Effect of Dexamethasone and 1,25(OH)2D3 on Proliferation and Osteogenic Differentiation of Cultured Human Bone Marrow Stromal Cells / 대한내분비학회지

BACKGROUND: It is crucial, in the case of regenerating bone by tissue-engineering technique, that osteoblast progenitors are proliferated and induced to differentiate to osteoblasts sequentially at the proper time. Osteoblasts can be obtained from bone itself or from osteoblast progenitors in bone marrow, even though the amount of human marrow stromal cells in marrow aspirate is usually scanty. These cells, however, have been known demonstrate the potential to easily proliferate and differentiate in osteoblasts, chondroblasts or adipocytes according to different microenvironmental factors. We evaluated the effect of dexamethasone and 1,25(OH)2D3 on the proliferation, differentiation, and mineralization of human marrow stromal cells in vitro. METHODS: We used twelve bone marrow aspirates obtained from different healthy bone marrow donors. Culture plates were randomly divided into the following four experimental groups; group 1 was cultured with control medium only, group 2 with control medium containing 1,25(OH)2D3, group 3 with control medium containing dexamethasone, and group 4 with control medium containing both 1,25(OH)2D3 and dexamethasone. 3H-thymidine uptake, protein content of cell lysates, alkaline phosphatase activities and alkaline phosphatase histochemistries were measured. Alizarin Red-S staining and quantification of dissolved dye were also performed. RESULTS: Combined stimulation of marrow stromal cells with both 1,25(OH)2D3 and dexamethasone was found to be effective to maintain stable long-term culture of the cells and to increased differentiation and mineralization of the cells. Synthesis and mineralization of matrix were highest when the cells were stimulated with 1,25(OH)2D3 alone during the early culture phase. However, 1,25(OH)2D3 shortened the lifespan of the cells. Interestingly, mineralization was higher in female donor cells than in male donor cells when stimulated with dexamethasone alone or with both dexamethasone and 1,25(OH)2D3. Neither 1,25(OH)2D3 nor dexamethasone affected cell proliferation. CONCLUSION: Our results suggest that the synergistic effect of dexamethasone and 1,25(OH)2D3 is important in maintaining long-term culture and differentiation of human marrow stromal cells. It is preferable to administer 1,25(OH)2D3 after the attachment of cultured osteoblasts to biomaterials has been established, since it could shorten cell survival despite the great increase of mineralization at the early culture phase.

Combined Anterior and Posterior Approach in Operating on Complex Acetabular Fractures / 대한정형외과학회잡지

PURPOSE: To report the results of a combined anterior and posterior approach to complex acetabular fractures and establish the guidelines for the operative treatment of complex acetabular fractures. MATERIALS AND METHODS: Thirteen fractures (8 both column, 5 T-shaped fractures) of thirteen patients (8 men, 5 women) were treated with this combined anterior and posterior approach from August 1995 to December 1999. We reviewed the clinical and radiological results for an average of 33months (range, 12-60) follow-up. RESULTS: This approach resulted in an anatomical reduction in ten (78%) patients and, two imperfect and one poor reduction. The average Harris hip score was 69.2 (range, 58-87) and the clinical results were good in eleven, very good in one and poor in one patient using the D'Aubigne/Postel clinical grading. A poor reduction occurred in one patient who had a both column fracture that extended to the ipsilateral sacroiliac joint combined with a joint subluxation. CONCLUSION: Overall clinical results for most complex acetabular fractures treated by a combined anterior and posterior approach were preferable to other approaches, but we must consider an extensile or extended ilioinguinal approach to be an alternative surgical approach in this complicated fracture that involves the sacroiliac joint.

