• Journal of the Korean Arthroscopy Society
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• v.14 no.2
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• pp.88-91
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• 2010

전방십자인대 재건술시 자가건 선택에 대해서는 많은 논쟁의 소지가 존재하며 많은 보고들이 나오고 있으나, 현 시점에서 이식건으로써 자가 골-슬개건-골이 표준(gold standard)라는 주장은 이제 변화하고 있으며, 골-건 고정방법의 개선에 따른 조기 슬관절 안정성의 호전으로 자가 슬괵건의 사용이 점점 증가되고 있는 추세이다. 자가 골-슬개건-골은 이식건으로써 강한 물성, 튼튼한 고정, 장기 추시에서 높은 성공률 등으로 젊고, 강한 활동을 요하는 운동선수에서 종종 선택되고 있으며 조기에 강한 활동으로의 운동 복귀를 할 수 있다. 그러나 슬관절 전방 통증, 무릎을 꿇을 때의 통증, 슬개골골절, 슬개-대퇴 관절의 염발음 및 대퇴사두근력의 감소 등 이식물 채취로 인한 공여부 이환이 문제가 되었다. 그래서 자가 골-슬개건-골의 이식건으로서의 문제점 및 문헌상 고찰을 하여 논하고자 한다.

• Journal of the Korean Arthroscopy Society
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• v.4 no.1
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• pp.13-18
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• 2000

Purpose : The purpose of this study was to compare the efficacy of bone-patellar tendon-bone(B-PTB) allograft with autograft B-PTB reconstruction of anterior cruciate ligament(ACL) according to the subjective and objective criteria. Materials and Methods : 42 patients were treated for acute rupture or chronic insufficiency of the ACL between March 1993 and June 1996. There were 18 autografts and 24 allografts for ACL reconstruction. At 2 years of follow-up after operation, autograft and allograft groups were compared based on subjective, objective criteria and Telos stress arthrometer. Results : The modified Feagin Scoring System revealed 16 patients$(88.9\%)$ with a satisfactory result by autografts, but 21 patients$(87.5\%)$ with a satisfactory result by allografts after 2-years follow-lip. There was no statistically significant difference between the two groups. ACL reconstruction with B-PTB allograft did not produce a significant functional deficit. But patellofemoral pain and crepitus were more frequent in the autografts$(33.3\%)$ than allografts$(8.3\%)$ (p<0.05). Conclusion : The ACL deficient knees treated with allografts for ACL reconstruction tended to be better than those reconstructed with autografts fur the reduction of patellofemoral crepitus and pain. B-PTB allograft provides an acceptable alternative to autograft tissue for reconstruction of the ACL.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.102-108
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• 1999

Purpose : The purpose of this study was to evaluate the clinical results of bone-patellar tendon-bone(B-PTB) allograft for ACL reconstruction without mechanical tensioning device. Material and Method : Forty-six knees in 43 patients were reviewed and evaluated with subjective evaluation, objective evaluation, Telos stress arthrometer and modified Feagin Scoring System. The average age at the time of operation was 27 years(range, 18-42) and the average follow up period was 41 months(range, 22-79). Authors reconstructed ACL using B-PTB allograft which was prepared by rehydration preoperatively without tensioning by mechanical tensioning device. The tension for allograft was obtained by full flexion and extension intraoperatively. All operation were performed arthroscopically by two-tunnel method to avoid the mismatching of allograft tendon length. Result : The modified Feagin Scoring System revealed 39 cases(84.7%) with excellent or good results and 7 cases(15.3%) with fair or poor results. The mean follow-up Lysholm Knee Score was 84. Telos arthrometer revealed 41 cases had an injured-to-uninjured difference of 5 mm or less(mean 2.3mm). The range of motion of knee was nearly normal and there was no extension lag in any cases at last follow up. Conclusion : Clinical results using B-PTB allograft showed less morbidity than B-PTB autograft. The intraoperative tensioning method by full flexion and extension without mechanical tensioning device was not bad. Therefore, B-PTB allograft is a good substitute material in reconstruction of the ACL.

