• Journal of the Korean Arthroscopy Society
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• v.8 no.2
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• pp.82-88
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• 2004

Purpose: In this study, we intended to ascertain the benefit of KT-2000 Knee arthrometer(KT-2000) in the diagnosis of ACL(Anterior cruciate ligament) injury by comparing the anterior displacement of normal knee with that of ACL deficient knee. Materials and Methods: We designated two examiners to measure the anterior displacement of the knee joint of 30 healthy individuals, using KT-2000, at 30$^{\circ}$ flexion setting of muscle full relaxation, contraction, 25$^{\circ}$ internal rotation and 25$^{\circ}$ external rotation and analyzed these results according to the variables and measured the preoperative anterior displacement of the ACL injured knee in the 30 patients who have gone through an arthroscopic ACL reconstruction later. Results: The results of examiner 1 are 6.5${\pm}$1.5 mm, 2.5${\pm}$0.9 mm, 4.8${\pm}$1.2 mm, 6.4${\pm}$1.3 mm in right knee and 5.6${\pm}$1.3 mm, 2.1${\pm}$0.8 mm, 4.5${\pm}$1.2 mm, 5.2${\pm}$1.3 mm in left knee, in order of muscle full relaxation, contraction, 25$^{\circ}$ internal rotation and 25$^{\circ}$ external rotation. The results of examiner 2 are 6.9${\pm}$1.2mm, 2.9${\pm}$1.1mm, 5.6${\pm}$1.6mm, 6.9${\pm}$1.5mm in right, 5.5${\pm}$1.7 mm,1.9${\pm}$0.9 mm, 5.1${\pm}$1.9 mm, 5.7${\pm}$1.6 mm in left knee, The side to side difference of examiner 1 in the setting of muscle relaxation is 0.9${\pm}$1.0 mm. The anterior displaement of ACL injured knee is average 11${\pm}$2.93 mm and difference of average 6.5${\pm}$2.31 mm form that of normal. In comparison between the right and left knees of healthy individuals, the both results of two examiners showed the statistical difference in the setting of muscle full relaxation but, the results showed the side to side difference below 2 mm in 25case(83%), 21case(70%) respectively and above 3 mm in just 1 case. In the comparison between the normal and ACL injured knees, the results show the statistical difference of the side to side difference in the setting of muscle relaxation(p<0.05). Conclusion: The KT-2000 result is affected by relaxation of muscles around knee, flexion angle of knee joint, rotation of tibia, the strength of displacing force, time of the test and physical factors as height and weight. However, the Accuracy of diagnosis of ACL injury by KT-2000 will increase if the examiner is skillful and the tests are made on the exact position of knee joint.

• Journal of the Korean Arthroscopy Society
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• v.5 no.2
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• pp.69-73
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• 2001

Purpose : To evaluate the clinical results and widening of bony tunnel after anterior cruciate ligament(ACL) reconstruction using hamstring tendon with Ligament Anchor(LA) screw, which is newly designed fur fixation of graft into femur. Materials and Methods : Fifty eight patients who were followed up at least more than 2 years after ACL reconstruction with four strands of Hamstring tendon were included in this study. The graft was fixed with LA screw at femoral tunnel and with bioabsorbable interference screw at tibial tunnel. The average period of follow-up was 28 months. The clinical results such as physical examination and Lysholm knee score and radiological results. widening of bony tunnel and instrumented anterior laxity test with $Telos^{\circledR}$(Telos stress device; Austin & Associates, Inc., Polston, US) were evaluated. Results . The Lysholm knee score was 60.0 in average preoperatively and improved to 94.0 in average at follow up. On the Lachman test, there were mild(+) instability in 16 cases, moderate(++) in 24, severe(+++) in 18 preoperatively. 50 cases were converted to negative and 8 to mild instability at follow up. On instrumented anterior laxity test with $Telos^{\circledR}$, side to side difference in 20 lb was 12.9mm in average preoperatively, and was decreased to 3.1mm in average follow-up. The femoral tunnel was widened from 10.6mm postoperatively to 12.7mm$(21.1\%)$ at follow up on antero-posterior plane and from 10.7mm to 12.4mm$(16.5\%)$ on lateral plane. Tibial tunnels was also widened from 9.8mm to 11.8mm$(20.7\%)$ on antero-posterior plane and from 9.9mm to 11.7mm$(18.9\%)$ in lateral plane. Conclusion : ACL reconstruction with hamstring tendon and LA screw was one of the choice of grafts and fixatives in restoring knee stability and in improving clinical results with little complications such as excessive widening of bony tunnel.

