Are enlarged peroneal tubercle and accessory anterolateral talar facet associated with calcaneal spur?

BACKGROUND: As the anatomical variations of the foot, enlarged peroneal tubercle (EPT) and accessory anterolateral talar facet (AALTF) have attracted the attention of foot surgeons in recent years. However, EPT and AALTF have not been examined for a relationship with calcaneus spur (CS) as a common osteophyte. METHODS: The subjects were 369 individuals who died in northeastern Thailand and were preserved as skeletal specimens. The authors examined for the presence of left and right EPT, AALTF, and calcaneus spur (CS). We divided the EPT (+) group with EPT and the EPT (-) group without it and also divided the AALTF (+) group with AALTF and the AALTF (-) group without it. The age at death and the presence of CS were compared statistically between the EPT (+) and EPT (-) groups and between the AATLF (+) and AALTF (-) groups. RESULTS: Out of the total 369 cases, EPT was found in 117 cases (31.7%), AALTF was positive in 91 cases (24.7%), and CS was found in 194 cases (52.3%). In comparison between EPT (+) and EPT (-) groups, CS was significantly higher (p < 0.0001) in the EPT (+) group, but there was no significant difference in age at death. In comparison between AALTF (+) and AALTF (-) groups, there was no significant difference in age at death or CS. CONCLUSION: This study showed a strong relationship between EPT and CS, and the prevalence of EPT and AALTF by age in Thailand was first reported. We believe it helps to know the pathogenesis and biomechanism of EPT and AALTF. TRIAL REGISTRATION: Not applicable.

Prevalence and risk factors of ankle osteoarthritis in a population-based study.

BACKGROUND: This study aimed to investigate the prevalence of radiographic ankle osteoarthritis (AOA) in Japan and identify its risk factors. METHODS: The analysis included data from the population-based cohort study, radiographs of the knees and ankles, ultrasonography of the ankle to examine chronic ankle instability (CAI), and questionnaires on ankle pain, job history, height, and body weight. A total of 597 individuals aged > 50 years were included in the study. The risk factors for AOA were calculated using multivariate logistic regression analysis. RESULTS: The study revealed a 13.9% prevalence of radiographic AOA among the participants, with 1.2% reporting painful AOA. Female sex, aging, history of ankle fractures, and CAI were identified as the risk factors associated with AOA. CONCLUSIONS: This cross-sectional study highlights the significant prevalence of radiographic AOA in a rural Japanese population, emphasizing the importance of considering ankle fractures and CAI as potential risk factors for AOA development. LEVELS OF EVIDENCE: Level II, prospective cohort study.

Relationship between oral frailty and locomotive syndrome in working-age individuals: a cross-sectional survey of workers in Japan.

BACKGROUND: Although the relationship between oral and physical frailty in older adults has been investigated, few studies have focused on the working-age population. This study examined the relationships of the number of remaining teeth and masticatory ability, i.e., signs of oral frailty, with locomotive syndrome (LS) in the working-age population. METHODS: The number of remaining teeth, masticatory ability, and presence of LS in 501 participants from four companies were examined. The relationships between the number of remaining teeth groups (≥ 20 teeth or ≤ 19 teeth) and LS and between the masticatory ability groups (high or low) and LS were examined. A binomial logistic regression analysis was conducted using LS from the stand-up test as the objective variable and the two subgroups based on the number of remaining teeth and potential crossover factors as covariates. RESULTS: The analysis included 495 participants (354 males and 141 females; median age, 43 years). The median number of remaining teeth among the participants was 28, and 10 participants (2.0%) had ≤ 19 teeth. The mean masticatory ability values were 39.9 for males and 37.7 for females, and 31 participants (6.3%) had low masticatory ability. In the stand-up test, those with ≤ 19 teeth had a higher LS rate than those with ≥ 20 teeth. The odds ratio for LS in the group with ≤ 19 remaining teeth was 5.99, and the confidence interval was 1.44-24.95. CONCLUSIONS: The results confirmed signs of oral frailty in the working-age population. Further, the number of remaining teeth possibly affects standing movement. Thus, oral frailty is associated with LS in the working-age population.

Association between low back pain and psychological stress response in a Japanese population-based study.