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.117-122
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• 2000

Purpose : To compare the mid term with long term follow up results of the anterior cruciate ligament(ACL)> reconstruction using patellar tendon. Materials and Methods : Seventy-six cases, which could be followed up more than 2 years were included in this study. They were classified into two groups, mid-term group(41 cases) with mean follow-up periods of 2 years and 10 months and long-term group(35 cases) off years and 6 months. Clinical and radiological results and peripatellar complications were evaluated & compared. Results . There was no statistically significant difference in radiological finding and anterior instability between two groups. However, the incidence of anterior knee pain, paresthesia at incision site, kneeling pain, crepitus and quadriceps weakness was lower in long-term group than in mid-term group. Conclusion : ACL reconstruction using patellar tendon graft could successfully restone the stability of knee joint, but there are some complications in donor site and patellofemoral joint. However this complications were gradually decreased with long term follow-up.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.132-136
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• 2005

Purpose: The purpose of this study was to compare the clinical results of the arthroscopic anterior cruciate ligament reconstruction used by Bone-Patella tendon-Bone autograft and Achilles tendon allograft. Materials and Methods: We reviewed the results of patients who had been managed with arthroscopic anterior cruciate ligament reconstruction using different graft such as Bone-Patella tendon-Bone autograft and Achilles les tendon allograft. 60patients (average age, 33.5 years)were retrospectively evaluated. The one group(average age, 33.4 years) was 32 patient who had been managed with arthroscopic anterior cruciate ligament reconstruction using Bone-Patella tendon-Bone autograft. The other group(average age, 32.1 years) was 28 patient who had been managed with arthroscopic anterior cruciate ligament reconstruction using Achilles tendon allograft. 2 groups were evaluated subjectively by Lysholm knee scoring scale and objectively by KT-2000 arthrometer. The follow-up period was more than a year(average, 18 month). An early rehabilitation protocol was instituted. Results: On Lysholm knee scoring scale, the final evaluation was nearly normal in all patients. We could not find statistical difference among the two groups by KT-2000TM arthrometer. Conclusion: The use of allografts may be an acceptable choice for ACL reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.91-96
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• 1999

Purpose : The purpose of this study is to compare the clinical and radiologic results of the anterior cruciate ligament(ACL) reconstruction using bone-patellar tendon-bone unit with doubled semitendinosus and gracilis tendons. Materias and Methods : Clinical results of ACL reconstructions which were performed in 47 patients using doubled semitendinosus and gracilis were compared with those performed in 45 patients using bone-patellar tendon-bone autograft. There were no differences in preoperative parameters(age, sex, instability). Average follow-up period were 17 months and 19 months each. Results : There were no significant differences between two groups in functional results (Lysholm knee score), degree of laxity and range of motion at final follow-up. However, the parapatellar complication, especially anterior knee pain after long distance walking or exercise and quadriceps weakness less occurred in hamstring tendon group than in bone-patellar tendon-bone group. Conclusion : Although there were no significant differences in clinical results of ACL reconstruction using bone-patellar tendon-bone autograft and doubled semitendinosus and gacilis, parapateller complications occurred more in the bone-patellar tendon-bone autograft group than in the doubled semitendinosus and gracilis group. It is thought that the careful selection of patient, achivement of skillful technique and active rehabilitation are important to prevent the parapatellar complications.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.2
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• pp.92-99
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• 2003

The prevalence of anterior cruciate ligament (ACL) injury is continuously increased due to sports activities and traffic accident. Simultaneously ACL reconstruction operations are on the increase. Several kinds of autografts and allografts are used in ACL reconstruction. Although ACL reconstruction using an autogenous bone-patellar tendon-bone graft is the good standard, it might have potential morbidity, anterior knee pain and minimal extension loss. To minimize the complications and disadvantages on each graft and to select appropriate graft for each patient, it is necessary to understand the unique characteristics of each graft for biomechanical aspect, morbidity and disadvantage. Selecting the appropriate graft depends on numerous factors including surgeon's preference and experience, patient's activity level and age, extent of ligament injury, tissue availability, and patient's selection for graft .

