New Light upon Your Shoulders

No abstract available.

New Light upon Your Shoulders

No abstract available.

Physical Examinations of Rotator Cuff Tear

Successful treatment of any pathological condition of the shoulder requires an accurate diagnosis. Physical examination represents an integral part of the assessment of shoulder disorders. Pain, loss of strength, decreased range of motion, and instability are the most common symptoms caused by a great variety of different shoulder pathologies. Therefore, a sophisticated clinical approach to the patient with shoulder pathology is essential. A standardized evaluation including a variety of diagnostic tests and clinical assessments improves the diagnostic accuracy by specifically examining one component of the shoulder complex. In most cases a careful physical examination will establish or suggest a diagnosis and special investigative techniques such as imaging procedures can be applied more selectively for confirmation or further evaluation of the pathological entity.

Clinical Findings of the CompleteRadial Rupture of the Meniscal Root Ligament of the Medial Meniscus Posterior Horn: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical findings of a complete radial rupture of the meniscal root ligament of the medial meniscus posterior horn. MATERIALS AND METHODS: From April, 2004 to December, 2004, nineteen patients (mean age, 56.5 years old) who were diagnosed with a medial root ligament rupture of the medial meniscus posterior horn during an arthroscopic treatment were enrolled in this study. The clinical findings, physical examinations, and the radiological and arthroscopic findings were analyzed retrospectively. RESULTS: Thirteen out of the nineteen cases had tenderness of the knee without specific trauma. The preoperative physical examination revealed posteromedial joint line tenderness in fifteen cases. A medial joint line protrusion with direct tenderness was observed in six cases (31.5%) and a positive McMurray test was observed in seventeen cases (89.5%). MRI was carried out in sixteen patients. All sixteen patients were diagnosed with a rupture of the meniscal root ligament using the author's diagnostic MRI criteria. CONCLUSION: Non-traumatic pain and posteromedial joint line tenderness in patients in their sixth decade are indications of a rupture of the meniscal root ligament of the medial meniscus posterior horn. Confirmation using MRI and arthroscopy is important for making a diagnosis.

Treatment of Periarticular Fracture of Elbow with Hinged External Fixator

PURPOSE: To evaluate the result of the treatment with external fixator and early ROM exercise to prevent the stiffness and contracture of the elbow in unstable elbow injury. MATERIALS AND METHODS: From Jan. 1997 to Dec. 2001, ten patients of unstable elbow injury treated with hinged external fixator and early ROM exercise were evaluated. The age was average 37 years. The patients were followed at least 1 years and motorcycle injury (4 cases) was most common. Nine cases were comminuted fractures and one case was fractures with dislocation. We estimated the result of the treatment with Mayo elbow performance index. RESULTS: ROM exercise started in average 2 days after operation. Two cases were treated by ilizarov and eight cases treated by elbow distracter modified by the author. The result of the treatment was estimated as following: excellent in two, good in three cases, fair in eight cases, and poor in two case. CONCLUSION: There were satisfactory results in patients treated with external fixation with early ROM exercise, whose injuries had difficulty in being fixed internally. The authors recommend hinged external fixation and early ROM exercise to prevent postoperative stiffness & contracture of elbow joint in this circumference.

Arthroscopic Bankart Repair and Rotator Interval Plication by Transglenoid Technique: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopic Bankart repair and rotator interval plication by the transglenoid technique on Traumatic Unidirectional Bankart Surgery (TUBS) with concomitant rotator interval widening. MATERIALS AND METHODS: From May 2002 to May 2003, 13 cases who underwent arthroscopic Bankart repair and rotator interval plication by the transglenoid technique were studied, out of the 14 cases that were diagnosed as TUBS with concomitant rotator interval widening. Follow up period was at least 1 year. Results were evaluated by Rowe score before and after surgery. RESULTS: All the cases were male. Nine cases were on the right shoulder and 4 on the left. The mean age was 22 years old (range, 14-26 years old). The mean duration from injury to operation was 4.3 (range, 1.3-10) years. The Rowe score was improved from 58.3 to 86.4 (p=0.00). Overall outcomes were excellent in 10 cases, good in 2 and fair in 1 at final follow up. There was no sulcus sign in any of the cases at the last follow up, and redislocation did not appear in any of the cases during the follow up period. CONCLUSION: In the treatment of TUBS with concomitant rotator interval widening, arthroscopic Bankart repair and rotator interval plication by the transglenoid technique have made good results.

