• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.82-85
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• 2009

Purpose: In anterior cruciate ligament (ACL) reconstruction, preservation of the remnant original tissue might promote graft healing and be helpful in proprioception. But this procedure is difficult and causes the notch impingement. So we introduce a surgical technique that makes a transtibial femoral tunnel at 10 or 2 o'clock position with preservation of remnant tissue. Surgical approach: We tried to preserve the remnant tissue and synovium as much as possible, especially those of tibial attachment and extending to the posterior cruciate ligament (PCL), so as to have some tension and to prevent notch impingement. We set the tibial drill guide at 40~45 degrees and the intra-articular guide tip was 1 mm anterior and medial to the conventional site. The starting point of tibial guide pin was proximal to the pes anserinus and anterior to the medial collateral ligament. When the reamer approached the cortical bone of the tibial articular surface, the reamer must be advanced very carefully to minimize injury to the remnant tissue. The tibial and femoral tunnel at 10 or 2 o'clock position were made with the reamer, the diameter of which was same with that of the graft. Conclusion: We report a remnant preserving technique in ACL reconstruction that makes a transtibial femoral tunnel at 10 or 2 o'clock position

• Journal of the Korean Arthroscopy Society
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• v.9 no.1
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• pp.51-55
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• 2005

Purpose: To compare the stability and clinical result after anterior cruciate ligament reconstructed knee after graft fixation using Intrafix in tibial tunnel with or without additional tibial post fixation. Materials and Methods: We analyzed 37 cases which were treated with four-strand hamstring tendon autograft during the period from May 2002 to January 2003. The grafts were fixed with Rigidfix system (Mitek Product, Johnson and Johnson, USA) in femur tunnel and Intrafix system (Mitek Product, Johnson and Johnson, USA) in tibial tunnel. After tibial fixation, additional tibial post fixation was done, which was determined by the serial case number prospectively. Patients were followed for average of fourteen months(range, thirteen to twenty-five months) At the time of final follow-up, patients were evaluated in terms of Lachman test, pivot shift test, Lysholm scores, IKDC (International Knee Documentation Committee) assessment, side-to-side KT-1000 maximum-manual arthrometer differences. Results: At last follow-up, Lysholm score was average 93.1(range: 65 to 98), IKDC assessment revealed that 26 cases had score of A, 10 cases had score of B and 1 case had score of C. The average maximum-manual KT-1000 arthrometer side ?to-side difference was 2.5 mm$(0{\sim}6mm)$. There was one case in which the Lachman test was graded as 2+ and four cases in which the Lachman test was graded as 1+ and the remaining thirty-two cases were normal by Lachman test. One case had a 2+ pivot-shift, and 2 cases had a 11 pivot-shift. The remaining 34 knees were normal on pivot -shift testing. The average maximum-manual KT-1000 arthrometer side-to-side difference was average 2.8 mm$(0{\sim}6mm)$ in Intrafix only group and average 2.2 mm$(0{\sim}4mm)$ in additional fixation group (P>0.05). Conclusion: Without additional tibial fixation, the stability of the anterior cruciate reconstructed knee with hamstring graft which was fixed with Intrafix was restored.

• Journal of the Korean Arthroscopy Society
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• v.11 no.2
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• pp.92-98
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• 2007

Purposes: The purpose of this study was to report surgical technique of double bundle anterior cruciate ligament(ACL) reconstruction and to compare the short-term clinical results between arthroscopic single-bundle and double-bundle ACL reconstruction. Materials and Methods: From May 2005 to May 2006, ninety-eight patients were underwent ACL reconstruction. We designed prospective study with sixty-one patients who were revealed isolated ACL injury. We serially checked clinical and radiologic data preoperatively and postoperatively. We compared single-bundle with double-bundle ACL reconstruction patients with preoperative datas and postoperatively 1-year data. There were 30 single bundle reconstruction and 31 double bundle reconstruction. Stability was assessed objectively by anterior stress radiographs with the $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer. The clinical results were assessed by IKDC(International Knee Documentation Committee) and OAK(Orthopadische Arbeitsgruppe Knie) scores. Also, we evaluated postoperative thigh circumference and range of motion. All of operations were done by only one surgeon. Results: At single-bundle reconstruction group, preoperative AP instability which was checked by $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer was $7.9{\pm}3.3$ and $7.4{\pm}2.0$, respectively. At double-bundle reconstruction group, it was $8.3{\pm}3.5$ and $7.9{\pm}3.2$, respectively. Residual AP laxity checked at 1 year after operation was $1.9{\pm}1.2$ and $2.2{\pm}1.6$ in single-bundle reconstruction group, and $1.1{\pm}0.9$ and $1.0{\pm}1.0$ in double-bundle reconstruction group. So, double-bundle reconstruction had better results in both anterior stress radiographs with the $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer, and there were significant differences in statistics. But, clinical results such as IKDC(International Knee Documentation Committee) scores, OAK(Orthopadische Arbeitsgruppe Knie) scores, thigh circumference and range of motion had no significant difference between two groups. Conclusions: On the basis of stability, the side-to-side anterior laxity of double-bundle ACL reconstruction was significantly better than that of single-bundle reconstruction, although there were no significant differences in the other clinical measures among them.

