Evolving Indication of Meniscal Allograft Transplantation / 대한정형외과학회잡지

The first human meniscal allograft transplantations (MATs) were performed 30 years ago. In the early era, candidates were limited to patients who have favorable joint conditions. MAT is currently indicated for patients with post-meniscectomy symptoms, such as compartmental pain or effusion after a subtotal or total meniscectomy. The current indication for MAT is being expanded to other patients who were not indicated previously. The present article reviews how the indications of MAT have changed over the years.

A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism: A case report

Diffuse alveolar hemorrhage (DAH) is a rare manifestation of trauma or long bone fracture. A relationship between fat embolism and DAH has been reported. A 73-year-old female developed sudden cardiac arrest during a femur fracture operation. Cardiopulmonary resuscitation (CPR) was repeated for about 130 minutes. During CPR, blood was detected in the endotracheal tube. Diffuse patch ground glass opacity appearance and increased pulmonary artery with bulging of interventricular septum toward the left ventricle were detected on a chest computed tomography scan. After full supportive care including ventilator therapy, the patient's condition became stabilized and she was extubated after 7 days. We report a case of DAH in the course of a suspected fat embolism during femur fracture operation. Although DAH is a rare manifestation of fat embolism, early diagnosis and aggressive treatment likely can decrease morbidity and mortality.

Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.

Clinical Results of Contralateral Arthroscopic Meniscectomy Performed with Unilateral Total Knee Arthroplasty: Minimum 3-year Follow-up

PURPOSE: We assessed the clinical outcome of contralateral arthroscopic meniscectomy performed with unilateral total knee arthroplasty (TKA). MATERIALS AND METHODS: From May 1999 to June 2006, 23 patients underwent unilateral total knee arthroplasty and contralateral arthroscopic meniscectomy at the same time. All patients were women and followed for at least 36 months, except 2 patients who died. For clinical assessment, range of motion of the knee joint, Hospital for Special Surgery (HSS) knee score and the Lysholm knee score were evaluated preoperatively and at the last follow-up. At arthroscopy, meniscal pathology and cartilage changes were recorded and classified according to the Outerbridge scale. Progression of osteoarthritis in the contralateral knee to subsequent TKA was also assessed. RESULTS: The mean age of the 21 patients was 67.1 years and the mean follow-up period was 5.7 years. All of the patients were diagnosed with osteoarthritis and had Outerbridge grade 3 or 4 cartilage changes. Eight of the 21 patients had subsequent TKA at an average of 3.1 years after the index operation. The other 13 patients had no further surgery and clinical results including the HSS knee score and the Lysholm score were improved from 74.5 and 60.6 preoperatively to 90.8 and 82.4 postoperatively, respectively (p<0.001). CONCLUSIONS: Contralateral arthroscopic meniscectomy performed simultaneously with unilateral TKA produces relatively good results regardless of the presence of cartilage degeneration.

Results of Gender-Specific Total Knee Arthroplasty: Comparative Study with Traditional Implant in Female Patients

PURPOSE: To compare the incidence of overhang between two distinct femoral components and whether there is clinical and radiological benefit of gender-specific implants in short-term follow-up. MATERIALS AND METHODS: One hundred and four knees in consecutive 66 female patients who underwent primary total knee arthroplasty due to primary osteoarthritis were included in this study. Overhang was measured and recorded in every cut surface of femur with both gender-specific and traditional trial femoral components respectively in every patient. Then, the knees were divided into two groups according to the type of the permanent femoral component they received. Clinical and radiological outcomes were compared between 2 groups at minimum 3 years after operation. RESULTS: Mean follow-up duration was 41.3 months (range, 36 to 50 months). Sixty two knees (59.6%) showed femoral overhang at least in one area with a traditional trial component, while 26 knees (25.0%) did with a gender-specific trial component (p<0.001). In terms of range of motion, Hospital for Special Surgery knee score, radiographic result, patella tilt angle and displacement, no significant difference was observed between two groups. CONCLUSIONS: The use of gender-specific implants substantially reduced the incidence of femoral overhang but did not demonstrate any clinical, functional or radiologic benefit in short-term follow-up.

