High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

BACKGROUND@#The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent re-operation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries.@*METHODS@#We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus.@*RESULTS@#There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the “successful healing” rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025).@*CONCLUSIONS@#There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears.LEVEL OF STUDY: Level IV, retrospective case series.

Redislocation after Bearing Exchange for the Treatment of Mobile Bearing Dislocation in Medial Unicompartmental Knee Arthroplasty

PURPOSE: This study was conducted to investigate the outcomes of bearing exchange for the treatment of mobile bearing dislocation in medial unicompartmental knee arthroplasty (UKA). MATERIALS AND METHODS: We retrospectively reviewed 18 patients (15 females and 3 males, mean age of 65 years) treated with bearing exchange following mobile bearing dislocation in medial UKA. The occurrence of bearing redislocation, the Oxford Knee Score, and radiographic changes at the last follow-up were investigated. RESULTS: Bearing redislocation after bearing exchange occurred in 9 of 18 patients (50%). Of these 9 patients, 7 underwent conversion to total knee arthroplasty after bearing redislocation. The 9 patients without bearing redislocation showed good to excellent clinical outcomes at a mean follow-up of 55 months after bearing exchange. The non-redislocation group had a higher percentage of posterior dislocation of the bearing than the redislocation group (55.5% vs. 22.2%, p=0.040). Univariate logistic regression analysis showed no significant risk factors for bearing redislocation. CONCLUSIONS: This study showed a high rate of bearing redislocation after isolated, mobile bearing exchange for bearing dislocation following medial UKA. Therefore, bearing exchange as a sole treatment should be carefully considered in selected patients with correctable causes of bearing dislocation.

Arthroscopic Meniscectomy for Medial Meniscus Horizontal Cleavage Tears in Patients under Age 45

PURPOSE: The purpose of this study was to evaluate the demographics, clinical features, and outcomes of arthroscopic partial meniscectomy (APM) for isolated medial meniscus horizontal cleavage tears (MMHCTs) in patients under 45 years of age. MATERIALS AND METHODS: We retrospectively reviewed 98 patients (100 knees) under 45 years who underwent APM for MMHCTs. Clinical outcomes were assessed using International Knee Document Committee (IKDC) subjective core, Tegner activity scale, visual analog scale (VAS) pain score, and a question on the symptom relief. RESULTS: 79% were male and 70% had no trauma. The mean symptom duration was 10 months. At arthroscopy, a flap tear was identified in 75%. At a mean of 19-month follow-up, the IKDC subjective score, Tegner activity scale, and VAS pain score were significantly improved compared to the preoperative values (p=0.025, p=0.043, and p=0.032, respectively). While 85% were free of symptoms, 15% had persistent pain. No significant differences in outcomes were observed based on the tear type and the presence of flap tears. No progression or development of radiographic degenerative changes was observed in all knees. CONCLUSIONS: Demographics of MMHCTs under age 45 showed a male dominance and higher frequency of non-traumatic tears. APM was beneficial to symptomatic HCTs in this cohort during the short-term follow-up. Type of HCTs and combined flap tears did not affect clinical outcomes.

The Parameters Affecting the Success of Irrigation and Debridement with Component Retention in the Treatment of Acutely Infected Total Knee Arthroplasty

BACKGROUND: The aims of our study were to evaluate the success rate of irrigation and debridement with component retention (IDCR) for acutely infected total knee arthroplasty (TKA) (< 4 weeks of symptom duration) and to analyze the factors affecting prognosis of IDCR. METHODS: We retrospectively reviewed 28 knees treated by IDCR for acutely infected TKA from 2003 to 2012. We evaluated the success rate of IDCR. All variables were compared between the success and failure groups. Multivariable logistic regression analysis was also used to examine the relative contribution of these parameters to the success of IDCR. RESULTS: Seventeen knees (60.7%) were successfully treated. Between the success and failure groups, there were significant differences in the time from primary TKA to IDCR (p = 0.021), the preoperative erythrocyte sedimentation rate (ESR; p = 0.021), microorganism (p = 0.006), and polyethylene liner exchange (p = 0.017). Multivariable logistic regression analysis of parameters affecting the success of IDCR demonstrated that preoperative ESR (odds ratio [OR], 1.02; p = 0.041), microorganism (OR, 12.4; p = 0.006), and polyethylene liner exchange (OR, 0.07; p = 0.021) were significant parameters. CONCLUSIONS: The results show that 60.7% of the cases were successfully treated by IDCR for acutely infected TKA. The preoperative ESR, microorganism, and polyethylene liner exchange were factors that affected the success of IDCR in acutely infected TKA.

