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Xu G, Wang Q, Li Z, Wu T. Computed tomography Osteoabsorptiometry: Review of bone density, mechanical strength of material and clinical application. Front Bioeng Biotechnol 2023; 11:1066709. [PMID: 37051272 PMCID: PMC10083511 DOI: 10.3389/fbioe.2023.1066709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
Computed Tomography (CT) imaging is an effective non-invasive examination. It is widely used in the diagnosis of fractures, arthritis, tumor, and some anatomical characteristics of patients. The density value (Hounsfield unit, HU) of a material in computed tomography can be the same for materials with varying elemental compositions. This value depends on the mass density of the material and the degree of X-ray attenuation. Computed Tomography Osteoabsorptiometry (CTOAM) imaging technology is developed on the basis of CT imaging technology. By applying pseudo-color image processing to the articular surface, it is used to analyze the distribution of bone mineralization under the articular cartilage, evaluate the position of prosthesis implantation, track the progression of osteoarthritis, and determine the joint injury prognosis. Furthermore, this technique was combined with indentation testing to discuss the relationship between the high bone density area of the articular surface, the mechanical strength of the bone, and the anchorage stability of the implant, in addition to the study of the relationship between mechanical strength and bone density. This narrative study discusses the pre- and postoperative evaluation of medical device implantation position, orthopedic surgery, and the clinical treatment of bone injury and degeneration. It also discusses the research status of CTOAM technology in image post-processing engineering and the relationship between bone material and mechanical strength.
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Affiliation(s)
- Guanghua Xu
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Institute of Sport and Exercise Medicine, North University of China, Taiyuan, China
| | - Qiuyuan Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Zhiqiang Li
- School of Physical Education, North University of China, Taiyuan, China
| | - Tingrui Wu
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- *Correspondence: Tingrui Wu,
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Shimizu T, Takahashi D, Nakamura Y, Miyazaki T, Yokota S, Ishizu H, Iwasaki N. Effect of periacetabular osteotomy on the distribution pattern of subchondral bone mineral density in patients with hip dysplasia. J Orthop Res 2022; 40:2626-2631. [PMID: 35076129 DOI: 10.1002/jor.25284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023]
Abstract
Despite the availability of long-term follow-up data, the effect of pelvic osteotomy on the natural history of osteoarthritis is not yet fully understood, partly because there is untapped potential for radiographs to better describe osteoarthritis. Therefore, this study aimed to assess the distribution of subchondral bone mineral density (BMD) across the acetabulum in patients with hip dysplasia immediately (2 weeks) and 1 year after undergoing periacetabular osteotomy (PAO). To that end, we reviewed 40 hips from 33 patients with developmental dysplasia of the hip who underwent PAO between January 2016 and July 2019 at our institution. We measured subchondral BMD through the articular surface of the acetabulum using computed tomography osteoabsorptiometry, dividing the distribution map into nine segments. We then compared the subchondral BMD between 2 weeks and 1 year after PAO in each area. At 2 weeks after PAO, the high-density area tended to be localized particularly in the lateral part of the acetabulum, whereas 1 year after PAO, the high-density area moved to the central and lateral parts. The percentage ratios of the subchondral BMD for the central-posterior, lateral-central, and lateral-posterior areas relative to the central-central area were significantly decreased at 1 year after PAO, as compared to those at 2 weeks after PAO. These findings suggest that loading was altered by PAO to be more similar to physiological loading. A long follow-up observational study is warranted to confirm the association between early changes in subchondral BMD by PAO and joint degeneration.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yumejiro Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takuji Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shunichi Yokota
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Tsukuda Y, Matsui Y, Endo K, Matsui Y, Kawamura D, Iwasaki N. Influence of differences in bone morphology on the distribution patterns of subchondral bone density across the trapeziometacarpal joint. Sci Rep 2022; 12:12368. [PMID: 35859017 PMCID: PMC9300633 DOI: 10.1038/s41598-022-16746-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/14/2022] [Indexed: 12/03/2022] Open
Abstract
We aimed to clarify the effects of morphological patterns of the trapezium and first metacarpal on the distribution of subchondral bone density across the articular surface of the trapeziometacarpal (TMC) joint using computed tomography osteoabsorptiometry. Thirty-three patients with normal TMC joints were evaluated. The percentages of the high-density areas in the radial-dorsal and ulnar-volar regions of the trapezium were significantly higher than that in the ulnar-dorsal region, and that of the ulnar-dorsal region of the first metacarpal was significantly lower than in the other three regions. The percentage of the high-density area of the radial-dorsal region of the trapezium and trapezial inclination (TI) showed a significant positive correlation, and the percentages of the high-density areas in the ulnar-dorsal and ulnar-volar regions had significant negative correlations with TI at the articular surface of the first metacarpal. These results indicate that bony morphologic differences in the trapezium affect the distribution pattern of subchondral bone density through the TMC joint.
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Affiliation(s)
- Yukinori Tsukuda
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Yuichiro Matsui
- Faculty of Dental Medicine, Hokkaido University, Kita 13 jo Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8586, Japan. .,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kaori Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yuki Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Daisuke Kawamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15 jo Nishi 7 chome, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Matsubara S, Onodera T, Iwasaki K, Hishimura R, Matsuoka M, Kondo E, Iwasaki N. Discrepancy in the Distribution Patterns of Subchondral Bone Density Across the Ankle Joint After Medial Opening-Wedge and Lateral Closing-Wedge High Tibial Osteotomy. Am J Sports Med 2022; 50:478-485. [PMID: 34913761 DOI: 10.1177/03635465211062235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) changes the alignment and dynamics of the ankle joint; however, differences in the stress distribution of the ankle joint after opening-wedge HTO (OWHTO) and closing-wedge HTO (CWHTO) are not understood. It is believed that subchondral bone density of the articular surface reflects the pattern of cumulative stress distribution across the joint surface. PURPOSE To clarify the effects of OWHTO and CWHTO on the distribution patterns of subchondral bone density across the ankle joint using computed tomography (CT)-osteoabsorptiometry. STUDY DESIGN Cohort study; Level of evidence, 4. METHODS Radiographic and CT data of 18 cases who underwent OWHTO (OW group), 12 cases who underwent CWHTO (CW group), and 11 cases with unilateral anterior cruciate ligament injury serving as controls were retrospectively reviewed. The subchondral bone density of the distal tibia was assessed in the 3 groups using CT-osteoabsorptiometry. The distal tibial surface of the ankle joint was divided into 4 parts in the coronal direction, and the percentage of the high-density area (%HDA) to each subregion was compared before and after HTO. RESULTS Preoperatively, comparing %HDA among the 3 groups, there were no significant differences in any regions. In the OW group, postoperative %HDA in the most medial region was significantly increased compared with preoperative %HDA (49.3% to 53.0%; P = .011), and postoperative %HDA in the most lateral region was significantly decreased (21.4% to 17.2%; P = .003). On the other hand, in the CW group, postoperative %HDA in the most medial region was significantly decreased (55.7% to 35.7%; P = .001), and %HDA in the second lateral region was significantly increased (23.6% to 29.2%; P = .002). CONCLUSION The ankle distribution pattern of subchondral bone density shifted significantly medially after OWHTO without fibular osteotomy, whereas the distribution pattern shifted laterally after CWHTO with fibular osteotomy. When the OWHTO is performed for patients with medial ankle osteoarthritis, surgeons should pay attention to potential postoperative progression of ankle osteoarthritis due to medial shift of the stress distribution in the ankle joint.
