Clinical and Radiologic Results of Transtibial Single Bundle Reconstruction and Double Bundle Reconstruction of the Posterior Cruciate Ligament Using the Allo-achilles Tendon / 대한정형외과학회잡지

PURPOSE: We performed transtibial single and double bundle reconstruction of the posterior cruciate ligament using the allo-achilles tendon and compared the results of single bundle reconstruction and double bundle reconstruction both clinically and radiologically. MATERIALS AND METHODS: This study included 41 cases of posterior cruciate ligament reconstruction between February 2000 and June 2007 that had data available for at least 2 years of follow-up. Twenty-two cases (53.7%) underwent single bundle reconstruction and 19 cases (46.3%) underwent double bundle reconstruction. Clinical results were analyzed by Lysholm score and IKDC standards scale, and the radiologic results were analyzed by the Telos(R) posterior translation test. RESULTS: The average Lysholm score at last follow-up was 85.4+/-4.7 in the single bundle group and 87.5+/-5.1 in the double bundle group. IKDC scores were grade A in 4 (18.2%), grade B in 14 (63.6%) and grade C in 4 (18.2%) in the single bundle group; they were 1 (15.3%), 15 (78.9%) and 3 (15.8%) in the double bundle group. Telos(R) posterior translation test scores were 5.06 mm (3.04-7.43 mm) in the single bundle group, and 4.04 mm (2.18-7.20 mm) in the double bundle group. There was significant improvement in clinical and radiological scores in both groups (p0.05). CONCLUSION: Further study with longer term follow-up is needed.

Injury to Soft Tissue Knee Structures in Patients with Tibia Plateau Fracture

PURPOSE: We wanted to analyze the incidence of soft tissue injury associated with fractures of the tibial plateau. MATERIALS AND METHODS: From November 2005 to December 2008, 36 patients with tibial plateau fractures were examined by radiologic studies. The fractures classified according to Schatzker's classification by using the plain radiographs and computed tomography, and then magnetic resonance imaging was done for assessing the accompanied injuries of the knee structure. RESULTS: For the 36 cases, accompanying lesions were observed in 30 cases (83.3%). Lateral meniscus damage was the most frequently associated damage, and this was observed in 17 cases (47.2%). Medial meniscus damage was found in 13 cases (36.1%). Anterior crucial ligament damage was found in 11 cases (30.6%). Posterior crucial ligament damage was found in 3 cases (8.3%). Medial collateral ligament damage was found in 16 cases (44.4%) and lateral collateral ligament was found in 8 cases (33.3%). CONCLUSION: Because soft tissue injury frequently accompanies tibial plateau fracture, MRI evaluation and proper management are necessary regardless of the severity of the fractures.

Method for Positioning the Tibial Tunnel in Anterior Cruciate Ligament Reconstructions

PURPOSE: This study determined that knee extension and its relationship to the slope of the intercondylar roof for positioning the tibial tunnel in ACL reconstructions. MATERIALS AND METHODS: Fifty subjects (25 men and 25 women) between the age of 25 and 40 were recruited for the study. We obtain a lateral roentgenogram of their knees in maximum extension. We measured knee extension angle, roof angle and the location of central axis of the tibial tunnel. We also used statview IV program for statistics. RESULTS: Regression analysis of the measurements from the two authors revealed knee extension (r2=0.846, p<0.0001), roof angle were reliably measured(r2=0.630, p<0.0001). There was a strong relationship between the two authors in their selection of the position for the center of the tibial tunnel(r2=0.702, p<0.0001). There was considerable variety in the degree of knee extension, roof angle and the position of the tibial tunnel. We failed to detect a difference between men and women since the population was insufficient. A correlation between knee extension and roof angle was week (r2=0.207, p<0.008). CONCLUSION: There is variety of extension angle and roof angle of knees among persons. It is required to customize the position of tibial tunnel in ACL reconstructions because of differences in anatomy.

Comparative Analysis between Patellar Resurfacing and Retention in Total Knee Arthroplasty: 5-year Follow-up Result / 대한정형외과학회잡지

PURPOSE: To compare the clinical and radiological results between patellar resurfacing, group and patellar retention group in total knee arthroplasty. MATERIALS AND METHODS: Of the 74 patients who underwent total knee arthroplasty on due to knee osteoarthritis since March 1996, and followed-up for at least for 5 years, there were 42 and 32 cases in the patellar retention and patellar resurfacing groups respectively. These subjects were evaluated preoperatively and at 1 and 5 years postoperatively using the pain score, Hospital for Special Surgery (HSS) knee score, walking and stair-climbing in knee function score and radiological analysis. The radiological evaluation was achieved by measuring the patellar tilt angle and displacement with a 45degreesmerchant view. The results were analyzed using the student's t-test. RESULTS: There were no significantly differences between the patellar resurfacing and patellar retention groups in the pain score, HSS knee score, walking in knee function score and radiological analysis (p>0.05), but the patellar retention group achieved superior results in stair-climbing (p<0.05). CONCLUSION: The clinical and radiological results were similar in the patellar retention and patellar resurfacing groups. The use of selective indications of patellar resurfacing is required in order to achieve better results for total knee arthroplasty.