Factors Correlated with the Reducibility of Varus Deformity in Knee Osteoarthritis: An Analysis Using Navigation Guided TKA

BACKGROUND: We hypothesized that a number of clinical and radiologic parameters could influence the reducibility of varus deformity in total knee arthroplasty. The aim of this study was to identify the factors correlated with reducibility of varus deformity and predict more accurately the amount of medial soft tissue release required in varus deformity total knee arthroplasty. METHODS: One hundred forty-three knees with preoperative varus alignment and medial osteoarthritis were included in this retrospective study. The total knee arthroplasties were performed using a navigation system (OrthoPilot) by single surgeon. To assess varus deformity, the authors measured preoperative mechanical axis angles and valgus stress angles. Mechanical tibial angles, mechanical femoral angles, femoral osteophyte sizes, and tibial osteophyte sizes were measured. The Ahlback grading scale was applied for radiologic parameters, and clinical parameters (age, body mass index, sex, duration of pain, and preoperative range of motion) were documented. Correlations between these factors and preoperative valgus stress angle were analyzed. RESULTS: A negative correlation was found between preoperative mechanical axis angle and preoperative valgus stress angle (p < 0.01, r = -0.38), and a positive correlation was found between the preoperative mechanical tibial angle and preoperative valgus stress angle (p = 0.01, r = 0.19). CONCLUSIONS: The present study shows that preoperative varus deformity and proximal tibial vara (measured by preoperative mechanical axis angle and mechanical tibial angle, respectively) are correlated with reducibility of varus deformity (measured by preoperative valgus stress angle), and clinical parameters (age, range of motion, duration of pain and body mass index) and other radiologic parameters (osteophyte size, severity of osteoarthritis and angulation of distal femoral joint surface) were not significantly correlated with reducibility of varus deformity.

Anatomical versus Non-Anatomical Single Bundle Anterior Cruciate Ligament Reconstruction: A Cadaveric Study of Comparison of Knee Stability

BACKGROUND: The purpose of this study was to compare the initial stability of anatomical and non-anatomical single bundle anterior cruciate ligament (ACL) reconstruction and to determine which would better restore intact knee kinematics. Our hypothesis was that the initial stability of anatomical single bundle ACL reconstruction would be superior to that of non-anatomical single bundle ACL reconstruction. METHODS: Anterior tibial translation (ATT) and internal rotation of the tibia were measured with a computer navigation system in seven pairs of fresh-frozen cadaveric knees under two testing conditions (manual maximum anterior force, and a manual maximum anterior force combined with an internal rotational force). Tests were performed at 0, 30, 60, and 90 degrees of flexion with the ACL intact, the ACL transected, and after reconstruction of one side of a pair with either anatomical or non-anatomical single bundle ACL reconstruction. RESULTS: Under manual maximal anterior force, both reconstruction techniques showed no significant difference of ATT when compared to ACL intact knee state at 30degrees of knee flexion (p > 0.05). Under the combined anterior and internal rotatory force, non-anatomical single-bundle ACL reconstruction showed significant difference of ATT compared to those in ACL intact group (p 0.05). Internal rotation of the tibia showed no significant difference in the ACL intact, the ACL transected, non-anatomical reconstructed and anatomical reconstructed knees. CONCLUSIONS: Anatomical single bundle ACL reconstruction restored the initial stability closer to the native ACL under combined anterior and internal rotational forces when compared to non-anatomical ACL single bundle reconstruction.

