Posterior Double PCL Sign; A Case Report of Unusual MRI Finding of Bucket-handle Tear of Medial Meniscus: A Case Report / 대한정형외과학회잡지

Among the MRI signs of meniscal bucket handle tears, a double posterior cruciate ligament (PCL) sign manifests on the sagittal images as a low signal band anterior and parallel to the PCL. The mesially displaced fragment may be confined to the intercondylar notch. However, the torn fragment is rarely displaced to the posterosuperior region of the PCL. If it does occur, separation at the anterior horn may be assumed. We propose this type of lesion be called the posterior double PCL sign in contrast to the ordinary double PCL sign. We present a case showing the 'posterior double PCL sign' accompanying an anterior cruciate ligament injury.

Acromioclavicular Separation with the Fracture of the Coracoid Process: 2 Cases report

The acromioclavicular separation (AC separation) is a common injury, which is often accompanied by the rupture of the coracoclavicular ligament (CC ligament) in severe occasions. In rare forms of AC separation, the fracture of the coracoid process would occur rather than the rupture of the CC ligament. Only 31 cases of such injury have been reported in the English literature. We present 2 additional cases with literature review. The fracture of the coracoid process is not readily seen on anteroposterior shoulder radiograms. Severe AC separation without widening of CC distance on anteroposterior shoulder radiogram heralds the fracture of the coracoid process.

The Result of Autologous Osteochondral Grafting for the Osteochondral Lesion of the Talus / 대한족부족관절학회지

PURPOSE: The purpose of this study is to assess the results of the autologous osteochondral grafting for the osteochondral lesion of the talus. MATERIALS AND METHODS: This study included 21 patient who had been treated with the open autologous osteochondral grafting between December, 1999 and December 2003. We treated the patients with autologous osteochondral grafting method who had the lesion of stage II or medial lesion of stage III without improvement for at least 6 months, the medial lesion of stage IV, the lateral lesion of stage III, IV by Berndt and Harty's classification or who had not improved with previous operation. The average duration of follow up was 26 (12-56) months. 6 patients had been treated with the previous operation that 3 patients with drilling, 3 patients excision, curettage and drilling. RESULTS: The average AOFAS Ankle/Hindfoot score was 92.7 points and no patient had a limitation of the daily activities due to pain or abnormal function. Postoperative radiography showed good joint congruency and postoperative MRI good incorporation of the graft. The average Lysholm knee score was 96 points and only two patients had mild knee pain during severe exertion. CONCLUSION: The autologous osteochondral grafting is the useful operative method when the lesion is advanced stage or when previous operative treatment has failed.

Diffuse Idiopathic Skeletal Hyperostosis Associated with Dysphonia and Dysphagia: A Case Report / 대한척추외과학회지

We encountered a rare case of diffuse idiopathic skeletal hyperostosis (DISH) associated with dysphonia and dysphagia. An 80 year-old man developed progressive dysphonia and dysphagia. The radiology study, esophagogram and nasopharyngoscopic exam revealed the esophagus and the posterior wall of the nasopharynx to be severely compressed by the unfused osteophyte of the 3rd and 4th cervical intervertebral space. It was thought that the osteophyte formation was caused by not merely DISH but degenerative changes due to a concentration of stress around the unfused hyperostosis. A resection of the osteophyte was performed, which resolved the clinical symptoms. The follow-up radiology study, esophagogram and nasopharyngoscopic exam showed that the osteophyte had disappeared.

The Result of the Modified Extension Block Technique in Bony Mallet Finger

PURPOSE: To evaluate the treatment outcomes of the modified extension block technique for bony mallet finger. MATERIALS AND METHODS: This study included 16 patients who had been treated with the modified extension block technique for bony mallet finger from December 2002 to January 2004. The average duration of follow up was 13 (12~17) months. The indication of operation was the presence of a large bony fragment invading more than 1/3 of the articular surface or the palmar subluxation in the distal interphalangeal joint. RESULTS: The average extension lag was 2.3 degrees, and the range of motion of the distal interphalangeal joint was 68.8 degrees. Radiograph showed bony union state in all cases. By the Crawford's evaluation criteria, 12 cases (75%) was excellent or good. Postoperative complications occurred in 3 cases, which were reduction loss within postoperative 2 weeks in 2 cases and mild pain with motion in 1 case. CONCLUSION: The modified extension block technique is a easy and simple method. It shows a good result without complications from skin incision. So, it seems a useful method for bony mallet finger.