Influence of synovial Joint Fluid of Rheumatic and Osteoarthritic on Chondrocyte in vitro / 대한정형외과연구학회지

PURPOSE: Earlier work suggested that two cytokines inhibit synthesis of type II collagen and of aggrecans by chondrocytes and they depress chondrocyte proliferation, but there was little report how the chondrocyte is modulated by culture conditions such as the joint fluids of the rheumatoid arthritis and that of the osteoarthritis. The purpose of this investigation was to determine whether RA(rheumatic arthritis) or OA(Osteoarthritis) joint fluid influence proliferation and differentiation in cultured human articular chondrocytes. MATERIALS AND METHODS: Human chondrocytes were cultured in a standard media (DMEM and 10% FBS), RA and OA joint fluid were added to media at the concentration of 20, 40 and 60% respectively for 1, 3 and 6days. 3H-thymidine and 3H-uridine uptake of cultured chondrocytes were measured as indicators of cell proliferation. Synthesis of human collagen type I, II was estimated by the RT-PCR procedures. RESULTS: 3H-thymidine uptake of the chondrocyte cultured in RA SF(synovial fluid) medium at 2 and 4 days; its uptake in the group treated by RA SF 20%, 40%, 60% increased more significantly than that in control group (P0.05). 3H-uridine uptake of the chondrocyte cultured in RA SF medium at 2 and 4 days; its uptake of the group treated by RA SF 20%, 40%, 60% increased more significantly than that of control group (P0.05). Human type I collagen mRNA expressions of the chondrocyte markedly increased in RA and OA SF mixed groups. Human type II collagen mRNA expressions of the chondrocyte were reduced in RA and OA SF mixed groups, especially RA SF 60% mixed groups. CONCLUSION: RA and OA SF increased the proliferation of the articular chondrocyte, but its decreased the differentiation of the chondrocyte. RA and OA SF may change the phenotype of the articular chondrocyte and this phenomenon was more outstanding in RA SF.

Arthroscopic Meniscal Repair Using Inside-Out Technique under Minimized Skin Incision

PURPOSE: The purpose of this study was to investigate the effect of the Inside-Out arthroscopic repair technique using minimized skin incision for the peripheral tear of the meniscus. MATERIAL AND METHOD: We treated 44 meniscal tears of 39 patients with Inside-Out arthroscopic repair technique using minimized skin incision from December 1995 to November 1997 and evaluated the result retrospectively. Follow-up period was from 23 months to 50 months(average 34.5 months) and patient age was from 4 to 55(average 26.7). Twenty cases(45%) were injured during sports and 34 cases(77%) were chronically injured case. Ninteen cases(43%) were combined with ligament injuries and among them, 18 cases had an anterior cruciate ligament injury. All cases had peripheral tear and 12 cases were bucket handle tear and 8 cases were tear of discoid meniscus and 3 cases had meniscal cyst. RESULT: During follow-up period, 41 cases(95%) were satisfied and had excellent or good results which were based on the evaluation form of Tapper & Hoover's criteria. Recurrences of meniscal tear were occurred in two cases and they were resutured arthroscopically. As complications, three cases had skin dimplings at the suture site and they were treated with subcutaneous dissection at the out patient clinic. CONCLUSIONS: Even if not many cases and short follow-up periods, we obtained good result. Therefore, we recommend the Inside-Out arthroscopic repair technique using minimized skin incision for the periph-eral tear of the meniscus in any repairable condition.

In Vitro Effects of Threapeutic Low Energy Ultrasound on Cultured Humon Articular Chondrocyte / 대한정형외과학회잡지

Ultrasound has been applied therapeutically to accelerate connective tissue healing and healing of long bone fracture. We performed this study to evaluate the effect of therapeutic low energy ultrasound on cultured human articular chondrocyte. Chondrocytes were isolated from articular cartilage of knee joint of young adult during notchy plasty of ACL reconstructive procedure using collagenase and cultured in DMEM solution. Therapeutic ultrasounds ( Intensity ; 1W/cm2, 0.75W/cm2, 0.25W/cm2. Frequency ; 1 MHz) were applied at the cultured human articular cartilage for 0, 30, 60, 90 seconds, repectively. 3H-Thymidine uptake, 3H-Uridine uptake and production of collagen Type I, Type II were evaluated on 3 days, and 5 days of culture. Decreased cell proliferation, decreased thymidine and uridine uptake, decreased production of human collagen Type I and complete loss of production of human collagen Type II were showed after high dose ultrasound application( 1W/cm2, 0.75W/cm2, 1MHz). After low dose ultrasound application( 0.25W/cm2, 1MHz), there were increased cell proliferation and increased production of human collagen Type II and production of Type I collagen was not changed after 3 days and 5 days. In summary, this study showed that decreased cell proliferation and collagen synthesis were observed with application of high dose ultrasound, whereas, increased cell proliferation and human collagen Type II synthesis were observed with application of low dose ultrasound.

