ABSTRACT
PURPOSE: To compare clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon- bone autograft and using fresh-frozen Achilles tendon allograft. MATERIALS AND METHODS: We enrolled 61 patients who underwent anterior cruciate ligament reconstruction by means of bone-patellar tendon-bone autograft or Achilles tendon allograft between March, 2002 and December, 2006. The bone-patellar tendon-bone group included 29 patients (mean age 30.4 years), and the Achilles tendon allograft group included 32 patients (mean age 32.5 years). The mean follow-up was 18.2 months and 25.7 months in each group, respectively. Preoperative and last follow-up clinical results were evaluated through physical examination, KT-2000 arthrometer, stress roentgenogram, IKDC knee rating system, and Lysholm knee score. RESULTS: The mean side-to-side difference in anterior translation, as measured by KT-2000 arthrometer, was significantly improved from 6.4 mm+/-3.0 to 3.2 mm+/-1.9 in the bone-patellar tendon-bone group, and from 7.6 mm+/-3.1 to 2.9 mm+/-2.0 in the Achilles tendon allograft group (p<0.001). The Achilles tendon allograft group improved more significantly than did the bone-patellar tendon-bone group (p=0.045). The mean side-to-side difference on stress roentgenogram was significantly improved from 5.3 mm+/-2.5 to 2.0 mm+/-2.1 in the bone-patellar tendon-bone group, and from 6.0 mm+/-3.4 to 2.2 mm+/-2.1 in the Achilles tendon allograft group (p<0.001). There was no significant difference between the two groups. According to the IKDC knee rating system at last follow-up, 26 (89.7%) patients in the bone-patellar tendon-bone group and 28 (87.5%) patients in the Achilles allograft group were normal or nearly normal. The mean Lysholm knee score significantly improved from 69.9 to 90.2 in the bone-patellar tendon-bone group, and from 64.4 to 91.4 in the Achilles tendon allograft group (p<0.001). CONCLUSION: Both bone-patellar tendon-bone and Achilles tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both bone-patellar tendon-bone autograft and Achilles tendon allograft be considered as graft substitutes for anterior cruciate ligament reconstruction.
Subject(s)
Humans , Achilles Tendon , Anterior Cruciate Ligament , Anterior Cruciate Ligament Reconstruction , Follow-Up Studies , Knee , Physical Examination , Transplantation, Homologous , TransplantsABSTRACT
PURPOSE: To assess the effect of intraoperative periarticular local injection in total knee arthroplasty. MATERIALS AND METHODS: We studied 36 patients (72 knees) that underwent bilateral simultaneous primary total knee replacement between October, 2005 and December, 2006. The study group (36 ipsilateral knees) received a 60 ml intraoperative periarticular injection containing a mixture of bupivacaine, epinephrine, morphine, ketorolac, and saline. The injection was made in the posterior capsule and surrounding soft tissues, muscles, and subcutaneous tissues. The control group (36 contralateral knees) did not receive this injection. Postoperative pain levels were evaluated at 2, 8, 24, 48, and 72 hours and 7 and 14 days using the Visual Analogue Scale (VAS). Hemo-vac drains were evaluated at postoperative days 1, 2, 3, 4, and 5. RESULTS: There was no side-to-side difference of VAS in both the study group and the control group according to the side chosen. Preoperative VAS was not significantly different between the two groups. There was a significant decrease in the VAS of the study group patients at 2, 8, 24, 48, and 72 hours postoperative, with the most significant decrease seen at 2 hours. Postoperative bleeding was significantly lower in the study group on the first day, with no difference seen thereafter between the two groups. CONCLUSION: Intraoperative periarticular local injection provides better immediate postoperative pain control in total knee arthroplasty.
Subject(s)
Humans , Arthroplasty , Arthroplasty, Replacement, Knee , Bupivacaine , Epinephrine , Hemorrhage , Ketorolac , Knee , Morphine , Muscles , Pain, Postoperative , Subcutaneous TissueABSTRACT
PURPOSE: To present the survival of consecutive patients with a minimum of three years follow-up after undergoing a metal-on-metal hip resurfacing arthroplasty. MATERIALS AND METHODS: Twenty hips from twenty patients (male: 16, female: 4) who underwent metal-on-metal resurfacing arthroplasty between October 2001 and April 2004 were followed up for at least 3 years. The mean patient age was 49 years (range 23~70), and the mean follow-up period was 56 months (range 36~84 months). A clinical evaluation was performed using the Harris hip score, and radiologic evaluation was performed regularly after surgery with plain radiographs. RESULTS: The mean Harris hip score improved from 46 points (range 73~32) preoperatively to 94 points at final follow-up. There were no cases of radiolucency or osteolysis around the stem or acetabular cup, and there was no migration of the acetabular or femoral component. The average femoral stem-shaft angle was 135degrees(range 121degrees- 139degrees), and at the final follow-up study, there was no change of the femoral stem. CONCLUSION: In the short-term, metal-on-metal resurfacing arthroplasty performed on the basis of bone quality and patient selection, showed excellent clinical and radiological results. Hip resurfacing is an attractive option for young patients fearing a potentially difficult future revision or for more active patients with hip disease.
