Correlation of Y Balance with Clinical Scores and Functional Tests after Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients

Background@#Criteria for return to sports (RTS) following anterior cruciate ligament (ACL) reconstruction have been extensively studied. But there is no consensus among investigators regarding which factors are most important in determining a safe RTS. @*Methods@#Sixty-one patients who underwent ACL reconstruction were included. Subjective knee scoring systems (International Knee Documentation Committee [IKDC] score and Lysholm score), functional performance tests (carioca test and single-leg hop for distance [SLHD] test), and isokinetic knee strength test were used for assessment and analyzed for association with the limb symmetry index (LSI) of the Y-balance test for lower quarter (YBT-LQ). @*Results@#The LSI of the YBT-LQ was significantly correlated with Lysholm score, IKDC score, Carioca, LSI for the SLHD, and extensor strength deficit at 6 months after ACL reconstruction. At 12 months, Lysholm score, IKDC score, LSI for the SLHD, and extensor strength deficit were significantly correlated with the LSI of the YBT-LQ. @*Conclusions@#The YBT-LQ test could be used conveniently as an additional tool to assess the patient’s functional performance results after ACL reconstruction in outpatient clinics.

Femoral Shaft Fracture in Klippel–Trenaunay–Weber Syndrome Patients – What to Do to Reduce Bleeding Risk: A Case Report / 대한고관절학회지

A fracture of the affected extremity in patients with Klippel–Trenaunay–Weber syndrome can be fatal due to massive bleeding and show poor results. A 42-year-old male presented with an old fracture of the right femoral shaft with metal failure. We planned an operation to remove the previously fixed plate and to perform re-fixation using an intra-medullary nail. Preoperative angiography was performed and the arteriovenous malformations were embolized in order to reduce the risk of bleeding. After angiography, the previously fixed plate was removed.After the operation, a second angiography was performed immediately and the venous malformation was embolized. One week after the first operation, a second operation was performed in order to reduce the fracture and to perform re-fixation using an intramedullary nail. The patient is being followed without major complication over a period of seven years after surgery. We recommend careful planning of preoperative and postoperative angiography and embolization in order to reduce the risk of bleeding in patients with Klippel–Trenaunay–Weber syndrome.

Comparison of Lower-Limb Alignment in Patients with Advanced Knee Osteoarthritis:EOS Biplanar Stereoradiography versus Conventional Scanography

Background@#Accurate measurement of the lower limb alignment is one of the most crucial factors in advanced knee osteoarthritis patients scheduled for surgery. Recently, EOS biplanar stereoradiography with three-dimensional reconstruction was developed. The purpose of this study was to compare radiographic parameters between conventional scanography and EOS in patients with advanced knee osteoarthritis who need surgical treatment. @*Methods@#A total of 52 consecutive patients (104 knees) with bilateral knee osteoarthritis of advanced stage (Kellgren-Lawrence [KL] grade 3 or 4) were retrospectively reviewed. We measured the hip-knee-ankle angle (HKA) on conventional scanograms. In EOS, we measured HKA, hip-knee-shaft angle, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle. To evaluate sagittal and axial plane alignment, knee flexion angle (KFA), and knee joint rotation (KJR) were also measured. @*Results@#Ninety knees were KL grade 4, and 14 knees were grade 3. The average HKA was 10.14° ± 6.16° on conventional scanograms and 11.26° ± 6.21° in EOS. HKA was greater in EOS than on conventional scanograms, and the difference (1.12°; range, −1.07° to 3.22°) was statistically significant (p < 0.001). Significant correlations were observed on the difference in HKA and mechanical medial proximal tibial angle (r = –0.198, p = 0.044), KFA (r = 0.193, p = 0.049), and KJR (r = 0.290, p = 0.003). In multivariable linear regression analysis, the difference in HKA had significant relationship with KFA (β = 0.286, p = 0.003) and KJR (β = 0.363, p < 0.001). @*Conclusions@#HKA measured on conventional scanograms and in EOS differed significantly and the difference had a significant correlations with KFA, KJR, and medial proximal tibial angle. Surgeons can consider these results before orthopedic surgery in patients who have advanced knee osteoarthritis.