Meniscus Reconstruction in Partially Removed Meniscus with Reflected Synovio-capsular Flap in Rabbit / 대한정형외과학회잡지

PURPOSE: The purpose of this paper was to investigate whether the reflected synovio-capsular flap, covering one-third of the remaining peripheral after partial removal of two-thirds of the central medial meniscus of rabbit knee, contributes to the regeneration of meniscus. MATERIALS AND METHODS: Forty rabbits were used in this study. In each rabbit the right knee was used for the experimental group in which the synovio-capsular flap was reflected after a partial meniscectomy, while the left knee, with only a skin incision, was used for the control group. The width and thickness of the regenerated menisci were measured with the Vernier calliper, and evaluated grossly by Hematoxylin-Eosin (H-E) staining, histochemically by safranin-O staining, and subcellularly by transmission electron microscopy at 4, 8, 12 and 16 weeks after the operation. RESULTS: The width and thickness of reflected synovio-capsular flaps gradually decreased until reaching a normal size. After eight weeks, there was no statistical difference between the experimental and control group. Twelve weeks after the operation, immature fibrocartilage cells appeared in the central portion of the reflected synovio-capsular flaps in 7 out of 8 rabbit knees. Sixteen weeks after the operation, more mature cartilage cells and their halos, stained very deeply with safranin-O, appeared in 6 out of 8 rabbit knees. In electron microscopic examination of cell shape, normal cell process and nuclear shape were observed with the passage of time. Rough endoplasmic reticulum and chromatin transparence peaked at 12 weeks and gradually returned to normal shape at 16 weeks. CONCLUSIONS: The results showed that the reflected synovio-capsular flap in rabbit was incorporated with the remaining peripheral portion of the meniscus and became a normal meniscus-like structure.

Rheumatoid Arthritis and HLA Class II Genotypes in Korean / 대한정형외과연구학회지

To determine which HLA antigens are associated with rheumatoid arthritis in Korean, we studied the HLA class II genotypes in 40 patients with rheumatoid arthritis and 35 normal healthy persons by the two step polymerase chain reaction. At first we designed 20 pairs of group specific primers followed by the alleles which have the same nucleotide sequences in the exon 2 region. We performed amplification reaction with these 20 pairs of primers for 32 cycles. Reaction products were electrophoresed and only specifically amplified products were reamplified for 15 cycles with total 76 pairs of allele specific primers. We typed the HLA class II genotypes with specific band patterns of each allele. The genotypes in patients were compared with those of normals. HLA-DR4 gave the highest relative risk for rheumatoid arthritis (RR=4), which was statistically significant (P0.05). Among HLA-DR4 subtypes, the frequency of Dwl4(0404) in patient group was relatively higher (19.2%) than that in normal control group(7.7%). The relative risk was high (2.85), although it was not statistically significant (P>0.05). From this study, HLA-DR4 was found to be highly associated while DRI was not associated with rheumatoid arthritis patients in Koreans.

Effect of Ginseng Saponin on Cultured Osteoblast / 대한정형외과학회잡지

Earlier work suggested that Ginseng saponin had an effect on healing of fracture and osteoporosis, hut there has heen no report on saponin effects on cultured osteoblast. The purpose of this study was to investigate the effect of saponin on cultured osteovlast of the mouse. Osteohlastic cells were isolated from periosteum-stripped parietal bones of neonatal rat calvaria, seeded at 4 x 10 4 cells/cm2 density, and cultured in standard medium and deficient medium, with addition of saponin (0(control), 10, 20, 50 microgram/ml concentration). Plating efficiency(adhesiveness), proliferation and the alkaline phosphatase activity of the osteohlasts were evaluated on 2 hours, days 2 and 7 of culture. Saponin was found to enhance the adhesiveness of seeded osteoblasts which were cultured with a deficient medium in comparison to the controls. It promoted cell proliferation of the osteoblasts cultured with a deficient medium in comparison to the controls. There was also a significantly enhanced increase of alkaline phosphatase levels in the presence of saponin during culture with deficient medium in comparison to the controls. In summary, the results showed that the saponin increased adhesiveness, proliferation and the alkaline phosphatase activity of the osteoblast cultured only in deficient medium.

