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Biomedical subjects

T Muneta

Publications and source records attributed to T Muneta.

At least 37 records · Page 2Linked to original sources
PubMed1998

Effects of aggressive early rehabilitation on the outcome of anterior cruciate ligament reconstruction with multi-strand semitendinosus tendon.

To evaluate the effects of aggressive early rehabilitation on the clinical outcome of anterior cruciate ligament reconstruction using semitendinosus (and gracilis) tendon, 103 of 110 consecutive patients who underwent ACL reconstruction using multistrand semitendinosus tendon (ST) or the central one-third of patellar tendon with bony attachments (BTB) were analyzed prospectively. Subjectively, the Lysholm score was not different among the groups. The Lachman test indicated a trend of less negative grade in the ST men's group than that in the BTB men's group. On the patellofemoral grinding test, only women patients of both groups showed pain, with less positive crepitation in the ST group than in the BTB group. KT measurements at manual maximum showed more patients with more than 5 mm differences in the ST group than in the BTB group. The results of this study suggest that aggressive early rehabilitation after the ACL reconstruction using the semitendinosus (and gracilis) tendon has more risk of residual laxity than with the BTB.

Adult↗
PubMed1998

Subtalar instability following lateral ligament injuries of the ankle.

A stress radiograph of the subtalar joint was taken using Telos equipment, while the X-ray beam was directed onto the posterior subtalar joint at angles of 30 degrees latero-medially and 40 degrees caudocranially. From this radiograph the subtalar tilt angle was measured as an index of stability of the subtalar joint. Intra-and interobserver evaluations of measurement of this angle were performed on 20 unstable ankles. The errors at a 95 per cent confidence level were 1.9 degrees for intraobserver A, 1.4 degrees for intraobserver B and 2 degrees in interobservation. Stability of the subtalar joint was evaluated on 46 lateral ligament injuries of the ankle (23 acute injuries and 23 chronic injuries) and 80 normal ankles. The subtalar tilt angle was 9.7 degrees +/ 3.2 degrees in acute injuries 10.3 degrees #/ 2.9 degrees in chronic injuries, and 5/2 degrees +/ 2/6 degrees in normal ankles. There were significant differences between the acute or chronic injury and the normal ankles. These results suggested that stability of the subtalar joint was disturbed following acute and chronic lateral ligament injuries of the ankle.

Adolescent↗
PubMed1998

Anterior cruciate ligament deficiency accompanied by patellar subluxation treated by reconstruction with lateral retinacular release.

Five patients with an anterior cruciate ligament (ACL) deficiency accompanied by patellar subluxation who were treated by ACL reconstruction with lateral retinacular release (LRR) are reported. In two patients, the LRR was performed at the same time as the ACL reconstruction, and in three patients, the LRR was performed secondarily. The three patients requiring the secondary LRR needed the procedure to recover knee stability to return to sporting activities. In all patients, the apprehension sign of the patella was subsequently improved. When managing ACL deficiencies in a young athletic population, patellar subluxation should be suspected. In our patients with patellar subluxation accompanying an ACL deficiency, ACL reconstruction with LRR was effective in relieving their instability.

Adolescent↗
PubMed1998

Objective factors affecting overall subjective evaluation of recovery after anterior cruciate ligament reconstruction.

The goal of this prospective study was to determine how objective measurements affect the overall subjective evaluation of recovery after anterior cruciate ligament (ACL) reconstruction and to evaluate the effects of graft material, residual instability and sporting activity on patient satisfaction. Ninety-seven patients with unilateral ACL injuries whose ACL was reconstructed using either a multi-strand semitendinosus (ST) graft or a central-third bone-patellar tendon-bone (BTB) graft were followed for an average of 30 months. An "overall subjective recovery score" was derived from the patients' evaluation of function of the operated knee as a percentage of the unoperated knee. The mean overall subjective recovery score at follow-up was 80% (range, 20% to 100%). This study strongly suggested that integrity of the knee extension mechanism, that is, good recovery of knee extension strength with achievement of full extension and no problems in the patellofemoral joint, is the most important factor in patient satisfaction after ACL reconstruction.

Adult↗
PubMed1998

Tendon transfer for equinovarus deformed foot caused by cerebrovascular disease.

