Outcome Differences of RemnantPreserving versus Non-Preserving Methods in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-analysis with Subgroup analysis

Purpose@#To analyze differences in clinical outcomes of arthroscopic anterior cruciate ligament reconstruction between remnant-preserving and non-preserving methods. @*Methods@#International electronical databases PubMed, Embase, and the Cochrane central database from January 1966 to December 2017 were searched for randomized controlled trials (RCTs) and observational studies that compared differences of clinical outcomes of ACL reconstruction with and without remnant preservation. A metaanalysis of these studies was performed to compare clinical outcomes. Subgroup analyses were conducted to evaluate the role of methodological quality in primary meta-analysis estimates. @*Results@#Five RCTsand six observational studies were included in this meta-analysis and subgroup analysis. The remnant-preserving method in arthroscopic ACL reconstruction showed a statistically significant difference compared to the non-preserving method regarding arthrometric evaluation (side-to-side difference). Lachman test, Lysholm scores, and IKDC subjective scores showed statistically minor difference in meta-analysis, but showed no significant difference in subgroup analysis. Remained parameters including pivot shift test, IKDC grades, incidence of cyclops lesion showed no statistically differences in meta-analysis or subgroup analysis. @*Conclusions@#This meta-analysis with subgroup analysis showed that arthroscopic remnant-preserving ACL reconstruction provided statistically significant but limited clinical relevance in terms of arthrometric evaluation. @*Results@#of Lachman test, Lysholm scores, and IKDC subjective scores demonstrated statistically minor differences.

Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Purpose@#Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. @*Materials and methods@#We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. @*Results@#The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSSknee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. @*Conclusions@#The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.

Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Purpose@#Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. @*Materials and methods@#We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. @*Results@#The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSSknee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. @*Conclusions@#The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.

Efficacy of Physiotherapist after Total Knee Arthroplasty

PURPOSE: The range of motion (ROM) of the knee and the satisfaction rate after total knee arthroplasty are the most important factors when evaluating the result of an operation. The purpose of this study was to determine whether the ROM and the functional outcome of these patients increase after joint exercise that is performed by special physiotherapists. MATERIALS AND METHODS: 200 cases of 120 patients, who underwent total knee replacement arthroplasty for osteoarthritis between August 2006 and May 2008, were enrolled in this study. These cases were randomly divided into 3 groups. Only CPM (continuous passive movement) and MSE (muscle strengthening exercise) were performed after KTA in the first group. In the second group, pROME was performed by physical therapists in our rehabilitation institution during the hospital stay, as well as CPM and MSE. CPM, MSE and pROME were performed by special physiotherapists during the hospital stay and also in the outpatient department after being discharged from the hospital in the third group. We compared the results of these groups. RESULTS: The range of motion was not increased among the groups. On the other hand, the third group showed a significantly higher functional outcome, as compared to that of the first and second groups. Conclusion: Although the range of motion of the knee joint was not increased enough to achieve statistical significance, the functional outcome showed significant increases with the pROME performed by physiotherapists. This result demonstrates that the knee exercises performed by special physiotherapists are useful and they can yield good outcomes in patients who underwent TKA.

Two-stage Reconstruction for Skin and Patellar tendon Defect with Bone-Patellar tendon-Bone Allograft : A Case Report

Various reconstructive surgery have been performed for repair of the patellar tendon defect due to direct trauma or infected open wound. But most surgical procedure need wide skin incision and soft tissue dissection, that result in joint stiffness or muscle weakness. We carried out two-stage reconstructive surgery used bone-patellar tendon-bone allograft and bioabsorbable interference screw for skin and patellar tendon defect due to repetitive debridment for infected wound management. The result was satisfactroy and the patient achieved nearly full return of knee motion and quadriceps strength.