Resection of the Proximal Tendinous Portion in Avulsion of the Semimembranosus Tendon from the Ischial Tuberosity in an Adult: A Case Report / 대한정형외과학회잡지

Hamstrings are composed of the semimembranosus and semitendinosus and biceps femoris muscles and act as extensors of the thigh and flexors of the leg. Avulsion of the hamstring from the ischial tuberosity has a high rate of incidence among adolescents and young adults, and most often results from exercises that require sudden acceleration and deceleration, such as running, soccer, hurdling and basketball. This injury, caused by forcible flexion of the hip with the knee extended, is commonly called "hurdlers' injury". There have been several reports describing treatment of hamstring proximal tendon avulsion injury by open reduction and internal fixation. We describe a case of semimembranosus tendon avulsion from the ischial tuberosity in the adult that was satisfactorily treated by resection of the proximal portion of the tendon.

Modified Phemister Technique with Mersilene Tape Augmentation in the Acute Acromioclavicular Joint Dislocation

PURPOSE: To find out the consequences of the surgical treatment of acromioclavicular joint dislocation, using modified Phemister technique with Mersilene tape augmentation. MATERIALS AND METHODS: We chose 26 patients who were able to follow up 1 year or more among the patients who were diagnosed as acromioclavicular joint dislocation in our hospital through February 2001 to March 2003 and took modified Phemister surgery with Mersilene tape augmentation. Patients with clavicle fracture were excluded. Evaluation of the surgical results was done with the condition or pain, function, range of motion by using Imatani evaluation system, and preoperative, postoperative and last follow up radiographs. RESULTS: Most of the cases showed satisfactory result. Clinical evaluations were 16 excellent (62%), 10 good (38%), radiological evaluations were 14 excellent (54%), 10 good (38%), 2 fair (8%), and no poor group. On the final follow up six cases showed vertical translation, but none had clinical symptoms. Seven cases showed a little inflammation at where pin were inserted, but after the removal of the pin, the inflammation was gone. CONCLUSION: The modified Phemister surgery for acromioclavicle dislocation is simple, but we can obtain strong fixation, and there is no burden of the removal of the metal plate, or complication of re- dislocation after the removal of the pin, so it is thought as a very effective surgery.

Operative Treatment of Traumatic Humeral Shaft Fracture: Comparision of Interlocking IM Nailing and Plate Fixation by Posterior Approach

PURPOSE: To compare the results and complications of interlocking IM nailing and plate fixation by posterior approach in the treatment of traumatic humeral shaft fracture MATERIALS AND METHODS: From March 1997 to March 2003, 49 patients undergone operation due to traumatic humeral shaft fracture. Follow-up was over one year. 28 patients operated with interlocking IM nailing initially and 21 operated with plate fixation by posterior approach prospectively. Statistics were compared using clinical and radiological outcomes and complications. RESULTS: Radiologically, bone union was observed after an average of 14.3 weeks in IM nailing, and 11.7 weeks in plate fixation. So plate fixation showed earlier bone union (p=0.012). Nonunion occurred in 4 cases (14.3%) operated with IM nailing, and 1 case (4.8%), that was open shaft fracture, with plate fixation. Nonunion occurred more frequently when operated by IM nailing. 6 cases showed limitation of shoulder movement due to damage of the rotator cuff by IM nail entry site. 1 case showed radial nerve palsy, and 1 case showed axillary nerve palsy in the case of IM nailing. Also, secondary surgery due to complications was operated in 9 cases (32.1%) in IM nailing and 1 case (4.8%) in plate fixation (p=0.03). CONCLUSION: In the case of traumatic humeral shaft fracture plate fixation by posterior approach was more useful than IM nailing in the decrease of complications and bone union. Such approach is thought to be an excellent method for anatomic reduction and nerve exploration in the case of open and comminuted fracture which accompany nerve injuries

