Common Peroneal Nerve Palsy Associated with Multiple Knee Ligament Injury / 대한스포츠의학회지

Common peroneal nerve (CPN) injury associated with multiple-ligament knee injury is relatively rare. A 38-year-old male presented with left knee pain occurred during ssireum (Korean wrestling). The patient exhibited positive Lachman, grade 3 varus stress, and also positive dial testing at 30°. Sensory loss of some area of left foot and foot drop were observed. Magnetic resonance imaging showed complete anterior cruciate ligament (ACL) rupture and posterolateral corner (PLC) injury. Motor nerve conduction velocity indicated left CPN palsy. ACL and PLC reconstructions were performed 10 days after injury and nerve exploration was done simultaneously. Neurolysis and primary repair were also performed. At 26 months after injury, muscle power of the tibialis anterior and extensor hallucis longus improved to grade 3, and sensation in CPN area recovered to about 60%. There was good stability in injured knee. To the best of our knowledge, this is the first case report describing CPN palsy with multiple-ligament knee injury during ssireum.

Isolated Fracture of Distal Humeral Trochlea

Isolated fracture of the distal humeral trochlea occurs while the axial load delivered to the elbow passes through the trochlear of the distal humerus. It has been rarely reported, because of those reasons. The trochlea is located deep inside of the elbow joint space and since it does not have the direct attachment with muscles or ligaments, a force is hardly transmitted directly. Also ulno-humeral joint is less influenced by compressive or shear force than radio-humeral joint. We report a case of isolated trochlear fracture with review of the literature.

A Comparative Study of Subcutaneous versus Intra-Articular Indwelling Closed Suction Drainage after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The aim of this study was to compare the drainage amount, total blood loss, and clinical results between two different positions of suction drainage after total knee arthroplasty. MATERIALS AND METHODS: A total of 100 patients who underwent one stage bilateral total knee arthroplasty were enrolled. In experiment 1 with 50 patients, we compared the drainage amount, pain, range of motion, and complications of the leg whose suction drain was inserted into the joint cavity with those of the contralateral leg whose suction drain was inserted in subcutaneous tissue. Another 50 patients of experiment 2 had suction drainage in the joint cavity of both legs and the total blood loss (sum of drainage output, exudates, and hematoma of subcutaneous tissue and joint) was calculated and compared with that of experiment 1. RESULTS: In experiment 1, the drainage amount was less in the leg with suction drainage in subcutaneous tissue compared with the contralateral leg with suction drainage in the joint cavity (p<0.001). However, the postoperative joint pain was significantly different only on post-operative day 2 between two legs. In experiment 2, there was no significant difference in the total blood loss between the two groups. CONCLUSION: Although the drainage amount was less in the leg whose suction drain was kept in subcutaneous tissue compared with the contralateral leg whose suction drain was in the joint cavity, the total blood loss and the clinical results were not significantly different according to the position of the suction drain. Therefore, we can conclude that the subcutaneous position of the suction drain did not yield superior results.

Ulnar Artery Thrombosis in Guyon's Canal

Causes of ulnar nerve compression in Guyon's canal are various, but thrombosis of the ulnar artery due to a single trauma is rarely reported. We report a case of ulnar nerve compression caused by traumatic thrombosis of the ulnar artery in Guyon's canal. Surgical excision of the ulnar artery thrombus and end to end anastomosis resulted in complete relief of the patient's symptoms.

Preoperative Prediction for Length of Patellar Tendon in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft / 대한스포츠의학회지

Preoperative prediction of patellar tendon length is important during anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autograft. Three methods of imaging analysis to predict patellar tendon length were compared in this study. One hundred and twenty-three patients who underwent ACL reconstruction using BPTB autograft by single surgeon during October 2002 through April 2011 were included. We measured the patellar tendon length from true and oblique lateral simple radiographs (classified according to degree of rotation) and magnetic resonance image (MRI). These values were compared with actual length measured during operation and assessed accuracy by calculating the coefficient of determination. The mean length of patellar tendon measured during operation and by true lateral and oblique lateral radiographs and MRI were 42.4+/-0.45 mm (range, 32.0-54.0 mm), 41.7+/-0.61 mm (range, 24.2-55.3 mm), 40.7+/-0.57 mm (range, 24.8-51.5 mm), and 41.7+/-0.52 mm (range, 28.7-56.0 mm), respectively. The correlation of patellar tendon length was the most strong between actual length and value from true lateral radiograph (coefficient of determination, r2=0.660) according to simple linear regression analysis. R2 values were 0.361 and 0.332 for oblique lateral radiograph and MRI compared to actual value, respectively. In conclusion, Patellar tendon length measured on true lateral radiograph was the best method to coincide with actual patellar tendon length among various preoperative prediction methods.