Rotator Cuff Repair using Mini - open Technique with Minimized Arthroscopic Acromioplasty / 대한정형외과학회잡지

Treatment of rotator cuff tears by open subacromial decompression has known successful in decreasing pain and restoring function in patients who have failed nonoperative treatment. But, open rotator cuff repair may result in significant deficits in strength and active motion by deltoid separation from the acromion. Deltoid detachment may be avoided by repair using mini-open technique. Arthroscopic subacromial decompression and the rotator cuff repair revel satisfactory results. Subacromial decompression involves decompression of the coracoacromial arch including routine release or resection of the coracoacromial ligament. Recent ligament-cutting studies have confirmed the role of the coracoacromial ligament as a static restraint to superior humeral head displacement. Complete resection of the coracoacromial ligament may be avoided through minimized arthroscopic acromioplasty. We evaluated all 11 patients with rotator cuff tears who underwent arthroscopic minimized subacromial decompression and rotator cuff repairs using mini-open technique. Their average age was 53 years (26 to 64 years); and the average follow-up was 13 months. Preoperatively, all patients complained pain and weakness. Follow-up using modified Hospital for Special Surgery shoulder score showed good to excellent results in 10 cases and poor results in 1 case an average 13 months postoperatively. We found that arthroscopic minimized subacromial decompression and repair using mini-open technique are safe, effective procedure for addressing cuff tears of a wide range of sizes.

Operative Treatment Using Minimized Internal Fixation and Tension Band Technique on Proximal Humeral Fracture / 대한정형외과학회잡지

Most proximal humeral fractures respond satisfactorily to simple conservative treatment, but operative treatment is recommended in cases where poor results are anticipated by prolonged immobilization, or because of severe displacement and comminution. We used a minimal internal fixation and tension band technique in severely displaced and comminuted cases to achieve firm fixation and avoid subacromial impingement. Passive range of motion of the involved shoulder began within the first postoperative day and active range of motion exercise was encouraged as soon as possible within the first postoperative week. Between February 1996 and November 1997, we operated using this technique on 15 patients ranging in age from 16 to 71 years (average 52). Follow-up averaged 13 months. During the follow-up period, all patients except one patient, had a active full range of motion on the affected limb. According to the evaluation on the 10 patients who had follow- up periods over 12 months by Hawkins rating scale of shoulder function, 6 patients had achieved a good result and 4 patients had achieved a fair result at the last follow up. In conclusion, tension band technique with minimal internal fixation could afford sufficient fracture stability to allow early, aggressive rehabilitation. As a method of internal fixation on a proximal humerus fracture, this technique may have particular advantages in elderly osteoporotic patients.

Effect of Ginseng Saponin on Human Chondrocyte / 대한정형외과학회잡지

Earlier work suggested that Ginseng saponin had an effect on osteoblast and other cells, but there has been no report on saponin effects on chondrocyte. The purpose of this study was to investigate the effect of saponin on cultured human chondrocyte. The chondrocyte was isolated from human articular cartilage of knee joint during notchplasty of ACL reconstructive procedure using collagenase, and cultured in standard medium and serum free deficient medium, with addition of saponin(0(control), 10, 20, 50 microgram/ml concentration). DNA, RNA synthesis of chondrocyte was estimated on 36 hours and 5 days of culture by measuring of thymidine and uridine uptake. Human collagen type I and II synthesis was estimated by reverse transcriptation-polymerase chain reaction on 36 hours of culture. Low dose saponin was found to enhance DNA, RNA, and collagen synthesis of chondrocytes which were cultured with a deficient medium in comparison to the controls. It promoted cell proliferation of the osteoblasts cultured with a deficient medium in comparison to the controls. But, high dose saponin was found to diminish the synthesis of DNA, RNA and collagen. In summary, the results showed that the saponin increased proliferation and differentiation of the chondrocyte cultured in deficient medium. Therefore saponin seemed to act as a physiologic stimulant on human chondrocyte. But further study should be done.

