• Journal of Korean Orthopaedic Sports Medicine
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• v.8 no.1
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• pp.26-32
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• 2009

Purpose: This study was performed to compare the strength of ligamentous attached sites of cadaveric distal femur and to obtain reliable biomechanical data to use in ligamentous reconstruction or augmentation. Materials and Methods: Fifteen cadaveric distal femurs were used for this study. After measuring the bone density, 5.0 mm cannulated screw (Experiment 1) or reconstructed porcine ligament (Experiment 2) was inserted into the each ligamentous attached sites of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). In experiment 2, reconstructed porcine graft was fixed with bioabsorbable screw in ligamentous insertion sites. And we measured the maximal pullout force of each ligamentous attached sites of cadaveric distal femur. Results: Average bone mineral density was $1.205{\pm}0.137\;g/cm^2$ in experiment 1, $1.236{\pm}0.089\;g/cm^2$ in experiment 2, which showed no statistically significant differences. In experiment 1, average pull-out strength of ACL, PCL, MCL and LCL group were $519.1{\pm}111.7$ N, $638.9{\pm}144.4$ N, $169.7{\pm}56.0$ N, $225.6{\pm}61.5$ N respectively. In experiment 2, the average pull-out strength were $310.6{\pm}31.0$ N, $379.9{\pm}47.4$ N, $104.0{\pm}14.4$ N, $131.5{\pm}21.9$ N respectively. In experiment 1, there was no significant difference between ACL and PCL group and between MCL and LCL group. However, the maximal pullout strength of MCL and LCL group were significantly lower than that of ACL and PCL group (p<0.01). Experiment 2 showed the same results of experiment 1. Conclusion: Because stiffness of MCL and LCL attached sites are much lower than that of ACL and PCL attached sites, we may consider augmented fixation in ligamentous reconstructions of MCL and LCL.

• Journal of the Korean Arthroscopy Society
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• v.12 no.2
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• pp.91-92
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• 2008

후방십자인대 및 후외측인대 재건술 후 결과는 많은 발전이 있었지만, evidence medicine의 측면에서 재활 방법에 관한 전향적 연구는 없다. 현재까지의 재활 방법은 다양하게 소개되었지만 전방십자인대 재건술처럼 가속 재활을 하는 것은 바람직스럽지 않다. 후방십자인대, 후외측인대 그리고 다발성 인대 재건술 후 재활은 수술 방법과 환자의 재건된 인대의 상태, 하지 정렬 등에 따라서 개별화하여 점진적으로 진행하여야 할 것이고, 재활기간 동안 의사의 세심한 관찰이 필요하다.

• 대한관절경학회:학술대회논문집
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• 2008.04a
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• pp.84-85
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• 2008

후방십자인대 및 후외측인대 재건술 후 결과는 많은 발전이 있었지만, evidence medicine의 측면에서 재활 방법에 관한 전향적 연구는 없다. 현재까지의 재활 방법은 다양하게 소개되었지만 전방십자인대 재건술처럼 가속 재활을 하는 것은 바람직스럽지 않다. 후방십자인대, 후외측인대 그리고 다발성 인대 재건술 후 재활은 수술 방법과 환자의 재건된 인대의 상태, 하지 정렬 등에 따라서 개별화하여 점진적으로 진행하여야 할 것이고, 재활기간 동안 의사의 세심한 관찰이 필요하다.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.109-114
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• 2002

Propose : The purpose of this retrospective study was to test the posterior cruciate ligament (PCL index) for diagnosis of a tear of the anterior cruciate ligament (ACL) by means of MR imaging. Materials and Methods : From Mar. 1997 to Feb. 2001, concomitant magnetic resonance imaging (MRI) and knee joint arthroscopy were performed in 56 patients of either pain or instability of the knee. The shortest distance between the femoral and tibial attachment of PCL (X) and the distance from that line to the tip of the arc marked by the PCL (Y) on the sagittal plane images were measured. The quotient of these two parameters (Y/X) defined the PCL index. Results : Using MRI diagnosis, there were 35 patients diagnosed with ACL rupture and 21 patients were ruled out of ACL injury. Using arthroscopy, 32 of the 35 patients diagnosed by MRI showed ACL rupture, and 20 of the 21 patients were ruled out of ACL injury. The mean PCL index was 0.40 in the 33 patients diagnosed with ACL rupture through arthroscopy. The mean PCL index was 0.23 in 23 patients with an uninjured ACL through arthroscopy. In 33 patients with ruptured ACL, this value exceeds 0.31. The index value was 0.31 in 3 patients with uninjured ACL. The value of the index was not above 0.31 with an uninjured ACL. PCL index on MRI had a sensitivity of $91\%$ and a specificity of $94\%$ for determining the status of the anterior cruciate ligament. Conclusion : Injury to the ACL changes the PCL index markedly. In diagnostically unreliable MR images, amelioration of the PCL index could help in the diagnosis of ACL injury.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.87-96
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• 2009

