Arthroscopic Bioabsorbable Screw Fixation of Unstable Osteochondritis Dissecans in Adolescents: Clinical Results, Magnetic Resonance Imaging, and Second-Look Arthroscopic Findings

BACKGROUND: This study aimed to evaluate the clinical and radiological outcomes of arthroscopic bioabsorbable screw fixation in osteochondritis dissecans (OCD) in adolescent patients with unstable lesions causing pain. METHODS: The study included 11 patients (10 males and 1 female) with OCD who underwent arthroscopic bioabsorbable screw fixation between July 2007 and February 2014 and were available for follow-up for more than 12 months. The mean age at diagnosis was 16.3 years (range, 11 to 19 years), and the average follow-up period was 51 months (range, 12 to 91 months). Clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, and International Knee Documentation Committee (IKDC) score measured before surgery and at follow-up. Functional evaluation was made using the Tegner activity scale. Magnetic resonance imaging (MRI) and second-look arthroscopy were performed at the 12-month follow-up. RESULTS: Between the preoperative assessment and follow-up, improvements were seen in the KOOS (range, 44.9 to 88.1), Lysholm knee score (range, 32.6 to 82.8), and IKDC score (range, 40.8 to 85.6). The Tegner activity scale also improved from 2.8 to 6.1. Based on postoperative MRI, there were eight Dipaola grade I cases and three grade II cases. No complications due to fixation failure developed in any case. Second-look arthroscopy at 12 months postoperatively revealed that the lesion was covered with cartilage in all cases. CONCLUSIONS: For unstable OCD lesions causing pain in adolescents, arthroscopic bioabsorbable screw fixation provided favorable outcomes with reduced pain and restoration of movement. Therefore, it should be considered as an effective treatment for OCD.

Comparing the Use of Single and Double Interlocking Distal Screws on a Polarus Intramedullary Nail for Humeral Shaft Fractures

BACKGROUND: Our aim was to make a comparative analysis of radiological and clinical outcomes of using either one or two interlocking distal screws on a Polarus intramedullary nail for the internal fixation of humeral shaft fractures. METHODS: From January 2008 to March 2014, we enrolled 26 patients with humeral shaft fractures who were operated on using intramedullary nails. The patients were divided into 2 groups according to how many interlocking distal screws were used to lock the Polarus nail: in group 1, a single interlocking distal screw was used in 12 patients; and in group 2, double interlocking distal screws, in 14 patients. We compared the degree of recovery of the displaced fracture fragments between the two groups. To compare the nonunion and shoulder function, we assessed each patient's modified American Shoulder and Elbow Surgerns (ASES) score. RESULTS: We found that 10 of 12 fractures achieved union in group 1, and 13 of 14 fractures, in group 2. We did not find a meaningful difference in the time to bone union between the two groups. The percentage of recovery of displaced fracture fragments until union was 66.9% for group 1 and 59.41% for group 2. At the final follow-up, we found that the scores for shoulder joint modified ASES was 78.7 for group 1 and 80.7 for group 2. CONCLUSIONS: Our results show that if locked appropriately, even a single screw on a Polarus nail can provide satisfactory radiological union and improved clinical outcome after intramedullary nailing of humeral shaft fractures.

The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

BACKGROUND: Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. METHODS: Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. RESULTS: The clinical success rate was 95.4% and the HSS scores were 93.9 +/- 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. CONCLUSIONS: The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.

Comparing the Use of Single and Double Interlocking Distal Screws on a Polarus Intramedullary Nail for Humeral Shaft Fractures

BACKGROUND: Our aim was to make a comparative analysis of radiological and clinical outcomes of using either one or two interlocking distal screws on a Polarus intramedullary nail for the internal fixation of humeral shaft fractures. METHODS: From January 2008 to March 2014, we enrolled 26 patients with humeral shaft fractures who were operated on using intramedullary nails. The patients were divided into 2 groups according to how many interlocking distal screws were used to lock the Polarus nail: in group 1, a single interlocking distal screw was used in 12 patients; and in group 2, double interlocking distal screws, in 14 patients. We compared the degree of recovery of the displaced fracture fragments between the two groups. To compare the nonunion and shoulder function, we assessed each patient's modified American Shoulder and Elbow Surgerns (ASES) score. RESULTS: We found that 10 of 12 fractures achieved union in group 1, and 13 of 14 fractures, in group 2. We did not find a meaningful difference in the time to bone union between the two groups. The percentage of recovery of displaced fracture fragments until union was 66.9% for group 1 and 59.41% for group 2. At the final follow-up, we found that the scores for shoulder joint modified ASES was 78.7 for group 1 and 80.7 for group 2. CONCLUSIONS: Our results show that if locked appropriately, even a single screw on a Polarus nail can provide satisfactory radiological union and improved clinical outcome after intramedullary nailing of humeral shaft fractures.