The Effect of the Hydrophobicity by Fluorocarbon Plasma Coating on the Degradation of Polylactic Acid / 대한정형외과학회잡지

The use of resorbable implants has always been attractive to surgeons because there is no need to remove implant ai'ter fracture fixation. Other advantages include decreased load sharing, multi-taskirv ancl no metal toxicity. But the strength and stiffness of resorhable implants are less than those of metallic implants. Therefore, these implants are suitahle for fixation of particular fractwre sites such as cancellous bone and epiphyscs in which shear loads comprise the major strains. The purpose of this experimental study was to determine whether there are changes in mechanical properties and tissue reactions in the polylactic acid (PLA) rod hy surface moditication using plasma coating or hexafluoropropylene (CF3CF=CF2). PLA rods were inserted into the subcutaneous tissue of back and distal femur in rabbits. Rods in subcutaneous tissue were retrieved for material characterization and those in distal femur were ohtained for histologic observation at postoperative 2, 5, 12 and 16 weeks. The results were as follows; 1. The hydrophobicity of PLA surface was successfully ohtained by plasma coating of hexatluoropropylene gas. 2. Thcre is no significant change in tissue reaction. between controi and plasma coating PLA group. 3. The diametral strength and 3-points bending strength of plasma coating groups were higher than those of control group until postoperative 12 wks, but, diminished at postoperative 16 weeks. In conclusion, the plasma coating of PLA rod using fluorocarbon is a reasonable technique to incrcase the surface hydrophohicily and a promising method to delay the reduction of the strength of PLA rod. Further study on thicker plasma coating and Jong term effect including degradation, nsetaholism and excretion of cotated fluorocarhon will be needed.

Simultaneous Pigmented Villonodular Synovitis and Synovial Chondromatosis in the Ankle Joint / 대한정형외과학회잡지

Pigmented villonodular synovitis and synovial chondromatosis are known as a poup of interrelated tumorous disorders that involve the lining of the joints, hursa and tendon sheath. Pigmented villonodular synovitis consists of proliferatin synovia1 tissue containing histiocytes, librohlasts, multinucleated giant cells, and capillaries that can destroy dense fihrous tissue, form soft tissue masses, and invade bone. Synovial chondromatosis consists of hyaline cartilage nodules within the synovium and synovial joint cavities, develop multiple loose fragments of cartilage within the joint. They may represent a reactive inflammatory process or henign neoplasm and usually occur in latge synovial joints, including the knee, hip and ankle. There are some reports stating that pigmented villonodular synovitis has coexisted with synovial chondromatosis. but none have reported that they occurred simultaneously in a large single joint. This is a report on a diagnosed and arthroscopicully treated pigmented villonodular synovitis and synovial chondromatosis that occurred simultaneously in the same ankle joint.

Necessity of Banked Autogenous Transfusion on the Total Knee Arthroplasty Using Autogenous Shed Blood Transfusion / 대한정형외과학회잡지