Snapping Knee caused by the Semitendinous Tendon: A Case Report / 대한정형외과학회잡지

Snapping syndrome has rarely been reported in the knee. A snapping knee mainly occurs in the case of a translation of the lateral meniscus or a lateral discoid meniscus. Other causes include biceps femoris tendon, semitendinosus iliotibial band, and popliteus tendon. We recently experienced a case of a snapping knee caused by the semitendinosus tendon passing over the medial tibial condyle as a result of trauma.

The Necessity of Deltoid Ligament Repair in Lateral Malleolar Fracture Combined with Medial Clear Space Widening

PURPOSE: To evaluate the necessity of deltoid ligament repair in lateral malleolar fracture associated with medial clear space widening. MATERIALS AND METHODS: The 82 cases of 82 patients received surgical treatment for lateral malleolar fracture with medial clear space widening in our hospital from Jan. 1996 to Feb. 2002. 73 male and 9 female patients were included respectively. Average follow-up period was 13.2 month (12~50). The methods of internal fixation of lateral malleolar fracture were 66 cases by cortical screw, 16 by plate and screws, and 9 by transfixing screw. RESULTS: Satisfactory reduction was obtained in 65 of 73 cases by only internal fixation of lateral malleolar fracture. Transfixing screw was needed in 8 cases. There was no need for repair of deltoid ligament. In clinical evaluation, no cases of limitation of movement in ankle was seen at final follow-up time. In radiologic evaluation, average medial clear space widening before operation was 5.89 mm (4.5~13 mm) and that of last follow-up time was 2.54 mm (1.5~3.5 mm). 95.2% was above good result. CONCLUSION: In treatment of unstable lateral malleolar fracture associated with medial clear space widening due to rupture of deltoid ligament, we obtained satisfactory result by accurate anatomical reduction or internal fixation. In these cases, there were no need for repair of deltoid ligament.

The Results of Distal Chevron Osteotomy for Hallux Valgus in Young Adult / 대한족부족관절학회지

PURPOSE: To analyze the risk factors and the treatment results of the distal chevron osteotomy for the hallux valgus in young adult. MATERIALS AND METHODS: Eleven cases of hallux valgus in 9 patients who underwent the distal chevron osteotomy between February 2000 and January 2004 were included for the study. For the clinical evaluation, we used hallux-metatarsophalangeal interphalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS). For radiological evaluation, we measured hallux valgus angle (HVA) and intermetatarsal angle (IMA). RESULTS: Five patients had family history of hallux valgus. Symptoms were aggravated by military drill and sports activity. The average AOFAS scale was 62.5 preoperatively, and 88.4 at final follow-up. The HVA and IMA were 34.9 degrees, and 15.8 degrees preoperatively, 16.3 degrees and 8.2 degrees at postoperative 6 weeks, and 19.9 degrees and 9.8 degrees at final follow-up. CONCLUSION: The symptoms of hallux valgus in young adults were aggravated by military drill and sports activity. Distal chevron osteotomy was useful for the treatment of the moderate to severe hallux valgus in young patients.

The Results of Distal Chevron Osteotomy for Hallux Valgus in Young Adult / 대한족부족관절학회지

PURPOSE: To analyze the risk factors and the treatment results of the distal chevron osteotomy for the hallux valgus in young adult. MATERIALS AND METHODS: Eleven cases of hallux valgus in 9 patients who underwent the distal chevron osteotomy between February 2000 and January 2004 were included for the study. For the clinical evaluation, we used hallux-metatarsophalangeal interphalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS). For radiological evaluation, we measured hallux valgus angle (HVA) and intermetatarsal angle (IMA). RESULTS: Five patients had family history of hallux valgus. Symptoms were aggravated by military drill and sports activity. The average AOFAS scale was 62.5 preoperatively, and 88.4 at final follow-up. The HVA and IMA were 34.9 degrees, and 15.8 degrees preoperatively, 16.3 degrees and 8.2 degrees at postoperative 6 weeks, and 19.9 degrees and 9.8 degrees at final follow-up. CONCLUSION: The symptoms of hallux valgus in young adults were aggravated by military drill and sports activity. Distal chevron osteotomy was useful for the treatment of the moderate to severe hallux valgus in young patients.

