Impact of Sleep Disorder as a Risk Factor for Dementia in Men and Women

Sleep is an essential physiological process, especially for proper brain function through the formation of new pathways and processing information and cognition. Therefore, when sleep is insufficient, this can result in pathophysiologic conditions. Sleep deficiency is a risk factor for various conditions, including dementia, diabetes, and obesity. Recent studies have shown that there are differences in the prevalence of sleep disorders between genders. Insomnia, the most common type of sleep disorder, has been reported to have a higher incidence in females than in males. However, sex/gender differences in other sleep disorder sub-types are not thoroughly understood. Currently, increasing evidence suggests that gender issues should be considered important when prescribing medicine. Therefore, an investigation of the gender-dependent differences in sleep disorders is required. In this review, we first describe sex/gender differences not only in the prevalence of sleep disorders by category but in the efficacy of sleep medications. In addition, we summarize sex/gender differences in the impact of sleep disorders on incident dementia. This may help understand gender-dependent pathogenesis of sleep disorders and develop therapeutic strategies in men and women.

Suggested Assessments for Sarcopenia in Patients With Stroke Who Can Walk Independently

Objective@#To investigate variables for assessment of stroke-related sarcopenia that are alternative options to the current assessment for sarcopenia, which focuses on age-related sarcopenia and also has limitations in addressing sarcopenia due to weakness resulting from stroke. @*Methods@#Forty patients (17 men, 23 women; mean age, 66.9±15.4 years) with first-ever stroke who can walk independently were included. Muscle mass was determined by measuring ultrasonographic muscle thickness of vastus intermedius, rectus femoris, tibialis anterior, medial gastrocnemius, and biceps brachii muscles in addition to using the skeletal muscle index (SMI) with bioelectrical impedance analysis. Muscle strength was assessed with the Medical Research Council (MRC) sum score as well as handgrip (HG) strength. Physical performance was measured by the Berg Balance Scale (BBS) along with 4-meter gait speed (4MGS). Correlations between each assessment in the three categories were analyzed and adjusted by stroke severity, comorbidity, and nutritional status. @*Results@#For muscle mass, SMI showed the highest correlation with the tibialis anterior muscle (r=0.783, p<0.001) among the other muscles. Regarding muscle strength, the MRC sum score correlated with the HG (r=0.660, p<0.001). For physical performance, the BBS correlated with the 4MGS (r=0.834, p<0.001). The same result was obtained after adjusting for factors of stroke severity, comorbidity, and nutritional status. @*Conclusion@#These results suggest that ultrasonographic muscle thickness of the tibialis anterior, the MRC sum score, and BBS might be alternatives to SMI, HG, and usual gait speed for sarcopenia in stroke patients.

Effect of Computerized Neuropsychologic Test in Subacute Post-Stroke Patient With Cognitive Impairment / 고신대학교의과대학학술지

OBJECTIVES: To investigate the effects of Computerized Neuropsychologic Test (CNT) on cognitive function and daily life performance in subacute post-stroke patients with cognitive impairment. METHODS: Korean Mini-Mentals State Examination (K-MMSE), Korean version of Modified Barthel Index (K-MBI) were investigated in 125 subacute post-stroke patients with cognitive impairment. We analyzed K-MMSE and K-MBI which were conducted 63 patients who had received CNT and 62 patient who had not received CNT from baseline to 8 weeks follow-up. In the experimental group, initial K-MMSE and K-MBI were conducted 13.3 ± 6.8 weeks after the onset of stroke and their age was 63.4 ± 13.3. In the control group, initial K-MMSE and K-MBI were conducted 13.2 ± 7.7 weeks after the onset of stroke and their age was 65.1 ± 11.6. RESULTS: The 8 weeks follow-up total K-MMSE score and total K-MBI score of experimental group were significantly higher than control group (P 0.05). In K-MMSE subsection, change of orientation, registration, language and visual reconstruction were correlated with total K-MBI s core after CNT. Especially, the experimental group, total K-MBI score of the left hemisphere damage group was significantly higher than the right hemisphere damage group (P < 0.05). CONCLUSIONS: This study shows that CNT is effective on subacute post-stroke patients with cognitive impairment. Improvement of cognitive function can expect a positive outcome on daily life performance, in particular, it can be expected to improve the prognosis of patients with stroke, the left hemisphere lesions.

