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Biomedical subjects

Kazuya Sugimoto

Publications and source records attributed to Kazuya Sugimoto.

At least 19 recordsLinked to original sources

Intra-articular angioleiomyoma of the knee: a case report.

We report a rare case of angioleiomyoma that occurred in the intra-articular portion of the knee joint. A 43-year-old female was referred to us with a 3-year history of recurrent pain and a loss of full extension of the right knee. Physical examinations revealed swelling and restriction of active full extension. Magnetic resonance imaging (MRI) revealed an intra-articular tumor. Surgical excision was performed, and the histology was characteristic of an angioleiomyoma. The patient became asymptomatic after the operation. At 2-year follow-up after the operation, no recurrence has developed.

Adult↗

Regeneration of the hamstring tendons after harvesting for arthroscopic anterior cruciate ligament reconstruction: a histological study in 11 patients.

The purpose of our study is to evaluate whether the hamstring tendons can regrow after harvesting for anterior cruciate ligament (ACL) reconstruction and whether the regenerate tissue can be histologically characterized as tendinous. Eleven of the patients (eight female and three male; mean age, 23 years; range 17-37 years) consented to participate in this study. One year after the ACL reconstruction, surgical biopsy was done. Regeneration of the tendon was detected macroscopically in 9 of the 11 patients. Histologically and immunohistochemically, the regenerated tendons closely resembled normal ones. The results of this study show the hamstring tendons can regenerate after harvesting for the ACL reconstruction.

Adolescent↗

Free and island flap transfers for the treatment of motor vehicle injuries.

Thirteen patients (10 males and 3 females; age range at surgery: 2 to 41 years, average: 13.5 years) with motor vehicle injuries of the foot (n = 10) and leg (n = 3) were treated using free and island flaps. Donor flaps consisted of a scapular flap in six cases, a peroneal flap in four, a latissimus dorsi musculocutaneous flap in one, gracillis muscle flap in one, and gastrocnemius muscle flap in one case. Free grafts were transferred in 10 patients and pedicle grafts in three. All flaps survived completely. Moderate scarring was noted in two patients who underwent scapular flap transfer, and growth disturbances occurred in two patients with metatarsal fracture accompanying epiphyseal plate injury. Functionally, no patients experienced any disturbance, and all reconstructed sites were cosmetically satisfactory. Early flap coverage of soft-tissue defects due to motor vehicle injury was shown to be useful from the point of view of both cosmetic and functional results.

Accidents, Traffic↗

Tissue-engineered approach for the treatment of steroid-induced osteonecrosis of the femoral head: transplantation of autologous mesenchymal stem cells cultured with beta-tricalcium phosphate ceramics and free vascularized fibula.

Autologous mesenchymal stem cells (MSCs) cultured with beta-tricalcium phosphate (beta-TCP) ceramics and with a free vascularized fibula were transplanted into three patients with steroid-induced osteonecrosis of the femoral head. The average follow-up period was 34 months and the average patient age at the time of surgery was 28 years old. Fifteen milliliters of bone marrow was obtained from the patients 4 weeks before surgery, and was used for in vitro proliferation of MSCs. beta-TCP granules were immersed in the MSC suspension and the cells were further cultured for 2 weeks. Cultured MSCs/beta-TCP composite granules were implanted into the cavity that remained after curettage of necrotic bone; and finally, a free vascularized fibula was grafted. All hips showed preoperative collapse and radiographic progression was observed in two hips postoperatively. Osteonecrosis did not progress any further and early bone regeneration was observed. This tissue-engineered approach has potentials for the treatment of osteonecrosis. However, our results suggested that the present procedure could not be used for cases with severe preoperative collapse.

Adult↗

Vascularized bone graft from the medial calcaneus for treatment of large osteochondral lesions of the medial talus.

