ABSTRACT
Seventy cases of moderate to severe hallux valgus deformities were operated by proximal metatarsal chevron osteotomy combined with modified McBride procedures from September 1994 to September 1996. The hallux valgus angle improved from an average of 35.1 degrees to 12.1 degrees postoperatively. The first intermetatarsal angle improved from an average of 15.4 degrees to 7.9 degrees. The position of sesamoids was normalized and the metatarsal bone shortened minimally. Union occurred in 6 weeks. Subjectively, pain was relieved in 95% of the patients, while walking and standing abilities improved in 90%. The shoewear improved in only 60% of the patients, showing less satisfactory results compared to other factors. In terms of complications, two recurrences occured but were treated without repeat surgery. Two malunions and four superficial wound infections occurred. In conclusion, proximal chevron metatarsal osteotomy combined with modified McBride procedures is a reliable operation as regards stability, technical ease, low complications and satisfactory results for moderate to severe Hallux valgus deformities.
Subject(s)
Humans , Congenital Abnormalities , Hallux Valgus , Hallux , Metatarsal Bones , Osteotomy , Recurrence , Reoperation , Walking , Wound InfectionABSTRACT
Localized pigmented villonodular synovitis is a monoarticular proliferative condition that may affect any joint but is frequently found in the knee. The locaiized form was less frequent than the diffuse one. The estimated frequency of localized pigmented villonodular synovitis among patients performed an arthroscopic procedure was known one case lor each 2,500 cases. Previous reports pointed that the lower recurrence rate after the arthroscopic excision for localized form. We also experienced a case of localized pigmented viilonodular synovitis located at the posterior compartment of the knee, so we report this case with review of literatures.
Subject(s)
Humans , Joints , Knee , Recurrence , Synovitis , Synovitis, Pigmented VillonodularABSTRACT
The short term beneficial effect of arthroscopic excision of synovial tissue in knees with rheumatoid arthritis have been well documented. The purpose of this study to report the results of synovectomy in patients with rheumatoid arthritis who have been observed at least 3 years. We analysed the clinical result with modified Laurin criteria, radiologic change and patients own satisfaction degree with survey. The results were as follows; 1. The preoperative symptoms were pain (100%), swelling (100%), decreased range of motion (83%) and joint tenderness (74%), and those were improved postoperatively to 43%, 60%, 11%, 43% each other. 2. Among the laboratory parameters, C-reactive protein (CRP) was improved most significantly (pvalue =0.026). 3. On simple supine A-P X-rays, the width of medial joint space and lateral joint space were compared to preoperatively and postoperatively. The width of medial joint space was 4.33mm preoperatively, and it was changed to 3.22mm at last follow up (p=0.032). Those of lateral joint space was changed from 4.24mm preoperatively to 3.27mm at last tollow up (p=0.106). 4. The grade of articular cartilage damage was related with severity of preoperative symptoms and the patients with low grade of articular cartilage damage showed more postoperative improvement. The result of operation was related to symptom duration, degree of X-ray change and degree of cartilage damage. 5. 58% ot patients were satisfied to results of synovectomy, 28% were answered neither satisfied nor ansatisfied and 14% were unsatisf'ied to operation. We concluded the arthroscopic synovectomy of the knee joints was effective procedure to improve the clinical symptoms, range of knee motion and to alleviate the inflammatory reaction at mid-term period al'ter the operation. So we consider this procedure is a palliative treatment that modified and alleviate the progression of rheumatoid arthritis of knee joints.
