Characteristics of Radial Tears in the Posterior Horn of the Medial Meniscus Compared to Horizontal Tears

BACKGROUND: The clinical and radiologic features of radial tears of the medial meniscus posterior horn were compared with those of horizontal tears. METHODS: From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Among these, 91 were radial tears in the medial meniscus posterior horn, and 95 were horizontal tears in the posterior segment of the medial meniscus. The patients' data (age, gender, duration of symptom, body mass index, and injury history), radiographic findings (Kellgren and Lawrence score, posterior tibial slope, and femorotibial angle), and chondral lesions were recorded. RESULTS: The patient factors of age, gender, and body mass index were related to radial tears of the medial meniscus posterior horn. Radial tears were significantly correlated with Kellgren and Lawrence score, varus alignment, posterior tibial slope, and severity of the chondral lesion. CONCLUSIONS: Radial tears of the medial meniscus posterior horn are a unique clinical entity that are associated with older age, females and obesity, and are strongly associated with an increased incidence and severity of cartilage degeneration compared to horizontal tears.

Treatment of Multiple Ligaments Injuries

Multiple ligament injury, which means disruption of at least 3 of the 4 major ligaments, generally occurs due to high energy trauma. Knee dislocation usually leads to the multiple ligament injury, and the terms 'knee dislocation' and 'multiple ligament injury' are used interchangeably. In some cases, a dislocated knee may have been spontaneously reduced immediately after the trauma. This is the reason why we should consider the possibility of knee dislocation and carry out a thorough vascular and neurologic evaluation when a patient with multiple ligament injury presents to an emergency department. Multiple ligament injury, when not properly treated, may lead to instability of the knee joint, resulting in posttraumatic arthritis. Though treatment and rehabilitation of multiple ligament injury is difficult, we should pursue full recovery of the knee joint through precise examination and proper treatment. There is controversy about conservative vs. surgical treatment, early vs. delayed surgeory, and repair vs. reconstruction, but surgical treatment and early reconstruction are now preferred.

Treatment of Osteofibrous Dysplasia and Associated Lesions

PURPOSE: To report long term treatment outcomes of osteofibrous dysplasia and association with adamantinoma. PATIENTS AND METHODS: From January 1984 to July 2001, 14 patients with osteofibrous dysplasia were followed for an average of 108 months (78 to 260 months). Our patient group consisted of 6 men and 8 women, with a mean age of 13.9 years (2 to 65 years). We reviewed the clinical and pathological features of all 14 patients. RESULTS: Thirteen patients had a lesion in the tibia, while one patient had lesions in both the tibia and the fibula. Initial treatments were observation after biopsy (6 patients), curettage with or without a bone graft (3 patients), resection followed by a free vascularized fibular bone graft (4 patients), or resection and regeneration with the Ilizarov external fixation (1 patient). Curettage was performed on 6 patients due to recurrence or progression after the initial treatment. Among these patients, one was diagnosed with AD from the biopsy of the recurrent lesion. This patient was further treated by segmental resection and pasteurization. After the initial pathology slides of the 13 patients were reviewed with immunohistochemical cytokeratin staining, one patient diagnosis was changed from osteofibrous dysplasia to osteofibrous dysplasia-like adamantinoma. CONCLUSION: Some patients with osteofibrous dysplasia require close observation because of the high association risk between osteofibrous dysplasia and adamantinoma, Immunohistochemical staining may be helpful in differentiating these two diagnoses.

Total Hip Arthroplasty with Ceramic-on-Ceramic Articulation: Minimum 5-year Follow-up Results / 대한정형외과학회잡지

PURPOSE: To evaluate the medium-term clinical and radiographic results of uncemented total hip arthroplasty with ceramic-on-ceramic articulation. MATERIALS AND METHODS: From February 1999 to August 2000, fifty-two primary total hip arthroplasties were performed on forty-two patients using a ceramic-on-ceramic bearing implant. The mean follow-up period was 5.4 years (range, 5-6.6 years) and the mean age at surgery was 43.2 years (range, 19-66 years). The clinical results were evaluated using the Harris hip score. The radiographic evaluations were carried out in terms of the stability of the components, the prevalence of osteolysis and wear. RESULTS: At the most recent follow-up, the mean preoperative Harris hip score improved from 63 points (range, 26-93 points) to 97 points (range, 82-100 points). The Harris hip score showed excellent results in 49 hips (94%) and good results in 3 hips (6%). Fixation by bone ingrowth was noted in all cases and there was no case with osteolysis or a deep infection. Ceramic wear was not detectable on the plain radiograph. Complications included one case of dislocation, one case of a fracture of the ceramic femoral head and one case of an intraoperative periprosthetic proximal femoral crack. CONCLUSION: Ceramic-on-ceramic articulation showed excellent clinical and radiographic results in terms of wear, osteolysis and loosening. A further follow-up study should be performed to evaluate the long-term clinical and radiographic results with special focus on the fracture of the ceramic material.