BACKGROUND: Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome. The purpose of this study was to evaluate the results of a vascularized bone graft transfer from the medial calcaneus to the large osteochondral lesion. METHODS: Four ankles in four patients with medial osteochondral lesions were treated through a medial transmalleolar approach. Vascularized bone graft was harvested from the medial calcaneus using the calcaneal branch of the posterior tibial artery and was placed through a fenestration of the medial aspect of the talar dome. The mean duration of postoperative followup was 34 (range 24 to 48) months. Clinical and radiographic evaluations were made before surgery and at final followup. RESULTS: According to the AOFAS ankle-hindfoot scale, mean pain and function scores improved from 20 to 33 points and 30 to 43 points, respectively. The mean total score improved from 60 to 83 points. Plain radiography at followup showed slight osteosclerosis in all patients, but joint space narrowing was not seen in any patient. Cysts seen preoperatively on MRI or CT resolved after 12 months postoperatively, and MRI or CT did not reveal any findings indicative of osteonecrosis. CONCLUSIONS: Clinical and radiographic results were satisfactory. Vascularized bone grafts harvested from the calcaneus were successful for the treatment of large osteochondral lesions of the medial talus.

Adult↗

Percutaneous drilling of symptomatic accessory navicular in young athletes.

BACKGROUND: Results of percutaneous drilling for symptomatic type II accessory tarsal navicular bone are not determined. HYPOTHESIS: Percutaneous drilling of accessory navicular synchondrosis will induce or accelerate bone union between the accessory and primary navicular bones. Bone union of the synchondrosis leads to symptomatic relief. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-one feet of 29 patients with type II accessory tarsal navicular treated by percutaneous drilling were reviewed. RESULTS: Twenty-four feet (77.4%) were assessed as excellent, 6 (19.4%) as good, and 1 (3.2%) as fair. No feet were assessed as poor. Bone union was obtained in 16 (80%) of the 20 feet when the proximal phalanx of the great toe was immature and in 2 of the 11 feet when it was mature. CONCLUSION: Percutaneous drilling of the synchondrosis was effective for a symptomatic type II accessory navicular, especially in patients with immature proximal phalanx of the great toe.

Adolescent↗

Premature failure of the polyethylene tibial bearing surface of the Interax knee arthroplasty.

Thirty-four patients (37 knees) were treated with the Interax knee arthroplasty. There were 31 female and 3 male patients with a mean age at surgery of 70 years (range, 53-84 years). Premature failure of the polyethylene tibial bearing surface occurred in 9 patients (9 knees). Eight patients of these required a revision operation because of early wearing out of the tibial surface 20 to 38 months after the operation. The failure was due to inadequate implant design in small component and polyethylene gamma irradiated in the air.

Aged↗

Cartilage thickness of the talar dome.

PURPOSE: To perform a successful operation, accurate information on the articular cartilage thickness of the talus is essential. The purpose of this study was to determine the articular cartilage thickness of the talar dome in the area where osteochondritis dissecans is common. TYPE OF STUDY: Convenient samples. METHODS: Articular cartilage thickness of the mid talar dome was measured in 29 ankles of 17 cadavers. The average age of the specimens was 70 years (range, 53 to 91 years). Twenty-two were from men and 7 were from women. Coronal sections of the mid talar domes were obtained from the specimens measuring 2 mm in width and 5 mm in depth. Radiographs of the sectioned specimens were taken and were enlarged with a personal computer. The thickness of the articular cartilage was measured at 9 areas: medial gutter (area 1), medial corner (area 2), medial edge of the dome plateau (area 3), lateral edge of the dome plateau (area 7), lateral corner (area 8), lateral gutter (area 9), and quarter points between areas 3 and 7 (areas 4, 5, and 6). RESULTS: The average thickness of the total areas was 1.35 +/- 0.22 mm in the male specimens and 1.11 +/- 0.28 mm in the female specimens. The thickest was area 2, which represented the medial corner, and the thinnest was area 9, which represented the lateral gutter in both men and women. There was a relationship between the thickness of the cartilage and the width of the talar dome. CONCLUSIONS: The thickness was usually less than 2 mm. However, the cartilage thickness varies widely by gender, area, and individual. CLINICAL RELEVANCE: Our report will help surgeons predict the volume of cartilage that needs to be repaired and produce treatment at a reasonable cost without an excessive invasion of patients.

