Factors Affecting the Extent of Graft Tendon Synovialization after Double-Bundle Anterior Cruciate Ligament Reconstruction: Based on Second-Look Arthroscopic Findings

BACKGROUND: We aimed to examine the factors that influence synovialization of the grafted tendon after double-bundle anterior cruciate ligament (ACL) reconstruction based on second-look arthroscopic findings. METHODS: Out of 205 knees that were treated between August 2008 and May 2016 with double-bundle ACL reconstruction using bio-absorbable cross-pins and Endobuttons for femoral tunnel fixation, we enrolled 65 knees (64 patients) that underwent second-look arthroscopy with hardware removal at 1 year postoperatively. Measured clinical outcomes included the Lysholm score and Tegner activity score that were evaluated preoperatively and during the final follow-up. We analyzed the relationship between synovial coverage and patient age, length of the preserved remnant tissue on the tibial side, type of bundle (anteromedial or posterolateral), type of graft (autograft or allograft), and time from injury to surgery. RESULTS: The area of synovial coverage showed a significant statistical correlation with patient age and the length of the preserved remnant tissue on the tibial side. The average synovial coverage was significantly better for the anteromedial bundle than for the posterolateral bundle, better for the autograft than for the allograft reconstruction, and better when treated in the acute stage than in the chronic stage. However, synovialization of grafted tendon did not correlate to clinical outcomes. CONCLUSIONS: While we were able to identify several factors influencing synovialization of the grafted tendon after double-bundle ACL reconstruction, including patient age, length of preserved remnant tissue of the torn ACL, type of bundle, type of graft, and time from injury to surgery, we found no evidence that increased synovialization improves clinical outcomes at 1 year postoperatively.

Rotational Long Scarf Osteotomy on Hallux Valgus in Elderly Patients with Osteoporosis / 대한정형외과학회잡지

PURPOSE: This paper reports an experience of rotational long scarf osteotomy for elderly patients with a hallux valgus deformity. MATERIALS AND METHODS: From January 2005 to July 2014, 37 cases in 24 patients over 70 years of age, who received rotational long scarf osteotomy for hallux valgus and were followed-up for at least 3 years, were evaluated. The bone mineral density (BMD) was checked in all cases preoperatively. The mean age at surgery was 73.9 years old. The mean follow-up period was 5.1 years. The plantar head fragment was rotated medially to correct the distal metatarsal articular angle (DMAA) and to cross the two cortices to form an “X” shape to prevent troughing. In the operating room, the DMAA was measured before and after rotation of the plantar head fragment. The hallux valgus angle, 1st intermetatarsal angle, range of motion of the first metatarsophalangeal (MTP) joint and American Orthopedic Foot and Ankle Society (AOFAS) score were measured both preoperatively and in the final follow-up. In addition, stress fractures were checked in the routine follow-ups. RESULTS: The average T-score of the preoperative BMD was −3.54. The mean DMAA measured in the operation room was corrected from 24.8° to 6.7°. The 1st intermetatarsal angle was corrected from 17.6° to 6.2° and hallux valgus angle was corrected 36.7° to 6.5°. The average range of motion of the first MTP joint was improved from 37.4° preoperatively to 64.3° in the final follow-up, and the average AOFAS scores were improved from 56.4 preoperatively to 89.2 at the final follow-up. No troughing was observed in any of the patients. In 3 cases, screw fixation failure made an additional screw necessary to obtain stability between the two fragments. No stress fractures were observed at the follow-up. CONCLUSION: The rotational long scarf osteotomy produced the effect of a DMAA correction. The rotational long scarf osteotomy might correct the DMAA and improve the clinical score in elderly hallux valgus patients.

Treatment of Friction Avulsion Injuries of the Foot: Report of 6 Cases / 대한정형외과학회잡지

Split thickness skin graft can be used as a one stage procedure for the immediate treatment of friction avulsion injuries in severe foot injuries. After cleaning the wound, a split thickness skin graft is taken from thigh and cover the wound. We have treated 6 patients with friction avulsion injuries of the foot.

Papineau Technique for Infected Nonunion of Tibia: Clinical Analysis / 대한정형외과학회잡지

Infected nonunion continues to be a major therapeutic challenge. Twenty-five cases of infected nonunion of tibia were trested by Papineau's cancellous bone graft at Department of Orthopedic Surgery, Taegu Medical Center from Jan. 1981 to Dec. 1987. The results were as follows. 1. Decortication, sequestrectomy and cancellous bone graft were performed simultaneously in every case. 2. Osseous union and eradication of infection were obtained at average 8 months.

Metal Failure in Treatment of Comminuted Fracture: Clinical Analysis / 대한정형외과학회잡지

Internal fixation of fractures always represents a race between the time required for bone healing and the inevitable fatigue failure of implant. The authors clinically analyzed the cause of metal failure in 34 cases at Department of Orthopedic surgery, Taegu Medical Center from Jan. 1981 to Dec. 1987. 1. Metal failure occured in 29 compression plates, 1 Kuntscher nail, 1 Jewett nail, 1 Ender nail, and 2 semitubular plates. 2. Involved bones were the femur in 28 cases, tibia in 3 cases, humerus in 1 cases, and the ulna in 2 csses. 3. The time interval between internal fixation and metal failure was average 7 months. 4. The cause of metal failure was deficiency of medial buttress in 14 cases and incorrect position of implant in 19 cases, and incorrect selection of implant in 1 case. 5. (Autogenic) Bone graft was not performed in the primary surgical treatment of 31 cases.

Effect of Diazepam Preadministration on the Induction of Anesthesia with Thalamonal-N2O-Oxygen / 대한마취과학회지

Fentanyl is known to be non-toxic to liver and kidneys and provides stability to the cardiovascular system. So it is often recommended for anesthetising gerlatric or high risk patients as a relatively safe agent. But untoward reactions such as muscle rigiditiy, bradycardia, and hypotension may be troblesome. We administered diasepam(0.15~0.2 mg/kg) intravenously 10 minutes before injectiong thalamonal(0.1 mg/kg) to reduce muscle rigidity due to fentanly and observed the time required for loss of consciousness, muscle rigidity, respiratory depression, changes in cardiac rhythm, heart rate and blood pressure. The data was compared with those obtained from the patients in whom anesthesia was induced with thalarnonal without diazepam. The results were as follows 1) The patients preadministered with diazepam(experimental group) lost conscious on an average of 5 minutes and 43 seconds while the non-preadministered patients (control group) responded to verbal command even 15 minutes after thalmonal injection. 2) Muscle rigidity was observedn in 12 patients in the experimental group: 7 patients showed respiratory depression combined with muscle rigidity. There were no patients who developed muscle rigidity in the control group, although 7 patients had respiratory depression. 3) Arrhythmia was not obaserved in either group. 4) On intubation, blood pressure lowered significantly in the experimental group: 7 patients had hypotension in this group while only 1 patient had hypotension in the control group. 5) In the control group, there were 5 cases of bradycardia and 1 case of hypotensions, but they did not require any treatment. In the experimental group, 5 out of 8 developed bradycardia with hypotension and one case needed vasopressor treatment.