Publications (9)19.49 Total impact
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Article: Comparison of the clinical outcome of double-bundle, anteromedial single-bundle, and posterolateral single-bundle anterior cruciate ligament reconstruction using hamstring tendon graft with minimum 2-year follow-up.
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ABSTRACT: The purpose of this study was to obtain more than 2 years' follow-up after surgery to investigate the effect of the difference in rotatory stability based on our previous data on the clinical outcome among 3 groups: double-bundle (DB) reconstruction group, anteromedial (AM) single-bundle reconstruction group, and posterolateral (PL) single-bundle reconstruction group. We randomly separated 55 patients with anterior cruciate ligament rupture into 3 groups: 18 in DB group, 18 in AM group, and 19 in PL group. The mean follow-up period is 33.7 months for the DB group, 31.9 months for the AM group, and 33.2 months for the PL group. We evaluated the Lysholm score, Tegner score, anterior laxity with the KT-1000 arthrometer (MEDmetric, San Diego, CA), rotator instability with the pivot-shift test, and muscle strength with knee extensor and flexor isokinetic peak torques at 60°/s. There were no significant differences in postoperative Lysholm score and Tegner score. Anterior stability of the knee, as measured by the KT-1000 arthrometer, was significantly better in the DB group than the PL group (P < .05). The negative rate of the manual pivot-shift test in the DB group was significantly superior to the PL group (P < .05). Muscle strength of the extensor in the DB group was significantly superior to that in the AM group (P < .05), and muscle strength of the flexor in the PL group was significantly inferior to that in both the DB and AM groups (P < .05). Two patients in the PL group had rerupture; however, there was no graft failure in the other groups. At 2 years' follow-up, patients undergoing DB anterior cruciate ligament reconstruction had greater extension strength than patients receiving an AM single-bundle reconstruction. The DB and AM groups had greater flexion strength than the PL group. The DB and AM groups had a similar rate of negative pivot-shift test results, whereas the PL group had fewer negative pivot-shift test results than the DB group. There were no KT-1000 side-to-side differences between the DB and AM groups, whereas the DB group had better results than the PL group. Overall, the clinical outcome as measured by Lysholm and Tegner scores was not different between groups. Level II, prospective comparative study.Arthroscopy The Journal of Arthroscopic and Related Surgery 07/2011; 27(7):906-13. · 3.02 Impact Factor -
Article: Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient.
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ABSTRACT: A case of a 14-year-old boy with a rare injury--an osteochondral fracture of the posterolateral tibial plateau associated with the anterior cruciate ligament (ACL) rapture, and Segond fracture characterized by an avulsion fracture of the lateral tibial plateau--is reported. This case was noteworthy because it involved a rare combination of ACL injuries. This injury was thought to be caused by the impaction between the posterior aspect of the lateral tibial plateau and the lateral femoral condyle during internal rotational displacement of the knee joint at the time of injury, because the osteochondral fracture of the posterolateral tibial plateau matched the site where the bone bruise was observed.Knee Surgery Sports Traumatology Arthroscopy 05/2011; 20(2):252-5. · 2.21 Impact Factor -
Article: Bilateral double-layered lateral meniscus: a report of two cases.
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ABSTRACT: Only a few cases of double-layered meniscus have been described in the English literature. We report two cases of bilateral double-layered lateral meniscus, where an additional semicircular meniscus was observed over the normal lateral meniscus. One of the patients exhibited a bucket-handle tear with a double-layered meniscus. To our knowledge, this abnormality is extremely rare and the incidence of double layered meniscus with bucket-handle tear has not been previously reported.Knee Surgery Sports Traumatology Arthroscopy 06/2009; 17(11):1336-9. · 2.21 Impact Factor -
Article: Time-related changes in the cross-sectional area of the tibial tunnel after compaction of an autograft bone dowel alongside a hamstring graft.
