Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- and Adjustable-Length Loop Cortical Fixation

BACKGROUND: Cortical suspensory femoral fixation is commonly performed for graft fixation to the femur in anterior cruciate ligament (ACL) reconstruction using hamstring tendons. The purpose of this study was to compare graft healing in the femoral tunnel, implant-related failure, and clinical results between fixed- and adjustable-length loop devices in outside-in ACL reconstruction. METHODS: A total of 109 patients who underwent ACL reconstruction using the outside-in technique from December 2010 to July 2014 were included. For femoral graft fixation, a fixed-length loop device was used in 48 patients (fixed-loop group) and an adjustable-length loop device was used in 61 patients (adjustable-loop group). For evaluation of graft healing in the femoral tunnel, magnetic resonance imaging was performed at postoperative 6 months and the signal-to-noise ratios (SNRs) of the tendon graft and tendon-bone interface in the femoral bone tunnel were evaluated. The presence of synovial fluid was evaluated to determine loop lengthening at the femoral tunnel exit. Clinical results assessed using International Knee Documentation Committee score, Tegner-Lysholm Knee Scoring scale, and knee instability tests were compared between groups. RESULTS: The SNRs of the tendon graft and tendon-bone interface were not statistically different between groups. The presence of synovial fluid at the femoral exit showed no statistical difference between groups. Clinical results were not significantly different between groups. CONCLUSIONS: The adjustable-length loop device provided comparable graft healing, implant-related failure, and clinical results with the fixed-length loop device, allowing adaptation of the graft to the different tunnel lengths. Therefore, it could be effectively used with an adjustment according to the femoral tunnel length.

Dynamic Three-Dimensional Analysis of Lachman Test for Anterior Cruciate Ligament Insufficiency: Analysis of Anteroposterior Motion of the Medial and Lateral Femoral Epicondyles

PURPOSE: To evaluate dynamic three-dimensional (3D) kinematic properties of the anterior cruciate ligament (ACL)-insufficient knees and healthy contralateral knees in awake patients during the Lachman test using biplane fluoroscopy. MATERIALS AND METHODS: Ten patients with unilateral ACL-insufficient knees and healthy contralateral knees were enrolled in this study. Each patient underwent the Lachman test three times in the awake state. The knee joint motions were captured using biplane fluoroscopy. After manual registration of 3D surface data from 3D-computed tomography to biplane images, dynamic 3D kinematic data were analyzed. RESULTS: The average anteroposterior (AP) translation of the medial femoral epicondyle of the ACL-insufficient knees (11.5+/-4.2 mm) was significantly greater than that of the contralateral knees (7.7+/-3.5 mm) (p<0.05). However, there was no statistically significant side-to-side difference in the average AP translation of the lateral femoral epicondyle. During the Lachman test, the distal femur was more externally rotated than the proximal tibia, which showed significant difference between both sides. CONCLUSIONS: During the Lachman test, the medial femoral epicondyle of the ACL-insufficient knee exhibited greater AP motion than that of the contralateral knee, whereas there was no significant side-to-side difference with regard to the AP motion of the lateral femoral epicondyle.

Three-Dimensional Reconstruction Computed Tomography Evaluation of Tunnel Location during Single-Bundle Anterior Cruciate Ligament Reconstruction: A Comparison of Transtibial and 2-Incision Tibial Tunnel-Independent Techniques