BACKGROUND: Psychological stress response refers to the negative emotional states generated when an individual perceives that they do not have the resources to cope with or respond to a threat. Low back pain (LBP) is a complex condition with multiple contributors, including psychological factors. However, whether LBP is a stressor that causes a psychological stress response remains unknown. This study aimed to investigate the association between LBP and psychological stress response in a Japanese population-based cohort. METHODS: Participants aged >50 years were recruited from inhabitants of a mountain village in Japan. The participants completed the following patient-reported outcome measures. The extent of the psychological stress response was measured using the Stress response scale (SRS)-18, which includes the subscales "Depression/Anxiety", "Irritability/Anger", and "Helplessness". LBP intensity in several situations/positions was measured using a numerical rating scale (NRS). Quality of life (QOL) was measured using the Oswestry Disability Index, EuroQol 5-dimension, and EuroQol visual analog scales. The association between SRS-18 and each parameter was statistically evaluated. RESULTS: A total of 282 participants (72.1 years old) were analyzed in this study, and 29.1% had chronic LBP. The SRS-18 total score of all participants ranged from 0 to 43, and the average SRS-18 total score was 7.7 ± 8.8 (depression/anxiety: 2.3 ± 3.2, irritability/anger: 2.4 ± 3.3, helplessness: 2.9 ± 3.2). SRS-18 scores of participants with LBP were significantly higher than those of participants without LBP. SRS-18 scores were significantly correlated with QOL scores (P < 0.01, correlation coefficient = 0.22-0.46). Multiple regression analysis showed that the NRS score of LBP during morning awakening was significantly associated with the SRS-18 total, depression/anxiety, and helplessness scores. CONCLUSIONS: Psychological stress responses were associated with LBP and LBP-related QOL among residents of a Japanese mountain village.

Anatomic Features of Patients With Recurrent Peroneal Tendon Dislocation.

BACKGROUND: There are several anatomic variations of the peroneal muscles and lateral malleolus of the ankle that may play an important role in the onset of peroneal tendon dislocation. PURPOSE: To investigate the anatomic variations of the retromalleolar groove and peroneal muscles in patients with and without recurrent peroneal tendon dislocation using magnetic resonance imaging (MRI) and computed tomography (CT). STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 30 patients (30 ankles) with recurrent peroneal tendon dislocation who underwent both MRI and CT before surgery (PD group) and 30 age- and sex-matched patients (control [CN] group) who underwent MRI and CT were included in this study. The imaging was reviewed at the level of the tibial plafond (TP level) and at the center slice between the TP and the fibular tip (CS level). The appearance of a malleolar groove (convex, concave, or flat) and the posterior tilting angle of the fibula were assessed on CT images. The appearance of accessory peroneal muscles, height of the peroneus brevis muscle belly, and volume of the peroneal muscle and tendons were assessed on MRI scans. RESULTS: There were no differences in the appearance of the malleolar groove, posterior tilting angle of the fibula, or accessory peroneal muscles at the TP and CS levels between the PD and CN groups. The peroneal muscle ratio was significantly higher in the PD group than in the CN group at the TP and CS levels (both P < .001). The height of the peroneus brevis muscle belly was significantly lower in the PD group than in the CN group (P = .001). CONCLUSION: A low-lying muscle belly of the peroneus brevis and a larger muscle volume in the retromalleolar space were significantly associated with peroneal tendon dislocation. Retromalleolar bony morphology was not associated with peroneal tendon dislocation.

Localization diagnosis of low back pain in a population-based study of a Japanese mountain village.

PURPOSE: The purposes of this study were to investigate 1) the location of low back pain (LBP) and 2) the relationships between the location of LBP and the LBP intensity or the quality of life (QoL) in a population-based study. METHODS: The location of LBP was categorized into four areas using palpation: midline of the lumbar region, paravertebral muscles, upper buttock, and sacroiliac joint. The extent of LBP in the situations/positions was assessed. The relationships between the location of LBP and the extent of LBP on the QoL were statistically analyzed. RESULTS: 174 participants (average age: 72.3 years-old) were analyzed in this study. 93 participants (53.4% of the total) who had experienced LBP in the past three months were included in the LBP-positive group. Numerical rating scale (NRS) scores of the LBP-positive group were highest in the standing position. 51.6% of the LBP-positive group had LBP at the midline of the lumbar region, 40.9% at the paravertebral muscles, 28.0% at the upper buttock, and 15.1% at the sacroiliac joint. In the standing position, NRS scores of LBP at the upper buttock were significantly higher than those at the midline of the lumbar region and the paravertebral muscles (P<0.05). The Oswestry Disability Index scores of participants who had pain at the upper buttock were significantly higher than those at the midline of the lumbar region or paravertebral muscles (P<0.05). CONCLUSION: Our study was the first report to investigate the location of LBP using palpation in a population-based study. LBP localization was significantly associated with LBP intensity and LBP-related QoL.