• 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 the Korean Arthroscopy Society
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• v.13 no.2
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• pp.143-148
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• 2009

Purpose: To investigate the causes of failure on ACL reconstructions and evaluate the effectiveness of one stage revision ACL reconstructions. Materials and Methods: From November 2004 to July 2008, thirty three patients who had got revision ACL recontstructions after reruptures of ACL were evaluated. The causes of failure of ACL reruptures were 22 vertical femoral tunnels, 7 neglected PLRI, 3 severe traumas and 1 deep infection after ACL reconstruction. The femoral tunnels were aimed at the 10 or 2 o'clock position and the tibial tunnels were used with previous tunnels. Previous femoral screws from the improper femoral tunnels were removed and filled with the new allograft bones. Results: The average periods of follow up were 22.2 months (12~52 months). There was improvement on an average Lysholm knee score from $61.5{\pm}16.8$ to $86.3{\pm}11.5$, IKDC score from $63.9{\pm}15.1$ to $81.3{\pm}14.3$. Mean side to side difference was decreased from $6.0{\pm}2.2\;mm$ to $1.6{\pm}1.4\;mm$ using KT-2000 arthrometer. Conclusion: One stage revision ACL reconstruction can be a useful method with good clinical results.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.26-30
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• 2002

Purpose: To estimate the initial and early phase fixation power of the human bone interference screw in reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone allograft. Materials and Methods: The results of twenty eight knees of reconstruction with bone-patellar tendon-bone allograft were analysed in 6 weeks, 12 weeks, 6 months and one year following operation. Physical examination including Lachman test, flexion rotation drawer test and jerk test were performed. The KT-1000 measurement was performed at the same time. In Lachman test 0 $\~$2mm anterior displacement of the tibia was considered normal. The KT-1000 measurement of normal side was compared with operation side and the difference of the two was recorded. The MRI was checked at final follow-up. Results: All but one knee showed normal in physical examination. The failed case showed proximal migration of the graft due to insufficient number of interference screw fixation in widened tibial tunnel. Conclusions: The human cortical bone interference screw showed sufficient initial and early phase fixation power in reconstruction of the anterior cruciate ligament.

• Journal of the Korean Arthroscopy Society
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• v.11 no.2
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• pp.111-116
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• 2007

Purpose: To assess the clinical results of ACL reconstruction with a fresh frozen Achilles allograft, retrospectively and the findings of the graft in second look arthroscopy. Materials and Methods: Twenty-eight ACL reconstructions using fresh frozen Achilles tendon allograft were included in this study between March 1999 and February 2003. The average age was 31.2 years old and the average follow-up was 16.6 months(range: 12-26 months). The clinical evaluation was done by KT-1000 arthrometer, Lysholm knee score, range of motion, Lachman and pivot-shift test. Results: In the last follow-up of Lachman test, 21 cases showed normal, 5 cases grade 1, 2 cases grade 2 and 1 case grade1. The results of pivot-shift test data, 23 cases(82.1%) were normal, 4 cases(14.3%) grade 1, 1 case(3.6%) grade 2. The mean maximum side-to-side difference was improved from 6.75mm preoperatively to 2.46mm in the last follow-up. Lysholm knee score was improved from 73.5 preoperatively to 91.6 in last follow-up. Re-rupture of the ACL graft was found in one case and one case of wound infection in the tibial incision was found. The 6 cases showed the good synovialization of the ACL graft. Conclusion: The anterior stability was restored with ACL reconstruction using fresh frozen Achilles allografts and the good synovialization was found in the second-look arthroscopy

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.134-137
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• 2000

Purpose : To evaluate tile clinical results of resorbable meniscal arrow fixation for repairable meniscal tear with concurrent anterior cruciate ligament(ACL) reconstruction. Materials and Methods : Between April, 1997 and June, 1999, we performed resorbable meniscal arrow fixation and ACL reconstruction simultaneously for 18 cases of repairable meniscal tears with ACL injuries. Nine cases were acute injuries, 5 cases, subacute and 4 cases, chronic. The average follow-up was 21.5 months($12\~38$ months). Results : The healing rate was $89\%$ for acute injuries, $80\%$ for subacute injuries and $50\%$ for chronic injuries. Conclusion : Resorbable meniscal arrow fixation with concurrent ACL reconstruction is a good treatment modality for acute and subacute injuries.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.2
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• pp.91-97
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• 2010