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Affiliation(s)
- Shinji Matsubara
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Faculty of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
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Abstract
This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed by an analysis of particular characteristics and outcomes of the treatment. OCD is seen in patients with open growth plates (juvenile OCD [JOCD] and in adults [AOCD] with closed growth plates [adult OCD). The etiology at smaller joints remains as unclear as for the knee. Mechanical factors (throwing activities [capitulum] seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important for the diagnosis. In low-grade and stable lesions, treatment involves rest and different degrees of immobilization until healing. When surgery is necessary, the procedure depends on the OCD stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable while with damaged cartilage, several techniques are used. Techniques such as drilling and microfracturing produce a reparative cartilage while other techniques reconstruct the defect with osteochondral grafts or cell-based procedures such as chondrocyte implantation. There is a tendency toward better results when reconstructive procedures for both the bone and cartilage are used. In addition, comorbidities at the joint have to be treated. Severe grades of osteoarthritis are rare.
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Affiliation(s)
- Juergen Bruns
- Wilhelmsburger Krankenhaus Groß-Sand, Hamburg, Germany,Juergen Bruns, Wilhelmsburger Krankenhaus Gross-Sand, Groß Sand 3, Hamburg, 21107, Germany.
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Numaguchi K, Momma D, Matsui Y, Yokota M, Oohinata J, Kondo E, Iwasaki N. Stress-Distribution Pattern Across the Glenohumeral Joint in Collegiate and Professional Baseball Players: A Computed Tomography Osteoabsorptiometry Study. Orthop J Sports Med 2021; 9:23259671211009185. [PMID: 34159211 PMCID: PMC8182204 DOI: 10.1177/23259671211009185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 02/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The influence of long-term loading conditions on the articular surfaces of
the glenohumeral joint can be determined by measuring stress-distribution
patterns. Long-term pitching activity changes the stress distribution across
the glenohumeral joint surface; however, the influence of competitive level
on stress-distribution patterns remains unclear. Purpose: To use computed tomography (CT) osteoabsorptiometry (CTOAM) to evaluate the
distribution of subchondral bone density across the glenohumeral joint in
collegiate and professional baseball players as well as to determine the
effects of pitching activity on the articular surfaces. Study Design: Descriptive laboratory study. Methods: We evaluated 73 shoulders in 50 baseball players. CT imaging data were
obtained from the dominant-side shoulder of 12 professional pitchers (PP
group) and 15 professional fielders (PF group). CT imaging data were also
obtained from both shoulders of 12 asymptomatic collegiate pitchers (CP
group) and 11 collegiate fielders (CF group). The pattern of distribution of
subchondral bone density across the articular surfaces of each glenohumeral
joint was assessed by CTOAM. As a measure of bone density, the mean
Hounsfield units (HU) were obtained for each joint surface, and the absolute
values of the dominant shoulder were compared for each group. Results: Stress-distribution patterns over the articular surfaces differed between the
dominant and nondominant sides in the CP group as well as between both
collegiate groups versus the PP group. In the CP group, the mean HU of the
humeral head surface were greater on the nondominant versus dominant side
(P = .035). On the dominant side, the mean HU of the
humeral head surface and glenoid were greater in the CP versus the PP group
(P = .001 and .027, respectively). Conclusion: Stress distribution on the articular surface of the glenohumeral joint was
affected by pitching ability and competitive level. Our analysis indicates
that the traction force on the glenohumeral joint surface might be greater
than compression force during pitching. Clinical Relevance: The present findings suggest that pitching activity results in low stress to
the articular surfaces of the glenohumeral joint. This supports the notion
that mechanical conditions play a crucial role in the etiology of disorders
specific to pitching activity.
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Affiliation(s)
- Kyosuke Numaguchi
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yuki Matsui
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | | | | | - Eiji Kondo
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
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Kameda T, Kondo E, Onodera T, Iwasaki K, Onodera J, Yasuda K, Iwasaki N. Changes in the Contact Stress Distribution Pattern of the Patellofemoral Joint After Medial Open-Wedge High Tibial Osteotomy: An Evaluation Using Computed Tomography Osteoabsorptiometry. Orthop J Sports Med 2021; 9:2325967121998050. [PMID: 33997060 PMCID: PMC8072873 DOI: 10.1177/2325967121998050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Medial open-wedge high tibial osteotomy (OWHTO) theoretically causes distalization and lateralization of the tibial tuberosity and the patella. Purpose/Hypothesis: The purpose of the study was to identify any changes in the stress distribution of subchondral bone density across the patellofemoral (PF) joint before and after OWHTO through the use of computed tomography (CT) osteoabsorptiometry. We hypothesized that OWHTO would alter the distribution of contact stress in the PF joint. Study Design: Case series; Level of evidence, 4. Methods: A total of 17 patients (17 knees) who underwent OWHTO were enrolled in this study between September 2013 and September 2015. All patients underwent radiologic examination preoperatively and at 1 year postoperatively, and the distribution patterns of subchondral bone density through the articular surface of the femoral trochlea and patella were assessed preoperatively and >1 year postoperatively using CT osteoabsorptiometry. The quantitative analysis of the obtained mapping data focused on location of the high-density area (HDA) through the articular surface of the PF joint. The percentage of HDA at each divided region of the articular surface of the femoral trochlea and the patella was calculated. Results: In the radiologic evaluation, the Blackburne-Peel ratio was significantly reduced (P < .001) after surgery, and the tilting angle of the patella was significantly decreased (P < .001). On CT evaluation, the percentage of HDA in the lateral notch and lateral trochlea of the femur and in the medial portion of the lateral facet of the patella increased significantly after OWHTO surgery (P ≤ .038). Conclusion: OWHTO significantly increased the stress distribution pattern of the lateral trochlea of the femur and the medial portion of the lateral facet of the patella. The procedure significantly lowered the patellar height and significantly decreased the patellar tilting angle after surgery.