Surgical correction was performed on 125 patients who had equinovarus deformity caused by a cerebrovascular accident and who needed an ankle foot orthosis for walking. The operative procedures involved anterior transfer of the long toe flexors (flexor hallux longus and flexor digitorum longus; long toe flexor group) or lateral transfer of the anterior tibial tendon (anterior tibial tendon group), combined with lengthening of the Achilles tendon. On evaluation more than 2 years after surgery, 83 of 110 patients of the long toe flexor group and eight of 15 patients of the anterior tibial tendon group were able to walk without a brace. Five patients of the anterior tibial tendon group who had shown strong contraction of the anterior tibial muscle during the swing phase before surgery, needed a brace because of a drop foot after surgery. Thus, lateral transfer of the anterior tibial tendon was abandoned in 1984. Recurrence of varus deformity was seen in approximately 15% of the patients in both groups. Anterior transfer of the long toe flexors, using them as dorsiflexor tendons or for tenodesis, seemed to produce better results.

Adult↗
PubMed1997

Sequential dynamics of monocyte chemotactic protein-1 expression in herniated nucleus pulposus resorption.

We previously demonstrated that the granulation tissues of herniated nucleus pulposus are composed of a marked infiltration of macrophages that strongly express monocyte chemotactic protein-1. Monocyte chemotactic protein-1 is a chemotactic cytokine that contributes to the activation and recruitment of macrophages. Relatively little is known about its role in the resorption process of herniated nucleus pulposus. To clarify the sequential dynamics of expression of monocyte chemotactic protein-1 in the granulation tissues of herniated nucleus pulposus, we introduced a rat autologous transplantation model of nuclear materials onto its lumbar dura mater and performed immunohistological analysis and competitive polymerase chain reaction assay using the grafted samples. Immunohistological analysis demonstrated that the majority of infiltrating mononuclear cells expressed monocyte chemotactic protein-1. Monocyte chemotactic protein-1 mRNA was expressed in the first 3 weeks after the procedure and was significantly and maximally upregulated at 1 week. To determine whether human recombinant monocyte chemotactic protein-1 facilitates the resorption process of herniated nucleus pulposus, we introduced another model of autologous transplantation, wherein the nuclear materials were grafted to the abdominal subcutaneous tissues and recombinant monocyte chemotactic protein-1 was subsequently applied to these materials. When monocyte chemotactic protein-1 was injected into the murine nucleus pulposus tissues, they reduced in size more rapidly than in the control group. These findings suggest that monocyte chemotactic protein-1 plays an important role in the recruitment of macrophages in the early phase of the resorption process of herniated nucleus pulposus and that its application may physiologically facilitate the resorption process of the nucleus pulposus.

Animals↗
PubMed1996

Arthroscopic meniscal repair in conjunction with anterior cruciate ligament reconstruction: factors affecting the healing rate.

Ninety-eight of 121 consecutive patients who underwent arthroscopy-assisted meniscal repair in combination with anterior cruciate ligament reconstruction were evaluated by second-look arthroscopy with an average interval of 16 months (range, 6 to 63 months). Of the 98 meniscal repairs, 73 had completely healed, 13 had incompletely healed, and 12 had not healed. Six possible factors that may have affected the healing of the repaired menisci were statistically analyzed. There were no statistically significant differences between the three groups with respect to sex, age, tear site on the medial or lateral meniscus, or residual anterior laxity as measured using the KT-1000. The factors that had a statistically significant impact on healing rate were the rim width and meniscal locking. Negative correlations with the healing rate were observed in menisci that were repaired in the central third zone and that had been locked or could be locked by probing at the time of surgery.

Adult↗
PubMed1996

Effects of knee flexion angle at graft fixation on the outcome of anterior cruciate ligament reconstruction.

Clinical outcome in 44 patients who underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendons augmented by the ligament augmentation device for chronic ACL deficiency was studied; average follow-up was 38 months (range, 24 to 52 months). In 19 patients, grafts were fixed with the knees at full extension (group 1), whereas in 25 patients, the grafts were fixed with the knees at 30 degrees of flexion (group 2). The results of subjective testing (Lysholm score), the Lachman test, the pivot-shift test, muscle strength testing, angle of extension loss, and follow-up arthroscopy were compared to assess the effects of flexion angle at fixation on stability and function. The range of motion in group 1 was significantly better than that in group 2. The stability of the knees and the arthroscopic appearance of the grafts in group 1 were, however, significantly worse than those in Group 2.