Comparison of Locking Plate Osteosynthesis versus Coracoclavicular Stabilization for Neer Type IIB Lateral Clavicle Fractures

Background@#The best option for the treatment of Neer type IIB lateral clavicle fractures remains controversial. The aim of this study was to compare outcomes and complications between pre-contoured locking plate osteosynthesis (PLPO) and coracoclavicular stabilization (CCS) using a TightRope for the treatment of type IIB fractures. @*Methods@#Forty-six consecutive type IIB fractures were treated with PLPO (17 cases) or CCS (29 cases). The mean follow-up period was 33.7 months (range, 12–144 months). Radiographic outcomes were evaluated using serial plain radiographs. Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). @*Results@#Of the 46 cases, complete bony union within 6 months after surgery was achieved in 42 cases (91.3%). The union rate was 100% (17/17) in the PLPO group and 86.2% (25/29) in the CCS group, showing a statistically significant difference (p = 0.043). No significant differences in terms of UCLA score (32.8 vs. 32.1), ASES score (93.2 vs. 90.8), or SSV (89.1% vs. 90.3%) were observed between the PLPO and CCS groups. The complication rates were 17.6% (3/17; 2 cases of screw breakage and 1 case of stiffness) in the PLPO group and 37.9% (11/29; 4 cases of nonunion, 3 cases of stiffness, 2 cases of skin irritation, 1 case of superficial infection, and 1 case of coracoid button migration) in the CCS group, showing no statistically significant difference (p > 0.05). Four cases with nonunion after CCS did not require reoperation because they had good to excellent clinical outcomes without radiographic progression. @*Conclusions@#Although a higher nonunion rate was observed in the CCS group compared with the PLPO group, satisfactory clinical outcomes were obtained for both groups. Both techniques can be regarded as useful options for the treatment of Neer type IIB lateral clavicle fractures.

The Characteristics of Nonmotorized and Electric Kickboard Injury: Retrospective Analysis from a Single Tertiary Institution / 대한스포츠의학회지

Purpose@#Recently, there has been an increasing number of kickboard injuries at our orthopedic clinic and emergency room. Therefore, this study is to identify the incidence and characteristics of nonmotorized and electric kickboard injuries with emergency room surveillance. @*Methods@#Between August 2018 and January 2021, patients who visited the emergency room of a tertiary hospital with nonmotorized and electric kickboard injuries were included. The incidence, severity, and characteristics were analyzed. @*Results@#There were a total of 204 patients who visited our emergency room during the study period. There were 139 nonmotorized kickboard injuries with 115 minor, 11 moderate, and 13 severe injuries. Fifty-six electric kickboard injuries were 47 minor, one moderate, and eight severe injuries. The incidence of injury depended on-site and was as follows: face and head (63.7%), upper extremity, lower extremity, abdomen and chest, and spine. @*Conclusion@#Face and head injuries were the most common injuries in body part, while minor trauma was the most common diagnosis. With the increasing incidence of kickboard injuries, we should be more mindful that protective equipment and safety rules may be necessary.

Graft Selection and Fixation in Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

Anterior cruciate ligament (ACL) reconstruction is a successful procedure independently by patient selection, timing of surgery, surgicaltechnique, choice of graft, and fixation methods. Among these factors, graft selection and fixation methods might be the most criticalyet controversial questions for surgeons. Although recent studies showed that grafts have advantages and drawbacks, there is still noideal graft. Similarly, many fixation methods of femoral and tibial tunnels have been proposed over the last few decades, with no clearsuperiority of one technique over another. Surgeons should be familiar with a variety of grafts, fixation techniques, and their specificassociated surgical procedures as well as the advantages and disadvantages of each. Therefore, this article summarizes the currentliterature and discusses the current state of graft selection and fixation methods in the treatment of an ACL injury.

Risk factors of uncontrolled periprosthetic knee joint infection after two-stage reimplantation

