Anterolateral Meniscofemoral Ligament of the Lateral Meniscus

Anatomical variations of the meniscus are a common anomaly that knee surgeons frequently encounter. However, anomalies of the anterior horn of the lateral meniscus (AHLM) are extremely rare. In this report, we present a newly discovered anomaly of the AHML: an anterolateral meniscofemoral ligament is described with clinical features and radiographic and arthroscopic findings.

The Etiology of Residual Symptoms after Hip Arthroscopic Treatment of Femoroacetabular Impingement: Analysis Using Finite Element Modeling / 대한정형외과학회잡지

PURPOSE: To analyze, using finite element model analysis, the causes of postoperative pain in patients who had arthroscopic treatment for femoroacetabular impingement (FAI). MATERIALS AND METHODS: Ten patients with FAI treated by arthroscopic surgery between July 2004 and July 2007 were selected. Five cases whose condition improved to a pain score of 3 postoperatively were assigned to comparative group A and 5 cases who had a second operation done due to a pain score of 1 were assigned to experimental group B. Finite element model analysis was done for the impingement test position. Femoral offset and alpha angle were measured to compare with contact pressure or von Mises stress. RESULTS: Preoperative von Mises stress and contact pressure were all higher in group B than group A. Maximal stress and pressure location was the anterolateral surface of the femoral head and neck, and this location was removed more accurately in group A. CONCLUSION: Finite element model analysis of FAI indicated that incomplete removal of a bump was the cause of pain, and that accurate location of the lesion and adequate bump removal are the definitive factors in reducing pain.

Arthroscopic Management of Femoroacetabular Impingement in Early Osteoarthritis of the Hip: 2 to 5 Year Results / 대한정형외과학회잡지

PURPOSE: To report the clinical and radiological outcomes of a mid-term follow-up of patients with femoroacetabular impingement treated using an arthroscopic method. MATERIALS AND METHODS: Of the patients who underwent an arthroscopic labrectomy (91 cases), femoroplasty (82 cases) or acetabuloplasty (9 cases) after a diagnosis of femoroacetabular impingement, 82 patients (91 cases) who had been followed up were examined. The preoperative and postoperative clinical outcomes were evaluated using the Modified Harris hip score, Hip Outcome Score, pain score and patient's satisfaction. The radiological assessment was performed by measuring the alpha angle, femoral offset, and center edge angle using simple radiographs and computed tomography. RESULTS: The patients consisted of 63 men and 19 women, whose mean age was 33.5 years (range, 15-70 years). The mean follow-up period was 42.2 months (range, 25-60 months). On the clinical results, the mean pain score improved from 0.72 points preoperatively to 2.02 points at the final follow-up. The Modified Harris hip score improved from 61.4 preoperatively to 83.4 at the final follow-up. The median patient satisfaction was 8.2 (range,0-10 points). On the radiological assessment, the alpha angle decreased from 60.9degrees to 40.4degrees, and the femoral offset recovered from 4.9 mm to 10.0 mm. CONCLUSION: The arthroscopic treatment of femoroacetabular impingement could be an excellent modality to prevent osteoarthritis of the hip. However, recovery of clinical results by arthroscopic treatment is not expected in elderly patients or those with developed osteoarthritis, a low preoperative Modified Harris hip score and concurrent degenerative disease.

Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage

PURPOSE: To find out the efficiency of two staged operation of patients with high energy proximal tibia fracture with severe soft tissue damage, the first step being external fixation, and the second, internal fixation with plates. MATERIALS AND METHODS: The study group was the 42 patients who had followed for one year out of a group of 56, performed the first step external fixation and the second step internal fixation with plates retrospectively, from March 2003 to March 2007. The average age of the study group was 51.4, 26 men, and 16 women participating in this study. The average time of follow up was 32 months. In the final follow up, investigations of the radiological assessments and functional abilities of the bony fusion were carried out along with the complications of the soft tissue. RESULTS: The duration after the first step external fixation until second step internal fixation to be performed was 14.9 (6~40) days in average. The final bone fusion took about 15 weeks, and according to the final follow up, the range of motion of the knee was around 110.8 degrees (6.2~117 degrees). In 31 cases, only the internal fixation was performed, while in 11 cases, soft tissue reconstruction was carried out with the internal fixations. As for the complications there were 2 cases of deep soft tissue infection, 2 cases of nonunion, 1 case of malunion and 1 case of knee joint stiffness. CONCLUSION: In cases of proximal tibia fracture with severe soft tissue damage, external fixation was important to secure the safety of the fracture, carry forward the anatomical alignment, plan the soft tissue safety and manage the wound to decrease the number of microbial in the next operation, which is the internal fixation with plates.

Correlation Between Clinical Result and Adjacent Segment Degeneration After Lumbar Spinal Fusion / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To determine the relationship between clinical outcome and adjacent segment degeneration (ASD) after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Few studies have analyzed the correlation between clinical outcomes and ASD. MATERIALS AND METHODS: Between January 2000 and December 2004, 217 patients who underwent lumbar spinal fusion (>2 years of follow-up) were evaluated. The patients were divided into 2 groups: one-segment (A) and two-segment (B). The UCLA grading scale was used to evaluate the prevalence of ASD on radiography. The association between clinical outcome and ASD was evaluated by Spearman's correlation. RESULTS: ASD occurred in 11.6% (13/112) of patients in group A and 15.2% (16/105) of patients in group B. The number of cases which progressed to more than 2 levels of the degenerative grade were 0 cases in group A and 13 cases (81.3%) in group B. In A, 5 out of 13 ASD cases downgraded one level in their clinical outcomes. In B, all 16 ASD cases downgraded more than one level in their clinical outcomes. Worsening in degenerative grade, was correlated with worse clinical outcome (Spearman's rho = 0.829, P <0.05). CONCLUSIONS: The association of clinical outcomes with ASD after fusion showed a significant correlation, especially association with ASD after multiple segment fusion.