Change in prevalence of vertebral fractures over two decades: a Japanese medical examination-based study.

INTRODUCTION: Although remarkable progress has been made in osteoporosis treatment over the last two decades, no study has reported the change in the prevalence of vertebral fractures (VFs) during this time. This study aimed to compare the prevalence and pattern of VFs at three time points from 1997 to 2019 in a Japanese medical examination-based study. MATERIALS AND METHODS: The participants of this study were inhabitants of a typical Japanese mountain village who participated in these surveys at three time points: 1997 (group A), 2009 or 2011 (group B), and 2019 (group C). The age- and sex-adjusted groups were defined as groups A', B', and C', respectively (39 men and 85 women; mean age 73.6-74.0 years old). The type and extent of deformities of the prevalent fractures from T4 to L4 on the lateral thoracic and lumbar spine radiographs were semiquantitatively evaluated. RESULTS: The prevalence of VFs has significantly decreased over the past two decades. In group A, the percentages of thoracic level, biconcave type, and severe deformity of VFs were significantly higher than expected. The bone mineral density of the participants increased significantly over time. The treatment rate for osteoporosis in participants with osteoporosis has improved over the past two decades. CONCLUSION: This study demonstrated that the prevalence of VFs has decreased, and the pattern of VFs has changed over the last two decades in a typical Japanese mountain village due to multifactorial improvements in skeletal fragility, including improvement in osteoporosis treatment rate.

Locomotive syndrome affects the acquisition of long-term care insurance system certification.

BACKGROUND: Locomotive syndrome is closely related to the state of long-term care. This study aimed to longitudinally evaluate long-term care certification occurrence in locomotive syndrome using data from the Miyagawa study. METHODS: The study included 470 individuals (168 males, 302 females; mean age, 70.7 years) with no long-term care certification at the time of participation in the study. Locomotive syndrome was classified into three stages (stages 1-3) according to the 25-question Geriatric Locomotive Function Scale. Analysis was performed with long-term care certification occurrence as the endpoint and locomotive syndrome stage as the explanatory variable. RESULTS: The median observation period was 6.3 years, and long-term care certification occurred in 69 (34.2%) and 30 (11.2%) of the participants in the locomotive syndrome and no-locomotive syndrome groups, respectively. Independent risk factors of long-term care certification occurrence were locomotive syndrome stage-3 (hazard ratio: 2.27) in the total number of studies, and locomotive syndrome stages 2 (hazard ratio: 2.49) and 3 (hazard ratio: 2.79) in females. Locomotive syndrome stage-3 was an independent risk factor in long-term care certification occurrence due to musculoskeletal disorders (hazard ratio: 3.89). CONCLUSIONS: The higher the locomotive syndrome stage, especially in females, the higher the risk of long-term care certification occurrence.

The Onset of Subtalar Joint Monoarthritis in a Patient with Rheumatoid Arthritis.

The involvement of the subtalar joint is uncommon in the early stages of rheumatoid arthritis (RA). We report a case of a 47-year-old female who had RA with isolated subtalar joint arthritis. The clinical history, magnetic resonance imaging, and pathological findings of the patient are presented. A careful evaluation of the patients for chronic ankle-to-heel pain should be conducted, and concomitant evaluation for inflammatory arthritis, including RA, should be considered.

Knotless Tendoscopic Peroneal Retinaculum Repair Technique for Recurrent Peroneal Tendon Dislocation.

