Simple Postoperative Exercise of Acute Achilles Tendon Rupture without Active Range of Motion Exercise / 대한족부족관절학회지

Purpose@#Postoperative exercise for acute Achilles tendon rupture is important for a patient’s return to daily life and sports. On the other hand, the protocol requires considerable effort to educate patients and continuous checking. This study evaluated the outcome of a new simple and delayed rehabilitation protocol after Achilles tendon rupture repair. @*Materials and Methods@#From July 2014 to November 2020, one hundred eighty-three patients were operated on by one surgeon. The exercise protocol was classified into two methods. One group (immediate protocol, control group) started immediate full weight bearing with a 20° plantar flexion range of motion from two days postoperatively. Ankle dorsiflexion was restricted to 0°. The other group (delayed protocol, case group) started full weight bearing with a controlled ankle motion boot from two weeks postoperatively. No range of motion exercise was allowed until six weeks postoperatively. Age, sex, body mass index, ankle range of motion, muscle power, time to return to previous physical activity, functional score, and complication rate were evaluated. The results of the two groups were compared using a Mann–Whitney test. Statistical significance was set as p0.05). @*Conclusion@#Simple and delayed postoperative rehabilitation of acute Achilles tendon rupture without active range of motion exercises showed satisfactory functional results and a low complication rate.

Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture

Purpose@#This study compared the clinical and radiological results of the femoral neck system (FNS) and cannulated compression screws (CCS) for the fixation of femoral neck fractures. @*Materials and Methods@#Patients who underwent FNS or CCS internal fixation for femoral neckfractures between January 2016 and January 2022 were analyzed retrospectively. The hip joint function using the Harris hip score (HHS) was evaluated three months and one year after surgery. The operation time, fracture healing time, and associated surgical complications in the two groups were compared and analyzed statistically. @*Results@#Seventy-nine patients were categorized into 38 FNS and 41 CCS groups. The FNS group had a longer operation time and higher postoperative HHS at three months (p<0.01). Femoral neck shortening was lower in the FNS group (p=0.022). There were no significant differences in the fracture healing time and other complications. @*Conclusion@#There were no differences in most clinical outcomes and complications between the two groups except for the three-month HHS and femoral neck shortening. This study suggests that FNS could be an alternative to CCS for treating femoral neck fractures.

Treatment of Cervical Perineural Cyst by the Transforaminal Epidural Steroid Injection / 대한정형외과학회잡지

Perineural cysts are usually discovered incidentally; only approximately one percent of such cysts are symptomatic. Symptomatic cervical perineural cysts, of which only five case reports have been found in the literature, are extremely rare and there is no consensus regarding treatment. When a cervical perineural cyst is discovered in a patient with cervical radiculopathy without the cause of other apparent compression, the cyst can be considered as a possible cause of cervical radiculopathy. In such cases, non-surgical conservative treatment can be considered before any surgical intervention. We reported the successful treatment of case of a 40-year-old woman with a symptomatic cervical perineural cyst by oral steroids and transforaminal epidural steroid injection.

Huge Pseudoaneurysm of Popliteal Artery Following Conservative Treatment of a Distal Femur Fracture: A Case Report

A pseudoaneurysm is a contained arterial disruption in the intimal and medial layers of an arterial wall. It may originate from a perforation caused by traumatic or iatrogenic injury or the dehiscence of a surgical anastomosis. Because of its insidious onset and delayed presentation, orthopaedic surgeons should be aware of the possibility of such a lesion after an initial trauma. We report on a case of a delayed huge pseudoaneurysm of the popliteal artery that occurred 11 months after conservative treatment of a supracondylar fracture of the femur in order to keep in mind the possibility of the delayed presentation of vascular injury after a distal femur fracture.

Localized Pigmented Villonodular Synovitis in an Unusual Location in the Knee: A Case Report / 대한정형외과연구학회지

Localized pigmented villonodular synovitis (LPVNS) is a rare lesion that can affect any joint, although it is most frequently found in the knee. When LPVNS affects the knee, it is usually a single mass of pedunculated appearance. We present a LPVNS occurred from the junction of the anterior horn of the lateral meniscus and the joint capsule in the knee. It detached and then moved at an unusual location, which caused pain, limitation of knee flexion and locking.

