Radiologic Evaluation of Degeneration in Isthmic and Degenerative Spondylolisthesis

STUDY DESIGN: A cross-sectional imaging study. PURPOSE: The objective was to assess the degree of degeneration and the associated factors through imaging studies of the lesion segment and the adjacent superior and inferior segments of isthmic and degenerative spondylolisthesis. OVERVIEW OF LITERATURE: Few articles existed for degeneration and related factors in isthmic and degenerative spondylolisthesis. METHODS: The subjects were 95 patients diagnosed with spondylolisthesis. Simple plain radiographs including flexion and extension and magnetic resonance imaging were used to investigate the degree of translation, disc degeneration, high intensity zone (HIZ) lesion, Schmorl's node (SN) and Modic changes. RESULTS: Advanced disc degeneration, grade 5, was shown to be significant in the index segment of the isthmic type (p=0.034). Overall, type 2 Modic change was most common in both groups and also, it was observed more in the isthmus group, specifically, the index segment compared to the degenerative group (p=0.03). For the SN, compared to the degenerative type, the isthmus type had a significantly high occurrence in the index segment (p=0.04). For the HIZ lesions, the isthmus type had a higher occurrence than the degenerative type, especially in the upper segment (p=0.03). CONCLUSIONS: Most advanced disc degeneration, fifth degree, SN and Modic change occurred more frequently in the lesions of the isthmus type. HIZ lesions were observed more in the isthmus type, especially in the segment superior to the lesion.

Minimum 1 Year Results of Arthroscopic Pull-out Repair for Posterior Root Tear of Medial Meniscus / 대한스포츠의학회지

This study is to evaluate clinical and arthroscopic second-look results of arthroscopic repairs of posterior root tears of medial meniscus which may cause loss of circumferential hoop tension and extrusion of meniscus. From October 2006 to May 2009, fifty-eight patients (59 knees) underwent arthroscopic pull-out repairs. Clinical results were evaluated using Hospital for Special Surgery (HSS) score and International Knee Documentation Committee (IKDC) score for 12-month follow-up. Second-look arthroscopy was done to evaluate meniscal healing in 21 cases. Magnetic resonance imaging (MRI) was performed to assess status of repaired meniscus and tibial tunnel position in 9 patients. Average preoperative HSS score and IKDC score of 59 cases were 69.5 and 36.0, respectively. Average postoperative HSS score and IKDC score of 59 cases had been changed into 90.3 (p<0.001) and 66.8 (p<0.001), respectively. Second-look arthroscopies revealed complete or incomplete healing except one case. Two patients showed increased one grade according to the Kellgren-Lawrence radiologic classification system and others showed no change. Of 9 patients who performed MRI, six patients showed complete healing. The average position of tibial tunnel was 4.8 mm anterior and 5.7 mm medial to center of posterior cruciate ligament. Arthroscopic pull-out repair technique using transtibial tunnel seems to be simple and effective procedure for posterior root tear of medial meniscus. Further evaluation of arthroscopic repair of posterior root tear of medial meniscus should be needed to prove the effectiveness on the prevention of osteoarthritis of knee.

Evaluation of the Factors Affecting Root Tears of the Posterior Horn of the Medial Meniscus as Confirmed during Total Knee Arthroplasty

PURPOSE: We examined the incidence of root tear of the medial meniscus posterior horn among patients who had undergone total knee replacement and we analyzed the factors that cause this tear. MATERIALS AND METHODS: We enrolled 258 knees of 173 patients who had undergone total knee replacement from January 2008 to June 2009. The mean age was 68.8 (range: 50~87). There were 23 men (28 cases) and 150 women (230 cases). We performed statistical correlation analysis between the assumed causes of meniscal tears (age, gender, grade of osteoarthritis, the predisposition site, BMI and varus deformity) and root tears. RESULTS: Meniscal tears were observed in 182 cases (70.5%), and there were 18 cases (64.2%) of 28 cases and 164 cases (71.3%) of 230 cases in the men and women, respectively. Root tear had correlation with the severity of osteoarthritis (p=0.040) and varus deformity (p=0.030), but other underlying factors didn't show significant correlation (p>0.05). CONCLUSION: Root tears of the medial meniscus posterior horn in total knee arthroplasty were related to the severity of osteoarthritis and varus deformity, but active interventions are required whether or not there are predisposing factors that cause osteoarthritis.

