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Purpose@#To compare the short-term clinical and radiologic outcomes of combined posterior cruciate ligament (PCL) and posterolateral complex (PLC) reconstruction to those of isolated PCL reconstruction (PCLR) for patients with posterolateral knee laxity less than grade III. @*Materials and Methods@#We retrospectively reviewed 49 patients (51 knees) who underwent PCLR between January 2008 and December 2015. Patients with a minimum follow-up of 24 months were included and divided into two groups (group A, isolated PCLR; group B, combined PCL and PLC reconstruction). Clinical outcomes were evaluated as the International Knee Documentation Committee (IKDC) subjective, Lysholm, and Tegner activity scale scores. Radiologic outcomes were also assessed using the side-to-side differences in posterior tibial translation via stress radiographs. @*Results@#A total of 30 cases were analyzed. There were no significant differences in the Lysholm and Tegner activity scale scores between the two groups preoperatively and at the final follow-up. However, group B showed a higher IKDC subjective score compared to group A at the final follow-up (group A, 72.8±8.9; group B, 77.7±10.1; p<0.05). Regarding the radiologic outcomes, group B also showed a significantly less side-to-side difference in posterior tibial translation compared to group A at the final follow-up (group A, 4.8±2.3 mm; group B, 3.8±2.1 mm; p<0.05). @*Conclusion@#Combined PCL and PLC reconstruction resulted in improved clinical and radiologic outcomes than isolated PCLR in patients who have less than grade III posterolateral laxity of the knee. In cases of PCL rupture with ambiguous PLC injury, combined PCL and PLC reconstruction may help to improve posterior residual laxity of the knee.
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Background/Aims@#Although anti-hepatitis C virus (HCV) assay is widely used to screen for HCV infection, it has a high false-positive (FP) rate in low-risk populations. We investigated the accuracy of anti-HCV signal-to-cutoff (S/CO) ratio to distinguish true-positive (TP) from FP HCV infection. @*Methods@#We retrospectively analyzed 77,571 patients with anti-HCV results. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of anti-HCV S/CO ratio in anti-HCV positive patients. @*Results@#Overall, 1,126 patients tested anti-HCV positive; 34.7% of patients were FP based on HCV RNA and/or recombinant immunoblot assay (RIBA) results. The age and sex-adjusted anti-HCV prevalence was 1.22%. We identified significant differences in serum aspartate transaminase and alanine transaminase levels, anti-HCV S/CO ratio, and RIBA results between groups (viremia vs. non-viremia, TP vs. FP). Using ROC curves, the optimal cutoff values of anti-HCV S/CO ratio for HCV viremia and TP were 8 and 5, respectively. The area under the ROC curve, sensitivity, specificity, positive and negative predictive values were 0.970 (95% CI, 0.959–0.982, p < 0.001), 99.7%, 87.5%, 87.4%, and 99.7%, respectively, for predicting HCV viremia at an anti-HCV S/CO ratio of 8 and 0.987 (95% CI, 0.980–0.994, p < 0.001), 95.3%, 94.7%, 97.1%, and 91.4%, respectively, for TP HCV infection at an anti-HCV S/CO ratio of 5. No patients with HCV viremia had an anti-HCV S/CO ratio below 5. @*Conclusions@#The anti-HCV S/CO ratio is highly accurate for discriminating TP from FP HCV infection and should be considered when diagnosing HCV infections.