Mechanoreceptors in the Remnants of Ruptured Anterior Cruciate Ligaments in Human Knees / 대한정형외과학회잡지

PURPOSE: This study was performed to identify the presence of mechanoreceptors in the tibial remnants of injured anterior cruciate ligaments (ACLs) in human knees by immunohistochemistry. MATERIALS AND METHODS: Twenty-one specimens of tibial remnants of ACLs from patients with ACL ruptures were obtained during arthroscopic ACL reconstruction procedures. As a control, two normal ACL specimens were taken from healthy men at the time of traumatic above the knee amputations. The ACL specimens were serially frozen-sectioned at a thickness of 40micrometer. The average number of sections from each specimen was 71.5 (total 1,502) in the remnant group and 132 (total 264) in the control group. Immunohistochemical staining was used for detection of the neural elements. The mechanoreceptors were identified under a light microscope and their locations and amounts were recorded. An independent sample t-test was used for analysis. RESULTS: In the remnants of the ACLs, ten mechanoreceptors were identified in 7 (33.3%) out of 21 cases. Nineteen mechanoreceptors were detected in the two normal ACLs, which demonstrated an even distribution at both the tibial and femoral attachments. There was no significant difference between the MR-present group (7 cases) and the MR-absent group (14 cases) with respect to the number of sections, age, and time from injury to surgery. CONCLUSION: The identification of mechanoreceptors in the remnants of ruptured ACL specimens could support the necessity for the preservation of the tibial remnant during ACL reconstruction to improve joint proprioception.

Arthroscopic Resection in the Management of Wrist Ganglion / 대한정형외과학회잡지

PURPOSE: To analyze the results of an arthroscopic resection of a wrist ganglion. MATERIALS AND METHODS: Seventeen cases were analyzed. Eleven cases were treated by arthroscopic resection and 6 cases were treated by an arthroscopic resection and a pull out extracapsular sac. For the functional evaluation, the level of pain, grip strength, range of motion and patient's satisfaction were analyzed. The average follow-up time was 22 months (10-38). RESULTS: In all patients, the functional results improved and all patients returned to work. No recurrence was noted. A ganglion stalk was identified in 14 cases, including 8 cases (scapholunate ligament), 3 cases (midcarpal joint), 1 cases (dual stalk), 1 case (lunotriquetral ligament) and 1 case (carpometacarpal joint). There was no case of Scapholunate instability and the scapholunate angle and gap were within the normal limits. CONCLUSION: An arthroscopic resection of a wrist ganglion is a safe and reliable alternative to an open resection.

Migration of a Broken Wire to the Popliteal Fossa After the Osteosynthesis of Patella Fracture: A Case Report

In the fixation of patellar fractures, wiring techniques including tension band and cerclage wiring have been widely used. Some patients do not want to operation for removal of wire unless mechanical irritation is present. Authors report a case of a patient with migration of a broken wire to the popliteal fossa after the osteosynthesis of patellar fracture.

Comparison of Clinical Results According to Amount of Preserved Remnant in Arthroscopic ACL Reconstruction using Quadrupled Hamstring Graft / 대한정형외과학회잡지

PURPOSE: To analyze the clinical results in an ACL reconstruction according to the amount of the tibial remnant of the ACL using a hamstring graft and looped sutures. MATERIALS AND METHODS: Sixteen patients who were followed up for at least 12 months after the ACL reconstruction with four strands of a hamstring tendon using a looped suture technique were enrolled in this study. The average follow-up was 35.1 months. At the last follow-up period, the patients were evaluated using the International Knee Documentation Committee (IKDC) scale and the HSS score, Lachman test, ant. drawer test, KT-1000, one-leg hoop test and proprioceptive function test (motion and position sense). They were then divided two groups according to whether they had more or less than 30% of the ACL remaining. The final results of the two groups were statistically compared. RESULTS: Average HSS score improved from 65.8 (preoperative) to 95.2 (last follow-up). No significant differences in functional outcome and mechanical stability were found except for proprioception. Regarding the threshold of the detection of the passive motion test at 30 degrees (p=0.030) and the reproduction of the passive positioning test at 15 degrees (p=0.032) and 30 degrees (p=0.024), the more remnant preserved group (>30%) showed better results than the less preserved group. CONCLUSION: Preserving the tibial remnant will preserve function of the mechanoreceptors and be helpful to the recovery of the function and healing of a graft after surgery.