• Journal of the Korean Arthroscopy Society
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• v.5 no.1
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• pp.1-6
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• 2001

Purpose : The purpose of this study was to compare the postoperative success and stability of arthroscopically assisted anterior cruciate ligament(ACL) reconstructions using central one third bone-patellar-tendon bone(BPB) autograft versus quadrupled semitendinos-us(ST) autograft as the medium term review. Materials and Methods : Eighty patients(40 BPBs,40 STs) with isolated ACL injury were available for a mean follow up of 49.4 months(BPB) and 48.8 months(ST). There was no significant difference between the two groups with respect to age and sex. We compare the final results between two groups with respect to subjective Lysholm score, objective laxity including anterior drawer test, Lachman test, pivot shift test, KT-2000 measurements and International Knee Documentation Committee(IKDC) evaluation system. Results : Postoperatively, positive anterior drawer test was found in $22.5\%\;and\;27.5\%$, positive Lachman test was found in $30.0\%$ and $25.0\%$ and positive pivot shift test was found in $15\%\;and\;20\%$ of the ST and BPB group, respectively(p>0.05). Mean side to side difference of KT-2000 at 20 lbs was 2.2 mm for the ST group and 2.1 mm for the BPB group. There was no significant difference between the two groups about Lysholm score(>0.05). Anterior knee pain was knee common in the BPB group. Eighty-three percent of the patients were nearly normal according to the IKDC grade in both groups. Conclusion : We consider that autogenous semitendinosus tendon is a good alternative subsititute in ACL reconstruction together with the bone-patellar tendon-bone autograft.

• Journal of the Korean Arthroscopy Society
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• v.4 no.1
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• pp.1-6
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• 2000

Purpose : The purpose of this study was to compare the results of ACL reconstruction using bone-patellar tendon-bone to hamstring. Materials and Methods : Thirty-two ACL reconstructions with autogenous BPTB and eighteen reconstructions with hamstring were compared in terms of functional outcome, stability and tunnel expansion. Results : The functional score of BPTB group was higher than hamstring group in OAK(Orthopadishe Arbeitsguppe Knie) and IKDC(International Knee Documentation Committee) system. In BPTB group, OAK scores were 71.6$({\pm}10.0)$ preoperatively and 88.5$({\pm}7.9)$ finally. In hamstring group, OAK scores were 73.9$({\pm}11.5)$ and 82.5$({\pm}12.9)$ respectively. There was no difference in stability checked by either $KT-1000^{TM}$ or stress view. Anterior tibial translation measured by $KT-1000^{TM}$ were 2.4$({\pm}1.8)$mm in BPTB and 2.3$({\pm}2.4)$mm in hamstring group. Anterior tibial translation in stress view were 2.8$({\pm}3.4)$mm in BPTB and 2.8$({\pm}2.5)$mm in hamstring group. There was no difference in tibial tunnel expansion but femoral tunnel was more enlarged in hamstring group than BPTB (P=0.03). Conclusion : As there was no difference in stability between two groups, it seems prudent to select either graft defend on such factors as anterior knee pain, skeletal maturity and cosmetic concern. Tunnel expansion seems not to affect stability, but further study is needed to confirm that decrease of which might improve stability.

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.1-6
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• 2002

Purpose : Evaluation and analysis of the incidence and causes of intraoperative and postoperative complications after arthoscopic anterior cruciate ligament(ACL) reconstruction using bone-patella. tendon-bone (BPTB) auto graft. Materials and Methods : We reviewed 85 cases of arthroscopic ACL reconstruction using BPTB autograft which had been followed up for more than 1 year. Intraoperative complications had been recorded and corrected during the operation. Postoperative complications were analyzed and compared between 3 groups which were classified by the last follow-up period after the operation. Results : There were a few intraoperative complications including patellar fracture(1 case), contamination of harvested graft(1 case), impingement of graft(2 cases), blow-out of tile posterior wall of the femoral tunnel(1 case) and intraarticular retraction of the screw(1 case). The result of the comparison of postoperative complications among the groups shows that the incidence of anterior knee pain, donor site pain and patellofemoral crepitation were significantly decreased after 2 years. But there was no significant decrease in these complications after 3 years. Conclusion : Intraoperative complications after arthroscopic ACL reconstruction using BPTB autograft were due to incorrect technique and carelessness of the operation team, and can be prevented by improvement of surgical technique and accumulation of experience. Postoperative complication were somewhat unavoidable but gradually improved with time; hence, we should consider it for the selection of graft donor.