최근 전방십자인대 손상의 치료에 남아있는 인대 다발이 이식건의 생물학적 치유를 도우며 고유 수용감각(proprioception) 기능을 유지할 뿐만 아니라 슬관절의 전방 전위 억제의 생역학적 기능을 가지는 것으로 연구되고 있다. 이러한 이론을 바탕으로 남아있는 전방십자인대를 보존하는 노력들은 다양하게 시도되고 있다. 전방십자인대 손상의 자연 경과는 아직도 논란이 되고 있으나 선택적인 환자에 있어서 보존적 치료는 비교적 좋은 결과를 얻을 수 있으므로 불필요한 재건술을 줄일 수 있다. 최근 시도되고 있는 선택적 다발 재건술 및 남아있는 다발을 보존하는 전방십자인대 재건 수술 수기들은 다양한 방법으로 시도되고 있으며 남아있는 다발을 보존하는 장점이 있으나 협소한 적응증을 가진다. 저자들의 남아있는 다발을 보존하는 전방십자인대 재건술은 자가 슬괵건을 이용한 단일다발 재건술을 시행하면서 잔존하는 이완된 다발에 봉합사를 통과시킨 후 봉합사를 추가적인 터널 없이 bioabsorbable cross pin (RIGIDfix system, Mitek, Johnson & Johnson, USA) 구멍을 통하여 당기고 고정하는 방법이다. 전방십자인대 재건술시 남아있는 다발을 보존하는 방법은 이식건의 생물학적 치유을 촉진하고 또한 경골 부착부에 남아있는 기계수용체를 보존하므로 기능적 회복에 도움이 될 것으로 기대된다. 저자들의 방법은 비교적 광범위한 적응증을 가지며 적은 합병증으로 남아있는 다발을 효과적으로 보존할 수 있는 술식으로 전방십자인대 수술시 좋은 치료 선택의 하나로 사료된다.

• Journal of the KSME
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• v.50 no.2
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• pp.51-54
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• 2010

이 글에서는 슬관절의 기능에 중요한 역할을 하는 인대인 전방십자인대의 부상에 대해 소개하고, 전방십자인대 부상기전을 연구하는 여러 가지 생체역학 연구 방법의 동향에 대해 알아보기로 한다.

• Journal of Korean Orthopaedic Sports Medicine
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• v.12 no.1
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• pp.16-23
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• 2013

Multiple ligament knee injury is defined as rupture to at least two of the four major knee ligament structures. Three or four knee ligament injury results in knee dislocation as complete disruption of the integrity of the tibiofemoral articulation. In multiple ligament knee injury, vascular and neurologic assessment should be performed meticulously and systematically. Emergency surgery should be needed if arterial injury is suspected. Surgical treatment rather than conservative management should be done and early surgery might be better than delayed surgery. Reconstruction of ACL and PCL, repair or reconstruction of MCL, and reconstruction of posterolateral corner are recommended, although many debates have occurred. Multiple ligament knee injury requires more aggressive management than single ligament knee injury.

• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.254-261
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• 2018

Purpose: Favorable results have been reported after the direct repair of chronic ulnar collateral ligament ruptures of the thumb metacarpophalangeal (MP) joint, but the results for radial ligament seem rather controversial. The purpose of this study is to compare the results of ligament reattachment between chronic rupture of the ulnar and the radial collateral ligament (RCL) of the joint. Methods: We reviewed retrospectively the radiologic and clinical results of ligament reattachment with suture anchors for chronic (more than 6 weeks) rupture of the collateral ligament of the thumb MP joint with averaged 22-month follow-up. The data between 6 radial and 8 ulnar ligament repairs were compared statistically. Results: The average of postoperative ulnar deviation angle was $13.3^{\circ}$ in radial ligament and $2.0^{\circ}$ in ulnar ligament (p=0.020) in the last follow-up plain X-ray. Postoperative ligament instability was positive in 4 out of the 6 radial repairs and no case with instability was observed in ulnar ligament. In postoperative follow-up, sustained joint subluxation was observed only in 2 out of the 6 radial repairs. Conclusion: The delayed repair of the RCL of the thumb MP joint resulted in less favorable outcomes and ligament instability was observed postoperatively in more than half of the cases.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.125-131
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• 2011

Optimal treatment of the torn posterior cruciate ligament (PCL) remains controversial. The type of tibial fixation (transtibial vs inlay), the femoral tunnel position within the femoral footprint (central, eccentric or isometric), and the number of bundles in the reconstruction (single-bundle vs double-bundle) are controversial issues. The PCL has a better chance of spontaneously healing than the anterior cruciate ligament (ACL) because of a rich blood supply (near the branch of the middle genicular artery) and coverage with a thicker synovium. In general, for easier passage of the graft and full visualization of the original ligament attachment site during the precise positioning of the tunnel, the remaining PCL fibers are usually debrided during reconstruction. However, the remaining remnant structures would significantly contribute to the posterior stability of the knee joint, the healing of the graft, preserving proprioceptive function of the mechanoreceptors in the PCL. Double bundle PCL reconstruction may result in some surgical complications because of increased complexity of making tunnel. Therefore, single bundle PCL reconstruction with remnant preservation seems to be an effective procedure.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.140-145
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• 2011

후방십자인대 손상의 이상적 치료는 아직까지도 확립되지 않았다. 과거 몇 십 년간 후방십자인대에 대한 지식과 슬관절 안정성에 대한 후방십자인대의 생역학에 대한 지식이 증가하였다. 특히 이중 다발에 대한 지식이 증가하고 이러한 모든 노력들은 후방십자인대의 해부학적인 특징을 최대한 복원하기 위해 이루어졌다. 재건술의 수술 방법은 특정 손상 양상에 따라 그에 맞게 이루어지는데 만성 손상의 경우나 remnant가 거의 존재하지 않는 경우에는 이중 다발을 재건하는 것이 만족스러운 결과를 보인다. 아직까지 이중 다발 후방십자인대 재건술의 결과에 대해서는 논란이 많은 것은 사실이나 장기 추시가 가능해지면 이중 다발 후방십자인대 재건술이 해부학적으로나 생역학적으로 더욱 정상에 가깝기 때문에 더 나은 장기적 결과를 보여줄 것으로 예상된다.