Intraoperative Graft Isometry in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: Little is known about the isometry of anatomic single-bundle anterior cruciate ligament (ACL) tunnel positions in vivo although it is closely related to graft tension throughout the range of motion. The purpose of this study was to evaluate intraoperative graft isometry in anatomic single-bundle ACL reconstruction in vivo. MATERIALS AND METHODS: Graft length changes were assessed before bio-screw fixation in the tibial tunnel by pulling the graft with tensions of 20 lbs and 30 lbs in full extension at flexion angles of 30°, 60°, 90°, and 120°. RESULTS: At the flexion angle of 30°, 20 lbs and 30 lbs of tension showed −0.4 mm and −0.6 mm length changes, respectively. The greater the flexion angle of the knee, the shorter the graft length in the joint. At the flexion angles of 90° and 120°, there was significant difference in the graft length change between 20 lbs and 30 lbs of tension. CONCLUSIONS: Anatomic single-bundle ACL reconstruction was non-isometric. The graft length was the longest in full extension. The tension of graft became loose in flexion. At the flexion angles of 90° and 120°, there was significant difference in the graft length change between 20 lbs and 30 lbs of tension.

Tendinopathy as Sports Injury: Characteristics and Management / 대한스포츠의학회지

With increased participation in sporting activity, overuse tendon injuries are a major problem in sports medicine. Tendinopathy is generic descriptive term for the clinical conditions in and around tendons arising from overuse. Tendinopathy is debilitating condition that results in significant deficits in performance and prolonged time away from activity. Histological studies show either absent or minimal inflammation. There are three main theories to explain the development of tendinosis, including the mechanical theory, vascular theory, and neural theory. Risk factors are divided into intrinsic factors and extrinsic factors. The management of tendinopathy revolves around modulating tendon pain, as pain is the presenting and limiting factor for activity. Despite an abundance of therapeutic options, the scientific evidence base for managing tendinopathies is limited. The aim of this review is to report the options for most widely used conservative management of tendinopathy.

A Systematic Review of Interspinous Dynamic Stabilization

BACKGROUND: A systematic literature review of interspinous dynamic stabilization, including DIAM, Wallis, Coflex, and X-STOP, was conducted to assess its safety and efficacy. METHODS: The search was done in Korean and English, by using eight domestic databases which included KoreaMed and international databases, such as Ovid Medline, Embase, and the Cochrane Library. A total of 306 articles were identified, but the animal studies, preclinical studies, and studies that reported the same results were excluded. As a result, a total of 286 articles were excluded and the remaining 20 were included in the final assessment. Two assessors independently extracted data from these articles using predetermined selection criteria. Qualities of the articles included were assessed using Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The complication rate of interspinous dynamic stabilization has been reported to be 0% to 32.3% in 3- to 41-month follow-up studies. The complication rate of combined interspinous dynamic stabilization and decompression treatment (32.3%) was greater than that of decompression alone (6.5%), but no complication that significantly affected treatment results was found. Interspinous dynamic stabilization produced slightly better clinical outcomes than conservative treatments for spinal stenosis. Good outcomes were also obtained in single-group studies. No significant difference in treatment outcomes was found, and the studies compared interspinous dynamic stabilization with decompression or fusion alone. CONCLUSIONS: No particular problem was found regarding the safety of the technique. Its clinical outcomes were similar to those of conventional techniques, and no additional clinical advantage could be attributed to interspinous dynamic stabilization. However, few studies have been conducted on the long-term efficacy of interspinous dynamic stabilization. Thus, the authors suggest further clinical studies be conducted to validate the theoretical advantages and clinical efficacy of this technique.

Clinical Outcome of Simple Discectomy for Recurrent Lumbar Disc Herniation

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To analyze the clinical outcomes of simple discectomy in patients with recurrent lumbar disc herniation. SUMMARY OF LITERATURE REVIEW: There are two methods of studying the treatment of recurrent lumbar disc herniation. The first type of study considers fusion for the prevention of complications such as postoperative lumbar segmental instability and persistent back pain. The second type of study assumes that simple discectomy without fusion is sufficient in the surgical management of recurrent lumbar disc herniation. MATERIALS AND METHODS: Sixteen patients who underwent simple discectomy due to recurrent lumbar disc herniation were followed up over 3 years. The mean age was 52.8 years (38-68 years). The mean follow-up period was 75.4 months (36-144 months). VAS scores for back pain and radiating lower leg pain were each compared pre- and post-operatively. The Oswestry Disability Index (ODI) was used to analyze the clinical outcome. A modified MacNab's outcome was used to evaluate patient satisfaction. Subjective survey data in a Delphi checklist was reviewed to verify clinical lumbar instability. RESULTS: The mean back pain VAS score showed 87.5% improvement (p<0.001). The mean lower leg VAS score showed 89% improvement (p<0.001). The mean preoperative ODI score was 29.9, and the mean score checked at the last follow up was 3.5. It thus showed 88.3% improvement (p<0.001). Excellent or good satisfaction was reported by fourteen patients (87.5%), and clinical lumbar instability was identified in one patient (6.3%). CONCLUSIONS: Simple discectomy without fusion is one of treatment option for recurrent disc herniation without instability.

Morphologic Changes of the Posterior Cruciate Ligament on Magnetic Resonance Imaging before and after Reconstruction of Chronic Anterior Cruciate Ligament Ruptures

PURPOSE: The purpose of this study was to compare the morphologic change of the posterior cruciate ligament (PCL) on magnetic resonance imaging (MRI) in chronic anterior cruciate ligament (ACL) tear before and after reconstruction. MATERIALS AND METHODS: On the MRI image after ACL reconstruction, a base line (BL) was drawn between the femoral and tibial insertion sites of the PCL. Point A was established as the vertically farthest point from BL. Line 1 and 2 were drawn respectively between point A and the insertions of PCL. The angles between BL and Line1 and 2 were defined as angle a and angle b. Correlations between the preoperative anterior knee instability assessed with the KT 1000 arthrometer and the parameters were evaluated. RESULTS: The average angle a was 52.3degrees+/-7.1degrees preoperatively and 30.1degrees+/-3.4degrees postoperatively, and the average angle b was 28.95degrees+/-4.62degrees preoperatively and 22degrees+/-2.9degrees postoperatively (p<0.05). The preoperative manual maximal side-to-side difference was 7.2+/-2.3 mm, which had no significant correlation with angle b. CONCLUSIONS: The preoperative buckling of PCL in the case of chronic ACL injury disappeared after ACL reconstruction. The degree of PCL buckling had no correlation with the degree of preoperative anterior instability.