Correlation Between Patients 'Satisfaction and Objective Measurement after ACL Reconstruction

PURPOSE: The aim of this study was to correlate patients 'satisfaction with the objective measurement of the knee stability after a ACL reconstruction using a patellar tendon autograft. MATERIALS AND METHODS: Contact was made with 120 patients who a ACL reconstruction using a patellar tendon autograft on unilateral ACL rupture between January 1995 and April 2002 by single surgeon. Assessment was made by the KOOS score, Tegner score, Lysholm score, patients 'satisfaction, IKDC score, manual physical examination, one leg hop test and radiologic AP translation. Paired t-test, Pearson product moment correlation(PPMC) and Spearman 's rank correlation test were used to test the correlation between the parameters. RESULTS: Radiologic AP translation showed a statistically significant correlation with manual lachman and pivot shift tests. The Lysholm score had a high correlation with the patients 'satisfaction and one leg hop test. The final IKDC evaluation system showed the highest correlations with the Lysholm score, the patients 'satisfaction, the Tegner score, the manual lachman test, one leg hop test. Resumption of sports and work according to the Tegner score correlated with the patients 'satisfaction but had a very low correlation with manual lachman test. The knee laxity measurement using manual lachman test correlated with neither one leg hop test nor the patients 'satisfaction. The one leg hop test correlated with the Lysholm score, the patients 'satisfaction, the final IKDC evaluation system. CONCLUSION: We conclude that the final IKDC evaluation system is a very reliable tool and the patients 'satisfaction is important for evaluating the results after ACL reconstructiuon. And the one leg hop test also appear to be a reliable way of evaluating the functional outcome of the ACL reconstruction.

Ceramic on Sandwich Ceramic Bearing Primary Cementless Total Hip Arthroplasty (Result of 2 to 5 years follow up) / 대한정형외과학회잡지

PURPOSE: To evaluate the short term clinical and radiological results of ceramic on sandwich ceramic bearing a primary cementless total hip arthroplasty. MATERIALS AND METHODS: Seventy-five hips, which underwent a total hip arthroplasty with sandwich typed liners as an index operation between December 1998 and October 2001 were examined. The mean follow-up period was 34.3 months, and the mean ages at surgery was 56. The clinical results were evaluated using the Harris hip score and the level of thigh pain. In addition, the radiolucent line, the subsidence of the stem, the migration of the acetabular cup, or osteolysis, proving and proof of loosening. RESULTS: The mean preoperative Harris hip score of 51.8 points was improved to 94.3 points at the final follow-up after surgery. Two cases were the fracture of ceramic components in postoperative three year. One of them was a fracture of the ceramic head and the other was a fracture and dislocation of the liner. Radiologically, there was one case of femoral stem subsidence and radiolucent line. CONCLUSION: The minimum 2-year clinical and radiological results of using ceramic sandwich ceramic bearing were satisfactory. However, breakages (fractures) of the ceramics have become an issue. Satisfactory clinical results can be obtained by limiting the acetabular inclination ranges from 40degrees to 45degrees, using a ceramic head with a larger diameter to increase the ratio between the diameter of the femoral head and neck, avoiding the use of a flange, reducing of the diameter of the femoral neck, the use of a thick-rimmed liner and improving the quality of the ceramic set. Therefore, the use of a sandwich ceramic liner needs to be reconsidered.

Spontaneous Thoracic Spinal Epidural Hematoma after Use of Anticoagulant / 대한척추외과학회지

A spinal epidural hemorrhage, secondary to thrombolytic and anticoagulative therapies, is becoming increasingly common. Urgent surgical decompression is generally warranted to preserve the neurological function. This case report describes an epidural hematoma, with neurological sequelae, in an elderly patient who received intravenous heparin therapy for about 48hrs due to unstable angina. The posterior decompression was urgently treated, but the neurological changes did not recover. The magnetic resonance imaging and operative findings are presented, along with a discussion of the anatomical and pathophysiological considerations that could lead to such a condition.

Range of Motion of Cervical Spine in Normal Korean People / 대한척추외과학회지

STUDY DESIGN: A prospective study is to evaluate the cervical range of motion through the analysis of the plain films of the cer-vical spine. OBJECTIVE: To provide criteria validity for the cervical lordosis, range of motion and segmental motion of each segment using normal Korean adults, as guide lines for the radiographic diagnosis and treatment of cervical diseases. MATERIALS AND METHODS: One hundred and four healthy Korean adults were examined. Roentgenographic lateral views were taken in neutral, active flexion and extension positions. Measurement of the range of motion and segmental motion of the cer-vical spine, using the technique of Penning and Bakke, were independently made by two observers. RESULTS: The mean angle of the lordosis and the range of motion were 19.8degrees+/-8.4degrees and 63.1degrees+/-11.2degrees respectively, and the range of motion of each segment were 10.3degrees+/-2.9degrees, 9.2degrees+/-3.0degrees, 13.5degrees+/-7.2degrees 15.1degrees+/-4.3degrees, 15.6degrees+/-4.4degrees and 13.0degrees+/-5.0degrees and C1-2, C2-3, C3-4, C4-5, C5-6 and C6-7, respectively. There were no differences in the lordotic angle between the ages and genders. The range of motion decreased with increasing age, but there was no difference between genders. The segmental motion was no different between genders, but decreased significantly with increasing age on segments C1-2, C5-6 and C6-7. CONCLUSIONS: No significant differences were found in the range of cervical motion of each segment and the lordotic angle of the Korean population compared with those of other populations. The range of cervical motion also decreased with increasing age. These data provide guidelines in the dynamics of cervical spine and for the roentgenographic diagnosis and treatment of cervi-cal diseases.