Intra-articular Patterns of Bucket Handle Meniscal Tears and Its Relation to Reducibility

BACKGROUND: The purpose of this study was to assess the intra-articular patterns in the rotational deformities of bucket handle meniscal tears (BHMTs) based on arthroscopic findings and their clinical relevance. METHODS: From 2004 to 2009, 42 patients with a BHMT diagnosed by magnetic resonance imaging underwent arthroscopic surgery. The arthroscopic data (all procedures were recorded) were evaluated retrospectively, and BHMTs were classified according to the rotational directions of centrally displaced fragments. To assess the reliability of the agreement in this classification, 2 orthopedic surgeons re-classified BHMTs, 1 week after first trial. Intra- and interobserver reliabilities were assessed using kappa statistics. In addition, we address specific tear patterns, associated anterior cruciate ligament injury, medio-lateral difference, reducibility, chronicity, and reparability. RESULTS: Most of the tears could be categorized into one of 3 morphologic patterns. Of the tears, 4.8% could not be categorized. BHMTs were classified, based on the rotational directions of centrally displaced fragments, as follows; the upward rotation group (type 1), the downward rotation group (type 2) and the reverse group (type 3). The most common intra-articular pattern was type 1 (29 patients, 69%). The occurrence of the other patterns was: type 2 in 7 patients (16.7%), type 3 in 4 patients (9.5%); we were not able to make a classification of type in 2 patients (4.8%). Intra-observer reliability was 0.86 in terms of kappa statistics, which implies almost perfect agreement. Mean interobserver reliability (0.73) showed substantial agreement. Type 1 and 2 tears were easily reduced, whereas all type 3 tears (4/4) needed additional procedures to achieve reduction. CONCLUSIONS: Based on arthroscopic findings, we describe a comprehensive BHMT classification scheme that encompasses 95.2% of all tears. Tear type was correlated with reducibility.

Novel Balance Tests for Assessing Functional Ankle Instability: Relationships with BMI and Gender / 대한족부족관절학회지

PURPOSE: To design novel balance tests to assess FAI and evaluate whether these tests are affected by BMI or gender, with the goal of developing reliable FAI assessment tests that are not influenced by these factors. MATERIALS AND METHODS: Participants included 20 young, healthy volunteers, 12 males and 8 females, with a mean age of 24+/-4 years and a mean BMI of 23+/-2.28. None of the subjects had known ankle instability. The following tests were assessed in each participant: single leg balance (SLB), percentage of leg press (PLP), single leg cycling (SLC), one leg squat (OLS), multiple direction reach-front/back/side (MDR-F/B/S), single leg hop (SLH), two leg jump (TLJ) and side step (SS). Data were analyzed using the SPSS 12.0 software program with ANOVA and t-test used. RESULTS: When grouped by BMI, we found that despite differences in BMI, the performances of all subjects were equivalent except for the one-leg-squat test, for which the mean ratios for underweight (1.69+/-0), normal weight (1.05+/-0.19), and overweight (0.93+/-0.30) individuals were significantly different (p=0.02); ratios for SLB (p=0.273), SLC (p=0.903), PLP (p=0.664), MDR-F/B/S (p=0.498, 0.908, and 0.503, respectively), SLH (p=0.332) were not significantly different. When calculated according to gender, we found that the OLS (p=0.013) and MDRS (p=0.034) were significantly different, while parameters for all the remaining tests were not affected. CONCLUSION: We found that the SLB, PLP, SLC, MDR-F/B, and SLH ratios were unaffected by BMI or sex and, therefore, are reliable parameters for assessing ankle instability.

Fracture of a Polyethylene Tibial Post in a Scorpio Posterior-Stabilized Knee Prosthesis

We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis.