Purpose: The purpose of this study was to evaluate the results of treatment for longitudinal meniscal tear in ACL rupture patients by clinical evaluation and $2^{nd}$ look arthroscopy. Materials and Methods: Among the patients who underwent surgery due to ACL rupture and longitudinal meniscal tear between 2002~2009, 32 patients were selected for the study. The patients were devided into three groups; group 1 had repair, group 2 had partial menisectomy due to impossible to repair, group 3 had conservative treatment due to stable meniscus. Comparative retrospective analysis was applied with KT 1000 arthrometer, Lysolm' score, Tegner activity score, IKDC subjective score, and $2^{nd}$ look arthroscopy. Results: Lysolm' score, Tegner activity score, IKDC subjective score showed no statistical difference in all three groups. KT-1000 side to side difference improved from 6.2, 6.15, 6.38 before surgery to 2.56, 2.49, 2.58 after surgery in group 1, 2, and 3, respectively. In group 1, second-look arthroscopy revealed complete healing in 12 patients, incomplete healing without any clinical symptoms in 2, and healing failure in 1. In group 2, second-look arthroscopy showed partial regeneration on margin of meniscectomy. In group 3, second-look arthroscopy revealed complete healing in 2 patients, while 4 showed incomplete healing so that have repaired. Conclusion: In the study, the outcome was better when the stable longitudinal meniscal tear on posterior horn with ACL rupture had active treatment.

• Journal of the Korean Arthroscopy Society
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• v.8 no.1
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• pp.19-25
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• 2004

Purpose: To compare the results of two different autografts used to reconstruct the anterior cruciate ligament(ACL): bone-patellar tendon-bone and quadruple hamstring tendon. Materials and Methods: Forty one cases (20 bone-patellar tendon-bone cases and 21 quadruple hamstring tendon cases) were followed up more than 2 years postoperatively. Patellar tendons were fixed with interference screws and hamstring tendons were fixed with cross pins and intrafix sheaths and screws. Follow-up results were evaluated with KT-2000 arthrometer, International knee Documentation Committee(IKDC) evaluation form and follow up X-ray Donor site morbidity was analysed. Results: Final IKDC) scores more than B grade and side to side differences of manual maximum test using KT-2000 arthrometer showed insignificant differences(p>) between the two groups. Plain radiographs of hamstring group showed marked widening of the femoral and tibial tunnels at postoperative 2 years. Patellar tendon group showed 30% rate of anterior knee complications. Conclusion: ACL reconstruction using autogenous hamstring graft with new fixation method showed comparable clinical results to using autogenous patellar tendon graft with fewer anterior knee symptoms.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.1
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• pp.48-57
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• 2010

Purpose: To compare the incidence and risk factors for osteoarthritis after anterior cruciate ligament (ACL) reconstruction between two groups using bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autograft. Materials and Methods: 53 cases of ACL reconstruction using patellar tendon and 40 cases using hamstring tendon were followed up at least 8 years. Radiographic evaluation was done according to the Kellgren and Lawrence's classification. Clinical functional testing (Lysholm Knee Scores, the Tegner activity scores) and laxity testing (Lachman, pivot shift tests), and the instrumented laxity testing with $Telos^{(R)}$ were all examined in relation to the development of osteoarthritis. Results: Radiographic osteoarthritic changes were detected in 24 patients (45.3%) in BPTB group and 14 patients (35.0%) in HT group. Accompanying meniscal injury (BPTB p<0.001; HT p=0.091), intervals from the injury to reconstruction of > 12 months (BPTB p=0.037; HT p=0.021), and patient's age at reconstruction of > 25 years (BPTB p=0.003; HT p=0.048) were found to be significant independent predictors of osteoarthritis. However, no statistically significant correlations were found between the development of osteoarthritis and the clinical outcome or the radiographic stability in both groups. Conclusion: Although ACL reconstruction using BPTB or HT autograft had good clinical results at an average follow-up of 10 years, considerable incidence of radiographic osteoarthritic changes were noted. Various factors such as accompanying meniscal injury, protracted time from injury to reconstruction, more than 25 years old at the time of reconstruction were related to radiographic osteoarthritic changes.