STUDY DESIGN: 3 cases report. OBJECTIVES: We present 3 cases of cervical myelopathy treated successfully by selective laminoplasty on 2 levels or less, using Kurokawa technique with a review of the relevant articles. SUMMARY OF LITERATURE REVIEW: As there were no clear criteria for the numbers of the laminae that require decompression in a standard laminoplasty, a wide level laminoplasty from C3 to C7 has been generally done. As a result, complications such as axial pain, C5 root paresis, and loss of range of motion have been reported commonly. To reduce these complications, recent studies have attempted less invasive procedures, such as selective laminoplasty or preservation of posterior ligament and muscle components. MATERIALS AND METHODS: There were two cases of developmental stenosis and one posterior compressive stenosis that underwent selective laminoplasty. The posterior shift of the spinal cord and the dural expansion were measured by magnetic resonance imaging at 3 or 4 weeks after surgery. Clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score. Axial pain was classified as follows; never: Grade 0; mild: Grade 1; moderate: Grade 2; and severe: Grade 4. RESULTS: The spinal cord had a tendency to shift posterioly and the dura mater was expanded in all cases. Clinical outcomes and axial pain were also improved in all. CONCLUSIONS: Selective laminoplasty that enabled the surgeon to perform a less invasive surgery preserving operative time and the patient to have a lower risk of C5 root paresis is effective for the developmental stenosis or posterior compressive stenosis less than 3 levels.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Dura Mater ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Muscles ; Operative Time ; Orthopedics ; Paresis ; Range of Motion, Articular ; Spinal Cord ; Spinal Cord Diseases

Functional knee braces are commonly prescribed to support anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the current literature on the use of functional knee braces of ACL with respect to biomechanical, clinical and functional outcomes. A literature search was conducted (2000 to 2017) by two independent reviewers using PubMed MEDLINE database. Articles were retrieved by an electronic search using keywords (anterior cruciate ligament, brace, and bracing) and their combinations. Current functional braces used to treat ACL injury were identified. Studies that met inclusion criteria were assessed for pertinent data. Fourteen studies met the inclusion criteria. Functional knee brace reportedly did not improve long-term clinical and functional outcomes following ACL reconstruction, but some studies suggest that functional brace may have some benefit with regard to biomechanics, proprioception, and subsequent injury rates. Functional knee brace after ACL reconstruction was found no significant difference in clinical and functional outcomes. But Further large-scale recent studies will be required to determine long-term outcomes of the brace.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament* ; Braces* ; Knee ; Ligaments ; Proprioception

Damage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. For these reasons, several techniques have been developed to repair the medial meniscus posterior root tear (MMPRT), many of which have shown complete healing of the repaired MMPRT. However, efforts to standardize or optimize the treatment for MMPRT are much needed. When planning a surgical intervention for an MMPRT, strict surgical indications regarding the effect of pullout strength on the refixed root, bony degenerative changes, mechanical alignment, and the Kellgren-Lawrence grade should be considered. Although there are several treatment options and controversies, the current trend is to repair the MMPRT using various techniques including suture anchors and pullout sutures if the patient meets the indications. However, there are still debates on the restoration of hoop tension and prevention of arthritis after repair and further biomechanical and clinical studies should be conducted in the future. The aim of this article was to review and summarize the recent literature regarding various diagnosis and treatment strategies of MMPRT, especially focusing on conflict issues including whether repair techniques can restore the main function of normal meniscus and which is the best suture technique to repair the MMPRT. The authors attempted to provide a comprehensive review of previous studies ranging from basic science to current surgical techniques.
Arthritis ; Diagnosis ; Humans ; Knee ; Menisci, Tibial ; Suture Anchors ; Suture Techniques ; Sutures

The optimal treatment for combined osteochondritis dissecans (OCD) with considerable bony defect of the lateral femoral condyle (LFC) and torn discoid lateral meniscus is unclear. We present a case of a 15-year-old female who was a gymnast and had a large OCD lesion in the LFC combined with deficiency of the lateral meniscus. The patient underwent the "one-step" technique of osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation after a failure of meniscectomy with repair at another hospital. Twenty-four months postoperatively, clinical results were significantly improved. Follow-up imaging tests and second-look arthroscopy showed well incorporated structured bone graft and fibrous cartilage regeneration as well as stabilized lateral meniscus allograft. She could return to her sport without any pain or swelling. This "one-step" surgical technique is worth considering as a joint salvage procedure for massive OCD lesions with torn discoid lateral meniscus.
Adolescent ; Allografts ; Arthroscopy ; Autografts ; Cartilage ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Menisci, Tibial ; Osteochondritis Dissecans ; Regeneration ; Sports ; Tears ; Transplantation ; Transplants

