山口 智志

BACKGROUND: The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) is a specifically designed scoring system for children and has been translated into several languages. However, to date, no validated Japanese version of this scoring system is available. PURPOSE: To translate the HSS Pedi-FABS into Japanese and assess its reliability and validity. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: The HSS Pedi-FABS was translated into Japanese and back-translated into English to confirm the appropriateness of the translation. A total of 764 children aged 9 to 15 years participated in the validation study. The participants answered the Japanese version of the HSS Pedi-FABS along with 2 other questionnaires in Japanese (the Physical Activity Questionnaire for Older Children [PAQ-C] and the physical activity questionnaire of the World Health Organization's Health Behavior in School-aged Children [HBSC PAQ]). At 1 month after the first assessment, the children answered the Japanese version of the HSS Pedi-FABS again. We evaluated reliability using the Cronbach alpha and the intraclass correlation coefficient. Validity was evaluated by quantifying floor and ceiling effects, correlations between the HSS Pedi-FABS and the PAQ-C, the HSS Pedi-FABS discrepancy between active and inactive groups divided by the HBSC PAQ, and correlation between the HSS Pedi-FABS and body mass index. RESULTS: HSS Pedi-FABS scores were slightly but significantly higher in male participants (mean = 16.7) than in female participants (mean = 13.2). The Cronbach alpha coefficient was .90, and the intraclass correlation coefficient value was 0.90, indicating excellent internal consistency and test-retest reliability, respectively. No floor (2.6%) or ceiling effect (1.0%) was observed. The HSS Pedi-FABS was significantly correlated with the PAQ-C (r = 0.70). The active group demonstrated a significantly higher score on the HSS Pedi-FABS (mean = 18.9) than did the inactive group (mean = 11.2). In terms of discriminative validity, the HSS Pedi-FABS was not correlated with body mass index (r = -0.15). CONCLUSION: The Japanese version of the HSS Pedi-FABS demonstrated appropriate reliability and validity, indicating that it is a useful tool to assess physical activity levels in Japanese children.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on children's lifestyles. Some studies have reported psychological changes in children after the pandemic, but information on musculoskeletal problems is scarce. This study aimed to investigate the incidence of knee pain and changes in physical activity after the spread of COVID-19 among elementary and junior high school students in Japan. METHODS: Knee pain and amount of physical activity were recorded on a monthly basis between August 2019 and February 2021 in children aged 8-14 years using a self-administered questionnaire. The amount of physical activity was scored using the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). The period until February 2020 was defined as "Before pandemic," and the period from March 2020 was defined as "After pandemic." The incidences of knee pain and HSS Pedi-FABS scores before and after the COVID-19 pandemic were compared. Additionally, we compared the prevalence of knee pain and HSS Pedi-FABS scores according to sex and age. RESULTS: We enrolled 886 and 881 participants before and after the pandemic, respectively. The prevalence of knee pain among the participants before and after the pandemic was 6.7% and 7.9%, respectively (p = 0.032). The mean HSS Pedi-FABS scores before and after the pandemic were 14.8 and 14.5, respectively (p = 0.005). Participants aged 14 years had a significantly lower incidence of knee pain (p = 0.013) and significantly higher HSS Pedi-FABS scores (p < 0.001) after the spread of COVID-19. CONCLUSIONS: In elementary and junior high school students, increase in the incidence of knee pain and decrease in the amount of physical activity after the spread of COVID-19 were observed.

BACKGROUND: The development of computer-assisted technologies to diagnose anterior cruciate ligament (ACL) injury by analyzing knee magnetic resonance images (MRI) would be beneficial, and convolutional neural network (CNN)-based deep learning approaches may offer a solution. This study aimed to evaluate the accuracy of a CNN system in diagnosing ACL ruptures by a single slice from a knee MRI and to compare the results with that of experienced human readers. METHODS: One hundred sagittal MR images from patients with and without ACL injuries, confirmed by arthroscopy, were cropped and used for the CNN training. The final decision by the CNN for intact or torn ACL was based on the probability of ACL tear on a single MRI slice. Twelve board-certified physicians reviewed the same images used by CNN. RESULTS: The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the CNN classification was 91.0%, 86.0%, 88.5%, 87.0%, and 91.0%, respectively. The overall values of the physicians' readings were similar, but the specificity was lower than the CNN classification for some of the physicians, thus resulting in lower accuracy for the human readers. CONCLUSIONS: The trained CNN automatically detected the ACL tears with acceptable accuracy comparable to that of human readers.

