Treatment of the Snapping Discoid Lateral Meniscus without Tear in Pediatrics: Contouring Surgery and Posterolateral Repair

PURPOSE: To evaluate the results of arthroscopic contouring surgery and posterolateral meniscal repair for pediatrics with snapping discoid lateral meniscus without tear. MATERIALS AND METHODS: Nine children below 10 years, with snapping discoid lateral meniscus without tear were evaluated in this study. 3 cases had a morphologic deformity of lateral meniscus in MRI and arthroscopic findings, but there was no meniscal tear. Only contouring surgery was performed in 6 cases, and in 3 cases, because of the instability of meniscus over 5mm in traction due to the relaxation of the menisco-capsular junction after contouring surgery, posterolateral repair was performed. The average duration of follow up was 39 months(range, 25 to 72 months). RESULTS: Additional posterolateral repair was done due to remaining snapping, in three cases of six contouring surgery cases. In all cases, snapping was disappeared. The average Lysholm score was improved from 71 in preoperative status to 97 in postoperative status(p=0.008) CONCLUSION: In case of the increased instability of the posterolateral corner of lateral meniscus after contouring surgery in the treatment of snapping discoid lateral meniscus, posterolateral repair is effective to improve the snapping symptom from meniscal subluxation.

Arthroscopic Inside-out Meniscal Repair Leaving Posterior Horn Tear

PURPOSE: To evaluate the clinical results of arthroscopic inside-out repair leaving posterior horn tear. MATERIALS AND METHODS: Among the patients taken arthroscopic meniscal repair due to meniscus longitudinal tear from Jan. 1999 to Dec. 2004, total 32 patients were evaluated, and followed at minimum of two years(mean 32 months). Meniscal repair was done as maximum 3mm interval. The length of unrepaired posterior horn was mean 7.5mm. RESULTS: Preoperative Lysholm score was mean 62.5 and postoperative improved to 91.0. Twenty eight cases(87.5%) showed excellent or good results by Tapper and Hoover criteria. In 4 cases, symptoms recurred at 4 to 12 months after repair and 2 cases were combined with ACL deficiency. Second look arthroscopy was performed in 10 cases, 4 cases for recurred symptom and 6 cases for determining whether healing of untreated posterior horn occurred or not. We observed complete healing of 4 cases and incomplete healing of 2 cases on the acquisition of stability. CONCLUSION: It was suggested that meniscal repair leaving posterior horn tear may be healed if both stabilities of the torn area and the knee joint were maintained.

Correlation between Anterior and Posterior Obliquity of the Sliding Lag Screw and Stability in Unstable Intertrochanteric Fractures

PURPOSE: To investigate the characteristics of the sliding pattern of the proximal fragment (head and neck) in unstable intertrochanteric fractures, which were fixed with a dynamic hip screw (DHS) with anterior to posterior or posterior to anterior insertion angle in the axial view. MATERIALS AND METHODS: AO type A2.1 intertrochanteric fracture was reproduced in 10 proximal femur model (Synbone, Malans, Switzerland). Five fractured models were reduced and fixed using DHS with anterior to posterior insertion angle (group 1) and five models were fixed with posterior to anterior angle (group 2). Load of 500 N (30 cycles) was applied to the fracture fragment-plate complex using Instron 6022. Data on the distance of sliding and the angle of rotation of the proximal fragment were collected and analyzed. RESULTS: No significant difference was noted statistically in the distance of sliding between the two groups (p=0.92). However, the mean angle of rotation was 13.4degrees and 8.0degrees in group 1 and 2, respectively and the difference was statistically significant (p=0.012). Anterior cortical fracture of distal fragment was noted in 3 cases of group 1. There was no fracture of the anterior cortex in group 2. CONCLUSION: In unstable intertrochanteric fracture, the insertion angle of the lag screw in axial view does seem to play a role in the fate of bone-plate complex. Early eccentric contact of both fragments caused rotation of the proximal fragment in all cases and anterior cortical fracture of the distal fragment in 3 cases of group 1.

A Comparative Study of Donor Site Morbidity between Patients with or without Iliac Donor Site Reconstruction after Anterior Thoracolumbar Spinal Fusion using Auto-Iliac Tricortical Strut done Graft / 대한척추외과학회지

STUDY DESIGN: A comparative retrospective study between those who have and have not undergone donor site reconstruction after thoracolumbar spinal anterior interbody fusion using an auto-iliac bone graft. OBJECTIVES: To determine the efficacy of iliac reconstruction in reducing iliac donor site morbidity. SUMMARY OF LITERATURE REVIEW: An autogenous bone graft harvested from the iliac crest is still the gold standard for spinal anterior interbody fusion. However, defects of a significant size often remain in the donor site, which may cause pain, pelvic instability and cosmetic deformity etc. Iliac donor site reconstruction with bone cement is one of the methods for reducing the donor site morbidity, with a relatively easy technique. MATERIALS AND METHODS: A review of patients who underwent iliac bone graft harvesting, with or without reconstruction, by a single orthopaedic surgeon was conducted. The iliac donor site morbidity, at least one after remote surgery was compared in those who had and had not undergone iliac reconstruction. All patients were evaluated by an independent observer. During a two and half year period, 61 patients met the inclusion criteria. Twenty-three patients underwent iliac donor site reconstruction with bone cement and 9 with auto rib bone reconstruction, while the remaining 29 had no donor site reconstruction. Patients were asked to assess the duration and severity of their donor site pain, using a visual analogue scale (VAS), and other morbidity, such as cosmetic deformity. RESULTS: The severity of chronic donor site pain was significantly reduced in the donor site reconstruction group; however, there were no statistically significant differences, other than chronic pain, in the morbidities. CONCLUSIONS: Iliac donor site reconstruction, with bone cement or auto-rib bone, is a relatively easy technique to perform after anterior spinal fusion. Better results can be expected, especially in reducing postoperative donor site pain.