The Result of Autologous Osteochondral Grafting for the Osteochondral Lesion of the Talus / 대한족부족관절학회지

PURPOSE: The purpose of this study is to assess the results of the autologous osteochondral grafting for the osteochondral lesion of the talus. MATERIALS AND METHODS: This study included 21 patient who had been treated with the open autologous osteochondral grafting between December, 1999 and December 2003. We treated the patients with autologous osteochondral grafting method who had the lesion of stage II or medial lesion of stage III without improvement for at least 6 months, the medial lesion of stage IV, the lateral lesion of stage III, IV by Berndt and Harty's classification or who had not improved with previous operation. The average duration of follow up was 26 (12-56) months. 6 patients had been treated with the previous operation that 3 patients with drilling, 3 patients excision, curettage and drilling. RESULTS: The average AOFAS Ankle/Hindfoot score was 92.7 points and no patient had a limitation of the daily activities due to pain or abnormal function. Postoperative radiography showed good joint congruency and postoperative MRI good incorporation of the graft. The average Lysholm knee score was 96 points and only two patients had mild knee pain during severe exertion. CONCLUSION: The autologous osteochondral grafting is the useful operative method when the lesion is advanced stage or when previous operative treatment has failed.

Recurrence Rate and Survival Analysis of the Lumbar Disc Herniation After Open Discectomy / 대한정형외과학회잡지

PURPOSE: The aim of this study was to estimate the true recurrence rate of lumbar disc herniation after open discectomy, and to compare these results with those from other studies. MATERIALS AND METHODS: From January 1992 to June 2002, the medical records and radiological findings, including a telephone survey were studied retrospectively. This study examined 306 cases, who had been operated by an open discectomy on a single level and had no other spinal lesions such as spondylolisthesis, spondylolysis, or spinal stenosis. MRI was used to confirm the diagnosis of a lumbar disc herniation in all cases. The recurrence of lumbar disc herniation was diagnosed only in those cases who had the same pattern of symptoms and was confirmed by MRI. The cases who had undergone additional surgery at another hospital at the same spinal level were also included as recurrence. In order to make up for weak points such the losses to a long term follow-up, statistical survival analysis was carried out using a life table method. In the life table method, the assumption is that all patients undergo surgery simultaneously. The longest follow-up duration was 11 years. RESULTS: In 252 of the 306 cases (82%), follow-up study was possible. The average duration of the follow-up was 5.9 years (from 1 to 11 years). The average age of the patients was 27.1 years (17 to 75), and the male to female ratio was 11.6: 1. The most common lesion of lumbar disc herniation was L4-5 (74%) at the initial diagnosis. The simple recurrence rate was 8.3% (21 cases) using the conventional method, in which the cases lost to follow-up were excluded. Survival analysis showed that, the annual recurrence rate was highest at the first year postoperatively as 3.4%, but decreased with time. At the last follow-up of 11 years, the cumulative survival rate was 88.9% and the recurrence rate was estimated to be 11.1% at final stage. CONCLUSION: Using survival analysis, the true rate of a recurrence of lumbar disc herniation after an open discectomy calculated. Even though the annual recurrence rate decreased with time, the true recurrence rate using the conventional method may be higher than the results obtained suggest.

The short term results of selective nerve root block in herniated lumbar disc patients / 대한척추외과학회지

STUDY DESIGN: A prospective study OBJECTIVES: To analyze the serial results of selective nerve root blocks in herniated lumbar disc patients. LITERATURE REVIEW SUMMARY: To our knowledge there has been no study demonstrating the serial efficacy of root blocks for patients with a herniated lumbar disc only. MATERIALS AND METHODS: Selective nerve root blocks were performed in 36 patients who had a lumbar disc herniation only, with radiculopathy, between November 2002 and April 2003. The diagnoses were made by CT or MRI, which agreed with the symptoms and physical examinations. There were 31 men and 5 women, with a mean age of 28.2 years. The mean interval between the onset and procedure was 7.6 weeks, ranging from 1 to 26 weeks. Mono- and double-segment injections were used in 18 cases, respectwely. The straight leg raising angle, visual analogue pain scale, and motor and sensory functions were investigated before, immediately, 2 days, and 1 and 3 months after the procedure. RESULTS: The mean straight leg raising angle improved significantly, from 28+/-9 degrees to 53+/-18 degrees, immediately, and was maintained until 3 months after the procedure (P<0.001). The visual analogue pain scale was also improved, from 4.6+/-0.9 to 2.0+/-1.5, immediately, and was maintained until 3 months after the procedure (P<0.001). Two of ten patients with motor weakness, and six of eighteen with sensory deficit were improved. There was no procedure related complication; however, surgical treatment was performed in two patients who showed no improvement until 3 months. CONCLUSIONS: Selective nerve root block is a safe and effective treatment method to obtain a rapid and remarkable improvement of radiculopathy in herniated lumbar disc patients.