OBJECTIVES: This study aimed to clarify the frequency-response relationship between exercise habits and locomotive syndrome in different age groups. METHODS: We analyzed 8,681 independent community dwellers who participated in a nationwide cross-sectional locomotive syndrome study. Participants were divided into young (20-39 years), middle (40-64 years), and old (≥ 65 years) groups. The presence of locomotive syndrome was evaluated using the locomotive syndrome risk tests. Exercise habits were assessed by exercise frequency (almost every day/sometimes/occasionally/never). The association between locomotive syndrome and exercise was assessed using the multiple logistic regression analysis adjusted for participant characteristics for each age category. RESULTS: Overall, 3,528 (41%) participants had locomotive syndrome. In the old group, the risk of locomotive syndrome was lower with an increased exercise frequency. However, this dose-response relationship was not found in the young group. The proportion of locomotive syndrome was lower even in participants who occasionally exercised (1-3 days/month) than those who never exercise in the young and middle age groups. CONCLUSIONS: Regular exercise reduced the risk of locomotive syndrome not only in middle and older adults but also in young adults. Moreover, increasing exercise frequency may provide benefits for locomotive syndrome prevention, especially among older adults.

＜文献概要＞外反母趾は高齢者に多くみられ,症状も症例によって多彩である.外反母趾に対する保存療法にはさまざまな方法があるが,効果的かつ患者に受け入れ可能な方法を選択するために,問診で靴を含めた生活習慣を把握すること,詳細な視診と触診で痛みの部位や原因を明らかにすることが重要である.患者の症状は何か,治療のゴールをどこにするかを明確にする必要があり,患者の生活様式や背景に合わせたテーラーメイド治療が求められる.

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.

【目的】COVID-19の初期の外出自粛が、身体活動に及ぼす変化を明らかにすること。【方法】インターネット調査。【結果】活動量は約4割が減少、座位時間は約3割が増加、外出機会は約半数に減少した。外食、イベントや集会、買いものなどを控えていた。身体活動量が減少した人のうち、特に50代以上の男性で運動に対する意欲が他の世代に比べ低かった。【結論】全世代での身体活動の低下と、世代や性別による違いが示唆された。(著者抄録)

BACKGROUND: Patellar and patellar tendon pain is a common limitation to children's participation in social and physical activities. Some factors have been implicated in the occurrence and protraction of knee pain, but the causal relationship is unknown. The purpose of this study was to investigate whether participants' physical characteristics and activity level are risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents. METHODS: A three-year prospective cohort study was conducted with healthy students who were aged 8-14 years old, in Japan. Height, weight, heel-buttock distance, straight leg raising angle, and dorsiflexion angle of the ankle joint were collected as individual physical factors at the beginning of each year. The presence of self-reported patellar and patellar tendon pain and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) was collected every month. Protraction was defined as either (1) pain lasting for more than three continuous months or (2) recurrent pain after more than three months of complete recovery. Participants who did not have any pain at the beginning of the observation period were included in the analysis. We analyzed the odds ratio (OR) of pain occurrence within a year of registration and protraction throughout the study period for all physical factors and HSS Pedi-FABS. RESULTS: We included 1133 participants in the analysis and 252 participants developed knee pain within a year. 34.8% of participants with pain experienced protraction during the follow-up period. A high HSS Pedi-FABS significantly predicted knee pain occurrence (OR 1.03, 95% confidence interval [CI] 1.01-1.05) and protraction (OR 1.03, 95% CI 1.00-1.05). In addition, younger children and girls were at a significantly higher risk of patellar and patellar tendon pain protraction (age, OR 0.81, 95% CI, 0.73-0.90; sex, OR 1.69, 95% CI, 1.09-2.64). Other physical factors did not significantly predict the occurrence or protraction of knee pain. CONCLUSIONS: This study showed that a greater physical activity level was a risk factor for the occurrence and protraction of patellar and patellar tendon pain in childhood. In addition, younger age and female sex predicted higher risk of protraction of pain.

