Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew

BACKGROUND: Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome. METHODS: Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. RESULTS: Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 +/- 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 +/- 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up. CONCLUSIONS: Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes.

Treatment of Recurrent Anterior Instability of Shoulder using Modified Bristow Procedure / 대한정형외과학회잡지

We performed 15 cases of modified Bristow procedures for recurrent anterior instability of shoulder from january, 1987 to december, 1992 and the following results were obtained. 1. The patient's age at initial dislocation varied from 15 years to 29 years of age. 2. The most common cause of the recurrent anterior instability of shoulder was sport injury(6 cases) and next were traffic accident, hanging with one hand. 3. The average loss of external rotation of shoulder after operation were 10 degrees and internal rotation were 7 degrees. 4. The post-operative complication and recurrence were not observed. 5. End results were excellent in 7 and good in 5 by Rowe's grading system. 6. Strict attention to bone block placement was mandatory and decreased the risk of screw malpo-sition.

Homotransplantation of Cultured Chondrocytes to prevent bony bridge formation and to help repair of the Damaged Growth Plate: An Experimental Study in a Canine tibial model / 대한정형외과학회잡지

The purpose of this study was to investigate the ability of cultured chondrocytes to prevent formation of bony bridge and possibly to repair of the damaged growth plate. Growth cartilage cells were obrained from the new born canine epiphyseal plates and was culture-expanded in high density. It took 14 days until formation of micro mass of cartilage cells which was easily removable from the culture flask. Twenty dogs were divided into two groups: group I (10), the medial side of growth plate of right proximal tibia was destroyed and cultured chondrocytes were homografted into the defect: and group II (10), the medial side of growth plate of right proximal tibia was destroyed and was left as it was. Left leg was served as a control. Serial radiological and histological observation were made until 16 weeks after homografting to determine the growth parrern. Following results were obtained. 1. In group I, 8 of 10 dogs had near normal growth with little angular deformity of the tibia, averaging 8° at post-op 16 weeks. Two dogs had 20° angulation at 16 weeks post-surgery. In contrast in group II, angular deformity was obvious at 4 weeks post-surgery, reaching 31° at 16 weeks post-surgery. 2. In group II, bony bridge was consistently formed on the medial side of the proximal tibia. In group I, the cultured chondrocytes initially appeared to be an amorphous cartiagenous mass, which, however, remained to contribute to matrix formation as time went on. 3. This study showed the ability of cultrued chondrocytes to prevent formation of bony bridge and possibly to repair the damaged growth plate. To prove the effectiveness of homografting of the growth cartilage cells for reconstruction of the growth plat, further studies should be followed.

Clinical Study of Ipsilateral Fracture of the Femur and Tibia / 대한정형외과학회잡지

Usually the condition of ipsilateral fracture of femur and tibia is called floating knee, it is termed applied to the flail knee joint segment. The key point of the treatment is focused to the early restoration of the knee function. We experienced 86 consecutive cases during the period from March 1978 to February 1991 in Yonsei University Wonju College of Medicine. Among them, 51 cases(above 16 years old) were analysed with the mean follow up period of 2.1 years(1.2-5.6 years). The results obtained were as follows: 1. Main cause of these fractures is traffic accident. Among them, the pedestrian accident is more than in-car accident. 2. The cases of open fracture were 13 cases (25.5%) in femur and 31 (60.8%) in tibia. The degree of open fracture was more severe in tibia. 3. There were 2 cases (3.9%) of fat embolism syndrome preoperatively. 4. At an average 25 months follow up after injury, the good and excellent result of the group 1 and 3 was 85.2%, and the group 2 and 4 was 71.4% by Karlström and Olerud criteria. 5. At the last follow up examination, the mean loss of range of motion of the knee was 5.6° in group 1 and 3, 10.9° in group 2 and 4(P < 0.05). 6. The operative treatment of the both side is better than case of one side operation and other side conservative treatment.

Arthroscopic meniscal repair: A clinical review / 대한정형외과학회잡지

No abstract available.