Operative Treatment of Metacarpal Shaft Fracture>: Comparision of Low-Profile Miniplating System and Kirschner Wire Fixation

PURPOSE: To compare Kirschner wire fixation and low profile miniplating system in metacarpal shaft fracture. MATERIALS AND METHODS: Patients, available at least 1 year, who received the operative treatment after being diagnosed as metacarpal shaft fracture from 1997 May to 2003 May were the subjects with the exclusion of thumb fracture and intraarticular metacarpal bone fracture and also cases involving Kirschner wire fixation on severe laceration or open fracture. On the last follow up total action motion (TAM) and plain radiographes was checked. RESULTS: In 7 cases (38.9%) where closed reduction and Kirschner wire fixation were carried out, 8 cases (61.5%) where open reduction and Kirschner wire fixation were carried out and 24 cases (88.9%) where open reduction using miniplate and screw showed either excellent or good results on TAM. 5 cases of dorsal angulation occured in closed reduction and Kirschner wire fixation group and 4 cases of dorsal angulation in open reduction and Kirschner wire fixation group however no cases of dorsal angulation occured in open reduction and miniplate and screw fixation group, and in all cases no rotational deformity, complications through ulnar or radial angulation occured. Internal fixation was carried out on 2 cases of nonunion which had closed reduction and Kirschner wire fixation carried out, while the rest all showed bony union. CONCLUSION: Selective use of low profile miniplate and screw fixation in the metacarpal shaft fracture is more effective than in cases of comminuted fracture which can not be achieved firm fixation by Kirschner wire fixation. Low profile miniplate and screw fixation can get more precise anatomical reduction and firm fixation so it allow early return to daily living activity and show low complication rate.

Radiologic and Clinical Findings of Anterior Femoroacetabular Impingement in Early Osteoarthritis of the Hip / 대한정형외과학회잡지

PURPOSE: A patient diagnosed with early osteoarthritis due to hip pain who went through arthroscopic treatment were studied in the radiologic aspect and clinical aspect of anterior femoroacetabular impingement (FAI). MATERIALS AND METHODS: The subjects were 43 early osteoarthritis patients from May 1995 to May 2003 who underwent arthroscopic treatment and were able to be followed for at least 1 year. These patients were divided into two groups, the first group with patients who had no osteoarthritis on simple radiograph but with degenerative changes of the labrum and cartilage on MR arthorgram and arthroscopy, and the second group with osteoarthirtic findings on simple radiograph. Both groups were checked to see if they showed signs of anterior FAI at the acetabulum and proximal femur on radiograph and MR arthrogram. Improvement after surgery was evaluated using the JOA (Japanese Orthopaedic Association) pain score. RESULTS: About FAI, 6 patients (29%) out of 21 in group 1 showed radiologic evidence of FAI, while 12 of out 22 (56%) had it in group 2, with a total of 18 patients (42%). The pain score of pre/post operation were improved in group 1 which showed evidence of FAI and while the score of group 2 were improved from 0.83 to 1.83 and 0.92 to 1.67 in group 2. And the pain score of the group 1 which showed no evidence of FAI were improved from 0.73 to 2.60 and the score of group 2 were improved from 0.60 to 2.10. As a result, there was small improvement in pain scores of patient group with FAI. CONCLUSION: Among the patients who were diagnosed with early primary osteoarthritis of th hip, we could find anterior femoroacetabular impingement in the radiogram in some cases and the patients with FAI have low pain relief. Therefore we can expect more improved clinical result with inspection of the anterior FAI.