The Clinical Outcomes and Assessment of Quality of Life in Arthroscopic Repair of Isolated Type II Superior Labral Anterior and Posterior Lesion Caused by Sports Injuries from Public / 대한스포츠의학회지

The purpose of this study was to morphologically classify the superior labral anterior and posterior (SLAP) lesion in people with athletic injuries and further research into the clinical result of arthroscopic repair of type II SLAP lesions. January 2005 to June 2012 occurred after sports activity in patients with shoulder pain diagnosed with isolated SLAP lesion by magnetic resonance imaging and arthroscopy were classified according to the tear type. Of these patients, 40 cases of type II SLAP patients were evaluated using American Shoulder and Elbow Surgeons (ASES) questionnaire and range of motion. Also satisfaction of surgery was evaluated by following up through phone calls using translated short form-36 (SF-36). At average of 35 months postoperatively, external rotation decreased slightly from 60.4 degrees to 56.2 degrees, forward elevation and internal rotation were both recovered to a range of pre-surgery but no significant changes were noticed statistically (p>0.05). Visual analogue scale, ASES scores, physical component summary, and mental component summary of SF-36 improved from 5, 1 to 1.2 (p=0.01), from 65.4 to 91.5 (p=0.017), 42.6 to 52.5 (p=0.047), and from 48.5 52.6 to (p=0.036), respectively. In comparison of a group of patients over forty years and less than forty, both groups showed good results, but group of patients less than forty years showed more improvement in pain relief, functional test, and postoperational satisfaction (p=0.004). Arthroscopic repair showed good results in patients with type II SLAP lesion due to athletic injuries especially when they were less than 40 years and it can be regarded as a good treatment with high satisfaction.

Comparison of Clinical Results and Second-Look Arthroscopic Findings of Remnant Preserving versus Non-Remnant Preserving Technique after Anterior Cruciate Ligament Reconstruction Using Achilles Allograft / 대한정형외과학회잡지

PURPOSE: This study was conducted for evaluation of clinical uses of anterior cruciate ligament (ACL) reconstruction with an Achilles allograft using the remnant technique by comparison and analysis stability, functional assessment and results of second-look arthroscopy between the remnant technique and the non-remnanat technique. MATERIALS AND METHODS: A total of 48 patients who underwent ACL reconstruction using an Achilles allograft were selected and divided into two groups depending on the presence of remnant. The preserving group included 26 patients and non-preserving group included 22 patients. The two groups were compared and analyzed with regarding to stability (Stress view Lachman test, pivot shift test), functional assessment (International Knee Documentation Committee, Lysholm score, Tegner score, single hoop test, shuttle turn, carioca test), and the result of second-look arthroscopy (study design: prosepective cohort study). RESULTS: In the final result, the remnant group showed significant improvement in the Tegner and carioca tests compared with the non-remnant group (p<0.05). In second-look arthroscopy, the remnant group showed better coverage of synovium (p<0.05). CONCLUSION: ACL reconstruction with an Achilles allograft using the remnant technique showed better results in functional assessment and finding in second-look arthroscopy compared with the non-remnant technique group.