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ABSTRACT: Extensive tunnel expansion in hamstring anterior cruciate ligament (ACL) reconstruction can complicate revision surgery. The purpose of this study was to examine our hypothesis that compaction of a bone dowel into the tibial tunnel reduces the cross-sectional area of the tunnel on the day of surgery and limits tunnel expansion to that of the cross-sectional area of the reamer at 4 months and 1 to 2 years. A bone dowel averaging 23 mm in length and 7 mm in diameter was harvested from the tibial tunnel in 10 patients undergoing hamstring ACL reconstruction. The tibial tunnel was dilated, and the bone dowel was compacted anterior to the tendon graft. The cross-sectional area of the tibial tunnel was calculated on the day of surgery and at 4 months and 1 to 2 years postoperatively from computed tomography scans. On the day of surgery, the cross-sectional area of the tibial tunnel was 34% smaller than the 50-mm2 cross-sectional area of the 8-mm reamer used to drill the tunnel (P < .001). At 1 to 2 years, the cross-sectional area of the tibial tunnel was smaller than that of the reamer in 6 subjects, was slightly larger (53 to 56 mm2) in 3 subjects, and was substantially larger (80 mm2) in 1 subject. A surgeon who compacts an autogenous bone dowel into the tibial tunnel alongside a hamstring graft can expect little to no tunnel expansion in 90% of patients at 1 to 2 years. To our knowledge, the limitation of tunnel expansion to that of the cross-sectional area of the reamer has not been shown with other tibial fixation techniques. Level IV, therapeutic case series.Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2006; 22(8):855-60. · 3.02 Impact Factor -
Article: Mechanical evaluation of a soft tissue interference screw with a small diameter: significance of graft/bone tunnel cross-sectional area ratio.
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ABSTRACT: The purpose of this study is to evaluate the mechanical properties of a graft fixation using a small diameter soft tissue interference screw and analyze the factors affecting the fixation strength. Forty porcine knees were used. A bone tunnel, either 4.5 mm (n=40) or 5.0 mm (n=40) in diameter, was created in the bone block obtained from the proximal tibia or the distal femur. A patella-patellar tendon specimen with varied width was harvested, and the distal end of the patellar tendon was fixed within the bone tunnel using a small diameter soft tissue interference screw (4 x 15 mm). Then, the patella-patellar tendon-bone block complex was loaded until failure occurred and the maximum load was measured. As potential influential factors on the fixation strength, the insertion torque, bone mineral density of the bone block, and graft/tunnel cross-sectional area ratio (GTR) of each specimen were calculated. A significant correlation between the maximum failure load and the insertion torque was demonstrated. The quadratic regression analysis showed a statistically significant correlation between the failure load and the GTR. Optimal GTR for achieving high fixation strength was approximately 80%. When used in appropriate conditions, the mean failure load was 177 N for the 4.5 mm screw and 180 N for the 5 mm screw. The use of a small diameter interference screw for the fixation of a tendon graft to a bone is clinically feasible. Our research showed that the selection of appropriate fitting conditions is an important factor for optimizing the properties of the fixation.Knee Surgery Sports Traumatology Arthroscopy 05/2006; 14(4):330-4. · 2.21 Impact Factor -
Article: A comparison of bone-patellar tendon-bone and bone-hamstring tendon-bone autografts for anterior cruciate ligament reconstruction.
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ABSTRACT: Most of the previous comparative studies between patellar tendon and hamstring tendon anterior cruciate ligament grafts compared grafts of different constructs fixed with different methods. To compare patellar tendon and hamstring tendon grafts with the same fixation method used to reconstruct the anterior cruciate ligament. Randomized controlled trial; Level of evidence, 1. During the reconstructive procedure, the hamstring tendon graft was prepared as a bone-hamstring-bone graft; both bone-patellar tendon-bone and bone-hamstring-bone grafts were fixed with interference screws. Eighty consecutive patients who underwent anterior cruciate ligament reconstruction were randomly assigned to either bone-patellar tendon-bone or bone-hamstring-bone groups. Follow-up examinations were performed for at least 5 years postoperatively. Seventy-two of the 80 patients (37 patients in the bone-patellar tendon-bone group and 35 in the bone-hamstring-bone group) were evaluated, with a mean follow-up period of 87.0 and 80.8 months, respectively. Follow-up examinations were performed using the International Knee Documentation Committee knee ligament standard and subjective knee forms. The mean KT-1000 arthrometer evaluation results showed no significant difference between the