The Long Term Results of Femoral Varus Osteotomy in Patients with Legg-Calve-Perthes Disease

PURPOSE: The purpose of this study was to evaluate the long term results of performing femoral varus osteotomy (FVO) for the treatment of Legg-Calve-Perthes disease (LCPD). MATERIALS AND METHODS: We selected 35 LCPD patients who received FVO and they were followed up to the time their skeletons' matured. The inclusion criteria were patients in a fragmentation stage, the patients were in Catterall group III or IV, and the patients underwent a teleoroentgenographic examination at the time of full skeletal maturity. RESULTS: The radiological outcome at the time of skeletal maturity was assessed using Stulberg's classification. The final results were 4 hips in class I, 17 hips in class II, 13 hips in class III, one hip in class IV and none in class V. The satisfactory results (good+fair hips) were 34 hips (97%). Significant shortening (>10 mm) was observed in 12 hips (34%). In 35 patients, 5 (14%) had same leg length (less than 2 mm difference), 27 (77%) had shortening of 2 mm or more, and 3 had lengthening of 2 mm or more in the operated limb. Of these 12 patients with significant shortening, only 3 patients (9%) showed shortening of 21 mm or more. CONCLUSION: FVO is a reliable method for managing LCPD in patients who are in Catterall group III or IV and who are in the fragmentation stage of disease.

Partial Tear of ACL at the Femoral Attachment of Posterolateral Bundle as a Cause of Knee Locking

OBJECTIVE: Locking of the knee is usually attributed to a tear of meoiscus, or to a loose body that rnechanically obstructs the motion of joint. A less frequently recognized cause of a locked knee is a partial tear of the ACL. The purpose of this study is to report that the partial tear of,the ACL at the femoral attachment site of posterolateral bundle provided a mechanical obstruction in the knW, and it is convicted the injury mechanism of isolated ACL. MATEIRALS AND METHODS: The author presents 16 cases in which the torn ACL was observed knee locking under arthroscopy fram February 1993 to June 1996. Patients ages ranged from 22 to 54 years. The mechanism of injuries were 6 sports activity (Ski 4, Soccer 1, Badminton 1), 4 slip down, 3 pedestrian car accidents and 3 unknown causes with especially low velocity injuries. Although the chief complain in each case was knee pain, all had locking knee that, on physical examination, locked from 5 to 20 of full extension, and 4 locked full flexion. The positive Lachman test was obtained 3 of the 16 paiients. Associated intraarticular injuries were 2 tears of the medial meniscus, 1 lateral meniscus. RESULTS: The average time to arthroscopy was 3 nonths with a range of 1 month to 10 rnonths. An arthroscopic diagnosis and treatment were performed and meniscal tears were ruled out as the cause of locking in all patients. The injury mechanism of isolated ACL was the hyperextensioo of the knee with leg I/R and especially low velocity injuries. The ACL was found to have a partial tear at the site of femoral attachment of an estimated P-L bundle. The torn segment of the ACL to become interposed between the lateral femoral condyle and the latera1 tibial condyle and to act as mechanical block was demcinstrated. CONCLUSION: In all cases, the torn portion of the ACL was excised under arthroscopy and knee locking was resolved.

Arthroscopically Assisted Posterior Cruciate Ligament Reconstruction Using Hamstring Tendon

INTRODUCTION: The reconstructions of posterior cruciate ligament (PCL) has been increasing because of increased incidence of insufficiency of the PCL and improved surgical skill Arthroscopic operation is known better than open in cruciate ligamet reconstruction in many respects. Arthroscopic PCL reconstruction, especially using hanstring tendon has some benefits. This study is retrospective study analyzing 20 patients treated by arthroscopically assisted PCL reconstruction using hamstring tendon. ALATERIAL AND METHODS: From November 1993 to June 1996, 20 patients with PCL insufficiency had heen treated by arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon by first author. The isometric point was located slightly posterosuperior than anatomic attachment in femur and 0.8-1.0cm below articular margin in tibia. They were confirmed by intraoperative fluoroscopy. The remnants of intact PCL bundle and meniscofemoral ligaments were preserved and added to the graft. They were nineteen men and one women, with a mean age 31.8 years (range, 15-56 years). RESULTS: The results were as follows; 1. The patients were followed from 13 months to 44 months after operation (average 2years and 2months ). 2. Post operative neurovascular irjuries were not found. 3. No revision case was observed and second operations were made in two cases with posterolateral rotatory instability after primary reconstruction. 4. All patient has no symptom of instability after operation. S. At last follow up, Lyshohn knee scores improved from 62 preoperatively to 89 postoperati.vely on average. CONCLUSION: Arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon is easier and less damage than using bone-patellar tendon-bone graft. It preserves intact meniscofemoral ligament, some intact fibers of PCL bundle and quadriceps mechanism. We think it is a effective treatment for PCL insufficiency patients."

Flexorplasty of Elbow in Brachial Plexus Injuries / 대한정형외과학회잡지

One of the most basic function in brachial plexus injury is the recovery of elbow flexion. So the important purpose in nerve surgery of brachial plexus injury is the recovery of the function of the musculocutaneous nerve. However, failure of the recovery of function of the biceps through surgery or in cases of neglected nerve surgery of more than 1 year needs the consideration of tendon transfer or free vascularized muscle graft. In these failed or neglected brachial plexus injury, flexorplasty is more often indicated because of associated surrounding muscle weakness or paralysis. We analyzed the functional results in brachial plexus injured 12 patients who underwent elbow flexorplasty between June, 1987 and Aug. 1994. In 2 patients, the elbow flexorplasty was augmented by a glenohumeral arthrodesis. The mean length of the follow-up was 52 months. The mean are of active flexion following flexorplasty was 81 degrees. The postoperative active Supination and loss of elbow extension was 40 and 28 degree respectively. At final objective evaluation, 6 patients were judged to have excellent; 2 good; 1 poor; 3 failure. At final subjective evaluation, 3 patients were judged to have excellent; 3 good; 3 failure.