Incomplete Reduction that Influence Reduction of Sesamoid as a Cause for Recurrence of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The incomplete reduction of the sesamoid has lately been issued as cause for recurrence. In this study, we analysed factors that may influence reduction of sesamoid. MATERIALS AND METHODS: The study consists of 50 cases operated by single surgeon. Eighteen cases were done by proximal chevron osteotomy, and 32 cases were done by scarf osteotomy. Hallux valgus (HV) angle and intermetatarsal (IM) angle were measured before and three months after the surgery. Sesamoid position (SP) was classified according to Hardy and Clapham grade system. RESULTS: After the proximal chevron osteotomy, the correction of the mean HV angle was 19.5degrees, and IM angle was 6.2degrees. SP was changed from 5.6 to 3.4 grade. After the Scarf osteotomy, the correction of the mean HV angle was 25 degree, and IM angle was 9degrees. SP was changed from 5.5 to 2.8 grade. There was difference of sesamoid's correction between two different method of surgery (p=0.127). However, better correction of sesamoid was witnessed with bigger correction angle regardless of method of surgery (p=0.002, 0.001). CONCLUSION: We believe surgical method do not effect sesamoid's correction but more correction angle can result in better correction of sesamoid position.

Incomplete Reduction that Influence Reduction of Sesamoid as a Cause for Recurrence of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The incomplete reduction of the sesamoid has lately been issued as cause for recurrence. In this study, we analysed factors that may influence reduction of sesamoid. MATERIALS AND METHODS: The study consists of 50 cases operated by single surgeon. Eighteen cases were done by proximal chevron osteotomy, and 32 cases were done by scarf osteotomy. Hallux valgus (HV) angle and intermetatarsal (IM) angle were measured before and three months after the surgery. Sesamoid position (SP) was classified according to Hardy and Clapham grade system. RESULTS: After the proximal chevron osteotomy, the correction of the mean HV angle was 19.5degrees, and IM angle was 6.2degrees. SP was changed from 5.6 to 3.4 grade. After the Scarf osteotomy, the correction of the mean HV angle was 25 degree, and IM angle was 9degrees. SP was changed from 5.5 to 2.8 grade. There was difference of sesamoid's correction between two different method of surgery (p=0.127). However, better correction of sesamoid was witnessed with bigger correction angle regardless of method of surgery (p=0.002, 0.001). CONCLUSION: We believe surgical method do not effect sesamoid's correction but more correction angle can result in better correction of sesamoid position.

The Clinical Results Using the Second Look Arthroscopic Findings and MRI after Allogenic Meniscal Transplantation

PURPOSE: The purpose of this study was to evaluate the clinical results and the changes of allogenic meniscal transplantation by using the second look arthroscopic findings and the MRI changes after surgery. MATERIALS AND METHODS: From July 1997 to February 2007, among the patients that underwent allogenic meniscal transplantation, we chose 25 patients who underwent secondary arthroscopic evaluation. 16 of these 25 patients were men and 8 were women. Secondary arthroscopic evaluation was done without MRI in 3 cases. The mean age was 36.1 yr and the average follow up period was 28 months. Biopsy by the secondary arthroscopic evaluation was done in 2 cases. We evaluated the clinical results by the Lysholm knee scoring scale, the Knee Society Score (KSS) system and the Hospital for Special Surgery (HSS) knee score. RESULTS: Second-look arthroscopy after allogenic meniscal transplantation revealed that 23 cases seemed normal at the probing procedure. 5 cases showed a decreased posterior horn size. The MRI findings and secondary arthroscopic findings matched in all cases. The clinical Lysholm score improved from preoperative 65.4 points to postoperative 80.6 points, the Knee Society Score (KSS) improved from preoperative 64.6 points to postoperative 82.6 points, the functional score improved from preoperative 70.2 points to postoperative 85.6 points and the Hospital for Special Surgery (HSS) knee score improved from preoperative 66.4 points to postoperative 82.5 points (p=0.000). The function after surgery improved on all the tests and this was proved by paired t-tests. CONCLUSION: Allogenic meniscal transplantation showed good results on the second look arthroscopy and the follow-up MRI and according to the clinical functional outcome. We think that confirmation through arthroscopy after follow-up MRI for the patients with clinical knee problems seems to be necessary.

ACL Reconstruction with a Minimally Invasive Physeal Plate in Adolescence: Technical Note

Substantial ACL ruptures are not common in adolescence or childhood. During this period, ACL tibia avulsion fractures are more common than substantial ACL ruptures are. However, recent advancements in MRI and increases in adolescent sports activity have led to increased diagnosis of substantial ACL ruptures. Many physeal-sparing ACL reconstruction methods have been reported. However, some physeal-sparing ACL reconstructions are associated with poor outcomes because of laxity in the reconstructed ligament and discordance in the isometric point. We report a 14-year-old male patient with a chronic substantial ACL rupture and a longitudinal medial meniscus tear who was treated with ACL reconstruction and all-inside meniscal repair, which spares the femoral physis and reduces tibia physeal injury with an Achilles allograft.