BACKGROUND: Anatomic tunnel positioning is important in anterior cruciate ligament (ACL) reconstructive surgery. Recent studies have suggested the limitations of a traditional transtibial technique to place the ACL graft within the anatomic tunnel position of the ACL on the femur. The purpose of this study is to determine if the 2-incision tibial tunnel-independent technique can place femoral tunnel to native ACL center when compared with the transtibial technique, as the placement with the tibial tunnel-independent technique is unconstrained by tibial tunnel. METHODS: In sixty-nine patients, single-bundle ACL reconstruction with preservation of remnant bundle using hamstring tendon autograft was performed. Femoral tunnel locations were measured with quadrant methods on the medial to lateral view of the lateral femoral condyle. Tibial tunnel locations were measured in the anatomical coordinates axis on the top view of the proximal tibia. These measurements were compared with reference data on anatomical tunnel position. RESULTS: With the quadrant method, the femoral tunnel centers of the transtibial technique and tibial tunnel-independent technique were located. The mean (+/- standard deviation) was 36.49% +/- 7.65% and 24.71% +/- 4.90%, respectively, from the over-the-top, along the notch roof (parallel to the Blumensaat line); and at 7.71% +/- 7.25% and 27.08% +/- 7.05%, from the notch roof (perpendicular to the Blumensaat line). The tibial tunnel centers of the transtibial technique and tibial tunnel-independent technique were located at 39.83% +/- 8.20% and 36.32% +/- 8.10%, respectively, of the anterior to posterior tibial plateau depth; and at 49.13% +/- 4.02% and 47.75% +/- 4.04%, of the medial to lateral tibial plateau width. There was no statistical difference between the two techniques in tibial tunnel position. The tibial tunnel-independent technique used in this study placed femoral tunnel closer to the anatomical ACL anteromedial bundle center. In contrast, the transtibial technique placed the femoral tunnel more shallow and higher from the anatomical position, resulting in more vertical grafts. CONCLUSIONS: After single-bundle ACL reconstruction, three-dimensional computed tomography showed that the tibial tunnel-independent technique allows for the placement of the graft closer to the anatomical femoral tunnel position when compared with the traditional transtibial technique.

The Clinical Characteristics and Endovascular Management Outcomes of Dural Carotid Cavernous Fistulas

PURPOSE: To describe the clinical characteristics and endovascular management outcomes of Dural carotid cavernous sinus fistula (Dural CCF). METHODS: Ocular symptoms, signs, and complications of 15 eyes from 14 patients confirmed with Dural CCF by angiography were examined. The medical records of patients who underwent endovascular management were analyzed retrospectively. RESULTS: The mean age of the patients was 50.6 +/- 14.2 years; 4 were men and 10 were women. The eye consisted of 7 right eyes and 8 left eyes. Two eyes were of hypertension patients. The chief clinical symptoms on the first visit were diplopia, injection, ocular pain, proptosis, ptosis, and tinnitus. On cerebral angiography, Barrow Type D was the most common consisting of 12 cases (80%). Endovascular embolization was performed in 13 eyes and the average number of times received was 1. Signs and symptoms improved over a mean of 4.5 months of clinical follow-up in 12 eyes. There were no ocular complications related to endovascular embolization. CONCLUSIONS: Dural CCF should be suspected in a middle-aged woman with injection or diplopia. Endovascular embolization is considered minimally invasive and highly successful for the treatment of Dural CCF.

Comparison of Results of 2-Hour, 6-Hour and Full-Time Patching Regimens in Treatment of Monocular Amblyopia

PURPOSE: To compare effects of a 2-hour, 6-hour, and full-time patching regimens in monocular amblyopia patients under 10 years of age. METHODS: This study recruited monocular amblyopia patients under 10 years of age. The patients were divided into a 2-hour patching group (group A, n=34), a 6-hour patching group (group B, n=33), and a full time patching group (group C, n=28) according to the patching time. A prospective analysis was then performed. The ages at the start of treatment, differences of corrected visual acuity between the 2 eyes and severity of the 3 groups were compared and analyzed. On the final evaluation, 'success' was defined when the difference of corrected visual acuity between the 2 eyes converted into logMAR was less than 0.1. RESULTS: The ages at the start of treatment in group A, B, C were 5.61, 5.48 and 5.71 years, respectively. The best corrected visual acuity of an amblyopic eye converted into logMAR changed to 0.13 after treatment in group A, to 0.16 in group B and to 0.19 in group C. Although visual acuity after the treatment was increased significantly compared to the beginning of treatment in all 3 groups, the final visual acuity showed no statistically significant difference among the 3 groups. Because the occlusion therapy success rates were 70.6%, 69.7% and 64.3% for groups A, B and C, respectively, there was no statistically significant difference. CONCLUSIONS: In the 2-hour, 6-hour, and full-time patching regimens, all patients showed a significant improvement in visual acuity although their success rates were not significantly different. Therefore, the part-time patching therapy favored by patients and parents is effective for the first treatment of amblyopia.