Background@#Periprosthetic infection after total knee arthroplasty is a challenging problem, and physicians should identify risk factors to decrease recurrence. However, risk factors for reinfection with two-stage reimplantation have not yet been well established. The purpose of this study was to assess treatment outcomes of subsequent twostage knee reimplantation and identify risk factors for uncontrolled periprosthetic knee joint infections. @*Methods@#We retrospectively reviewed 70 knees diagnosed with a periprosthetic knee joint infection treated with two-stage reimplantation between September 2011 and October 2016 at our institution. Patients in the controlled infection group (group C) required no further medication or surgical treatment within 2 years after reimplantation.Patients in the uncontrolled infection group (group U) displayed symptoms of active infection after resection arthroplasty or were reinfected after two-stage reimplantation. We compared group C and group U, and analyzed potential risk factors for uncontrolled prosthetic joint infection (PJI). @*Results@#Of 70 knees included in this analysis, 53 (75.7%) were clinically deemed free from infection at the latest follow-up. The remaining 17 knees (24.3%) required additional surgical procedures after two-stage reimplantation.Demographics were not statistically significantly different between the two groups. Wound complications were statistically more frequent in group U (p = 0.030). Pre-reimplantation C-reactive protein (CRP) was statistically different between groups C and U (0.44 and 1.70, respectively, (p = 0.025). Among the cultured microorganisms, fungus species were statistically more frequently detected in group U compared with group C ((p = 0.031). @*Conclusions@#The reinfection rate of our two-stage reimplantation protocol was 24.3% in the included cases.Wound complications, higher pre-reimplantation CRP levels, and fungus species were statistically more common in group U compared with group C. Our findings will help in counseling patients and physicians to understand that additional caution may be required when treating PJI if the aforementioned risk factors are present.Level of evidence: IV, case series.

Two-stage revision anterior cruciate ligament reconstruction

With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active infection, and concomitant knee pathology (e.g., malalignment, other ligamentous injuries, meniscal or chondral lesions). Among these potential scenarios requiring a two-stage revision, tunnel-widening is the most common cause; the first stage involves graft removal, tunnel curettage, and bone grafting, followed by revision ACL reconstruction in the second stage. The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results.

Two Cases of Anti-M of Donated Bloods Confirmed at pH 6.5 / 대한수혈학회지

Anti-M is detected at room temperature and is often found in the sera of people who have never been exposed to human red cells. In a few cases, anti-M can be detected at 37 degrees C or at the antiglobulin phase, and these antibodies can cause hemolytic diseases in newborn or hemolytic transfusion reactions. Some examples of anti-M demonstrate stronger agglutination at low pH (pH 6.5), and when they react with the red blood cells of the MM type (dosage effect). An unexpected antibody test was carried out for the routine screening of donated blood and two cases that reacted to all panel cells at 5 degrees C were found, which indicated anti-M. We repeated the unexpected antibody identification test at pH 6.5 and confirmed the presence of anti-M. The reduction of the test system pH is a useful and simple method for detecting some cases of anti-M.

A Case of Anti-Wr(a) with Anti-E / 대한수혈학회지

Authors found a case of anti-Wr(a) with anti-E antibody in 67 years old female patient. Anti-Wr(a) in Korea was reported for the first time in 2005. Anti-Wr(a) has been associated with hemolytic transfusion reaction (HTR) and hemolytic disease of the newborn (HDN). It is necessary to study the incidence of Wr(a) antigen and anti-Wr(a) in Korea.

A Study to Establish Rare Blood Type Donor Registration System / 대한수혈학회지

BACKGROUND: To find compatible rare bloods, the Korean Red Cross (KRC) blood center is currently testing many units randomly selected from the units in storage. Since this procedure is usually very time-consuming, it is necessary to establish a new donor management system for the rare blood types. METHODS: We evaluated 261 units of red blood cells (RBCs), which were supplied as compatible bloods to the requests of hospitals in 2003. RESULTS: A total of 14 hospitals requested 248 units of compatible RBCs for their 39 patients through 64 occasions and 261 units were supplied. The blood types of 35 patients were identified using the medical records of the hospitals. A total of 19 kinds of specific antigens were negative and, among them, 10 kinds of single specific antigens were negative and 9 kinds of multiple antigens were negative. The frequencies of the negative antigens were C+e(17.9%), E+c(10.3%) and Jka(10.3%), respectively. The number of tested blood units was 1,894 and the rate of compatibility was 13.8%. The mean age of 257 blood donors was 22.5 and, among them, 220 donors (85.6%) were multiple donors with 7.5 collections on average. CONCLUSION: We conclude that the rare blood type donor registration system is necessary and suggest the following preconditions. First, the results of compatible blood test and irregular antibody screening test for the blood donor need to be registered automatically by the blood information management system(BIMS). Second, the test system should be improved to enhance the irregular antibody detection rate. Third, establishment of a frozen-thawing system for RBCs is needed. Fourth, the donors need to be informed of the results of their rare blood type, if any, including irregular antibody. Fifth, a new organization should be established to manage the rare blood type donor registration system. Finally, well cooperation with hospitals and KRC blood center is needed to ensure the stability of blood service for rare blood type RBCs.