Peroneal tendon dislocation (PTD) is sometimes diagnosed as a sports-related injury, of which many cases lead to recurrent PTD (RPTD). Superior retinaculum repair is the major operative treatment of RPTD. The technique described herein comprises 8 steps: (1) Standard tendoscopic examination, (2) debridement of the pseudo-pouch base, (3) first anchor insertion, (4) suture relay, (5) second anchor insertion and suture relay, (6) third anchor insertion and suture relay, (7) suture tightening, and (8) suture bridge. Although this tendoscopic peroneal retinaculum repair technique is complicated, expensive, and requires a longer operation time, it incorporates a double-row suture bridge. Therefore, it has a wider contact surface between the superior retinaculum repair and fibula bone and tighter fixation than does a single-row technique. Moreover, our technique is knotless and thereby avoids knot-related complications. Tendoscopy has additional advantages in terms of less postoperative pain, fewer complications, and better cosmesis. In conclusion, this knotless tendoscopic peroneal retinaculum repair technique for RPTD is a patient-friendly surgery compared with previous procedures.

Characterization of Bone Tissue and Bone Morphology in Taurine Transporter Knockout Mice.

Taurine, a sulfur-containing amino acid, has been shown to protect against tissue damage. It is highly accumulated in bone cells, including osteoblasts, where it enhances bone tissue formation. The quality of bone is defined by its microarchitecture, accumulated microscopic damage, collagen quality, mineral crystal size, and turnover rate. In this study, the effects of taurine depletion on bone metabolism and bone quality were investigated in taurine transporter knockout (TauT-/-) mice. The bone volume and trabecular number of 20-month-old male TauT-/- and TauT+/+ mice were measured by micro-computed tomography, and bone tissues were observed using hematoxylin and eosin and immunohistochemical staining methods. In the TauT-/- mice, the bone area of the proximal region of the femur was significantly smaller than that in the TauT+/+ mice, and the bone volume and trabecular number of the femur neck were significantly lower. Although the bone mineral densities in the mid-diaphysis and proximal regions were lower in the TauT-/- mice, the difference was significant for the proximal region only. Moreover, taurine depletion decreased the mineral density and strength parameters in the cancellous bone. The results of this study suggest that taurine plays an important role in maintaining bone quality.

Novel elemental grading system for radiographic lumbar spondylosis in a population based-cohort study of a Japanese mountain village.

PURPOSE: Lumbar radiography is a primary screening tool for lumbar spondylosis (LS). Kellgren-Lawrence (KL) classification is widely used to evaluate LS; however, it cannot individually evaluate each radiographic feature. The purpose of this study was to 1) evaluate radiographic LS using a novel elemental grading system and 2) investigate the relationship between the grades of radiographic LS and low back pain (LBP) in a population-based cohort study. METHODS: A total of 260 (75 men, 185 women; mean age, 71.5 ± 8.7 years) participants were included in this study. Participants were divided into two groups according to the presence of LBP (LBP- and LBP+ groups). Radiographic features, including osteophyte (OP), disc height narrowing (DHN), vertebral sclerosis (VS), and spondylolisthesis (SL), were classified between grades of 0-2 grades according to the extent of radiographic changes. The sum of grades at each intervertebral level was designated as the intervertebral grade (IG). RESULTS: Intra- and inter-observer reliability (kappa coefficient) of OP, DHN, VS, and SL were 0.82-0.92. OP, DHN, VS, and IG grades were significantly higher in the LBP+ group than in the LBP- group. There were no significant differences in KL grades between the LBP- and LBP+ groups. Logistic regression analysis demonstrated that VS grade was a significant independent factor associated with LBP. CONCLUSION: The novel elemental grading system of LS would reflect LBP more accurately than the KL classification by individually evaluating each radiographic feature.

Is musculoskeletal pain related to locomotive syndrome even in young and middle-aged adults?

OBJECTIVES: Locomotive syndrome (LS) is the leading cause of persons needing long-term care in old age and is characterized by locomotive organ impairment including musculoskeletal pain. The aim was to examine the association between musculoskeletal pain and LS in young and middle-aged persons. METHODS: A total of 836 participants (male 667, female 169; mean age 44.4 years) were examined in this cross-sectional study. The LS was evaluated by three screening tools: the two-step test, the stand-up test, and the 25-question Geriatric Locomotive Function Scale. Musculoskeletal pain, exercise habits, physical function (walkability and muscle strength), and physical activity were also assessed. RESULTS: The LS was found in 22.8% of participants. The number with musculoskeletal pain was significantly higher in those with the LS. A significant correlation was found between the degree of musculoskeletal pain and exercise habits. Less regular exercise was significantly associated with higher LS prevalence. Physical activity and function were greater in participants with more regular exercise. CONCLUSION: Musculoskeletal pain was significantly related to LS even in young and middle-aged persons. The present results suggest that control of musculoskeletal pain and improvement of exercise habits in young and middle-aged persons might help prevent the LS.