Histologic changes in dog intraarticular patellar tendon transplants / 대한정형외과학회잡지

No abstract available.

A clinical study of femoral neck fracture / 대한정형외과학회잡지

No abstract available.

An Experimental Study on Neochondrogenesis in Full Thickness Defect of Articular Cartilage Using Autogenous Periosteal Graft / 대한정형외과학회잡지

The chondrogenic potential of free autogenous periosteal grafts for osteochondral defects was investigated at the Department of Orthopaedic Surgery, Yonsei University, Wonju College of Medicine. Five millimeter diameter of circular full-thickness defects were made in patellar groove of both femur in 64 adolescent rabbits and the rectangular periostei, prepared from the proximal tibiae, were placed over the defects of patellar groove and sutured(cambium layer, facing joint surface) and the rabbits were allowed to move actively. A serial gross and histologic examinations of neochondrogenesis were done during 8 weeks. The results were as follows. l. At 2 weeks after operation, neochondrogenesis was hardly seen either in the graft group or in the control group. The defects were partially filled with some fibrous tissue. 2. After 6 weeks of operation, all defects in the graft group(postop 6 weeks and 8 weeks) were filled with hyaline cartilage cells but only 38% (postop 6 weeks) and 44% (postop 8 weeks) of the control group were filled with hyaline cartilage cells. 3. The cartilages, formed at 6 and 8 weeks, were more mature and better than those formed at 4 weeks. 4. The newly formed hyaline cartilage of the graft group filled the defect earlier and were better than those of the control group. 5. The chondrocytes in the newly formed tissue were originated from the cambium layer of periosteal grafts. 6. Free autogenous periosteal grafts can repair a full-thickness defect in a joint surface by producing tissue that resembles articular cartilage grossly and histologically.

A Clinical Study of Slipped Capital Femoral epiphysis / 대한정형외과학회잡지

Slipped femoral capital epiphysis is a disease of adolescence, a period of altered skeletal development brought about by physiologic hormonal changes. Its actual cause is unknown. The clinical correlation between slipped femoral capital epiphysis and endocrine disease is well known. The slipped capital femoral epiphysis is displaced posterolateral side and 8 cases have been reported in Korea. The author reports here a typical case of bilateral slipped femoral epiphysis and unilateral three cases during the years 1984 throught 1987. The results were as follows :l. Among the 12 patients, male were 8 and female were four, left were 7 and right was one in unilateral cases. 2. All our cases treated by closed reduction and in situ pinning showed good results without complications. 3. As a result, we recommended gentle closed reduction and in situ pinning as the most favorable method of treatment for the slipped capital femoral epiphysis.

A Clinical Study of Epiphyseal Injury About the Knee / 대한정형외과학회잡지

A Epiphyseal injury in children is common following trauma to result in significant and permanent loss of function and growth. We analyzed 24 cases of epiphyseal injuries about the knee inchildren, who were treated in the Department of Orthopaedic Surgery, Yonsei University, Wonju College of Medicine from Jan. 1980 to Dec. 1987. The results were as follows :1. The sex ratio between male and female eas 2.5: 1, and mean age was 11 years old. 2. Large number of cases were by slip-down, traffic accidents or fall. 3. Epiphyseal injuries about the knee occurred in 12% among the 417 cases of childrens epiphyseal injuries. In point of injury patterns, large number of cases were Salter-Harris type 2 and type 3 injuries in the distal femur and the proximal tibia. 4. They were treated with closed reduction and plaster immobilization in 66%, with operative reduction and internal fixation in 34%. 5. Complications occurred in 6 cases : Knee pain and limitation of motion, angular deformity and limb shorteniing.