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Affiliation(s)
- Toshiaki Kameda
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Jun Onodera
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Hokkaido, Japan
| | - Kazunori Yasuda
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Harkin WE, Pennock AT, Bastrom TP, Edmonds EW. Does Youth Baseball Result in Morphologic Changes of the Lateral Elbow? A Prospective MRI Study. Clin Orthop Relat Res 2021; 479:623-631. [PMID: 33534261 PMCID: PMC7899490 DOI: 10.1097/corr.0000000000001468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Stress from overhead throwing results in morphologic changes to the shoulder in youth baseball players. With greater valgus torque stresses, the elbow experiences injuries specifically attributed to throwing. However, no previous work that we know of has assessed throwing-related morphologic changes of the elbow without associated conditions. QUESTIONS/PURPOSES (1) Do children who play competitive baseball have enlargement or overgrowth of their radial head shape and/or capitellum compared with the nondominant elbow on MRI? (2) Do children who stop playing year-round baseball have less enlargement of the lateral elbow structures than children who maintain a high level of play? METHODS A prospective study was conducted between 2015 and 2018 on preadolescent boys who underwent voluntary MRI of their bilateral elbows before the start of the spring baseball season. Twenty-six children agreed to participate out of a four-team league that was asked to participate; their first MRI was obtained at a mean (range) age of 12 years (10 to 13). We also obtained their history related to throwing and performed a physical examination. Players had a mean of 5.6 years of playing before their first MRI, and half the children (13 of 26) were year-round baseball players. Sixty-two percent (16 of 26) reported being either or both a pitcher or catcher as their primary position. No child was excluded from participation. Three years later, these boys were asked to return for repeat MRI and physical examinations. Fifty-eight percent (15 of 26) of players were still playing at the 3-year MRI. Continued play or new onset of pain was documented. Radiographic measurements were then compared between dominant and nondominant arms, and the differences of these changes were compared between those who had continued playing during the study period and those who had quit. The measurements were made in all three planes of the radial head and capitellum, both osseous and cartilaginous. Measurement intrarater and interrater reliability were in the good-to-excellent range (intraclass correlation coefficient 0.77 to 0.98). RESULTS When we compared dominant and nondominant arms, we found there was no dominant arm overgrowth (difference between baseline and 3-year measurements) in any measurement; for example, sagittal capitellum measurements in dominant arms were 2.5 ± 1.1 mm versus non-dominant arms: 2.8 ± 1.1 mm (mean difference -0.23 [95% CI -0.55 to 0.08]; p = 0.13). There was only undergrowth of the cartilaginous axial diameter of the radial head (change in dominant: 2.5 ± 1.3 mm; change in nondominant: 3.2 ± 1.7 mm; mean difference -0.64 mm [95% CI -1.2 to -0.06]; p = 0.03). There was no enlargement of the lateral elbow structures when children who continued to play were compared with children who stopped playing; for example, the difference in the bone-only growth ratio of the sagittal radial head to humerus of those still playing was 0.001 ± 0.03 and it was 0.01 ± 0.03 for those not playing (mean difference -0.01 [95% CI -0.04 to 0.01]; p = 0.29). CONCLUSION In healthy children who play baseball for multiple years between the ages of 6 to 11 years, continued torque at the elbow from throwing does not result in morphologic changes as it does in the shoulder. Despite evidence that injuries and surgery because of long-term participation in a throwing sport results in a larger radial head and capitellum, our study presents evidence that outside an injured elbow, throwing alone does not appear to change the morphology of the lateral elbow. Therefore, changes to the radial head size could presuppose other elbow pathology and future study could be performed to better evaluate the correlation. LEVEL OF EVIDENCE Level I, prognostic study.
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Affiliation(s)
- William E Harkin
- W. E. Harkin, A. T. Pennock, E. W. Edmonds, Department of Orthopedic Surgery, University of California, San Diego, CA, USA
- A T. Pennock, T. P. Bastrom, E. W. Edmonds, Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, CA, USA
| | - Andrew T Pennock
- W. E. Harkin, A. T. Pennock, E. W. Edmonds, Department of Orthopedic Surgery, University of California, San Diego, CA, USA
- A T. Pennock, T. P. Bastrom, E. W. Edmonds, Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, CA, USA
| | - Tracey P Bastrom
- W. E. Harkin, A. T. Pennock, E. W. Edmonds, Department of Orthopedic Surgery, University of California, San Diego, CA, USA
- A T. Pennock, T. P. Bastrom, E. W. Edmonds, Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, CA, USA
| | - Eric W Edmonds
- W. E. Harkin, A. T. Pennock, E. W. Edmonds, Department of Orthopedic Surgery, University of California, San Diego, CA, USA
- A T. Pennock, T. P. Bastrom, E. W. Edmonds, Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, CA, USA
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Abstract
Background Repetitive mechanical stress on the elbow joint during throwing is a cause of ulnar collateral ligament dysfunction that may increase the compressive force on the humeral capitellum. This study aimed to examine the effects of ulnar collateral ligament material properties on the humeral capitellum under valgus stress using the finite element method. Methods Computed tomography data of the dominant elbow of five healthy adults were used to create finite element models. The elbows were kept at 90° of flexion with the forearm in the neutral position, and the ulnar collateral ligament was reproduced using truss elements. The proximal humeral shaft was restrained, and valgus torque of 40 N·m was applied to the forearm. The ulnar collateral ligament condition was changed to simulate ulnar collateral ligament dysfunction. Ulnar collateral ligament stiffness values were changed to 72.3 N/mm, 63.3 N/mm, 54.2 N/mm, 45.2 N/mm, and 36.1 N/mm to simulate ulnar collateral ligament laxity. The ulnar collateral ligament toe region width was changed in increments of 0.5 mm from 0.0 to 2.5 mm to simulate ulnar collateral ligament loosening. We assessed the maximum equivalent stress and stress distribution on the humeral capitellum under these conditions. Results As ulnar collateral ligament stiffness decreased, the maximum equivalent stress on the humeral capitellum gradually increased under elbow valgus stress (P < .001). Regarding the change in the ulnar collateral ligament toe region width, as the toe region elongated, the maximum equivalent stress of the humeral capitellum increased significantly under elbow valgus stress (P < .001). On the capitellum, the equivalent stress on the most lateral part was significantly higher than that on other parts (P < .01 for all). Conclusion Under elbow valgus stress with elbow flexion of 90° and the forearm in the neutral position, ulnar collateral ligament dysfunction increased equivalent stress on the humeral capitellum during the finite element analysis. The highest equivalent stress was noted on the lateral part of the capitellum.
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Momma D, Iwamoto W, Endo K, Sato K, Iwasaki N. Stress Distribution Patterns Across the Shoulder Joint in Gymnasts: A Computed Tomography Osteoabsorptiometry Study. Orthop J Sports Med 2020; 8:2325967120962103. [PMID: 33244475 PMCID: PMC7678403 DOI: 10.1177/2325967120962103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background: The distribution pattern of subchondral bone density is an indicator of stress distribution over a joint surface under long-term physiologic loading. The biomechanical characteristics of the articular surfaces of the shoulder joint in gymnasts can be determined by measuring this distribution pattern. Purpose: To evaluate the distribution of subchondral bone density across the shoulder joint in male collegiate gymnasts and to determine the effects of gymnastic activities on its articular surfaces under long-term loading conditions using computed tomography osteoabsorptiometry (CTOAM). Study Design: Descriptive laboratory study. Methods: CT image data were obtained from both shoulders of 12 asymptomatic male collegiate gymnasts (gymnast group; mean age, 19.4 years; range, 18-22 years) and 10 male collegiate volunteers (control group; mean age, 20.2 years; range, 18-22 years). The distribution pattern of subchondral bone density across the articular surfaces of each shoulder joint was assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the articular surfaces differed between the gymnasts and the controls. In the gymnasts, high-density areas were detected on the posterosuperior articular surface of the humeral head and the anterosuperior and/or posterosuperior articular surface of the glenoid. Mean bone density was greater in the gymnasts than in the controls (P < .0001). Conclusion: Stress distribution over the articular surfaces of the shoulder joint was affected by gymnastic activities. Stress was concentrated over the superior part of the glenohumeral joint in male collegiate gymnasts. Clinical Relevance: The present findings suggest that gymnastic activities increase stress to the articular surfaces of the superior glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the origin of disorders particular to gymnastic activities.
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Affiliation(s)
- Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Wataru Iwamoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Endo
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
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Shiota J, Momma D, Yamaguchi T, Iwasaki N. Long-term Stress Distribution Patterns Across the Ankle Joint in Soccer Players: A Computed Tomography Osteoabsorptiometry Study. Orthop J Sports Med 2020; 8:2325967120963085. [PMID: 33283002 PMCID: PMC7686641 DOI: 10.1177/2325967120963085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background: The distribution pattern of subchondral bone density is considered to
accurately reflect the stress distribution over a joint under long-term
physiologic loading. The biomechanical characteristics of the surface of the
ankle joint in soccer players can be determined by measuring this
distribution pattern under long-term loading. Purpose: To evaluate the distribution of subchondral bone density across the ankle
joint in soccer players and to determine the effects of soccer activities,
including kicking motion, on the ankle joint surface under long-term loading
conditions by computed tomography (CT) osteoabsorptiometry (CTOAM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: CT imaging data were obtained from both ankles of 10 soccer players (soccer
group) and 10 nonathletic volunteers (control group). The distribution
patterns of subchondral bone density across the articular surface of the
ankle joints were assessed by CTOAM. Quantitative analysis was performed of
the locations and percentages of high-density areas on the articular
surface. Results: Stress distribution patterns over the ankle joint differed between the soccer
players and controls. In the soccer players, the high-density areas were
found in the anterior part of the distal tibia and proximal talus as well as
the distal fibula. The percentages of high-density areas were greater in the
soccer players compared with controls (P < .0001). Conclusion: Stress distribution over the articular surface of the ankle joint was
affected by soccer activities. A high stress concentration was seen in
soccer players in the anterior part of the tibia and talus and in the
fibula; such excessive stress may lead to anterior impingement.
