Methods: Preoperative CT data from 26 patients pertaining to adult spinal deformities were investigated in this study. We applied a 3D image processing method for a detailed investigation. Virtual cylinders were used to mimic SAI screws. These were placed to penetrate the sacral iliac joint without violating the other cortex. We then assessed the trajectory of the longest SAI screw and the ideal entry point of SAI using a color mapping method on the surface of the sacrum. We measured the location of the nerve root at S1 in relation to the foramen at S1 and the sacral surface. Results: As per the results of our color mapping, it was determined that areas that received high scores are located medially and caudally to the dorsal foramen of S1. The mean angle between a horizontal line and a line connecting the medial edge of the foramen and nerve root at S1 was 93.5°. The mean distances from the dorsal medial edge of the foramen and sacral surface to S1 nerve root were 21.8 mm and 13.9 mm, respectively. Conclusions The ideal entry point of the SAI screw is located medially and caudally to the S1 dorsal foramen based on 3D digital mapping. It is also shown that this entry point spares the S1 nerve root from possible iatrogenic injuries.

BACKGROUND/AIMS: The pharmacokinetics of tacrolimus (TAC) is known to be largely influenced by single-nucleotide polymorphisms (SNPs) in CYP3A5. Patients starting TAC require careful dose adjustment, owing to the wide range of optimal dosages, depending on their CYP3A5 expression status. Here, we evaluated whether individualization of TAC dosages based on CYP3A5 SNPs would improve its therapeutic efficacy in ulcerative colitis. METHODS: Twenty-one patients were prospectively treated, with their initial dosage adjusted according to their CYP3A5 status (0.1, 0.15, and 0.2 mg/kg/day for CYP3A5*3/*3, CYP3A5*1/*3, and CYP3A5*1/*1, respectively). Their clinical outcomes were compared with those of patients treated with a fixed dose (0.1 mg/kg/day). RESULTS: The first blood trough level of CYP3A5 expressors, CYP3A5*1/*3 or CYP3A5*1/*1, and the overall rate in achieving the target blood trough level within a week in the individualized-dose group were significantly higher than those in the fixed-dose group (5.15±2.33 ng/mL vs. 9.63±0.79 ng/mL, P=0.035 and 12.5% vs. 66.7%, P=0.01). The remission rate at 2 weeks in the expressors was as high as that in the nonexpressors, CYP3A5*3/*3, in the individualized-dose group. CONCLUSIONS: Individualized TAC treatment is effective against ulcerative colitis regardless of the CYP3A5 genotype.
Colitis, Ulcerative ; Cytochrome P-450 CYP3A ; Genotype ; Humans ; Pharmacokinetics ; Polymorphism, Single Nucleotide ; Prospective Studies ; Tacrolimus ; Ulcer

BACKGROUND/AIMS: Oral mesalazine is an important treatment for ulcerative colitis (UC), and non-adherence to mesalazine increases the risk of relapse. Controlled-release (CR) mesalazine has 2 formulations: tablets and granules. The relative acceptabilities of these formulations may influence patient adherence; however, they have not been compared to date. This study aimed to evaluate the acceptabilities of the 2 formulations of CR mesalazine in relation to patient adherence using a crossover questionnaire survey. METHODS: UC patients were randomly assigned to 2 groups in a 1:1 ratio. Patients in each group took either 4 g of CR mesalazine tablets or granules for 6 to 9 weeks, and then switched to 4 g of the other formulation for a further 6 to 9 weeks. The acceptability and efficacy were evaluated by questionnaires, and adherence was assessed using a visual analog scale. The difference in acceptabilities between the 2 formulations and its impact on adherence were assessed. RESULTS: A total of 49 patients were prospectively enrolled and 33 patients were included in the analysis. Significantly more patients found the tablets to be less acceptable than the granules (76% vs. 33%, P=0.0005). The granules were preferable to the tablets when the 2 formulations were compared directly (73% vs. 21%, P=0.004), for their portability, size, and numbers of pills. The adherence rate was slightly better among patients taking the granules (94% vs. 91%) during the observation period, but the difference was not significant (P=0.139). CONCLUSIONS: CR mesalazine granules are more acceptable than tablets, and may therefore be a better option for long-term medication.
Colitis, Ulcerative ; Drug Compounding ; Humans ; Medication Adherence ; Mesalamine ; Patient Acceptance of Health Care ; Patient Compliance ; Prospective Studies ; Recurrence ; Tablets ; Ulcer ; Visual Analog Scale