Review of Meniscal Allograft Transplantation Focusing on Long-term Results and Evaluation Methods

With recognition of the biomechanical role of the meniscus, such as load distribution and joint stability in the knee joint, there has been a shift in the treatment of meniscal tears from open total meniscectomy to preservation of the meniscal functions as much as possible with symptomatic relief. Recently, technical development of meniscal surgery, with advanced arthroscopic equipment and instruments, enables biological reconstruction of load bearing functions in the meniscus deficient knee through allograft tissue transplantation as well as repair of torn menisci. Meniscal allograft transplantation (MAT) has been considered as one of the few viable treatment options for the young meniscectomized knees based on various animal experiments and clinical studies. Still, there is insufficient evidence for the long-term chondroprotective effect of human MAT. Some long-term follow-up studies showed that the technique resulted in graft degeneration, deformation, and tear, and structural changes in the remodeling process in early MAT cases, disrupting functional restoration of the original meniscus. Nevertheless, advanced outcomes are documented in some recent studies. The purpose of this article is to review the mid- and long-term follow-up results of MAT and to improve understanding of MAT with evaluation methods of meniscal transplants using magnetic resonance imaging or second-look arthroscopy.

Clinical Results and Prognostic Factors of Arthroscopic Surgeries for Discoid Lateral Menisci Tear: Analysis of 179 Cases with Minimum 2 Years Follow-up

PURPOSE: The purpose of this study was to evaluate the clinical results and prognostic factors of arthroscopic surgeries for tears of the discoid lateral menisci. MATERIALS AND METHODS: From March 1997 to September 2005, 260 patients received arthroscopic surgeries due to discoid lateral menisci tears. Among these patients, 179 knees in 168 patients were followed up for at least 2 years and were enrolled into this study. The following prognostic factors were evaluated: sex, age, symptom duration, and type of meniscal tear. Visual analogue score (VAS), Lysholm score, and Ikeuchi grade were assessed as clinical results of arthroscopic surgeries. RESULTS: The mean VAS and Lysholm score improved at the last follow-up. According to the Ikeuchi grade, 104 cases were rated as excellent, 51 cases as good, and 23 cases as fair. Male sex (p<0.033), age younger than 20 years (p=0.0474), and symptom duration less than 12 months (p<0.044) were good prognostic factors. However, there was no correlation between tear types of discoid lateral menisci and clinical results. CONCLUSIONS: Sex, age, and symptom duration could be significant prognostic factors of arthroscopic surgeries for tears of discoid lateral menisci.

Meniscus Allograft Transplantation

The biomechanical function of the meniscus is well known and its chondroprotective effect is very important. The meniscus should be preserved whenever possible, but subtotal or total meniscectomy is sometimes inevitable, and especially if considerable tissue damage already exists. Although meniscal allograft transplantation (MAT) is performed for the meniscus-deficient knees to restore the biomechanical function of the meniscus, its current indication has been limited to the symptomatic young patients who do not have advanced osteoarthritis. However, the osteoarthritic process is usually progressive over the time even if there are minimal symptoms. When evident clinical symptoms are present, it is usually associated with advanced cartilage damage. In this status, MAT cannot be indicated or the result of surgery would be very poor. Thus, the status of the articular cartilage should be carefully assessed in subtotal or total meniscectomized knees by performing radiographic and high-resolution magnetic resonance imaging and a meticulous physical examination. MAT could be considered if there is an objective evidence of cartilage damage even without evident clinical symptoms.