Comparison of the Clinical Effects of Implantation of Aspheric and Spherical Intraocular Lenses

PURPOSE: To compare postoperative visual acuity, spherical equivalent and contrast sensitivity of eyes implanted with either spherical C-flex(TM)(570C) or aspheric C-flex(TM)(970C) intraocular lenses (IOL). METHODS: Forty eyes implanted with posterior chamber intraocular lenses were divided into two groups: C-flex(TM)(570C) (20 eyes) and C-flex(TM)(970C) (20 eyes). In these two groups, postoperative best corrected visual acuity (logMAR), spherical equivalent and contrast sensitivity was performed at one month and three months, postoperatively. RESULTS: In the spherical group, the preoperative naked visual acuity was 1.25+/-0.46 (logMAR). The best corrected visual acuity at postoperative three months was 0.49+/-0.28. In the aspheric group, the preoperative naked visual acuity was 1.29+/-0.67. The best-corrected visual acuity at postoperative three months was 0.39+/-0.30. There were statistically significant differences in best-corrected visual acuity between the preoperative and the postoperative three months results in the spherical IOL group and in the aspherical IOL group. There were no statistically significant differences in spherical equivalent between preoperative and postoperative one-month results and between preoperative and postoperative three-month results in the spherical IOL group and the aspherical IOL group. In the aspherical IOL group, contrast sensitivity at postoperative one and three months were better in the all spatial frequency than in the preoperative scotopic condition. CONCLUSIONS: When we compared eyes implanted with the spherical C-flex(TM)(970C) with eyes implanted with the spherical C-flex(TM) (570C), there were no statistically significant differences in spherical equivalent or best corrected visual acuity. The aspherical IOL group showed better contrast sensitivity than did the spherical IOL group postoperatively at both one month and three months.

Anterior Cruciate Ligament Tear: Reliability of MR Imaging to Predict Stability after Conservative Treatment

OBJECTIVE: The aim of this study is to evaluate the reliability of MR imaging to predict the stability of the torn anterior cruciate ligament (ACL) after complete recovery of the ligament's continuity. MATERIALS AND METHODS: Twenty patients with 20 knee injuries (13 males and 7 females; age range, 20-54) were enrolled in the study. The inclusion criteria were a positive history of acute trauma, diagnosis of the ACL tear by both the physical examination and the MR imaging at the initial presentation, conservative treatment, complete recovery of the continuity of the ligament on the follow up (FU) MR images and availability of the KT-2000 measurements. Two radiologists, who worked in consensus, graded the MR findings with using a 3-point system for the signal intensity, sharpness, straightness and the thickness of the healed ligament. The insufficiency of ACL was categorized into three groups according to the KT-2000 measurements. The statistic correlations between the grades of the MR findings and the degrees of ACL insufficiency were analyzed using the Cochran-Mantel-Haenszel test (p < 0.05). RESULTS: The p-values for each category of the MR findings according to the different groups of the KT-2000 measurements were 0.9180 for the MR signal intensity, 1.0000 for sharpness, 0.5038 for straightness and 0.2950 for thickness of the ACL. The MR findings were not significantly different between the different KT-2000 groups. CONCLUSION: MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.

MR Imaging of Stable Posterior Cruciate Ligament Grafts in 21 Arthroscopically Proven Cases

OBJECTIVE: To describe the magnetic resonance (MR) appearance of intact posterior cruciate ligament (PCL) grafts. MATERIALS AND METHODS: Thirty-one postoperative MR examinations were performed in 21 grafts of 20 patients after PCL reconstruction. All 21 grafts were proven to be intact on second-look arthroscopic examination. Two musculoskeletal radiologists retrospectively analyzed the MR findings and reached decisions by consensus. The signal intensity (SI) of the graft on proton density-weighted and T2-weighted images, as well as the shapes, locations, and segments of increased SI were recorded. The graft thickness was also recorded and correlated to elapsed time since reconstructive surgery. RESULTS: The SI of the graft was high (15/31, 48%), intermediate (10/31, 32%), or low (6/31, 19%) on proton density-weighted images, and high (9/31, 29%), intermediate (6/31, 19%), or low (16/31, 52%) on T2-weighted images. The graft SI decreased significantly as postoperative time elapsed. The shape of the increased SI within the grafts was band-like (14/25, 56%) or focal (11/25, 44%). The increased SI was located in the proximal (18/25, 72%), middle (21/25, 82%), and distal (12/25, 48%) segments. In the axial plane, the location of increased SI was intrasubstance (19/25, 76%) or peripheral (10/25, 40%). A 'focal' shape of increased SI was found significantly more in Achilles tendon allografts, while a band-like shape was more frequent in autogenous double-loop hamstring tendon grafts. Graft thickness ranged from 5-15 mm. The difference in graft thickness relative to postoperative time was not statistically significant (p = 0.79). CONCLUSION: Stable PCL grafts commonly showed an increased SI at any segment or location, even though they were stable. The shape of increased SI differed according to allograft donor sites. However, SI tended to decrease as time elapsed.