Is locomotion training effective for middle-aged workers?

OBJECTIVES: Locomotion training (LT) consisting of single-leg standing and squatting was developed to help prevent locomotive syndrome (LS), and is typically used in older people. The objective of this study was to examine the effects of LT on young and middle-aged people. METHODS: This study was performed at two companies. Workers in company A engaged in LT five times/week for 1 year, whereas workers in company B did not. Baseline and follow-up checkups consisted of questionnaires and physical performance tests, including three kinds of locomotion tests. RESULTS: In total, 88 and 101 workers in companies A and B, respectively, met the inclusion criteria. LS stage, stand-up test results, and scores on a geriatric locomotive function scale significantly improved among workers in company A, but only stand-up test results significantly improved among workers in company B. Quadriceps power increased in company A, but did not change in company B. Especially, workers with LS in company A had more significant changes than those without LS and those in company B. CONCLUSIONS: The results of this longitudinal study suggest that LT is useful even for young and middle-aged workers. LT was especially more effective for workers than those without LS.

Repair of Acute Patellar Tendon Rupture Using an Internal Brace Technique.

Acute patellar tendon rupture is a serious injury, resulting in the disruption of the knee extensor mechanism. Many authors recommend augmented repairs of patellar tendon ruptures to allow early active rehabilitation. An internal brace technique, which is a ligament augmentation using high-strength suture tape and knotless anchors, has been used as augmentation for the primary tendon or ligament injury. A case of acute patellar tendon rupture in a Judo player, who was successfully treated with primary repair and augmentation using an internal brace technique, is presented. In this case, the patient regained full function of the knee and returned to full sports activities postoperatively. An internal brace technique provides biomechanical stability of the repaired tendon without donor site morbidity and could be an effective procedure for the treatment of acute patellar tendon rupture.

Prevalence of and risk factors for hallux rigidus: a cross-sectional study in Japan.

BACKGROUND: Hallux rigidus (HR) is a common osteoarthritis of the first metatarsophalangeal joint. However, the epidemiology and risk factors of this pathology have yet to be clarified. METHODS: We have been conducting cohort studies among individuals over 50 years old every 2 years since 1997. This study analyzed data from the 7th to 10th checkups in 2009, 2011, 2013, and 2015. We investigated the prevalence of HR and its risk factors in a total of 604 individuals (mean age, 67.1 ± 6.4 years; 208 men, 396 women). Radiographic HR was defined as Hattrup and Johnson classification grade 1 or higher. Knee osteoarthritis (KOA) was scored according to the Kellgren-Lawrence grading system. Radiographic KOA was defined as grade 2 or higher. Cases with a hallux valgus (HV) angle of 20° or higher were defined as showing HV. Statistical analyses were performed using the Kruskal-Wallis test, Fisher's exact test, logistic regression modeling, and the Cochran-Armitage trend test. All p-values presented are two-sided and values of p < .05 were considered statistically significant. RESULTS: The prevalence of HR was 26.7% (161/604). Rates of grade 0, 1, 2, and 3 HR according to the Hattrup and Johnson classification were 73.3% (443/604), 16.4% (99/604), 8.0% (48/604), and 2.3% (14/604), respectively. Overall ratio of symptomatic HR was 8.1%. Univariate analysis revealed KOA, gout attack (GA), and HV as significantly associated with HR. The same factors were confirmed as independent risk factors for HR in multivariate analysis. All parameters were significantly associated with HR. Odds ratios of KOA, HV, and GA for HR were 1.73, 3.98, and 3.86, respectively. The presence or absence of KOA was significantly associated with severity of HR. CONCLUSIONS: This study revealed that the prevalence of HR in the elderly (≥50 years) was 26.7%. KOA, HV, and GA were independent risk factors for HR. KOA was associated with severity of HR.

Central Sensitization in Chronic Low Back Pain: A Population-Based Study of a Japanese Mountain Village.