type:text [ABSTRACT]【Objectives】Radial tears of the lateral meniscus are difficult to treat because the circumferential fibers that constitute the meniscal body are torn, and simple sutures intended to maintain both ends of the torn sites can easily slip and cut out. To overcome this, we developed a new suture construct to fix the radial tear in the meniscus. In this study, we examined the biomechanical properties of a new suture construct using a 6-degree-of-freedom (DOF) robotic system and a porcine knee.【Methods】Five intact fresh frozen porcine knees and a 6-DOF robotic system was used in this study. First, we investigated whether a radial tear of the lateral meniscus would reduce the resultant force. Second, we investigated whether meniscal sutures would improve the resultant force. We also investigated the differences in the tibial shift and rotation.【Results】The resultant force with a radial tear was significantly smaller than that with an intact meniscus, and the novel sutures and horizontal sutures improved the resultant force. The tibia shifted medially and posteriorly at 30° of knee flexion and medially at 45° of knee flexion with a radial tear below the 5 Nm valgus torque. Significant improvement was observed with the meniscus suture. Furthermore, the tibia rotated the valgus with a radial tear and improved with a meniscus suture under the 5 Nm valgus torque.【Conclusions】Our new suture method may provide new insights into treatment of radially torn lateral meniscus with a minimum number of sutures.

OBJECTIVES: The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life in patients with hallux valgus. METHODS: Patients scheduled to undergo hallux valgus surgery were recruited. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific quality of life was assessed using the Self-Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores was assessed using univariate and multivariate analyses. RESULTS: Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS. CONCLUSION: More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific quality of life and severer foot pain.

OBJECTIVE: To compare the effects of 3 implant designs, with and without hydroxyapatite reinforcement, on push/pull-out strength and rotational torque. METHODS: Three implant designs (Gamma 3, INTERTAN, and PFNA-II) were selected for comparison. A hydroxyapatite cylinder (NEOBRACE) was used to reinforce the interface between the femoral head and the lag screw. Maximum push-out strength, maximum pull-out strength, and peak rotational torque were measured in cellular blocks mimicking osteoporotic cancellous bone, with and without NEOBRACE. RESULTS: In the push-out test, INTERTAN produced a significantly higher push-out strength in osteoporotic bone density cellular blocks than the other lag screws and blades (P < .05). With the addition of NEOBRACE, push-out strength was significantly higher for INTERTAN and PFNA-II (P < .05) than for the non-NEOBRACE group. In the pull-out test, INTERTAN produced a significantly higher pull-out strength in the osteoporotic bone density cellular blocks than did the other lag screws and blades (P < .05). With the addition of NEOBRACE, the pull-out strengths of INTERTAN and Gamma 3 versus those of the non-NEOBRACE group significantly increased (P < .05). In the rotational torque test, INTERTAN produced significantly greater rotational torque in the osteoporotic cellular blocks than the other lag screws and blades (P < .05). The addition of NEOBRACE resulted in a significant increase in rotational torque only for INTERTAN (P < .05). CONCLUSION: The use of NEOBRACE supported an increase in push/pull-out strength and rotational torque, especially in systems with a relatively increased bone or implant interface area.Level of Evidence: Level V.