Time-Dependent Clinical Results of Rotating-Platform Total Knee Arthroplasty According to Mechanical Axis Deviation

PURPOSE: We hypothesized that the low contact stress (LCS) posterior stabilization system in knees with 3degrees deviation). The clinical assessments were performed using the Knee Society score and Hospital for Special Surgery systems and Western Ontario and McMaster Universities index. RESULTS: The survival rate was 97.4% in Group 1 and 96.8% in Group 2. No statistically significant intergroup difference was observed in the clinical scores before surgery and since 1 year after surgery (p>0.05). However, a significant intergroup difference was noted between 6 months to 1 year after surgery (p<0.001). Less than 2 mm radiolucent lines were found more frequently in Group 2. Time-dependent improvement was noted within one year after TKA in both groups. CONCLUSIONS: Most of the expected improvements were achieved at 6 months after surgery in Group 1 and at 1 year after surgery in Group 2. The present study suggests that the LCS system yields time-dependent improvement regardless of coronal alignment deviation.

Remnant Preservation is Helpful to Obtain Good Clinical Results in Posterior Cruciate Ligament Reconstruction: Comparison of Clinical Results of Three Techniques

BACKGROUND: The purpose of the present study was to compare the clinical results of 3 posterior cruciate ligament reconstruction techniques according to the time from injury to surgery and remnant PCL status and to evaluate the efficiency of each technique. METHODS: The records of 89 patients who underwent primary PCL reconstructions with a posterolateral corner sling were analyzed retrospectively. Thirty-four patients were treated by anterolateral bundle (ALB) reconstruction with preservation of the remnant PCL using a transtibial tunnel technique in the acute and subacute stages of injury (group 1). Forty patients were treated with remnant PCL tensioning and an ALB reconstruction using the modified inlay technique in the chronic stage (group 2), and fifteen patients were treated with double-bundle reconstruction using the modified inlay technique (group 3). The double-bundle reconstruction was performed if there was a very weak or no PCL remnant. RESULTS: The mean side-to-side differences in posterior tibial translation on the stress radiographs were reduced from 10.1 +/- 2.5 mm in group 1, 10.6 +/- 2.4 mm in group 2, and 12.8 +/- 3.2 mm in group 3 preoperatively to 2.3 +/- 1.4 mm in group 1, 2.3 +/- 1.5 mm in group 2, and 4.0 +/- 2.5 mm in group 3 at the last follow-up (p < 0.001, p < 0.001, and p < 0.001, respectively). Statistical analyses revealed that group 1 and group 2 were similar in terms of side-to-side difference changes in posterior tibial translation on the stress radiographs; however, group 3 was inferior to group 1 and group 2 at the last follow-up (p = 0.022). The clinical results were not significantly different among the three groups. CONCLUSIONS: Excellent posterior stability and good clinical results were achieved with ALB reconstruction preserving the injured remnant PCL in the acute and subacute stages and remnant PCL tensioning with ALB reconstruction in the chronic stage. The PCL injuries could be surgically corrected with different techniques depending on both the remnant PCL status and the interval between the knee trauma and operation.