Changes in the Mechanoreceptors of the Anterior Cruciate Ligament of Patients with Degenerative Arthritis / 대한정형외과학회잡지

PURPOSE: To clarify the morphologic and quantitative changes of mechanoreceptors of the human ACL with degenerative arthritis. MATERIALS AND METHODS: Eleven fresh specimens of anterior cruciate ligament (ACL) were obtained from patients with degenerative arthritis during TKA. As a control, two fresh specimens were taken from healthy men at the time of a traumatic above knee amputation. The whole ligaments were serially frozen and sectioned at a thickness of 40 mum. After immunohistochemical staining, the mechanoreceptors were observed under a light microscope. The ratios of sections showing mechanoreceptors were calculated. Statistical analyses were performed using the chi-square test. RESULTS: In the two control specimens, nineteen mechanoreceptors were found, evenly distributed at the femoral and tibial ends. However, the average number of mechanoreceptors was 1.4 (total 15) in the arthritic ligaments (p<0.05), and these were located near the femoral side rather than the tibial end. The percentage of sections showing mechanorecptors was 8.3% in the arthritic group and 40.2% in the control group (p<0.05). All receptors were round or fusiform shaped Ruffini corpuscles; Pacinian corpuscles could not be found in either group. Nine of 15 mechanoreceptors in the arthritic groups were "necrotic" in shape. CONCLUSION: Mechanoreceptors in arthritic ACL were significantly reduced in number and mainly necrotic in shape. Our findings suggest that the numerical and morphological changes of mechanoreceptors are closely related with reduced proprioception in degenerative arthritis.

Prognostic Value of Peak Flow Rate and Post Void Residual Urine Measured by Abdominal Compressing Immediately after TURP / 대한비뇨기과학회지

PURPOSE: Although a transurethral resection of the prostate (TURP) is the most effective treatment method for benign prostatic hyperplasia (BPH), it is difficult to predict the exact prognosis with this method. The peak flow rate (PFR) and post void residual urine (PVR), measured by abdominal compressing immediately after TURP in the operating room, were evaluated to see if they correlated with the surgical outcome. MATERIALS AND METHODS: Fifty patients, having undergone TURP, had their PFR and PVR measured by abdominal compressing, both before and after TURP in the operating room. The abdomen was compressed to 100cm H2O of intravesical pressure with a concrete test hammer. All patients were requested to undergo uroflowmetry, and their international prostate symptom scores (IPSS) were assessed, 3 months after surgery. RESULTS: The PFR and PVR, measured by abdominal compressing immediately after TURP, correlated well with the PFR measured 3 months after the TURP (p<0.05). Higher PFR, lower PVR and a greater improvement in the IPSS were observed, but these were not statistically significant. CONCLUSIONS: In conclusion, the PFR and PVR, measured by abdominal compressing immediately after TURP, are thought to be a good parameter for predicting the prognosis of TURP.

Study on Consciousness of Korean Adults for Circumcision / 대한비뇨기과학회지

PURPOSE: There is controversy surrounding the benefits and risks to health of a circumcision of the male prepuce. The purpose of this study was to provide educational material to the general population and medical doctors to help them understand appropriate opinions relating to a circumcision. MATERIALS AND METHODS: A prospective study, including 1,124 adult men, 772 women, with sons, and 971 doctors, was performed. The subjects were interviewed, in detail, about their cognition of circumcision, their circumcision status, their age at circumcision, how many men received circumcisions, their reasons and thoughts relating to circumcision, the pros and cons and their current knowledge of the health benefits and risks associated with male circumcision. RESULTS: 81% of the general subjects, and 77% of the doctors, taking part in the study, were circumcised. The most common age at circumcision, accounting for 34% of the subjects, was over 18 years old. 77% of the general subjects, and 80% doctors, agreed with circumcision. The greatest motive for a circumcision, accounting for 38% of the subjects, was their parents wish. The satisfaction rate of a circumcision was 93%. Most Koreans (69%) considered that a circumcision is an ordinary operations in males. CONCLUSIONS: In this study, most Korean men were found to be circumcised, and were very much satisfied with the results, and on most occasions the procedure had been performed after adolescence. These results suggest that, in Korea, circumcision has a position as a customary conduct, and in itself is inevitable. Therefore, it is essential to explain the advantages and disadvantages of a circumcision to patients and their parents.