The Clinical Results of Posterior Cruciate Ligament Reconstruction: Preservation of Remnant Posterior Cruciate Ligament / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to provide the clinical results of arthroscopic posterior cruciate ligament (PCL) reconstruction with preservation of the original ligament with use of a posterior trans-septal portal and to compare the clinical outcomes between double-loop hamstring tendon autografts and Achilles tendon allografts. MATERIALS AND METHODS: 36 patients underwent PCL reconstruction with hamstring tendon autografts and with Achilles tendon allografts. At the final follow-up, patients were evaluated by four measurements: Lysholm knee scores, Telos stress radiography, IKDC grade, and second look arthroscopic examination. RESULTS: The postoperative mean Lysholm knee scores, the postoperative mean distances of posterior displacement by the Telos stress test, and the postoperative IKDC grades demonstrated statistically significant differences compared to the preoperative. The postoperative mean distances of posterior displacement by the Telos stress test and the postoperative IKDC grades demonstrated no statistically significant difference between two groups. CONCLUSION: The clinical results of arthroscopic PCL reconstruction with preservation of the original remnant ligament with use of a posterior trans-septal portal were good. The clinical outcomes of double-loop hamstring tendon autografts were equivalent to those of the Achilles tendon allograft.

Arthroscopic ACL Reconstruction with Autologous Hamstring Tendon using Bioabsorbable Cross Pin Fixation on the Femoral Side / 대한정형외과학회잡지

PURPOSE: To evaluate clinical results after arthroscopic ACL reconstruction using hamstring autograft with 2 femoral bioabsorbable cross pins fixations. MATERIALS AND METHODS: We evaluated the results of 97 knees in 97 patients who had arthroscopic ACL reconstruction using hamstring autograft fixed with 2 femoral bioabsorbable cross pins from September 2001 to September 2002. Average follow up was 21.9 months (range: 18-32 months). Patients were evaluated by KT 1000 arthrometer test, Lysholm score, IDKC score at preoperative and follow-up examination. Second-look arthroscopy was performed in 49 knees. RESULTS: Average Lysholm score was 72.3 (range: 51-83) preoperatively and 93.1 (range: 71-99) postoperatively. At final IKDC evaluation, 59 knees were normal (A), 36 knees nearly normal (B), 2 knees abnormal (C), and severe abnormal (D) none. Mean side-to-side difference on maximum manual evaluation using KT-1000 was at 1.3 mm (range: 1-6 mm) at follow-up. 49 knees underwent arthroscopic 2nd look evaluation, of which 31 knees preserved good tension, 18 knees some laxity, graft failure or rupture is none. CONCLUSION: ACL reconstruction using four strands hamstring autograft fixed with 2 bioabsorbable cross pins on the femoral side showed good stability in 97.9% patients at mean 21.9 months follow-up, and can be considered clinically safe and useful method.