The short term results of selective nerve root block in herniated lumbar disc patients / 대한척추외과학회지

STUDY DESIGN: A prospective study OBJECTIVES: To analyze the serial results of selective nerve root blocks in herniated lumbar disc patients. LITERATURE REVIEW SUMMARY: To our knowledge there has been no study demonstrating the serial efficacy of root blocks for patients with a herniated lumbar disc only. MATERIALS AND METHODS: Selective nerve root blocks were performed in 36 patients who had a lumbar disc herniation only, with radiculopathy, between November 2002 and April 2003. The diagnoses were made by CT or MRI, which agreed with the symptoms and physical examinations. There were 31 men and 5 women, with a mean age of 28.2 years. The mean interval between the onset and procedure was 7.6 weeks, ranging from 1 to 26 weeks. Mono- and double-segment injections were used in 18 cases, respectwely. The straight leg raising angle, visual analogue pain scale, and motor and sensory functions were investigated before, immediately, 2 days, and 1 and 3 months after the procedure. RESULTS: The mean straight leg raising angle improved significantly, from 28+/-9 degrees to 53+/-18 degrees, immediately, and was maintained until 3 months after the procedure (P<0.001). The visual analogue pain scale was also improved, from 4.6+/-0.9 to 2.0+/-1.5, immediately, and was maintained until 3 months after the procedure (P<0.001). Two of ten patients with motor weakness, and six of eighteen with sensory deficit were improved. There was no procedure related complication; however, surgical treatment was performed in two patients who showed no improvement until 3 months. CONCLUSIONS: Selective nerve root block is a safe and effective treatment method to obtain a rapid and remarkable improvement of radiculopathy in herniated lumbar disc patients.

The short term results of selective nerve root block in herniated lumbar disc patients / 대한척추외과학회지

STUDY DESIGN: A prospective study OBJECTIVES: To analyze the serial results of selective nerve root blocks in herniated lumbar disc patients. LITERATURE REVIEW SUMMARY: To our knowledge there has been no study demonstrating the serial efficacy of root blocks for patients with a herniated lumbar disc only. MATERIALS AND METHODS: Selective nerve root blocks were performed in 36 patients who had a lumbar disc herniation only, with radiculopathy, between November 2002 and April 2003. The diagnoses were made by CT or MRI, which agreed with the symptoms and physical examinations. There were 31 men and 5 women, with a mean age of 28.2 years. The mean interval between the onset and procedure was 7.6 weeks, ranging from 1 to 26 weeks. Mono- and double-segment injections were used in 18 cases, respectwely. The straight leg raising angle, visual analogue pain scale, and motor and sensory functions were investigated before, immediately, 2 days, and 1 and 3 months after the procedure. RESULTS: The mean straight leg raising angle improved significantly, from 28+/-9 degrees to 53+/-18 degrees, immediately, and was maintained until 3 months after the procedure (P<0.001). The visual analogue pain scale was also improved, from 4.6+/-0.9 to 2.0+/-1.5, immediately, and was maintained until 3 months after the procedure (P<0.001). Two of ten patients with motor weakness, and six of eighteen with sensory deficit were improved. There was no procedure related complication; however, surgical treatment was performed in two patients who showed no improvement until 3 months. CONCLUSIONS: Selective nerve root block is a safe and effective treatment method to obtain a rapid and remarkable improvement of radiculopathy in herniated lumbar disc patients.

