Effects of Glucose on Blastocyst Formation and Their Cell Numbers of Mouse Embryos / 대한산부인과학회잡지

OBJECTIVE: Mammalian embryos undergo changes of energy environment for transfer from oviduct to uterus. An experimental design was used to examine the effects of glucose on the development in vitro of mouse embryos. METHODS: Two cell embryos were recovered from ICR female mice (3-4 weeks) at 46-50 hrs after 5 IU hCG injection (mated just after hCG injection) and cultured in 50 micro gram MEM droplets supplemented with nothing (control; n=46), 0.5 mM glucose (Group A; n=46) or 3.15 mM glucose (Group B; n=46) under mineral oil. All experimental media were supplemented with 20% human follicular fluid. Results were observed: (i) the number of zona-intact blastocysts (ZiB); (ii) the number of zona-escaped blastocysts (ZeB; hatching~hatched); (iii) the mean cell numbers; and (iv) the proportion of inncer cell mass (% ICM) in the blastocysts. RESULTS: Total blastocyst formation rates were (NS) in glucose groups (group A: 52.2; B: 47.8%) than control group (60.9%). ZiB rates the highest (p<0.05) in control (47.8%) than those in group A (21.7%) and B (28.3%). ZeB rates the highest (NS) in group A (30.4%) than those in control (13.0%) and group B (19.6%). Blastocysts, cultured in group B (50.5), had the highest (NS) mean cell numbers compared with the others (control: 39.2; group A: 45.6). The % ICM in blastocysts cultured in group A (20.6%) was the highest (NS) than those of other tested groups (control: 15.2%; group B: 13.9%). CONCLUSION: This study shows that a low dose of glucose added to culture medium increases the developmental capacity of 2 cell embryos in mice.

Clinical Application of N+7 Method for the Solution of Graft: Tibial Tunnel Discrepancy in Anterior Cruciate Ligament Reconstruction

PURPOSE: The purpose of this study is to prevent the graft-tunnel mismatching by N+7 method and to present the experience of the authors in anterior cruciate ligament reconstruction, using the patellar ten- don by N+7 method. MATERIALS AND METHODS: Authors analyzed 34 cases who had taken the anterior cruciate ligament reconstruction from April 1998 to July 1999, at Asan Medical Center, by N+7 method. By measuring the patellar tendon length(N), tibial guide was set an angle of N+7 degree. We analyzed the results by dividing the cases into 3 groups by the degree of extrusion of the bone plug from the tibial tunnel. RESULTS: Clinical results were acceptable in 79.4%(27 cases), protrusion in 8.8%(3 cases) and recession in 11.8%(4 cases). When the angle of tibial tunnel was less than 50 degrees, there wasn't a protruded case in 19 cases. Comparing with 15 cases of the angle which was larger than 50 degrees, there were three protruded cases. CONCLUSION: Clinical results of anterior cruciate ligament reconstruction using the patellar tendon, with N+7 method is superior to empirical methods which was performed by authors, previously at the point of positioning of ideal tibial tunnel and conveniency of the technique. Especially, if the graft tendon length is shorter than 43mm, N+7 method is preferable.

Reconstruction of the Posterolateral Instability of the Knee / 대한정형외과학회잡지

PURPOSE: This study reports the results of a treatment for posterolateral instability of the knee with a modified Muller's method. MATERIALS AND METHODS: Fourteen patients (3 acute and 11 chronic cases) with a modified Muller's method and with a follow-up period of more than 12 months, average follow-up period of 15 months (range, 12 to 22 months) was included. We recorded and analysed the physical findings (reverse Lachmann test and varus stress test at 30 degree knee flexion), stress roentgenograms at preoperative 8 postoperative 12 months, magnetic resonance imagings and Lysholm score at preoperative, postoperative 3, 12 months and the last follow-up. RESULTS: Average Lysholm score was 65A preoperatively and 90.0 at postoperative 12 months. The posterolateral stabilities of the knee were improved in all cases postoperatively, according to the clinical stability tests (reverse Lachmann test and varus stress test at 30 degree knee flexion) and stress roentgenograms. CONCLUSIONS: Modified Muller's technique-the reconstruction of the popliteus tendon using iliotibial band-represents an excellent method to restore tension in the posterolateral complex of the acutely and chronically injured knee.