A Comparison of Closed Reduction and Open Reduction in Children with Fracture of Lateral Humeral Condyle / 대한정형외과학회잡지

PURPOSE: The fracture of humeral lateral condyle in children was classified and the complications and results were analyzed according to the treatment modality and the types of fracture. MATERIALS AND METHODS: 92 patients who could be followed up one year or more, and were treated for a humeral lateral condyle fracture from May 1995 to May 2001 were studied. 66 cases were male, 26 cases were female, and 79 cases were under 9 years of age. The Milch stage I encountered in 12 cases, and II in 80 cases. Jacob stage I were encountered in 15 cases, stage II in 59 and stage III in 18 cases. Conservative treatment was performed in 9 cases and surgery was performed in 83 cases. A closed reduction and internal fixation with K-wire was performed in 18 cases, and an open reduction and internal fixation was performed in 65 cases. RESULTS: The change in the carrying angle was not clinically significant except for 7 cases, with a cubitus varus and cubitus valgus deformity. The change in the carrying angle showed an average -1.3 (from +7 to -18). The results according to the Hardacre criteria were `excellent' in 46 cases, `good' in 41 and `poor' in 5. Regarding the complications, bony spur formation was encountered in 8 cases, overgrowth of the lateral condyle and cubitus varus in 4, cubitus valgus in 3, avascular osteonecrosis in 3, premature epiphyseal fusion in 2, nonunion in 2, delayed union in 1, fish-tail deformity in 1, local infection in 5, range of motion limitation in 2 and transient radial nerve palsy in 1 case. CONCLUSION: Humeral lateral condylar fractures have a high rate of complications and clincally significant complication appeared mainly in stage II and III. This suggests that more a careful dissection of the soft tissue and anatomical reduction in Jakob stage III is required in cases of an open reduction.

Arthroscopic Treatment of the Lipoma Arborescens in All Compartments of the Knee: A Case Report / 대한정형외과학회잡지

Lipoma arborescens is a villous proliferation of fatty tissue in the synovial membrane, and known causes are trauma, meniscal injury, inflammation, infection, degenerative change, tumor, and so forth. The reported cases are extremely rare. We report a case of lipoma arborescens developed in all compartments of the knee joint, and treated well with arthroscopic surgery.

Conservative Treatment of the Displaced Clavicular Shaft Fracture in Multiple Injury

PURPOSE: To analyse the comparative clinical results between adults with multiple injury including the clavicular shaft fracture and only clavicular shaft fracture who had supportive care through retrospective aspect. MATERIALS AND METHODS: We had 48 adult patients in this hospital with simple fracture and multiple injury including the clavicular shaft whom we were able to evaluate at least more than a year. 12 of 48 patients were with only clavicular shaft fracture and the rest of them were with multiple injury. We classified patients into two groups those who had fracture with displacement for group A (A1 for the cases with over 50% of fracture surface contact rate and A2 for less than 50% from the images of simple X-ray) and those who had comminuted fracture for B. We compared the time of bone union, nonunion rate of only clavicular fractures and multiple injury, clinical results for patients who had supportive care with retrospective aspect. RESULTS: A1 (7 cases), A2 (4 cases), B (1 case) were prevalent in the group of only clavicular shaft fracture and A1 (8 cases) and A2 (16 cases) and B (12 cases) were prevalent in the group of multiple injury. For the cases with supportive care, we could find 1 nonunion case (8%) and 11 union cases on average 2.91 months in the group of only clavicular shaft fracture and 7 nonunion cases (19%) and 29 union cases on average 3.58 months in the group of multiple injury. The best clinical results had occurred in 8 cases (67%) of only clavicular shaft fracture group and 19 cases (53%) of multiple injury group. We could find out the union from all 8 nonunion cases that took operation afterward. CONCLUSION: Although the choice of treatment of clavicular fracture is supportive care, but multiple injury including the clavicular fracture is a high-energy injury, so the possibility of comminuted and displacement is high, so that nonunion rate is high. The possibility of early surgery must be considered seriously.