Recurrence Rate and Survival Analysis of the Lumbar Disc Herniation After Open Discectomy / 대한정형외과학회잡지

PURPOSE: The aim of this study was to estimate the true recurrence rate of lumbar disc herniation after open discectomy, and to compare these results with those from other studies. MATERIALS AND METHODS: From January 1992 to June 2002, the medical records and radiological findings, including a telephone survey were studied retrospectively. This study examined 306 cases, who had been operated by an open discectomy on a single level and had no other spinal lesions such as spondylolisthesis, spondylolysis, or spinal stenosis. MRI was used to confirm the diagnosis of a lumbar disc herniation in all cases. The recurrence of lumbar disc herniation was diagnosed only in those cases who had the same pattern of symptoms and was confirmed by MRI. The cases who had undergone additional surgery at another hospital at the same spinal level were also included as recurrence. In order to make up for weak points such the losses to a long term follow-up, statistical survival analysis was carried out using a life table method. In the life table method, the assumption is that all patients undergo surgery simultaneously. The longest follow-up duration was 11 years. RESULTS: In 252 of the 306 cases (82%), follow-up study was possible. The average duration of the follow-up was 5.9 years (from 1 to 11 years). The average age of the patients was 27.1 years (17 to 75), and the male to female ratio was 11.6: 1. The most common lesion of lumbar disc herniation was L4-5 (74%) at the initial diagnosis. The simple recurrence rate was 8.3% (21 cases) using the conventional method, in which the cases lost to follow-up were excluded. Survival analysis showed that, the annual recurrence rate was highest at the first year postoperatively as 3.4%, but decreased with time. At the last follow-up of 11 years, the cumulative survival rate was 88.9% and the recurrence rate was estimated to be 11.1% at final stage. CONCLUSION: Using survival analysis, the true rate of a recurrence of lumbar disc herniation after an open discectomy calculated. Even though the annual recurrence rate decreased with time, the true recurrence rate using the conventional method may be higher than the results obtained suggest.

Second-look Arthroscopic Findings after Anterior Cruciate Ligament Reconstruction: Comparison between Achilles allograft and Bone-Patellar tendon-Bone autograft

PURPOSE: The purpose of this study was to compare the arthroscopic findings between autograft group and allograft group minimal 1 year after anterior cruciate ligament reconstruction. MATERIALS AND METHODS: From Jul. 1999 to Feb. 2002, we performed second look arthroscopy to 55 patients(60 knees), who had already received anterior cruciate ligament reconstruction minimal 1 years ago(average 16 months) in our hospital. All patients visited our hospital just for removal of tibial hardware. Among 60 knees, 24 cases had operated using bone-patellar tendon-bone autograft(group 1), 36 cases using Achilles tendon allograft(group 2). We evaluated the clinical results by instability, subjective complaint and level of activity. Also we analyzed the second look arthroscopic findings by graft revascularization, fissuring, laxity and intraarticular general status. RESULTS: There was no differene in clinical results except 2 patients who complained mild anterior knee pain in group 1. At second look arthroscopy, well vascularized cases were 13 cases(54%) in group 1 and 15 cases(41%) in group 2 respectively. Fissuring of graft was more prominent in group 2(5 cases, 14%) rather than group 1(3 cases, 9%). Fibrous tissue formation around graft was found in 3 cases(14%) of group 1 and 7 cases(20%) of group2. According to Outerbridge grading system of articular cartilage, more than grade II change in patellofemoral joint were detected more prominently in group 1(7 cases, 32%) than group 2(7 cases, 21%). CONCLUSION: In clinical results, there was no difference between Achilles allograft and Bone-Patellar tendon-Bone autograft used for reconstruction of anterior cruciate ligament. On second look arthroscopy, patellofemoral arthrosis was more prominent in autograft group, but revascularization of graft and the change of perigraft tissue showed more favorable result.

