Healing potential of the transected posterior cruciate ligament of the rabbit / 대한정형외과학회잡지

PURPOSE: This study was undertaken to elucidate the natural healing potential in posterior cruciate ligament (PCL) injury using histological and biomechanical methods. MATERIALS AND METHODS: PCLs of 92 rabbits were cut partially or completely cut on one side. In Group I, 75% of the PCL was cut preserving the synovium partially. In Group II, the PCL and synovium were completely severed. Investigations were performed by gross inspection, histological examination after Hematoxylin-Eosin (HE) staining and tensile stress testing using an Instron. RESULTS: Continuity of the ligaments began to appear at 2 weeks in group I and at 12weeks in group II. Proliferation of fibroblasts and vessels were observed in HE stained ligaments at 6 and 12 weeks in both groups. The ultimate tensile strength in group I was .3% and in group II 33.1% at 12 weeks. CONCLUSION: Although the mechanical properties of the regenerated ligaments were poor, this study demonstrats that the rabbit PCL has healing potential irrespective of the degree of injury.

Complications and Prognostic Factors of Endoscopic Anterior Cruciate Ligament Reconstruction Using Autogenous Patellar Tendon / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the author's cases of arthroscopic one-tunnel anterior cruciate ligament reconstruction using autogenous patellar tendon in which the complications occured as well as offer advice on how to avoid them and salvage the situation if they occur. MATERIAL AND METHODS: Ninety cases out of 164 arthroscopic ACL reconstructions were followed up for more than 12 months (average 27 months) . The clinical results were evaluated by OAK and IKDC knee rating systems and radiographic results by lateral roentgenographs of the fully extended knee. Fifty-two cases were evaluated by a second look arthroscopy at least 12 months postoperatively. RESULTS: Poor results were noted only in 5 (5%) cases. Four cases out of the 5 poor results were chronic ACL deficient knees, and 2 cases out of the 5 had valgus instability. Mean percentage of roof impingement was -5.7%. Impingement was noted in 11 cases and 3 cases out of the 11 had poor results. During second look arthroscopy, grafted ACL of nearly normal appearance were noted in 26 (50%) cases. Five cases showed impingement and 3 cases out of the 5 had poor results. CONCLUSION: The results of our study denote that chronicity of ACL injury is a prognostic factor for the result after reconstruction, and more so for combined ACL and medial collateral ligament injury. Also, verifying accurate placement of tunnels for graft by arthroscope or intraoperative radiograph seems to be an essential step in preventing impingement, which was shown to be an important prognostic factor according to the results of this study.

Arthroscopic Meniscal Repair

Between December 1994 and December 1996, 42 patients underwent arthroscopic meniscal repair in our institute. Among them, 31 patients with a follow up more than one year were reviewed. Mean age was 24.4 years(range, 18-52 years) and mean interval between onset of symptom and opera- tion was 12.3 months(range, 3 days-6 years). The associated injuries were tibial plateau fracture(6 cases), anterior cruciate ligament injury(4 cases) and posterior cruciate ligament injury(2 cases). The type of tear were longitudinal in 28 cases(90%) and combined in 3 cases(10%). Most of the meniscal tear were encountered in posterior hom(12 cases, 39%) and middle portion(11 cases, 35%). Out side to in technique was used in anterior horn tears and inside to out technique in middle or posterior hom tears. In tibial plateau fractures, arthroscopic assisted reduction was performed with autogenous bone graft. Ligament reconstructions were performed in the cases of associated cruciate ligament injury. According to Ikeuchis grading system, the result was satisfactory(excellent or good) in 23 cases(74%), fair in 6 cases(19%) and poor in 2 cases(6%). But in the cases of isolated meniscal injury, the result was satisfactory in 95%. The result of arthroscopic repair in the meniscal tears associated with other intra-articular injuries seems to be worse than that of the isolated injuries.