Reliability and validity of the Japanese version of the short questionnaire to assess health-enhancing physical activity (SQUASH) scale in older adults.

[Purpose] We tested the reliability and validity of the Japanese version of the Short Questionnaire to Assess Health-enhancing Physical Activity scale in asymptomatic older adults and sought to confirm discriminator validity in women with osteoarthritis. [Subjects] The participants included an asymptomatic comparison group (men and women) and women with knee or hip osteoarthritis. [Methods] The test-retest method was used to assess reliability. The International Physical Activity Questionnaire was chosen to assess criterion-related validity. Discriminator validity was assessed by comparing the asymptomatic and osteoarthritis groups. [Results] Mean age for the asymptomatic groups was 63 ± 6 years for men (n = 23) and 61 ± 7 years for women (n = 51), and it was 63 ± 9 years for the osteoarthritis group (n = 32). The total score and scores for all items, except for heavy housework items, were significantly correlated with the retest. Criterion-related validity showed significantly weak to moderate correlations between the respective scale categories. For discriminator validity, the total scores and scores for bicycle commuting, light housework, and three leisure items differed significantly between the asymptomatic and osteoarthritis groups. [Conclusion] The Short Questionnaire to Assess Health-enhancing Physical Activity scale is a reliable and valid measure in asymptomatic older adults, and can discriminate between osteoarthritic and asymptomatic women.

Bone formation within the articular cartilage of the lateral compartment of varus osteoarthritic knees.

BACKGROUND: One of the causes of failure after unicompartmental knee arthroplasty (UKA) for varus osteoarthritis is the progression of osteoarthritis in the lateral compartment. Bone formation within the articular cartilage has been reported as a possible cause of the deterioration of the osteoarthritis. However, its prevalence and histology are still uncertain. The purpose of the current study is to investigate bone pieces obtained from the lateral compartment of the knee during total knee arthroplasty (TKA) radiographically and histopathologically, and to examine the bone formation within the articular cartilage in detail. METHODS: Thirty-four consecutive patients, who underwent TKA for varus osteoarthritis of the knee, were included in this study. There were 6 males and 28 females and the mean age at the surgery was 74 years (range 63-85 years). Fifty-seven and 99 sagittal slabs were acquired from the resected bone pieces of the distal lateral femoral condyle and lateral tibial plateau, respectively. These slabs were investigated by soft X-ray radiographs and histopathological analyses stained with hematoxylin-eosin and elastica-Masson. RESULTS: On soft X-ray radiographs, bone formation (in which bone trabeculae were clearly detected) within the articular cartilage was observed in 8 (14.0%) of 57 femoral slabs and 7 (7.1%) of 99 tibial slabs. Histopathological analyses revealed that the bone which had formed comprised normal trabeculae and fatty marrow. There was rich vascularity in the cartilage around the formed bone. CONCLUSIONS: The current study is the first to describe the prevalence, location, and histopathological findings of bone formation within the articular cartilage of the lateral compartment of varus osteoarthritic knees. Since the thickness of the cartilage covering the bone formation is less than that without it, it may result in the deterioration of the lateral compartment after UKA.

Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article.

OBJECT: Incidental durotomy (dural tear) is a common complication of lumbar spine surgery. The purpose of this study was to clarify the anatomical location of and the specific causative factors for incidental durotomy during primary lumbar spine surgery. METHODS: The authors retrospectively reviewed 1014 consecutive cases involving patients (412 women and 602 men; mean age 57 years; age range 11-97 years) who underwent a surgical procedure for treatment of degenerative lumbar spinal disease at their institution between 2002 and 2008. In total, 1261 disc levels were treated surgically. Disease at the treated levels included 544 disc herniations, 453 instances of spinal canal stenosis without spondylolisthesis, 188 instances of lumbar spinal canal stenosis with spondylolisthesis (degenerative spondylolisthesis), 49 instances of combined stenosis (stenosis with disc herniation), and 22 juxtafacet cysts. In 5 of the treated levels, the condition was classified as "other" disease. Treatment included fenestration with discectomy in 547 levels, fenestration alone in 626, fenestration with resection of juxtafacet cysts in 22, unilateral recapping laminoplasty in 20, posterolateral spinal fusion or posterior lumbar interbody fusion in 17, microscopic discectomy with tubular retractor in 14, and "other" in 15. RESULTS: Unintended durotomy occurred in 4% of cases and in 3.3% of disc levels. The incidence of dural tear was significantly higher in women (5.6%) than in men (3%). The incidence of dural tear was 2% in disc levels with lumbar disc herniation, 1.8% with lumbar spinal canal stenosis without spondylolisthesis, 9% with degenerative spondylolisthesis, and 18.2% with juxtafacet cysts; the incidence was significantly higher in levels with degenerative spondylolisthesis or levels with juxtafacet cysts, than in those with other diseases. Incidental durotomy occurred in 4 critical anatomical zones, namely, the caudal margin of the cranial lamina, cranial margin of the caudal lamina, herniated disc level, and medial aspect of the facet joint adjacent to the insertion of the hypertrophic ligamentum flavum. CONCLUSIONS: Risk factors for unintended durotomy were female sex, older age, degenerative spondylolisthesis, and juxtafacet cysts. In this study, the authors identified 4 high-risk anatomical zones that spine surgeons should be aware of to avoid dural tears.