In the orthopaedic field, some elective surgeries such as joint replacement, spinal surgery and limb salvage procedures for musculoskeletal tumors frequently need various amounts of blood transfusions. However, homologous transfusion occasionally results in various side effects, such as allergic reaction, febrile reaction, and the transmission of infectious diseases such as syphilis, hepatitis and AIDS, ctc. Recently, these complications especially in elective surgery might result in medicolegal or social problems. Risks from transfusions in elective surgery can be minimized with prebanked autologous transfusion. To evaluate the necessity of prehanked autogenous transfusion, fifty five patients who had unilateral hybrid total knee arthroplasty (noncemented at the femoral side and cemented at the tibial and patellar sides) were operated on by the same surgeon from April 199S to July 1997 and had autogenous shed blood transfusion were evaluated for postoperative blood loss, amount of autogenous shed blood, amount of transfusion, hemoglobin and hematocrit. The results were as follows: 1. The distribution of preoperative hemoglobin was from 9.6g/dL to 16.5g/dL (average: 1.8g/dL). 2. The distribution of the amount of blood loss for three days postoperatively was from 156ml to 2001 ml (average: 798ml). 3. The distrihution of the amount of transfusion of autogenous shed blood was from 30ml to 600ml (average: 448ml). 4. There were two patients who had febrile reactions above 38 after transfusion of autogenous shed blood. 5. Forty-six patient(84%) had a homologous transfusion and the average amount of transfusion was 1.9 pint. 6. Total amount of homologous transfusion was decreased according to the increased amount of hemoglobin and the amount of transfusion was statistically decreased above the level of I 3g/dL(Students t-test, P=0.0005). 7. There were no significant differences in the amount of homologous transfusion between age, sex, type of disease, type of implants. In conclusion, most of our patients(84%) needed homologous blood transfusion in unilateral hyhrid total knee arthroplasty and the amount of transfusion decreased in patients who had hemoglobin above 13.0g/dL. So we recommend preparing banked autogenous hlood preoperatively in patients who have a lower hemoglobin level in unilateral hyhrid total knee arthroplasty.

Affinity of Osteoblasts on Bone Cements Incorporated with Amino Groups / 대한정형외과학회잡지

Biomaterial surfaces can be characterized by their chemical, morphologic, and electrical surface features. The adhesion and proliferation of different types of mammarian cells on various surfaces depends on polymer surface characteristics like water wettability and charge. In clinical aspect, bone to bone cement interface loosening has been one of the causes of failure of the prosthetic implantation. In this study, the bone cement was, thus, modified by mixing a monomer with amino group, which is a positively charged chemical group, to improve cellular adhesion and proliferation and to decrease bone to bone cement interface loosening. To incorporate amino-charged groups in the bone cement, we used dimethylaminoethyl- metacrylate (DAEMA) as a adding material. As experimental materials, CMW1 bone cement (control) and CMW1 mixed with monomer containing 1mol% dimethylaminoethylmetacrylate (DMA1) and CMW1 mixed with monomer containing 3mo1% dimethylaminoethylmetacrylate (DMA3) were used. To estimate the wettability of surface of bone cement, water contact angle was measured using contact angle goniometer and water absorption was measured using the disc samples. Osteoblasts were isolated from neonatal, Spraque-Dawley rat calvaria. After 3 culturing passages, the osteoblasts were plated on the cement disks, which are placed in a 24-well tissue-culture plate, at a density of 1 X 10 (5) cells/cm. After culturing for 2, 6, 24, and 48 hours, the number of attached cells on each cement discs were counted and cell morphologies were examined with scanning electron microscope (SEM). No significant difference in the water contact angle (63-64degrees) is statistically found between 3 groups (P>0.05). The water absorbencies of DMA1 (3.61+/-0.28%) and DMA3 (6.70+/-0.56%) were higher than that of the control (2.59+/-0.21%). Diametral tensile strength were decreased at DMA1 and DMA3 groups in comparing with control and that of DMA3 was smallest (P0.05) at each culturing period. In summary, well spread osteoblasts and increased attachment and growth of them were observed, when they were plated on the amino-charged cement discs. The histocompatibility of the amino-charged cements may increase the attachment between bone and cement. However, mechanical strength may decrease due to higher water absorbency. The author will further study to find the material that is cytocompatible and that does not lead to deteriorate mechanical properties.