PURPOSE: Medial meniscus posterior root tear (MMPRT) causes progression of medial meniscus extrusion (MME). This study aims to calculate the progression rate of MME based on findings in two preoperative magnetic resonance imaging (MRI) scans and determine the associated factors. MATERIALS AND METHODS: We retrospectively reviewed 33 patients (27 females and 6 males; mean age, 60 years) who underwent MRI twice, at a mean interval of 48 days. We measured the medial meniscus body width, medial joint space width (MJSW), and MME. The MME progression rate was derived from regression analysis of the increase in MME (ΔMME) between the two MRI scans. In addition, the correlations of the MME increase rate with age, body mass index, femorotibial angle, and MJSW were evaluated. RESULTS: The mean MME increased from 3.4 mm to 4.5 mm (p<0.001). A good correlation was observed between ΔMME and the interval of MRI scans (R²=0.621), and the MME progression rate was 0.020 mm per day. A moderate correlation was observed between the MME increase rate and the MJSW (R²=0.432). CONCLUSIONS: The MME progression rate was rapid in MMPRT and narrowing of the MJSW was associated with the progression of MME. LEVEL OF EVIDENCE: V, Cross-sectional study
Body Mass Index ; Cross-Sectional Studies ; Female ; Humans ; Joints ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial ; Retrospective Studies ; Risk Factors ; Tears

PURPOSE: To verify the effectiveness of detecting medial meniscus posterior root tears (MMPRTs) using weight-bearing posterior-anterior (PA) radiographs. MATERIALS AND METHODS: Twenty-three patients were diagnosed with an MMPRT using magnetic resonance imaging (Group A), with 23 matched individuals forming the control group (Group B). The distance between medial tibial eminence and the lateral edge of the medial femoral condyle (MTE–MFC distance) and medial joint space (MJS) width were measured on weight-bearing PA radiographs, with the knee flexed at 45° (Rosenberg view). Absolute medial meniscus extrusion (MME) was measured on magnetic resonance images. RESULTS: The MTE–MFC distance was greater and the MJS width was smaller in Group A than Group B (7.7 ± 1.7mm versus 6.0 ± 1.24mm and 3.2 ± 0.8mm versus 4.5 ± 0.7 mm, respectively; P < 0.05). The MTE–MFC distance and MJS width correlated with MME (r = 0.603 and 0.579, respectively; P < 0.05), and the extent of MME was greater in Group A than Group B (4.1 ± 1.1mm versus 1.8 ± 1.5 mm, respectively; P < 0.05). CONCLUSIONS MMPRTs increase the MTE–MFC distance and decrease the MJS width, with these measurements correlating to the MME. Therefore, measurement of the MTE–MFC distance and MJS width on the Rosenberg view could be a useful preliminary method for the diagnosis of an MMPRT.LEVEL OF EVIDENCE: IV

PURPOSE: Posterior root repair of the medial meniscus (MM) can prevent rapid progression of knee osteoarthritis in patients with a MM posterior root tear (MMPRT). The anatomic reattachment of the MM posterior root is considered to be critical in a transtibial pullout repair. However, tibial tunnel creation at the anatomic attachment is technically difficult. We hypothesized that a newly developed point-contact aiming guide [Unicorn Meniscal Root (UMR) guide] can create the tibial tunnel at a better position rather than a previously designed MMPRT guide. The aim of this study was to compare the position of the created tibial tunnel between the two meniscal root repair guides. MATERIALS AND METHODS: Thirty-eight patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the UMR guide (19 cases) or MMPRT guide (19 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada's measurement method postoperatively. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines referring to three anatomic bony landmarks (anterior border of the posterior cruciate ligament, lateral margin of the medial tibial plateau, and retro-eminence ridge). The expected anatomic center and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. The distance between the anatomic center and tunnel center was calculated. RESULTS: The anatomic center of the MM posterior root footprint was located at a position of 79.2% posterior and 39.5% lateral. The mean of the tunnel center in the UMR guide was similar to that in the MMPRT guide (posterior direction, P = 0.096; lateral direction, P = 0.280). The mean distances between the tunnel center and the anatomic center were 4.06 and 3.99mm in the UMR and MMPRT guide group, respectively (P = 0.455). CONCLUSIONS The UMR guide, as well as the MMPRT guide, is a useful device to create favorable tibial tunnels at the MM posterior root attachment for pullout repairs in patients with MMPRTs.LEVEL OF EVIDENCE: IV

PURPOSE: To evaluate the clinical effects of using anatomical bony landmarks (Parsons' knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. MATERIALS AND METHODS: We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. RESULTS: Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. CONCLUSIONS: Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Arthroscopy ; Humans ; Knee ; Knee Joint ; Retrospective Studies ; Transplants