Clinical Significance of Prostatitis in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The clinical significance of prostatitis associated with benign prostatic hyperplasia (BPH) remains to be determined. We determined the differences in the prevalence, pattern, clinical symptoms and outcome in BPH patients both with, and without prostatitis. MATERIALS AND METHODS: This prospective study included 134 consecutive patients with lower urinary tract symptoms related to BPH. The patients were divided into 2 groups relating to the expressed prostatic secretion caused by prostate massage (group 1: more than 10 leukocytes per high power field, group 2: less than 10 leukocytes per high power field). Tamsulosin, a selective alpha1-blocker, and finasteride were administered at doses of 0.2 and 5mg, respectively, once a day for one year. The primary efficacy criteria included, symptomatic improvement (International Prostate Symptom Score: I-PSS), maximum flow rate (Qmax) and residual urine volume. RESULTS: Prostatitis was identified in 67 of 119 patients (56.3%); the other 15 patients failed the prostatic massage. Of the patients with associated prostatitis, 8 (11.9%) showed bacterial growth. The serum PSA level was higher in group 1 than in group 2, but there were no significant differences in the other clinical parameters. There was no significantly difference in the improvement of the total I-PSS after treatment between the two groups. However, in group 1, the rritative symptom was significantly less improved (p<0.05). CONCLUSIONS: Prostatic inflammation is a common finding in patients with symptoms of BPH. In such cases, the response to medical treatment for irritative symptoms was inferior in the BPH only cases. There is a need for more studies to distinguish chronic prostatitis and BPH, and to ascertain any additional treatment requirements.

Arthroscopic ACL Reconstruction Using Quadrupled Hamstring Graft-Result of Stump Preserving Technique: Follow-up More Than 3 Years

PURPOSE: This article describes the technique for ACL reconstruction using hamstring grafts and looped sutures to preserve the tibial remnant of injured ACL effectively and reports the clinical results. MATERIALS AND METHODS: From Feb. 1995 to May 1996, fourteen injured ACL knees were treated with arthroscopic reconstruction using a quadrupled hamstring autograft. At the last follow-up(average 41 months), subjective and OBJECTIVE assessments were evaluated. Two proprioceptive function tests(motion and position sense) were performed and statistically analysed(paired t-test). Clinical results were recorded by HSS rating scale. RESULTS: Average HSS score was improved from 56.2(preoperative) to 92.1(last follow-up). At the last follow-up, the average anterior displacement(side to side difference) was measured 3.1mm on stress x-rays and 3.4mm on KT-1000 arthrometer(maximum manual force). No significant differences in mean proprio-ceptive values were found between both knees(p<0.05). CONCLUSTION: The clinical results were satisfactory and we suggest the possibility of preservation of the proprioception is increased if integrity of tibial stump of the ACL is preserved. Further supportive studies for the proprioception will be needed.

Arthroscopic Treatment of Displaced tibial Intercondylar Eminence Fractures: A Comparison of K-wires vs. Screw Fixation / 대한정형외과학회잡지

OBJECTIVES: To assess and compare the degree of reduction and clinical results following arthroscopic cannulated screw and K-wire fixation for type III displaced tibial intercondylar eminence fractures. METHODS: From 1991 to 1997, 20 patients with type III of intercondylar eminence fractures were arthroscopically treated (K-wire in 12 and screw in 8) and followed up 31 mo. in average. Degrees of reduction, extension loss and residual joint laxity were checked. And statistical analysis was done (Mann Whitney U-test) . Functional results were recorded by Meyers & McKeever's criteria. RESULTS: Degrees of reduction showed +2.1mm in K-wire group, and -1.3mm in screw group (avg., p<0.05) . Anterior displacements were 2.2mm and 1.7mm in stress x-rays and 3.5mm and 1.2mm in KT-1000 arthrometer, respectively (avg.,p<0.05) . Average loss of extension was 7 in K-wire group and 3 in screw group. There were excellent 9, good 3 in K-wire group and excellent 7, good 1 in screw group. CONCLUSION: Because of arthroscopic screw fixation able to compress and sink the fragment, it may showed less extension loss and residual laxity than K-wire fixtion. It is recommendable for the first choice to the treatment of type III tibial intercondylar eminence fractures with relatively large fragment.

