Purpose: The correlation between the graft bending angle (GBA) of the anteromedial bundle and posterolateral bundle after anterior cruciate ligament reconstruction (ACLR) and postoperative tunnel enlargement was evaluated. Methods: Two hundred fifty-eight patients (137 males, 121 females; mean age 27.3 years) who had undergone doublebundle ACLR were included. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months postoperatively. The area of the tunnel aperture for femoral anteromedial tunnel (FAMT) and femoral posterolateral tunnel (FPLT) was measured; the area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The femoral tunnel angles were obtained with Cobb angle measurements. The femoral tunnel angle in the coronal plane was measured relative to the tibial plateau (coronal GBA). On the median value, the patients were divided into two groups in each of FAMT and FPLT; those with a coronal GBA of FAMT of !27 were classified as group A, while those with a coronal GBA of <27 were classified as group B, those with a coronal GBA of FPLT of !23 were classified as group C, while those with a coronal GBA of<23 were classified as group D. Results: Group A included 129 knees, while group B included 129 knees. Groups A and B did not significantly differ regarding FAMT enlargement. Group C included 133 knees, while group D included 125 knees. The percentage of FPLT enlargement in group C was significantly smaller than that in group D (p ¼ 0.001). Conclusions: A steep coronal GBA of the FPLT after ACLR results in greater FPLT enlargement. The present findings suggest that surgeons should avoid creating a steep GBA of the FPLT in the outside-in technique.

Background Hallux valgus deformity has been reported to be associated with increased postural sway. However, the direction and magnitude of postural sway associated with hallux valgus remain inconclusive. We assessed the association between hallux valgus deformity and postural sway using a force plate. Methods The subjects were 169 healthy volunteers, > 40 years old (63 males, 106 females, average age: 66.0 ± 12.4 years old), who took part in an annual medical examination. We investigated the photographic hallux valgus angle (°), total trajectory length of the gravity center fluctuation (mm), area of the center of pressure (mm2), mediolateral and anteroposterior postural sway (mm) in a standing position with 2-legged stance and eyes open, hallux pain (Numerical Rating Scale), trunk and lower limb muscle mass (kg). We classified the subjects into a hallux valgus group (n = 44, photographic hallux valgus angle of 1 or both feet ≥ 20°) and a no hallux valgus group (n = 125, photographic hallux valgus angle of both feet < 20°) and analyzed the relationship between hallux valgus and postural sway. Results The anteroposterior postural sway in the hallux valgus group (6.5 ± 2.8) was significantly greater than in the no hallux valgus group (5.4 ± 2.2, p = 0.014), and the lower limb muscle mass in the hallux valgus group (12.4 ± 2.2) was significantly smaller than in the no hallux valgus group (13.5 ± 3.2, p = 0.016). The total value of the photographic hallux valgus angle on both feet was positively correlated with the anteroposterior postural sway (p = 0.021) and negatively correlated with the lower limb muscle mass (p = 0.038). The presence of hallux valgus (p = 0.024) and photographic hallux valgus angle (p = 0.008) were independently related to the magnitude of anteroposterior postural sway. Conclusions Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. Trial registration 2017 − 135. Registered 22 August 2017.

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Category: Hindfoot, Trauma Introduction/Purpose: As a result of arthropathy change on the lateral side of subtalar joint after intra-articular calcaneal fracture, the secondary disorders such as pain or restricted range of motion occasionally occur. The purpose of this study is to examine factors that cause such arthropathy change. Methods: We divided 23 joints into two groups according to arthropathy change of the lateral side of subtalar joint: the existence of such arthropathy (O) group included 8 joints, the absence of arthropathy (N) group included 15 joints. The patients’ mean age at the time of surgery were 49.1 years and 54.9 years respectively, and the mean follow-up period were 16.1 months and 12.4 months respectively. The anterolateral approach or the sinus tarsi approach was used for both groups, and the medial approach was combined as needed. The fixing materials were a plate or screws, and in some cases, staples and Kirschner wires were used in combination. We assessed Sanders classification, postoperative clinical evaluation using Creighton-Nebraska scale, and the width, height and dislocation of subtalar joint surface of calcaneus. Results: The breakdown of the Sanders classification is as follows: N group consists of 3 joints of type 2A, 7 of type 2B, 3 of type 2C, 1 of type 3BC, 1 of type 4. O group consists of 5 joints of type 2A, 2 of type 2B, 1 of type 2C. The proportion occupied by Sanders classification type 2A in O group was larger than in N group. The average of the postoperative clinical evaluation was 94.9points in N group, 86.9points in O group. In postoperative image evaluation, the mean width in the was 106.2% in N group, 117.1% in O group, the mean dislocation of the subtalar joint surface was 0.4 mm in N group and 1.1 mm in O group. Conclusion: It was suggested that Sanders type 2A and the residual dislocation of the subtalar joint surface may be a cause of arthropathy change on the lateral side of subtalar joint.