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Background@#We aimed to investigate the current trend of joint replacement surgery incidence in patients with rheumatoid arthritis (RA) in South Korea and to compare the incidence of joint replacement surgery in each affected joint. @*Methods@#We performed this big data analysis to investigate the current trend of joint replacement surgery incidence in patients with RA in South Korea and to compare the incidence of joint replacement surgery in each affected joint. This retrospective study was based on data from the Korea National Health Insurance claims database. @*Results@#The prevalence of RA increased every year (0.13% in 2008, 0.25% in 2016). The number of newly diagnosed patients increased from 29,184 in 2010 to 38,347 in 2016. The incidence rate of joint replacement surgery in patients with RA increased from 0.72% in 2010 to 4.03% in 2016. The knee (68.3%) was the most commonly replaced joint. The relative risk (RR) of additional joint replacement surgery was highest for the shoulder joint (RR,1.454; 95% confidence interval, 0.763–2.771). The median time from diagnosis to surgery was the shortest in the elbow joint (379 days) and the longest in the shoulder joint (955 days). The median time for each joint was short in order of the elbows, ankles, hips, knees, and shoulders (p < 0.01). @*Conclusions@#The most frequently and initially replaced joints were different, but the prevalence and incidence of RA, as well as those of joint replacement surgery, have recently increased in South Korea. Joint replacement surgery in RA was the highest for the knee joint. The median time from diagnosis to surgery was shortest for the elbow, followed by the ankle, hip, knee, and shoulder. Regardless of whether patients are symptomatic, evaluation of large joints such as the knee, elbow, ankle, and hip should be considered from an early stage.
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Synovial chondromatosis is a proliferative chondrogenic benign tumor originating from the synovial membrane of the joint. Radiological findings occupy an important part in the diagnosis of patients with synovial chondromatosis, which appear in various forms, and are often misunderstood such as tuberculous arthritis and rheumatoid arthritis. In many cases, the findings of rice body, which are common in tuberculous arthritis and rheumatoid arthritis, and synovial chondromatosis are similar on magnetic resonance imaging. A case of primary synovial chondromatosis that was mistaken for tuberculous arthritis or rheumatoid arthritis by imaging findings is reported.
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Corynebacterium striatum (C. striatum ) is an aerobic Gram-positive rod, which is an organism of the respiratory tract and skin. Because of its low virulence, it is usually thought to be a contaminant even if it is shown in culture tests, but it can cause endocarditis and respiratory infections, and rarely meningitis and arthritis. Infection with C. striatum has been reported in patients with reduced immunity, as well as in patients with catheter or broken skin barriers. Septic knee arthritis caused by C. striatum infection is rarely reported, and knee joint infection by C. striatum in patients who underwent arthroscopic debridement for previous septic arthritis is even more rare. Therefore, we report a case of septic knee arthritis caused by C. striatum that was improved by early diagnosis and arthroscopic treatment.
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Purpose@#The least constrained prosthesis is generally recommended in primary total knee arthroplasty (TKA). Nevertheless, a varus/valgus constrained (VVC) prosthesis should be implanted when a semi-constrained prosthesis is not good for adequate stability, especially in the coronal plane. In domestic situations, however, the VVC prosthesis could not always be prepared for every primary TKA case. Therefore, it is sometimes impractical to use a VVC prosthesis for unsual unstable situations. This study provides information for preparing VVC prostheses in the preoperative planning of primary TKA through an analysis of primary VVC TKA cases. @*Materials and Methods@#This study reviewed 1,797 primary TKAs, performed between May 2003 and February 2016. The reasons for requiring VVC prosthesis and the preoperative conditions in 29 TKAs that underwent primary TKA with a VVC prosthesis were analyzed retrospectively. @*Results@#In primary TKA, 29 cases (1.6%) in 27 patients (6 male and 21 female) used VVC prosthesis. Two patients underwent a VVC prosthesis on both knees. The mean age of the patients was 63.4 years old (34–79 years). The mean flexion contracture was 16.2° (-20°–90°), and the mean angle of great flexion was 111.7° (35°–145°). The situations requiring a VVC prosthesis were severe valgus deformity in 10 knees, knee stiffness requiring extensive soft tissue release in 10 knees, previously injured collateral ligaments in five knees, and distal femoral bone defect due to avascular necrosis in four knees. The mean tibiofemoral angle was 25.7° (21°–43°) in 10 cases with a valgus deformity. The mean flexion contracture was 37.5° (20°–90°), and the mean range of motion was 48.5° (10°–70°) in 10 cases with knee stiffness. @*Conclusion@#The preparation of VVC prosthesis is recommended, even for primary TKA in cases of severe valgus deformity (tibiofemoral angle>20°), stiff knee (the range of motion: less than 70° with more than 20° flexion contracture), and the cases with a previous collateral ligament injury. This information will help in the preparation of adequate TKA prostheses for unusual unstable situations.