Mid-term Results of Single-Radius Cruciate Retaining Total Knee Arthroplasty: Minimum 5 Year Follow-up

PURPOSE: The single-radius design of the knee implant was introduced to improve the results of total knee arthroplasty (TKA) by reducing maximum extensor forces, and it also represents more physiologic quadriceps force pattern, which could have a positive effect on knee function after TKA. We studied mid-term results of single-radius designed cruciate retaining (CR) TKA. MATERIALS AND METHODS: We analyzed the functional improvement and radiological osteolytic pattern after TKA using the single-radius Scorpio CR prosthesis. TKA was performed on 102 knees. The mean follow-up period was 73.8 months. For clinical assessment, the range of motion (ROM), Harris hip score, and functional outcome score were obtained preoperatively and at last follow-up. RESULTS: The average ROM was 100.2degrees preoperatively and 121.7degrees at last follow-up. The average knee score was 59.2 points preoperatively and 92.9 points at last follow-up. The average functional outcome score was improved from 51.9 points preoperatively to 85.4 points at last follow-up. Radiolucency was observed in four knees but all were non-progressive lesions smaller than 2 mm. CONCLUSIONS: The clinical outcome of TKA using the single-radius CR prosthesis was good during the mid-term follow-up and the incidence of osteolysis was very rare.

Infection Following Total Knee Arthroplasty

For most orthopedists, total knee arthroplasty (TKA) has been regarded as the most effective surgery for patients with severe knee diseases. Though seldom occur, postoperative infection certainly remains one of the most devastating and dreaded complications of TKA. Thus, careful and early diagnosis is needed. After diagnosis, categorize the infection type and choose a rightful and sequential step of treatment are recommended.

The Mid-Term Results of High-Flex Total Knee Arthroplasty: Minimum 5-Year Follow-Up Results / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the mid-term results of high-flexion total knee arthroplasty. MATERIALS AND METHODS: We retrospectively reviewed 77 patients who underwent 119 total knee arthroplastys using high-flexion implants (LPS-flex(R) , Zimmer, Warsaw, IN, USA) from November 2004 to June 2006. The mean age was 67.3 years (range, 54-83 years), and the average follow-up duration was 71.1 months. We assessed preoperative and last follow-up functional outcomes with ranges of motion (ROM) and the Hospital for Special Surgery (HSS) score and investigated their ability to squat, sit cross-legged knee, kneel, or stand up from the floor or a chair at the final follow-up. The Knee Society Radiographic evaluation and scoring system was used for radiologic evaluation. RESULTS: The mean ROM increased from 104.7degrees preoperatively to 129.8degrees postoperatively at the final follow-up. The average HSS score improved from 42.7 points preoperatively to 93.5 points postoperatively. At the final follow-up, 33 patients (42.8%) were able to squat; 75 patients (97.4%) were able to sit cross-legged; 27 patients (35.0%) were able to kneel; 45 patients (58.4%) were able to stand up from the floor and 73 patients (94.8%) were able to stand up from a chair. Six cases encountered stiff knees as a complications, and were treated with manipulation procedures. 1 mm radiolucent lines were detected in 5 cases, but none of them were progressive. CONCLUSION: We believe that the hyperflexion implant itself is not a cause of early loosening. Research on reasons regarding early loosening and long-term follow-ups will be needed.

The Management of Knee Dislocation and Multiple Ligament Injuries / 대한스포츠의학회지

Multiple ligament injuries of the knee means more than two ligament injuries, using as an analogue of the knee dislocation. The first priority in the early diagnosis and treatment of the knee dislocation is a vascular evaluation of extremity and careful neurovascular examination should be done firstly. It is common opinion in the treatment of multiple ligament injuries that surgical treatment is superior to conservative treatment. Especially, early ligament repair or reconstruction and aggressive rehabilitation are recommended in young active patients.

Proprioceptive and Knee Joint Kinematics for Comparison of Remnant Preserved versus Non-remnant Anterior Cruciate Ligament Reconstruction Using Achilles Allograft / 대한스포츠의학회지

The purpose of remnant preserving technique in anterior cruciate ligament (ACL) reconstruction is to preserve mechanoreceptor and accelerate revascularization. In this study, we compared a group who underwent remnant preserving technique using Achilles tendon allograft with the other group of conventional ACL reconstruction in terms of proprioception, kinematic analysis, knee strength test and dynamic postural stability. Twenty-four patients were followed up for longer than 12 months after ACL reconstruction. They were separated into two groups; remnant preserving group (n=12) and non-remnant group (n=12). Proprioception test was conducted through joint position sense (JPS) and threshold to detection of passive motion. The remnant preserving group showed significantly less difference from the normal side than the non-remnant group. In kinematic analysis, there was statistically significant difference in peak flexion angle during the swing phase. However the 60degrees JPS, knee strength test, performance capacity test and dynamic postural stability did not showed the significant difference. Remnant preserving technique of ACL reconstruction was meaningful in preserving proprioception and the result showed akin to the unaffected gait.

