Japanese version of the Patient-rated elbow evaluation score correlates with physician-rated Japanese orthopaedic association-Japan elbow society elbow function score.

BACKGROUND: The association between Patient-Rated Elbow Evaluation: Japanese version (PREE-J) and Japanese Orthopaedic Association-Japan Elbow Society Elbow Function score (JOA-JES score) is unclear. This study evaluated the association between PREE-J and JOA-JES scores. METHODS: The patients with elbow disorders were divided into two groups: Group A (conservative treatment, n = 97) and Group B (surgical treatment, n = 156). The patients were also divided into four disease subgroups according to the JOA-JES classification (rheumatoid arthritis, trauma, sports, and epicondylitis groups), and the association between PREE-J and JOA-JES scores in each disease category was examined. In group B, associations between PREE-J and JOA-JES scores were examined pre-and postoperatively. RESULTS: In group A, there were significant associations between PREE-J and JOA-JES scores. In group B, a strong association between preoperative PREE-J and JOA-JES scores was observed in all disease categories. There was also a significant association between postoperative PREE-J and JOA-JES scores. Additionally, group B showed significant postoperative improvements in PREE-J and JOA-JES scores. CONCLUSIONS: The PREE-J score correlates well with the JOA-JES score and reflects treatment response before and after treatment.

Prognostic factors and clinical features in metacarpophalangeal joint hyperextension after ligament reconstruction with trapeziectomy: A retrospective cohort study.

BACKGROUND: Management of metacarpophalangeal (MCP) hyperextension deformity in thumb carpometacarpal (CMC) joint arthritis is challenging. It remains unclear how the preoperative MCP joint angle affects the outcomes. The present study aimed to clarify the associations between postoperative MCP hyperextension deformity and outcomes, and to determine the preoperative MCP joint angle that can predict poor outcomes. METHODS: We investigated the functional outcomes of patients who underwent surgery for CMC arthritis at two institutions from 2016 to 2020. All patients received a modified Thompson technique, ligament reconstruction suspension arthroplasty, and had no additional treatment for MCP hyperextension. The patients were divided into three groups according to their postoperative MCP joint angles: Group A, <10°; Group B, 10°-20°; Group C, >20°. Evaluations included preoperative and postoperative VAS, Quick DASH, range of motion (ROM), grip power, pinch strength, first web space angle, and postoperative trapezial space ratio (TSR). RESULTS: Overall, 66 eligible patients (72 thumbs) were identified and received follow-up for a mean of 25.2 months. The 72 thumbs were assigned to Group A (n = 38), Group B (n = 16), and Group C (n = 18). Group C had significantly lower preoperative MCP joint angle and postoperative grip power, pinch strength, and TSR compared with the Group A (P < 0.05). However, there were no significant differences in VAS, Quick DASH, ROM, and first web space angle (P > 0.05). The preoperative risk factor for highly residual MCP hyperextension was preoperative MCP joint angle (OR = 1.078; P = 0.001), with a cut-off value of 21.5° (AUC = 0.79; sensitivity = 0.813; specificity = 0.821). CONCLUSIONS: Postoperative MCP hyperextension of >20° after ligament reconstruction with trapeziectomy has adverse effects on functional outcomes. In cases with preoperative MCP joint angle of >21.5°, additional treatment for MCP hyperextension should be considered.

Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lateral epicondylitis of the humerus - Secondary publication.

BACKGROUND: The guidelines presented herein provide recommendations for the management of patients with lateral epicondylitis of the humerus. These recommendations are endorsed by the Japanese Orthopaedic Association (JOA) and Japan Elbow Society. METHODS: The JOA lateral epicondylitis guideline committee revised the previous guidelines on the basis of the "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which emphasized the importance of the balance between benefit and harm, and proposed a desirable method for preparing clinical guidelines in Japan. These guidelines consist of 11 clinical questions (CQs), 9 background questions (BQs), and 3 future research questions (FRQs). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS: The committee proposed recommendations for each CQ by determining the level of evidence and assessing the consensus rate. Physical therapy was the best recommendation with the best evidence. The BQs and FRQs were answered by collecting evidence based on the literature. CONCLUSIONS: The guidelines presented herein were reviewed systematically, and recommendations were proposed for each CQ. These guidelines are expected to be widely used not only by surgeons or physicians but also by other healthcare providers, such as nurses, therapists, and athletic trainers.

Suspensionplasty with the abductor pollicis longus tendon for osteoarthritis in the carpometacarpal joint of the thumb.

PURPOSE: Many surgical procedures have been described for treating painful osteoarthritis at the carpometacarpal joint of the thumb. This article reports our clinical and radiographic results in performing suspensionplasty using the abductor pollicis longus (APL) tendon without tendon interposition after a complete trapeziectomy for patients with painful osteoarthritis in the carpometacarpal joint of the thumb. METHODS: Eighteen patients (2 men, 16 women), including 21 thumbs with advanced arthritis of the first carpometacarpal joint, who were treated by suspensionplasty using the APL tendon after a complete trapeziectomy were evaluated both clinically and radiographically. Ten thumbs were classified as stage III and 11 were classified as stage IV (Eaton's classification). The average follow-up period was 33.3 months. RESULTS: All patients (18 patients, 21 thumbs) reported pain with daily use before surgery; after surgery 13 of the 21 thumbs had no pain, 5 thumbs had mild pain with strenuous activity, and the remaining 3 thumbs had mild pain with light work. At the final follow-up evaluation the radial and palmar abductions each were 56 degrees +/- 9 degrees and 56 degrees +/- 6 degrees. The grip and key-pinch strengths were 16 +/- 6 kg and 4 +/- 1 kg, respectively. The first metacarpal subsidence at rest was 15% and the additional subsidence when performing a 2-kg key pinch was 6% in the final follow-up radiographic findings. CONCLUSIONS: This study showed that the APL suspensionplasty has a favorable outcome for painful osteoarthritis in the carpometacarpal joint of the thumb and that the APL tendon can be removed as a deforming force without any abduction weakness. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Dorsal and palmar material properties of the adult human flexor profundus tendon in Zone II.