Intramedullary Nailing of Distal Tibial Fractures with Percutaneous Reduction by Pointed Reduction Forceps

PURPOSE: The purpose of this study is to analyze the radiographic and clinical results of intramedullary nailing after percutaneous reduction using pointed reduction forceps for spiral or oblique fractures of the distal tibia. The benefit of percutaneous reduction using pointed reduction forceps in anatomical reduction and maintenance was assessed. MATERIALS AND METHODS: From January 2005 to December 2009, 47 cases of distal one-third tibial fracture were managed by intramedullary nailing using pointed reduction forceps. Thirty-eight cases were spiral fracture and nine cases were oblique fracture. In all cases, the percutaneous reduction was achieved using pointed reduction forceps under fluoroscopy control. While maintaining the reduction with the pointed reduction forceps, the intramedullary nail was inserted. The pointed reduction forceps were removed after insertion of proximal and distal inter-locking screws. Alignment was evaluated with anterior-posterior and lateral radiographs taken immediately post-operation and at the time of union. RESULTS: At immediate post-operation, the mean displacement of valgus and anterior angulation was 0.57degrees and 0.24degrees, respectively. That of valgus and anterior angulation at bone union was 0.37degrees and 0.16degrees, respectively. The average duration of bone union was 16.1 weeks. CONCLUSION: Intramedullary nailing with percutaneous reduction using pointed reduction forceps for distal tibial fractures was an easy and effective method for achievement of accurate alignment intra-operatively. Accurate alignment was successfully maintained until bone union.

Adjacent Vertebral Compression Fracture after Percutaneous Vertebroplasty

STUDY DESIGN: A retrospective study. OBJECTIVES: To find out the characteristics and the risk factors of adjacent vertebral compression fracture after percutaneous vertebroplasty. SUMMARY OF LITERATURE REVIEW: Percutaneous vertebroplasty is regarded as more effective treatment than conservative care, but additional fracture could cause complications during follow up. MATERIALS AND METHODS: We analyzed 43 patients who had only one vertebral compression fracture after one vertebroplasty. The number of patients who had additional compression fracture within one level from the operated vertebra were 23 cases (Group I); beyond two levels from the operated vertebra were 20 cases (Group II). We compared the onset period of additional compression fracture, the degree of osteoporosis, age, level, restoration of vertebral body height and kyphosis between the two groups. RESULTS: The onset period of additional compression fracture was 18.7+/-28.1 months in Group I and 42.7+/-39.4 months in Group II, showing significant difference between the two groups. Group I had more cases of previous vertebroplasty on thoraco-lumbar vertebra than Group II. The restoration rate of vertebral body height of Group I was 42.3+/-40.9% and that of Group II was 22.8+/-21.6%, which shows significant difference between the two. CONCLUSION: Adjacent vertebral compression fracture after vertebroplasty can occur earlier than non adjacent one. We need to pay attention to the patients who had higher restoration rate of vertebral body height after vertebroplsty as they are more prone to having additional adjacent compression fracture.

Long-term Results of Hybrid Total Knee Arthroplasty: Minimum 10-years Follow-up

PURPOSE: To evaluate the survival rate and long term clinical outcomes of hybrid total knee arthroplasty (TKA). MATERIALS AND METHODS: We retrospectively analyzed 113 hybrid TKAs (NexGen) in 86 patients that were followed for more than 10 years. Kaplan-Meier survival curves were generated using revision as an end point. Knee Society Score (KSS) and range of motion were evaluated for clinical assessment and plane radiographs were used to evaluate implant problems. RESULTS: At 11.2 years (range, 10 to 12.2 years) of follow-up on average, 7 knees required revision. The reason for revision was aseptic loosening in 4 knees (1 in femoral and tibial component and 3 in tibial component only) and infection in 3 knees. The survival rate was 93.8% at 12 years for all knees, and 96.5% when septic loosening was excluded. The KSS improved from 29.3 to 91.5 in the Cruciate-Retaining type (CR) and from 21.5 to 90.3 in the posterior stabilizing type (PS) at latest follow-up. The average range of motion was improved from 120.6degrees to 133.8degrees in the CR type and 119.5degrees to 135.5degrees in the PS type. CONCLUSIONS: Hybrid TKA provides good survival rates and clinical results comparable to cemented TKA.