A Comparative Study of Behavioral and immunohistological Changes after Spinal Cord Injury between Young and Adult Rats / 대한정형외과학회잡지

PURPOSE: The aim of this study was to compare the behavioral and immunohistochemical changes in a spinal cord injury (SCI) between young and adult rats and to clarify the differences in the mechanism underlying the changes in a SCI between young and adult rats. MATERIALS AND METHODS: A total of 25 young and 25 adult male Sprague-Dawley rats (5 weeks and 16 weeks old) were used. The rats were anesthetized with pentobarbital and laminectomies were carried out at the level of the 11th and 12th thoracic vertebra. Using a modified New York University Impactor, a SCI was induced by dropping a 10 gm weight at a height of 20 mm. The bladders were emptied manually twice a day to prevent urinary problems. The animals that received no surgery were used as the normal controls. Behavior tests were performed using the Basso-Beatti-Bresnahan (BBB) scoring system, 1 and 7 days after the weight drop injury. The difference in the BBB score between the young and adult rats were analyzed by a paired t-test with a p value <0.05 considered significant. The injured spinal cords were dissected at 1 and 7 days after surgery. H-E stain and immunohistochemistry for c-Jun and GFAP were performed in the spinal cord sections. The immunoreactions were visualized by incubation for 1 hour at RT in an avidin-biotin-peroxidase complex in PBS and 5-10 min in 0.05% 3, 3 -diaminobenzidine and 0.01% H2O2 in 0.1 M PBS. RESULTS: The hind limbs of young rats were paralyzed 1 day after surgery, but had recovered partially 7 days after surgery. However, the adult rats remained in the paralyzed status 7 days after surgery. The c-Jun expression level increased in the gray matter up to 7 days after the weight-drop injury in adult rats. The c-Jun expression level increased significantly in the gray matter 1 day after the injury in the young rats. However, the c-Jun expression level decreased significantly in the gray matter 7 days after the injury in the young rats compared with that of the 1 day post-injury. The GFAP expression level in the gray matter increased 1 day after the weigh-drop injury in the adult rats. However, it decreased in the necrotic region 7 days after the injury in the adult rats. GFAP expression in the gray matter increased gradually up to 7 days after the injury in the young rats. CONCLUSION: These results suggest that lack of recovery from a SCI in adult rats may be related to the continuous upregulation of c-Jun expression and/or the downregulation of GFAP after the weight-drop injury. In contrast, the upregulation of GFAP expression and/or the downregulation of c-Jun expression in the spinal cord might be related to a partial recovery in young rats after a weight-drop injury.

Expressions of the p53 and MDM-2 Genes in Primary Chondrosarcoma and Secondary Chondrosarcoma from Osteochondromatosis / 대한정형외과학회잡지

PURPOSE: To evaluate the relationships between mutations of the p53 and MDM-2 proteins in human primary chondrosarcoma and in secondary chondrosarcoma from osteochondromatosis. MATERIALS AND METHODS: From January, 1984 to April, 2000, 33 cases were grouped into three categories: Group I, osteochondromatosis (18 cases), group II, secondary chondrosarcoma (6 cases), group III, primary chondrosarcoma (9 cases). We analysed the expressions of the p53 and MDM-2 proteins. All specimens were embedded in paraffin and stained using the Streptavidin-Biotin peroxidase method with anti-p53 antibody, and DO7 anti-MDM-2 antibody IF2 as monoclonal antibody. RESULTS: The expressions of the p53 and MDM-2 proteins, the pathologic grade of each group, and clinical outcomes were compared and analysed. The expressions of the p53 and MDM-2 proteins in each group were significantly different (p<0.05). However, MDM-2 protein expression was similar between group II and III. Both p53 and MDM-2 protein were expressed most frequently in group III and this was significant. There was an increased manifestation of the p53 and MDM-2 protein in the higher pathologic grade. The 5-year survival rate of patients with a malignant tumor was about 70%. In expired patients, the histologic grade was grade III, and both proteins were expressed, which enabled a relationship to be established between p53 and MDM-2 protein expression and a poorer prognosis. CONCLUSION: In osteochondromatosis, the coexpression of the p53 and MDM-2 proteins was not observed, but isolated p53 or MDM-2 expression was observed in some cases. According to this study, it is helpful as a basic study for early detection of malignant translation of osteochondromatosis. In conclusion, we suggest that the expressions of the p53 and MDM-2 proteins are useful indicators of prognosis.