The short term results of selective nerve root block in herniated lumbar disc patients / 대한척추외과학회지

STUDY DESIGN: A prospective study OBJECTIVES: To analyze the serial results of selective nerve root blocks in herniated lumbar disc patients. LITERATURE REVIEW SUMMARY: To our knowledge there has been no study demonstrating the serial efficacy of root blocks for patients with a herniated lumbar disc only. MATERIALS AND METHODS: Selective nerve root blocks were performed in 36 patients who had a lumbar disc herniation only, with radiculopathy, between November 2002 and April 2003. The diagnoses were made by CT or MRI, which agreed with the symptoms and physical examinations. There were 31 men and 5 women, with a mean age of 28.2 years. The mean interval between the onset and procedure was 7.6 weeks, ranging from 1 to 26 weeks. Mono- and double-segment injections were used in 18 cases, respectwely. The straight leg raising angle, visual analogue pain scale, and motor and sensory functions were investigated before, immediately, 2 days, and 1 and 3 months after the procedure. RESULTS: The mean straight leg raising angle improved significantly, from 28+/-9 degrees to 53+/-18 degrees, immediately, and was maintained until 3 months after the procedure (P<0.001). The visual analogue pain scale was also improved, from 4.6+/-0.9 to 2.0+/-1.5, immediately, and was maintained until 3 months after the procedure (P<0.001). Two of ten patients with motor weakness, and six of eighteen with sensory deficit were improved. There was no procedure related complication; however, surgical treatment was performed in two patients who showed no improvement until 3 months. CONCLUSIONS: Selective nerve root block is a safe and effective treatment method to obtain a rapid and remarkable improvement of radiculopathy in herniated lumbar disc patients.

Second-look Arthroscopic Findings after Anterior Cruciate Ligament Reconstruction: Comparison between Achilles allograft and Bone-Patellar tendon-Bone autograft

PURPOSE: The purpose of this study was to compare the arthroscopic findings between autograft group and allograft group minimal 1 year after anterior cruciate ligament reconstruction. MATERIALS AND METHODS: From Jul. 1999 to Feb. 2002, we performed second look arthroscopy to 55 patients(60 knees), who had already received anterior cruciate ligament reconstruction minimal 1 years ago(average 16 months) in our hospital. All patients visited our hospital just for removal of tibial hardware. Among 60 knees, 24 cases had operated using bone-patellar tendon-bone autograft(group 1), 36 cases using Achilles tendon allograft(group 2). We evaluated the clinical results by instability, subjective complaint and level of activity. Also we analyzed the second look arthroscopic findings by graft revascularization, fissuring, laxity and intraarticular general status. RESULTS: There was no differene in clinical results except 2 patients who complained mild anterior knee pain in group 1. At second look arthroscopy, well vascularized cases were 13 cases(54%) in group 1 and 15 cases(41%) in group 2 respectively. Fissuring of graft was more prominent in group 2(5 cases, 14%) rather than group 1(3 cases, 9%). Fibrous tissue formation around graft was found in 3 cases(14%) of group 1 and 7 cases(20%) of group2. According to Outerbridge grading system of articular cartilage, more than grade II change in patellofemoral joint were detected more prominently in group 1(7 cases, 32%) than group 2(7 cases, 21%). CONCLUSION: In clinical results, there was no difference between Achilles allograft and Bone-Patellar tendon-Bone autograft used for reconstruction of anterior cruciate ligament. On second look arthroscopy, patellofemoral arthrosis was more prominent in autograft group, but revascularization of graft and the change of perigraft tissue showed more favorable result.

