Over-the-top Augmentation with ABC Synthetic Ligament in the Treatment of Acute Rupture of Anterior Cruciate Ligament

PURPOSE: To evaluate the clinical outcome after the over-the-top augmentation with ABC synthetic lig-ament for the treatment of acute rupture of anterior cruciate ligament at least two years follow up. MATERIALS AND METHODS: From January 1992, authors have treated acute rupture of ACL with this method on 91 cases. Among these, 46 cases were available for full data acquisition. At the last follow-up, clinical results were analyzed subjectively and objectively by Lachman, pivot shift test and presence of joint effusion. Functional evaluation was performed by various knee ligament scoring systems and the side-to-side differences were measured with KT-2000 arthrometer. RESULTS: On Lachman test, 82.7% were under grade Iⅈ grade 0 : 17 cases(37%), grade I: 21 cases(45.7%), grade III: 8 cases(17.3%). 89.3% were under grade 0 & Ion pivot shift test. On measure-ment of side-to-side difference, 25 cases(54.3%) were showed difference less than 3 mmand the differences of 16 cases(34.8%) were 3~5 mm. On six cases joint effusions were present. Among these six cases, four cases were accompanied by anterior instability which were brought to second look arthroscopy. Two cases were treated with several times of aspiration and steroid instillation. The one case was failed its continuity which solved with ACL reconstruction with patellar bone-tendon-bone autograft. The other three cases showed only lax ACL which was cared with retightening of ligament at the femoral attach-ment site. At the last follow up, 37 cases(80.4%) were resulted excellent and good on Lysholm score and 41 cases(89.1%) were group A & B on IKDC score. On Tegner scale, 34 cases(73.9%) were above five point. CONCLUSIONS: Authors suggest this over-the-top augmentation of ACL with synthetic polyester ligament would be good treatment option with several advantages; early rehabilitation is possible to get maximal function of knee and no tunnel in the lateral condyle would be good for late ACL reconstruction even though failure of this artificial ligament.

Open Reduction and Internal Fixation of Intraarticular Calcaneal Fractures by the Extended Lateral Approach / 대한정형외과학회잡지

The operative treatment of intraarticular calcaneal fractures has three principal aims; restoration of the height and width of the calcaneus, reconstruction of the subtalar and calcaneocuboid joint surfaces, and stable osteosynthesis. The purpose of this study is to demonstrate the effectiveness of the open reduction and internal fixation by the extended lateral approach for the treatment of the intraarticular calcaneal fractures. Twenty-one calcaneal fractures of 20 patients were treated by open reduction and internal fixation using an extended lateral approach from April, 1993 to March, 1994. The autogenous iliac bone graft was done in all patients. These patients were evaluated from 12 to 24 months (average 15.2 months) after surgery. The following results were obtained; 1. Seventecn cases (80%) out of 21 were estimated as good or excellent result. 2. Preoperative Bohler's angles, Gissane's angles and inclination angles were observed as average -0.5degrees, 101degrees and 38degrees respectively, and these were improved as average 23.3degrees, 117degrees and 54degrees, postoperatively. 3. There were two cases of skin necrosis as complication. In conclusion, the extended lateral approach is one of the good methods for the treatment of intraarticular calcaneal fractures. We think that accurate reduction of the posterior facet, acceptable recovery of Bohler's angle and early postoperative mobilization are the most important things for the best result of the intraarticular calcaneal fracture surgery.