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Parrot beak tear is a white-white meniscal injury that often occurs in isolated injuries. Partial meniscectomy for parrot beak tears is often recommended, owing to the avascular zone; however, partial meniscectomy, especially with the lateral meniscus, has a high failure rate for return to sports, leading to residual meniscus extrusion and lateral compartment osteoarthritis. Thus, we have developed a repair technique to preserve the parrot beak tear of the avascular zone. This is a modification of the inside-out repair with additional reduction sutures. We recommend this procedure as a technique for repairing avascular parrot beak tears of the lateral meniscus., Technique Video Video 1 We demonstrate a technique for a parrot beak tear of the lateral meniscus of the avascular zone, in which we present the modification of the inside-out repair with additional reduction sutures and bone marrow-derived fibrin clot, based on “ABCs” theory of meniscal repair: anatomic reduction, biologic augmentation, and circumferential compression across the tear site. This case involved the right knee of a 21-year-old professional soccer player who had a parrot beak tear of the lateral meniscus. From the anterolateral portal view, a parrot-beak tear was observed in the lateral meniscus in the figure-four position. This tear started from the anterior to the posterior portion of the white-white zone of the lateral meniscus. The residual meniscus had a horizontal tear. After meniscal instability was confirmed by a probe, an arthroscopic rasp was used to freshen the sites of the tears in the meniscus and to promote healing through the anteromedial portal. Reduction sutures were then placed on the body of the parrot beak tear using a Scorpion suture passer through the anterolateral portal viewing from anteromedial portal. A NanoPass was inserted into the joint below the anterior horn of lateral meniscus and the reduction suture was retrieved through the capsule in the far anterolateral portal without damaging the articular cartilage of the tibial plateau viewing from anteromedial portal. We confirm the reduction suture work for this parrot beak tear viewing from anteromedial and anterolateral portal. The 11-G bone marrow harvest needle was used to harvest 10 mL of bone marrow aspirate from the lateral side of the intercondylar notch of the right knee through the anteromedial portal viewing from the anterolateral portal, which is positioned in the deep flexion position without a tourniquet. Dual meniscal repair needles loaded with 2-0 braided polyester sutures with clots are inserted into the injured site through a cannula positioned in the anteromedial portal viewing from the anterolateral portal. The suture needles are retrieved under direct visualization through a previously prepared lateral incision. After inserting the clot, needles loaded with 2-0 sutures alone are penetrated through the unstable portion of the meniscus through the anteromedial portal viewing from the anterolateral portal. Stitches were placed at 3-mm intervals. The repaired meniscus covers the articular surface of lateral compartment viewing from the anterolateral portal.

Background During the coronavirus disease 2019 (COVID-19) pandemic, home quarantining and refraining from non-essential and non-urgent outings were enacted. The exact impact of the response to the COVID-19 pandemic on the activities of daily living (ADLs) in the general elderly population remains unclear. Thus, this study aimed to investigate the impact of the COVID-19 pandemic on the ability to go out, which is an important part of ADL, in the general elderly population. Methods A cross-sectional survey was conducted at a COVID-19 vaccination center in Habikino City, Osaka, Japan. Participants, aged ≥ 65 years, completed a questionnaire surveying general information, ADLs, presence of musculoskeletal symptoms, and quality of life at pre- and post-outbreak. Participants were classified into two groups based on their pre- and post-outbreak ability to go out: the Able-Able group comprised those who were able to go out before and after the pandemic, while the Able-Disabled group comprised those who had deteriorated in their ability to go out over the course of the pandemic. Univariate and multiple logistic regression analyses were performed to identify factors associated with the Able-Disabled group. Results Among 33,191 elderly people living in the city, 12,088 (36.4%) participated in this study. In total, 341 (2.8%) people could not go out even pre-pandemic and 346 (2.9%) patients lost the ability to go out during the course of the pandemic. Independent risk factors for membership in the Able-Disabled group were older age, male sex, high body mass index, decreased daily exercise or no exercise habits, and new-onset musculoskeletal symptoms (back and joint pain). Conclusions The current study included 36% of the general elderly population living in a Japanese city. In total, 2.9% had lost the ability to go out post-outbreak, and the total number of elderly people unable to go out had doubled within 2 years after the start of the pandemic. A vicious cycle could occur in which ADLs decline due to decreased physical activity and reduced frequency of outings. It may be important for elderly people to avoid decreasing the opportunities for daily exercise and going out to maintain their ADLs.

