Results of Anterior Cruciate Ligament Reconstruction Using Second Look Arthroscopic Examination: Focus on Graft Material and Age / 대한정형외과학회잡지

PURPOSE: We classified patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction into six groups according to graft material and age, and clinical, radiological, and second look arthroscopic results were compared and analyzed. MATERIALS AND METHODS: From January 2006 to December 2009, 57 patients underwent arthroscopic ACL reconstruction and second look arthroscopic examination. We divided patients according to graft materials into the autogenic hamstring tendon group (group 1) and the allogenic tibialis tendon group (group 2), and according to age into three groups (A, B, and C). The mean age at follow-up for second look arthroscopy was 34 years old. Fifty four patients were male and three patients were female, and mean follow-up period was 21.8 months. The result was clinically evaluated using a KT-1000 arthrometer under anesthesia, and the subjective and objective score of International Knee Documentation Committee (IKDC), and radiologically evaluated using the Telos(TM) stress test. We observed graft tension, synovialization and gross findings through a second look arthroscopic examination. RESULTS: The clinical and radiographic results in patients in group 1 and group A showed excellent finding, however, no statistically significant difference was observed. Second look arthroscopic examination in group 1 and group A showed excellent finding. In particular, the formation of synovialization showed excellent finding (50% or more synovialization) in 75% of patients in group 1A who were young and used an autogenic tendon graft, and 45% of patients in group 2C (over 50 years old and allogenic graft), and they were significantly different (p=0.046). There was significant difference in that tension of graft was excellent in group 1A (less than 3 mm). Through the IKDC evaluation method, 93% of cases that showed normal formation of synovialization and 50% of cases that showed inadequate formation of synovialization showed 'like normal' abnormality, so that was correlation was observed between synovialization and IKDC evaluation (p=0.001). CONCLUSION: Patients who used autogenic hamstring tendon and who were young showed excellent synovial membrane formation. In the old age group, autogenous graft will be more optimal.

Vídeo-artroscopia da articulação fêmoro-tíbio-patelar em cães após secção do ligamento cruzado cranial guiada por artroscopia / Videoarthroscopy of the stifle joint in dogs after cranial cruciate ligament rupture guided by arthroscopy

Avaliaram-se e classificaram-se por meio da vídeo-artroscopia as alterações da articulação fêmoro-tíbio-patelar (FTP), 21 dias após secção experimental do ligamento cruzado cranial (LCCr) em cães, tendo como referência os parâmetros encontrados no exame artroscópico imediatamente anterior à secção. Ao exame artroscópico, foi possível visibilizar os cotos remanescentes do LCCr e as alterações articulares, como aumento da vascularização, aumento das vilosidades na membrana sinovial, bem como fibrilação e osteófitos, principalmente nas bordas trocleares do fêmur. Os resultados sugerem que a artroscopia é um método preciso de avaliação macroscópica dos tecidos articulares moles e duros.

By the use of videoarthroscopy, the changes of the stifle joint after experimental rupture of cranial cruciate ligament (CCL) in dogs were evaluated and classified, based on the parameters found at the arthroscopic examination right before the rupture. By the arthroscopic examination, it was possible to visualize the remainings of the CCL and joint changes such as increase of the vascularity and synovial proliferation increase in the synovial membranes, as well as fibrillation and irregularities on the joint surfaces and osteophyte formation, mainly on the trochlear ridges. The results suggest that arthroscopy is a precise method for macroscopic evaluation of the smooth and bone joint tissues.

