Anatomic Reconstruction of the Lateral Ankle Instability Using the Semitendinosus Allograft Tendon and Interference Screws / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcome of the anatomic reconstruction of the lateral ankle instability using the semitendinosus allograft tendon and the interference screws. MATERIALS AND METHODS: This study is based on the 12 feet of lateral ankle instability that had been treated with anatomic reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) using the semitendinosus allograft tendon and the interference screws. The majority of patients were young and physically active. We evaluated the patients' VAS pain scores, AOFAS scores and Karlsson-Peterson ankle scores for the 11 feet involved with at least 12 months follow up, both pre- and post-operative. In addition, we evaluated patient satisfaction. We measured the talar tilt angles and the talar anterior translations from ankle stress views. RESULTS: The average age at surgery was 25.9 years old (19-57 years); patients had symptoms of recurrent sprain for average 31.4 months before surgery. The average follow up period was 14 months. For reconstruction, we used 4.0mm thick allograft semitendinosus tendon and interference screws. VAS pain scores decreased from 6.0 to 1.1 (p<0.05) and AOFAS scores improved from 70.4 to 90.4 postoperatively (p<0.05). Karlsson-Peterson ankle scores improved significantly from 54.6 to 92.4 (p<0.05). Radiographic talar tilt decreased from 15.7degrees to 3.2degrees postoperatively (p<0.05). Eighy-two percent of the patients were satisfied with the results and the patients had returned to their jobs by 3.7 months after surgery. CONCLUSION: Anatomic reconstruction of the ATFL and the CFL in the lateral ankle instability patients using the semitendinosus tendon and the interference screws is an ideal surgical option especially for young athletes with high grade instabilities.

Short-term Results of the Total Ankle Arthroplasty with HINTEGRA(R) Total Ankle Prosthesis / 대한족부족관절학회지

PURPOSE: End-stage ankle arthritis is frequently combined with ankle-hindfoot deformity or ankle instability and therefore additional surgical procedures are often required when performing total ankle arthroplasty. We report the short term clinical and radiographic results of the total ankle arthroplasty with/without the combined adjunctive surgical procedures. MATERIALS AND METHODS:The study is based on the 17 ankles (16 patients) of end-stage ankle arthritis that were treated with HINTEGRA(R)Total ankle prosthesis (Newdeal, Lyons, France) total ankle arthroplasty (TAA) from 2004 to 2007 with at least 12 months follow-up. The combined adjunctive procedures as well as the VAS pain score, AOFAS score, radiographic measurements and patient satisfactions were evaluated. RESULTS:Average follow-up period was 29 months (13~55 months) , and the age was average 62 years (39~75 years) old. Among total of 17 ankles, varus deformity and lateral ankle instability were found in 4 cases and 3 cases respectively. Twenty additional procedures such as Achilles triple hemisection (9), calcaneal displacement osteotomy (4) and lateral ankle ligament reconstruction (3) were performed in adjunct to TAA in 13 ankles. VAS pain score improved from preoperative average 8.4 (7~10) to 2.0 (0~5) and the AOFAS functional score improved from 41.8 points (13~71 points) to 90.6 (77~100 points) at final follow-up. Ninety-four percent of the patients were satisfied with the surgery. CONCLUSION: We confirmed that many adjunctive combined surgical procedures are often necessary in addressing the end-stage ankle arthritis (74%) with total ankle arthroplasty. We also achieved quite good clinical and radiographic short term results, although the long term follow-up study with larger number of cases are needed in the future.

Outcome of Nonoperative Treatment for Proximal Plantar Fasciitis: Comparative Analysis According to Plantar Fascia Thickness / 대한족부족관절학회지

PURPOSE: To evaluate the clinical outcome of proximal plantar fasciitis after nonoperative treatment, and also to find the correlation of the heel pain with the plantar fascia thickness measured by ultrasonography. MATERIALS AND METHODS: The study is based on 41 patients, 46 feet of the proximal plantar fasciitis that were treated conservatively with at least 12 months follow-up. All were treated with heel pad, Achilles and plantar fascia stretching and pain medications for at least 3 months. Heel ultrasonography was performed at the beginning of the treatment to measure the plantar fascia (PF) thickness and the echogenicity. PF thickness over 4 mm and less were grouped in to group A and B respectively to compare the clinical outcome. RESULTS: Average thickness of the PF at the calcaneal attach was 5.2 mm. Symptom duration before the treatment was average 13.2 month; group A being 14.6 months and group B being 9.0 months with no significant difference (p=0.09). As functional evaluation, Roles-Maudsley score improved from 3.4 initially to 2.3 at final follow-up, while morning heel pain also improved from average VAS pain score of 7.2 to 4.0. However Maudsley and VAS score both didn't show statistical difference between the 2 groups (p>0.05). CONCLUSION: Plantar fasciitis improved substantially with the nonoperative treatments. However, the 2 groups, divided according to 4 mm thickness by ultrasonography, didn't show significant difference in either symptom duration or in the clinical outcomes.

Percutaneous Vertebroplasty in the Treatment of Osteoporotic Compression Fracture (99 Patients, 171 Vertebral Bodies)

PURPOSE: This study was designed to compare the clinical and radiologic outcome of the patients who underwent percutaneous vertebroplasty among the groups based on follow-up period and BMD. MATERIALS AND METHODS: A total of 99 patients (171 vertebral bodies) underwent percutaneous vertebroplasty from January 2001 to September 2003. The patients were divided into 3 groups by follow-up periods, and also divided into 2 groups by BMD. We investigated the difference of radiologic and clinical effects among the groups. Radiologic findings was assessed as vertebral height restoration rate and rate of reduction loss by measurement of the height of vertebral body. The clinical outcomes were graded into 5. The statistical analysis was done using Chi-squire test and Independent-samples T test. RESULTS: Among the groups divided by follow-up period, there was no statistically significant difference of clinical and radiologic results except the rate of reduction loss between group I and group III (p>0.05). Between the groups divided by BMD, there was no statistically significant difference of clinical and radiologic results. CONCLUSION: Percutaneous vertebroplasty with bone cement for the osteoporotic compression fracture is an efficient procedure and considered as technique producing pleasurable clinical and radiologic results regardless of follow up-period and BMD.

The Effect of Aprotinin for Reducing Blood Loss and Amount of Transfusion in Total Knee Arthroplasty

PURPOSE: To evaluate the effect of Aprotinin in reducing postoperative blood loss and amount of transfusion in total knee arthroplasty. MATERIALS AND METHODS: In a prospective study, 100 patients undergoing bilateral total knee arthroplasty were investigated. A low dose Aprotinin was administred in randomly selected fifty patients and the other fifty patients were selected as control group. Postoperative blood loss, the amount of intraoperative and postoperative transfusion, preoperative and postoperative value of hemoglobin and hematocrit were evaluated and statiscally compared. Postoperative complications were assessed. RESULTS: Significant reduction in postoperative total blood loss was observed (Aprotinin group:1195 ml, control group:2216 ml). The amount of packed red blood cells transfusion was also reduced in Aprotinin group (Aprotinin group: 2.0 units, control group: 4.0 units), and fresh frozen plasma (Aprotinin group: 0.1units, control group: 1.2 units) as well. Aprotinin also reduced the decline in hemoglobin and hematocrit levels at the first, second and fourth postoperative days. There were no clinical evidence of complications such as anaphylactic shock, deep vein thrombosis, thromboembolism, myocardiac infarction and acute renal failure. CONCLUSION: Aprotinin is safe and effective in reducing postoperative blood loss and amount of blood transfusion in total knee arthroplasty.