Evaluation of Patella Alignment using Computed Tomographic Image

PURPOSE: This study was evaluated to find out meaning of patellofemoral alignment related to anterior knee pain using computed tomographic image. MATERIALS AND METHODS: This study include 32 cases, 21 persons as a patient group which had been treated due to anterior knee pain related to tight lateral retinaculum from Jan. 1999 to Dec. 1999 and 36 cases, 18 persons as a control group which had no history of anterior knee pain and no abnormal finding malalignment by physical examination. Patellofemoral alignment was evaluated by measuring sulcus angle, congruence angle and lateral patellofemoral angle using computed tomographic images in 0 degrees and 20 degrees knee flexion patellofemoral alignment of the patient group was compared with that of the control group statistically. All 32 cases of the patient group had an arthroscopic lateral release and the patellofemoral alignment was rechecked on computed tomographic images. RESULTS: There was statistically difference between the average measurement of patient group and that of the control group on the computed tomographic images in 0degree and 20degree flexion of the knee. Also the average measurement after lateral release in patient group was corrected significantly. CONCLUSION: Laterally aligned patella during 0 degrees and 20 degrees knee flexion in computed tomographic should not be considered as normal variation but as pathologic condition related to anterior knee pain.

Avulsion of Pectoralis Major Tendon: A Case Report / 대한정형외과학회잡지

Avulsion of the pectoralis major muscle is a rare injury, with only about 20 cases reported in literature. Most cases occur in a younger, more athletic population. The object of this paper is to report our experience of a complete avulsion of the pectoralis major muscle from the insertion site of the proximal humerus and we obtained excellent result with immediate surgical repair and rehabilitation.

Osteochondritis Dissecans of the Femoral Condyles Treated with Operation in Adults

PURPOSE: Up to now, there are several controversies in many aspects of osteochondritis dissecans. In this paper, we have intended to evaluate the frequent location and the etiology of the osteochondritis dis-secans of the femoral condyles, and to assess the adequate modality of operative treatment and its results according to the modality. MATERIALS AND METHODS: We reviewed retrospectively forty-four knees in forty patients. We analysed their clinical and radiological finding to take the incidence at both condyles and its etiology and to estab-lish the modality of applied operative methods according to the status of the lesion. The performed operative methods were multiple drilling(1 case), fragment fixation(2 cases), curettage & multiple drilling(36 cases), osteochondral autotransplantation(5 cases). The majority of these operation was proceeded under arthroscopy. Its clinical results were assessed by Aichroth's result grading system after an average follow-up of two-years and eleven months(range, one year and two months to six years and one month). RESULTS: Twenty one cases were medial femoral condylar lesions, and 23 cases were lateral. 91% patients had had the history of the definitive trauma(20 cases) or the minor repetitive trauma in their envi-ronments(20 cases). After operative treatment, seven knees had an excellent result; twenty-nine, a good result; six, a moderate result; and two, a poor result. Satisfactory result was 82%. CONCLUSIONS: On the basis of this review, we suggest that there is no difference in incidence between both femoral condyles, and that the trauma is seemed to play a major role as an etiologic factor. Majority of operated patients showed satisfactory results after application of our treatment modality.

Comparison of the Results of PCL Reconstruction using Bone-Patellar Tendon-Bone by Open Method and Arthroscopic Method / 대한정형외과학회잡지

PURPOSE: To compare the results of posterior cruciate ligament reconstruction by open and arthroscopic method. MATERIALS AND METHODS: From 1995 to 1997, 18 reconstructions of posterior cruciate ligament were performed. Group 1 (open method) was composed of 9 cases and group 2 (arthroscopic method) was consisted of 9 cases. After 21-month follow-up, The two groups were compared by clinical and radiologic methods. RESULTS: Clinically, Lysholm knee score was 80 points in group 1 and 83 points in group 2 after operation. Post operative results by Hughston's criteria were good in 5, fair in 2 and poor in 2 cases (group 1) and good in 6, fair in 2 and poor in 1 cases (group 2). Radiologically, post operative average of posterior drawer stress view was 5.2 mm (group 1) and 5.0 mm (group 2). Almost double the operation time was taken to reconstruct posterior cruciate ligament by arthroscopic method than open method. There were technical errors in 2 cases performed by arthroscopic method. CONCLUSIONS: The results of both methods had no significant difference. We think that the reconstruction of PCL using patellar tendon by open method is a recommendable treatment method together with arthroscopic method, if the merits or demerits of both methods are considered carefully. But more long-term follow-up is necessary to compare the results of PCL reconstruction by open and arthroscopic methods.