Swing Door Reduction Malar Plasty Without the Need for Fixation

The zygomatic bone is one of the most important bone in forming the facial contours. Asians, especially Northeast asians, including Koreans have a very wide and protruding zygomatic bone making, they have a very rough and manly look. Most of the malar osteotomy reductions including triangular osteotomy need a fixation of the bone fragment to prevent the nonunion or malunion of the zygomatic bone or the lower margin of the bone fragment after the surgery. 76 cases were reviewed between October 2004 and August 2006 which were operated in Korean hospitals and Shanghai hospital in China. 74 of the 76 cases were done for women, and the average age was 27.5(21-38). The first osteotomy was done where the frontal process and temporal process meet with a safety zone between the orbital margin towards the oral angle. The electronic saw maintains a 45 degrees to the zygomatico-maxillary buttress with preservation of the 5mm of the outer table of the zygomatic bone. However the inner table has a greater preservation of the bone and periosteum from the osteotomy. The second osteotomy line was towards the downward-laterally at a almost 90 degree angle with a 5mm interval between the first cut starting at the zygomatic body inferior laterally. To prevent the mobility and the loss of the bone when using the electronic saw for the preauricular incision or post sideburn incision, osteotome was used. In the 76 cases followed by 2 weeks, no dropping of the buccal area was found nor unwanted anterior dropping of the buccal fat was found. The authors used triangular osteotomy method and the method of creating artificial depression through 3 partial osteotomy prior to this method. There was no inferior displacement of the bone fragment after the surgery. There was essentially no loss of the bone of the osteotomy surface due to the incomplete fracture of the osteotomy-fracture of the swing zygomatic body using the osteotome. Comparing to other operations, operating time was shorter and recovery was faster. It was economical because fixation equipments did not use. Also, it was easy to do asymmetry correction since broken bone and spicule were easily moved as an operator's intention.

Treatment of Spontaneous Osteonecrosis of the Knee Using the Oxford Unicompartmental Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic outcomes of unicompartmental knee arthroplasty (UKA) in patients with spontaneous osteonecrosis. MATERIALS AND METHODS: Between September 2002 and March 2005, 15 patients with 16 knees were treated with UKA for the treatment of spontaneous osteonecrosis. There were thirteen women and two men with a mean age of 64 years old. The clinical assessment was performed using the American Knee Society Score system. The preoperative radiography was analyzed according to the size and stage of the osteonecrotic lesion and the osteoarthritic changes. Postoperatively, the presence of new osteonecrotic lesion, loosening of the implant, subsidence and arthritic changes was recorded. RESULTS: The mean preoperative knee score and the knee function score was improved from 52.5 to 89.2 and 56.0 to 85.2, respectively. There was no new necrotic lesion in the lateral compartment, loosening of the implant, subsidence or arthritic change. CONCLUSION: UKA in patients with spontaneous osteonecrosis provided satisfactory clinical and radiological results in the short to medium term.

Spontaneous Osteonecrosis of the Knee in the Elderly over 60 Years Old / 대한정형외과학회잡지

PURPOSE: This study examined the results of treatment according to the stage and size of a spontaneous osteonecrosis lesion of the knee (SONK) in the patients over 60 years of age. MATERIALS AND METHODS: Twenty-two knees from 19 patients over 60 years of age were treated for spontaneous osteonecrosis of the knee at our institution between January, 2000, and June, 2004. The mean follow time was 20.7 months. The condylar ratios, proportion of the lesion size to the condyle were measured. The size was obtained by multiplying the values from the anteroposterior and lateral radiographs. The stages were classified radiographically, and the treatment results were analyzed according to the size and stage. Conservative treatment was performed if the ratio and size were 40% or 5.0 cm2. A paired T-test, Spearman correlation test and Wilcoxon test were used for the statistical evaluation. RESULTS: There was a higher prevalence in females (15 patients, 79%), and the mean age was 65 years (46-77 years). Bilateral involvement was observed in 3 patients. The lesions involved mainly the medial femoral condyle (21 cases, 95%). Seven cases (31%) had a condylar ratio 40%. Conservative treatments were performed in 5 cases staged radiographically as I or II and there were no significant changes in the knee scores (p=0.931). Of the 17 cases staged III and IV radiographically, conservative treatment and arthroplasty were performed in 7 and 10 cases, respectively. Seven cases, in whom conservative treatments had been performed, showed a decreased in the knee scores compared with the increased knee scores in 10 patients treated with arthroplasty (p=0.943). CONCLUSION: An accurate diagnosis and measurement of the size and staging of spontaneous osteonecrosis of knee in patients over 60 years of age is important for proper treatment. Clinically, no further progression of symptoms is visible on grade I and II spontaneous osteonecrosis of the knee after conservative treatment. However, arthroplasty improves the clinical results in patients with radiological grade III and IV osteonecrosis compared with conservative treatment.