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Background/Aims@#The risk factors for the development of primary biliary cholangitis (PBC) is unclear. This study aimed to investigate the risk factors associated with PBC in Korea through a questionnaire survey. @*Methods@#Consecutively enrolled 103 PBC patients from six referral hospitals and 100 age- and sex-matched community controls participated in this study. A standardized questionnaire survey including demographics, lifestyle, individual and familial medical history and reproductive history was prospectively collected and analyzed. @*Results@#The PBC patients had a mean age of 58.3 years and a female proportion of 86.4%. The age- and sex-matched controls had a similar educational level and economic status to the PBC patients. Among the lifestyle factors, the multivariable analysis showed smoking including both first-hand and second-hand (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.06 to 3.93), history of autoimmune diseases (OR, 2.46; 95% CI, 1.06 to 6.35), and family history of PBC (OR, 17.76; 95% CI, 1.77 to 2,418.74) were significantly associated with PBC, whereas alcohol intake was negatively associated with PBC. Among reproductive factors, the number of induced abortions was significantly associated with PBC, while the number of full-term deliveries was negatively associated with PBC. @*Conclusions@#A family history of PBC, accompanying autoimmune diseases, and smoking were significantly associated with PBC. More induced abortions and less full-term deliveries were associated with PBC in women. In contrast, mild to moderate alcohol intake was negatively associated with PBC. Further studies are warranted to validate the results of this study and to search for clues about the pathogenesis of PBC.
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Purpose@#This study examined the effect of lag screw insertion on proximal fragments by separating the right and left sides of intertrochanteric fractures in elderly patients that underwent intramedullary nailing. @*Materials and Methods@#Patients aged ≥65 years that underwent intramedullary nailing after a diag-nosis of intertrochanteric fractures during the period February 2012 to May 2016 were included in the study. The subjects were divided into right and left side groups. The effect of the clockwise rotational force generated when a lag screw was inserted on the proximal fragment was evaluated in both groups. @*Results@#In the right and left groups, most proximal fragments were located in the intramedullary canal after surgery (45 cases [75.0%] and 67 cases [73.6%], respectively). Clockwise rotation due to lag screw placement in the right group occurred in two cases (3.3%), which both showed internal rotation, and in four cases (4.4%) in the left group, all of which showed external rotation. @*Conclusion@#After intramedullary nailing of intertrochanteric fractures in elderly patients, proximal fragments were mostly located in the intramedullary cavity. The results obtained confirmed that the clockwise rotational force generated by lag screw insertion did not affect left or right sides.
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Purpose@#This study examined the effect of lag screw insertion on proximal fragments by separating the right and left sides of intertrochanteric fractures in elderly patients that underwent intramedullary nailing. @*Materials and Methods@#Patients aged ≥65 years that underwent intramedullary nailing after a diag-nosis of intertrochanteric fractures during the period February 2012 to May 2016 were included in the study. The subjects were divided into right and left side groups. The effect of the clockwise rotational force generated when a lag screw was inserted on the proximal fragment was evaluated in both groups. @*Results@#In the right and left groups, most proximal fragments were located in the intramedullary canal after surgery (45 cases [75.0%] and 67 cases [73.6%], respectively). Clockwise rotation due to lag screw placement in the right group occurred in two cases (3.3%), which both showed internal rotation, and in four cases (4.4%) in the left group, all of which showed external rotation. @*Conclusion@#After intramedullary nailing of intertrochanteric fractures in elderly patients, proximal fragments were mostly located in the intramedullary cavity. The results obtained confirmed that the clockwise rotational force generated by lag screw insertion did not affect left or right sides.