Patient satisfaction is crucial in pay-for-performance initiatives. To achieve further improvement in satisfaction, modifiable factors should be identified according to the surgery type. Using a prospective cohort, we compared the overall treatment satisfaction after microendoscopic lumbar decompression between patients treated postoperatively with a conventional physical therapy (PT) program (control; n = 100) and those treated with a PT program focused on low back pain (LBP) improvement (test; n = 100). Both programs included 40 min outpatient sessions, once per week for 3 months postoperatively. Adequate compliance was achieved in 92 and 84 patients in the control and test cohorts, respectively. There were no significant differences in background factors; however, the patient-reported pain score at 3 months postoperatively was significantly better, and treatment satisfaction was significantly higher in the test than in the control cohort (−0.02 ± 0.02 vs. −0.03 ± 0.03, p = 0.029; 70.2% vs. 55.4%, p = 0.045, respectively). In the multivariate logistic regression analysis, patients treated with the LBP program tended to be more satisfied than those treated with the conventional program, independent of age, sex, and diagnosis (adjusted odds ratio = 2.34, p = 0.012). Postoperative management with the LBP program could reduce pain more effectively and aid spine surgeons in achieving higher overall satisfaction after minimally invasive lumbar decompression, without additional pharmacological therapy.

Restrictions during the coronavirus disease 2019 (COVID-19) pandemic have decreased physical activity levels, which may result in locomotive syndrome. This study evaluated the change in locomotive syndrome prevalence and associated risk factors among an elderly population before and after a coronavirus outbreak.This written self-administered cross-sectional survey was conducted in conjunction with the coronavirus disease vaccination program in Habikino City, Japan. Participants who were aged ≥65 years completed the five-question Geriatric Locomotive Function Scale before and during the pandemic. The diagnosis of locomotive syndrome and its stage was based on the Geriatric Locomotive Function Scale score: stage 1 (2-3 points), 2 (4-5 points), and 3 (≥6 points). Data on lifestyle changes, including regular exercise, during the pandemic were collected.This study included 12,197 participants (36.7% of the city's total elderly residents). The prevalence of locomotive syndrome increased from 41.3% to 47.1% after the outbreak. In total, 765 (6.3% of overall population) and 295 (9.5% of the participants who had stages 1-2 before the pandemic) participants developed locomotive syndrome and stage 3 locomotive syndrome, respectively. The multivariate logistic regression analysis indicated that a decrease in exercise was significantly associated with the onset of locomotive syndrome (all stages) (odds ratio = 2.5, p 0.001) and locomotive syndrome stage 3 (odds ratio = 2.6, p 0.001).Extrapolation of the study's findings to the entire population of Japan suggests that approximately 2 million elderly individuals might develop locomotive syndrome after the coronavirus outbreak. Additionally, 10% of the participants with mild-moderate locomotive syndrome before the pandemic may develop severe locomotive syndrome after the outbreak. The greatest risk factor for new-onset or worsening locomotive syndrome was a decrease in daily exercise. Thus, there is an urgent need for adequate exercise guidelines during the coronavirus pandemic, especially for the elderly population.

Physical function impairment in patients with low back pain (LBP) occurs due to the influence of psychosocial factors. Only a few studies have objectively evaluated physical function. We aimed to objectively assess the physical functions of individuals subjects with LBP, and clarify the association between physical function and psychosocial factors. We enrolled 411 individuals with LBP working in special needs schools. We examined their degree of pain, and the psychosocial factors strength through the STarT Back Tool, which categorized them into the low-risk, medium-risk, and high-risk groups. We assessed their abdominal muscle endurance, lower limb muscle strength, and hip joint flexibility. The relationships between these physical functions and psychosocial factors were analyzed by logistic regression models. Those in the high-risk group had significantly lower abdominal muscle and lower limb muscle strength (p