Adolescent↗
PubMed1996

Forefoot pressures during walking in feet afficted with hallux valgus.

Forefoot pressures during walking in feet with hallux valgus were recorded using pressure-sensitive film, and the relationships between deformities and foot pressures were analyzed. There were 32 female subjects comprising 50 feet with hallux valgus, of which 20 feet underwent surgery. As in normal feet, the pressure patterns of feet with hallux valgus were varied: peak pressures were under the first metatarsal head, under the second and/or third metatarsal heads, and first, second, and/or third metatarsal heads. Peak pressures of hallux valgus feet were larger in each type than those of the normal foot. In feet with hallux valgus showing peak pressures under the first metatarsal heads, the hallux valgus angle and the intermetatarsal angle were larger than those in feet showing peak pressures on the second and/or third metatarsal heads. After surgery, peak pressures were under the second and/or third metatarsal heads and they decreased.

Adult↗
PubMed1995

Evaluation of anterior cruciate reconstruction reinforced by the Kennedy ligament augmentation device. An arthroscopic and histological study.

Fifty anterior cruciate ligament reconstructions with the Kennedy ligament augmentation device were examined arthroscopically and histologically 6 to 61 months after operation. The autogenous segments used were the quadriceps tendon in 13 and the semitendinosus tendon, with or without gracilis, in 37. The arthroscopic findings were rated as good in 31, fair in 15 and poor in 4, and there was correlation between these grades and KT-1000 measurements. The histological findings were graded as good in 17, fair in 26 and poor in 4; these did not correlate with the arthroscopic grades but with the time interval after reconstruction. Maturation of the autogenous augmented segment was found to progress with time, but took more than 3 years to become complete.

Adolescent↗
PubMed1995

The effects of tibial tunnel placement and roofplasty on reconstructed anterior cruciate ligament knees.

Seventy-five anterior cruciate ligament (ACL) reconstructions augmented with the Kennedy Ligament Augmentation Device were evaluated according to classification of tibial drill-hole position on the basis of the anatomic landmarks of the ACL by two-dimensional radiographic imaging of the fully extended knee. The effects of roofplasty to avoid graft impingement were also assessed. The tibial drill-hole position was classified in relation to the medial intercondylar tubercle on anterior-posterior (AP) view, and in relation to Blumensaat's line (B-line) on lateral view. Arthroscopic evaluation of the ACL and incidence of chronic synovitis as well as Lysholm knee score, manual knee tests, knee extension and flexion angles, and knee tester measurements were performed. The results indicated that the knee joints in which the tibial drill hole was positioned laterally from the medial intercondylar tubercle or in which the tibial drill hole was positioned anteriorly to the B-line showed a tendency to develop more postoperative chronic synovitis. The knees in which the tibial drill hole was positioned anteriorly to the B-line also showed larger AP laxity. There was no difference between the non-roofplasty and roofplasty groups.

Adult↗
PubMed1995

Lower leg fracture with Parkes-Weber syndrome complicated by disseminated intravascular coagulation.

Reports of Parkes-Weber syndrome complicated by disseminated intravascular coagulation (DIC) are rare in the orthopaedic literature. This is a case report of a 23-year-old man who had this syndrome and who sustained a lower-leg fracture complicated by the DIC. Open reduction was not attempted because the DIC worsened after manual reduction. Amputation was rejected by the patient. Three months of continuous infusion of heparin and replacement therapy with fresh frozen plasma was done. Cast immobilization without further reductions was continued. The DIC improved and union of the fractures was observed at 2 years and 3 months after injury.

Adult↗
PubMed1994

Load affects remodeling of transplanted, autogenous bone-patellar tendon-bone segments in a rabbit model.