Treatment of Degenerative Arthritis of Knee Joint Using Holmium : YAG Laser / 대한정형외과학회잡지

In spite of the many improvements in arthroscopic surgical techniques for the treatment of mild to moderate degree degenerative joint diseases which were resistant to conservative treatment, the results are variable, showing a tendency to decline in therapeutically following the passage of time. Using a 2.1 un holmium: YAG laser we operated on patients with mild to moderate degenerative joint diseases which had not improved through conservative treatment. We evaluated the results of arthroscopic laser surgery for degenerative joint disease and investigated the proper indication and complications of laser surgery. We operated on 28 knees of 28 patients between July 1995 and June 1996. There were 16 females and 12 males. The average follow-up period was 16.3 months and the average age was 54.5 years. Under epidural or general anesthesia, we used arthroscopic tools, including laser, and the laser power was modified according to the type of operation (chondroplasty: 1.0Jx20pulse/sec, meniscectomy: 2.0Jx15pulse/sec, bone drilling: 2.5Jx10 pulse/sec). We used Bauer & Jackson's classification of articular cartilage change, and performed 12 laser chondroplasties in grade II, III, V lesions, 16 chondroplasties and laser bone drilling in grade IV, VI lesions, 16 laser meniscectomies, 6 laser synovectomies and 2 lateral retinacular releases. Medial femorotibial arthritis was the most common site. Postoperative results by Orgilvis-Harris & Fitsialos's methods indicated that 82% of treated patients were satisfied and only two patients (7%) did not improve. As a postoperative complication, eight patients complained of postoperative effusion which was subsided by medication and physical therapy. We performed second-look arthroscopic examinations in four knees that had been treated with laser chondroplasy and drilling. Regenerated tissues at the operated site were observed in three cases, but denuded articular cartilage and naked subchondral bone at the operated site were found in one case as a sign of osteonecrosis. Concluding this short-term study, 2.1 holmium: YAG laser in arthroscopic surgery seems to be effective in mild to moderate degenerative joint disease but care should be taken to avoid thermal injuries to the adjacent normal cartilages.

Ligament Injuries Combined with Proximal Tibia and Fibula Fracture / 대한정형외과학회잡지

It is well known that fractures around the knee joint are usually combined with ligament injuries but it is easy to miss the ligament injuries during the treatment of fractures. The invention of the MRI and the development of arthroscopic techniques has made it easy to diagnose and care for ligament injuries. Authors reviewed the patients who had fractures around the knee joint to evaluate the frequencies, types, treatments and the results of combined ligaments injuries. There were 57 cases with the fracture of the proximal tibia and fibula which could be follwed up at least one year: from January 1992 to June 1995. There were 19 cases (33%) which had combined ligament injuries. The ligament injuries were diagnosed by stress X-ray & MRI evaluation and confirmed by arthroscopic examination. Single lateral rim avulsion fracture of proximal tibia was the most common type of fractures (7 cases, 37%). There were 11 cases (57%) of combined injuries of anterior cruciate ligament and medial collateral ligament. It was the most common combined ligament injury. Except for one, eleven cases that were combined with lateral rim avulsion of proximal tibia had anterior cruciate ligament injury. There were ten cases (53%) of fibula head and neck fractures which were combined with ligament injuries. The total number of the injured ligament was 35 and the common rupture sites of the injured ligaments was the attachment site of femur (13 cases) and tibia (16 cases). There were seven meniscal injury cases (37%). The interval from injury to operation averaged 14.1 days because many cases were acute injuries. Primary repairs for ruptured ligament were done in 31 cases (88%) because of their attachment site injuries. There were no instabilities except one case which was treated with posterior cruciate ligament reconstruction using semitendinosus ligament. It had a grade I posterior instability at the last follow-up. Early diagnosis and proper treatment on the ruptured ligaments and the torn meniscus combined with proximal tibia and fibular fractures seem to be important for a good prognosis.

Unstable C1, 2 Cervical Spine Injuries Treated with Halo vest / 대한정형외과학회잡지

In a consecutive series of 15 patients with unstable C1,2 cervical spine injuries treated with halo vest, 1992-1996, a total 7 patients (comprising 46%) among the patients with C1,2 cervical spine injuries, had odontoid fractures, no patient had neurologic injury. In all cases, initial treatment was Halter or skull traction for 1-2weeks. In the vitally stable state, they were stabilized with halo vest for 12-16 weeks. In 2 cases of C1,2 instability, initial treatment was internal fixation and halo vest for the same time. 2 cases of the patients, who were treated with halo vest, had additional posterior wiring and fusion due to instability checked after removal of halo vest. There was no other serious complications during the treatment. One case (25%) of 4 Anderson-d' Alonzo type II fractures was failed to unite. The halo vest was well tolerated in all patients and assured a high percentage of healing. Flexion-extension motion was measured with dynamic lateral cervical tomography. The age range was 17-67 (mean 41.3) years and male/female ratio was 3/2. Complications during the treatment were pin loosing (1 case) and halo vest frame breakage due to falling down. Pain on motion and stiffness of neck were the most frequently remained symptoms. But the symptoms were mild and did not usually have any major impact on return to work or leisure activities.