Infraisthmal Fractures of the Femur / 대한정형외과학회잡지

Infraisthmal fracture of the femur is defined as a fracture from just below the isthmic portion to a point about 3 inches above the joint surface of the medial femoral condyle. This study investigated 85 csses of the infraisthmal fracture of the femur admitted at Department of Orthopaedic Surgery, Yonsei University, Wonju College of Medicine from June 1981 to December 1985 with the follow up study. The results obtained were as follows : 1. The sex ratio between male and female was 4.7: 1. Among the 85 cases, mean age of male and female was 30.1 and 39.4 year old respectively. 2. Cabse of fracture was traffic accident almostly. 3. By Reis and Hirschberg Classification, Type 1, 2 and 3 fractures were 28 (32.8%), 36(42.4%) and 21 (24.7%) respectively. 4. Associated injuries were found in 27 patients (31.8%). 5. Ninety three per cent of all cases were treated with internsl fixation by AO principle average 6.7 days after injury. 6. Among the 17 cases of complication, 11 cases were treated with AO technique and autogenous bone graft and one case with electromagnetic field. 7. Eleven cases among the 17 cases of complication were broken plate, non-union, loosening of the screws and etc. These were almostly caused by early weight bearing after discharge.

Study of Periosteal Reaction in Normal Infants / 대한정형외과학회잡지

The incidental observation of periosteal new bone formation on long bones is common in pediatric radiology without any symptoms in extremities : for example, the humeri on chest examination and the femora on abdominal roentgenograms. The purposes of the author is to report the results of a roentgenologic study of the long bones in 100 normal infants and 100 chilren between 1 and 2 years old who had no symptoms refereble to the skeleton to determine the incidence, roentgen characteristics, pathogenesis and significance of this type of periosteal new bone. The results obtained were as follows : 1. Periosteal new bone occured in 28% in normal infants group but did not occured in children group between 1 and 2 years. 2. The site in order of decreasing frequency were femur, tibia, and humerus. 3. Periosteal new bone is always on the diaphysis and usually extended onto the metaphysis to a variable extent, but it has not been observed to reach the end of metaphysis. 4. It seems most logical that the periosteal new bone found in these infants is simply a roentgen manifestation of normal periosteal bone growth in the period of greatest activity. 5. It is not an indication for treatment unless a definite relationship with a specific disease is proven.

Treatment of Complete Acromioclavicular Dislocation with Kirschner Wire/Tension-Band Wiring / 대한정형외과학회잡지

Injuries to the acromioclavicular joint are usually the result of force applied downward to the acromoion. Surgery treatment modalities for grade IU complete acromioclavicular dislocation are extremely varied and usually successful. 13 cases of complete acromioclavicular dislocation were operated by techniuqe of Kirschner wire with tension-band wiring at Wonju Christian Hospital from June 1984 to Oct. 1985. And they had been followed for average 17.8 months and following results were obtained. l. Of the 13 cases, male was 8 cases(61%) and female was 5 cases(39%) . 2. The most common cause of injury was traffic accident. Nexts were fall down, slip down and direct blow. 3. Results were evaluated by using Weaver and Dunn criteria, 12 cases(92.3%) were good and 1 case was fair but this technique involved a more extensive implant removal that required general anesthesia. Therefore, AO tension-band wiring is thought useful operative method in the treatment of acromioclavicular dislocation.

Clinical Study of Traumatic Fracture and Dislocation of the Elbow Joint / 대한정형외과학회잡지

The elbow joint is the most commonly dislocated-joint in the body except for the shoulder, and in children less then 10 years old, it is the most frequently dislocated articulation. The injury and the treatment are well described in most standard textbooks, but the characteristic findings and follow-up evaluations are not generally recognized. Authors have clinically analyzed 45 cases of traumatic fracture and dislocation of the elbow joint which are treated between January, 1975 and June, 1985 at the Department of Orthopedic Surgery, Wonju Medical College of Yonsei University. The results were as follows; 1. The age incidences were in even distribution except in the old ages where the incidence was low and the male to female ratio was 7: 3. 2. The major cause of the injury of the elbow was fall down (60%). 3. Posterior and posterolateral dislocations were about 60% of all cases. 4. Associated fractures were 35.6% of all the elbow dislocations, of which medial epicondyle fracture had the highest incidence. 5. Complications including ulnar nerve injury (3 cases), median nerve injury(1 case), radial nerve mjury(1 case), rupture of brachial artery(2 cases), recurrent dislocation(1 case) and calcification of ligament(2 cases) were observed. 6. Pure elbow dislocation occurred in 13 cases (28.9%). 7. The average immobilization period for patient with non-operative treatment (45%) and operative treatment(55%) were 7 days and 3 weeks, respectively, and much better results were seen in patients with non-operative treatment than in operative treatment and in shortened immobilization period.