• 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.12 no.1
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• pp.24-31
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• 2008

Purpose: We purposed to analyze the incidence and the patterns of the injuries associated with anterior cruciate ligament(ACL) tears. Materials and Methods: We retrospectively reviewed 547 knees that had undergone ACL reconstructions and compared the associated injuries according to the time of injury(acute vs. chronic), the cause of injury(sports vs. non-sports) and the type of sports. Results: Medial collateral ligament(MCL) injury and bone contusion were more in acute injury group less than 3 months after trauma(p=0.001, 0.019) and the injuries of medial or lateral meniscus were more in chronic injury group more than 3 months after trauma(p=0.014, 0.029). The trochlea in acute injury group(p=0.027) and the medial femoral condyle in chronic injury group(p=0.011) had higher incidence of chondral injury. Grade I, II chondral injury was frequent in acute injury group(p=0.016) and grade III, IV chondral injury was frequent in chronic injury group(p=0.017). Lateral meniscus injury was frequent in sports injury group(P=0.035). Medial collateral ligament injury was frequent in ski(P=0.005), and chondral injury was in gymnastics(P=0.017). Conclusions: The incidences of medial and lateral meniscus tears and grade III, IV chondral defects were high in chronic injury group. According to the causes of the tears and the types of sports, some differences in the incidence and pattern of associated injuries were found.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.107-113
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• 2012

Purpose: The purpose of this study was to evaluate the posterior cruciate ligament (PCL) reconstruction with single bundle, single-incision technique using Achilles tendon and tibialis anterior allograft with ligament remnant preservation. Materials and Methods: Twenty six patients underwent PCL reconstruction was included. There were 21 males and 5 females. Mean age was 32 years. Used graft was a fresh frozen Achilles tendon allograft (group I, 14 cases) and tibialis anterior allograft (group II, 12 cases). Arthroscopic PCL reconstruction was performed using transtibial, single-incision and single bundle technique with remnant preserving as possible. For clinical evaluation, range of motion, posterior drawer test, Lysholm score, Tegner activity scale, International Knee Documentation Committee (IKDC) grade and posterior stress radiograph were used. The mean follow-up period was 21.6 months (12-40 months). Associated injuries were 5 medial collateral ligament injuries, which were treated by conservative method. Results: Range of motion (ROM) was returned to normal range in 24 cases, but ROM deficit under $10^{\circ}$ flexion was 2 cases at final follow-up period. Preoperative posterior drawer test was 17 cases in grade II and 9 cases in grade III. At final follow-up 13 cases returned within normal grade, 7 cases grade I and 6 cases grade II posterior instability. Lysholm mean score was improved from preoperatively 62 to 90 at final follow-up period. Tegner activity mean scale improved from preoperatively 3.5 to 5.6 at final follow-up period. IDKC grade was grade A was 3 cases, grade B 17 cases, grade C 6 cases. In posterior stress radiograph, posterior displacement was improved from mean 12 mm preoperative to 4.5 mm at final follow-up. There were no statistical differences between two groups in clinical evaluations. There were two cases of re-rupture of graft at the bone-tendon junction in group I. Conclusion: We had successful results of PCL reconstruction with single-incision, single bundle technique using Achilles and tibialis anterior allograft without difference between two groups in patients with PCL injury. There were more re-rupture of graft in Achilles tendon group.

• Journal of the Korean Arthroscopy Society
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• v.2 no.2
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• pp.107-113
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• 1998

This study is retrospective analysis of 31 patients treated by arthroscopically assisted ACL reconstruction, from September 1995 to September 1996. ACL reconstructions using autogenous bone patellar tendon bone (B-PT-B) were done in 18 patients, and using hamstring tendon were done in 13 patients. We used four-stranded hamstring tendon grafts and fixed the grafts using Endobutton and screw. The mean postoperative Lysholm knee score was 87.2 points in B-PT-B. group, and 89.0 points in hamstring tendon group. There were no clinically significant results between two groups in Telos test, quadriceps atrophy, Lachman test, anterior drawer test and pivot shift test, but the incidences of anterior knee pain were lower in hamstring group. Four-stranded hamstring tendon graft showed enough stability and good functional outcome similar to that of patellar tendon graft, and had an advantage of quicker return of quadriceps function and less donor site morbidity.

