 58 and 78 min/day in the ankle osteoarthritis and controls, respectively. CONCLUSIONS: The physical activity level of ankle osteoarthritis patients was lower than that of controls. Only a limited proportion of ankle osteoarthritis patients met the physical activity recommendation.

It is important to know the relationship between flexor tendon traction force and applied finger flexion force generated during the rehabilitation of trigger finger. However, there has been no report on this relationship using the Jamar dynamometer in clinical practice and cadaveric study. Therefore, the purposes of this cadaveric study were to measure the value of flexion force when pulling a tendon via the method used in clinical practice and to investigate the relationship between the traction force of the flexor tendon and the flexion force of the finger output based on the Jamar dynamometer. In this study, each finger of a fresh-frozen cadaver was pulled, and the finger flexion force was measured with the Jamar Plus+ Digital Hand Dynamometer （Performance Health, Chicago, IL, USA）. There was a strong first-order correlation between the flexor tendon traction force and the finger flexion force, and the value of the finger flexion force［N］divided by the flexor tendon traction force［N］was 0.195-0.321. Under the same flexor tendon traction force, the exerted finger flexion force was in the following order: middle finger, index finger, ring finger, and little finger（maximum to minimum）. It is important to consider these findings when performing rehabilitation of trigger finger.

はじめに:近年、性同一性障害に対する認識が高まっているが、スポーツ現場で活動する整形外科医は、性同一性障害のアスリートに対する認知度やサポートのための知識、日常診療やスポーツ現場で性同一性障害のサポート経験が少ない可能性がある。目的:本研究の目的は、アスリートの診療に関わる整形外科医を対象に1)性同一性障害に対する認知度や知識、2)性同一性障害アスリートのサポート経験の有無を明らかにすることである。方法:千葉大学整形外科および関連病院に勤務し、アスリートの診療に関わる整形外科医を対象に質問票による調査を行った。1)研究協力者背景:性別、スポーツドクター資格の有無、研究協力者が診療しているアスリートの競技種目、2)性同一性障害、IOC Consensus Meeting 2015の認知率、3)性同一性障害アスリートへのサポート経験の有無等を調査した。結果:研究協力者は男性65名、女性5名だった。研究協力者が診療しているアスリートの競技種目は、サッカー、ラグビー、野球など多岐に渡った。性同一性障害、IOC Consensus Meeting 2015の認知度は、各86%、6%だった。11%が性同一性障害アスリートの存在を認識したことがあり、1名は実際にサポート経験があった。まとめ:性同一性障害の認知率は2010年代の他の報告と同等だった。少数ではあるが性同一性障害アスリートを認識またはサポート経験がある医師も存在した。整形外科医に対する教育体制や、各競技団体、またはスポーツ界全体でのサポート体制の構築が望まれる。(著者抄録)

Background: Osteochondritis dissecans (OCD) rarely occurs in multiple joints. Furthermore, the existence of left-right asymmetric OCDs in different joints of the contralateral side of the body and lesions occurring with a temporal difference is rare. Here, we report a rare case with multiple OCDs sequentially detected in various joints. Case Presentation. The 15-year-old male patient was referred to our hospital for an OCD in the medial femoral condyle of the left knee. He had a history of an OCD in his right elbow, and his father had a history of surgically treated OCDs in both knees. One year and five months after, surgery was performed to the lesion in his left medial femoral condyle, a new OCD lesion occurred in the femoral trochlea of the same knee, which was again treated surgically. Five months after the second surgery, the patient returned with pain in the right knee, and an OCD on the right femoral trochlea was detected by an MRI scan. This lesion remained stable without any further restriction in physical activities for 17 months until detachment occurred and was again treated surgically. Conclusion: In cases with history and a family history of multiple OCDs, in particular, with a short stature, an MRI scan should be performed for the symptomatic joint to detect and treat the lesion before progression.

60歳女性。58歳時に当院で変形性膝関節症に伴う両膝痛に対し左人工膝関節全置換術(TKA)を施行後、半年経過で右TKAを他院で受けたが、術後に右膝関節の可動域制限を伴う疼痛、歩行時の違和感が持続したため当院へ再受診となった。単純X線とCT所見より右脛骨コンポーネントの回旋設置位置不良に伴う疼痛および可動域制限と診断され、再置換術が行われた。CTによる術前評価に基づく脛骨コンポーネントの回旋位を修正した結果、術後には右膝関節可動域は改善し、右膝痛、歩行時の違和感も消失した。

A displaced avulsion fracture at the tibial attachment of the posterior cruciate ligament is considered an indication for surgical reduction and internal fixation because nonunion and remaining posterior instability of the knee are common consequences of conservative treatment. The problems with standard open surgical techniques are that they are relatively invasive despite the limited operative field and it is impossible to explore intra-articular lesions by the posterior approach. An arthroscopic procedure has the advantage of being minimally invasive and allowing the surgeon to detect and treat associated intra-articular injuries. We present an arthroscopic reduction-internal fixation technique using an adjustable-length loop device. A trans-septal portal is created to visualize the fracture fragment directly, and the fragment is reduced and penetrated with a cannulated drill under fluoroscopic guidance. An adjustable-length loop device is relayed from the posteromedial portal and pulled out through the fragment in an anterograde fashion, placing a button on top of the fragment. By tightening the loop, downward compression can be applied to the fragment. Overall, this technique provides good reduction and bone union, and excellent clinical outcomes, including posterior knee stability, can be achieved.