Various Pathologic Lesions Associated with Anterior Shoulder Instability: Experience over 10-Years of Arthroscopic Treatment / 대한정형외과학회잡지

PURPOSE: We report upon the frequency and results of treatment for various pathologic lesions such as ALPSA lesions, capsular laxity, mid-capsular tear and HAGHL lesions in cases of anterior shoulder instability. MATERIALS AND METHODS: Two hundred and four consecutive patients with anterior shoulder instability underwent arthroscopic repair and the outcomes were evaluated according to various lesions and treatment modalities in a retrospective study afte a minimum of one year elapsed after surgery. RESULT: All 24 cases of ALPSA lesions were treated using the arthroscopic transglenoid suture technique. Clinical results were excellent in 18 cases. Of 67 cases of capsular laxity, type IV Bankart lesion was combined in 42. 47 cases were treated with the transglenoid technique and 20 with the transglenoid suture technique and capsular shrinkage. The clinical results were excellent in 45 cases. All 11 cases of mid-capsular tear were treated with its combined lesion, and the clinical results proved to be excellent in 8 cases. Of the 4 cases of HAGHL lesions, all cases were treated with the direct suture technique, and 2 had excellent clinical results. CONCLUSION: In the case of anterior shoulder instability, various pathologic lesions as well as Bankart lesion can be found. Therefore, the evaluation of the exact pathologic lesion causing instability and its appropriate treatment are important for satisfactory surgical outcomes. The arthroscopic transglenoid suture technique is one of the most useful methods of reconstruction in various pathologies of shoulder instability.

Classification and Treatment of SLAP Lesion / 대한정형외과학회잡지

PURPOSE: The Snyder's classification of SLAP lesion has many limitations in clinical use, His classification has no correlation with the mechanism of jnjury and treatment. Therefore, new rational classification oriented with injury mechanism and its treatment was needed. MATERIALS AND METHODS: This is a retrospective study of 74 patients with SLAP lesion which were found during arthroscopic treatment of 194 patients diagnosed with recurrent shoulder dislocation, impingement syndrome or SLAP lesion between March 1989 and January 1997. Mean follow-up time was 36 months (range, 18 to 72 months) and average age of patients was 26 years old (range, 17-47 yrs). All patients were arthroscopically examined and treated. We classified the SLAP lesion into 3 groups according to the stability of biceps anchor. Group I had superior labral tear (flap tear or bucket-handle tear or degenerative tear) with intact biceps stability, group II had disturbed biceps anchor (unstable shoulder), and group III is a mix of group I and II. By our classification, group I was 32 cases, group II was 31 cases, and group III was 11 cases. We treated the SLAP lesion according to our new classification. Group I was treated with arthroscopic debridement, group II with stabilization of biceps anchor, and group III with arthroscopic debridement and stabilization of biceps anchor. RESULTS: The result by the Rowe rating scale was excellent or good in 29 cases of 32 in group I, 25 cases of 29 in arthroscopic transglenoid suture technique group and 1 case of 2 in the group treated with biodegradable tack (Suretec) in group II, and 10 of 11 cases in group III. There was only one case of postoperative recurrence and no complication was found. Our transglenoid suture technique had a reasonable recurrence rate with few complications. CONCLUSIONS: Thus we propose our new classification and treatment of SLAP lesion, and arthroscopic transglenoid suture technique for the treatment of SLAP type II and III.