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Affiliation(s)
- Junki Shiota
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
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Sada K, Chiba K, Kajiyama S, Okazaki N, Yonekura A, Tomita M, Osaki M. Bone Mineral Density and Microstructure of the Elbow in Baseball Pitchers: An Analysis by Second-Generation HR-pQCT. J Clin Densitom 2020; 23:322-328. [PMID: 31006601 DOI: 10.1016/j.jocd.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Baseball pitchers' elbows are exposed to repeated overloading during the throwing motion, which causes bone structural changes such as bone sclerosis and osteophyte formation. They have been observed by clinical CT and MRI, while the bone microstructural change has not yet been studied in vivo. The aims of this study were to establish a method of imaging the elbow joint using second-generation high-resolution peripheral quantitative CT and to investigate the bone microstructural change in baseball pitchers' dominant elbows. METHODS The subjects were 17 baseball pitchers. The elbow was fixed using a custom-made cast and scanned by second-generation high-resolution peripheral quantitative CT. The scan conditions were as follows: voxel size 60.7 μm, integration time 43 ms, scan length 30.6 mm, and total scan time 8 min. Volumetric bone mineral density (vBMD) and trabecular bone microstructure were analyzed in the 6.5-mm3 cubic regions set in the capitellum and trochlea, and the dominant and nondominant elbows were compared. RESULTS vBMD, bone volume fraction (BV/TV), and trabecular thickness (Tb.Th) at the capitellum were significantly higher in the dominant elbow than in the nondominant elbow. On the other hand, no parameters at the trochlea were significantly different. CONCLUSIONS Higher vBMD accompanied by thicker trabecular bone was observed at the capitellum. These bone microstructural changes would reflect the valgus stress generated by the pitching motion in the elbow joint.
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Affiliation(s)
- Kiyoshi Sada
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Shiro Kajiyama
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Narihiro Okazaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Yonekura
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masato Tomita
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Matsuura T, Iwame T, Iwase J, Sairyo K. Osteochondritis Dissecans of the Capitellum :Review of the Literature. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 67:217-221. [PMID: 33148891 DOI: 10.2152/jmi.67.217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association of player position with capitellar OCD. Elbow pain and a longer playing history might be related to progression of capitellar OCD but do not in themselves increase the risk of development of the condition. The cause of capitellar OCD is likely to include a combination of repetitive microtrauma and internal factors, such as ischemia and genetic predisposition. A combination of radiography, computed tomography, magnetic resonance imaging, and ultrasonography have aided our understanding of the pathology of capitellar OCD. Screening using ultrasonography enables early detection and provides an opportunity for successful conservative treatment. Treatment has conventionally included both operative and nonoperative measures based on the stage and size of the lesion, skeletal maturity, subjective symptoms, and structural integrity of the cartilage. Early-stage lesions respond better to nonoperative treatment than those in more advanced stages. Operative indications include persistent symptoms despite nonoperative treatment, symptomatic loose bodies, and displacement or detachment of fragments. J. Med. Invest. 67 : 217-221, August, 2020.
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Affiliation(s)
- Tetsuya Matsuura
- Department of Orthopedics, Tokuhshima University, Tokushima, Japan
| | - Toshiyuki Iwame
- Department of Orthopedics, Tokuhshima University, Tokushima, Japan
| | - Jyoji Iwase
- Department of Orthopedics, Tokuhshima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokuhshima University, Tokushima, Japan
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14
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Funakoshi T, Furushima K, Miyamoto A, Kusano H, Horiuchi Y, Itoh Y. Predictors of Unsuccessful Nonoperative Management of Capitellar Osteochondritis Dissecans. Am J Sports Med 2019; 47:2691-2698. [PMID: 31348868 DOI: 10.1177/0363546519863349] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondritis dissecans of the humeral capitellum (capitellar OCD) is a common injury among adolescent throwing athletes. Some younger patients with incomplete maturity of the epiphysis and early-stage capitellar OCD are good candidates for nonoperative treatment. However, during initial examination, predicting the need for surgical treatment in patients with capitellar OCD is difficult. PURPOSE To perform multivariate ordered logistic regression analysis of data obtained from patients' medical records and images on initial examination and identify the predictors of unsuccessful nonoperative management of capitellar OCD. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS This study included 245 elbows with capitellar OCD (all male; mean age, 14 years [range, 10-27 years]). Patients were divided into 3 groups comprising 148 elbows requiring an immediate operation on initial examination, 48 requiring nonsurgical treatment, and 49 requiring an operation after nonoperative management. Baseline data and radiographic parameters, such as lesion location, lesion size, modified Minami classification, radial head size, skeletal age difference between both elbows on initial examination, lesion size on computed tomography, and staging on magnetic resonance imaging, were retrospectively reviewed. Univariate and multivariate ordered logistic regression analyses of spontaneous healing of the lesion were conducted. RESULTS Univariate logistic regression analysis showed that radial head enlargement and skeletal age difference were significantly associated with spontaneous healing. In multivariate ordered logistic regression analysis, radial head enlargement (anteroposterior and lateral) and skeletal age difference were significant predictors of lack of spontaneous healing (odds ratio [OR], 2.76, P =.025; OR, 7.92, P =.026; and OR, 1.84, P =.0089, respectively). CONCLUSION To predict spontaneous healing in the moderate stage, plain radiographs would be important to evaluate radiocapitellar congruity and skeletal age. This study showed that preoperative radiographic findings of radial head enlargement and advanced skeletal age of the throwing side compared with that of the nonthrowing side were predictors of advanced-stage capitellar OCD. Despite several limitations, the statistical significance and correlations herein provide important information on preoperative surgical planning to surgeons.
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15
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Miyamura S, Sakai T, Oka K, Abe S, Shigi A, Tanaka H, Shimada S, Mae T, Sugamoto K, Yoshikawa H, Murase T. Regional Distribution of Articular Cartilage Thickness in the Elbow Joint: A 3-Dimensional Study in Elderly Humans. JB JS Open Access 2019; 4:JBJSOA-D-19-00011. [PMID: 31592501 PMCID: PMC6766381 DOI: 10.2106/jbjs.oa.19.00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
During elbow procedures, reconstruction of the joint (including the articular cartilage) is important in order to restore elbow function; however, the regional distribution of elbow cartilage is not completely understood. The purpose of the present study was to investigate the 3-dimensional (3-D) distribution patterns of cartilage thickness of elbow bones (including the distal part of the humerus, proximal part of the ulna, and radial head) in order to elucidate the morphological relationship among them.