Effect of Norepinephrine Irrigation in Primary Total Knee Replacement Arthroplasty / 대한정형외과학회잡지

PURPOSE: We studied the effect of norepinephrine irrigation during total knee replacement arthroplasty (TKRA) on blood loss reduction. MATERIALS AND METHODS: A prospective study of 30 patients who received TKRA from the same surgeon between March 2003 and November 2003, was done. Patients were alternately allocated into two groups. The study group included 15 cases in which 1: 200, 000 diluted norepinephrine was used for irrigation intra-operatively, whereas the control group included 15 cases received normal saline irrigation. Postoperative drain and transfusion amounts were compared between the two groups using the independent t-test. RESULTS: Early bleeding amounts for 6 hours after surgery were a significant difference between the two groups (study group 410.3 cc, control group 517.3 cc, p-value=0.03). However, delayed bleeding amounts during postoperative 6-48 hours (study group 163.8 cc, control group 244.7 cc, p-value=0.05) and transfusion amounts (study group 0.80 unit, control group 1.47 unit, p-value=0.07) were smaller in the study group, but showed no significant differences. CONCLUSION: Using norepinephrine diluted in normal saline as an irrigation solution during TKRA can be considered for reducing early post operative bleeding.

Lateral Retinacular Release in Primary Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To determine the effect of lateral retinacular release on patellofemoral alignment in primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From June 1990 to December 1998, 351 cases of TKA, which were followed up more than 3 years, were divided into two groups, 147 cases (group I) with lateral retinacular release and 204 cases (group II) were without release. We compared the two groups in terms of the range of motion, patellofemoral alignment and clinical results using a Hospital for Special Surgery score. RESULTS: Average range of motion in group I (112 degrees preoperatively and 113 degrees on final follow-up) and group II (114 degrees preoperatively and 113 degrees on final follow-up) showed no statistical difference. The average functional knee score in group I (58 preoperatively and 88 on final follow-up) and group II (59 and 85 respectively) also showed no statistical difference. Patellar maltracking occurred in 4 cases (2.7%) in group I and 31 cases (15.2%) in group II. Patellar tilting (4.5 degrees in group I and 7.7 degrees in group II) and patellar translation (3.7 mm in group I and 7.8 mm in group II) showed significant statistical difference between the two groups at the final follow-up. CONCLUSION: Patellar tracking was better in the lateral retinacular release group, although there was no clinically significant difference at the short term follow-up period.

Reconstruction after Surgical Treatment of the Hypopharyngeal Cancer: Forearm Free Flap and Pectoralis Major Myocutaneous Flap / 대한이비인후과학회지

BACKGROUND: The comparison of information and complication after pharyngoesophageal reconstruction using the forearm free flap and pectoralis major myocutaneous flap was rarely reported. OBJECTIVES: To compare the information(duration of the procedure, nasogastric tube feeding and hospital stay etc) and complications after pharyngoesophageal reconstruction using the forearm free flap and pectoralis major myocutaneous flap, we reviewed the records of 19 patients with squamous cell carcinoma of the hypopharynx. MATERIALS: The records of 19 patients with squamous cell carcinoma of hypopharyx between June 1989 and November 1995 at Chungnam National University Hospital were reviewed retrospectively. Ten of 19 patients were reconstructed with forearm free flap and the others were reconstructed with pectoralis major myocutaneous flap. RESULTS: In 10 patient using forearm free flap, the duration of procedure, the duration of hospital stay, duration of nasogastric tube feeding and viability of flap were 13.7 hours, 38.5 days, 24 days and 80% respectively. In 9 patients using pectoralis major myocutaneous flap, the duration of procedure, the duration of hospital stay, the duration of nasogastric tube feeding and viability of duration were 7.38 hours, 29.1 days, 19 days and 88.9% respectively. There was no significant difference in complications between the groups. CONCLUSION: The pectoralis major myocutaneous flap was slightly superior to forearm free flap in aspect of the duration of procedure, hospital stay, duration of nasogastric tube feeding and viability. There was no statistically significant difference of complications. But we think that the more cases were required to compare the forearm free flap and pectoralis major myocutaneous flap.