Arthroscopic Revision ACL Reconstruction

PURPOSE: We analyzed the 11 knees in 11 patients who had arthroscopic revision anterior cruciate liga-ment(ACL) reconstruction and demonstrate the causes of failure of ACL reconstruction and report the clinical result of arthroscopic revision ACL reconstruction. MATERIALS AND METHODS: From March 1997 to April 1999, 11 patients who underwent ACL reconstruction at other hospital had been treated by revision ACL reconstruction. Their mean age at revision was 26.4 years, average time from primary to revision surgery was 26.8 months and average length of follow up was 22 months. We evaluated the results of revision surgery by symptom, Lysholm knee score, physical examination and KT-100 arthrometer. RESULTS: The causes of failure of ACL reconstruction were 8 improper tunnel placements(6 femoral tunnels, 2 tibial tunnels), 2 graft incorporation failure and 1 multiple ligament injury(N=l 1). After revi- sion all patients had improved symptom. There was improvement of average Lysholm knee score from 70 to 87( 2 excellents, 7 goods, 1 fair, 1 poor) with success rate of 82%( 9/11). The data showed decrease of the mean side to side difference from 10.9 mm to 1.7 mm by KT-1000 arthrometer. CONCLUSION: The most common causes of failure of ACL reconstruction were surgical techniques and anatomical tunnel placement was the most important among them.

Core Decompression and Impaction Bone Graft in Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of core decompression with impaction bone graft in regard to the stage of the disease. MATERIALS AND METHODS: Forty-two cases in 32 patients were classified using ARCO (Association Research Circulation Osseous, 1992) classification and twenty-five cases were compared with postoperative follow-up MRI evaluation. There were 26 male and 6 female patients. Ten patients among 32 were bilatellally involved. RESULTS: There were 9 hips of stage 1 (A,O; B,1; C,8), 29 hips of stage 2 (A,1; B,6; C,22) and 4 hips of stage 3 (only C). Radiological progression was seen in 21 of 42 hips (50%); 22% of stage 1 (2/9), 59% of stage 2 (16/29) and 75% of stage 3 (3/4). Clinical failure with total hip arthroplasty conversion was seen in 11 of 42 hips (26%); 28% of stage 2 (8/29) and 75% of 3 (3/4). Forty-three percents of lateral lesions (11/26 cases) and all cases with femoral head involvement more than 30% showed clinical failure and radiologic progression. CONCLUSIONS: When the outcome of core decompression with impaction bone graft was evaluated according to ARCO classification, the progression of the stage or conversion to total hip arthroplasty was more common in the larger lesion and lateral location of necrosis. So, we could predict that core decompression with impaction bone graft was ineffective in preventing the progression of disease in the case of large extent and/or lateral location of necrosis.