Arthroscopic Adhesiolysis of Partial Knee Ankylosis / 대한정형외과학회잡지

Partial knee ankylosis is a recognized complication of following open operative procedure, trauma and disease processes about the knee. Intraarticular trauma or surgical procedures such as TKR, synovectomy or patellar fracture were main source of intraarticular or extraarticular soft tissue adhesion and contracture were resulted from distal femoral and proximal tibial fractures. The purpose of this study is to report the value of arthroscopic adhesiolysis of partial knee ankylosis and to evaluate the clinical results of its application in various conditions. From October 1982 to December 1992, 56 cases in 54 patients who had severe limitation of motion in the knee joint following open operative procedure or trauma about the knee were treated by fibroarthrolysis under the arthroscopic control. For release of thick fibrous tissue, we used our designed blunt metal bar. The following results were obtained. There were 30 males and 24 females and the age at the time of release ranged from 20 to 69 years old(average 38.7 years old). The interval between last open operative procedure or trauma and arthroscopic adhesiolysis ranged from 3 months to 6 years(average 16 months). The interval between arthroscopic adhesionlyssis and the last follow up evaluation ranged from 1 year to 9 years(average 49 months), The average preoperative range of knee motion was 42.2 and the postoperative range of motion under the anesthesia was 115.5 and the average final knee range of motion at follow up was 101.3. So the average loss of motion between postoperative and final motion was 14.2. Complications were one case of patellar and tibial condylar fracture respectively. In the author's experience, arthroscopic adhesiolysis seems to be applied to the various condition of the partial knee ankylosis and the results are better than the other surgical procedures when it was performed early enough16).

Arthroscopic Manipulation in Frozen Shoulders / 대한정형외과학회잡지

Frozen shoulders improve mostly by the conservative management, such as medication therapy and positive physical therapy. Despite the vast majority regain motion and have reduced pain with gentle but persistent exercises, patients do not always spontaneously recover motion. Arthroscopic manipulation may be recommanded in patients whose symptoms last more than 6 months or when the conservative treatment fails and severe stiffness is primarily originated. Nineteen cases of frozen shoulder underwent arthroscopic manipulation under the general anesthesia from February, 1990 to February, 1992. All but one case had shoulder pain and 13 cases(68.4%) had trivial trauma history at the time of symptom onset. One of the chief complaint was the limitation of motion; abduction: 19 cases, external rotation: 17 cases, flexion: 13 cases, extension: 11 cases, internal rotation: 8 cases and adduction: 7 cases. Average abduction range at the time of admission was 63.9°. In the average 23 months follow up(15 months to 3 year 2 months), painless was shown in 13 cases and significantly decreased pain in 6 cases, and all the patients were satisfactory with the results. The range of the abduction motion was changed from 64° to nearly normal. All of the patients improved by 1 month to 4 months, average 2.9 months. We propose arthroscopic manipulation could be recommended in the treatment of frozen shoulder if an appropriate conservative treatment is not effective.

Total Knee Replacement in Rheumatoid Arthritis / 대한정형외과학회잡지

The symptoms of the rheumatoid arthritis are variable enough to be ranged from mild to severe case. Synovectomy, fusion, and total knee replacement are to be applied according to the site and degree of involvement as surgical treatments. In the analysis, we compare the result of PCL retention TKR patients with those of PCL sacrificing TKR patients and of cemented TKR patients with those of cementless TKR patients. Function of the knee was evaluated using the knee score system of the Hospital for Special Surgery. From Nov, 1982 to Nov. 1990, total knee replacment was performed on 128 knees in 77 patients with rheumatoid arthritis at the Kyung Hee University Hospital and were followed for from two to ten years(average, four years eleven months). 1. The age at operation was ranged from 21 years to 72 years(average 53.2 years). There were seventy one female and six male patients. 2. The cruciate sacrificing prosthesis(group I ) were 42 cases and cruciate retention prosthesis(group II) were 86 cases. 3. The average preoperative range of motion was 85. 5 degree and the average post-operative range of motion was 107. 7 degree. Group I changed from 74. 7 degree to 105. 8 degree and Group II changed from 90. 5 degree to 108. 5 degree. 4. The average preoperative flexion contracture was 28. 7 degree and average post-operative flexion contracture was 7.8 degree. Group I changed from 37 degree to 8.4 degree and Group II changed from 24. 7 degree to 7. 5 degree. 5. The average preoperative tibiofemoral angle was varus 7. 4 degree in 69 cases and valgus 7. 6 degree in 59 cases. The average postoperative tibiofemoral angle was valgus 7. 2 degree. 6. The average preoperative knee Rating Score was 35. 2 point and the average postoperative score improved to 82. 7 point. Group I changed from 31. 3 point to 79. 4 point and Group II changed from 37 point to 84. 2 point. 7. 107 cases were cemented TKR and the 21 cases were cementless. There was no significant difference in those groups. 8. Additional operations were THR in eight cases, TER in five cases, TAR in four cases, TSR in one case, TWR in one case, Swanson prosthesis in one case, knee synovectomy in two cases, elbow synovectomy in three cases, and wrist synovectomy in two cases. 9. Complication included loosening in one case, partial ankylosis in three cases, and deep infection in one case.

Tumors in the Sacrum: 7 cases report / 대한정형외과학회잡지

Tumors of the sacrum are relatively uncommon. The diagnosis is difficult, especially in the early phase of the disease, because the clinical manifestations are nonspecific, the clinical signs may be vague and the radiologic changes are needed to differentiate from intestinal gas shadow. The clinical features are sacral pain, sensory change on perineum, urination difficulty, constipation, and sciatica. Seven cases of sacral tumor were treated at the Department of Orthopaedic Surgery, Kyung Hee University, from October 1981 to October 1992, and the results were as follows: 1. Because of the variability of the sacral tumor, we cannot define the most common tumor. 2. There is difficult in early diagnosis of the tumor, because the symptoms of tumor are similar to that of lumbar disc herniation and the radiologic findings are subtle. 3. CT and MRI are very effective methods to detect the tumor in the sacrum. 4. Curettage, excision, resection, sacrectomy and internal fixation were done according to the kinds of tumors and the amount of bony destruction.

Arthroscopic treatment of knee adhesion in total knee patient / 대한정형외과학회잡지

No abstract available.