The Study of Anatomical Measurement of Distal Femur and Compatibility of Femoral Prosthesis in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to provide the basic data for the anatomy of distal femur by real measurement, to determine the morphologic fit between the distal femur of Koreans and the femoral prostheses in total knee arthroplasty. MATERIALS AND METHODS: For 173 knees of 117 patients who underwent total knee arthroplasty, we measured the mediolateral width and the anteroposterior height of the distal femur during operation. RESULTS: The average mediolateral width of the distal femur was 68.4+/-4.3 mm, and the average anteroposterior height of the medial and lateral condyle were 59.0+/-4.7 mm and 60.8+/-4.0 mm respectively. the distal femurs of Koreans are smaller on average than the femoral prostheses used in Korea. The average ratio of height to width of the distal femur is 0.86+/-0.07, but the ratios of the five different kinds of femoral prostheses were not constant. So discrepancy between the ratio of the distal femur and the femoral prosthesis results in poor bony coverage. CONCLUSION: A more adequate femoral prosthesis is required to improve the compatibility to the distal femur. These results should contribute to the development of new model of femoral prosthesis for Koreans.

Evaluation of Patella Alignment using Computed Tomographic Image

PURPOSE: This study was evaluated to find out meaning of patellofemoral alignment related to anterior knee pain using computed tomographic image. MATERIALS AND METHODS: This study include 32 cases, 21 persons as a patient group which had been treated due to anterior knee pain related to tight lateral retinaculum from Jan. 1999 to Dec. 1999 and 36 cases, 18 persons as a control group which had no history of anterior knee pain and no abnormal finding malalignment by physical examination. Patellofemoral alignment was evaluated by measuring sulcus angle, congruence angle and lateral patellofemoral angle using computed tomographic images in 0 degrees and 20 degrees knee flexion patellofemoral alignment of the patient group was compared with that of the control group statistically. All 32 cases of the patient group had an arthroscopic lateral release and the patellofemoral alignment was rechecked on computed tomographic images. RESULTS: There was statistically difference between the average measurement of patient group and that of the control group on the computed tomographic images in 0degree and 20degree flexion of the knee. Also the average measurement after lateral release in patient group was corrected significantly. CONCLUSION: Laterally aligned patella during 0 degrees and 20 degrees knee flexion in computed tomographic should not be considered as normal variation but as pathologic condition related to anterior knee pain.

Avulsion of Pectoralis Major Tendon: A Case Report / 대한정형외과학회잡지

Avulsion of the pectoralis major muscle is a rare injury, with only about 20 cases reported in literature. Most cases occur in a younger, more athletic population. The object of this paper is to report our experience of a complete avulsion of the pectoralis major muscle from the insertion site of the proximal humerus and we obtained excellent result with immediate surgical repair and rehabilitation.

Osteochondritis Dissecans of the Femoral Condyles Treated with Operation in Adults

PURPOSE: Up to now, there are several controversies in many aspects of osteochondritis dissecans. In this paper, we have intended to evaluate the frequent location and the etiology of the osteochondritis dis-secans of the femoral condyles, and to assess the adequate modality of operative treatment and its results according to the modality. MATERIALS AND METHODS: We reviewed retrospectively forty-four knees in forty patients. We analysed their clinical and radiological finding to take the incidence at both condyles and its etiology and to estab-lish the modality of applied operative methods according to the status of the lesion. The performed operative methods were multiple drilling(1 case), fragment fixation(2 cases), curettage & multiple drilling(36 cases), osteochondral autotransplantation(5 cases). The majority of these operation was proceeded under arthroscopy. Its clinical results were assessed by Aichroth's result grading system after an average follow-up of two-years and eleven months(range, one year and two months to six years and one month). RESULTS: Twenty one cases were medial femoral condylar lesions, and 23 cases were lateral. 91% patients had had the history of the definitive trauma(20 cases) or the minor repetitive trauma in their envi-ronments(20 cases). After operative treatment, seven knees had an excellent result; twenty-nine, a good result; six, a moderate result; and two, a poor result. Satisfactory result was 82%. CONCLUSIONS: On the basis of this review, we suggest that there is no difference in incidence between both femoral condyles, and that the trauma is seemed to play a major role as an etiologic factor. Majority of operated patients showed satisfactory results after application of our treatment modality.

