Anatomical Single-bundle Anterior Cruciate Ligament Reconstruction Using a Freehand Transtibial Technique

PURPOSE: In anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel. SURGICAL TECHNIQUE: We present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique. MATERIALS AND METHODS: Between January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 12 months post-operatively. Clinical evaluation was done using the Lysholm score and International Knee Documentation Committee (IKDC) grade. All patients were analyzed by 3-dimensional computed tomography (3D CT) at 1 week after surgery. RESULTS: The mean Lysholm score improved from 68.2+/-12.7 points preoperatively to 89.2+/-8.2 points at final follow-up. At final follow-up, the IKDC grade was normal in 42 patients and nearly normal in 13 patients. None of the patients had a positive pivot shift test, anterior drawer test and Lachman test at final follow-up. The anatomical position of the femoral tunnel was confirmed on 3D CT scans. CONCLUSIONS: The three-point freehand technique for SB transtibial ACL reconstruction is a simple, anatomic technique showing good clinical results.

Spontaneous Healing of a Displaced Bucket-Handle Tear of the Lateral Meniscus in a Child

Bucket-handle tears less frequently occur in the lateral meniscus than in the medial meniscus. An 11-year-old male patient complained of painful swelling and locking due to a displaced bucket-handle tear of the lateral meniscus. We recommended an arthroscopic surgery; however, the patient left the hospital without surgical treatment. Six weeks afterwards, he returned without any complain of pain and he regained full range of motion. The final follow-up magnetic resonance imaging showed reduction of the torn meniscal fragment without any signal changes suggestive of a meniscal tear. We report a rare case of an isolated displaced bucket-handle tear of the lateral meniscus in an 11-year-old patient that healed spontaneously without surgical intervention.

Result of Midfoot Fusion with Locking Plate / 대한족부족관절학회지

PURPOSE: The purpose of this study was to compare and analyze the results of midfoot arthrodesis with locking plate fixation and the other instruments. MATERIALS AND METHODS: Twenty one patients, a total of 22 feet who underwent midfoot arthrodesis at our institution were reviewed retrospectively from January 2006 to December 2011. Locking plates were used in 9 cases, and the other instruments such as K-wires, screws, staples were used in 13 cases. Radiologic union time was evaluated and compared between both groups. Preoperative & postoperative AOFAS midfoot scores were evaluated and compared as clinical results. RESULTS: The average AOFAS score was rising from 69.7 to 89.4 in locking plate group and from 67.6 to 80.7 in the other instrument group. There was no statistically significant difference in two groups (p=0.179). The mean radiologic union time was 10.2 weeks in locking plate group, 12.6 weeks in the other instrument group with no significant difference (p=0.062). One case of peroneal nerve irritation was detected as a complication in locking plate group. One case of peroneal nerve irritation and 1 case of superficial wound infection with skin sloughing were detected in the other instrument group. CONCLUSION: There was no statistically significant difference for union time and clinical results in both groups. A locking plate can be one of the useful option for midfoot arthrodesis.