A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities.

BACKGROUND: For arthroscopic anterior cruciate ligament reconstruction, the most commonly used graft constructs are either the hamstring tendon or patellar tendon. Well-controlled, long-term studies are needed to determine the differences between the 2 materials. HYPOTHESIS: There is a difference between hamstring and patellar tendon grafts in the clinical results of anterior cruciate ligament reconstructions at 7 years. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Two groups of 90 patients each, consecutively treated with hamstring or patellar tendon grafts, were followed and assessed at 1, 2, 5, and 7 years after surgery. RESULTS: At the 7-year review, abnormal radiographic findings were seen in 45% (24/53) of the patellar tendon group and in 14% (7/51) of the hamstring tendon group (P = .002). Although there was no significant difference between the groups in extension deficit (P = .22), the percentage of patients with an extension deficit increased significantly in the patellar tendon group from 8% at 1 year to 25% at 7 years (P = .02). No significant change was seen in the hamstring tendon group over time (P = .20). There was no significant difference in laxity between the groups on Lachman (P = .44), pivot-shift (P = .39), or instrumented (P = .44) testing. Graft rupture occurred in 4 patients from the patellar tendon group and in 9 patients from the hamstring tendon group (P = .15). Both autografts gave excellent subjective results, as evidenced by the International Knee Documentation Committee evaluation and Lysholm knee scores at 7 years. CONCLUSIONS: Both hamstring and patellar tendon grafts provided good subjective outcomes and objective stability at 7 years. No significant differences in the rate of graft rupture or contralateral anterior cruciate ligament rupture were identified. Patients with patellar tendon grafts had a greater prevalence of osteoarthritis at 7 years after surgery; therefore, the authors preferred hamstring tendons as the primary graft choice in anterior cruciate ligament reconstructions.

Traumatic separation of a type I bipartite patella: a report of four knees.

Four knees in three patients with traumatic separation of a Type I bipartite patella are reported. Sudden anterior knee pain and an audible pop occurred at the time of the injury and the patients had aching or dull pain before the traumatic episode. Previous aching or dull pain led us to differentiate this type of injury from a usual transverse fracture. A round fracture line seen on the radiographs also led us to differentiate this type of injury from a stress fracture. Accordingly, the diagnosis of a traumatic separation of a Type I bipartite patella was confirmed. This is the first report of a traumatic separation of a Type I bipartite patella to our knowledge.

Pigmented villonodular synovitis of the knee with lesions of the bursae.

Five patients with pigmented villonodular synovitis of the knee associated with lesions of the posterior periarticular bursae were treated by posterior exploration, excision of the bursal tissue, and routine anterior synovectomy of the knee. It was hypothesized that complete excision of the posterior periarticular bursae would reduce the high recurrence rate of pigmented villonodular synovitis of the knee. To completely excise the periarticular lesions, two posterior oblique skin incisions were used. In all patients, periarticular lesions were seen clearly on computed tomography scans after air arthrography and on magnetic resonance imaging scans. The patients were followed up for 6.9 years on average (range, 3.3-8.1 years) after surgery. One of five patients required reoperation because of recurrence. Two of five patients required manual mobilization after release of the intraarticular adhesion. However, in the remaining three patients, who started continuous passive motion exercise immediately after surgery, full range of motion was restored within 3 months after the operation. Complete excision of the periarticular lesions is recommended to reduce the high recurrence rate, and continuous passive motion exercise immediately after surgery also is recommended to prevent reduction of range of motion.