• Journal of Korean Orthopaedic Sports Medicine
• /
• v.6 no.2
• /
• pp.92-98
• /
• 2007

Purpose: We evaluated the clinical results of arthroscopic ACL reconstruction using quadrupled hamstring tendon with tibial remnant-preserving technique. Materials and Methods: Thirty-five cases were evaluated from Feb, 2003 to May, 2006. The average interval from injury to surgery was $2.6{\pm}1.6$ months. The cause of injury was mostly sports-related trauma. The average follow-up period was 17 months. Tibial remnant was preserved as much as possible and caution was taken not to damage the remnant during ACL reconstruction. Postoperative rehabilitation was the same as the usual rehabilitation method after ACL reconstruction, except for delaying motion for 2 weeks with an extension locking brace. Clinical evaluation was performed using ROM; Lachman test; pivot-shift test; anterior displacement measurement using KT-2000 arthrometer; Lysholm score and proprioception measured by single limb standing test. Results: There was no limitation of knee motion without contracture. The Lachman test and pivot-shift test were both negative. The side-to-side difference of anterior displacement measured using KT-2000 arthrometer was improved from 6.7 mm to 2.2 mm. The average Lysholm score improved from 81 to 96. The single limb standing test for proprioceptive evaluation showed no significant difference from a normal leg. Conclusion: ACL reconstruction with tibial remnant-preserving technique can preserve mechanoreceptors with prorioception and expect good functional recovery.

• Journal of the Korean Arthroscopy Society
• /
• v.8 no.2
• /
• pp.75-81
• /
• 2004

Purpose: Recent development and advances in arthroscopic surgical techniques for Anterior Cruciate Ligament(ACL) reconstruction have led to the ideal location for the etric point from 10 o'clock (in right knee) and 13:30 (in left knee) to 10:30 (in right knee) and 14 o'clock (in left knee) in the frontal plane. This study was performed to compare operative methods and the radiologic results of femoral tunnels made through the tibial tunnel(trans-tibial approach) and the anteromedial portal. Material and Methods: From January 2003 to May 2004, one-hundred reconstructions of anterior cruciate ligament were performed. Group I (femoral tunnel through tibial tunnel) was composed of 50 cases and group ll (femoral tunnel through anteromedial portal) was consisted of 50 cases. The study was performed to compare the radiographic results of femoral tunnels made through the tibial tunnel and the anteromedial portal and operative methods. Results: In operative methods at Group II, femoral tunnel was made more easily at isometric point than Group I, a good visual field was achived because 100$^{\circ}$ flxion of knee, they can be reduced risk of posterior cortical breakage and tunnel-graft mismatching and decreased divergence of femoral interference screw in radiology (P<0.05). The angle between femoral tunnel and longitudinal axis of ACL wae increased at Group ll. Conclusion: Aanteromedial portal technique was more useful in ACL reconstruction for femoral tunnel toward 10 o'clock to10:30(in right) or 1:30 to 2 o'clock(in left).

• Journal of the Korean Arthroscopy Society
• /
• v.10 no.2
• /
• pp.187-191
• /
• 2006

Few cases have been reported in which the femoral interference screw has migrated into the posterior compartment after an ACL reconstruction. It usually requires removal, because it leads usually to mechanical symptom. However, the arthroscopic removal of a screw is a technically demanding procedure, especially in the case of an intact integrated ACL graft or one that is encapsulated around the screw. We present a case in which a displaced femoral interference screw migrated within the posterior compartment 11 years postoperatively, after the graft had been successfully incorporated at the femoral site and showed good continuity on MRI and arthroscopic examination. Although it is often technically challenging, through the use of a posterior trans-septal portal, we can successfully remove a displaced femoral interference screw even in the most difficult locations in the posterior compartment without damage to ACL graft.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.17 no.5
• /
• pp.522-529
• /
• 2016

This study examined the effects of 4-weeks of backward walking exercise on ROM, VAS (Visual Analogue Scale) score and proprioception in anterior cruciate reconstruction patients. Fourteen subjects were randomly assigned to either a backward walking group (BWG, n=7) or a control group (CON, n=7) and then participated in rehabilitation program for 4 weeks. The ROM of the flexion significantly decreased in both groups (BWG, p<0.001 vs CON, p<0.01), while ROM of extension significantly decreased only in the BWG (p<.05) post exercise, but no significant difference was observed between groups. Additionally, VAS score decreased significantly in both groups (P<0.001) and BWG was lower than CON post exercise (p<0.001). Finally, proprioception decreased significantly in both groups (BWG, p<0.001 vs CON, p<0.05), but did not differ significantly between groups. These results suggest that the 4 week backward walking rehabilitation program improves ROM, VAS score, and proprioception and has positive effects on functional recovery of anterior cruciate ligament reconstruction patients.