Subject(s)
Humans , Arthritis, Rheumatoid , C-Reactive Protein , Cartilage , Cartilage, Articular , Follow-Up Studies , Joints , Knee Joint , Knee , Palliative Care , Range of Motion, ArticularABSTRACT
Rheumatoid arthritis can result in progressive deformity of the forefoot, which leads to marked limitation in shoe wear, significant pain, and substantial diminution in standing and walking ability. Twenty feet of seventeen patients with severe forefoot deformities underwent surgical correction hy means of first metatarso-phalangeal arthrodesis and resection arthroplasties of the lesser M-P joints from May, I 994 to March, l996. The results were as follows; l. Suhjective improvement in pain, standing and walking ability, and shoe wear was excellent in fifteen (7~5%) feet, good in three (l5%), fair in one (5%), and poor in one (5%) foot. 2. The average hallux valgus angle (HVA), 1st intermetatarsal angle (IMA) were improved from 46.7 and 13.7 to 11. 1 and 8.2 degree individuaIly. 3. The average angle of dorsiflexion after the first metatarsophalangeal (MP) joint arthrodesis was 12.9 degree. 4. Complications of the procedures were minimal; three delayed wound healing, one non-displaced fracture of fusion site due to trauma, one malunion of the 1st MTP joint, one recurrence of the fibular deviation of the lesser toes.
Subject(s)
Humans , Arthritis, Rheumatoid , Arthrodesis , Arthroplasty , Congenital Abnormalities , Foot , Hallux Valgus , Joints , Recurrence , Shoes , Toes , Walking , Wound HealingABSTRACT
The purpose of this study is to evaluate the results of primary repair and autogenous tendon augrnentation for acute rupture of anterior cruciate ligament. We primarily repaired 13 cases of acute ACL injury with autogenous tendon augmentation between Jul. 1988 and Jan. 1996. Among 13 cases, there were 2 isolated ACL injuries and 11 cases were combined with MCL injuries. All 13 cases were followed up over 1 year. An average follow up period was 4.1 years (1.1 - 8). All patients had open primary rnultiple suture repair and semitendinosus tendon (11 cases) or iliotibial band (2 cases) augmentation at average 3.6 days after the injury. In 11 cases, medial collateral ligarnent injuries were noted and these ruptured ligaments were supplemented with staple or vicryl suture. We evaluated the results with Lysholm Knee Score, KT-1000 arthrometer, postoperative ROM of knee, thigh muscle atrophy, extension lag, Lachman and pivot shift test. The clinical results were as follows 1. Lysholm Knee Score was mean 87.2 points; over 90 points: 5 cases, 80-8$ points: 5 cases, 70-79 points: 3 cases 2. Using the KT-1000 arthrometer, the average side to side difference wm 1.8nun in 201b (89N) and the compliance index was average 1.7mm. 3. Postoperative ROM of knee was nearly normal and there was no extensioe lag in any cases. But, we performed arthroscopic adhesiolysis in one case for limited motion of knee joint a ( postoperative 8 months. Thigh circumference was measured 0.95 cm difference than the healthy side at 10cm above upper pole of patella. 4. Lachman test was positive in 2 cases. 5. Pivot shift test was positive in 2 cases. Even if not many cases, we obtained relatively satisfactory results. So the pirimary repair with autogenous tendon auynentation was recornmandable procedure for acute rupture of ACL, especially combined with MCL injury.
Subject(s)
Humans , Anterior Cruciate Ligament , Compliance , Follow-Up Studies , Knee , Knee Joint , Ligaments , Methods , Muscular Atrophy , Patella , Polyglactin 910 , Rupture , Sutures , Tendons , ThighABSTRACT
Operative reduction is not essential for mild to moderate spondylolisthesis, but some authors agree that reduction of spondylolisthesis is beneficial for widening of intervertebral canal and consequently for decompression of neural tissue even though the degree of slippage is grade I or II. In our institute, we sometimes reduced the slippage for these reasons. But at follow up study we would find redisplacement and the degree of it seemed to be associated with the kind of instruments. So we analyzed redisplacement rate according to the kind of instruments in 59 cases of spondylolisthesis that were followed more than one year. The conclusions were as follow; 1. There was no significant correlation between reduction and redisplacement rate with pathologic type, lesion site, age,iscectomy and clinical result at least in grade I or II spondylolisthesis (P>0.05). 2. The pedicle screw system was more useful in reduction and its maintenance than the Luque ring system (P<0.001). 3. Redisplacement was occurred mainly within 2 months after operation, 4. The cause of redisplacement after reduction seems to be associated with mechanical insecurity before consolidation of the grafted bone takes place.