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Purpose@#This study examined the effects of the postoperative administration of parathyroid hormone (PTH) on fracture healing in intertrochanteric fractures accompanied by osteoporosis in elderly females. @*Materials and Methods@#Female patients aged 65 years and more who underwent surgery after a diagnosis of intertrochanteric fractures and osteoporosis during the period from July 2013 to December 2017 were included as subjects. The subjects were divided into two groups: PTH-treated group and non-PTH-treated group. The formation time of the first callus, timing of the bridging callus, and time of bony union for both groups were evaluated. @*Results@#In the PTH-treated group, the mean time of the first callus formation, average time of bridging callus, and the average time of bony union were 32, 58, 83 days, respectively, which were significantly shorter than that of the untreated group. @*Conclusion@#PTH, a treatment for osteoporosis, promotes callus formation and the healing process. Therefore it will be helpful in intertrochanteric fractures accompanied by osteoporosis in elderly females.
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Background@#This study aims to investigate the frequency of distal femoral and popliteal arterial calcification and to evaluate the intraoperative and postoperative effects of arterial calcification in patients undergoing total knee arthroplasty using a tourniquet. @*Methods@#The records of 5,438 patients who had undergone primary total knee arthroplasty between January 2003 and January 2017 were retrospectively reviewed. We examined the preoperative radiographs of the knee from all patients for calcifications of the femoral and popliteal arteries. Vascular calcification was identified on preoperative radiographs in 223 cases. Intraoperative and postoperative complications were investigated among these patients. Postoperative complications were analyzed from the time of surgery to the last follow-up (minimum 1-year follow-up). @*Results@#Vascular calcification of the arteries around the knee was found in 223 cases (4.1%). The mean patient age was 70.6 years in the non-calcification group and 73.8 years in the calcification group (p > 0.05). The calcification group was classified into medial, intimal, or mixed subgroups according to the morphology of calcification on preoperative radiographs. The medial type included 46 cases (20.6%); intimal type, 161 cases (72.2%); and mixed type, 16 cases (2.7%). There was no statistically significant difference in demographic and surgical data among the three groups. There were intraoperative complications in two cases in the medial type group, both of which involved tourniquet failure. There was also a postoperative complication in one case in the medial type group, which involved wound dehiscence at 2 weeks postoperatively. No other postoperative complications were identified during 1-year follow-up. @*Conclusions@#Despite the presence of calcifications in the arteries around the knee, total knee arthroplasty (using a tourniquet) can be performed without serious complications.
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Background@#In arthroscopic shoulder surgery, a mechanical fluid-irrigation system is used to wash out blood from the joint. If used at high pressure, it can cause side effects such as fluid extravasation, leading to airway obstruction after surgery. Desflurane is prone to increasing sympathetic nerve activity and plasma catecholamine release more than another inhalation anesthetics. The objective of this study was to determine whether desflurane could increase in the irrigation pump pressure than sevoflurane in shoulder arthroscopy. @*Methods@#Patients were randomized into a sevoflurane group (group S) and a desflurane group (group D). Each included 20 patients. For group S, sevoflurane 1.2 MAC and intravenous remifentanil were administered for anesthesia maintenance. Group D received desflurane 1.2 MAC and intravenous remifentanil. Starting at 20 mmHg of pump pressure, the surgeon estimated the visibility of the surgical field (grade I–IV). After that, the pressure was freely adjusted by the surgeon to obtain clear vision with the arthroscope during the surgery. @*Results@#The maximum pressure of the mechanical water pump was higher in group D than group S (54.0 ± 6.8 mmHg vs. 48.9 ± 5.7 mmHg, P = 0.017), but the difference was not statistically significant at a significance level of 0.01. The arthroscopic visibility at the surgical site did not differ significantly between the two groups (P = 0.284). @*Conclusions@#When desflurane is used in arthroscopic shoulder surgery, it does not require more pressure from the irrigating-fluid pump to secure a clear vision of the surgical site, compared to sevoflurane.
