Degeneration of the Cruciate Ligaments in Osteoarthritic Knee

PURPOSE: To assess the histological degeneration of the cruciate ligaments and it's correlation with gross appearance of the cruciate ligaments and functional status of the knee. MATERIALS AND METHODS: Macroscopic and microscopic evaluations of cruciate ligaments were made in 80 osteoarthritic knees undergoing cruciate-substituting total knee arthroplasty (TKA). Gross appearance was classified into "normal", "abnormal" and "tear". A scoring system was made to represent the degree of histological degeneration, and correlation with the gross appearance and functional status by knee society score (KSS) was statistically analysed. RESULT: Gross appearance of the anterior cruciate ligament (ACL) was "normal" in 24 cases, "abnormal" in 50 and "tear" in 6 with average histological score 3.7, 4.5 and 8.0 respectively. Gross appearance of the posterior cruciate ligament (PCL) was "normal" in 70, "abnormal" in 10 with average histological score 3.8 and 6.4 respectively. There was no "tear" of the PCL. Gross appearance of the ACL was correlated with histological score of ACL and PCL (p<0.05) and KSS (p<0.05). CONCLUSION: Gross appearance of the ACL was related to the degree of histological degeneration of the PCL as well as the ACL and functional loss of the knee. Therefore intraoperative gross appearance of the ACL can be one of the factors to decide if the PCL would be sacrificed or not during TKA.

Early Results of Primary High Flex Total Knee Arthroplasty

PURPOSE: We retrospectively evaluated the early results after total knee arthroplasty(TKA) using the Nexgen LPS-Flex fixed bearing knee system. MATERIALS AND METHODS: Ninety-five knees(71 patients) which used the LPS-Flex system for primary TKA and followed-up for a minimum 2 years were evaluated. Evaluation included preoperative and postoperative range of motion(ROM), factors affecting the postoperative ROM, Knee Society Score(KSS), knee function score, tibio-femoral angle and postoperative complications. RESULTS: Knee ROM was increased from preoperative 9.7 degrees - 123.6 degrees to postoperative 1.7 degrees - 130.7 degrees. The mean KSS and function score were improved from preoperative 53, 55 to postoperative 85 and 90 respectively. The tibio-femoral angle was changed from preoperative 5.5 degrees varus to a postoperative 5.3 degrees valgus. Two cases of early loosening of the femoral components occurred. One case underwent revision surgery while the other was closely followed up. There was no deep infection. CONCLUSION: Primary total knee arthroplasty with Nexgen LPS-flex system showed satisfactory early results including excellent ROM, except 2 cases of early loosening of femoral component. The etiology of this loosening requires further evaluation and study.

Arthroscopic Reduction and Pull-out Suture Fixation for the Intercondylar Eminence Fracture of the Tibia

PURPOSE: Meyers-McKeever and Zaricznyj proposed a classification for intercondylar eminence fractures of the tibia. Type III and IV classifications are generally accepted as surgical indications for the fractures. The purpose of the present study was to evaluate the effectiveness of arthroscopic reduction and multiple pull-out suture fixation for displaced intercondylar eminence fractures of the tibia. MATERIALS AND METHODS: Twenty two cases were examined, with a average age of 14(5~23) years, and the average follow-up was 34 months(24 months~6 years). Patients were evaluated according to the Meyers and McKeever criteria, and were scored at 6 weeks, 4 months, 8 months, each year and at the last follow-up. Patients underwent the following evaluations: radiological, range of motion, Lachman test, pivotshift test and the KT 2000 arthrometer. RESULTS: The average union time was postoperative week 9.3(6~12 weeks). According to the Meyers and McKeever criteria, the cases showed the following outcomes at the final follow-up: 19(86.4%) excellent, 2(9.1%) good and 1(4.5%) poor. CONCLUSION: Using the short- and mid-term arthroscopic reduction and multiple pull-out suture fixation procedure for displaced intercondylar eminence fractures of the tibia resulted in 95.5%(19) of cases showing good or excellent outcomes, indicating this procedure is effective.

Meniscus Hoop Tensioning Function of the Meniscofemoral Ligament: An Experimental Study Using the Knee Joint of the Pig

PURPOSE: To prove experimentally if the posterior meniscofemoral ligament (PML) has hoop tensioning function for the lateral meniscus using the knee joint of the pig. MATERIALS AND METHODS: Amputated stumps with the knee joint of the pig (Yorkshire) were used. The experiment was performed under 6 conditions; 1) intact PML with intact lateral meniscus (LM), 2) intact PML with radial tear of posterior horn of LM, 3) intact PML with total lateral meniscectomy, 4) cut PML with intact LM, 5) cut PML with radial tear of posterior horn of LM, and 6) cut PML with total lateral meniscectomy. The pressure-sensitive film (Prescale,Fuji) was inserted under the lateral femoral condyle and axial loads was transmitted to the knee joint with universal testing machine (Instron, model No.4469, USA). The pressed area, maximum pressure and average pressure were measured by the Prescale imaging analysis system FDP-901E series. RESULTS: With the intact PML, there was little difference in pressed area and maximum and average pressures between the conditions of intact meniscus and radial tear of posterior horn of LM. With the cut PML, regardless of the states of the LM, pressure concentration (much decreased pressed area, and increased maximum and average pressures) occurred, which had similar results to the condition of total lateral meniscectomy with intact PML. CONCLUSION: The PML of the pig had hoop tensioning function for the LM under axial loads.

Angiographic Embolization as a Treatment of Postoperative Bleeding / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of the angiographic embolization for the treatment of postoperative bleeding. MATERIALS AND METHODS: Six patients who suffered massive postoperative bleeding underwent angiographic embolization from March 1998 to June 1999. The initial diagnosis was femoral fractures in 4 patients, infected total hip arthroplasty in a patient, and open humerus fracture in a patient. When angiography revealed arterial tear, embolization was performed. The authors evaluated the effectiveness and the complication of angiographic embolization. RESULT: Five patients had arterial tear and one patient had diffuse bleeding from the granulation tissue. Angiographic embolization was performed in all patients. There were 3 cases of injury of the deep femoral artery, a case of injury of a branch of the subclavian artery, and a case of injury of the superior gluteal artery. After the procedure swelling subsided and the amount of transfusion diminished in all patients. There was no complication related to angiographic embolization. CONCLUSION: When there is suspicion of arterial injury after the operation, angiographic embolization can be used to confirm arterial injury and to control bleeding.