• Journal of the Korean Arthroscopy Society
• /
• v.12 no.1
• /
• pp.7-11
• /
• 2008

Purpose: The purpose of this study was to compare the clinical outcomes of ACL reconstruction using autogenous hamstring tendon and allo-tibialis tendon. Materials and Methods: Between March 2002 and March 2005, We performed 30 ACL reconstuructions using hamstring autograft and 20 ACL reconstuructions using tibialis tendon allograft. The average follow up period was 22 months in auto-hamstring tendon and 18 months in allo-tibialis tendon. For the clinical evaluation, we measured the Lysholm score, International Knee Documentation Committee(IKDC) score and anterior laxity by KT-2000 arthrometer at final follow up and compare the results between two groups. Results: The Lysholm score improved from 69.5 preoperatively, to 95.3 at final follow-up in the hamstring autograft groups and from 69.0 to 90.4 in the tibialis allograft groups. According to the IKDC evaluation form, 80% of autogenous hamstring tendon group and 73% of allograft group were good results, higher than B(almost normal)(p>0.05). The average KT-2000 arthrometer side-to-side difference, decreased from 7.1mm preoperatively, to 1.8mm at final follow-up in the hamstring autograft groups and from 7.4 mm to 2.4mm in the tibialis allograft groups. Conclusion: The clinical results of ACL reconstruction using auto-hamstring tendon and allo-tibialis tendon showed no significant differences. The allo-tibialis tendon is an acceptable substitute for auto-hamstring tendon in ACL reconstruction.

• Journal of the Korean Arthroscopy Society
• /
• v.3 no.1
• /
• pp.17-23
• /
• 1999

Purpose : We intend to review clinical results after Anterior cruciate ligament(ACL) reconstruction using hamstring tendon arthroscopically. Materials & Methods : Sixty two patients who had underwent arthroscopic ACL reconstruction using hamstring tendon from Mar. 1996 to Mar. 1997 were reviewed. The average follow-up was 16 months and average age at operation was 27 years old. Clinical results were evaluated with physical examination, Lysholm Knee score and instrumented anterior laxity test with Telos Results : The average preoperative Lysholm knee score was 57.0 and postoperative average of that was 91.8. All cases of 62 patients had normal range of motion of knee and were able to walk with no problems at follow-up. On the Lachmann test, there were mild(+) instability in 24 cases, moderate(++) in 24 cases, severe(+++) in 14 cases preoperatively and 48 cases were converted to negative, 14 cases mild postoperatively. On instrumented anterior laxity test with Telos, difference between normal and affected knee on 20 lb which was 13.4mm preoperatively was decreased to 4.7mm at follow-up and anterior stability was regained(P<0.05). Parapatellar complications such as crepitus in 18 cases(29.5%), atrophy of quadriceps in 23 cases(36.5%) were observed. There were 2 cases of inaccuracy of guide pin of semifix screw intraoperatively and 3 cases of malposition of semifix screw postoperatively. Conclusion : ACL reconstruction using hamstring tendon seems to be a effective procedure to establish the stability of knee joint but is technically demanding procedure and leaves some parapatellar complications.

• Journal of the Korean Arthroscopy Society
• /
• v.16 no.1
• /
• pp.1-8
• /
• 2012

Purpose: To evaluate clinical and radiologic outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes who were selected with authors' new operative indications. Materials and Methods: We evaluated 15 patients with open physes who underwent a transtibial ACL reconstruction and were followed up for 4~6 years after surgery. Our operative indications involved 1) choronologic age of ${\geq}$ 16 in male and ${\geq}$ 14 in female, 2) open physes of ${\leq}$ 2 mm width, and 3) Risser sign and Tanner stage of ${\geq}$ 3. Tibialis anterior tendon allograft was used in all patients, and endobutton and bioscrew were used for femoral and tibial fixations, respectively. Functional outcomes were evaluated using Lysholm Knee Scoring scale, Tegner activity scale, and International Knee Documentation Committee (IKDC) 2000 subjective score. Physical examinations to evaluate stability involved Lachman and pivot shift tests. For radiographic results, we evaluated side to side differences of anterior displacement in stress views. In addition, with use of scannograms taken at last follow-up, we examined side to side differences of femorotibial angles, anatomical and mechanical lateral distal femoral angles, mechanical medial proximal tibial angles and leg lengths. Results: The mean Lysholm Knee score was 51(40-61) points preoperatively and 97(94-100) points at last follow up. The mean Tegner activity score was 2.6 points preoperatively and 7.1 points at last follow up. The mean IKDC score was 32.6 points preoperatively and 88.3 points at last follow up. The mean anterior displacement of the tibia was improved from 6.7(${\pm}1.0$) mm to 1.9(${\pm}0.9$) mm. There were no leg length discrepancies over 5 mm and no statistically significant differences in all the radiographic variables representing growth disturbance. Conclusion: This study suggests that patients with open physes who selected by authors' new indication would safely undergo transphyseal ACL reconstruction with successful outcomes.