Abstract Background Mobility decrease leading to disability can gradually develop during early life, however, its related factors are not well clarified. Therefore, we investigate the related factors of mobility decrease at various levels, using nationwide data in Japan. Methods In total, 8681 independent community dwellers aged 20-89 years were analysed (average age, 51.6 years; 58.5% women). Three stages of mobility decrease were based on the locomotive syndrome risk test: Stage 1, emerging; Stage 2, progressing; Stage 3, progressed to restrict social engagement. Age was analysed using a simple quadratic function model. Results The prevalence of Stages 1-3 was 31.6% (n = 2746), 5.8% (n = 504), and 3.2% (n = 278), respectively. On the multivariable logistic regression, increased age in participants aged ≥40 years (stage 1: odds ratio[OR] 1.05-1.20, stage 2: OR 1.04-1.22, stage 3: OR 1.05-1.22), female (stage 1: OR 2.28, 95% confidence interval [CI] 1.99-2.61, stage 2: OR 2.40, 95% CI 1.77-3.25, stage 3: OR 1.80, 95% CI 1.19-2.72), overweight status (stage 1: OR 1.56, 95% CI 1.34-1.82, stage 2: OR 3.19, 95% CI 2.38-4.27, stage 3: OR 2.87, 95% CI 1.90-4.32), hypertension (stage 1: OR 1.20, 95% CI 1.01-1.41, stage 2: OR 1.99, 95% CI 1.49-2.64, stage 3: OR 2.10, 95% CI 1.44-3.05), and diabetes mellitus (stage 1: OR 1.62, 95% CI 1.17-2.24, stage 2: OR 1.57, 95% CI 0.93-2.66, stage 3: OR 2.10, 95% CI 1.13-3.90) were positively associated. The frequency of physical activity/sports, even a few per month, was inversely associated with all stages (stage 1: OR 0.59-0.72, stage 2: OR 0.50-0.67, stage 3: 0.36-0.53). A one-year increase in age had a stronger impact on mobility decrease in older adults than in younger ones. Increased age in participants aged &lt; 40 years and smoking were associated with Stage 1, while intake of various foods was inversely associated with Stages 1 and 2. Conclusion Increased age (&lt; 40 years) was associated with emerging mobility decrease, while that (≥ 40 years) was associated with any levels of mobility decrease. Female, lifestyle habits, including physical activities and overweight status, were associated with mobility decrease at every level.

BACKGROUND: 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. PURPOSE: To clarify the trend in the incidence of ATRs and the proportion of surgery using the nationwide health care database in Japan. STUDY DESIGN: Descriptive epidemiology study. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

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.

日本国民における性・年代別のロコモ度テスト参照値を明らかにするために、ロコモ度テスト10,000人調査を行った。地域在住の、独立した20歳代から80歳代の生活者10,444名にロコモ度テストを行い、8,681名(女性5,074名、男性3,607名)を解析対象とした。2ステップテスト、立ち上がりテストは、30歳代から40歳代より低下が始まっていた。一方、ロコモ25は70歳代後半より急激にスコアが増加した。本調査の結果は、今後のロコモに関連する研究のみならず、普及・啓発活動にも活用できる。(著者抄録)

COVID-19のパンデミックにより、少なくとも数年に及ぶ生活様式の変更の必要が予想される。自粛による身体活動の低下は、幅広い世代に負の影響を与え、慢性疾患の悪化やロコモティブシンドローム、フレイルの増悪等が危惧される。新しい生活様式のなかでも、われわれは国民に身体活動を確保して移動機能を保持していただき、ひいては健康寿命の延伸に寄与する柔軟な方法やシステムを模索する必要がある。本座談会では「コロナ時代のロコモ対策をめざす方向とは」をテーマにコロナ時代における高齢者、勤労世代、若年者でのロコモ対策についてエキスパートの先生方よりお話を伺った。(著者抄録)

COVID-19のパンデミックにより、少なくとも数年に及ぶ生活様式の変更の必要が予想される。自粛による身体活動の低下は、幅広い世代に負の影響を与え、慢性疾患の悪化やロコモティブシンドローム、フレイルの増悪等が危惧される。新しい生活様式のなかでも、われわれは国民に身体活動を確保して移動機能を保持していただき、ひいては健康寿命の延伸に寄与する柔軟な方法やシステムを模索する必要がある。本座談会では「コロナ時代のロコモ対策をめざす方向とは」をテーマにコロナ時代における高齢者、勤労世代、若年者でのロコモ対策についてエキスパートの先生方よりお話を伺った。(著者抄録)

＜文献概要＞アキレス腱症は非付着部症と付着部症に分類され,病態が若干異なる。病態に応じたさまざまな治療法が提唱されているが,非付着部症,付着部症ともに運動療法を中心とした保存療法が主体となる。

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.

BACKGROUND: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex. METHODS: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan. RESULTS: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score. CONCLUSION: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex.

BACKGROUND: The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head on foot radiographs. METHODS: A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head's lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations. RESULTS: The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (77%, 27%, and 29% for rounded, intermediate, and angular, respectively, P < .001), and the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. These associations were also significant in the multiple regression analysis. CONCLUSION: A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.