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PURPOSE@#We assessed bone mineral density (BMD) changes with aromatase inhibitor (AI) treatment in women with breast cancer and determined whether BMD T-scores changed with vitamin D supplementation.@*METHODS@#This single-center, retrospective study included postmenopausal patients with breast cancer who had undergone surgical resection of stage I, II, or III estrogen- and/or progesterone-receptor-positive breast cancer and received adjuvant AIs (letrozole, anastrozole, and exemestane) at Kangbuk Samsung Hospital from January 2003 to July 2017. Baseline BMD T-scores of the femoral neck, proximal femur, and lumbar spine were obtained. The first group received vitamin D oral supplements (25,000 IU, monthly) or intravenous (IV) injections (200,000 IU, every 6 months). The second group did not receive vitamin D. T-scores were re-assessed at 12 and 24 months. BMD changes in the femoral neck, proximal femur, and lumbar spine were examined and compared according to vitamin D therapy.@*RESULTS@#A total of 118 women were included in the study. Eighty-four patients (71.2%) were aged >50 years, and most patients (64.1%) were postmenopausal. Group 1 (n=76, 64.4%) had received vitamin D oral supplements (25,000 IU, monthly) or IV injection (200,000 IU, every 6 months) during AI therapy. Group 2 (n=42, 35.6%) did not receive vitamin D during AI therapy. At baseline, 42.2% and 28.6% exhibited osteopenia at the femoral neck in Group 1 and Group 2, respectively. Both groups had T-score declines after AI therapy, with mean decreases of 0.23 and 0.41 at the femoral neck and lumbar spine, respectively, after 12 months and 0.40 and 0.55 at the femoral neck and lumbar spine, respectively, after 24 months in Group 1. However, differences in BMD T-score change at the femoral neck, total proximal femur, and lumbar spine between the groups were not statistically significant.@*CONCLUSION@#Trends toward a decline in BMD in the femur and lumbar spine were observed in postmenopausal women with breast cancer receiving AI therapy. We did not observe a protective role of vitamin D supplementation against bone loss with AI therapy. A longer follow-up duration is necessary to determine whether vitamin D protects against bone loss during AI therapy.
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Avascular necrosis (AVN) is defined as the cellular death of bone and bone marrow components due to the loss of blood supply, and associated with post-traumatic or non-traumatic events. AVN usually involves the epiphysis of a long bone, such as the femoral and humeral heads, which are susceptible to osteonecrosis. Many studies have been conducted but they were restricted to investigations of femoral head avascular necrosis. The presence of osteonecrosis in the proximal femur may impair biological fixation after total hip arthroplasty. We report a 56-year-old male patient with avascular necrosis located not only at the femoral head, but also in the entire femur, including the medullary cavity, who underwent total hip arthroplasty 2 years earlier along with a review of the relevant literature.
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Humanos , Masculino , Pessoa de Meia-Idade , Artroplastia de Quadril , Medula Óssea , Epífises , Fêmur , Cabeça , Cabeça do Úmero , Necrose , OsteonecroseRESUMO
Klebsiella pneumoniae causes that liver abscess mostly, also spread to pneumonia, meningitis, urinary tract infections. Septic arthritis caused by K. pneumoniae is a quite rare and has not been reported in Korea. Therefore, the authors report a case of the septic arthritis in the knee joint caused by K. pneumoniae in a patient with type 2 diabetes mellitus and osteoarthritis of the knee that successfully treated by early detection and arthroscopic synovectomy.