Modified Tension Band Wiring Combined with Anti-Gliding Loop Augmentation Technique for the Treatment of Comminuted Patellar Fracture: Technical Note and Report of Early Results: Technical Note

In order to investigate the feasibility of a modified tension band combined with anti-gliding loop augmentation technique for the treatment of comminuted patellar fracture, 21 patients with comminuted patellar fracture were enrolled in this study. After the modified tension band wiring of patellar fracture, a cerclage wire was passed around the patella. Anti-gliding loops were made on the bending sites of Kirshner-wires. A knot was tied using both ends of the anti-gliding loops, and the cerclage wire was tightened using proximal knots. Bone union was achieved at 4.5+/-1.5 months postoperatively without nonunion. The Lysholm score was 87.1+/-2.8, and the range of motion of the knee was 2.1degrees+/-3.4degrees to 132.2degrees+/-6.5degrees at the last follow-up. The modified tension band combined with anti-gliding loop augmentation technique might be considered an alternative modification of modified tension band wiring for the treatment of comminuted patellar fracture.

Comparison of the Clinical Outcomes after Total Knee Arthroplasty with the LCS Rotating Platform Mobile Bearing Knee System and the PFC Sigma RP-F Mobile Bearing Knee System

BACKGROUND: We compared clinical outcomes after total knee arthroplasty with the Low Contact Stress (LCS) rotating platform mobile bearing knee system and the Press Fit Condylar Sigma rotating platform high flexion (PFC Sigma RP-F) mobile bearing knee system. METHODS: Fifty cases of total knee arthroplasty were performed with the PFC Sigma RP-F mobile bearing knee system and sixty-one cases were performed with the LCS mobile bearing total knee arthroplasty. The average duration of follow-up was 2.9 years. RESULTS: The mean Hospital for Special Surgery (HSS) knee score was 62.1 (range, 52 to 75) in the LCS group and 61.9 (range, 50 to 74) in the Sigma RP-F group preoperatively, and 90.1 (range, 84 to 100) in the LCS group and 89.8 (range, 83 to 100) in the Sigma RP-F group at the final follow-up. The mean preoperative flexion contracture was 6.7degrees (range, 0degrees to 10degrees) in the LCS group and 9.3degrees (range, 0degrees to 15degrees) in the Sigma RP-F group preoperatively. The mean range of motion was 124.6degrees (range, 105degrees to 150degrees) in the LCS group and 126.1degrees (range, 104degrees to 145degrees) in the Sigma RP-F group at the final follow-up. CONCLUSIONS: After a minimum duration of follow-up of two years, we found no significant differences between the two groups with regard to the range of knee motion or the clinical or radiographic results.

Change in Effective Leg Length after Angular Deformity Correction by Hemiepiphyseal Stapling

BACKGROUND: The hemiepiphyseal stapling has both positive and negative effects on effective leg length. The purpose of this study was to analyze change in effective leg length after angular correction by hemiepiphyseal stapling, and to validate in clinical cases. METHODS: Mathematical analysis of a hemiepiphyseal stapling model was conducted. The induced formula was validated in 6 cases fulfilling the assumptions of the model. Anatomical parameters involved in this formula were measured in additional 21 cases undergoing hemiepiphyseal stapling or hemiepiphysiodesis. RESULTS: Effective leg length increased or decreased according to three parameters in this model: 1) limb length distal to the operated physis (L), 2) width of the operated physis (d), and 3) the amount of angular deformity to be corrected (theta). Actual change in effective leg length of 6 cases similar to this model coincided with the predicted change at least in its direction. L/d ratio was 4.82 +/- 0.51. CONCLUSIONS: Considering the narrow range of the L/d ratio, hemiepiphyseal stapling is likely to decrease effective leg length if the amount of angular correction is less than 10degrees, whereas to increase it if the amount of angular correction is larger than 16degrees. This should be taken into consideration when selecting the surgical method for angular deformity correction in skeletally immature patients.