The Healing Effectof Bone Morphogenic Protein with Fibrin Glue on an Injury of the Tendon-Bone Junction / 대한정형외과학회잡지

Purpose: The author hypothesizes that exogenously injected BMP, which is mixed with fibrin glue, can accelerate the healing of a bone-tendon junction injury and increase its holding strength during the early regeneration period. Materials and Methods: A direct injury model of the bone-tendon junction was made using the Achilles tendon-calcaneus bone of 54 rabbits: and the transected Achilles tendon was repaired to its original insertion site using the Krackow method. In Group 1, no additional manipulation was performed. In Group 2, only fibrin glue was injected into the junction between the Achilles tendon and the calcaneus in order to exclude the effect of the fibrin glue. In Group 3, BMP-2 incorporated into the fibrin glue was injected into the junction. The results were evaluated by histological analysis and biomechanical tests at 2, 4, and 8 weeks after surgery. The Kruskal-Wallis test was used for a statistical evaluation. Results: Histological analysis revealed the early appearance of fibrocartilage at 2 weeks in Group 3: the area of the fibrocartilage expanded with time. The biomechanical tests showed significant differences in the maximum stress between Groups 1 and 3, and between Groups 2 and 3, at 2, 4, and 8 weeks. 74.4% of the normal maximum stress was recovered at 8 weeks in Group 3. Conclusion: The combined use of BMP-2 and the fibrin glue can accelerate the healing of an injury of the bone-tendon junction.

Comparison between Unicompartmental and Total Knee Arthroplasty in the Same Patient(Short term results)

PURPOSE: To evaluate and compare the short-term clinical results of unicompartmental and total knee arthroplasty in the same patient. MATERIALS AND METHODS: Twenty patients who had primary TKA in their one knee and primary UKA in the other between August 2002 and July 2004, followed up more than 2 years, comprised the study population. The mean age at their first operation was 67.9 years. The clinical and radiologic outcomes were identified and analysed. The operating time, postoperative drainage, resultant transfusion and the subjective preference were evaluated. RESULTS: In the UKA knee, HSS score of 59.7 in average, the mean ROM of 120.2 degrees and tibiofemoral angle of 2.8 degrees in varus position were measured preoperatively. These values changed posteoperatively in 24 months follow-up into, 89.4, 131.7 degrees and 4.6 degrees in valgus position. In the TKA knee, the mean preoperative HSS score was 52.5, tibiofemoral angle was 5.4 degrees in varus position, ROM of 117.5 degrees. After 24 months posto- peratively, HSS score improved to 86.3, ROM of 125.9 degrees, tibiofemoral angle of 5.6 degrees in valgus position. And we found meaningful short operation time with UKA, conspicuous decrease of drained blood and low tendency of transfusion after UKA. In patient's preference, 8 out of 20 felt no difference between two knees and 8 out of 20 preferred UKA knee at 24 months follow-up. CONCLUSION: Satisfactory radiologic and clinical results were shown after UKA. Early clinical outcomes of UKA were not inferior to those of TKA.

Bilateral Simultaneous Sleeve Fracture of the Patella : A Case Report

Sleeve fractures of the patella are cartilaginous avulsion fractures from the lower pole of the patella. They occur mainly due to sports injuries in adolescents. They may be missed in diagnosis due to rare incidence and small bony fragment on simple radiographs. In this report, an unusual bilateral simultaneous sleeve fracture in a healthy child is described.

Liposclerosing Myxofibrous Tumor in Tibia: A Case Report and Review of the Literature

Liposclerosing myxofibrous tumor (LSMFT) is a benign fibro-osseous lesion that is characterized by a complex mixture of histologic elements, including its fibrous dysplasia-like features and its lipoma, myxofibroma, xanthoma and pseudo-Paget's bone patterns. However, this lesion is considered by some researchers as a variant of fibrous dysplasia or as the non-specific end result of degenerative change, while it is considered by others as a definite clinicopathologic entity. Here, we report on a case of LSMFT occurring in tibia, which is a very uncommon location for this tumor, and we review the related literatures. The case presented here shares features with those described for LSMFT, except for the location of this tumor. We believe that more studies on a larger scale that compare LSMFT with other benign bone lesions, including fibrous dysplasia, are required to clarify the origin and behavior of this lesion.