The Length of the Patellar Tendon in Normal Adults

PURPOSE: This study was conducted to measure the length of the patellar tendon in normal adults and to analyze the effect of several anthropological variables on the patellar tendon length. MATERIALS AND METHODS: The study included 316 knees (278 males, 38 females) that were undergoing anterior cruciate ligament reconstruction with a bone-patellar-bone autograft. The patellar tendon length was measured on the middle 1/3 of the ipsilateral patellar tendon taken during the operation and we analyzed the relationships between the tendon length and age, weight, height and gender using simple correlation tests and linear regression analysis. RESULTS: The mean tendon length was 42.6 mm (range: 30~60 mm) and the mean age, mean weight and mean height was 32.7 years, 72.8 kg and 170.2 cm, respectively. There was weak negative correlation between the tendon length and age (Pearson correlation r=-0.187) and weak positive correlation between the tendon length and weight (r=0.288) but there was no significant correlation between tendon length and the body mass index (p=0.282) There was a positive correlation between tendon length and height (r=0.434). There was a significant difference between the males and females for the length of tendon (p<0.001), yet after removing the variance of height, the difference was statistically insignificant (beta=-0.041, p=0.491). The linear regression equation for the patellar tendon length (y, in centimeters) as a function of height (x, in centimeter) can be expressed as y=0.032x1.183. CONCLUSION: The length of the patellar tendon is correlated with height, and a patient's height can predict the length of the patellar tendon.

Factors Affecting the Range of Motion after Revision Total Knee Arthroplasty

PURPOSE: We aimed to analyze the clinical results and investigate the factors that affect the range of motion (ROM) after revision total knee arthroplasty. MATERIALS AND METHODS: We measured the range of motion from 61 knees of 55 patients who underwent revision total knee arthroplasty using the Nexgen(R) LCCK and we investigated the factors affecting the postoperative ROM, including age, the body mass index (BMI), the preoperative ROM, deformity, causes of revision (septic vs. aseptic) and the type of polyethylene inserts (constrained vs. posterior-stabilized). The clinical results and radiographic findings were assessed using the American Knee Society Score and the roentgenographic method of the American Knee Society. RESULTS: The mean range of motion was improved from 113.7degrees to 127.2degrees. The preoperative ROM (p=0.000) and diagnosis (p=0.006) significantly influenced the postoperative ROM, yet age (p=0.386), BMI (p=0.054), deformity (p=0.218) and the type of polyethylene insert (p=0.195) were not related to the postoperative knee ROM. The American Knee Society Knee Score and Function Score on average was improved from 31.7 and 27.9 points to 86.7 and 64.7 points, respectively. CONCLUSION: The range of motion and clinical results were satisfactory after revision total knee arthroplasty using the Nexgen(R) LCCK, and the important factors affecting the range of motion after operation were the preoperative ROM and the causes of revision. The range of motion after arthroplasty using the constrained type polyethylene insert was not inferior to that using the posterior-stabilized insert.

Recent Trend and Transition of Last 10 Years of Ski and Snowboard Injuries / 대한스포츠의학회지

To analysis the trend of ski and snow board injury, and use this study result in designing injuries prevention strategy. We studied 25,292 patients who had the ski and snow board injuries in a ski resort in Pyeongchang Gun, Gangwon Do, Korea during 1999-2001 season, 2005-2007 season, and 2008-2010 season. They were studied with a questionnaires, physical examination and radiograph. And the analysis was based on age, sex, injury type and site and slope level of difficulty. Snow board related injury have increased, injury to teens and thirties increased, injury to female snowboarder increased (p<0.001), contusion type of ski and snow board injury increased (p<0.001) and upper extremity injury increased but beginner grade slope injury (p<0.001) decreased since last 10 years. The overall type and site of ski and snowboard injuries have changed due to increased snowboard injury, gender and age of them have shown the diversity since last 10 years.