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Background: Deep infrapatellar bursitis (DIB) has been detected in cases of Osgood-Schlatter disease (OSD). However, the clinical implications of DIB in the apophyseal stage, during the period when OSD has not yet developed, remain unclear. Purpose: To investigate the factors related to DIB in the apophyseal stage in preadolescent baseball players. Study Design: Cross-sectional study, Level of evidence, 3. Methods: The study participants were junior baseball players who participated in a medical checkup in 2020. We included knees in the apophyseal stage evaluated using ultrasonography, and classified them into the bursitis and no-bursitis groups using color-enhanced Doppler ultrasonography. We also investigated bone lesions of the tibial tuberosity, determined by fragmentation of the bone and irregularity of the ossification center. Demographic data, practice duration, pressure pain on tuberosity, pain while playing baseball (visual analog scale), heel-buttock distance (HBD), straight-leg raise angle, and range of hip internal and external rotation were evaluated. Group comparisons were performed using the Mann-Whitney U test and Fisher exact test, and a logistic regression analysis was performed. Results: A total of 261 knees (139 male players; age 10.5 ± 1.1 years) were included, 30 in the bursitis group and 231 in the no-bursitis group. Bone lesions were present in 4 knees in the bursitis group and in 32 knees in the no-bursitis group; there was no significant relationship between the presence of bone lesions and bursitis. Compared with the no-bursitis group, the bursitis group had a significantly longer practice duration (12.9 ± 3.3 vs 15.2 ± 3.8 hours/week, respectively; P = .003) and larger HBD (0.5 ± 1.3 vs 1.4 ± 2.4 cm, respectively; P = .003). The logistic regression analysis showed that practice duration ( P = .001) and HBD ( P = .004) were significantly related to the presence of bursitis. Conclusion: DIB in the apophyseal stage was related to practice duration and thigh muscle tightness. These findings may help predict overload and thigh muscle tightness at a very early stage.

Background: Hallux valgus deformity has been reported to be associated with increased postural sway. However, the direction and magnitude of postural sway associated with hallux valgus remain inconclusive. We assessed the association between hallux valgus deformity and postural sway using a force plate.Methods: The subjects were 169 healthy volunteers, >40 years old (63 males, 106 females, average age: 66.0 ± 12.4 years old), who took part in an annual medical examination. We investigated the photographic hallux valgus angle (°), total trajectory length of the gravity center fluctuation (mm), area of the center of pressure (mm2), mediolateral and anteroposterior postural sway (mm) in a standing position with 2-legged stance and eyes open, hallux pain (Numerical Rating Scale), trunk and lower limb muscle mass (kg). We classified the subjects into a hallux valgus group (n=44, photographic hallux valgus angle of 1 or both feet ≥20°) and a no hallux valgus group (n=125, photographic hallux valgus angle of both feet <20°) and analyzed the relationship between hallux valgus and postural sway. Results: The anteroposterior postural sway in the hallux valgus group (6.5 ± 2.8) was significantly greater than in the no hallux valgus group (5.4 ± 2.2, p=0.014), and the lower limb muscle mass in the hallux valgus group (12.4 ± 2.2) was significantly smaller than in the no hallux valgus group (13.5 ± 3.2, p=0.016). The total value of the photographic hallux valgus angle on both feet was positively correlated with the anteroposterior postural sway (p=0.021) and negatively correlated with the lower limb muscle mass (p=0.038). The presence of hallux valgus (p=0.024) and photographic hallux valgus angle were (p=0.008) independently related to the magnitude of anteroposterior postural sway. Conclusions: Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. Trial registration: 2017-135. Registered 22 August 2017