Two Stage Surgical Treatment of Acute Traumatic Knee Dislocation / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to determine the effectiveness of a new two stage surgical treatment for acute traumatic knee dislocation. MATERIALS AND METHODS: The study involved 15 knees in 14 patients treated between October 1997 and November 2001. The mean follow-up period was 24 months. In the first surgical stage, medial and/or lateral ligament complexes were repaired or reconstructed within two weeks of the injury. In the second surgical stage, once full range of motion was obtained 3-6 months later, anterior or posterior cruciate ligaments (ACL or PCL) were reconstructed if significant laxity was present. The final outcomes were assessed using stress X-rays, range of motion and Lysholm score. RESULTS: There were ten cases of MCL tear and eight cases of LCL tear. All MCL and LCL injuries were either repaired or reconstructed. All cases had both ACL and PCL tears. Following the first stage of MCL/LCL surgery, the second stage surgery of ACL or PCL reconstructions was deemed to be necessary in three and seven cases, respectively. Five cases did not require ACL or PCL reconstruction. In stress X-rays at the last follow up examination, MCL, LCL, ACL and PCL instability was graded as 0 or 1 in 15, 14, 15 and 11 cases, respectively. PCL instability was graded as 2 in four cases. The mean postoperative Lysholm score was 87.6 points. CONCLUSION: The two stage surgical approach described here resulted in good outcomes for patients suffering from acute knee dislocation patients in terms of range of motion and stability.

Usefulness of MRI in Dexision for Operation in Shoulder Diseases of Athletes / 대한정형외과학회잡지

PURPOSE: MRI has been widely used in the evaluation of shoulder diseases in many athletic patients. The purpose of this study was to evaluate the usefulness of MRI in treatment of shoulder diseases in athletes. MATERIALS AND METHODS: Fifty-seven athletes were evaluated for shoulder diseases from March 1995 through July 1997. MRI was performed in thirty cases (53%). We analyzed the findings of MRI and checked if operation was determined by MRI findings. RESULTS: MRI findings revealed rotator cuff tear in 6 cases (20.0%), including one full thickness tear and five partial thickness tear. Among 57 cases, four cases (7.0%) were operated. Only in one case (3.3%) was open acromioplasty and rotator cuff repair in accordance with the finding of full thickness tear of rotator cuff on MRI decided upon. One case, which was initially treated conservatively, was treated by arthroscopic acromioplasty later. The two other cases were treated with arthroscopic acromioplasty and Bankart repair with capsular shift without MRI. CONCLUSIONS: MRI is not so useful for determining surgery in initial examination of shoulder diseases of athletes. MRI should be better reserved for cases with rotator cuff disease developed after trauma, cases without improvement by conservative measures or the unusual cases with difficulty in clinical diagnosis.

Surgical Treatment of Unstable Thoracolumbar Fractures with Posterior Approach / 대한정형외과학회잡지

PURPOSE: To analyze the results of posterior reduction with AO internal fixator or screw-rod system in thoracolumbar fracture and to find an adequate method of treatment. MATERIALS AND METHODS: We analyzed 40 cases of unstable thoracolumbar fractures who were operated with posterior approach without additional anterior approach. All cases were divided into two groups by the instrument used: Group A (25 cases) with AO internal fixator and Group B (15 cases) with screw-rod system. They were classified according to AO classification. RESULTS: There was no significant difference in correction and maintenance of sagittal index among types of AO classification except neurological recovery which was better in Type A. AO internal fixator had better results than screw-rod system in correction and maintenance of sagittal index, but no difference in neurological recovery. Eleven cases had more than 5 degrees of correction loss at final follow-up. In these cases, we found several findings; decreased vertebral body height, decreased disc height, bony collapse around screw at superior segment, metal loosening between rod and screw and metal breakage of screw. CONCLUSIONS: We concluded that AO internal fixator was good for the posterior reduction of thoracolumbar fracture in this study. But we think that continuous follow-up and further study are needed.