Healing Potential of the Transected Posterior Cruciate Ligament of the Rabbit

PURPOSE: We intended to investigate the spontaneous healing response of the posterior cruciate liga-ment(PCL) of the knee to the location of injury in a mature rabbit model. MATERIALS AND METHODS: In the group I(30 rabbits), PCLs were transected at femoral insertion site and in the group II(30 rabbits), they were transected at mid-substance. Subsequent changes were investigated by histological examination with Hematoxylin-Eosin(HE) staining, immunohistochemical analysis for growth factors and biomechanical test with Instron machine(model 4206). Sham operation was performed on the contralateral side, which was used as the control. RESULTS: On gross inspection, significant difference was not observed between the two groups but scar tissue was thicker in group II than group I. On histological examination and immuno-his-to-chem-i-cal study, there was no significant differnce too. On tensile stress test with Instron machine, ultimate tensile strength steadily increased with time, but it was significantly lower than control in both groups. The length of healed ligaments also increased with time in both groups. CONCLUSION: The spontaneous healing of the PCL can occur in the mature rabbit, yet there were no significant differences of healing characteristics between group I and II. The healed ligaments were elongated and biomechanical properties were far inferior to those of control. We expect the further study on spontaneous healing of PCL with more researches on the other factors which are not considered in this

The Change of the Mechanoreceptor in Anterior Cruciate Ligament following Injury of Posterior Cruciate Ligament in the Rabbit / 대한정형외과연구학회지

PURPOSE: The purposes of this study was to evaluate the changes in the mechanoreceptor in the anterior cruciate ligament(ACL) in relation to the healing course following transected posterior cruciate ligament(PCL) MATERIAL AND METHODS: Adult New Zealand White rabbits were used in our study. The PCLs of 40 rabbits were transected at mid-substance on one side. Sham operation was performed on the contralateral side, which served as their own control. At postoperative 2nd, 12th, 24th and 36th week, subsequent changes of the mechanoreceptors were examed histologically with modified gold-chloride staining and arthritic change of cartilage was examed by gross inspection. RESULTS: On gross inspection, the healing process of the transected PCLs began to appear at 6th week, since then the width has steadily increased. There was no evidence of cartilage degeneration from 6th week to 36th week. The number of mechanoreceptor was statistically decreased and morphological degradation was seen as compared with the control side at 6th, 12th and 24th week. The number of type 2 and type 3 mechanoreceptor had been statistically increased over time as the healing of PCL progressed. CONCLUSION: In rabbit model, the mechanoreceptor in ACL changed in response to the stability of the knee with injured PCL. But, further studies are necessary to explain the correlation between the change of mechanoreceptor in ACL and development of arthritis in the knee with injured PCL

Biomechanical Effect of Cyclic Loading on the Reconstructed Posterior Cruciate Ligament: Comparison between Inlay and Transtibial Technique / 대한정형외과학회잡지

PURPOSE: To compare differences in the biomechanical characteristics of posterior cruciate ligament (PCL) reconstructed by the inlay and transtibial techniques. MATERIALS AND METHODS: PCL reconstruction was performed in 12 pairs of porcine hindlimbs using the inlay and transtibial techniques. Cyclic load testing was carried out in three steps. The first step was 750 cycles at 35-350 N, the second 10,000 cycles at 35-350 N, and the third 10,000 cycles at 45-450 N. Length changes of the reconstructed PCLs were measured and the sites of rupture observed. RESULTS: Among the 10 pairs of limbs that completed the test procedure, the graft ruptured before step 3 in all specimens except one in the transtibial group, and seven specimens completed step 3 testing in the inlay group. Comparing the load elongation curves obtained in step 2 tests, more elongation of the graft was evident in the transtibial group (p<0.05). The site of rupture was proximal 1/3 (2 specimens) or distal 1/3 (1) to the graft in the inlay group, and in the distal 1/3 for all specimens of the transtibial group. CONCLUSION: These results suggest that the tibial tunnel orifice renders a risk of attritional rupture to the graft in the transtibial technique. In this respect, the inlay technique has a biomechanical advantage over the transtibial technique.

Discomfort in Winter Season after Fixing Lateral Malleolar Fracture with Plates: A comparison between stainless steel and titanium plate / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to find a method of proving cold discomfort in patients who complain during the winter seasons, after receiving an internal fixation with a metal plate, and to determine the different in the developments of cold discomfort according to the type of metal plate used. MATERIALS AND METHODS: Among 26 cases of lateral malleolar fracture, 16 stainless-steel plates and 10 titanium plates were compared. Discomfort was induced by placing ice over both lateral malleoli (ice provocation test), and the side on which discomfort was induced first was recorded. RESULTS: Ten patients who felt discomfort in the winter, among which 8 cases stainless-steel plate and 2 cases titanium plate. The degree of pain was rated as 3.6 on average (ranging 2-4) on the VAS (visual analogue scale). CONCLUSION: Cold discomfort during the winter season can be confirmed by using the ice provocation test (p=0.0004). The frequency of discomfort during the winter season was higher (p=0.126) in cases filted with stainless-steel plate (50%) than in those with a titanium plate (20%).