• Journal of the Korean Arthroscopy Society
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• v.2 no.2
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• pp.124-128
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• 1998

From Feb. 1996 to Feb. 1997. among sixty-four patients of anterior cruciate ligament(ACL) reconstruction using multi-stranded hamstring tendon and EndoButton fixation, twenty-five patients of volunteer, 15 men and 10 women, from 16 to 50 years of age(mean 27.6 years) underwent arthroscopic evaluation. Arthroscopic evaluation was routinely performed one year after surgery along with an examination of stability. The purpose of this study was to arthroscopically evaluate the morphological changes that occurred in hamstring tendon autograft one year after ACL reconstruction. Both of the tendon graft and the adjacent fibrous tissues were observed for gross appearance and physical properties with probing and response to passive anterior translation. Biopsy samples were taken from the surrounding fibrous tissue and the tendon graft. Grossly, we found a well-defined ligamentous structure with good tension tested with a probe. A common finding was that the reconstructed ligaments were embedded in a layer of the synovium, and blood vessels could be seen on the anterior surface of the ligament. The biopsy tissue was placed in formalin solution and subjected to histological preparation by hematoxylin and eosin staining method. The hamstring tendon graft appeared histologically normal under light microscopic finding. There were a few vessels located between existing collagen bundles, and the vessels had an orderly pattern. The surrounding fibrous tissue envelope was covered with synovium. We pleased with preliminary findings in our evaluation.

• Journal of the Korean Arthroscopy Society
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• v.12 no.2
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• pp.112-117
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• 2008

Purpose: Double-bundle reconstruction of anterior cruciate ligament(ACL) has the advantage of restoring the isometry and original function of ACL. The purpose of this study is to evaluate the clinical results following double-bundle reconstruction of ACL using autogenous hamstring grafts through an accessory anteromedial portal. Materials and Methods: From January 2005 to July 2006, sixty patients(52 males, 8 females) underwent double-bundle ACL reconstruction using autogenous hamstring tendons..The mean age was 31.7 years($20{\sim}51$ years). The mean follow up period was 13.4 months($12{\sim}16$ months). We made a horizontal-oblique skin incision just medial to tibial tuberosity and harvested semitendinosus and gracilis tendon. Tibial tunnel for posterolateral bundle was made near its anatomical position. By modifying an anatomic reconstruction of ACL by Yasuda et al., we made a femoral tunnel for posterolateral bundle through accessory anteromedial portal. Tunnels for anteromedial bundle were made with conventional method. We reconstructed anteromedial bundle with semitendinosus tendon and posterolateral bundle with gracilis tendon. Clinical results at last follow up were evaluated by range of motion, extent of anterior displacement(KT-1000 arthrometer), pivot-shift test. Functional evaluation of clinical outcomes were evaluated by Lysholm score and modified Feagin Scoring System. Results: There was no limitation of motion of knee joint at last follow up. Mean side to side difference of anterior displacement of tibia by KT-1000 arthrometer was improved from 8.4 mm preoperatively to 1.7 mm postoperatively(p<0.05). Average Lysholm score was improved from 64.1 preoperatively to 92.2 postoperatively(p<0.05). In modified Feagin Scoring System, 90% of cases were rated as good or excellent. Conclusion: Double-bundle reconstruction of ACL using autogenous hamstring grafts through accessory anteromedial portal results in good clinical outcomes.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.2
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• pp.73-78
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• 2010

Purpose: To compare the clinical results after reconstruction of the anterior cruciate ligament (ACL) between above the 50 years old patients and below the 50 years old patients retrospectively. Materials and Methods: The results obtained 18 patients above 50 years old (mean age 55.1) and 198 patients below 50 years old (mean age 31.2) who underwent reconstruction of the ACL between July 2004 and April 2008. Clinical evaluation was performed with the International Knee Documentation Committee (IKDC) and Lysholm knee score scale. Anterior displacement of knee was measured by KT-2000 arthrometer. Results: Lysholm scores improved from 69.5 to 93.6 in patients above 50 years old, from 69.0 to 92.6 in patients below 50 years old (p<0.05). According to IKDC score, results more than nearly normal was 83% (15 cases) in patients above 50 years old, 86% (170 cases) in patients below 50 years (p<0.05). The mean difference of anterior displacement measured by KT-2000 was decreased from 7.4 mm to 2.2 mm in patients above 50 years old, from 7.1 mm to 2.0 mm in patients below 50 years old (p<0.05). Conclusion: There was no significant difference between the patients above 50 years old and below 50 years old. In patients above 50 years old, the reconstruction of ACL obtained satisfactory results.