Comparison of the Results of PCL Reconstruction using Bone-Patellar Tendon-Bone by Open Method and Arthroscopic Method / 대한정형외과학회잡지

PURPOSE: To compare the results of posterior cruciate ligament reconstruction by open and arthroscopic method. MATERIALS AND METHODS: From 1995 to 1997, 18 reconstructions of posterior cruciate ligament were performed. Group 1 (open method) was composed of 9 cases and group 2 (arthroscopic method) was consisted of 9 cases. After 21-month follow-up, The two groups were compared by clinical and radiologic methods. RESULTS: Clinically, Lysholm knee score was 80 points in group 1 and 83 points in group 2 after operation. Post operative results by Hughston's criteria were good in 5, fair in 2 and poor in 2 cases (group 1) and good in 6, fair in 2 and poor in 1 cases (group 2). Radiologically, post operative average of posterior drawer stress view was 5.2 mm (group 1) and 5.0 mm (group 2). Almost double the operation time was taken to reconstruct posterior cruciate ligament by arthroscopic method than open method. There were technical errors in 2 cases performed by arthroscopic method. CONCLUSIONS: The results of both methods had no significant difference. We think that the reconstruction of PCL using patellar tendon by open method is a recommendable treatment method together with arthroscopic method, if the merits or demerits of both methods are considered carefully. But more long-term follow-up is necessary to compare the results of PCL reconstruction by open and arthroscopic methods.

The Efficacy of MRI in Anterior Cruciate Ligamant Injury

Ligament injuries of the knee joint are very common among competitive athletes. Acrurate assessment ot the nature of these injuries is a prerequisite for appropriate therapy. The purpose of this study is to evaluate the significance of MRI findings in assesing the status of ACL tear and associated injuries. 31 cases of ACL injuries were examined and reconstructed arthroscopically from Jan. 1997 to Sep. 1997 at Kyung Hee University Hospital. 1n all cases, we reviewed preoperative physical and MRI findings and performed postoperative radiologic assessments. Results were as follows; 1. Lachman test and Pivot shift test were positive in all 31 cases but anterior drawer test was positive in 29 case,s. 2. In MRI findings, 24 cases were interpretated as complete ACL tear and / cases as inccomplete ACL tear. But these 7 cases were confirmed as complete tear in mthroscopic exanunation with careful probing of ACL fiher. 3. MRI showed associated meniscal injuries in 19 cases(61%)-14 cases(74%) at medial meniscus, 5 cases(26%) at lateral meniscus. All cases were confirmed arthroscopically. In conc1usion, physical findings are more reliable than MRI findings in diagnosing the complete ACL tear and deciding the ACL reconstruction. But MRI findings are very helpful to assess the associated injuries and plan the treatments.

Arthroscopic Excision of the Complete Type of Suprapatellar Plica

The suprapatellar plica is a remnant of the embryonic septum separating the suprapatellar pouch from the knee joint. Complete type of suprapatellar plica is rarely reported and its clinlical significance is controversial. The purpose of this study is to verify the complete type of suprapatellar plica as an important cause of anterior knee pain and to evaluate the clinical results after arthroscopic excisien of it. From September 1991 to April 1997, we studied prospectively 54 patients, 90 knees which were diagnosed as cornplete type of suprapatellar plica preoperatively. The mean age was 32 years (15-57 years) and sex distribution was 14 males and 40 females. For the preoperative diagnosis, we checked clinical symptom, past history, physical finding and plain X-ray routinely and performed bone scan, double contrast arthrogram and MRI, if necessary. All patients complained vague anterior knee pain at standing, sitting, stair climbing and exercise for long times. All 90 knees were examined arthroscopically. Among them, 80 knees had complete type of suprapatellar plica and remaining 10 knees had other findings. After all, positive predictive value of preoperative diagnosis for complete type of suprapatellar plica was 89%. Among 36 patients diagnosed as bilateral preoperatively, 33 patients(92%) were confirmed as bilateral in arthroscopic examination. After arthroscopic excision of plica, clinical results were total relief of pain in 19 knees(24%), improvement in 55 knees(69%), no change in 6 knees(7%) and none of worsening. In conclusion, complete type of suprapatellar plica should be considered as an important cause of anterior knee pain especially which is vague, intermittent and bilateral.