Geometric Measurement of Bony Structure of Kness in Korean and The Study of Tibial Plateau Coverage in Total Knee Arthroplasty / 대한정형외과연구학회지

No Abstract Available.

Reconstruction of the Posterior Cruciate Ligament by the Modified Tibial Inlay Method / 대한정형외과학회잡지

PURPOSE: To introduce the modified tibial inlay technique and evaluate the clinical results of 44 patients who underwent PCL reconstruction by this method and were followed-up for more than 2 years. MATERIALS AND METHODS: The clinical results were assessed using the Orthopadishe Arbeitsgruppe Knie (OAK) and International Knee Documentation Committee (IKDC) knee scoring systems. The integrities of the reconstructed PCLs were assessed using posterior stress radiographs and the manual maximum displacement test using a KT-1000 (TM) arthrometer. RESULTS: The average 65.8+/-9.4 OAK score, 10.8+/-4.6 mm displacement by stress radiographs and 9.4+/-4.1 mm displacement by KT-1000 (TM) arthrometer, were improved to an average 87.5+/-7.8, 3.4+/-0.4 mm, 2.7+/-0.9 mm, respectively, at the last follow-up. By the IKDC and OAK scoring systems, 35 cases (79%) and 40 cases (90%), respectively, showed satisfactory clinical outcome. A second arthroscopic examination was performed in 20 of 44 cases. No case showed rupture of the grafted tendon. However, 3 cases showed recurrence of posterior instability, which requried a retightening at the tibial bone block site. CONCLUSION: The modified tibial inlay technique may improve the quality of outcome of arthroscopic PCL reconstruction, because this technique can avoid grafted tendon abrasion at the posterior orifice, and this preserve the remnant PCL bundle, and it allows the retightening of loose grafted tendon to be performed easily.

Clinical Comparison of Posterior Cruciate Retained and Sacrificed in Mobile Bearing Total Knee Arthroplasty

PURPOSE: To evaluate the effect of posterior cruciate ligament retaining on clinical results in tota] knee arthroplasty. MATERIALS AND METHODS: Ninety-nine cases(80 patienis) of osteoarthritis were evaluated average 39 months(range 25-98 months) after total knee arthroplasty with LCS. the cases was divided into posterior cruciate retained group I(54 knees) and sacrificed group Il(45 knees). RESULTS: There was no statistically significant difference in H.S.S. knee score(I:87.4+/-6.3, II:86.1+/-5.7), range of motion(l:113.7 degrees +/- 19.8 degrees, II:111.9degrees +/-10.9 degrees), stability and roent- genographic findings, however, the functional score of the H.S.S. score was higher in group I(l: l8.2+/-5.6, II:15.3+/-4.5. p<0.05) and 6 patients with preoperative range of motion below 50 were in group II. 4 patients of 5 bilateral paired patients who ascended and descended stairs with one leg at a time prefer PCL retained side subjectively. CONCLUSION: We found no significant difference between group I and II in clinical results, however, might be that subjective symptom is excellent in group I and PCL sacrificed design seems to be effective in severely deformed knees and too tight PCL tension.

The surgical treatment of tibial avulsion fracture of the posterior cruciate ligament: Results between fixation methods and usefulness of arthroscopic exam / 대한정형외과학회잡지

PURPOSE: To introduce the results of surgical methods in tibial avulsion fracture of the posterior cruciate ligament (PCL) and arthroscopic exam as useful therapeutic one. MATERIALS AND METHODS: 32 cases with tibial avulsion fracture of the PCL were received surgical treatment and followed up at least 12 months. Clinical results were evaluated with IKDC score and posterior laxity test with Telos device. The posterior approach was performed in 31 cases (19 screw fixation, 12 pullout suture) and arthrosco-pic reduction and fixation in one. Since 1995, arthroscopic exam was performed on the beginning of operation in all cases and combined injury was treated simultaneously. RESULTS: The IKDC scores were A (normal) in 8, B (nearly normal) in 21, C (abnormal) in 2, D (severe abnormal) in 1 and two of C and D showed posterior instability. 7 of 17cases from 1995 had a combined injury and all revealed above B. The result of compar-ison of screw fixation and pullout suture technique showed no difference between them. CONCLUSION: The results were favorable regardless of surgical methods and arthroscopy was useful in diagnosis and treatment of combined injury.