• Journal of the Korean Arthroscopy Society
• /
• v.9 no.2
• /
• pp.154-161
• /
• 2005

Purpose: to describe the histologic appearance of the type III bone bruise in knees which had sustained an acute anterior cruciate ligament (ACL) rupture. Materials and Method: Twenty-five patients who sustained acute ACL rupture were prospectively enrolled in this study. On MRI, 14 patients demonstrated type III bone bruise on lateral femoral condyle, and 11 patients didn't demonstrated bone bruise. Arthroscopic evaluation and biopsy of the articular cartilage and subchondral bone wert performed before ACL reconstruction. Histologic and immunohistochemical evaluations were done. Results: There was no difference between the bone bruise and control group in the hematoxylin-eosin staining for cell distribution, Masson's trichrome staining for collagen and immunohistochemical staining for type I and type II collagen (p>0.05). But in the safranin-O staining for glycosaminoglycan distribution, the bone bruise group had an evidence of decreased staining at the superficial and middle layers, compared with the control group (p<0.05). We also found fatty change of bone marrow in calcified zone of the bone bruise group with safranin-O staining. Conclusion: We suggest that the type III bone bruise found on MRI indicates a substantial damage to normal articular cartilage homeostasis, and may induce further damage of the articular cartilage.

• Journal of the Korean Arthroscopy Society
• /
• v.16 no.2
• /
• pp.160-166
• /
• 2012

Purpose: The aim of this study was to determine the patterns of the stress distribution within the reconstructed anterior cruciate ligament (ACL) double bundles in response to an anterior tibial load and rotatory load at $45^{\circ}$ flexed knee model by use of a 3-dimensional finite element analysis (FEM). Materials and Methods: The $0^{\circ}$ and $45^{\circ}$ flexed 3-D knee model were reconstructed based on the high resolution computed tomography (CT) images from the right knee of a healthy male subject. To simulate double bundle ACL reconstruction, in $0^{\circ}$ analytic model, four 7 mm diameter tunnels were created at the center of each anteromedial (AM) and posterolateral (PL) footprints on the femur and tibia. The grafts were inserted into the corresponding bone tunnels and then reconstructed knee model was flexed to $45^{\circ}$. As a next step, the 5 mm anterior tibial load and internal rotational load of $10^{\circ}$ were applied on the final Computer aided design (CAD) model. And then stress patterns of each bundle were assessed using a finite element analysis. Results: In response to the 5 mm of anterior tibial load, the AM bundle showed increased stresses around the tibial and femoral attachment sites; especially in the anterior aspect of the bundle. In the PL bundle, the highest stress concentration was also noticed on the anterior aspect of the bundle. Under $10^{\circ}$ internal rotational load, the stress concentration was predominant around the anterior aspect of the tibial attachment site within the AM bundle. The PL bundle also showed highest stress concentration on the anterior aspect of the bundle. Conclusion: Although the stress patterns were not identical among the AM and PL bundle, there were common trends in the stress distribution. The stress concentration was predominant on the anterior aspect of both bundles in response to the anterior tibial load and rotatory load.

• Journal of the Korean Arthroscopy Society
• /
• v.7 no.1
• /
• pp.92-95
• /
• 2003

A 34-year-old man with ACL total rupture due to slip down injury, had received ACL reconstruction using autogenous hamstrings tendon with cross-pin femoral fixation. Postoperative course was as usual. But postoperative 3 months later, he complained posterolateral knee pain, recurrent effusion and mild instability. He was managed repeatitive aspiration and nonsteroid antiinflammatory drugs but was failed to relieve symptoms & signs. In CT scans, perforation of posteromedial femoral cortex of lateral femoral condyle was found. In second look arthroscopy, two pieces of broken femoral cross pin were found in between tibiofemoral Joint which was badly injured cartilage. We considered malposition of pins was the main cause of failure. We propose that femoral tunnel must be made more acute angle and femoral cross-pin guide must be positioned more external rotation 10-20 degree than transepicondylar axis made confirm the cross-pin tunnel position in order to avoid posterior cortex perforation and early failure.