Bilateral Femoral Subtrochanteric Insufficiency Fractures after Long-term Bisphosphonate Therapy / 대한정형외과학회잡지

Bisphosphonates are widely used for the treatment of osteoporosis to prevent fractures. Although their safety and efficacy have been well documented, some recent reports have drawn attention to a possible correlation between long term bisphosphonate therapy and the occurrence of insufficiency fractures owing to prolonged bone turnover suppression. A 71-year-old woman presented to our emergency room with pain and deformity of the left thigh with low energy injury. Radiographs showed a left femur subtrochanteric fracture and a transverse sclerotic fracture line in the right femur subtrochanteric area with cortical thickening, which indicate insufficiency fractures. She had been treated with sodium alendronate 70 mg per week for 6 years and was suffering from prodromal symptoms in both thighs from 3 months ago. After surgery and intraoperative bone biopsy for a left subtrochanteric fracture, her osteoporosis medication was changed with a bone forming agent. We have analyzed the characteristics of insufficiency fractures related to long term bisphosphonate therapy. Physicians should keep in mind the possibility of insufficiency fracture in cases such as ours, especially with prodromal thigh pain.

The Influence of Tibial Positioning on the Diagnostic Accuracy of Combined Posterior Cruciate Ligament and Posterolateral Rotatory Instability of the Knee

BACKGROUND: To determine if tibial positioning affects the external rotation of the tibia in a dial test for posterolateral rotatory instability combined with posterior cruciate ligament (PCL) injuries. METHODS: Between April 2007 and October 2007, 16 patients with a PCL tear and posterolateral rotatory instability were diagnosed using a dial test. The thigh-foot angle was measured at both 30degrees and 90degrees of knee flexion with an external rotation stress applied to the tibia in 2 different positions (reduction and posterior subluxation). The measurements were performed twice by 2 orthopedic surgeons. RESULTS: In posterior subluxation, the mean side-to-side difference in the thigh-foot angle was 11.56 +/- 3.01degrees at 30degrees of knee flexion and 11.88 +/- 4.03degrees at 90degrees of knee flexion. In the sequential dial test performed with the tibia reduced, the mean side-to-side difference was 15.94 +/- 4.17degrees (p < 0.05) at 30degrees of knee flexion and 16.88 +/- 4.42degrees (p = 0.001) at 90degrees of knee flexion. The mean tibial external rotation was 5.31 +/- 2.86degrees and 6.87 +/- 3.59degrees higher in the reduced position than in the posterior subluxation at both 30degrees and 90degrees of knee flexion. CONCLUSIONS: In the dial test, reducing the tibia with an anterior force increases the ability of an examiner to detect posterolateral rotary instability of the knee combined with PCL injuries.

Comparative Study of ACL Double-bundle Reconstruction with and without Functional Knee Brace: Minimum 1-year Follow-up Results / 대한정형외과학회잡지

PURPOSE: To compare the clinical efficacy after an arthroscopic ACL double-bundle reconstruction with and without functional knee brace. MATERIALS AND METHODS: Between July 2004 and May 2006, fifty patients who underwent an ACL double-bundle reconstruction with and without a functional knee brace for more than a 1-year follow-up were evaluated. The patients were treated with brace (Group 1, 22 cases) or without (Group 2, 28 cases) a brace after surgrey. Stability was assessed by maximal manual testing with a KT-1000 arthrometer, anterior stress radiographs using the Telos device and a lateral pivot shift test. The clinical results were assessed by the OAK (Orthopadische Arbeitsgruppe Knie) score, IKDC (International Knee Documentation Committee) score, mid thigh circumference and the range of motion. RESULTS: More than one year after surgery, average of OAK score, IKDC score, lateral pivot shift test of the stability results and maximal manual testing with the KT-1000 arthrometer, stress radiographs with the Telos device, mid thigh circumference difference, range of motion of the clinical results were similar in both groups. CONCLUSION: An ACL double-bundle reconstruction produces similar stability and clinical results regardlness of whether or not a functional knee brace is used.