Arthroscopic Decompression and Shaving of Popliteal Cyst Using Posteromedial Portal: Technical Note

PURPOSE: To present the surgical procedure of arthroscopic decompression and shaving of popliteal cyst using posteromedial portal. OPERATIVE TECHNIQUE: After diagnostic knee arthroscopic examination, if there is associated intra-articular pathology with popliteal cyst, appropriate arthroscopic procedure has to be performed to adress the associated intra-articular pathology. It is the most important procedure to find the opening of connection between joint cavity and popliteal cyst at posteromedial compartment using anterolateral or posteromedial In some cases the capsular fold overlie the opening of connection, so thorough diagnostic examnation is mandatory. When the opening of connection is visualized, it is enlarged about 8 mm by the arthroscopic decompressive procedure of popliteal cyst using arthroscopic shaver which is approached via the posteromedial portal. After then arthroscope is positioned at posteromedial portal and advanced into popliteal cyst via enlarged opening to visualize the inside of popliteal cyst. While visualizing the inside of popliteal cyst, a 18 gauge spinal needle is introduced by outside-in technique from medial side of the skin overlying popliteal cyst. And then we make trans-cystic portal at the site of spinal needle by incising the skin with # 11 blade and arthroscopic shaver is introduced within popliteal cyst via trans-cystic portal, and arthroscopic cystectomy is performed to shave the inner wall of popliteal cyst with arthroscopic shaver. DISCUSSION: The arthroscopic procedure for popliteal cyst is an alternative of traditional surgical removal of popliteal cyst and it is expected to diagnose and to manage associated intra-articular pathology and to perform arthroscopic decompression and cystectomy effectively using posteromedial portal.

Results of Arthroscopic All-Inside Sutures in Medial Meniscus with Concomitant Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopic all-inside suture using 2 posteromedial portals for medial meniscus posterior horn (MMPH) tears by second-look arthroscopy in patients received concurrent anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: From May 1997 to June 2001, 78 MMPH tears were treated with arthroscopic all-inside sutures with concurrent anterior cruciate ligament (ACL) reconstruction. Among these 39 patients were availablefor follow-up evaluation by second-look arthroscopy. All MMPH tears were repaired using the arthroscopic all-inside suture technique using 2 posteromedial portals. Second-look arthroscopy was performed on average 19 months (range 6 to 40 month) after the ACL reconstruction and meniscal repair. Meniscus healing status was defined and classified. According to the Henning classification, they were divided into complete healing, incomplete healing, and failure. Tear size, type and location were analyzed and compared with healing category. We determined clinical criterias for success in meniscal status as; (1) no positive among 4 clinical objective parameters: joint line pain and tenderness, locking or catching, recurrent effusions, and positive McMurry test; and (2) complete healing of all-inside sutured meniscus during second-look arthroscopy. RESULTS: Of 39 knees assessed by second-look arthroscopy, 32 (82.1%) showed complete healing, 6 (15.4%) incomplete healing without any positive findings of clinical symptoms. Furthermore, all in the incompletely healed group showed complete healing of the posterior horn, which was sutured by allinside suture, whereas incomplete healing was observed at the junctional areas between all-inside and inside-out sutures, mainly at the posteromedial corner. So the overall success rate was 97.4% (38/39) for all-inside suture healing. The one (2.6%) patient with clinical failure revealed a retear of the repaired site, and subsequent subtotal menisectomy was performed. KT-2000 arthrometry showed that sagittal knee laxity was less than 2 mm (Average 1.5 mm, SD 0.72) in all reconstructed knees. The average knee scores, Lysholm knee score and HSS score, at final follow up were 95.5 and 96.5, respectively. As expected, small, longitudinal, and more peripheral (red-red zone) tears resulted in a higher healing outcome. CONCLUSION: Accurate repair with arthroscopic all-inside vertical suture using a suture hook, resulted in a high healing rate even in large and complex vertical tears. Arthroscopic all-inside meniscal suturing may be an optimal treatment for medial meniscus posterior horn tear greater than 1 cm during concurrent anterior cruciate ligament reconstruction.