Popliteal Artery Entrapment Syndrome caused by a Anomalous Origin of the Gastrocnemius Muscle: Case Report

Popliteal artery entrapment syndrome (PAES) occurs when an abnormal anatomic relationship between the popliteal artery and the surrounding musculotendinous structures causes repeated arterial compression with exercise. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. PAES can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. This syndrome is a rare but potentially limb threatening anatomical anomaly occurring predominently in young adults. We experienced two cases who have suffered from a coldness and pain of lower leg. Angiogram and MRI were performed and we diagnosed as a popliteal artery entrapment syndrome. We report two cases of rare anomalous origin of the gastrocnemius muscle in intraoperative findings.

Long Term Results After Resection of the Discoid Meniscus in Children / 대한정형외과학회잡지

PURPOSE: We retrospectively reviewed the long term results of arthroscopic resection of the discoid meniscus in children and evaluated postoperative clinical symptoms and radiological changes. MATERIALS AND METHOD: The results of arthroscopic surgery in 27 symptomatic discoid menisci of 22 patients who were under 15 years old at the time of operation (average; 11 year 9 month old) were evaluated. Average follow-up period was 9 years 4 months (5 years-18 years 1 months). Clinical results were analyzed according to Ikeuchi's clinical grading system and radiological degenerative changes were classified according to Fairbank at the last follow-up. RESULTS: According to Ikeuchi's grading system, excellent results were obtained in 10 cases (37.0%), good in 12 cases (44.4%), fair in 5 cases (18.5%). No radiological change was observed in 1 case (3.7%), 1 radiological sign in 5 cases (18.5%), 2 radiological signs in 13 cases (48.1%) and more than 3 radiological signs in 8 cases (29.6%) in the last follow-up radiograph. No correlation between clinical results and radiological changes. CONCLUSION: Arthroscopic resection of discoid meniscus in children was effective at relieving symptoms over a follow up of more than 5 years, though radiological degenerative changes occurred. We recommend that follow up is resuired to determine whether the clinical results of knees in middle or older age groups will worsen.

Comparison of Bone Tunnel Widening after ACL Reconstruction between Bioabsorbable Interference Screw and Metallic Interference Screw Fixation

PURPOSE: We evaluated the relationship among the radiographic enlargement of femoral and tibial bone tunnels, fixation material, clinical results and period of follow-up after anterior cruciate ligament(ACL) reconstruction with single incision arthroscopic technique using bone-patella tendon-bone. MATERIALS AND METHODS: We evaluated 91 knees of arthroscopic ACL reconstruction during the period of June 1993 to February 2001 excluding combined posterior cruciate ligament(PCL) injury. Average follow-up period was 44 months(12-78 months). We classified these cases into bioabsorbable screw group and metal screw group according to the screw materials. We took anteroposterior and lateral X-ray films at postoperative 3 months, 1 year, final follow up and measured the size of femoral and tibial tunnel. We evaluated the side-to-side difference using KT-2000 arthrometer and clinical results with Lysholm score. RESULTS: Eight cases of 47 cases in bioabsorbable screw group had bony cystic changes at femoral tunnel and 44 cases in metal screw group had not. Tibial tunnel widening was seen in 38 cases of absorbable screw group and 31 cases of metal screw group. Cases which had femoral and tibial tunnel widening had no knee joint instability clinically. CONCLUSION: There were femoral tunnel widening in bioabsorbable screw group, but not in metal screw group. Delayed inflammatory reaction in bioabsorbable screw may make this phenomenon but there was no correlation between femoral tunnel widening and clinical results. More longterm follow-up will be needed for futher degenerative changes and graft failure.

Popliteal Artery Entrapment Syndrome: A Case Report / 대한정형외과학회잡지

Popliteal artery entrapment syndrome is a rare but potentially limb threatening anatomical anomaly occurring predominantly in young adults. We experienced a case of a 19 year old man who had suffered from a coldness of his left lower leg, without past history of trauma. Angiogram and MRI were performed and we diagnosed as a popliteal artery entrapment syndrome. The popliteal artery was entrapped in its abnormal course around the medial head of the gastrocnemius muscle, which originated from the femur laterally and the cephalad. Thrombectomy, decompression of the popliteal artery and reposition of the medial head of the gastronemius muscle were successfully done. Blood flow was restored after surgical repair.