An Experimental Study about the Effect of Tibial Lengthening on the Soft Tissue in Rabbits / 대한정형외과학회잡지

Most studies of limb lengthening have concentrated on the osteotomy. In the present study, the response of soft tissue (muscle, artery, nerve) to different length, rates or rhythms of distraction have been investigated to define the nature of any damage and to see whether new muscle is created. The purposes of the this study are to evaluate the optimum condition for soft tissue during limb lengthening and to study the effect of different rates & rhythms of tibial lengthening on the soft tissue in rabbits hy observing the changes of muscle, artery and nerve. We lengthened the right tihiae of fifty-four growing New Zealand white rabbits by callotasis. The left tibiae were used as control. The rabbits were divided into three different rates & rhythms groups: Group 1 (increments of 0.5mm /day, divided 2 times/day), Group II (increments of 0.5mm/day, divided 3 times/day), Group III (increments of 10mm/day, divided 2 times/day). Each Group was subdivided into three lengthening groups: 1 ( 10% lengthening), 2 (20% lengthening), 3 (30% lengthening). At the end of lengthening, histopathologic & histomorphometric studies were done on the medial heads of gastrocnemius muscles, the posterior tibial artery and the posterior tibial nerve. In the histopathological study, these were stained by hematoxylin eosin, PAS and observed by light microscopy. Electron microscopic examination was done in all samples. In light microscopic findings, the sum of scores of the following five suhjects, each counted from 0 to 3, were analysed for individual groups between the experimental side and the control by the Mann-Whitney test and the kruskal-Wallis test. The following conclusions were made hased on the above observations; 1. There was no significant difference between groups I, II and III, but there was a significant dif-ference between the 10%, 20% and 30% lengthening groups by histopathologic study. And the predominant responses of muscle to the lengthening were atrophy and endomysial fibrosis. 2. There was no change in the proportion of the muscle fiber types by histomophomeric study. 3.ln the initial phase, the muscle adaptation to the gradual lengthening was attained by sliding in Jess than 20% distraction but finally the muscle was regenerated by new muscle formation. 4. Major soft tissue complication to the gradual lengthening was induced by muscle. But arteries & nerves were well adapted to the gradual lengthening up to 30% Iengthening.

MR Findings of Chondromalacia Patella: Correlation of the Grade and Associated Lesions with ArthroscopicFindings

PURPOSE: To assess the MR findings of chondromalacia patella and correlate the grade and associated lesionswith the arthroscopic findings. MATERIALS AND METHODS: Twenty-five patients with pain in the anterior part of theknee underwent fat-suppressed axial and coronal T2-weighted, dual echo sagittal proton density-weighted andT2-weighted, and in some cases, T1-weighted and T2*-weighted imaging, using a 10-cm field of view, and a 5-inchgeneral purpose coil. We retrospectively assessed these find dings, and the locations, grades and associatedlesions, and correlated these with the arthroscopic findings. RESULTS: Fourteen cases(56%) of chondromalaciapatellae were arthroscopic grade I / II, nine(36%) were grade III, and two(8%) were grade IV; associated lesionswere medial synovial plicae (16 cases, 64%), meniscus tear (10 ; 40%), cruciate ligament injury (two ; 8%),complete or incomplete discoid meniscus (four ; 16%), bipartite patella (one ; 4%) and Osgood-Schlatter disease(one ; 4%). In 24 cases, MR imaging indicated chondromalacia patella ; 17 cases were grade I / II, five were gradeIII, and two were grade IV. the location of chondromalacia patella was the medial facet (five cases ; 20%), lateralfacet (three ; 12%), junction of the medial and odd facet (13 ; 52%), and diffuse involvement (four ; 16%). Thesensivity and specificity of MR imaging were 72% and 96% respectively. CONCLUSION: We evaluated the exact locationand grade of chondromalacia patella and associated lesions, as seen on MR images. These and the arthroscopicfindings showed close correlation, and in cases involving this condition, MRI is thus a useful indicator of anappropriate surgical method and plan.