PURPOSE: Central sensitization (CS) is defined as the increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. CS has been proposed as an underlying mechanism of chronic pain in musculoskeletal disorders including low back pain (LBP). A Central Sensitization Inventory (CSI) has recently been developed for screening participants with CS. However, the association of CS with chronic LBP (cLBP) in the general population remains unknown. The purpose of this study was to investigate the association of CS with cLBP using the CSI in a population-based cohort of a Japanese mountain village. PARTICIPANTS AND METHODS: Participants aged more than 50 years were recruited from the inhabitants of a mountain village in Japan. Participants completed the following patient-reported outcome measures. Severity of CS was assessed by the CSI. LBP intensity was measured on a numerical rating scale (NRS). Health-related quality of life (QOL) was measured using the EuroQol 5-dimension (EQ-5D), EuroQol-visual analogue scales (EQ-VAS), and the Oswestry Disability Index (ODI). The association of CS and each parameter was statistically evaluated. RESULTS: A total of 272 participants (average age: 72.1 years-old) were analyzed in this study, and 28.3% had cLBP. Average NRS, ODI and CSI scores were significantly higher in the cLBP group than in the without LBP (LBP-) group. There was a significant correlation between CSI and NRS scores (r=0.34, P<0.0001), ODI (r=0.60, P<0.0001), EQ5D (r=-0.55, P<0.0001) and EQ-VAS (r=-0.52, P<0.0001). A multiple regression analysis identified that ODI, EQ-VAS and age were factors significantly associated with CSI. CONCLUSION: The results of this study suggest that CS is involved in the pathological condition of cLBP in the local residents of a Japanese mountain village.

Arthroscopic Internal Brace Augmentation With Arthroscopic Modified Broström Operation for Chronic Ankle Instability.

Lateral ankle sprains are very common injuries that sometimes lead to chronic lateral ankle instability. The modified Broström operation is the gold standard procedure for treatment of chronic lateral ankle instability. Currently, this operation is performed arthroscopically. Broström repair depends on the quality of the remnant ligament. In cases with an insufficient remnant ligament, Gould augmentation or reconstruction using the gracilis tendon is generally performed. Recently, tape augmentation (internal brace) also has been used to support an insufficient ligament. This article introduces arthroscopic tape augmentation with arthroscopic modified Broström operation. This technique consists of creation of a talar anchor hole and fibular anchor hole, reattachment of the remnant ligament to the fibula with tape, and tape fixation to the talus. This technique uses only one knotless anchor screwed to the fibula for both the modified Broström operation and fixation of the tape. This technique is relatively simple and produces similar results as an open procedure.

Endoscopic resection of scar tissues and bone graft with an intramedullary nail left in situ for distal femoral nonunion after nailing: A case report.

Femoral shaft nonunion after the intramedullary nailing has been successfully treated with advances in surgical technique. Nonetheless, the techniques cause morbidity to periosteum at the fracture site. We report the case of a 67-year-old man who underwent endoscopic surgery for refractory nonunion following the fracture of the distal femoral shaft, despite two fixations using an interlocking nail. In addition, the patient had uncontrolled diabetic mellitus. Endoscopy allowed us to acquire a clear view of the nonunion site, in which the resection of scar tissues and the packing of the cancellous bone were performed. At the final follow-up, bone healing was observed, and the patient was able to return to normal daily and social activity.

Arthroscopic Treatment of Primary Synovial Chondromatosis of the Subscapular Bursa: A Case Report.

INTRODUCTION: Synovial chondromatosis is a rare metaplastic disorder of the synovial membrane. Primary synovial chondromatosis of the shoulder joint is a rare localization and extra-articular localization around the shoulder is much less common. CASE REPORT: We report a rare case of a 13-year-old boy with primary synovial chondromatosis of the subscapular bursa. Computed tomography and magnetic resonance imaging showed that multiple cartilaginous loose bodies were found in the subscapular bursa and the glenohumeral joint. Arthroscopic removal of loose bodies and synovectomy of the subscapular bursa was performed through sublabral foramen. CONCLUSION: Pre-operative investigation for the precise location of the lesions was important for the planning the operative procedure. Arthroscopic removal of loose bodies and synovectomy was useful treatment options for synovial chondromatosis of the subscapular bursa.