Management of Acute Combined Injuries of the Medial Supporting Structures and Anterior Cruciate Ligament of the Knee

PURPOSE: We introduce the management protocol of medial structures-ACL combined injury patients in Asan Medical Center and evaluate the results of the management according to severity of medial injuries. MATERIALS AND METHODS: From Jan.1994 to May 1998, we treated 30 cases of acute combined injuries of medial structures and ACL. Unless the medial structures shows grade IIIwithout end point, we man-aged the medial structures conservatively and conducted ACL reconstuction . After that, we analysed the results of the management. Evaluation was based on the Lysholm knee scoring system, physical examina-tion and stress radiographs. RESULTS: The functional result by Lysholm knee scoring revealed 92.4/95.3(medial structures conserva-tive / repair groups) respectively. Except 1 case of persistent medial laxity in medial structures repair group, there was no severe complication in both groups. CONCLUSIONS: There was no significant medial laxity after conservative management in grade I,II,III with end point injury of medial supporting structures and we had good results in severe medial injury involving MCL, posterior oblique ligament in terms of ROM and stability with open repair of medial structures and delayed arthroscopic ACL reconstruction.

Effect of Ligament Fixation and Rehabilitation on Clinical Results in Arthroscopic PCL Reconstruction

The purpose of this study is to compare the effects of intraoperative fixation and postoperative rehabili-tation on postoperative results in arthroscopic PCL reconstruction. We analyzed the posterior stability of the knee on 47 patients(48 knees) with posterior cruciate liga-ment injury whose posterior cruciate ligament had been recostructed arthroscopically and followed for minimum 1 year period at Asan Medical Center from March 1993 to May 1998. The patients were divided into the two groups according to intraoperative fixation and postoperative rehabilitation. In A group, one interference screw or staple fixed in distal femur and proximal tibia irre-spective to bone quality and fixation strength during screw insertion, and rehabilitation was started as early as anterior cruciate ligament reconstruction. In B group, additional screw or staple was fixed if fixa-tion strength was weak during screw insertion, and delayed rehabilitation program was performed as schedule. Lysohm knee score was 65.3 in group A and 75.8 in group B preoperatively but 86.0 in group A and 86.5 in group B at last follow up postoperatively. posterior stability was determined by difference in pos-terior tibial translation between the injured and the opposite knee with Telos device. Differences in poste-rior tibial translation on average were 6.9 and 3.0 mmin group A and B, respectively. Conclusively, arthroscopic posterior cruciate reconstruction with firm fixation strength and delayed rehabilitation program is effective to restore more reliable posterior stability.

Valgus High Tibial Osteotomy for Osteoarthritis of the Knee / 대한정형외과학회잡지

Recently there has been decreasing trend of high tibial osteotomy in management of the gonarthrotic patients partly due to recurrence of the symptom and, more importantly, due to the relative success of the total knee joint replacement procedure. But there is still room for the high tibial osteotomy, although it may be 'outdated' procedure, in that younger active patients do well postopera- tively for an enough period of time and that even the older have some gain of pain-relief in early postoperative period. The purpose of this study is to detect the affecting factors of the result of the operation. We reviewed 25 valgus high tibial osteotomies in 23 patients who had medial gonarthrosis and could be followed-up more than 1 year among 32 cases between August 1989 and January 1994. The mean length of follow-up was 30 months(ranged twelve to fifty four months). The results were compared according to modified grading of the HSS score. All cases showed the increase of the score from preop. average 65.2 points to postop. 87.8 points, mainly by the decrease of pain and the increase of functional activity. The severity of degenerative change on the radiographs and the degree of varus seemed to be related with the early clinical results of the operation, but the age was not a major affecting factor. These results could be debatable due to some differences from the others', and long term follow-up would be needed.

Surgical Treatment of the Distal Radius Fracture / 대한정형외과학회잡지

Fractures of the distal radius are one of the most common injuries met in the orthopedic field. Once it was thought that good function comes despite of poor anatomic restoration in the distal radius fractures. But now there are wide consensus that more aggressive surgical treatments are needed in such complex fractures to fulfill the better clinical results. We reviewed 56 consecutive distal radius fractures of 54 patients treated surgically in Orthopedic Department of Asan Medical Center between October 1989 and July 1994. The mean length of follow-up was 29.2 months. Clinical end results were statistically analyzed according to each anatomi- cal variables and state of distal ulna, and anatomies and results were analyzed according to different surgical modalities in each fracture classes. Radial length and radial inclination was significantly correlated with clinical results. The clinical results were significantly worse when dorsal tilt exceeded 10. In intraarticular type of fractures, residual articular incongruency seems to be the significantly affecting factor of development of arthritis and the clinical result. The associated fracture of distal end of the ulna did not significantly affect the result. In same type of fracture class, achievement and loss of reduction, arthritis, and Demerit score show no significant differences between groups of different surgical modalities. Probably this is due to proper choice of modalities in each different situations.