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Affiliation(s)
- Satoshi Miyamura
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kunihiro Oka
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Shingo Abe
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Atsuo Shigi
- Department of Orthopaedic Surgery, Yukioka Hospital, Osaka, Japan
| | - Hiroyuki Tanaka
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Shoichi Shimada
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuo Mae
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuomi Sugamoto
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Murase
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
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Tsukuda Y, Kawamura D, Matsui Y, Iwasaki N. Morphological characteristics of the sigmoid notch of the distal radius affect the stress distribution patterns in the distal radioulnar joint. J Hand Surg Eur Vol 2019; 44:496-502. [PMID: 30309275 DOI: 10.1177/1753193418803522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to clarify the effects of morphological patterns of the sigmoid notch on the stress distribution across the articular surface of the distal radioulnar joint using a computed tomography osteoabsorptiometry method. Fourteen wrists from 13 patients were classified into two groups according to the type of sigmoid notch, namely the 'C' type and ski-slope sigmoids, and the percentages of high-density areas on the articular surface were quantitatively analysed. The percentage of the high-density area of the dorsal region in the ski-slope sigmoid group was significantly greater than that of the 'C' type sigmoid group (16% vs 4.1%) and of the volar region of the ski-slope sigmoid group (16% vs 2.4%). The results indicate that bony morphological differences in the radial sigmoid notch affect the stress distribution pattern through the distal radioulnar joint.
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Affiliation(s)
- Yukinori Tsukuda
- 1 Department of Orthopaedic Surgery, Otaru General Hospital, Otaru, Japan
| | - Daisuke Kawamura
- 2 Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuichiro Matsui
- 2 Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- 2 Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Momma D, Funakoshi T, Endo K, Yokota M, Fujisaki K, Iwasaki N. Alteration in stress distribution patterns through the elbow joint in professional and college baseball pitchers: Using computed tomography osteoabsorptiometry. J Orthop Sci 2018; 23:948-952. [PMID: 30431007 DOI: 10.1016/j.jos.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/02/2018] [Accepted: 06/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Long-term pitching activities change the stress distribution across the elbow joint surface in living subjects, however the influence of the different strength of stress on the stress distribution patterns remain unclear. The aims of this study were to evaluate the distribution of subchondral bone density across the elbow joint in different levels of pitchers, and to reveal the influence of the strength of stress on the elbow joint surface under long-term loading conditions of baseball pitching. METHODS The current analysis was performed using computed tomography (CT) image data obtained from the throwing side elbow of 12 nonthrowing athletes (controls), 15 college baseball pitchers (college group) and 13 professional baseball pitchers (professional group). The distribution patterns of subchondral bone density through the articular surface of the elbow joints were assessed using a CT osteoabsorptiometry method. The quantitative analysis was based on location and percentages of high-density area on the articular surface. RESULTS High-density area in the college and professional groups were found in the anterior part of the captellum, posterior part of the trochlea and radial head. In the professional group, the percentages of high-density area in the anterior part of the capitellum, posterior part of the trochlea, radial head and olecranon were significantly greater than in the college group. CONCLUSIONS Stress distribution on the articular surface of the elbow joint was affected by pitching abilities or competitive levels. Our analysis indicates that high strength of stress in professional baseball players produce potential risk of elbow injuries.
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Affiliation(s)
- Daisuke Momma
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan.
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan.
| | - Kaori Endo
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan.
| | - Masashi Yokota
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan.
| | - Kazuhiro Fujisaki
- Department of Intelligent Machines and System Engineering, Hirosaki University, Hirosaki, Japan.
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan.
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Is There an Association Between Borderline-to-mild Dysplasia and Hip Osteoarthritis? Analysis of CT Osteoabsorptiometry. Clin Orthop Relat Res 2018; 476:1455-1465. [PMID: 29698301 PMCID: PMC6437563 DOI: 10.1097/01.blo.0000533619.50951.e3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The definitive treatment of borderline-to-mild dysplasia remains controversial. A more comprehensive understanding of the etiology of osteoarthritis (OA) and clarification of any possible association between borderline-to-mild dysplasia and the pathogenesis of OA are essential. QUESTIONS/PURPOSES (1) Does the distribution of acetabular subchondral bone density increase according to dysplasia severity? (2) Is there an association between borderline-to-mild dysplasia and OA pathogenesis? METHODS We evaluated bilateral hips of patients with developmental dysplasia of the hip who underwent eccentric rotational acetabular osteotomy (ERAO) for inclusion in the dysplasia group and contralateral hips of patients with unilateral idiopathic osteonecrosis of the femoral head (ONFH) who underwent curved intertrochanteric varus osteotomy (CVO) for the control group. ERAO was performed in 46 patients and CVO was performed in 32 patients between January 2013 and August 2016 at our institution. All patients underwent bilateral hip CT. The study included 55 hips categorized according to dysplasia severity: (1) borderline-mild, 19 hips (15° ≤ lateral center-edge angle [LCEA] < 25°); (2) moderate, 20 hips (5° ≤ LCEA < 15°); (3) severe, 16 hips (LCEA < 5°); and (4) control, 15 hips. Thirty-seven dysplastic hips (age < 15 or > 50 years old, prior hip surgery, subluxation, aspherical femoral head, cam deformity, and radiographic OA) and 17 control hips (age < 15 or > 50 years old, bilateral ONFH, LCEA < 25° or ≥ 35°, cam deformity, and radiographic OA) were excluded. CT-osteoabsorptiometry (OAM) predicts physiologic biomechanical conditions in joints by evaluating subchondral bone density. We evaluated the distribution of subchondral bone densities in the acetabulum with CT-OAM, dividing the stress distribution map into six segments: anteromedial, anterolateral, centromedial, centrolateral, posteromedial, and posterolateral. We calculated the percentage of high-density area, which was defined as the upper 30% of Hounsfield units values in each region and compared least square means difference estimated by the random intercept model among the four groups. RESULTS In all regions, the percentage of high-density area did not differ between the borderline-mild group and the control (eg, anterolateral, 16.2 ± 5.6 [95% CI, 13.4 to 18.9] versus 15.5 ± 5.7 [95% CI, 12.4 to 18.5, p = 0.984]; centrolateral, 39.1 ± 5.7 [95% CI, 36.4 to 41.8] versus 39.5 ± 4.7 [95% CI, 36.6 to 42.5, p = 0.995]; posterolateral, 10.9 ± 5.2 [95% CI, 8.0 to 13.8] versus 15.1 ± 6.8 [95% CI, 11.7 to 18.5, p = 0.389]). In the anterolateral region, a smaller percentage of high-density area was observed in the borderline-mild group than in both the moderate group (16.2 ± 5.6 [95% CI, 13.4-18.9] versus 28.2 ± 5.1 [95% CI, 25.5-30.9], p < 0.001) and the severe group (16.2 ± 5.6 [95% CI, 13.4-18.9] versus 22.2 ± 6.8 [95% CI, 19.2-25.2, p = 0.026). CONCLUSIONS Our results suggest that the cumulative hip stress distribution in borderline-to-mild dysplasia was not concentrated on the lateral side of the acetabulum, unlike severe dysplasia. CLINICAL RELEVANCE Based on the stress distribution pattern, our results may suggest that there is no association between borderline-to-mild dysplasia and the pathogenesis of OA. Further studies are needed to evaluate the association between borderline-to-mild dysplasia and instability of the hip.