Intraneural Ganglion of the Peroneal Nerve: A Report of 3 Cases / 대한정형외과학회잡지

An intraneural ganglion mainly affects the common peroneal nerve but the condition is relatively rare. Ganglions arising from the joint, tendon sheath or sheath of a peripheral nerve. We report three cases of intraneural ganglion cysts in the peroneal nerve that were treated by an excision.

Result of PCL Substitution Type Total Knee Arthroplasty with Scorpio(R) System (minimum 3-year follow up) / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiologic result of total knee arthroplasty using Scorpio. total knee system retrospectively. MATERIALS AND METHODS: Between January 1999 and December 2001, 71 knees in 51 patients who had been followed up mean 3.6 years (minimum 3.0 years) after total knee arthroplasty with Scorpio(R) system (posterior substitution type) were evaluated retrospectively for clinical result, active range of motion, flexion contracture and radiologic result. RESULTS: The average active range of motion increased from 108degrees (75-144degrees) preoperatively to 120degrees(90-144degrees) at last follow up. The average flexion contracture improved from 12degrees(0-30degrees) preoperatively to 2degrees(0-13degrees) at last follow up. The average HSS knee score was measured 54 preoperatively and was measured 88 postoperatively. There was no difference in clinical result, active range of motion and flexion contracture between resurfaced patella group and nonresurfaced patella group. Radiologic evaluation revealed radiolucency rate of 11% in Tibia anteroposterior view and 10% in femur. Complications were periprostheitc fracture in one case, deep infection in one case and peroneal nerve palsy in one case. In one case, femoral and tibial component migration due to aseptic loosening was noted. Revision of tibial and femoral component was done. CONCLUSION: The 3.6 years follow up results of Scorpio(R) system (posterior substitution type) were excellent in range of motion and function. There was no difference between resurfaced patella group and nonresurfaced patella group in clinical result.

Arthroscopic Debridement for the Osteoarthritic Ankle: Clinical Results and Prognostic Factors / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopic debridement in osteoarthritic ankle and prognostic factors. MATERIALS AND METHODS: Between Feb. 2001 and Mar. 2004, twenty-seven patients who had an osteoarthritic ankle disease were managed by arthroscopic debridement. The mean age of the patients was 50.0 years (20-71) and the mean follow-up after operation was 16.2 months (12-36). There were 18 men (66.7%) and 9 women (33.3%). The preoperative radiographic findings were divided into 4 groups according to the classification system by Takakura et al. Preoperative AOFAS ankle-hindfoot scale and subjective satisfaction were checked at the last follow-up visit, and the results were compared. RESULTS: In radiological evaluation, stage I was 6 cases (22.2%), stage II was 14 cases (51.9%), stage III was 4 cases (14.8%), and stage IV was 3 cases (11.1%). The mean preoperative AOFAS ankle-hindfoot scale was 59.1+/-16.7 and improved to 66.5+/-24.3 at last follow-up. Especially, in stage I, preoperative AOFAS score was 69.3+/-18.7 and improved to 74.3+/-29.7, and in stage II, preoperative AOFAS socre was 63.0+/-9.6 and improved to 77.1+/-12.9. But in the stage III and IV, preoperative scores were not improved. The preoperative radiographic findings correlated with the outcome at the last follow-up time (p<0.05). The group with loose body and the group without anterior osteophyte showed better AOFAS score compared to the control group, but there was no statistically significant difference between the two-groups. In subjective satisfaction, excellent or good results were achieved in 14 cases (51%). CONCLUSION: We suggest that arthroscopic debridement is an effective treatment in which preservation of alignment and reasonable articular cartilage can be achieved.

Minimally Invasive Lumbar Microdiscectomy using Tubular Retractor: A Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the early clinical results of lumbar microdiscectomy using minimally invasive tubular retractor (METRx-MD system, Medtronic Sofamor Danek, Memphis, TN), and to validate the merits of minimally invasive spinal surgery. MATERIALS AND METHODS: From April, 2003 to April 2004 we retrospectively studied a consecutive series of 45 patients who underwent lumbar microdiscectomy using minimally invasive tubular retractor. In all cases, minimally invasive approach using the tubular retractor were performed with a 2 cm sized paramedian incision. The following data were collected: clinical outcomes, operative time, intraoperative blood loss, need for blood replacement, time needed before ambulation, length of hospital stay, and complications. The clinical outcomes were assessed by the modified MacNab criteria. RESULTS: Minimally invasive tubular microdiscectomy was performed in 45 patients over a 12-month period with an average follow-up of approximately 8 months. The clinical outcomes assessed by MacNab criteria were excellent in 33 patients (73%), good in 10 patients (22%). The average operative time was 63 minutes (range, 35 to 95 minutes). The average blood loss was 62 mL (range, 50 to 110 mL). None of the patients needed blood replacement. With the exception of 2 patients, all patients could walk at the day of surgery. The average hospital stay was 2.3 days. None of the patients had dural tear, wound problem, or other complications. CONCLUSION: Lumbar microdiscectomy using tubular retractor can offer a useful modality for the treatment of lumbar herniated disc with the merits of minimally invasive spinal surgery. Further long-term, randomized, prospective investigations are needed to fully evaluate the impact of this technique.