Repair and Kennedy LAD Augmentation to Posterior Cruciate Ligament Injury / 대한정형외과학회잡지

The significance of the posterior cruciate ligament (PCL) in the stability of the knee and the necessity for surgical repair of its tears are still controversial. The purpose of this study is to present the short term results of surgical repair and Kennedy LAD augmentation for 15 cases with PCL injury. In 14 patients (15 knees), the torn PCL was repaired with pullout suture technique and Kennedy LAD augmentation was done from june 1993 to june 1994. The follow-up period ranged from 12 months to 25 months (average, 18months). The main causes of injuries were traffic accidents in 12. Thirteen of the patients were men and one was a woman, ranging in age from 17 to 52 years(average, 35 years). 10 knees were acute injury and repaired at average 9 days after injury. There were 11 cases that had combined injuries(4 ACL injuries, 4 meniscus injuries, 3 MCL injuries etc). In eight knees, the tear was in mid substance area and in five it was near femoral attach site and in two it was near tibial attach site. Postoperative results were evaluated by roentgenographic evaluation of posterior sagging and Lysholm knee score. 11 knee were stable but 4 knees were unstable posteriorly during postoperative follow-up period. 3 chronic injuried knees were included in 4 posteriorly unstable knees. There are 7 combined knee injuries in 11 stable knees and no combined injuries in unstable knees and average Lysholm knee score was 89.7 in stable knees and 90 in unstable knees and there was no significant difference between two groups. On the based of this study, surgical repair with pollout suture technique and augmentation with Kennedy LAD in acute PCL injury is a one of the good method for preventing posterior sagging but more longer follow-up period and more cases must be needed to accept this method.

Open Reduction and Internal Fixation of Fractures of the Acebabulum / 대한정형외과학회잡지

Open reduction and internal fixation of the displaced fractures of the acetabulum represents one of the greatest challenge in fracture surgery. The purpose of our study is to report the results of operative treatment and establish the guideline for the operative treatment of the displaced acetabular fractures with the analysis of the clinical and radiological results. This retrospective study reports the results of 21 fractures in 21 patients(19 male and 3 female) treated by open reduction and internal fixation from January 1990 to July 1994. The patients were followed up more than 1 year and mean length of follow-up was 2.3 years. According to Letournel's classification, we had 9 elementary fractures(42.8%) and 12 associated fractures(57.2%). Among the elementary fractures, the posterior wall fracture was the most common type(7 cases, 33.3%) and the transverse-posterior wall fracture was the most common type among associated fractures(4 cases, 19.0%). Surgical approaches were 14 Kocher-Langenbeck, 6 Ilioinguinal and 1 extended iliofemoral. Indirect reduction and specially designed reduction method using C-arm and radiolucent operating table were also helpful to achieve satisfactory reduction. Overall quality of clinical results was graded according to the D'Aubigne and Postel rating score. Satisfactory reduction was gained in 16 cases(76.1%). Unsatisfactory reduction was gained in 5 cases(23.8%). Among the cases within category of satisfactory reduction, there were 7 excellent and 8 good clinical results. But among unsatisfactorily reduced 5 cases, there were 2 good clinical results. It seems that the satisfactory operative reduction of the fracture is the factor that correlates with a satisfactory clinical result. There were complications such as 3 secondary osteoarthritis(14.2%), 3 wound infection(14.2%, 2 superficial and 1 deep), 2 iatrogenic nerve palsy(9.5%, 1 sciatic and 1 obturator nerve) and 1 intrapelvic protrusion acetabuli(4.7%) and no postoperative ectopic ossification.