Cellulitis in Young Adults / 대한정형외과학회잡지

While the microbiology of cellulitis in the pediatric population and systemic diseases(DM, Cirrhosis, etc) is well known,the causative bacteria and clinical aspect of cellulitis in young adults are less descrihed. this study was undertaken to identify the causative organisms and clinical aspect of adult cellulits. We analysed 121 medical records of 115 young adult patients with cellulitis who had been admitted at the department of orthopaedic surgery, National Police hospital from Jan. 1994. to Dec. 1996. The results were as follows. 1. The age of patient was between 21 yrs and 25 yrs, and the sex of all patients was male. 2. The lower leg and foot were the most frequently involved site of cellulitis as 92 cases(74.2%). 3. The potals were suspected in 65 cases(56.5%),of them, traumas were detected in 43 cases(66.1%), non-traumatic skin lesions in 23 cases(33.9%). 4. In most cases, initial systemic symptoms (fever, chill, headache, etc.) and local symptoms (local heating, tenderness, etc.) were found. 5. The laboratory findings revealed leukocytosis in 19%, elevated ESR in 94%, positive CRP in 80%. 6. Microorganism were detected in 16 of 38 pus cultures. Gram positive microorganisms were detected in 15 of 16 cases culture positive. 7. 6.7% of patients with cellulitis experienced recurrence in same lesions. In conclusion, the retrospective analysis of 115 young adult patients with cellulitis showed that primary cause of young adult cellulit was circulatory disturbance and lymphatic obstruction of the lower extremities most often involved by trauma. therefore, supportive treatments such as rest,elevation,ice packs are considered prior to antibiotic treatment.antibiotic treatment aimed at gram-positive cocci appears to be sufficient.

Chondroblastoma of the patella: a case report / 대한정형외과학회잡지

Tumor and tumor-like lesion of the patella are extremely rare. The following have been reported: giant cell tumor; osteoblastoma; osteoid osteoma; chondroblastoma; solitary osteochon droma; chondroma; ganglion; simple bone cyst; aneurysmal bone cyst; hyperparathyrodism (brown tumor); malignant lymphoma; haemangioendothelioma; haemangima; primary osteosarcoma; plasmocytoma and metastases. Chodroblastoma in patella were very rare and first repoted by Jerone Cohren in 1963. On review of our literatures, we could not find reported case in Korea. The purpose of this paper is to present an unusual case of chondroblastoma of the patella.

MIR Arthrography of the Labral-Capular-Ligamentous Complex : Normal Variations and Pitfalls / 대한정형외과학회잡지

MR arthrography is a useful modality for evaluating the labrocapsular ligamentous complex (LCLC) of the shoulder. This study was performed to describe normal anatomic variations and pitfalls in image interpretation related to evaluation of the LCLC. MR arthrogram of 56 shoulders in 41 asymptomatic young, active, male volunteers were prospectively reviewed to evaluate the labral shapes, capsular insertions and images which may mimic the lesions of glenohumeral instability. The anterior and posterior parts of the labra, respectively, varied in shape: triangular (72%,36%), round (13%,35%), cleaved (8%,1%), notched (2%,0%), flat (5%,24%), and absent (0%,4%). The anterior and posterior capsular insertions, respectively, varied in site: Mosely and Oevergaard type I (82%,62%), type II (13%,36%), and type III (5%2%). A number of pitfalls in image interpretation were discovered. Articular cartilage undercutting the labrum (29%) and middle glenohumoral ligament in proximity to anterior labrum (5%) simulated a labral tear. Joint fluid interposed in the central, superior portion of the sublabral sulci (25%) simulated a SLAP lesion. Synovial fold (38%) in the axillary pouch resembled a loose body. Knowledge of normal variations and pitfalls in MR arthrogram image interpretation of labral-capsular-ligamentous complex will help the orthopedist to accurately detect debilitating derangements associated with the glenohumeral instability.