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Humanos , Artrite , Artrite Infecciosa , Diabetes Mellitus Tipo 2 , Klebsiella pneumoniae , Klebsiella , Articulação do Joelho , Joelho , Coreia (Geográfico) , Abscesso Hepático , Meningite , Osteoartrite , Pneumonia , Infecções UrináriasRESUMO
Nonalcoholic fatty liver disease (NAFLD), together with metabolic syndrome and obesity, has shown a rapid increase in prevalence worldwide and is emerging as a major cause of chronic liver disease and liver transplantation. Among the various phenotypes of NAFLD, nonalcoholic steatohepatitis (NASH) is highly likely to progress to development of end-stage liver disease and cardiometabolic disease, resulting in liver-related and non-liver–related mortality. Nonetheless, there is no standardized pharmacotherapy against NASH and many drugs are under development in ongoing clinical trials. To develop a successful anti-NASH drug, it is necessary to select an appropriate target population and treatment outcomes depending on whether the mode of action is anti-metabolic, anti-inflammatory or anti-fibrotic. Recently, innovative surrogate markers have been investigated to replace hard outcomes such as liver histology and mortality and reduce the clinical trial duration. Currently, several drugs with fast track designation are being tested in phase III clinical trials, and many other drugs have moved into phase II clinical trials. Both lean NAFLD and typical obese NAFLD have been extensively studied and genetic variants such as PNPLA3 and TM6SF2 have been identified as significant risk factors for lean NAFLD. In the near future, noninvasive biomarkers and effective targeted therapies for NASH and associated fibrosis are required to develop precision medicine and tailored therapy according to various phenotypes of NAFLD.
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Biomarcadores , Tratamento Farmacológico , Fibrose , Necessidades e Demandas de Serviços de Saúde , Fígado , Hepatopatias , Transplante de Fígado , Mortalidade , Hepatopatia Gordurosa não Alcoólica , Obesidade , Fenótipo , Medicina de Precisão , Prevalência , Fatores de RiscoRESUMO
Laparoscopic sleeve gastrectomy has become a standard procedure in bariatric surgery owing to its efficacy and simplicity. However, this procedure can cause life-threatening complications such as a gastric staple-line leak. A 24-year-old woman was transferred to the emergency department for evaluation of epigastric pain. Nine days prior to transfer, she underwent laparoscopic sleeve gastrectomy at another institution. Abdominal computed tomography (CT) revealed fluid collection with air density along the left subphrenic space and gastrosplenic ligament area. Intravenous antibiotics and total parenteral nutrition were initiated. She underwent percutaneous catheter drainage. On postoperative day 18, an esophagogastroduodenoscopy was performed to assess the site and size of the leak, and revealed a leak at the proximal staple line just below the gastroesophageal junction. A newly designed, fully covered antimigratory esophageal stent was placed to cover the leak from the distal esophagus to gastric midbody. Follow-up abdominal CT demonstrated improvement of the fluid collection at the location of the previous gastric leak. The stent was removed 3 weeks after insertion, and a barium study confirmed no more leakage. In this case, we experienced that the newly designed esophageal stent was safe and effective for preventing migration in the management of leak after laparoscopic sleeve gastrectomy.
