ABSTRACT
PURPOSE: Authors pursuit the meaningful guide for doing arthroscopic meniscetomy in the treatment of symptomatic discoid meniseus of the knee by determining the needed resection margin(partial or total) from the schematic diagram of degeneration and tear which is based on pre-operative MRI. MATERIALS AND METHODS: We analyzed the findings of MRI and operation retrospectively for 32 knees. At first, we designed authors own schematic diagram of discoid meniscus and divided it into 6 x 6 block. The radiologists draw the pattern of degeneration and tear on diagram from pre-operative MRI and the orthopedic surgeons draw the status of degeneration, tear and remaining meniscus after meniscetomy by retrospective analysis of video documentation. Two diagrams were compared for analysis. RESULTS: We had used morselization technique to save meniscus as much as possible on doing meniscetomy. The resected margin of cases were as follows; 9 cases were partial, 21 cases were subtotal and 2 cases were total meniscetomy. But in this study, 19 cases were requested total resection margin on pre-op MRI evaluation. Among these 19 cases, 17 cases of partial or subtotal meniscetomized were reviewed again on video documentation to determine the remained meniscus would be removed completely or not. In 13 of 17 cases, remaining menisci have advanced horizontal tear and rims were not stable that would be rather cases of total meniscetomy. CONCLUSION: Use of diagram of degeneration and tear on the basis of pre-op MRI would be valuable guide to determine appropriate resection margin and moreover the technique of the meniscetomy in the treatment of symptomatic discoid meniscus.
Subject(s)
Knee , Magnetic Resonance Imaging , Orthopedics , Retrospective StudiesABSTRACT
PURPOSE: To evaluate the clinical outcome after the over-the-top augmentation with ABC synthetic lig-ament for the treatment of acute rupture of anterior cruciate ligament at least two years follow up. MATERIALS AND METHODS: From January 1992, authors have treated acute rupture of ACL with this method on 91 cases. Among these, 46 cases were available for full data acquisition. At the last follow-up, clinical results were analyzed subjectively and objectively by Lachman, pivot shift test and presence of joint effusion. Functional evaluation was performed by various knee ligament scoring systems and the side-to-side differences were measured with KT-2000 arthrometer. RESULTS: On Lachman test, 82.7% were under grade Iⅈ grade 0 : 17 cases(37%), grade I: 21 cases(45.7%), grade III: 8 cases(17.3%). 89.3% were under grade 0 & Ion pivot shift test. On measure-ment of side-to-side difference, 25 cases(54.3%) were showed difference less than 3 mmand the differences of 16 cases(34.8%) were 3~5 mm. On six cases joint effusions were present. Among these six cases, four cases were accompanied by anterior instability which were brought to second look arthroscopy. Two cases were treated with several times of aspiration and steroid instillation. The one case was failed its continuity which solved with ACL reconstruction with patellar bone-tendon-bone autograft. The other three cases showed only lax ACL which was cared with retightening of ligament at the femoral attach-ment site. At the last follow up, 37 cases(80.4%) were resulted excellent and good on Lysholm score and 41 cases(89.1%) were group A & B on IKDC score. On Tegner scale, 34 cases(73.9%) were above five point. CONCLUSIONS: Authors suggest this over-the-top augmentation of ACL with synthetic polyester ligament would be good treatment option with several advantages; early rehabilitation is possible to get maximal function of knee and no tunnel in the lateral condyle would be good for late ACL reconstruction even though failure of this artificial ligament.
Subject(s)
Anterior Cruciate Ligament , Arthroscopy , Autografts , Follow-Up Studies , Joints , Knee , Ligaments , Polyesters , Rehabilitation , RuptureABSTRACT
Horizontal tear of the meniscus occurs most commonly in older patients. The tear begins initially with a simple horizontal cleavage which divides the meniscus into superior and inferior leaves resembling a fish mouth and which may become a flap or more complex tear with time if subjected to repeated injury. Thirty-four patients(36knees/40menisci) with horizontal tear of the meniscus, treated with arthroscopic partial meniscectomy except in 3 extensive tears at Ulsan University Hospital from Jan. 1993 to Jun. 1996, were analyzed to investigate the factors that may be associated with this type of meniscal tear, and the results were as follows; 1. The tears commonly occurred in labor workers(61.7%) and without obvious trauma history(67.6%), and the average age at the time of surgery was 44 years. 2. The most common site of the tear was posterior horn of the medial meniscus (62.5%). 3. The 40 horizontal tears consisted of 12 horizontaVcleavage(30%), 3 horizontaVflap(7.5%), and 25 horizontaUdegenerative complex tears(62.5%). 4. Degenerative changes were frequently noted in both arthroscopy(69.5%) and roentgenography (72.2%).