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Matsui Y, Funakoshi T, Momma D, Miyamoto A, Endo K, Furushima K, Fujisaki K, Iwasaki N. Variation in stress distribution patterns across the radial head fovea in osteochondritis dissecans: predictive factors in radiographic findings. J Shoulder Elbow Surg 2018; 27:923-930. [PMID: 29477668 DOI: 10.1016/j.jse.2017.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/12/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Predictive factors for the development of osteoarthritis in adolescent osteochondritis dissecans (OCD) of the humeral capitellum remain unclear. The objectives of this study were to assess subchondral bone density in the radial head fovea of patients with OCD and to evaluate stress distribution in the radiocapitellar joint. The relationship between radiologic classification and stress distribution, according to multivariate ordinal regression analysis, was also investigated. METHODS Computed tomography (CT) imaging data from 54 male patients with OCD (mean age, 13.1 years) were collected. Stress in the radial head fovea was measured using CT osteoabsorptiometry. A stress map was constructed and divided into 4 sections, and percentages of high-density regions in each section were quantitatively analyzed. Multivariate ordinal regression analyses were performed of bone density, incorporating the stage, location, and size of the OCD lesion and the presence of medial elbow disturbance in the radiographic images. RESULTS The percentage of high-density area in the anteromedial, posteromedial, and the anterolateral sections of the radial head fovea were significantly increased compared with the posterolateral section. Multivariate ordinal regression analysis revealed that the location and size of the lesion and a history of excessive valgus stress were associated with imbalances in the radial head fovea. CONCLUSIONS When the OCD lesion is large and located laterally and a medial epicondyle disturbance is apparent on radiographs, the risk for developing advanced radiocapitellar osteoarthritis should be considered. These findings can be useful in the decision-making process for treating OCD.
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Affiliation(s)
- Yuki Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Orthopedic Surgery, Keiyu Orthopaedic Hospital, Tatebayashi, Japan.
| | - Daisuke Momma
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Azusa Miyamoto
- Department of Orthopedic Surgery, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Kaori Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kozo Furushima
- Department of Orthopedic Surgery, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Kazuhiro Fujisaki
- Department of Intelligent Machines and System Engineering, Hirosaki University Graduate School of Science and Technology, Hirosaki, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Miyamura S, Oka K, Abe S, Shigi A, Tanaka H, Sugamoto K, Yoshikawa H, Murase T. Altered bone density and stress distribution patterns in long-standing cubitus varus deformity and their effect during early osteoarthritis of the elbow. Osteoarthritis Cartilage 2018; 26:72-83. [PMID: 29037846 DOI: 10.1016/j.joca.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 08/29/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the bone density and stress distribution patterns in long-standing cubitus varus and clarify the effects of the deformity on bone density. DESIGN We created three-dimensional computed tomography (CT) elbow models from 21 patients with long-standing cubitus varus deformities without advanced osteoarthritis (OA) and assessed the deformity by superimposing the affected humerus onto a mirror-image of the contralateral normal. Elbows were divided into 13 regions before measuring the bone density of each region and comparing the percentage of high-density volume (%HDV) between affected and normal sides. We constructed finite element models and quantitatively analyzed stress distribution. RESULTS Average degrees of deformities were 20.1° of varus, 6.4° of extension, and 12.7° of internal rotation. The medial side of the affected humerus and ulna, Anteromedial trochlea (P < 0.001), Medial coronoid (P = 0.004), and Medial olecranon (P = 0.049) had significantly higher %HDVs than their normal counterparts. Conversely, %HDVs on the affected lateral side, Capitellum (P < 0.001), Anterolateral trochlea (P = 0.010), Posterolateral trochlea (P < 0.001), Lateral coronoid (P = 0.007), and Lateral olecranon (P < 0.001) were significantly lower than the normal side. The affected radial head %HDVs at Anterolateral and Posteromedial quadrants were high (P = 0.007) and low (P = 0.007), respectively. The bone density distribution coincided with stress distribution patterns revealed by finite element analysis (FEA), except in the lateral region influenced by forearm rotation. CONCLUSIONS Repetitive stress on the medial elbow may alter bone density distribution patterns, probably presenting from early stage of OA.
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Affiliation(s)
- S Miyamura
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - K Oka
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; Osaka University Healthcare Center, 17-1 Machikaneyama-cho, Toyonaka, Osaka 560-0043, Japan.
| | - S Abe
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - A Shigi
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - H Tanaka
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - K Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - H Yoshikawa
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - T Murase
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
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Kajiyama S, Muroi S, Sugaya H, Takahashi N, Matsuki K, Kawai N, Osaki M. Osteochondritis Dissecans of the Humeral Capitellum in Young Athletes: Comparison Between Baseball Players and Gymnasts. Orthop J Sports Med 2017; 5:2325967117692513. [PMID: 28321431 PMCID: PMC5347432 DOI: 10.1177/2325967117692513] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Osteochondritis dissecans (OCD) lesions are often observed in the humeral capitellum both in young baseball players and gymnasts. It is generally believed that capitellar OCD in baseball players can be seen on an anteroposterior (AP) radiograph with the elbow in 45° of flexion. However, the mechanism of injury seems to be different in baseball players and gymnasts. Repetitive valgus overload with the elbow in flexion is believed to be the cause of capitellar OCD lesions in baseball players, whereas weightbearing with the elbow in extension may be the cause of OCD in gymnasts. Purpose: To determine the difference in capitellar OCD location between baseball players and gymnasts and to propose the optimal AP radiographic angle of the elbow for visualization of early-stage OCD lesions in adolescent gymnasts. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Subjects consisted of 95 baseball players (95 elbows) and 21 gymnasts (24 elbows) with a mean age of 13.7 years (range, 11-18 years). To localize the lesion, inclination of the affected area in the humeral capitellum against the humeral axis was investigated using sagittal computed tomography images of the elbow. The inclination angle was defined as the angle between the long axis of the humerus and the line perpendicular to a line that connected the anterior and posterior margin of the lesion. The inclination angle in each group was compared and statistically analyzed. Results: The mean inclination angle was 57.6° ± 10.7° in baseball players and 28.0° ± 10.7° in gymnasts. Capitellar OCD lesions were located more anterior in baseball players when compared with gymnasts (P < .01). Conclusion: Due to differences in applied stress, capitellar OCD lesions in baseball players were located more anteriorly compared with those seen in gymnasts. Therefore, although AP radiographs with the elbow in 45° of flexion are optimal for detecting OCD lesions in baseball players, radiographs with less elbow flexion or full extension are more useful in gymnasts, especially in early-stage OCD.
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Affiliation(s)
- Shiro Kajiyama
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Satoshi Muroi
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Hiroyuki Sugaya
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Norimasa Takahashi
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Keisuke Matsuki
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Nobuaki Kawai
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Funakoshi T, Furushima K, Momma D, Endo K, Abe Y, Itoh Y, Fujisaki K, Tadano S, Iwasaki N. Alteration of Stress Distribution Patterns in Symptomatic Valgus Instability of the Elbow in Baseball Players: A Computed Tomography Osteoabsorptiometry Study. Am J Sports Med 2016; 44:989-94. [PMID: 26831631 DOI: 10.1177/0363546515624916] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Repetitive valgus stress applied during a throwing motion can lead to various elbow disturbances, including ulnar collateral ligament (UCL) injury. Subchondral bone density reportedly reflects the cumulative force on a joint surface under actual loading conditions. PURPOSE (1) To evaluate the distribution of subchondral bone density across the elbow joint in asymptomatic baseball pitchers and symptomatic valgus instability pitchers and (2) to clarify the alterations in stress distribution pattern associated with symptomatic UCL insufficiency pitching activities. STUDY DESIGN Controlled laboratory study. METHODS Computed tomography (CT) imaging data were collected from the dominant-side elbow of 7 nonathletic volunteers (controls), 12 asymptomatic pitchers (asymptomatic group), and 12 symptomatic valgus instability pitchers with UCL insufficiency (symptomatic group). Bone mineral density across the elbow joint was measured with CT osteoabsorptiometry. A 2-dimensional mapping model was divided into 4 areas of the distal end of the humerus and 5 areas of the ulna with the radial head. The locations and percentages of high-density areas on the articular surface were quantitatively analyzed. RESULTS High-density areas in the asymptomatic and symptomatic groups were found in the anterolateral and posteromedial parts of the humerus and in the radial head, posteromedial to the ulna. The high-density areas in the anterior and posteromedial of the humerus, the radial head, and the posteromedial part of the ulna in the controls were smaller than those in the baseball group. In the symptomatic group, the percentages of high-density areas in the anterolateral part of the humerus (mean, 36.3%; 95% CI, 31.9%-40.7%) and the anterolateral part of the ulna (mean, 31.7%; 95% CI, 24.3%-39.1) were significantly greater than those in the asymptomatic group (P = .047 and P < .0001, respectively). CONCLUSION Symptomatic UCL insufficiency was associated with characteristic high-stress distribution patterns on the anterolateral part of the capitellum and the anterolateral part of the ulna. The current results indicate that symptomatic UCL insufficiency produces excessive and cumulative stress in the elbow joint. CLINICAL RELEVANCE The information obtained from the CT images can useful for early detection of overstress conditions of the elbow joint.