OBJECTIVEAlthough minimally invasive endoscopic surgery techniques are established standard treatment choices for various degenerative conditions of the lumbar spine, the surgical indications of such techniques for specific cases, such as segments with ossification of the ligamentum flavum (OLF) or calcification of the ligamentum flavum (CLF), remain under investigation. Therefore, the authors aimed to demonstrate the short-term outcomes of minimally invasive endoscopic surgery in patients with degenerative lumbar disease with CLF or OLF.METHODSThis is a retrospective cohort study including consecutive patients who underwent microendoscopic posterior decompression at the authors’ institution, where the presence of OLF and CLF did not influence the surgical indication. Fifty-nine patients with OLF and 39 patients with CLF on preoperative CT were identified from the database. Subsequently, two matched control groups (one each matched to the OLF and CLF groups) were created using propensity scores to adjust for age, sex, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index, and diagnosis. The background, surgical outcomes, and changes in clinical scores were compared between the matched groups. If there was a significant difference in the improvement of clinical scores, a multivariate linear regression model was applied.RESULTSOn performing univariate analysis, patients with OLF were found to have a higher body mass index (Mann-Whitney U-test, p = 0.001), higher incidence of preoperative motor weakness (chi-square test, p = 0.019), longer operative time (Mann-Whitney U-test, p < 0.001), and lower improvement in the JOA score (mixed-effects model, p = 0.023) than the matched controls. On performing multivariate analysis, the presence of OLF was identified as an independent variable associated with a poor recovery rate based on the JOA score (multivariate linear regression, p < 0.001). In contrast, there were no significant differences between patients with CLF and their matched controls in terms of preoperative and surgical data and postoperative improvements in clinical scores.CONCLUSIONSAlthough the perioperative surgical outcomes, including the surgical complications, and the in-hospital period did not significantly differ, the short-term improvement in the JOA score was significantly lower in patients with degenerative lumbar disease accompanied by OLF than in the patients from the matched control group. In contrast, there were no significant differences in the short-term improvement in clinical scores and perioperative outcomes between patients with CLF and their matched control group. Thus, the surgical indications of minimally invasive posterior decompression for patients with CLF can be the same as those for patients without CLF; however, the indications for patients with OLF should be further investigated in future studies, including the other surgical methods.

Background: Osteochondral autograft transplantation (OAT) for capitellar osteochondritis dissecans (OCD) requires harvesting of tissue from the asymptomatic knee joint. However, donor site morbidity (DSM) in such cases remains unclear. Purpose: To evaluate DSM and postoperative radiographic findings in patients undergoing OAT for advanced capitellar OCD. Study Design: Case series; Level of evidence, 4. Methods: Eighty-six juvenile athletes underwent OAT for advanced capitellar OCD. The 2000 International Knee Documentation Committee subjective score, rate of return to sports, and symptoms in the donor knee were assessed at a mean follow-up of 86 months (range, 28-185 months). Additionally, 49 of the 86 patients were assessed by radiographic and magnetic resonance imaging (MRI) findings of the knee donor site. DSM was defined according to the usual criterion (persistent symptoms for >1 year or the need for subsequent intervention) and a stricter criterion (the presence of any symptoms, such as effusion, patellofemoral complaints, crepitation, unspecified disturbance, stiffness, pain/instability during activities, and osteoarthritic change). The stricter criterion was also used to allocate patients into a DSM group and a no-DSM group. Results: Two and 11 patients were determined to have DSM according to the usual and stricter criteria, respectively. All patients returned to the competitive level of their sports. The mean International Knee Documentation Committee score was 99.0. MRI findings showed abnormal signal intensity in 17 patients (35%) and hypertrophic changes in 11 patients (22%) at the donor harvest sites. The MOCART (magnetic resonance observation of cartilage repair tissue) score was higher in the no-DSM group (mean, 68.2) than in the DSM group (mean, 52.9) ( P = .027). Conclusion: OAT for juvenile athletes with advanced capitellar OCD provided good clinical outcomes. The DSM rate was relatively low (2.3%) with the usual criterion but high (12.8%) with the stricter criterion. MRI showed an abnormal signal intensity and hypertrophy in some cases.