BACKGROUND: The purpose of this study is to report a modified transtibial technique to approach the center of anatomical femoral footprint in anterior cruciate ligament (ACL) reconstruction and to investigate the accurate femoral tunnel position with 3-dimensional computed tomography (3D-CT) and radiography after reconstruction. METHODS: From December 2010 to October 2011, we evaluated 98 patients who underwent primary ACL reconstruction using a modified transtibial technique to approach the center of anatomical femoral footprint in single bundle ACL reconstruction with hamstring autograft. Their femoral tunnel positions were investigated with 3D-CT and radiography postoperatively. Femoral tunnel angle was measured on the postoperative anteroposterior (AP) radiograph and the center of the femoral tunnel aperture on the lateral femoral condyle was assessed with 3D-CT according to the quadrant method by two orthopedic surgeons. RESULTS: According to the quadrant method with 3D-CT, the femoral tunnel was measured at a mean of 32.94% +/- 5.16% from the proximal condylar surface (parallel to the Blumensaat line) and 41.89% +/- 5.58% from the notch roof (perpendicular to the Blumensaat line) with good interobserver (intraclass correlation coefficients [ICC], 0.766 and 0.793, respectively) and intraobserver reliability (ICC, 0.875 and 0.893, respectively). According to the radiographic measurement on the AP view, the femoral tunnel angles averaged 50.43degrees +/- 7.04degrees (ICC, 0.783 and 0.911, respectively). CONCLUSIONS: Our modified transtibial technique is anticipated to provide more anatomical placement of the femoral tunnel during ACL reconstruction than the former traditional transtibial techniques.
Adolescent ; Adult ; Anterior Cruciate Ligament Reconstruction/*methods ; Female ; Femur/*radiography/surgery ; Humans ; Imaging, Three-Dimensional/*methods ; Male ; Middle Aged ; Surgery, Computer-Assisted/*methods ; Tibia/radiography/surgery ; Tomography, X-Ray Computed/*methods

Anterior cruciate ligament (ACL) rupture leads to weakened quadriceps muscle strength and a decline in proprioception, impairing the neuromuscular control of the lower extremities. ACL reconstruction, aimed at addressing such structural and functional instability, has become a primary treatment method for young and active patients. Consequently, there have been significant advancements in surgical techniques, resulting in improved clinical outcomes. However, achieving successful outcomes after ACL reconstruction is not solely dependent on the surgery itself; pre- and postoperative rehabilitation and management are equally crucial. A well-designed functional recovery program based on medical evidence before and after ACL reconstruction plays a vital role in restoring function to preinjury levels. The process of the functional recovery program, from presurgery to sports return, should adhere to certain principles. These principles involve prompt and accurate clinical diagnosis and patient classification after injury, systematic programs addressing joint swelling and inflammation control, reduction of arthrogenic muscle inhibition, restoration of range of motion, muscle strength recovery, and proprioception restoration. Postoperatively, it is essential to go beyond traditional methods (such as range of motion restoration and muscle strengthening) by implementing a functional recovery program that includes enhancement of proprioception and neuromuscular control system from the early stages, considering the biological healing response of the graft. This comprehensive approach is vital for achieving optimal outcomes in the recovery of function after ACL reconstruction.

n patients who have undergone knee joint surgery or suffer from osteoarthritis, weakened quadriceps muscle strength is often observed. This can lead to various pathological issues in the long term, such as abnormal gait and persistent knee pain. Due to the need to protect against pain or surgical site complications, high-intensity exercise is often restricted for most patients with muscle atrophy in the knee joint due to surgery or osteoarthritis or surgery. To overcome this challenge, various methods are being attempted, including exercise combined with neuromuscular electrical stimulation, blood flow restriction (BFR) exercise, and biofeedback exercise. Recently, BFR exercise has garnered attention in line with these strategic trends. Applying low-intensity BFR exercise to patients who have undergone anterior cruciate ligament reconstruction surgery or suffer from knee joint osteoarthritis, most studies report improvements in strength, muscle mass, and functional enhancement of the knee joint. Compared to non-BFR high-intensity exercise, it has been reported that increases in maximal strength and muscle mass are similar, but pain reduction is superior with BFR exercise. Engaging in low-intensity BFR exercise for a sufficient duration can minimize the risk of injury associated with high-intensity exercise while maximizing the exercise’s effectiveness, leading to symptom improvement and enhancement of knee joint function. Furthermore, when conducted according to specified manuals, the likelihood of cardiovascular imbalance, muscle damage, thrombosis, and embolism due to BFR is low, making it a safe rehabilitation method.