Clinical Results of Unicompartmental Knee Arthroplasty / 대한정형외과학회잡지

The results of unicompartmental knee arthroplasty are still controversial. The purpose of this study is to evaluate the clinical results of three different component systems of unicompartmental knee arthroplasties. From December 1982 to January 1996, 106 unicompartmental knee arthroplasties were performed. There were 13 Modular II(group I), 47 Microloc(group II) and 46 Allegretto(group III) unicompartmental knee arthroplasties. Average follow-up period was 7 years 1 month. At the last follow-up, average knee score of Hospital for Special Surgery(HSS) was 92 points and average tibiofemoral angle was valgus 3.5 degrees. Among three groups, there was no significant difference in knee score of HSS and tibiofemoral angle. Twelve knees(11%) in all three groups have required revision. The causes of revision were six implant wears(all in group II), five implant loosenings(one in group I and four in group III) and one deep infection(in group II). In conclusion, the results of unicompartmental knee arthroplasty at average 7.1 years follow-up period were satisfactory. High incidence of insert wear in Microloc unicompartmental knee arthroplasty(group II) might be due to thin polyethylene insert supported by metal backed tibial tray.

Osteolysis around Screw in Cementless Total Knee Replacement / 대한정형외과학회잡지

Screw fixation of the tibial component offers advantages in initial fixation in cementless total knee replacement. But the high incidence of screw related osteolysis was reported. The purpose of this study is to evaluate clinical results of cementless total knee replacement and to look for radiographic changes at the screw-bone interface. From January 1988 to December 1991, primary cementless total knee replacements with Miller Galante I (Zimmer, Warsaw. IN) were performed to 53 knees at Kyung Hee university hospital. Among them, 21 cases which could be followed-up for more than 4 years were studied retrospectively about the clinical and radiographic results. The mean follow-up period was 5.5 years(ranged from 4.2 years to 8 years). At the last follow-up period, knee scores of Hospital for Special Surgery were improved from mean 56 points to 90 points and the range of motion from 72 degrees to 110 degrees. In the last follow-up radiographs, osteolysis around screw was classified as linear(type I ), cystic(type II ) and cavitary(type III ) according to the width of the lucency around screws. Among 21 cases, radiographic findings of osteolysis around screw were detected in 10 cases but not in 11 cases. But clinical results were similar between these two groups. Among the total 84 screws(4 screws in each case), 21 screws(25%) showed screw related osteolysis typed as I in 13 screws(15.4%), II in 4 screws(4.8%) and III in 4 screws(4.8%). Among the 13 cases that followed-up more than 6 years, 20 screws(38%) showed screw related osteolysis typed as in 11 screws(21.2%), I in 5 screws(9.6%) and II in 4 screws(7.8%). The most frequently involved site of screw was anteromedial(33.3%). In conclusion, after mean 5.5 year follow-up, the clinical results were satisfactory but the development of osteolysis around screw might be an indicator of the implant failure.

Press Fit Condylar Total Knee Arthroplasty

The PFC (Press Fit Condylar) knee was first implanted clinically in 1984 with retention of posterior cruciate ligament. Thereafter PFC modular version had been developed at 1988 with option of posterior cruciate ligament substitution and minor design changes. We classified the 170 patients, 252 knees which underwent the PFC total knee arthroplasty in the period from January 1988 to May 1995 into three groups. In group I, 62 patient. Had 93 total knee arthroplasties with insertion of the original PFC total knee prosthesis with retention of posterior cruciate ligament from January 1988 to October 1991. In group Iia, 51 patients had 74 total knee arthroplasties with insertion of the modular PFC total knee prosthesis with retention of posterior cruciate ligawient from November 1991 to May 1995. In group III, 57 patients had 85 total knee arthroplasties with insert.ion of the modular PFC total knee prosthesis with substitution of posterior cruciate ligament from November 1991 to May l995. Average follow-up periods were 7 years 5 months in group I and 3 years 2 months in group Iia and Ilb. Clinical and radiographic results were similar among the group I, Iia and llb except slight better scores in group Iia and Iib than group I, even though group IlI and IlI had short follow-up periods, Postoperative implant wear was developed at 5 knees in group I, 1 knee in group Iia and not developed in group Ilb. Implant loosening was developed at 1 knee only in group 1. Revisional arthroplasty was performed to 7 knees in group I, 1 knee in group Iia and not in group 1Ib. In conclusion, posterior cruciate ligament substitution group had no difference in functional results with the retention group. In the problem of implant wear, posterior cruciate ligament substitution group was superior to the retention group but similar in loosening.

Reconstruction of old ruptured posterior cruciate ligament using polytetrafluoroethylene(Gore-Tex) / 대한정형외과학회잡지

No abstract available.