Factors Affecting Measurement Error of Vertebral Axial Rotation and Reduction of Measurement Error through Training / 대한정형외과학회잡지

PURPOSE: To identify the changes of bony landmarks with rotation and to compare the reliability and accuracy of Perdriolle's method before and after training on the exact bony landmarks. MATERIALS AND METHODS: Simple A-P radiographs were taken with rotation from 5 degree to 50 degree at 5 degree interval using 10 dry human vertebrae (2 sets of T3, T6, T9 8 L3) with no bony abnormality. Axial rotation was measured before and after training on the exact bony landmarks by three observers, twice for each radiographs. Repeated measures of ANOVA were used for inter- 0.05). Incidence of error greater than 5 degree was high at upper thoracic vertebra and 20 degree-40 degree of rotation regardless of training. The effects of training, however, was greatest at T3 and 20 degree-40 degree of rotation. Inter- < intraobserver variance was diminished at T3 and at the rotation between 20 degree-40 degree after training. CONCLUSIONS: We could conclude that training on the exact bony landmarks did not reduce the overall error incidence. Accuracy and reliability, however, was increased at T3 after training and the efficacy of training was more evident in moderate vertebral rotation than in small or large vertebral rotation.

Chronological Changes of the Human Allograft Meniscal Transplants: MRI, Arthroscopic and Histologic Study

Vascular ingrowth is essential for the survial of the graft tissue. The purposes of this study were to evaluate any changes in signal intensity of cqropreserved meniscal allograft with time in the magnetic resonance images(MRI) and to demonstrate the viability of the grafts. Eight patients underwent meniscal transplantation with cryopreserved allcgrafts using the bone block technique. MRIs of the knee were taken at 3 days, 3 weeks, 6 weeks, 3 month, 6 months. And I year after the implantation. A second-look arthroscopy and a small meniscal biopsy(sized 2mm x 2mm1 at the peripheral and central part of the meniscus were conducted at 3 months and 1 year. Three days after the operation, the signal intensity of the implanted meniscus revealed a homogenrous low signaJ intensity that could not be differentiated from that of' a contralateral normal meniscus. At 3 weeks, a high signal intensity appeared at the periphery of the meniscus. This signal, which did not communicate into the joint space, fuither intensified at 6 weeks. The high signal intensity of the meniscus, though still higher than that of the normal meniscus, decrexsed slightly at 3 months and continued to decrease progressively even a year after the implantation. The second-look arthroscopy revealed that the grafts were viable and that there was no tearing or shrinking of the meniscus. Cellular proliferation was also found at the central edge oi' the meniscus at 3 months. This cellular pattern differentiated from that of a nonmal meniscus in that the d stribution of cells was not in an even, but in a clonal pattem. The cellularity after a year, however, was sirnilar to that of normal meniscus except some area with deficiency of cells. It can be concluded that increased signal intensity of' the implanted meniscus with time indicates hypervascularity caused by vascular ingrowth, similar to the high signal intensity ot>tained from normal meniscus in young children. Increasecl signal intensity in the chronological postoperative MRls demonstrates the viability of the implanted cryopreserved meniscal allograft.

Diagnosis of Acute Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

The purposes of this study were to evaluate the diagnostic modalities of the acute rupture of anterior cruciate ligament(ACL) and to know the differences hetween complete and partial ACL rupture preoperatively, analyzing the methods of physical examimation and the clinical features in acutely injured patient. We analyzed the anterior drawer test, Lachman test, KT-2000 arthrometer, MRI findings and associated injuries in the 35 patients who were confirmed to have ACL rupture by arthroscopy of the knee joint, performed within a month after trauma. We divided the patients by arthroscopy into 2 groups: complete rupture group and the partial rupture group. Among the 35 cases of ACL rupture, there were 10 cases of partial rupture and 25 cases of complete rupture. The Lachman s test was the most sensitive method of the physical examinations in detecting acute ACL injuries, with 90% and 92% positive rate in each group retrospectively. KT-2000 arthrometer with more than 3mm side-to-side difference showed all positive findings except one. The findings of ACL rupture in MRI were discontinuity, increased signal intensity, ahnormal course of ACL fibers and so on. The sensitivity of MRI in diagnosing the acute injuries of ACL was 97.2% hut had difficulties in differentiating the complete from partial rupture. Associated injuries of the ACL injured knee were medial and lateral meniscus tear and medial collateral ligament injury. The diagnosis of acute ACL rupture was made possihle hy physical examinations and with use of the KT-2000 arthrometer and MRI was useful in detecting the ACL rupture or associated injuries but not in differentiating complete from partial rupture of the ACL.

The Reliability and Accuracy of Perdriolle's Method on Measurement of Spinal Axial Rotation / 대한정형외과학회잡지

The purpose of this study is to determine how accuratively and reliably the Perdriollo s method can measure vertebral rotaton according to the level of vertebra and true axial rotation. Standard AP radiographs were taken using 10 dry human vertebra (two set of T3, T6, T9, T12, L3) with 5degrees increments in axial rotation, ranging from 0degrees to 50degrees. In order to evaluate the reliability of Perdriolle s method, three observers measured each radiograph twice, and intet-and intraobserver variance were estimated. The accuracy of Perdriolle's method was analyzed by total error analysis, root mean square error (RMSE) and Deviation of differences. 372 errors were made in the 660 measurement and 88.9% of all measurements were within +/- 5degrees of true rotation angle. There were no signigicant difference in the intraobserver measurement at each level whereas interobserver measurements were significantly different only at T3 level. The measurement was also the least accurate at T3 (RMSE=6.2292). We concluded that Perdriolle's method using torsion meter is an accurate and reliable one to measure the vertebral rotation with less accuracy and reliability in high thoracic level.