Subject(s)
Animals , Humans , Horns , Menisci, Tibial , Mouth , RadiographyABSTRACT
The paint gun is an industrial instrument which ejects paint through a small opening with pressure of l,500 to 3,000 Ib/inch. In case of the paint-gun injury, the paint penetrates through a tiny wound of skin and spreads widely along the fascial plane or tendon sheath. It destroys the tissues rapidly. Moreover, the toxicity of the paint material evokes acute inflammatory reaction which is accompanied by localized swelling, erythema, heat and sometimes generalized symptoms (i.e fever). Local toxic reaction leads to swelling, circulatory disturhance and foIlowed hy gangrene of the tissue. Sometimes tissue condition is too desperate to survive and bring about amputation unfortunately. Authors treated eleven patients of the paint gun injury f'rom March 1988 to April 1995. The paint materials were removed thoroughly via large skin incision as immediately as possible after the injury. Usually the wound is left to be open for seven to ten days and is followed by delayed primary wound closure. In our experience of three cases of delayed removal( two, five and seven days after injury), the outcomes were poor with problems of pain, sensory disturhance, limitation of finger motio, and two cases of digit amputation. On doing paint gun injection, right hand was used to hold the paint-gun and left hand was used to hold the cable. Our study showed right hands were injured mainly(nine cases). It means the paint gun injury is caused by inattention of work partner.
Subject(s)
Humans , Amputation, Surgical , Erythema , Fingers , Gangrene , Hand , Hot Temperature , Paint , Skin , Tendons , Wounds and InjuriesABSTRACT
Pennig wrist fixator (Orthofix) is a dynamic external fixator which allows wrist motion in applied state in the treatment of distal radius fracture. The authors have treated unstable distal radius fracture with Orthofix external fixator and additional percutaneous K-wire fixation from January 1990 to June 1996. Among these cases, the authors analysed the clinical result of 40 cases which were available for follow-up for more than one year. The analysis was performed on the basis of the change of radiographic findings and modified Gartland & Werley criteria. The results were as follows; 1. According to Frykmann classification, 3 cases were Type I; 1 case, Type II; 4 cases, Type III; 2 cases, Type IV; 4 cases, Type V; 5 cases, Type VI; 20 cases, Type VII; 1 case, Type VIII. 2. We could get the improved values after operation as radial inclination 22.6degrees, radial length 10.7mm and volar tilt 8.8degrees. 3. There were little differences in value between at the immediate postoperative roentgenogram and at the last follow up one; radial inlclination decreased 1.2degrees, radial length shortened 2.5mm, volar tilt decreased 2.3degrees. 4. In 3 cases, the level of the ball joint of the fixator was not adjusted appropriately, so the initial satisfactory reduction was disrupted. 5. According to modified Gartland & Werley criteria, 34 cases (85%) were excellent and good. Pennig dynamic wrist fixator (Orthofix) allows the wrist motion earlier than the static external fixator without disturbing the initial reduction state, so it could be suggested as one of the good fixation devices for the treatment of the unstable distal radius fracture.
Subject(s)
Classification , External Fixators , Follow-Up Studies , Joints , Radius Fractures , Radius , WristABSTRACT
The distal thigh atrophy is a frequently associated sigh in the presence of knee pathology, and it is usually proved by the difference of the distal thigh circumference using tapeline measurement. But the proper position of measurement is known at this moment. From January of 1988 to December of 1991, we have 320 patients who had knee problems. Among them, 50 patients were selected as a sample of this study. We measured distal thigh circumference of normal and abnormal side by patella and also real circumference and area by taking cross sectional C-T image at each point of measurement. The obtained data are analysed by SPSS for statistical treatment. And the results are as follows: 1) We notice the largest difference on the point of 10cm above superior pole of patella. 2) The vastus medialis is the most conspicuously atrophied muscle among quadriceps and the atrophy of hamstring is minimal. 3) We have experienced the largest difference in cruciate ligament injury but a little difference in meniscus pathology. 4) There is no significantly difference between tapeline measurement and real circumference. As a conclusion of study, The position of 10cm above from the patella upper pole is the best site of clinical measurement of distal thigh circumference, and the muscle mainly associated with artophy is vastus medialis.
Subject(s)
Humans , Atrophy , Knee , Ligaments , Patella , Pathology , Quadriceps Muscle , ThighABSTRACT
No abstract available.
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No abstract available.
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No abstract available.