Bony Ankylosis Secondary to Heterotopic Ossification Following Total Knee Arthroplasty: A Case Report

Bony ankylosis secondary to heterotopic ossification following total knee arthroplasty is extremely rare, and to the best of our knowledge, there has been no reported case of this in Korea. We present such a case in a 48 year-old female who underwent primary total knee replacement due to traumatic osteoarthritis.

Treatment of the Acromioclavicular Joint Dislocation Using a AO Hook Plate

PURPOSE: We wanted to evaluate the results of treating acromioclavicular joint dislocation using an AO hook plate. MATERIALS AND METHODS: Between February 2008 and September 2009, 10 patients underwent implant removal after surgical treatment of acromioclavicular joint dislocation using a AO hook plate. The Constant-Murley scoring system was administered postoperatively for evaluating the clinical results, and simple X-ray was taken for evaluating the state of reduction. RESULTS: All cases showed satisfactory results on the clinical and radiological study. The mean Constant-Murley score at follow-up was 90.5 (range: 84~95). Three patients had some degree of discomfort with the hook plate, but these symptoms were relieved on removal of the plate. The radiological evaluation showed restoration of the vertical displacement of the clavicle in all the patients. No complications occurred such as infection, plate failure or redislocation after removal of the plate. CONCLUSION: The short term follow-up results of treating acromioclvicular joint dislocation using an AO hook plate were satisfactory both clinically and radiologically.

Patellofemoral Evaluation in Korean Patients using Three-dimensional Computed Tomography

PURPOSE: The purpose of this study was to analyze sex- and laterality-specific patellofemoral alignment using three-dimensional computed tomography (3D-CT) in normal Korean patients. MATERIALS AND METHODS: The study included 90 patients (45 men, 45 women; 180 knees) with no history of anterior knee pain or malalignment by physical examination. The mean patient age was 42.2 years (Range: 24~66 years). 3D-CT scanning was performed with each patient in the supine position with 15degrees of knee flexion. Patellofemoral joint alignment was evaluated by measuring the sulcus angle, congruence angle, lateral patellofemoral angle, condyle-patellar angle, and condyle-lateral angle. RESULTS: Comparing men and women, respectively, the sulcus angles were 145.9degrees+/-8.9 and 149.4degrees+/-9.7, the congruence angles were 12.6degrees+/-22.7 and 12.0degrees+/-19.6, the lateral patellofemoral angles were 9.9degrees+/-6.0 and 8.5degrees+/-4.3, the condyle-patellar angles (lateral facets) were 14.2degrees+/-7.1 and 11.8degrees+/-4.8, the condyle-patellar angles (patellar axes) were -8.5degrees+/-7.7 and -10.6degrees+/-6.1, and the condyle-lateral angles were 15.5degrees+/-7.6 and 16.4degrees+/-4.0. There was no significant difference in these measurements between left and right knees, but there was a significant difference in the sulcus angle and condyle-patellar angle between men and women (p<0.05). CONCLUSION: These data will hopefully serve as a basis for evaluating normal patellofemoral alignment and for diagnosing patellofemoral malalignment in Korean patients.

Relationship between the Arthritic Changes and a Deficiency of the Anterior Cruciate Ligament in Osteoarthritic Knees

PURPOSE: The aim of this study is to determine the relationship between the arthritic changes and a deficiency of the anterior cruciate ligament (ACL) in osteoarthritic knees. MATERIALS AND METHODS: Between May 2003 and January 2008, 815 cases of total knee arthroplasty that were due to degenerative osteoarthritis of the knee were enrolled in this study. Flexion contracture, the tibia-femoral angle, translocation of the tibial spine and erosion on the posteromedial tibial plateau were assessed and we tried to determine the relationship between these findings and an ACL-deficiency. RESULTS: The mean flexion contracture in the knees with a deficient ACL was 10.7degrees and this was 8.8degrees in the knees with an intact ACL, and this difference was statistically significant (p=0.001). The tibia-femoral angle of the patients with an ACL-deficiency was 7.97degrees varus on average, and that for patients with an intact ACL was 4.38degrees varus, and the difference was found to be highly dependent upon the ACL's integrity (p=0.000). 77.6% of the knees with varus deformity exceeding 15degrees showed an abnormal ACL. Translocation of the tibial spine doesn't predict ACL integrity. Bone erosion on the posteromedial tibial plateau was significantly frequent in patients with ACL-deficient knees (p=0.000). For the knees with erosion on the posteromedial tibial plateau, 85% of these knees showed an ACL deficiency. CONCLUSION: Varus deformity exceeding 15degrees and erosion on the posteromedial tibial plateau can reflect ACL deficiency.