n patients who have undergone knee joint surgery or suffer from osteoarthritis, weakened quadriceps muscle strength is often observed. This can lead to various pathological issues in the long term, such as abnormal gait and persistent knee pain. Due to the need to protect against pain or surgical site complications, high-intensity exercise is often restricted for most patients with muscle atrophy in the knee joint due to surgery or osteoarthritis or surgery. To overcome this challenge, various methods are being attempted, including exercise combined with neuromuscular electrical stimulation, blood flow restriction (BFR) exercise, and biofeedback exercise. Recently, BFR exercise has garnered attention in line with these strategic trends. Applying low-intensity BFR exercise to patients who have undergone anterior cruciate ligament reconstruction surgery or suffer from knee joint osteoarthritis, most studies report improvements in strength, muscle mass, and functional enhancement of the knee joint. Compared to non-BFR high-intensity exercise, it has been reported that increases in maximal strength and muscle mass are similar, but pain reduction is superior with BFR exercise. Engaging in low-intensity BFR exercise for a sufficient duration can minimize the risk of injury associated with high-intensity exercise while maximizing the exercise’s effectiveness, leading to symptom improvement and enhancement of knee joint function. Furthermore, when conducted according to specified manuals, the likelihood of cardiovascular imbalance, muscle damage, thrombosis, and embolism due to BFR is low, making it a safe rehabilitation method.

n patients who have undergone knee joint surgery or suffer from osteoarthritis, weakened quadriceps muscle strength is often observed. This can lead to various pathological issues in the long term, such as abnormal gait and persistent knee pain. Due to the need to protect against pain or surgical site complications, high-intensity exercise is often restricted for most patients with muscle atrophy in the knee joint due to surgery or osteoarthritis or surgery. To overcome this challenge, various methods are being attempted, including exercise combined with neuromuscular electrical stimulation, blood flow restriction (BFR) exercise, and biofeedback exercise. Recently, BFR exercise has garnered attention in line with these strategic trends. Applying low-intensity BFR exercise to patients who have undergone anterior cruciate ligament reconstruction surgery or suffer from knee joint osteoarthritis, most studies report improvements in strength, muscle mass, and functional enhancement of the knee joint. Compared to non-BFR high-intensity exercise, it has been reported that increases in maximal strength and muscle mass are similar, but pain reduction is superior with BFR exercise. Engaging in low-intensity BFR exercise for a sufficient duration can minimize the risk of injury associated with high-intensity exercise while maximizing the exercise’s effectiveness, leading to symptom improvement and enhancement of knee joint function. Furthermore, when conducted according to specified manuals, the likelihood of cardiovascular imbalance, muscle damage, thrombosis, and embolism due to BFR is low, making it a safe rehabilitation method.

n patients who have undergone knee joint surgery or suffer from osteoarthritis, weakened quadriceps muscle strength is often observed. This can lead to various pathological issues in the long term, such as abnormal gait and persistent knee pain. Due to the need to protect against pain or surgical site complications, high-intensity exercise is often restricted for most patients with muscle atrophy in the knee joint due to surgery or osteoarthritis or surgery. To overcome this challenge, various methods are being attempted, including exercise combined with neuromuscular electrical stimulation, blood flow restriction (BFR) exercise, and biofeedback exercise. Recently, BFR exercise has garnered attention in line with these strategic trends. Applying low-intensity BFR exercise to patients who have undergone anterior cruciate ligament reconstruction surgery or suffer from knee joint osteoarthritis, most studies report improvements in strength, muscle mass, and functional enhancement of the knee joint. Compared to non-BFR high-intensity exercise, it has been reported that increases in maximal strength and muscle mass are similar, but pain reduction is superior with BFR exercise. Engaging in low-intensity BFR exercise for a sufficient duration can minimize the risk of injury associated with high-intensity exercise while maximizing the exercise’s effectiveness, leading to symptom improvement and enhancement of knee joint function. Furthermore, when conducted according to specified manuals, the likelihood of cardiovascular imbalance, muscle damage, thrombosis, and embolism due to BFR is low, making it a safe rehabilitation method.