Second-Look Arthroscopy after ACL Reconstruction: Comparison of Patellar Tendon Autografts with Hamstring Tendon Autografts / 대한정형외과학회잡지

PURPOSE: To evaluate the healing status of reconstructed anterior cruciate ligament (ACL) and meniscal repair through second-look arthroscopy after arthroscopic reconstruction of the ACL. MATERIALS AND METHODS: We analyzed 81 cases by second-look arthroscopy among 397 cases that received ACL reconstruction during the period from June 1996 to December 2000. Second-look arthroscopy was conducted on average 18.8 months after reconstruction. 53 cases received a patellar tendon autograft, 28 cases received a hamstring tendon autograft and 29 cases received meniscal repair. We measured graft tension using displacement by probing, and synovial coverage by visual analysis at second-look arthroscopy. The improvements in Lysholm knee scores and KT-2000 arthrometer results were evaluated to compare patellar and hamstring tendons. RESULTS: The patellar tendon group showed normal tension in 41 cases and lax tension in 12 cases. The hamstring tendon group showed normal tension in 22 cases and lax tension in 6 cases. In the patellar tendon group, synovial coverage was good in 38 cases, half in 4 cases, and pale in 11 cases, whereas the hamstring tendon group was good in 25 cases, half in 2 cases, and pale in 1 case. Synovial coverage was better in the hamstring tendon group (p<0.05). Although there was no statistical significance, the hamstring tendon group was superior to the patellar tendon group in terms of graft tension, Lysholm knee scores and KT-2000 arthrometer results. CONCLUSION: The hamstring tendon group with ACL reconstruction was superior to the patellar tendon group, but long term follow-up will be necessary to further evaluate results.

Arthroscopic Shaving Cystectomy of Popliteal Cyst / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of arthroscopic direct shaving cystectomy of popliteal cyst. MATERIALS AND METHODS: We treated 14 cases of popliteal cyst by arthroscopic shaving cystectomy from March 1998 to October 1999. The mean duration of follow up was 18 months. We estimated operative time, and checked sonography 6 months and 1 year after surgery. Pain, ROM and recurrence were checked 1 year after surgery. RESULTS: The average operation time was 45 minutes (31-58), and the duration to regain full pain free motion of knee was the next day or two days after surgery. There was no recurrence, no discomfort or pain and all were free of ROM. Rauschning and Lindgren Criteria were all Grade 0 and Grade 1. CONCLUSION: Arthroscopic shaving cystectomy using a motorized shaver is an effective alternative to the open technique for popliteal cystectomy.

Arthroscopic Synovectomy of the Wrist in Rheumatoid Arthritis / 대한정형외과학회잡지

PURPOSE: We evaluated the therapeutic effectiveness of arthroscopic synovectomy in patients with rheumatoid wrists. MATERIALS AND METHODS: Nineteen wrists in 18 patients (4 males and 14 females, average age 49.2 years) who had not responded to anti-rheumatic medications, were treated with arthroscopic synovectomy. Patients 'subjective symptoms were evaluated using a visual analogue scale for pain and satisfaction. Standard posteroanterior radiographs taken preoperatively and at the final follow up were ana-lyzed using the modified Larsen/Rau score system (normal, 0; total destruction, 40). The average follow up period was 29.5 months. RESULTS: The mean preoperative pain score was 8.6 and this decreased to 3.6 one year after the operation, but increased to 4.4 at the final follow-up, suggesting a tendency of pain aggravation with time. The average satisfaction score at the final follow up was 6.3. The mean modi-fied Larsen/Rau score was 6.1 preoperatively and this increased to 8.4 at the final radiographs, demonstrating the slow progression of degen-erative changes. The severity of joint degeneration showed no correlation with the postoperative results. CONCLUSION: Arthroscopic synovectomy of rheumatoid wrists results in an effective reduction of pain and high satisfaction. Prolonged bene-fit should be observed by long term follow-up.

Classification and Treatment of the Tear of Lateral Discoid Meniscus

PURPOSE: It is widely accepted that partial meniscectomy has done in case of the discoid meniscus. Authors classify the type of the discoid meniscus and report the results of different treatment according to type of tear. MATERIALS AND METHODS: We analyze the 68 patients, 70 knees. After classifying the type of tear according to the arthroscopic findings, we compare the findings of physical examination and X-ray each other, predict arthroscopic findings by MRI findings and report the results of different treatment according to type of tear. RESULTS: There are type 1(no tear) 8 knees(l 1.4%), type 2(longitudinal tear) 4 knees(5.7%), type 3(horizontal tear) 19 knees(27.1%), type 4(central hole) 9 knees(12.9%), type 5(peripheral tear) 10 knees(14.2%), type 6(transverse tear) 8 knees(11.4%) and type 7(complex tear) 12 knees(17.1%). We has performed partial meniscectomy after meniscal repair of tear site in some cases of type 5,6,7 and got the good results at the follow up period. There is no progressive arthritic changes. CONCLUSION: It is necessary to diagnose the exact type of tear and to treat according to it.