Matrix Metalloproteinase-1 and Transforming Growth Factor-beta1 Expression during Distraction Osteogenesis and Fracture Healing of the Rat / 대한정형외과학회잡지

PURPOSE: To evaluate the temporal and spatial expression of Transforming Growth Factor-beta1 and Matrix Metalloproteinase-1 in distraction osteogenesis and fracture healing models. MATERIALS AND METHODS: Distraction osteogenesis was performed on the tibial diaphyses of Sprague- Dawley rats (latent period for 1 week, distraction for 2 weeks). The rats were euthanized at each week and the level of mRNA expression was assessed by real-time RT PCR and immunohistochemical staining. RESULTS: Although the level of TGF-beta1 mRNA and MMP-1 mRNA expression was increased during distraction osteogenesis and fracture healing, the level of mRNA expression was significantly higher in the distraction phase in the distraction group than in the fracture healing group at the same phase. After the distraction phase, the level of mRNA expression in both groups decreased to the base line. The peak expression of mRNA was followed by that of TGF-beta1 mRNA. Immunohistochemical staining revealed that TGF-beta1 was expressed mainly in the osteoblast and endothelial cells, and MMP-1 was expressed mainly in the endothelial cells of the vessel. CONCLUSION: There is specific time sequence in the expression of TGF-beta1 and MMP-1 during fracture healing and distraction osteogenesis. These results suggest that TGF-beta1 expression might be associated with the angiogenesis induced by MMP-1 expression during new bone formation.

A Comparison of Patella Retention versus Resurfacing in Total Knee Arthroplasty: A Minimum 7 Year Follow-up / 대한정형외과학회잡지

PURPOSE: To evaluate and report the clinical and radiological results of patients that had undergone patellar retention and resurfacing during total knee arthroplasty. MATERIALS AND METHODS: From July 1993 to December 1999, 54 patients (73 cases) underwent total knee arthroplasty by one surgeon. We divided these patients into the patellar retention group and patellar resurfacing group, and compared the clinical and radiological results of the two groups. The indications of patellar retention were a small patella, nearly normal articular cartilage, minimal preoperative patellofemoral pain, poor patellar bone quality, and young patient age. In these cases, osteophytes of the patella were removed and marginal electrocauterization was performed. There were 32 patients (41 cases) in the patellar retention group and 22 patients (32 cases) in the patellar resurfacing group. The mean follow-up period was 106.7 months in the patellar retention group and 93.6 months in the patellar resurfacing group. We evaluated the patients using the knee rating system of the American Knee Society (knee score and functional score), knee arthroplasty rating system of the Hospital for Special Surgery (HSS score), patellofemoral score, range of motion of the knee joint, and performed a radiological evaluation by use of the radiographical evaluation system of the Knee Society at the last follow-up period. Also, to evaluate patellofemoral congruence, we used Keblish's method. RESULTS: At the last follow-up, the mean knee score and functional score were 90.4 and 75.5 for the patellar retention group, and 86.1 and 70.0 for the patellar resurfacing group, respectively (p=0.29, p=0.27). The HSS score was 85.2 for the patellar retention group and 84.8 for the patellar resurfacing group (p=0.30). The Bristol patellar score and Lonner Patellofemoral score were 8.7 and 82.0 for the patellar retention group and 8.8 and 85.6 for the patellar resurfacing group, repectively (p=0.86, p=0.86). The mean value of the patellofemoral score was slightly higher in the patellar resurfacing group, but statistically there was no difference between the two groups. There were also no statistically differences in the others parameters. CONCLUSION: We obtained favorable results by selective patellar resurfacing total knee arthroplasty, although there were no significant differences for both the patellar retention and resurfacing group. We believe that it may be better to select a proper indication than to just follow the preference of the surgeon for patellar resurfacing.