The Characteristics of Current Whole Blood, Blood Components and Its Standard Values / 대한수혈학회지

BACKGROUND: Current blood and blood components are prepared from 320ml or 400ml blood collection. The analytic values and standard values of blood and blood components were evaluated at Seo-Bu Blood Center, The Republic of Korea National Red Cross, Seoul, Korea. METHODS: Blood and blood components were analyzed with weight, specific gravity, content volume, RBC counts, WBC counts, platelets counts, hemoglobin, hematocrit, pH, total protein, albumin, factor VII and bacterial culture. RESLUTS: The volume, hemoglobin, hematocrit and pH of 320ml and 400ml standard unit of whole blood was 328 +/- 31ml and 405 +/- 22ml, 12.7 +/- 1.7g/dl and 14.8 +/- 2.0g/dl, 38.0 +/- 4.0% and 40.8 +/- 4.6%, mean of 7.16 and 7.13, respectively. The volume and hematocrit of packed red cells prepared from 320ml and 400ml standard unit of whole blood was 188 +/- 23ml and 248 +/- 23ml, 73.2 +/- 4.7% and 72.6 +/- 5.4%, respectively. Leukocytes poor red cells from 400ml standard unit of whloe blood showed 225 +/- 12ml of volume, 71 +/- 2.4% of hematocrit, and WBC removal was 87 +/- 5%. The volume, hematocrit and total protein in washed red cells was 224 +/- 11ml, 59 +/- 6.0% and 0.10 +/- 0.05g/unit, respectively. Leukocytes concentrates revealed 50 +/- 4.6ml of volume, 2.0 +/- 0.5x109/unit of WBC count and WBC recovery was 78 +/- 6.0%. Platelet concentrates prepared from 320ml and 400ml standard unit of fresh whole blood showed 38 +/- 3ml and 48 +/- 3ml of volume, 4.68 +/- 1.60x1010 and 5.55 +/- 1.80x1010 of platelet per unit, and 7.05 +/- 0.25 and 6.95 +/- 0.34 of pH, respectively. The fresh frozen plasma from 320ml standard unit of whole blood contained 143 +/- 25ml of volume, and that from 400ml whole blood showed 161 +/- 27ml of volume and 112 +/- 33 IU/unit of factor VII. The cryoprecipitate from 320ml whole blood showed 42 +/- 3ml of volume and 81 +/- 9 IU/unit of factor VII. There were no bacterial growth for all the components inoculated. CONCLUSION: At Seo-Bu Blood Center, we evaluated the characteristics of current blood and blood components, and established the standard values for whole blood (320ml, 400ml) as well as packed red cells, leukocytes poor red cells, washed red cells, leukocyte concentrates, platelet concentrates, fresh fozen plasma and cryoprecipates from 320ml and 400ml whole blood based on the present studies. Compared to the Standards for Blood Banks and Transfusion Services, American Association of Blood Banks, values of evluated items of current blood and blood components showed comparable results, but platelet counts from 320ml collection did not meet to those standards.

Survey on Knowledge, Attitude and Concern of Some Blood Donors Regarding AIDS (Acquired Immuno Deficiency Syndrome) / 대한수혈학회지

AIDS, which is being spreaded world-wide, would have the number of the patients and the infected persons to several million persons since the first patient had been reported among the homosexualists in 1981, and in our country patients of 323 persons had been found till 1993, therfore we could have significant concern and warning. Accordingly, this writer intended to present basic data to the blood Project and AIDS preventive movement by investigating knowledge, attitude and concern regarding AIDS including blood donors, and analyzed data of 1,920 pages by questionaire method from March to August 1994. According to the results, it is rather well-known as far as general knowledge, attitude and concern regarding AIDS are concerned, however, items which are 20-40% wrongly known are as followings: AIDS is infected by virus. It is infected by insects such as mosquito. It is infected with tight kiss with the person infected with AIDS. Risk of being infected with AIDS will be reduced if using condom when sexual intercourse. It may be infected through the foods. It may be infected by the same bacteria attacking venereal disease. And WHO(world Health Organization) designated Dec. 1st as AIDS'Day. Items which are 40-60 wrongly known are as followings: AIDS can be infected by blood donation, Now vaccine preventing AIDS has been developed. In our country, Preventive law of AIDS is established. And in the field of the attitude and concern, it was surveyed as important as being hahdied by the broadcasting and newspaper, and 60470% of the persons answered that they would avoid AIDS infected person, and 76% of male and 87.1% of female gave the reply thet AIDS infected persons should be administered extraordinarily by isolated accommodation by the nation.