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Feminino , Humanos , Adulto Jovem , Fístula Anastomótica , Antibacterianos , Cirurgia Bariátrica , Bário , Catéteres , Drenagem , Serviço Hospitalar de Emergência , Endoscopia do Sistema Digestório , Junção Esofagogástrica , Esôfago , Seguimentos , Gastrectomia , Ligamentos , Obesidade , Nutrição Parenteral Total , Stents , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To investigate the incidence of venous thromboembolism (VTE) after total knee arthroplasty (TKA) with chemoprophylaxis using acetylsalicylic acid (AA) or rivaroxaban in Korean patients. MATERIALS AND METHODS: Between May 2011 and November 2013, 268 TKA patients (330 cases) were randomly allocated to 3 groups (group A: subcutaneous injection of 5,000 IU low-molecular-weight heparin for 2 days followed by oral administration of 100 mg AA for 5 days; group X7: oral administration of 10mg rivaroxaban for 7 days; and group X10: oral administration of 10 mg rivaroxaban for 10 days). Multidetector-row computed tomography (MDCT) was performed at 10 days and 3 months postoperatively to evaluate VTE changes. RESULTS: The VTE incidence was 38.2%, 20.0%, and 10.0% in groups A, X7, and X10, respectively (p < 0.001). Pulmonary embolism (PE) was identified in 19.1%, 10.0%, and 2.7% in groups A, X7, and X10, respectively (p < 0.001). Proximal or symptomatic deep vein thrombosis (DVT) occurred primarily in group A, but the incidence was not significantly different among groups. On follow-up MDCT, PE was resolved completely with treatment in 29/30 (96.7%), and so was asymptomatic distal DVT in 24/27 (88.8%) without treatment. CONCLUSIONS: Rivaroxaban had a lower incidence of overall VTE than AA, but no difference was observed in symptomatic VTE. The 10-day course of rivaroxaban had a lower incidence of overall VTE than the 7-day course.
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Humanos , Administração Oral , Artroplastia , Artroplastia do Joelho , Aspirina , Quimioprevenção , Seguimentos , Heparina de Baixo Peso Molecular , Incidência , Injeções Subcutâneas , Joelho , Tomografia Computadorizada Multidetectores , Embolia Pulmonar , Rivaroxabana , Tromboembolia Venosa , Trombose VenosaRESUMO
PURPOSE: Little is known about the isometry of anatomic single-bundle anterior cruciate ligament (ACL) tunnel positions in vivo although it is closely related to graft tension throughout the range of motion. The purpose of this study was to evaluate intraoperative graft isometry in anatomic single-bundle ACL reconstruction in vivo. MATERIALS AND METHODS: Graft length changes were assessed before bio-screw fixation in the tibial tunnel by pulling the graft with tensions of 20 lbs and 30 lbs in full extension at flexion angles of 30°, 60°, 90°, and 120°. RESULTS: At the flexion angle of 30°, 20 lbs and 30 lbs of tension showed −0.4 mm and −0.6 mm length changes, respectively. The greater the flexion angle of the knee, the shorter the graft length in the joint. At the flexion angles of 90° and 120°, there was significant difference in the graft length change between 20 lbs and 30 lbs of tension. CONCLUSIONS: Anatomic single-bundle ACL reconstruction was non-isometric. The graft length was the longest in full extension. The tension of graft became loose in flexion. At the flexion angles of 90° and 120°, there was significant difference in the graft length change between 20 lbs and 30 lbs of tension.
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Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Articulações , Joelho , Amplitude de Movimento Articular , TransplantesRESUMO
PURPOSE: The purpose of this study is to evaluate the incidence and treatment of recurrent hemarthrosis after total knee replacement (TKR). MATERIALS AND METHODS: Among a total of 5,510 patients who underwent TKR from March 2000 to October 2016, patients who had two or more bleeding 2 weeks after surgery were studied. Conservative treatments were performed for all cases with symptoms. In patients who did not respond to conservative treatment several times, embolization was performed. We retrospectively evaluated the postoperative bleeding time, bleeding frequency, treatment method, and outcome. RESULTS: Seventeen (0.3%) of the 5,510 patients developed recurrent hemarthrosis. Bleeding occurred at an average of 2 years 3 months after the operation. Joint aspiration was performed 3.5 times (range, 2 to 10 times) on average, and 14 cases (82.3%) were treated with conservative treatment. In 3 patients with severe bleeding and hemorrhage, embolization was performed. CONCLUSIONS: Recurrent hemarthrosis after TKR is a rare disease with a low incidence of 0.3% and usually could be treated by conservative treatment. If recurrences occur repeatedly, embolization through angiography or surgical treatment may be considered, but the results are not satisfactory and careful selection of treatment modalities is warranted.