Early Results of MIS-QS Total Knee Arthroplasty: A Comparison with Conventional Procedure for the Same Patient / 대한정형외과학회잡지

PURPOSE: This study assessed the early clinical and radiological results of Minimally Invasive Surgery- Quadriceps sparing total knee arthroplasty (MIS-QS TKA), and compared these results with those of conventional TKA. MATERIALS AND METHODS: Between August 2004 and March 2005, 17 patients with bilateral TKA on their one side using a regular procedure and the other using the MIS-QS technique were evaluated and compared. The clinical assessment was performed by measuring the range of motion, Knee Society Score, and a radiological evaluation by standing anteroposterior, supine lateral, and Merchant view preoperatively, 2 weeks, 6 weeks, 3 months and 1 year after surgery. Statistical analysis was performed using a paired t-test. RESULTS: The average range of knee motion was slightly larger in the MIS-QS group at all periodsbut there was no statistical difference between the two groups. The Knee Society Score was similar at the 3 month and 1 year periods. The alignment of the implants was satisfactory in both groups and postoperative patellar alignment checked in the Merchant view was better in the MIS-QS group at all periods. CONCLUSION: There were no differences in the clinical aspects at 1 year period between the two groups. However, the MIS-QS group showed better patellar alignment than the conventional group for up to 1 year.

Juxtacortical Glomus Tumor of the Tibia with an Uncertain Malignant Potential

Glomus tumors are mesenchymal neoplasms that are composed of modified smooth muscle cells of the normal glomus body. Most glomus tumors are benign and they occur in the distal extremities, and particularly the subungual lesions that occur in the hand, the wrist and the foot. We report here on a case of a solid type glomus tumor that had an uncertain malignant potential with a juxtacortical location at the distal tibia, and there were no neoplastic erosion of the cortical surface and no periosteal reaction. The tumor cells showed mild nuclear atypia and moderate mitotic activity (3-5/10HPF). Prominent intranuclear cytoplasmic pseudoinclusions were also observed. This case is interesting due to the very unusual tumor location of the juxtacortical area of the long bone, the atypical histologic features and the unique cytological finding of cytoplasmic intranuclear inclusions throughout the tumor cells.

Measurement of the Posterior Condylar Angle in Koreans : Comparison between Three Dimensional Computed Tomography Study and Magnetic Resonance Imaging Study

PURPOSE: This study is to measure the posterior condylar angle (the angle between the femoral epicondylar axis and the femoral posterior condylar axis) which is commonly used for determining the degree of femoral component rotation during total knee replacement with magnetic resonance imaging (MRI) and three dimensional computed tomography (3D CT) and to assess the difference of this angle in Koreans. MATERIALS AND METHODS: We examined the 257 knee MRIs and 118 knee 3D CTs. And we measured the clinical posterior condylar angle in MRIs, and the clinical and surgical posterior condylar angle in 3D CTs. RESULTS: The clinical posterior condylar angle on MRI was male, 5.56degrees and female, 5.81degrees (mean, 5.66degrees). The clinical posterior condylar angle was male, 5.48degrees and female, 5.85degrees (mean, 5.55degrees), and the surgical posterior condylar angle was male, 3.68degrees and female, 4.02degrees (mean 3.74degrees) on 3D CT. There was no statistical difference in clinical posterior condylar angle between MRI and 3D CT (p>0.05) and between male and female(p>0.05). CONCLUSION: There was no difference in clinical posterior condylar angle between MRI and 3D CT. We suggest that 3degrees external rotation of femoral component from posterior condylar axis may not be enough in Koreans during total knee replacement.

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.