The Histologic Mapping of Sensory Innervation in the Human Anterior Cruciate Ligament / 대한스포츠의학회지

Recently, rising curiosity on remnant preservation technique of anterior cruciate ligament (ACL) reconstruction, there is much interested in being and distribution of the mechanoreceptor of ACL. So, we performed histologic analyzing and mapping of sensory nerve fiber of the human ACL in this study. Total of 20 anterior cruciate ligaments were obtained from total knee replacement. Each ACL samples was divided into seven specimens; tibial insertion site, mid transitional site, femoral insertion site, and in between the sites, and total of 140 tissue samples were stained with hematoxylin-eosin and immunohistochemical, and observed with light microscope. Five hundred thirty-four fine neuroparticle structures, Ruffini corpuscles, and free nerve endings were observed in 20 ACL samples. The mean of fibers observed were 1.88, 1.71, 1.15, 1.08, 1.15, 1.55, and 1.82, respectively from tibial insertional site to femoral insertional site. With immunohistochemical stain, S-100 protein was strong positive at nerve cells, but was weak positive or negative at neurofilament. Mapping of sensory nerve distribution were done based on the results. We identified the mechanoreceptor of the human ACL using optical and immunohistochemical methods and mapped the histologic distribution of that.

Inhibitory Effects of 1',2'-Dihydrorotenone on Osteoclast Differentiation and Bone Resorption In Vitro and In Vivo / 체질인류학회지

It is important to identify therapeutic compounds with no adverse effects for use in the chemotherapy of patients with bone-related diseases. The aim of this study was to identify a new compound that inhibits osteoclast differentiation and bone resorption. Herein, we examined the effects of 1',2'-dihydrorotenone on osteoclast differentiation and bone resorption in vitro and in vivo. 1',2'-dihydrorotenone inhibited receptor activator of NF-kappaB ligand (RANKL)-induced osteoclast differentiation of cultured bone marrow macrophages (BMMs) in a dose-dependent manner. However, 1',2'-dihydrorotenone did not exert cytotoxic effect on BMMs. 1',2'-dihydrorotenone suppressed the expression of c-fos and NFATc1 as well as osteoclast-specific genes in BMMs treated with RANKL. Treatment with RANKL inhibited the expression of inhibitors of differentiation/DNA binding (Id)1, 2, and 3; however, in the presence of 1',2'-dihydrorotenone, RANKL did not suppress the expression of Id1, 2, and 3. Furthermore, 1',2'-dihydrorotenone inhibited bone resorption and considerably attenuated the erosion of trabecular bone induced by lipopolysaccharide treatment. Taken together, these results suggest that 1',2'-dihydrorotenone has the potential to be applied in therapies for bone-related diseases.

Meniscal Allograft Transplantation: Clinical Results and Recovery of Sports Activity / 대한스포츠의학회지

The purpose of this study was to evaluate the clinical results and recovery of sports activity in patients who received meniscal allograft transplantation. From December 1999 to May 2009, we selected 36 cases out of 38 cases who received meniscal transplantation using fresh frozen allograft. The mean age was 33.8 years (range: 17-50 years) and the mean follow up was 68.8 months (range: 12-142 months). Clinical results were evaluated with knee assessment scoring system (KASS), Lysholm knee score and International knee Documentation Committee. The information of quadriceps and hamstrings strength recovery was obtained using Tegner activity scale, Tegner activity score and Biodex system II (Biodex, USA), and it was used to evaluate the recovery of sports activity. The average KASS score was increased from 61.7 preoperatively to 83.8 postoperatively. The average Lysholm score was increased from 77.7 preoperatively to 87.7 postoperatively. Also, Tegner activity scale, Tegner activity score and the recovery of quadriceps and hamstrings increased at 1year after surgery. In knee joint position sense, the proprioception increased compared to preoperational count. We propose the meniscal allograft transplantation is one of a proper treatment after subtotal or total meniscectomy, which can significantly relieve pain and improve function of the knee joint.