Nineteen fresh frozen adult human flexor digitorum profundus (FDP) tendons in Zone II were studied to compare the differences in material properties between the dorsal (dFDP) and palmar (pFDP) side of each tendon biomechanically, biochemically and histologically. We have found that tissue from the dorsal side of each flexor tendon has (1) greater strength; (2) less collagen crosslinking (hydroxypyridinium); and (3) a larger single bundle cross-sectional area than tissue from the palmar side of the same tendon. These data clearly demonstrate that the dorsal and palmar sides of the adult human (FDP) tendon in Zone II differ materially. These differences suggest that there may be biomechanical advantages in placing core sutures dorsally when repairing flexor tendons, a technique that we have previously described.

Resection of the distal pole of the scaphoid for scaphoid nonunion with radioscaphoid and intercarpal arthritis.

PURPOSE: The treatment of scaphoid nonunion with degenerative arthritis poses a clinical problem that is particularly challenging in cases of associated dorsal intercalated segmental instability collapse, radiocarpal and intercarpal degenerative changes, and poor scaphoid bone quality. The purpose of this study was to report our clinical experience performing a distal scaphoid resection for symptomatic scaphoid nonunion in patients with either radioscaphoid or intercarpal arthritis who have had multiple surgeries. METHODS: Nine patients with recalcitrant scaphoid nonunion and associated degenerative arthritis treated by resection of the distal scaphoid fragment were evaluated both clinically and radiographically. Eight patients were male and one patient was female; the average follow-up period was 28.6 months (range, 12-52 mo). RESULTS: Seven patients reported pain with daily use and the remaining 2 patients reported mild pain with light work before surgery, whereas after surgery 4 of the 9 patients had no wrist pain and the remaining 5 patients had only mild pain with strenuous activity. The wrist range of motion improved from 70 degrees (51.4% of the opposite wrist) to 140 degrees (94% of the opposite wrist) and grip strength improved from 18 kg (40% of the opposite wrist) to 30 kg (77% of the opposite wrist). Clinical results were excellent in 6 patients and good in 3 patients based on a modified Mayo wrist-scoring chart. Radiographically neither additional degeneration nor progress of degenerative changes was noted after surgery in 8 patients. Newly developed degenerative arthritis occurred at the proximal scapholunate capitate articulation in the remaining patient who has a type II lunate, which had a facet (medial facet) articulation with the hamate. CONCLUSIONS: The results of this study showed that distal scaphoid resection produces a satisfactory clinical outcome, requires only a short period of immobilization, and should be considered one of the surgical options for long-standing scaphoid nonunion with either radioscaphoid or intercarpal degenerative arthritis. Nevertheless care must be taken in performing this procedure on patients whose preoperative radiograph show a type II lunate.

Rapidly growing fibro-osseous pseudotumor of the digits mimicking extraskeletal osteosarcoma.

Fibro-osseous pseudotumor of the digits is a rare benign lesion characterized histopathologically by a fibroblastic proliferation with foci of osseous differentiation. We report a case of fibro-osseous pseudotumor of the digits with a rapidly growing lesion in a 30-year-old woman. Because of its rapid growth and aggressive histopathological appearance, this lesion can be mistaken for a malignant neoplasm such as extraskeletal or parosteal osteosarcoma, despite its benign clinical behavior. For a soft tissue mass in the digit with a clinicopathological feature of pseudomalignancy, the clinician should consider fibro-osseous pseudotumor of the digits as a possible diagnosis, thereby avoiding inappropriately aggressive surgery.

Lateral closing wedge osteotomy of the distal radius for advanced stages of Kienböck's disease.

Seven patients with advanced Kienböck's disease, stage III-B and IV by Lichtman classification, who were treated with lateral closing wedge osteotomy of the distal radius were evaluated clinically and radiographically. The clinical results were correlated with radiographic changes. Five patients had stage III-B and 2 had stage IV disease; average follow-up period was 50 months (range, 24-93 months). Clinical results were good in 4 patients, fair in 2 patients, and poor in 1 patient based on Nakamura's postoperative clinical scoring system. The carpal-ulnar distance ratio and lunate-covering ratio increased and the radioscaphoid angle improved significantly. The improvements in radioscaphoid angle and Nakamura's postoperative clinical score showed a significant correlation. The satisfactory clinical outcome of lateral closing wedge osteotomy of the distal radius for advanced-stage Kienböck's disease can be attributed to the effects of the increased lunate-covering ratio and the improved radioscaphoid angle on carpal alignment.

Flexor carpi radialis tendinitis caused by malunited trapezial ridge fracture in a professional baseball player.

Flexor carpi radialis tendinitis is an uncommon cause of pain experienced over the flexor aspect of the wrist. It may be a primary condition caused by overuse syndrome, or it may be a secondary condition associated with osteoarthritis of the carpometacarpal joint of the thumb, osteoarthritis of the scaphotrapezial joint, scaphoid fracture, or scaphoid cyst. We present a case report of flexor carpi radialis tendinitis caused by a malunited trapezial ridge fracture, in a professional baseball player who was treated successfully by excision of the malunited trapezial ridge fragment.