Arthroscopic Reduction and Pull-out Suture in the Treatment of Fractures of the Intercondylar Eminence of the Tibia

No Abstract Available.

Bone tunnel enlargement after anterior cruciate ligament reconstruction / 대한정형외과학회잡지

PURPOSE: To evaluate the bone tunnel enlargement after an anterior cruciate ligament reconstruction (ACLR), We compared the results between a group that had a bone-patellar tendon-bone (BPTB) autograft (group 1) that included the nubbin and one that had a hamstring double looped autograft (group 2). MATERIALS AND METHODS: We evaluated 120 knees over a one year follow-up period. In group 1, the tibial tunnel was completely filled with nubbin. The clinical results were evaluated using the IKDC knee rating system and a KT-2000 arthrometer. Changes in the bone tunnel width on ordinary radiographs were measured periodically. RESULTS: Clinically, there was no significant difference between the two groups. In group 2, more tunnel enlargement occured (p<0.05). ACLR that included the nubbin in the BPTB autograft showed better results in the tunnel enlargement than the others. CONCLUSION: ACLR using the nubbin at the BPTB autograft is one of the solutions available for prevention of bone tunnel enlargement after ACLR.

Arthroscopic Revision ACL Reconstruction

PURPOSE: We analyzed the 11 knees in 11 patients who had arthroscopic revision anterior cruciate liga-ment(ACL) reconstruction and demonstrate the causes of failure of ACL reconstruction and report the clinical result of arthroscopic revision ACL reconstruction. MATERIALS AND METHODS: From March 1997 to April 1999, 11 patients who underwent ACL reconstruction at other hospital had been treated by revision ACL reconstruction. Their mean age at revision was 26.4 years, average time from primary to revision surgery was 26.8 months and average length of follow up was 22 months. We evaluated the results of revision surgery by symptom, Lysholm knee score, physical examination and KT-100 arthrometer. RESULTS: The causes of failure of ACL reconstruction were 8 improper tunnel placements(6 femoral tunnels, 2 tibial tunnels), 2 graft incorporation failure and 1 multiple ligament injury(N=l 1). After revi- sion all patients had improved symptom. There was improvement of average Lysholm knee score from 70 to 87( 2 excellents, 7 goods, 1 fair, 1 poor) with success rate of 82%( 9/11). The data showed decrease of the mean side to side difference from 10.9 mm to 1.7 mm by KT-1000 arthrometer. CONCLUSION: The most common causes of failure of ACL reconstruction were surgical techniques and anatomical tunnel placement was the most important among them.

The Results of Arthroscopic All-Inside Repair Using Two Posteromedial Portals for The Posterior Horn Tears of Medial Meniscus

PURPOSE: To evaluate the efficiency and clinical result of all-inside repair using 2 posteromedial portals for medial meniscus posterior horn tear. MATERIALS AND METHODS: We evaluated 63 knees with m 'al meniscus posterior horn tear, which were repaired by all-inside method using 2 posteromedial portals between March 1997 and March 1999. They were assessed by variable parameters such as pain, joint line tenderness, effusion and McMurray testing. Of these, 30 knees were assessed by the second-look arthroscopy or MRI and the results were graded as healed, incompletely healed or failed. The healing rates were calculated and the effect of tear location, type of tear, the number of sutures used, ACL reconstruction and the repair technique was analyzed. RESULTS: Overall, asymptomatic healing occurred in 96.9/o of knees. At second-look arthroscopy or MRI, the healing rate was 93.3% with 83.3% healed and 10.0% incompletely healed, The failure rate was 6.7%(2 cases). There was no complication at follow up. Th rate of healing increased when tears were longitudinal in the peripheral site, the numbers of suture were smaller, when the repair was combined with the ACL reconstruction and when all-inside technique was performed independently. CONCLUSION: All-inside method using 2 posteromedial portals has a high healing rate and is an improved technique due to its safety, ease than Morgan's method and rigid fixation with vertical suture.