The question of whether or not load affects the remodeling of a transplanted autogenous free graft was addressed by removal of the patella-patellar tendon-tibial tubercle complex from the right knees of 15 New Zealand White rabbits. The tubercle was split, and the tendon was divided with each half trimmed to an equal width. The autograft complex was transplanted into a subcutaneous tunnel on the back of the rabbit. Controlled cyclic loads were applied via transcutaneous sutures to half of the graft, while the other half remained unloaded. The mechanical stiffness and strength and the cell density of loaded and unloaded halves of the autograft were measured in nine animals at 3 weeks and in six animals at 6 weeks. Five autografts from four additional rabbits served as unimplanted controls. An analysis of variance showed that the loaded portions of the autografts had a significantly higher failure strength (mean of 90%) and were significantly stiffer (mean of 62%) than the unloaded halves at 3 and 6 weeks. Failure strength was significantly greater (mean of 90%) at 3 weeks than at 6 weeks. The autografts were less stiff and had a lower failure strength than the unimplanted controls, with the greatest difference occurring in the unloaded segments at 6 weeks. Histology revealed that both loaded and unloaded segments demonstrated an increase in cellularity at 6 weeks compared with 3 weeks. This report introduces a model for the study of the effect of load on soft-tissue grafts and demonstrates that loading affects the remodeling process of a transferred autograft.

Animals↗
PubMed1994

Posteromedial release of congenital club foot in children over five years of age.

We reviewed 19 children with 24 congenital club feet at a mean of 11 years after one-stage posteromedial release at the age of five years or older (mean 6.8 years). Thirteen feet had undergone previous surgery. Nineteen feet were functionally excellent or good, three were fair and two had required subtalar arthrodesis. Radiographs showed good alignment of the tarsal bones, although mild adduction or varus deformity remained in several feet. Deformities of the bones were more common in feet which had had previous surgery.

Child↗
PubMed1992

Effusions after anterior cruciate ligament reconstruction using the ligament augmentation device.

Persistent effusions occurred in 4.3% (seven patients) of 164 patients who underwent anterior cruciate ligament (ACL) reconstruction using an autograft augmented with the ligament augmentation device (LAD) between 1986 and 1989. No bacteria were cultured from the joint fluid. The radiograph in each case showed a tibial drill hole located anteriorly or anterolaterally. Arthroscopy confirmed an abraded LAD in six cases and breakage of the LAD in one case and impingement of the graft on the femoral condyle during extension. Under polarized light microscopy, the histology of the synovia showed foreign body giant cells in one case and particles among the proliferative cells in four cases. The effusions subsided in two cases after notchplasty and in five cases after removal of the LAD. Impingement of the graft on the femoral condyle due to incorrect positioning of the tibial drill hole presumably produced particles that induced synovitis and effusions.

Adolescent↗
PubMed1992

[Force measurement of reconstructed anterior cruciate ligament in relation to changes in length in experiments using cadaver knees].

The effects of tibial and femoral attachment sites on changes in length and force were investigated in ACL grafts, using eight cadaver knees. Two tibial and three femoral attachment sites were chosen, such as the anteromedial and central sites in the tibial insertion of the ACL, and the central and anterior-superior sites in the femoral insertion, as well as the over-the-top route. Changes in the length in all combinations of these attachment sites was measured from extension to 150 degrees flexion at 15 degrees intervals by the displacement of a cord 2 mm in diameter which simulated the graft. The holes through the attachment sites were then enlarged to accept a 6 mm wide LAD (Ligament Augmentation Device, 3M). The force in this LAD graft was measured over the same range of knee flexion using a buckle transducer for all combinations of sites. Changes in length and force were affected more by the femoral attachment site. There was a close correlation between length changes and force measurements except at a neighborhood of the full extension. Changes in force between a given combination of sites failed to show a reproducible pattern among the knees tested.

Anterior Cruciate Ligament↗
PubMed1992

Neglected Lisfranc's joint dislocation.

A 34-year-old man presented with a deformed and painful foot 14 months after surgery for a Lisfranc's dislocation; the procedure had been done elsewhere. Radiographs showed a lateral dislocation of the Lisfranc's joint that had not been reduced. At the time of reexploration, the split anterior tibial tendon was displaced between the medial and middle cuneiform bones, which was blocking reduction. After placing the anterior tibial tendon into its normal position, the reduction remained incomplete because of a deformed articular surface. Arthrodesis of the Lisfranc's joint was then performed. In a lateral dislocation of the Lisfranc's joint, which is irreducible by manipulation, an interposition of the anterior tibial tendon should be suspected.

Adult↗