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Affiliation(s)
- Tadanao Funakoshi
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Daisuke Momma
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kaori Endo
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Kazuhiro Fujisaki
- Department of Intelligent Machines and System Engineering, Hirosaki University Graduate School of Science and Technology, Hirosaki, Japan
| | - Shigeru Tadano
- Division of Human Mechanical Systems and Design, Hokkaido University Graduate School of Engineering, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Kawasaki T, Sashi R, Moriya S, Kaketa T, Kobayashi H, Itoigawa Y, Kaneko K. Computed tomography osteoabsorptiometry for assessing the density distribution of subchondral bone as a measure of long-term mechanical stress in the "rugby shoulder". J Shoulder Elbow Surg 2013; 22:800-6. [PMID: 22981446 DOI: 10.1016/j.jse.2012.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/10/2012] [Accepted: 07/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rugby is a collision sport with a high risk of shoulder injury. Although traumatic anterior shoulder instability is common, the long-term effects of rugby and joint instability on the shoulder have not been described; thus, this study assessed the effects of rugby itself, and joint instability, on the glenoid cavity. MATERIALS AND METHODS Both sides of the shoulders from 25 rugby players and 17 control patients with unilateral shoulder instability were prospectively evaluated by means of computed tomography osteoabsorptiometry, which represents the distribution of mineralization in subchondral bone plate (DMSB) as a marker of the long-term loading history of a joint. For the quantitative analysis, intergroup differences of maximum Hounsfield unit (HU) values in 7 areas on the glenoid were assessed in the uninjured intact shoulder to characterize the influence of rugby. Side-to-side differences of the HUs in each area were assessed in each participant to characterize the effects of shoulder instability. For the qualitative analysis, associations between the patterns of each DMSB and each group were assessed by means of correspondence analysis. RESULTS All examined areas on the glenoid had a significantly higher HUs in rugby players. Shoulder instability affected the HUs in both groups. A qualitative analysis demonstrated that the maximum HU tended to be shifted more inferiorly in rugby players and in the unstable shoulders. CONCLUSIONS Rugby affects the shoulder joint, regardless of any history of instability, suggesting that "rugby shoulder" tends to involve degenerative changes, such as osteoarthritis or labral tears.
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Affiliation(s)
- Takayuki Kawasaki
- Department of Orthopaedic Surgery, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan.
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Long-term stress distribution patterns of the ankle joint in varus knee alignment assessed by computed tomography osteoabsorptiometry. INTERNATIONAL ORTHOPAEDICS 2012; 36:1871-6. [PMID: 22777383 DOI: 10.1007/s00264-012-1607-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/14/2012] [Indexed: 12/31/2022]
Abstract
PURPOSE The stress distribution of an ankle under various physiological conditions is important for long-term survival of total ankle arthroplasty. The aim of this study was to measure subchondral bone density across the distal tibial joint surface in patients with malalignment/instability of the lower limb. METHODS We evaluated subchondral bone density across the distal tibial joint in patients with malalignment/instability of the knee by computed tomography (CT) osteoabsorptiometry from ten ankles as controls and from 27 ankles with varus deformity/instability of the knee. The quantitative analysis focused on the location of the high-density area at the articular surface, to determine the resultant long-term stress on the ankle joint. RESULTS The area of maximum density of subchondral bone was located in the medial part in all subjects. The pattern of maximum density in the anterolateral area showed stepwise increases with the development of varus deformity/instability of the knee. CONCLUSIONS Our results should prove helpful for designing new prostheses and determining clinical indications for total ankle arthroplasty.
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Shimizu T, Iwasaki N, Nishida K, Minami A, Funakoshi T. Glenoid stress distribution in baseball players using computed tomography osteoabsorptiometry: a pilot study. Clin Orthop Relat Res 2012; 470:1534-9. [PMID: 22290131 PMCID: PMC3348294 DOI: 10.1007/s11999-012-2256-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is important to understand the loading conditions when considering the pathology of shoulder disorders in overhead athletes. However, because throwing is a complicated motion and methods to directly determine stress distribution are complex, direct measurement of the stress distribution across the glenohumeral joint has not been attempted. Subchondral bone density reportedly reflects the cumulative stress acting on a joint surface under actual loading conditions. QUESTIONS/PURPOSES To assess alterations in stress distribution across the glenoid cavity caused by pitching, we investigated the distribution of subchondral bone density in nonathletic volunteers and asymptomatic baseball players, including fielders and pitchers. METHODS We collected CT imaging data from the dominant-side shoulder of 10 nonathletic volunteers (controls), 10 fielders, and 10 pitchers in a competitive college baseball league (all men aged 19–24 years, mean 20.7 years). We measured the distribution of subchondral bone density of the glenoid cavity using CT osteoabsorptiometry. The obtained stress distribution map was divided into four segments: anterosuperior, anteroinferior, posteroinferior, and posterosuperior regions. We quantitatively analyzed the location and percentages of high-density regions on the articular surface. RESULTS The percentages of high-density regions, including the anteroinferior and posterior segments, were greater in pitchers and fielders than in controls. The percentages of high-density regions did not differ between pitchers and fielders. CONCLUSIONS The bicentric density patterns indicated that the cumulative force of pitching activity affected the long-term stress distribution across the glenoid cavity. CLINICAL RELEVANCE Our data should be useful for analyzing pitching activity and clarifying the pathology of shoulder disorders associated with throwing.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15 Nishi 5 Kita-ku Sapporo, Hokkaido, 0608368 Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15 Nishi 5 Kita-ku Sapporo, Hokkaido, 0608368 Japan
| | - Kinya Nishida
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15 Nishi 5 Kita-ku Sapporo, Hokkaido, 0608368 Japan
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15 Nishi 5 Kita-ku Sapporo, Hokkaido, 0608368 Japan
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15 Nishi 5 Kita-ku Sapporo, Hokkaido, 0608368 Japan
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Alterations in stress distribution patterns through the forearm joint surface of the elbow in baseball players assessed using computed tomography osteoabsorptiometry. J Orthop Sci 2012; 17:253-60. [PMID: 22323013 DOI: 10.1007/s00776-012-0198-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/17/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND The distribution of subchondral bone density well reflects long-term resultant stress acting on an articular surface in living joints. Consequently, a measurement of the distribution pattern can determine the stress distribution across the elbow joint surface under long-term loading conditions of baseball pitching. Our purpose was to elucidate the characteristic alterations in the distribution pattern of subchondral bone density across the forearm bones of the elbow with pitching activities. The hypothesis is that pitching activities would change the stress distribution in living subjects. METHODS The analysis was performed using computed tomography (CT) images obtained from the dominant elbow of ten nonthrowing athletes (control group), ten college baseball fielders (fielder group), and ten college baseball pitchers (pitcher group). The distribution pattern of subchondral bone density through the articular surface of the proximal radius and ulna bones was assessed using CT osteoabsorptiometry. RESULTS The maximum density area was located in the posterior part of the trochlea notch in all study participants. This maximum density area was significantly increased in the baseball groups compared with that in the control group. The pitcher group also showed a significant distribution of the maximum density area in the anterior part of the radial head. CONCLUSION Our analysis indicates that pitching activities increase actual stress on the articular surface not only in the posterior part of the trochlea notch but also in the anterior part of the radial head. The stress across the elbow may be expanded from the ulnohumeral to the radiohumeral joint by repetitive pitching activities in living subjects.