Clinical Evaluation using MRI and Arthroscopy after Meniscal Transplantation / 대한정형외과학회잡지

Purpose: To evaluate the status of transplanted menisci using MRI and arthroscopy. Materials and Methods: Between March 1998 and October 2004, twenty three patients underwent a meniscal transplant at our institution. Twenty-one out of 23 patients were available for follow-up and were evaluated an average of 44 months (range, 19 to 87 months). Four allografts were medial and 17 were lateral. There were 17 men and 4 women with ages ranging from 16 to 47 years (mean, 29.6 years). The clinical outcomes were evaluated using the Lysholm score, the International Knee Documentation Committee (IKDC) subjective score and the modified Hospital for Special Surgery (HSS) score. MRI and arthroscopic examinations were performed in 18 and 11 patients respectively. Results: The average Lysholm score improved from 60.6 to 85.7, and that of the IKDC subjective score and modified HSS score (knee score/functional score) was 79.5 and 88/93 respectively. Six of the eleven knees that underwent the arthroscopic examinations were confirmed to be normal. The MRI evaluation revealed all the allografts to have healed completely but there was degeneration/shrinkage of the allografts, and injuries to the surrounding articular cartilage. Extrusion or subluxation of the menisci was observed in all cases. Conclusion: Meniscal transplantation may be an effective procedure for young and active patients suffering from pain after a meniscectomy with minimal degenerative changes. However, a partial tear, extrusion or subluxation of the allograft menisci and a progression of degenerative arthritis have been reported. Therefore, more accurate and reliable surgical techniques as well as a long-term follow-up are recommended.

Arthroscopic Evaluation of Posterolateral Rotatory Instability of the Knee / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to confirm the efficacy of arthroscopic findings for the diagnosis of posterolateral rotatory instability (PLRI) of the knee. MATERIALS AND METHODS: We retrospectively evaluated 27 patients (28 cases) who had been operated upon for PLRI between February 1998 and June 2001. All patients underwent preoperative or intraoperative arthroscopic examinations including anterior/posterior cruciate ligament, popliteus tendon, inferior and superior popliteomeniscal fascicle, popliteofibular ligament, lateral meniscus, instability and abnormal popliteomeniscal motion for internal and external rotation. RESULTS: Instability, which means popliteal hiatus widening during internal rotation of the tibia, was identified in all cases (100%). Tear of the inferior and superior popliteomenical fascicle was identified in 24 cases (86%) and abnormal popliteomeniscal motion during rotation was identified in 20 cases (71%). Popliteus tendons were abnormal in 18 cases (65%) with 5 cases (19%) of complete tear and 13 cases (46%) of partial tear or elongation. CONCLUSION: These results suggest that arthroscopic evaluation of the popliteal hiatus structures in the patients suspected for PLRI of the knee is helpful for diagnosis and the determination of treatment modality.

Correlation of Second-look Arthroscopy and MR Findings of Anterior Cruciate Ligament Graft

PURPOSE: To evaluate the postoperative MR findings of the healthy anterior cruciate ligament (ACL) grafts which were confirmed by the second-look arthroscopic examination. MATERIALS AND METHODS: Among 419 cases who underwent the arthroscopic ACL reconstruction by one operator between June 1996 and January 2001, we evaluated 33 MR scans of 29 patients who underwent the postoperative MR scan and the second-look arthroscopic examination (4 patients underwent postoperative MRI twice). There were 18 male and 11 female patients, and the patient 's age ranges from 16 to 59 years-old (mean 29.7). There were 15 cases of autogeneous bone-patellar tendon-bone (BPTB) grafts, 13 cases of autogeneous double-loop hamstring grafts, and 1 case of allogeneous BPTB graft. Thirty-three MRIs were divided into 3 groups according to the time interval between operation and postoperative MR examination: less than 6 months, 7 to 12 months, and more than 13 months. The MR findings of ACL grafts - signal intensity, morphology, continuity, orientation, diameter - were analyzed. RESULTS: The increased signal intensity was found in 29 ACL grafts (87.7%) among 33 MR images. The most common pattern of the graft morphology was a longitudinal streak increased signal band (27 cases, 81.8%). The partial rupture was seen in 9 cases (27.3%), and the lax orientation in 4 cases (12.1%). According to Howell 's scoring system, the signal intensity score of the graft tended to decrease with time after operation, and the sagittal diameter of the graft tended to increase with time after operation. CONCLUSION: The main MR finding of the healthy ACL graft was longitudinal streak increased signal band. The graft signal intensity seemed to decrease, and the sagittal diameter of the graft seemed to increase, as time passes after operation.