Influence of Type of Screw on the Bacterial Adherence and Infection / 대한정형외과학회잡지

The purpose of the study was to evaluate the effect of commonly used orthopaedic material, stainless steel (SS) screw (2.7xlOmm, Synthes) and titanium (Ti) screw (2.7x10mm, Synthes), on bacterial adherence and infection. The bacteria used for this study was Staphylococcus epidermidis for its ability of adherence. For in vitro assay, screws of each material were placed into test tube containing 107 colony forming unit (CFU) of S. epidermidis in trypticase soy broth for 18 hours. Following incubation, each screws were treated either with trypsin or with an ultrasonic cleaner. For in vivo assay, we inoculated 5x107 CFU of S. epidermidis into the proximal tibial metaphysis of the rabbits, and then inserted Ti screw on the right side and SS screw on the left side. The amount of in vitro adherence of S. epidermidis was greater for SS screw than for Ti screw. Especially following trypsin treatment, SS groups yielded significantly higher bacterial counts than Ti group, respectively (1.4x105 CFU vs 2.8x104 CFU, p<0.05). We found a significantly higher bacterial count after use of SS screw than after Ti screw in rabbits in vivo assay also. Trypsin treatment for identifying biofilm embedded bacteria from implanted metal may be useful in the diagnosis of infection. Ti screw appears to have biocompatibility to inhibit bacterial adherence compared with SS screw in the rabbit tibial model.

One Case of Sparganosis Infestation of the Thigh and Popliteal Area Combined with Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

Human sparganosis is one of the fhost common tissue parasitoses caused by helminthes in Korea. Human sparganosis is found most frequently in subcutaneous or adipose tissue of the abdominal wall, thoracic wall and inguinal region, it is rarely found in the orbital cavity, abdominal cavity, brain, breast, or lower extremities. We experienced one ease of sparganosis which developed into the thigh and popliteal area in combination with avascular necrosis of the femoral head. The case is a 59 years old male. The patient had the history of eating raw meat as a tonic food 3 years ago. The presenting symptom was left hip joint pain. We confirmed the sparganosis in microscopic findings of worms and by immunologic serum studies. The avascular necrosis of the femoral head was detected with plain roentgenography and magnetic resonance imaging. Many spargana were removed from the lesions by surgical excision. Two of them were alive, and others had degenerated or calcified. The life cycle and route of infestation of sparganosis were discussed briefly and related literatures were reviewed.

Comparison of Conservative and Operative Treatment of Achilles Tendon Rupture / 대한정형외과학회잡지

The treatment of Achilles tendon rupture is controversial between surgical repair and conservative cast treatment. Until the 1970s, treatment of Achilles tendon rupture was predominantly surgical repair, but Lea and Smith reported better results in conservative treatment of Achilles tendon rupture and other authors confirmed their good results with cast treatment. This study was attempted to compare the subjective and objective results between operative and conservative treatments of patients with ruptured Achilles tendon. In a retrospective study, 30 Patients with ruptured Achilles tendon were analyzed from January 1990 to May 1994. 15 patients were surgically repaired(group I), and 15 patients were treated with gravity equines short leg walking cast(group II), Patient's subject satisfaction, duration from trauma to normal activity level, plantar flexion power, tendinous healing state checked by ultrasonography, and complications were compared, and following results were obtained. 1. All patients satisfied with conservative treatment in group II, while 12 patients were satisfied with operative treatment in group I. 2. The plantar flexion power of injured side was 89% in group I, 87% in group II comparing with uninjured side. 3. Ultrasonographically, mean thickness and ruptured midportion thickness in group II was thicker than those of group I(8.7, 10.6 vs 9.2, 13.2mm), but focal sonolucent area which indicates incomplete healing was observed more in group II than in group I(4 vs 2). 4. Three patients had complications in group I-1rerupture, 1 infection and 1 sural nerve injury.

Quantitative Sensory Test for the Detection of Diabetic Peripheral Neuropathy / 대한정형외과학회잡지

The aim of this study was to compare widely used quantitative sensory tests to evaluate the diabetic neuropathy(DN). We tested plantar sensation of 40 patients with diabetes mellitus(Group I: 20 with neuropathic symtom, Group II: 20 without symptom) using Semmes-Weinstein monofilament(touch sensation), Biothesiometer(vibration sensation) and EMG. This result was also compared with that of the control group. Eighty percent of Group I and thirty percent of Group II had abnormal EMG findings. Group I had decreased vibration and touch sensation. Comparison of vibration perception threshold(Biothesiometer) with touch pressure sensation(Semmes-Weinstein monofilament) showed that the test with Biothesiometer was relatively accurate, however it was complicated, time consuming and that the test with monofilament was simple and easily performed in the field even though it was relatively crude. 5.07 monofilament could be very effective in the eearly detection of diabetic neumpathy. In conclusion, we recommend 5.07 monofilament as a screening method of diabetic neuropathy and biothesiometer as its follow-up method.

Roentgenographic Study on Shape and Size of the Femoral Head of Normal Korean Adults / 대한정형외과학회잡지

In order to provide the basic data about the hip joint arthroplasty, we measured the femoral head diameter, offset and position in normal 150 males and 150 females using a standardized roentgenographic technique that provided views perpendicular to the plane of the femoral neck in which the focus centered on the lesser trochanter of the femur. We obtained 11.4% of magnification rate by comparing the real size of femoral marker with radiologic size. The result of this study are as following: The mean femoral head diameter was 46.4 ±4.1mm in male and 45.1±3.8mm in female. The mean femoral head offset was 39.2±4.8mm in male and 37.8±4.6mm in female. The mean femoral head position was 48.9±3.2mm in male and 47.6±3.6mm in female.