Aged↗

Seventeen-year follow-up of a reattachment of a nonunited anterior tibial spine avulsion fracture.

Seventeen years ago we treated a nonunited avulsion fracture of the anterior tibial spine with open reduction and pull-out wires. When the patient was 9 years old, she fell and bruised her left knee. The knee was immobilized for a month in a long cast. When she was 24 years old, she felt severe knee pain and giving way after playing tennis 1 month before her first visit to our hospital. She complained of knee pain, giving way, locking, and 15 degrees loss of knee extension. Radiographs showed a large nonunited fragment at the intercondylar eminence of the tibia. She underwent a reattachment surgery. When she was re-evaluated 17 years after surgery, she had no pain, no giving way, no locking, and no loss of knee extension. On physical examination, there was no instability. Plain anteroposterior and lateral radiographs showed a well-united fragment of the anterior tibial spine. In conclusion, the open reduction for knee pain, giving way, locking, and loss of knee extension caused by nonunion of avulsion of the anterior tibial spine yielded satisfactory results. We believe that in cases of nonunited anterior tibial spine fractures it is necessary to attempt to secure the anterior cruciate ligament in an anatomic position.

Anterior Cruciate Ligament Injuries↗

Intra-articular synovial hemangioma; a rare cause of knee pain and swelling.

INTRODUCTION: Synovial hemangioma is a rare intra-articular benign tumor that is difficult to diagnose because of its nonspecific symptoms. Patients are generally children or young adults with a nontraumatic recurrent swollen painful knee. CASE PRESENTATION: A 24-year-old woman presented with a 20-year history of recurrent pain and swelling in the right knee. Physical examination revealed a small painful point adjacent to the medial side of the patella. Magnetic resonance imaging revealed an intra-articular tumor. After arthroscopic examination, surgical excision was performed. The histology was characteristic of synovial hemangioma. RESULTS: Open complete synovectomy of the circumscribed capillary hemangioma was successful, and the patient remains asymptomatic 2 years after surgery.

Adult↗

Effects of reinforcement with the iliotibial tract flap in ACL reconstruction using bone-patellar tendon-bone.

INTRODUCTION: We attempted to reinforce the transplanted ligament by wrapping it with the iliotibial tract (ITT) flap to get more volume and to protect the graft from impingement in the intercondylar space postoperatively in reconstruction of the anterior cruciate ligament (ACL) using bone-patellar tendon-bone (BTB), and investigated the results in comparison with those of BTB alone. MATERIALS AND METHODS: The study included 88 cases (88 knees). Group A comprised 43 knees with the reinforcement and group B 45 knees with BTB alone. Both groups were evaluated by second-look arthroscopy, magnetic resonance imaging (MRI), manual testing, International Knee Documentation Committee (IKDC) score, and histopathological evaluation more than 2 years after the reconstruction. RESULTS: In the second-look arthroscopic findings, 84% of the reconstructed ACL in group A had good appearance, and no fibrous split was observed. The ratio of fibrous disorder was significantly less in group A in comparison with group B (p=0.0037). Distinct reduction of the tension of the reconstructed ligament was observed in 9% of group A and 36% of group B (p=0.0088). Regarding the results of the Lachman test, the ratio of the negative group was higher in group A (p=0.0067). In the MRI findings fulfilled pictures to the inside of the reconstructed ligament were observed in 77% of the patients photographed in group A. In contrast, the fibrous split was observed in 55% in group B. CONCLUSIONS: Reinforcement by wrapping with the ITT flap for the BTB autograft was effective in ACL reconstruction. The ratio of fibrous disorder and reduction of tension in the reconstructed ligament decreased.

Adolescent↗

Glomus tumor of the lateral aspect of the knee joint.

BACKGROUND: We report a rare case of glomus tumor that occurred in the lateral joint of the knee. A 54-year-old man was referred to us with a 3-year history of lateral pain in the left knee and the diagnosis of lateral meniscus injury. Physical examination revealed a small trigger point localized just on the lateral joint space. Magnetic resonance imaging (MRI) showed a very small round mass in the subcutaneous tissue at the level of the lateral joint space. TREATMENT: Excisional biopsy was performed, and the histology was characteristic of a glomus tumor. The patient was asymptomatic immediately after the operation. At the 3-year follow-up after the operation, no recurrence was seen.