Angioleiomyosarcoma Arising from the Deep Femoral Vein: A report of one case / 대한흉부외과학회지

A 69-year-old man was admitted to our hospital for deep vein thrombosis, and he had experienced two episodes of left leg swelling: one happened after an 11 hour-air trip from Europe in June 2007, and the other developed 3 days after an operation for a herniated lumbar disc in July 2007. We treated him for a deep vein thrombosis of the deep femoral vein after admission. However, we arrived at the final diagnosis of angioleiomyosarcoma after the operation for the tentative diagnosis of deep vein thrombosis. We removed the firmly engorged deep femoral vein on the second operation. We report here on a case of angioleiomyosarcoma that arose from the deep femoral vein.

A Case of Candida Bursitis Associated with Etanercept Treatment in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Tumor necrosis factor (TNF)-alpha blockade has been well proved to significantly improve the disease course of rheumatoid arthritis. However, since TNF-alpha plays an important role in the immune system against external infectious organisms, it was reported that TNF-alpha blockade could increase the frequency of serious opportunistic infections such as tuberculosis. Fungal bursitis is a rare infectious disease following sever infections, malignancies and immune deficiencies. Moreover, there was no report on fungal bursitis occurring after administration of TNF-alpha blockade in Korea to date. Recently we experienced a 58-year-old female patient with rheumatoid arthritis who presented soft buttock mass after treatment with etanercept and was finally diagnosed as fungal bursitis by Candida parapsilosis.

Heterotopic Bone Formation in Patient who Underwent a Posterior Cruciate Ligament Reconstruction using the Inlay Method and Posterolateral Corner Sling with a Tibia Tunnel: A Case Report / 대한정형외과학회잡지

We describe a case of posterolateral capsular heterotopic ossification requiring a surgical excision after a PCL (Posterior Cruciate Ligament) reconstruction using the modified inlay method and PLCS (posterolateral corner sling) with a tibia tunnel. A 21-year-old female patient had suffered a blunt proximal tibial direct trauma 6 months earlier. She did not experience limb ischemia or a pulse deficit before she visited our out patient clinic. She had not suffered any trauma in other sites, and showed a range of motion of 0 to 30degrees at 4 months after surgery. There was no specific finding on the X-ray images. Arthroscopic adhesiolysis was performed and her range of motion increased to 0 to 120degrees. However, 6 months after the initial operation, she showed ankylosis and heterotopic ossification at the posterior aspect, which was surgically removed at 12 months postoperatively. After the second surgery, there was no recurrence and she showed a 0 to 140degrees range of motion at postoperative 42 months.

Neurolymphomatosis Involving Sciatic Nerve: A Case Report / 대한정형외과학회잡지

The term "Neurolymphomatosis" includes the infiltration of the peripheral nervous system by lymphoma and nontumor lymphocytes. A neurolymphomatosis has not been classified as a distinct entity. Hence, its characteristic symptoms are often missed, and oncologists or neurological consultants fail to obtain an accurate diagnoses. We encountered a case of non-Hodgkins lymphoma involving the sciatic nerve, which has never been reported in the orthopedic literature in Korea. We report a case of neurolymphomatosis with a brief review of the literature.

A Comparison of Fibular Head Tunnel and Tibial Tunnel in the Reconstruction of a Posterolateral Instability of the Knee / 대한정형외과학회잡지

PURPOSE: This study compared the surgical results of various posterolateral corner sling methods performed through either the fibula head tunnel or tibia tunnel in patients with chronic PLRI (PosteroLateral Rotatory Instability). MATERIALS AND METHODS: Between January 1999 and October 2003, 20 and 19 patients who had undergone surgery for PCL (posterior cruciate ligament) tensioning and an ALB (anterolateral bundle) reconstruction through the fibula head tunnel or tibia tunnel, respectively and were followed up more than 1 year were enrolled in this study. RESULTS: The fibular head tunnel was found to be superior compared with the tibia tunnel method in terms of the operation time (36.5+/-7.5 versus 68.4+/-12.8) (p<0.0001), rotational stability (p= 0.0018) and IKDC objective score (p<0.0001). In the fibula head tunnel group, 85% of patients had an equal to normal or tighter than normal rotational stability in the tibial tunnel group with 63% having an equal to normal or tighter than normal side at the last evaluation. In the IKDC objective score, 85% of patients in the fibula head tunnel group had a rating B or higher at the last evaluation compared with 79% in the tibial tunnel group (p<0.0001). However there were no significant differences in anteroposterior stability and OAK score. CONCLUSION: The modified posterolateral corner sling through the fibula head tunnel produces better results in terms of a posterolateral rotational stability of grade II chronic PLRL in a combined PCL injury than that using the tibia tunnel method.