The Effect of Finasteride on Spermatogenesis in Rat / 대한비뇨기과학회지

No abstract available.

A Histological Comparative Analysis of Thermal Side Effects of Excimer Laser Versus Holmium : YAG Laser in the Human Articular Cartilage / 대한정형외과학회잡지

The methods available for arthroscopic debridement vary widely in cost and efficiency. The use of laser treatment is growing rapidly with advantages of production of smooth surface and avoidance of direct contact. Nevertheless, growing attention is directed to the negative side effects of laser-controlled cartilage ablation, especially to the depth effects of the various lasers on which various scientific studies have focused. The purpose of this study is to evaluate the thermal side effects of Ho: YAG laser and Excimer laser on human articular cartilage hy histological analysis. Sixteen human articular cartilages were obtained during total knee arthroplasty for patients with advanced degenerative arthritis. Three craters, 1cm in diameter, were created on each articular cartilage by shaver, Holmium: YAG laser and Excimer laser in the saline medium. These total 48 craters were prepared to tissue specimen by paraffin blocks and stained with Hematoxylin-Eosin(HE) and Massons trichrome. Under the light microscope, we analysed extents of thermal necrosis and thermal change in craters. Also some specimens were fixed by 2.5% glutaraldehyde and ohserved in changes of three different methods under scanning electron microscope. We report the results as follow: 1. The average times to making one crater were 25 seconds in shaver, 33 seconds in Holmium: YAG laser, and 65 seconds in Excimer laser respecti vely. 2. In gross inspection, the most smoothing surface of crater was seen on the specimens of Excimer laser. 3. In histological findings, thermal necrosis on hematoxylin and eosin sections was not noted after shaver use, whereas seen average of 243.8+/-159.6micrometer in Molmium: YAC laser and 36.6+/-17.1micrometer in Excimer laser(p=0.000). Thermal change on trichrome-stained sections was not noted after shaver use, hut showed average of 372.1 +/-203.1micrometer in Holmium: YAG laser and 76.0+/-47. Imicrometer in Excimer laser(p=0.000). 4. In scanning electron micrograph, coagulation of collagen fiher in the matrix was ohserved, with less extents in Excimer than Holmium: YAG laser. In conclusion, Excimer laser was superior to Holmium: YAG laser in terms of thermal necrosis and precision, whereas Holmium: YAG laser was more effective due to rapid time for procedure. To minimize the thermal necrosis during laser chondroplasty, we suggest it is desirable to less energy and reduce exposure time to laser beam on the articular surface.

Pull - out Strength of Different Multiple Suturing Method of the Cruciate Ligament / 대한정형외과학회잡지

The aim of this study was to measure the immediate pull-out strengths by increasing the number of suture loops and to compare the immediate pull-out strengths of three different suturing techniques. In one group, the number of suture loops increased from 2 to 9 and the suturing technique of multiple loops through the proximal ligament stumps was used. The other group, the three different techniques were transverse, vertical, and criss-cross suture. The ultimate strength for the 2 loops was 16.62 (+/-6.7)N, for the 3 loops was 34.45 (+/-12.5)N, for the 4 loops was 54.80 (+/-17.7)N, for the 5 loops was 74.30 (+/-21.4)N, for the 6 loops was 102.49 (+/-13.5)N, for the 7 loops was 105.05 (+/-24.8)N, for the 8 loops was 129.50 (+/-76.1)N, for the 9 loops was 229.50 (+/-48.7)N. The transverse suture had a mean ultimate strength of 47.38 (+/-14.8)N, where-as the vertical suture failed at 76.94 (+/-26.4)N and the criss-cross suture at 101.82 (+/-25.7)N. Consequently, their strength can be improved by increasing the number of loops and we suggest that the criss-cross suture technique is reliable method for clinical use, because of high failure strength and wider apposition area of bone to ligament.

Treatment of the unstable thoracolumbar spine fractures using A-O internal fexator instrument / 대한정형외과학회잡지

No abstract available.

The hypobaric spinal anesthesia for total hip-replacement arthroplasty / 대한정형외과학회잡지

No abstract available.