Treatment of Periprosthetic Supracondylar Femur Fractures Following Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study examined the outcomes of treatment in periprosthetic supracondylar fractures of the femur after total knee arthroplasty with the plates of internal fixation and retrograde intramedullary nailing using clinical and radiological methods. MATERIALS AND METHODS: Between August 1998 to May 2010, 24 cases of periprosthetic supracondylar fractures of the femur around the stem were selected and 18 cases of a stabled fracture without a loosening of the stem were chosen. The mean age was 69.1 (range 55-83) years and the mean follow period was 42.8 (range 14-142) months. In 18 cases, 8 cases who used a plate to gain anatomical alignment were categorized as group A and 10 cases who used retrograde intramedullary nailing were called group B. The union period, range of motion before fracture and last follow up, HSS score and tibiofemoral angle in both groups were compared. RESULTS: Radiographic union was obtained in all cases. The mean union period was 5 and 4.8 month in group A and B, respectively. In group A, the range of motion just before fracture was 120degrees and the last follow up was 93degrees. In group B, the range of motion before fracture was 124.5degrees and the last follow up was 96.8degrees. Although the range of motion in both groups had decreased appreciably (p0.05). The HSS score in group A was 87 just before the fracture and decreased to 79.8. The HSS score in group B was 85 before fracture and decreased to 81. The final HSS score at the last follow up decreased in both groups but the decrease and difference between the two groups was not significant (p>0.05). The coronal alignment in group A was 6.2 valgus just before the fracture and 4.4 valgus at the last follow up. The coronal alignment in group B was 6 valgus before the fracture and 5.2 valgus at the last follow up (p>0.05). CONCLUSION: In the treatment of periprosthetic supracondylar fractures of the femur after total knee arthroplasty, both an open reduction with internal fixation of the plates and retrograde intramedullary nailing showed good results in the clinical and radiological fields.

The Results of the P.F.C(R) Sigma(TM) RP-F Knee System in High Flex Rotating Platform Total Knee Arthroplasty -Comparison of Preoperative Range of Motion less than 90degrees Versus more than 90degrees-

PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of using the P.F.C(R) Sigma(TM) RP-F Knee System for high flex rotating platform-flexion total knee arthroplasty in 2 groups of patients with a preoperative range of motion (ROM) less than 90 degrees or more than 90 degrees, respectively. MATERIALS AND METHODS: From January 2005 to November 2006, eighty-two patients received the P.F.C(R) Sigma(TM) RP-F Knee System for high flex rotating platform total knee arthroplasty, and they were evaluated for a minimum of 3 years. We subdivided the patients into two groups: the preoperative ROM less than 90degrees group and the more than 90degrees group. The clinical results were assessed using the ROM, the Hospital for Special Surgery (HSS) score, the Knee Society Score (KSS) and the Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) score. The radiological results were evaluated using the tibio-femoral angle and the presence of loosening or osteolysis of the components. RESULTS: The ROM increased in the two groups at the last follow-up. The mean ROM range at the last follow up was significantly increased more in the less than 90degrees group compared to that in the more than 90o group. The HSS score, KSS, and WOMAC score significantly increased in the two groups, but there was no statistical difference between the two groups. The tibio-femoral angle improved in the two groups. There was no aseptic loosening or osteolysis. CONCLUSION: The postoperative clinical and radiological measures were significantly improved using the P.F.C(R) Sigma(TM) RP-F Knee System on the short term follow-up, and especially for the patients whose preoperative ROM was poor.

Early Full Weight Bearing after an Autogenous Structural Bone Graft for Treating a Medial Tibial Bone Defect in Total Knee Arthroplasty: Minimum 5 Years Follow up Results

PURPOSE: We evaluated the results of early full weight bearing after an autogenous bone graft and metal screw fixation of severe varus deformity with a medial tibial bone defect in total knee arthroplasty. MATERIALS AND METHODS: From August 1996 to March 2004, 34 patients (43 cases) were selected for the analysis. The average age was 68 and the mean follow up period was 72 month. The clinical results were evaluated using the knee range of motion and the Hospital for Special Surgery (HSS) score. The radiological results were evaluated using the tibiofemoral angle, the presence of loosening, radiolucent lines and osteolysis and the component's location. RESULTS: The mean HSS score increased from 46 to 87 points on the final follow up. The mean range of motion was increased from 71degrees to 118degrees on the final follow up. The mean femorotibial angle showed varus deformity angulation (23.5degrees) at pre-operative surgery, 6.2degrees valgus deformity for the first 7 postoperative days and 6.1 valgus at the last follow up. CONCLUSION: These findings suggest that an autogenous structural bone graft and metal screw fixation has fine results and makes early ambulation possible for the patient who has severe varus deformity with a medial tibial bone defect.