Tensioning of Remnant Posterior Cruciate Ligament with a Reconstruction of the Anterolateral Bundle in Chronic PCL Injuries / 대한정형외과학회잡지

PURPOSE: This report introduces a new method for tensioning the remnant PCL with a reconstruction of the anterolateral (AL) bundle of the PCL using a modified tibial inlay technique with an assessment of the outcome of this method in chronic PCL injury. MATERIALS AND METHODS: From January 1998 to August 2003, eighty six patients was underwent tensioning of a laxed remnant PCL with a reconstruction of the anterolateral bundle of the PCL. Of these, fifty two patients who were followed up for more than 2 years were evaluated. Tensioning was performed using a distal transfer of the tibial attachment with the posteromedial approach in the supine position. The AL bundle of the PCL was reconstructed with 4 bundles of a hamstring autograft or tibialis anterior tendon allograft. The stability was assessed objectively using stress radiographs with the Telos(R) device and the maximal manual test with the KT-1000 arthrometer. The clinical results were assessed by the IKDC (International Knee Documentation Committee) and OAK (Orthopadische Arbeitsgruppe Knie) scores. The posterior drawer test, varus stress test, posterolateral drawer test and dial test in 30 degrees and 90 degrees flexion were performed for a physical examination. RESULTS: The average side to side difference of the posterior tibial translation in stress radiographs with the Telos(R) device decreased from 10.4+/-2.0 mm to 2.2+/-1.0 mm. The average side to side difference in the maximal manual test with the KT-1000 arthrometer also decreased from 8.2+/-1.5 mm to 1.9+/-1.0 mm. The final IKDC score was A in eleven (21.2%), B in thirty-five (67.3%) and C in six (11.5%) patients. The average OAK score improved from 64.3+/-8.9 to 90.8+/-7.2. CONCLUSION: Tensioning of the laxed remnant PCL with a reconstruction of the AL bundle in chronic PCL injuries showed good clinical results and excellent posterior stability.

Effects of a Posterior Cruciate Ligament Resection on the Flexion-Extension Gap in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To assess the effects of a posterior cruciate ligament resection on the tibiofemoral joint gap in total knee arthroplasty. MATERIALS AND METHODS: The effect of a PCL resection on the tibiofemoral joint gap was analyzed prospectively in 58 patients (69 knees) who had undergone TKA between May 2003 and April 2006. The knee was exposed using a modified subvastus approach. The medial soft tissue was released and a tibial cutting was made first. The tibial insertion of a PCL was protected during the tibial resection by inserting a thin osteotome in front of the posterior spine. An extension and flexion gap were measured using a balancer/tensor device (Stryker Howmedica Osteonics(R), Allendale, NJ, USA) under manual maximal stress before and after the PCL resection. The change of the joint line and the posterior inclination on preoperative and postoperative lateral roentgenograms was also assessed. RESULTS: After the PCL resection, the flexion gap and extension gap increased by an average of 3.6+/-1.5 mm and 2.0+/-1.0 mm, respectively. Although the PCL resection resulted in an increasing a flexion gap and extension gap, the increase in the flexion gap was larger than that of the extension gap by 1.6 mm. CONCLUSION: A PCL resection resulted in an increase in the flexion and extension gaps by 3.6 mm and 2.0 mm, respectively. Therefore, a PCL resection would be a good alternative method for controlling the flexion-extension gap in TKA.