Medium Term Results of a Mobile Bearing Total Knee Replacement / 대한정형외과학회잡지

PURPOSE: The LCS (low contact stress) mobile bearing knee replacement has been used extensively. The purpose of this study was to report at least five-year clinical results of a primary total knee replacement performed with LCS mobile bearing design. MATERIALS AND METHODS: From January 1992 to October 1997, author performed 80 total knee arthroplasties in 59 patients with LCS mobile bearing knee replacement. At the final follow-up, one patient had died, and ten patients had been lost to follow-up. The patients were evaluated with HSS (Hospital for Special Surgery) knee rating system and radiographic analysis. RESULTS: The fifty-six knees in the forty-two patients were examined for final clinical and radiographic analysis at five to ten years. The average active range of knee flexion was from 5 degrees to 112 degrees preoperatively and 0 degrees to 123 degrees at the final follow-up evaluation. The average HSS score was 60.7 points preoperatively and 88.9 points at the final follow-up evaluation. Of the 56 knees, none had a dislocation of the mobile bearing prosthesis, one case had a traumatic periprosthetic fracture and four cases required reoperation, one for infection, one patellar revision for patellar polyethylene breakage, one rotating platform change to thicker one for posterior instability during flexion and one meniscal bearing change for medial meniscal bearing wear. There was no significant progressive periprosthetic osteolysis on follow-up radiographs. CONCLUSION: After five to ten years of follow-up, the LCS knee replacement was found to be performing well, with durable clinical and radiographic results.

Magnetic Resonance Imaging on Posterior Cruciate Ligament Injury: Can the PCL hea

PURPOSE: The aim of this study was to elucidate the continiuty of ligament in chronic injury of the pos- terior cruciate ligament(PCL). MATERIALS AND METHODS: Magnetic resonance imaging(MRI#) of twenty-six PCL injury patients with grade II or III laxity and more than 5mm side to side difference on stress radiographs were reviewed in terms of ligamentous continuity and thickness of the ligament at average 7.2 months(range:1-36) after injury. RESULTS: Eighteen PCLs(69%) showed continuity of PCL. When thickness of the ligament in cases without continuity was rated as zero, the average thickness of the PCLs as compared to intact portion of the ligament increased as the time from injury elapsed; 16.4% in 0 2 months group(7 cases), 30.0% in 3- 5 months group(6 cases), 53.8% in 6-8 months group(9 cases) and 80.0% in over 9 months group(4 cases). CONCLUSTION: More than two thirds of PCLs in symptomatic chronic injury showed ligamentous continuity on MRI. The longer the interval from injury was, the thicker the PCL was.

Complications and Prognostic Factors of Endoscopic Anterior Cruciate Ligament Reconstruction Using Autogenous Patellar Tendon / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the author's cases of arthroscopic one-tunnel anterior cruciate ligament reconstruction using autogenous patellar tendon in which the complications occured as well as offer advice on how to avoid them and salvage the situation if they occur. MATERIAL AND METHODS: Ninety cases out of 164 arthroscopic ACL reconstructions were followed up for more than 12 months (average 27 months) . The clinical results were evaluated by OAK and IKDC knee rating systems and radiographic results by lateral roentgenographs of the fully extended knee. Fifty-two cases were evaluated by a second look arthroscopy at least 12 months postoperatively. RESULTS: Poor results were noted only in 5 (5%) cases. Four cases out of the 5 poor results were chronic ACL deficient knees, and 2 cases out of the 5 had valgus instability. Mean percentage of roof impingement was -5.7%. Impingement was noted in 11 cases and 3 cases out of the 11 had poor results. During second look arthroscopy, grafted ACL of nearly normal appearance were noted in 26 (50%) cases. Five cases showed impingement and 3 cases out of the 5 had poor results. CONCLUSION: The results of our study denote that chronicity of ACL injury is a prognostic factor for the result after reconstruction, and more so for combined ACL and medial collateral ligament injury. Also, verifying accurate placement of tunnels for graft by arthroscope or intraoperative radiograph seems to be an essential step in preventing impingement, which was shown to be an important prognostic factor according to the results of this study.

Endoscopic Anterior Cruciate Ligament Reconstruction with Autogenous Bone-Patellar Tendon-Bone: In Arthroscopic Second Look Cases / 대한정형외과학회잡지

Nineteen cases out of over 100 cases which had been reconstructed the deficient anterior cruciate ligament(ACL) by the bone-patellar tendon-bone(BPTB) autograft 12 months before or more(mean 15.8 months) were evaluated during the second-look arthroscopy. Before the second-look, the patients were evaluated the clinical results of ACL reconstruction by the Müller's knee rating score and the radiographical results by the lateral roentgenography of the fully extended knees. The location of the center of tibial tunnel from the anterior end of the line of the tibial plateau was 35.2%(range, 22 to 47%) on average. The average intercondylar roof angle was 36.6 degrees(range, 28 to 45 degrees). The mean percentage of roof impingement was

A clinical study of trochanteric fracture of the femur / 대한정형외과학회잡지

No abstract available.

Final Follow-up of Epiphysiodesis at Skeletal Maturity in Residual Poliomyelitis / 대한정형외과학회잡지

During the twenty two years, Aug. 1963 through Aug. 1985, we performed 83 cases of epiphysiodesis on patients with leg length discrepancy due to poliomyelitis. In an attempt to determine the accuracy of predicted correction, we analyzed predicted final discrepancy at the time of operation and actual final discrepancy at or near skeletal maturity. Of the 83 cases, 30 cases were available for final evaluation. Among four methods of prediction that have been employed, those of White and Stubbins, and Anderson, Green and Messner were statistically reliable. The method of Gill and Abbott was statistically not reliable in our series, presumably because it utilizes percentile distribution of stature based on Caucasian population in the United States. Mosley's prediction was also made on 8 of the cases. However, we were unable to reach statistically significant conclusion, obviously because of short period of preoperative assessment on limited number of cases at this time. Prediction of correction on 5 cases in which both lower extremit.ies were affected, was statistically not reliable in all methods employed.

Reconstructive Surgery for Old Ligament Injuries of the Knee / 대한정형외과학회잡지

Reconstructive surgeries for old ligament injuries of the knee vary according to the site and nature of injury as well as the age, health, physical demand and cartilage condition of the patients. No single best procedure is present for any old ligament injuries, but the most adaptable technique should be applied according to accurate diagnosis and experiences of surgeon. We reviewed our experiences of several reconstructive surgeries for the 38 cases with chronic ligamentous instabilities and summarized as following. 1) The most prevalent age of the patients was the third decades and males were 5.3 times more common than females. 2) Traffic accidents was the most common cause. 3) Tear of anterior cruciate ligament and medial collateral ligament appeared to be the most common injury. 4) Results at final follow up was not seemed to be affected by severity or location of ligament injury. 5) Intraarticular reconstruction without combined extraarticular reconstruction was not considered to be effective enough for anterior cruciate ligament deficient knee. 6) Although the number of cases was not large enough, we reviewed various reconstructive surgical techniques for comparison and evaluated the effects.