Surgical Attempt for Elimination of Transepiphyseal Closure after Physeal Damage / 대한정형외과학회잡지

Approximately 15% of all fractures in children involve the physis. Although the majority heal without impairment of the growth mechanism, epiphyseal growth plate fracture-seperation can lead to shortening and angulation. The physiologic events in epiphyseal growth fracture seperation that lead to growth disorders relate to 1) destruction of the epiphyseal circulation and 2) communication between the epiphyseal circulation with its osteoprogenitor cells, thus forming a bony bridge. Although the classic procedure of osreotomy, epitphysiodesis, leg shortening and leg lengthening have not lost their importance in the treatment of the sequeales of partial closure of an epiphyseal plate, the possibility of regaining growth in the affected region should be considered before other measures are taken. Simple excision of the bone bridge is ineffective, since the large cancellous surface thus produced will allow for rapid reformation of the bridge. Thus, a material has to be interposed into the defect created by removal of such a bridge in order to prevent its reformation. Langenskiold first demonstrated that a bone bridge could be effectively resected and its reformation prevented by utilizing fat as an interposition material. Other investigators have used a variety of different interposition materials to prevent bone bridge recurrence following operative removal including cartilage, Silastic, Methymethacrylate, bone wax, muscle flap, Gelfoam as well as fat. Thus it is the purpose of this study to analysis and comparing shortening and angulation by resection of a bone bridge and its replacement with different interposition materials. For this study, a total of 32 rabbits with an initial weight of about 600 to 800 gm was used. Control group comprised 4 rabbits and after appmpriate preparation, the medial condyle of the pmximal tibia was exposed surgically. One plug of bone was removed at the level of the epiphyseal plate using a small curet to a depth of 5 mm. and in the other groups, we made a defect with the same curet and filled it with an interposition material directly. The following experimental groups were created. Group 1 (N-4) Control group: no interposition material Group 2 (N-4) Gelfoam interposition material Group 3 (N-4) Bone was interposition material Group 4 (N-4) Muscle flap interposition material Group 5 (N-4) Fat interposition material Group 6 (N-4) Bone cement interposition material Group 7 (N-4) Silastic interposition material Postoperatively the anirnals were sacrificed 15wks following operation. As sacrifice, tibia including fibular is removed, examined grossly and radiographed. Tibia length and angular deformity were determined by measurement of radiographs. Specimens stained with H-E stain were observed during 15 wks after operation. Through these examination, following results were obtained. l. In control group, coronal histological sections of each curetted proxirnal tibial growth plate revealed osseous bridging as early as 3 wks, and this bridging was found consistently in all control groups for the duration of the study. 2. The groups using gel foam, muscle flap and bone wax as interposition material were found effective for the prevention of the formation of epiphyseometaphyseal bone bridge to some extent. 3. The groups using Silastic or bone cement diminished both the angular deformity and growth retradation to a highly significant degree. Although the use of fat did reduce somewhat the amount of shortening and angular deformity when used as an interposition material, it was not effective as Silastic or bone cement. 4. Coronal histological section of the traumatized, margin of the growth plate, with an interposition material revealed thin fibrous layer and lose columnar orientation, foam rounded clone-like structures and randomness to growth. The injured portion of the cartilage may originate from the regeneration of the adjacent part of the growth plate. From these morphological and radiological results, it is suggested that Silastic or bone cement is better interposition material in the elimination of trahsphyseal closure after physeal damage.

Treatment of Complete Acromioclavicular Joint Dislocation by Weaver and Dunn Method / 대한정형외과학회잡지

No abstract available in English.