Effect of Water Extract of Papaya on RANKL-induced Osteoclast Differentiation / 대한해부학회지

Balance between bone-resorbing osteoclats and bone-forming osteoblasts is important in bone homeostasis. In particular, increased osteoclast formation and activity are responsible for bone diseases such as osteoporosis, rheumatoid arthritis, periodontal disease. Natural metabolites of plants have recently received much attention as lead compounds for the development of novel therapeutic strategy. The purpose of this study was to search the natural products to inhibition osteoclast differentiation. Water extract of papaya significantly inhibited receptor activator of nuclear factor-kappaB ligand (RANKL)-induced osteoclast differentiation in bone marrow macrophages (BMMs) in a dose dependent manner. However, water extract of papaya did not affect cytotoxicity when compared with control. Water extract of papaya inhibited the phosphorylation of p38 and JNK induced by RANKL. The mRNA expression of c-Fos, NFATcl, TRAP and OSCAR induced by RANKL was inhibited by water extract of papaya treatment. Also, water extract of papaya suppressed the protein expression of c-Fos and NFATc1 in BMMs treated with RANKL. Taken together, these results suggest that papaya may be a useful drug in the treatment of bone-related disease.

Revision Total Knee Arthroplasty using NexGen(R) LCCK with Allograft / 대한정형외과학회잡지

PURPOSE: To analyze the clinical and radiographic results after revision total knee arthroplasty (TKA) using Nexgen(R) LCCK (Legacy(R) knee constrained condylar knee, Zimmer, Warsaw, IN) with allograft. MATERIALS AND METHODS: Twenty patients (21 knees) taken revision TKA were analyzed. The average age of the patients was 69.2 years old and the average of follow-up duration was for 2 year to 8 years 2 months (average 3 years 5 months). The clinical result and radiographic measurements were assessed using the Hospital for Special Surgery (HSS) knee rating score and the roentgenographic method of the American Knee Society. RESULTS: The mean interval from TKA to revision surgery was 6 years 4 months. In all cases, allograft was used. The average range of motion was increased from 93degrees to 107degrees, HSS score was increased from an average of 45 to 87 points. Postoperative femorotibial alignment was averaged 5.7degrees valgus. In all cases, radiolucency was below 4 scores and there was no loosening of implant. But, three radiopaque lines around a stem. There were wound dehiscence in 1 case and superficial infection in 2 cases. CONCLUSION: Satisfactory results were obtained in revision TKA using a NexGen(R) LCCK with allograft. But, this study is favorable for the long term follow-up.

Comparison of Posterior-Cruciate Retaining versus Substituting P.F.C. Total Knee Arthroplasty (A Randomized Study) / 대한정형외과학회잡지

PURPOSE: To compare the functional results of posterior cruciate-retaining (PCR) and posterior sub- stituting (PS) replacement in patients undergoing primary total knee arthroplasty (TKA) for osteoarthritis. MATERIALS AND METHODS: A randomized controlled study was carried out to compare the clinical and radiological outcomes of PCR and PS primary P.F.C.(R) TKA. One hundred and sixty eight patients (188 cases), who had a primary diagnosis of osteoarthritis, and an intact functioning posterior cruciate ligament, were enrolled in this study. The patients were randomized regardless of the level of posterior cruciate ligament preservation. One hundred and eighty eight cases had a minimum 6-year follow-up, which included 96 and 92 cases in the PCR and PS groups, respectively. RESULTS: The Knee Society Score, the Hospital for Special Surgery (HSS) knee rating scores, average flexion contracture and radiologic alignment improved significantly, but there were no significant difference between the two groups. On the other hand, the mean postoperative flexion angles in the PCR and PS knees increased from 114.7degrees to 121.2degrees and 119.3degrees to 131.3degrees, respectively (p<0.05). CONCLUSION: There were no significant differences between PCR and PS TKA in the follow-up knee scores. However, the level of postoperative improvement in further flexion was better in the PS group.