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Jones KJ, Osbahr DC, Schrumpf MA, Dines JS, Altchek DW. Ulnar collateral ligament reconstruction in throwing athletes: a review of current concepts. AAOS exhibit selection. J Bone Joint Surg Am 2012; 94:e49. [PMID: 22517395 DOI: 10.2106/jbjs.k.01034] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kristofer J Jones
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
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Nishida K, Iwasaki N, Fujisaki K, Funakoshi T, Kamishima T, Tadano S, Minami A. Distribution of bone mineral density at osteochondral donor sites in the patellofemoral joint among baseball players and controls. Am J Sports Med 2012; 40:909-14. [PMID: 22307081 DOI: 10.1177/0363546511435085] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND To theoretically minimize complications of osteochondral graft harvest from the knee, grafts should be obtained from the site of lowest stress distribution across the joint. HYPOTHESIS Long-term stress distribution over the patellofemoral (PF) joint surface is not equal in athletes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Measurement of subchondral bone density can determine long-term resultant stress acting on an articular surface in living joints. Our analysis was performed using computed tomography (CT) image data obtained from bilateral knees of 10 college baseball fielders (fielder group) and 10 college baseball pitchers (pitcher group) and 2 control groups, including 10 college soccer players (soccer group) and 10 nonathletes (nonathlete group). The distribution pattern of subchondral bone density throughout the articular surface of the PF joint was assessed using the CT osteoabsorptiometry method. The quantitative analysis focused on the location of the low-density area at the articular surface to assess potential osteochondral donor sites. RESULTS All participants in the pitcher and fielder groups demonstrated a low-density area widely distributed in the proximal part of the lateral trochlea. On the other hand, a high-density area was located in the distal part of the lateral notch, of the medial notch, and of the medial trochlea. No apparent differences in the distribution pattern were found between the baseball groups and the control groups. CONCLUSION Our analysis, based on CT osteoabsorptiometry, indicates that the proximal lateral trochlea of the distal femur has the highest percentage area of low bone density at the PF joint level in donor knees of baseball players, soccer players, and nonathlete controls. CLINICAL RELEVANCE From a biomechanical viewpoint, the proximal lateral trochlea is the optimal site for harvesting osteochondral grafts in performing mosaicplasty for baseball players. This selection for the donor site may minimize postoperative PF joint symptoms.
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Affiliation(s)
- Kinya Nishida
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan
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Iwasaki N, Kamishima T, Kato H, Funakoshi T, Minami A. A retrospective evaluation of magnetic resonance imaging effectiveness on capitellar osteochondritis dissecans among overhead athletes. Am J Sports Med 2012; 40:624-30. [PMID: 22174341 DOI: 10.1177/0363546511429258] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been widely used to characterize osteochondritis dissecans (OCD) lesions. However, the usefulness of MRI for predicting fragment stability in OCD of the humeral capitellum (capitellar OCD) remains unclear. HYPOTHESIS Preoperative MRI cannot accurately diagnose fragment instability of capitellar OCD in overhead athletes. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 1. METHODS Twenty-seven male overhead athletes who had undergone surgery for capitellar OCD were included in the study. A single senior musculoskeletal radiologist blindly reviewed preoperative MRI of these OCD lesions. The radiologist reported the presence or absence of each of the 4 MRI signs indicating fragment instability as described by De Smet et al. The lesions were also classified according to the MRI staging system of Dipaola et al for characterizing the lesions. Intraoperative assessment of fragment stability was used as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for fragment instability as assessed by MRI. RESULTS According to the MRI criteria by De Smet et al and the Dipaola et al staging system, 21 (78%) and 20 (74%) lesions were defined as unstable, respectively. The obtained results yielded a sensitivity of 89% and a specificity of 44% for diagnosing fragment instability using the De Smet et al MRI criteria and a sensitivity of 83% and a specificity of 44% using the Dipaola et al MRI staging system. The PPV and NPV for fragment instability were 76% and 67% using the De Smet et al criteria and 75% and 57% according to the Dipaola et al staging system, respectively. The overall correlation rate of Dipaola et al MRI and intraoperative stages was 41%. CONCLUSION Preoperative MRI cannot precisely diagnose fragment instability of capitellar OCD that requires operative treatments in overhead athletes. Especially, MRI indicating stable lesions is considered not to be useful in predicting intraoperative instability of capitellar OCD in this study population.
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Affiliation(s)
- Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15, Nishi 7, Sapporo 060-8638, Japan.
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Makabe H, Iwasaki N, Kamishima T, Oizumi N, Tadano S, Minami A. Computed tomography osteoabsorptiometry alterations in stress distribution patterns through the wrist after radial shortening osteotomy for Kienböck disease. J Hand Surg Am 2011; 36:1158-64. [PMID: 21664073 DOI: 10.1016/j.jhsa.2011.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 04/02/2011] [Accepted: 04/04/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The distribution pattern of subchondral bone density is considered to closely reflect the stress distribution across a joint under physiological loading conditions. Our purpose was to determine alterations in the distribution pattern of subchondral bone density across the distal articular surfaces of the radius and the ulna in patients with Kienböck disease after radial shortening. METHODS We collected preoperative and postoperative computed tomography (CT) image data from 7 wrists of 7 patients who had undergone radial shortening for Kienböck disease. We measured the distribution of subchondral bone density through the distal articular surface of the radius and the ulna using a CT osteoabsorptiometry method. The obtained data were quantitatively assessed by calculating the high-density area ratio of the entire radiocarpal joint surface, scaphoid fossa, lunate fossa, and distal ulnar surface. RESULTS At the mean postoperative period of 27 months, the mean high-density area ratio in the entire distal articular surface of the radius significantly decreased from 0.413 preoperatively to 0.141 postoperatively. The postoperative value in each fossa demonstrated a significant reduction from 0.253 to 0.096 in the scaphoid fossa and from 0.160 to 0.045 in the lunate fossa. No significant alteration in the value was found in the distal ulna at follow-up. CONCLUSIONS Our CT osteoabsorptiometry analysis suggests that the distribution of subchondral bone density in both scaphoid and lunate fossae notably decreases after radial shortening. This indicates that radial shortening unloads the lunate by reducing the actual stress across the distal articular surface of the radius in subjects with Kienböck disease. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Hikaru Makabe
- Department of Orthopaedic Surgery and Radiology, Hokkaido University School of Medicine, Sapporo, Japan
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