Glomus Tumor↗

Partial tarsal arthrodesis for rheumatoid feet.

Partial intertarsal joint arthrodesis was performed on 12 feet of 11 patients as a surgical treatment for planovalgus deformity of the foot and lesions of the intertarsal joints caused by rheumatoid arthritis. Single arthrodesis was performed on the talocalcaneal joint in eight feet, two of which underwent simultaneous total ankle arthroplasty, and on the talonavicular joint in two feet. Double arthrodesis was done on the talocalcaneal and talonavicular joints in one foot and on the talonavicular and calcaneocuboid joints in one foot. Screws or staples were used for fixation. Patients were followed for 2 years to 8 years 7 months (average 4 years 3 months). Osseous fusion was achieved in all feet, and satisfactory pain relief was obtained in all cases except one. We performed this surgery in patients who were relatively active, and the results indicated that arthrodesis of a small number of joints that caused pain and deformity was effective in reducing pain and correcting the deformity. We concluded that partial tarsal arthrodesis should be performed on a limited number of joints during the early stages of planovalgus deformity of the foot because more joints are found to be fixed during the advanced stages. However, progression of the osteoarthritis was found in the neighboring joints. Close follow-up observation is needed.

Journal Article↗

Ankle arthroplasty using three generations of metal and ceramic prostheses.

Ankle arthroplasties using metal and polyethylene prostheses were done on 28 patients (30 ankles) with painful osteoarthritis or rheumatoid arthritis between 1975 and 1980. Significant loosening and subsidence of the metal prostheses occurred in most patients, and ceramic prostheses were introduced in 1980. Ceramic prostheses with or without cement were used to replace 60 ankles in 56 patients with painful arthritis between 1980 and 1991. Revision surgery was required for five patients (five ankles) during the followup period (mean, 12 years 6 months). Loosening and subsidence of the prostheses were seen in 50% of patients within 5 years after the index procedure. As a result, a new design of bead-formed alumina coated with hydroxyapatite was used. A tibial prosthesis fixed to the posterior cortex of the tibia with a screw was used from 1991. These new ceramic prostheses were used to replace 70 ankles in 62 patients between 1991 and 2000. Thirty-six patients (36 ankles) with a mean age of 71 years (range, 50-87 years) had osteoarthritis, and 26 patients (31 ankles) with a mean age of 60 years (range, 41-76 years) had rheumatoid arthritis. During followup, with an average of 5 years 2 months, three patients (three ankles) required revision surgery (one for infection, two for talar necrosis). Overall results for patients with osteoarthritis were excellent in 21 ankles, good in 10 ankles, fair in two, ankles and poor in zero ankles. Results in patients with rheumatoid arthritis were excellent in five ankles, good in 16 ankles, fair in three ankles, and poor in two. In the intermediate study, 29 patients (31 ankles; 91.2%) with osteoarthritis and 19 patients (21 ankles; 76.9%) with rheumatoid arthritis were satisfied with the short-time results of arthroplasty.

Adult↗

Ankle and pantalar arthrodeses using vascularized fibular grafts.

From 1989 to 1998 ankle and pantalar arthrodeses using vascularized fibular grafts were performed for seven patients. The indications for surgery were chronic nonunion following fracture of the distal tibia in four patients, rheumatoid arthritis in two, and talus necrosis in one. The ankle joint was fused in the two patients with a pilon fracture, and in the other five patients, both the ankle and subtalar joints were fused. In one patient, additional bone grafting was required for delayed union. In the other six patients, the mean period required to obtain radiographic bone union was 6 months (range, 4-9 months). The time until the patients could walk without braces ranged from 6 to 20 months (mean, 12.3 months). Local infection was not encountered in any patients. This procedure represents a viable option for patients in whom a standard, less complicated arthrodesis cannot be performed.

Adult↗