Subject(s)
Humans , Arthroplasty , Follow-Up Studies , Hip , Osteolysis , Patient SelectionABSTRACT
PURPOSE: To examine the correlation between the Navigation and radiographic measurements for the postoperative mechanical axis and component position in total knee arthroplasty. MATERIALS AND METHODS: From December 2005 to May 2006, Navigation assisted MIS TKA was performed on 46 knees of 34 patients. After fixing the components, the mechanical axis (MA) of the lower extremity, femoral component position to the mechanical axis in the coronal plane (theta), tibial component position in the coronal (beta) and sagittal (sigma) planes was measured using the Navigation. Two observers measured the same angles using the postoperative follow-up radiographs. The measurements were compared and the correlation between the Navigation and radiographic measurement was analyzed. RESULTS: The average Navigation measurements were valgus 0.02+/-1.09 degrees for MA, varus 0.05+/-0.96 degrees for theta, valgus 0.02+/-0.86 degrees for beta and 4.03+/-1.25 degrees for sigma. The mean radiographic measurements of observer 1 were valgus 0.71+/-3.73 degrees for MA, valgus 1.14+/-1.72 degrees for theta, valgus 0.90+/-1.47 degrees for beta and 4.51+/-2.03 degrees for sigma. Those of observer 2 were valgus 0.12+/-3.39 degrees, valgus 0.16+/-1.96 degrees, valgus 0.30+/-1.65 degrees and 3.85+/-1.60 degrees, respectively. CONCLUSION: The average of measurement for the component position showed a statistically significant difference in the MA (p=0.001), theta (p=0.000) and beta (p=0.000) among three groups. There were a relatively high correlation between observer 1 and 2 for the radiographic measurements (r=0.67-0.96). However there was a very low correlation between the Navigation and radiographic measurements (r=0.10-0.39). Therefore, the possibility of a difference between the Navigation and radiographic measurement need to be considered when evaluating the component position.
Subject(s)
Humans , Arthroplasty , Axis, Cervical Vertebra , Follow-Up Studies , Knee , Lower ExtremityABSTRACT
PURPOSE: To evaluate usefulness of Navigation system by comparing the radiographic results of femoral and tibial component position between conventional total knee replacement (TKA) and Navigation-assisted TKA. MATERIALS AND METHODS: From December 2003 to January 2006, TKA with Scorpio(R)(Osteonics, NJ,USA) were preformed for 53 knees of 41 patients. Among them, 26 knees (Group A) were operated by conventional TKA and 27 knees (Group B) were by Navigation-assisted TKA. We measured the femorotibial angle (omega), femoral component coronal (alpha) and sagittal angle(gamma), tibial component coronal (beta) and sagittal angle (delta) according to the radiographic evaluation of American Knee Society. We also measured the coronal femoral component angle to the femoral mechanical axis (theta) and femoro-tibial mechanical axis. RESULTS: alpha, omega and thetaangle showed no significant difference between two groups (p>0.05). beta, gammaand delta angle were 89.2+/-1.9, 4.3+/-1.7, 81.4+/-2.9 degree in group A and 90.5+/-1.2, 2.8+/-1.6, 86.6+/-2.2 degree in group B, respectively. There was statistically significant difference in beta, gammaand deltaangle (p<0.05). The range of deviation from desired angle showed no significant difference in femoro-tibial mechanical axis and betaangle. However, there was statistically significant difference in thetaangle with more accuracy in group B (p=0.0001) CONCLUSION: There were statistically significant differences in betaand gammaangle between conventional TKA and Navigation assisted TKA. We could get more accurate femoral component coronal angle to the mechanical axis with the Navigation system.
Subject(s)
Humans , Arthroplasty , Arthroplasty, Replacement, Knee , Axis, Cervical Vertebra , KneeABSTRACT
Osteomyelitis of the patella is a very rare condition that is generally considered a disease of childhood. The diagnosis is delayed frequently because of its rarity and variability in presentation. The authors report a case of patellar osteomyelitis, which presented as prepatellar bursitis in a child.
Subject(s)
Child , Humans , Bursitis , Diagnosis , Osteomyelitis , PatellaABSTRACT
PURPOSE: To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle. MATERIALS AND METHODS: From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria. RESULTS: There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle. CONCLUSION: Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.
Subject(s)
Female , Humans , Male , Ankle , Ankle Joint , Arthritis , Classification , Follow-Up StudiesABSTRACT
PURPOSE: To evaluate the incidence of orthopaedic injuries and develop guidelines for routine radiologic examinations in patients with traumatic brain injury in order to reduce the incidence of delayed diagnosis. MATERIALS AND METHODS: For this study, 175 out of 720 traumatic brain injury patients, who were treated at Sun General Hospital from May 1994 through December 1997, were analyzed. The incidences of musculoskeletal injury and delayed diagnosis were checked. RESULTS: Clavicle fracture occurred most frequently, followed by tibia-fibular fracture, femur fracture, pelvic fracture or hip fracture-dislocation, axial spine fracture, radius-ulnar fracture, knee ligament injury, fracture of the hand and humerus. The overall incidence of delayed diagnosis was 14 percent (24 patients) . And multiple (more than 2) injuries occurred in 43 patients (24%) . CONCLUSION: The data of this study suggest that a radiologic survey, including X-rays of chest, long bones of the lower extremites, pelvis (both hips) and entire axial spine, should be obtained in patients with traumatic brain injury. Also careful examination of the knee should be included.
Subject(s)
Humans , Brain Injuries , Clavicle , Delayed Diagnosis , Femur , Hand , Hip , Hospitals, General , Humerus , Incidence , Knee , Ligaments , Pelvis , Solar System , Spine , ThoraxABSTRACT
Post-traumatic pisotriquetral osteoarthritis is an unusual condition and its diagnosis is not easy to make. This disease must be distinguished from other conditions that cause ulnar side wrist pain. We experienced a case of post-traumatic pisotriquetral osteoarthritis treated by pisiformectomy.