BACKGROUND: The purpose of this study was to clarify 1) the measurement error of the pronation angle using the first metatarsal axial radiograph with the pronation angle along the longitudinal axis of the first metatarsal as the reference standard, 2) the influence of variability in the foot position on the measurement error, and 3) the intra- and interrater reliability of pronation angle measurement using digitally reconstructed radiographs. METHODS: Digitally reconstructed radiographs of the first metatarsal were generated from the computed tomography images of 10 feet without hallux valgus (non-HV group) and 10 feet with hallux valgus (HV group). In total, 135 images were created at different degrees of supination, plantarflexion, and adduction from each foot to simulate the first metatarsal axial view. Then, the pronation angle of the first metatarsal was measured. The measurement error was determined using the mean error and 95% limits of agreement. Simple linear regression analysis was used to test the correlations of the measurement error with pronation, plantarflexion and adduction angles. The intra- and interrater reliability of measurement was assessed using the intraclass correlation coefficient and minimum detectable change values. RESULTS: The mean measurement errors were 0.1° for both the non-HV and HV groups. There was no significant correlation of the measurement error with pronation, plantarflexion or adduction angles for both groups. Additionally, the intraclass correlation coefficients for the intra- and interrater reliability were more than 0.9 in both the non-HV and HV groups with the minimum detectable change values ranging from 0.7° to 1.4°. CONCLUSION: The measurement error of first metatarsal pronation using the axial view was clinically acceptable. The measurements were not influenced by the variability in foot position while obtaining the radiograph. The first metatarsal axial view could be used to quantify the first metatarsal coronal rotation.

BACKGROUND: Maintenance of good health and a healthy lifestyle have significant impacts on the lives of university students. However, university students are prone to engage in risky health behaviors, resulting in impaired health status. Electronic health (eHealth) literacy is an important factor in maintaining a healthy lifestyle. However, no studies have assessed the eHealth literacy levels and the associated lifestyle behaviors among university students in Japan. OBJECTIVE: The purposes of this study were to clarify the eHealth literacy level, the participant characteristics associated with eHealth literacy, and the association of eHealth literacy with lifestyle behaviors of students in a Japanese university. METHODS: A questionnaire-based cross-sectional study of 3183 students at a national university in Japan was conducted. eHealth literacy was quantified using the Japanese version of the eHealth Literacy Scale (eHEALS). The association between participant characteristics (gender, school year, department of study, and living status) and eHEALS score was assessed using t tests. Additionally, the associations of eHealth literacy with lifestyle behaviors (exercise, smoking, alcohol consumption, etc.) were evaluated using logistic regression analyses. RESULTS: The mean eHEALS score was 23.6/40 points. The mean eHEALS score for students in medical departments was 27.0/40 points, which was 2.9 points higher than that of nonmedical students (P<.001). Similarly, the graduate school participants had higher scores than the undergraduate students. The proportion of participants who exercised regularly was higher in the high eHEALS score group than in the low score group, with an adjusted odds ratio of 1.39 (P<.001). CONCLUSIONS: The eHealth literacy level of university students in Japan was comparable to that of the general Japanese population. Graduate students, as well as those in medical departments, had higher eHealth literacy. Furthermore, students with higher eHealth literacy had better exercise routines.

近年のLGBTQ(Lesbian、Gay、Bisexual、Transgender、QueerもしくはQuestioningの頭文字をとったもの)といった言葉になぞられえられるように、ジェンダーの多様化が目望ましい。他方、生まれ持った生物学的な性別が性分化疾患等により従来の男女による性別で区別するのが困難な場合もある。スポーツは現在、男女の区別のある競技が大多数であり、性別二元制を基本とするが、既存の性別二元制の枠に当てはまらないジェンダーやセクシャリティを持つアスリートも存在する。例えばトランスジェンダーアスリートは生まれ持った性別とは異なる性別を選択し、新たな性別の枠で競技生活を送る場合もある。性分化疾患を抱える一部の女性アスリートは血中濃度が一般女性を大きく上回る高アンドロゲン血症を抱えている。これらにより女性競技での公平性が問われるといった事態につながりかねないため、スポーツの公平性を保つ目的でIOCはIOC Statement of the Stockholm Consensus on Sex Reassignment in SportsやIOC Consensus Meeting on Sex Reassignment and Hyperandrogenism November 2015を時代の変遷に合わせ制定している。(著者抄録)