bone-patellar tendon-bone and bone-hamstring-bone groups (1.2 +/- 2.1 mm and 1.7 +/- 1.4 mm, respectively; P = .24). However, symptoms related to graft harvest (anterior kneeling pain) were more frequently observed in the bone-patellar tendon-bone group, and unsatisfactory results were correlated with severe kneeling pain in 3 patients from this group (P = .0056). Significant hamstring muscle weakness without complaint of functional deficit was found in the bone-hamstring-bone group (P = .0045). Bone-hamstring-bone grafts were shown to reduce the risk of problems at the graft harvest site compared to bone-patellar tendon-bone grafts, with comparable results in the remaining clinical parameters tested.The American Journal of Sports Medicine 03/2006; 34(2):213-9. · 3.79 Impact Factor -
Article: Avoiding Posterior Cruciate Ligament and Roof Impingement With Transtibial Anterior Cruciate Ligament Reconstruction: Keys to Correct Tunnel Placement
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ABSTRACT: Avoiding posterior cruciate ligament (PCL) impingement, avoiding roof impingement, and replicating the tension pattern of the intact anterior cruciate ligament (ACL) are the keys to successful ACL reconstruction. To avoid PCL impingement, the tibial tunnel should be placed in the coronal plane at an angle between 60° and 65° with the medial joint line, and the lateral edge of the tibial tunnel should pass through the apex of the lateral tibial spine. Placement of the tibial tunnel with these 2 criteria usually requires removal of the medial wall of lateral femoral condyle (ie, wallplasty) until the space between the PCL and lateral femoral condyle exceeds the diameter of the graft by 1 mm. The guidewire should be drilled through the lateral hole in the bullet of the guide and enter the notch midway between the PCL and lateral femoral condyle. To avoid roof impingement without a roofplasty, the tibial tunnel should be customized in the sagittal plane 5 to 6 mm posterior and parallel to the intercondylar roof with the knee in maximum hyperextension, which accounts for variability in roof angle and knee extension. We prefer to use the Howell 65 Degree Tibial Guide to place the tibial tunnel with these criteria in the coronal and the sagittal planes. When the femoral tunnel is drilled through and in line with the correctly placed tibial tunnel, and when the back wall of the femoral tunnel is 1 mm thick, the tension pattern in the graft replicates that of the intact ACL.Techniques in Orthopaedics 08/2005; 20(3):211-217. -
Article: The EZLoc: A Simple, Rigid Femoral Fixation Device for a Soft Tissue Anterior Cruciate Ligament Graft
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ABSTRACT: The EZLoc is a new femoral fixation device for soft tissue anterior cruciate ligament (ACL) reconstruction that combines superior fixation properties (1427 N strength, ∞N/mm stiffness, and high resistance to slippage) with a simple surgical technique. The EZLoc is composed of a slotted body through which the ACL graft is looped and a deployable lever arm that rigidly fixes the graft on the anterolateral cortex of the femur. The EZLoc comes in a sterile package with a sharp-tip passing pin that is secured in the slotted body with a suture tied under tension. After the ACL graft is passed into the femoral tunnel, the suture is cut, the passing pin is removed, and the suture is tensioned, which deploys the lever arm and fixes the EZLoc on cortical bone. The EZLoc can be used with both the one- and 2-tunnel ACL reconstruction techniques, and is available in several length and diameter combinations that are for use in tunnels ranging from 20 to 60 mm in length and ACL grafts ranging from 5 to 10 mm in diameter.Techniques in Orthopaedics 08/2005; 20(3):238-244. -
Article: Revision anterior cruciate ligament reconstruction using the regenerated semitendinosus tendon: analysis of ultrastructure of the regenerated tendon.
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ABSTRACT: In this report, we present a case of a college skier who sustained a rerupture of the reconstructed anterior cruciate ligament (ACL) 8 months after surgery in which an autogenous semitendinosus tendon graft was used. At the revision surgery, the harvested semitendinosus tendon appeared to be regrown. Thus the regenerated tendon was reharvested, and in combination with the gracilis tendon, was used as a graft. The electron microscopic examination revealed a difference in fibril diameter between the regenerated tissue and the normal tendon. Although the regenerated semitendinosus tendon could be reharvested, the feasibility of its use for revision surgery is still to be determined.Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2004; 20(5):532-5. · 3.02 Impact Factor
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Institutions
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2004
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Kobe University
- Department of Orthopaedic Surgery
Kōbe-shi, Hyogo-ken, Japan
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