The Correlation of Tunnel Position, Orientation and Tunnel Enlargement in Outside-in Single-Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a frequently described phenomenon. The possible etiology is multi-factorial with some mechanical and biological factors. Among those, we intended to determine the relation between the location and orientation of the femoral tunnel and the femoral tunnel enlargement after outside-in single-bundle ACL reconstruction. MATERIALS AND METHODS: A retrospective study including 42 patients who received single-bundle ACL reconstruction with the outside-in technique was conducted. Femoral and tibial tunnel locations were evaluated with the quadrant method and bird's-eye view using volume-rendering computed tomography. The angle and diameter of bone tunnel and the degree of tunnel enlargement were evaluated using standard radiographs. RESULTS: The degree of femoral tunnel enlargements were 42% and 36% on the anteroposterior (AP) and lateral radiographs, respectively, and the degree of tibial tunnel enlargements were 22% and 23%, respectively. Shallower location of the femoral tunnel was significantly correlated with greater femoral tunnel enlargement on the AP radiograph (r=0.998, p=0.004) and the lateral radiograph (r=0.72, p=0.005) as was the higher location of the femoral tunnel on the AP radiograph (r=-0.47, p=0.01) and the lateral radiograph (r=-0.36, p=0.009) at 12 months after surgery. CONCLUSIONS: This study revealed that more anterior and higher location and more horizontal orientation of the femoral tunnel in coronal plane could result in widening of the femoral tunnel in outside-in single-bundle ACL reconstruction.

The Results of Unstable Distal Radius Fracture Following Volar Locking Plate Fixation in Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purposes of this prospective study were to find out whether the reduction is maintained 1 year after the volar locking plate fixation of unstable distal radius fracture in elderly patients, and to evaluate the effect of the patient's age and bone mineral density (BMD) on the maintenance of radiographic reduction. MATERIALS AND METHODS: Thirty-eight patients aged 65 years or older, with an unstable distal radius fracture were treated by open reduction and internal fixation with the volar locking plate system. Plain radiographs of the wrist, obtained immediately after surgery, were compared with those taken 1 year postoperatively. The evaluated radiographic parameters included radial inclination, volar tilt, ulnar variance and step off. The authors also evaluated correlations between patient factors of age and BMD and the postoperative changes of the four radiographic parameters. RESULTS: Initial surgical reduction of unstable distal radius fractures was maintained in all 38 patients for 1 year after surgery. No significant correlation was found between patient factors of age, and BMD and the postoperative changes of radiographic parameters during the first year after surgery. CONCLUSION: Using volar locking plate for initial reduction was maintained until bony union in elderly patients and showed satisfactory outcome. Also, there was no correlation found in between postoperative changes of radiographic parameters, and the age of patients and BMD until the final bony union.

Radiological and Clinical Outcome after Simple Discectomy of Central Massive Lumbar Disc Herniation

STUDY DESIGN: This is a retrospective case control study. OBJECTIVES: To analyze our results following simple discectomy of central massive disc herniation focusing on instability for the usefulness of intervertebral fusion. SUMMARY OF LITERATURE REVIEW: Lumbar instability is a complication of central massive disc herniation. However, there is limited evidence on the correlation between lumbar instability and loss of disc material. MATERIALS AND METHODS: A total of 25 patients who had undergone discectomy for a single-level lumbar disc herniation were followed up for two years. The clinical group (group A) included 12 patients that had a compromised canal with greater than 50% of the herniated disc, while the central axis of the herniated disc was less than 20% deviated from the center axis of the spinal canal, as seen on MRI. The control group (group B) had 13 patients that had a compromised canal with less than 50% of the herniated disc while their axis was more than 20% deviated from the center axis of the spinal canal. Clinical and radiologic instability, pain and functional disability were compared between the two groups. RESULTS: No differences was found between the two groups in clinical instability, radiological instability, visual analogue scale (VAS), and the Oswestry disability index (ODI). CONCLUSIONS: Central massive disc herniation after discectomy did not show a significant difference in clinical or radiological instability from that of other herniation types.