• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.209-213
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• 2006

Purpose: Conventional transtibial approach for the anterior cruciate ligament (ACL) reconstruction tended to place the femoral tunnel in too vertical position (11 or 1 o'clock), which could provide the postoperative anteroposterior (AP) stability but not provided the rotational stability. Therefore we present a surgical technique to make the transtibial femoral tunnel at 10 or 2 o'clock position. Surgical approach: To make a transtibial femoral tunnel at the 10 or 2 o'clock position, the direction and position of the tibial drill guide was important. We set the tibial drill guide at $40{\sim}45$ degrees and the intraarticular guide tip was 1 mm anterior and medial to the conventional site. The starting point for the guide pin on the proximal tibia was proximal to the pes anserinus and anterior to the medial collateral ligament. The tibial tunnel was initially drilled 1mm less than the diameter of the graft. Then femoral offset guide could be easily placed at 10 or 2 o'clock position through the tibial tunnel. The tibial tunnel and the femoral tunnel of 30 mm in length were made with the reamer that was same size with the graft. Conclusion: We report a surgical technique to create a transtibial femoral tunnel at 10 or 2 o'clock position in ACL reconstruction to provide the rotational stability as well as the AP stability.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.1-6
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• 2008

Purpose: The purpose of this study is to compare the results of the arthroscopic reconstruction of ACL using autologous hamstring tendon and autologous bone-patellar tendon-bone. Materials and Methods: From January, 2000 to December, 2004, 120 patients underwent arthroscopic ACL reconstruction using autologous hamstring tendon(60 cases) and autologous bone-patellar tendon-bone(BPTB)(60 cases). The mean followed up period of hamstring tendon group was 42 months(range $24{\sim}69$ months) and patellar tendon group was 52 months(range $24{\sim}84$ months). At the time of the final follow up, sixty patients in each group were evaluated the results of physical examination, activity level, patients' satisfaction, functional status, and objective anteriror stability using KT-2000 arthrometer. Results: At the time of the final follow up we compared the two groups who had ACL reconstruction using either autologous hamstring tendon or BPTB, and the final results of the Lachman test showed negative, or mildly positive in 85%(51 cases) of the hamstring tendon group and 90%(54 cases) of the BPTB group. Pivot shift test indicated positive in both groups, 8%(5 cases) and 5%(3 cases) respectively and showed no statistically significant difference. The evaluation of the anterior laxity using the KT-2000 arthrometer revealed no significant difference in the hamstring and BPTB groups: differences less than 3 mm compared to the healthy side were 85%(51 cases) and 90%(54 cases)(p>0.05). The Lysholm score improved from a preoperative score of 51 to a postoperative score of 79.1 in the hamstring groups and from 52 to 82.2 in the BPTB groups. According to the IKDC rating system, 87%(52 cases) were normal or near normal in the hamstring group. In the BPTB group, 83%(50 cases) were normal or near normal. The Tegner score for the hamstring groups was 4.8 preoperatively and 7.1 at the final follow up, and the Tegner score for the BPTB groups was 4.5 preoperatively and 7.3 after the last follow-up. The anterior knee pain was found in 7%(4 cases) in the hamstring tendon group and 10%(6 cases) in the patellar tendon group. Conclusion: Arthroscopic ACL reconstruction using both the autologous hamstring tendon and the patellar tendon during their mid term follow up period demonstrated excellent results. However, the final results during their last follow up showed no statistically significant difference between the two groups.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.128-133
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• 2012

Purpose: This study examined the relationship between graft appearance on follow-up magnetic resonance imaging (MRI) and knee stability after double bundle anterior cruciate ligament (ACL) reconstruction. Materials and Methods: For each patient, 1.5 tesla MRI's were obtained. The signal intensity of grafts was divided into 3 grades by Sononda's classification. The course of grafts was divided into two patterns: straight and curved. We assessed Lachman test, KT 2000 arthrometer and anterior drawer stress radiograph using Telos$^{(R)}$ in $30^{\circ}$ knee flexion for anterior stability and evaluated pivot shift test for rotatory stability. The correlation between graft appearance on MRI and the results of knee stability tests was evaluated. Results: The anteromedial (AM) graft was evaluated as being grade 1 in 66.7%, grade 2 in 26.7%, and grade 3 in 6.7% of the cases and the posterolateal (PL) graft was assessed as being grade 1 in 63.3%, grade 2 in 33.3%, and grade 3 in 3.3% of the cases according to the signal intensity. The AM graft was evaluated as being straight in 83.3% and curved in 16.7% of the cases, and the PL graft was assessed as being straight in 86.7% and curved in 13.3% of the cases according to the course. The course of AM graft was correlated with the results of anterior stability tests and the course of PL graft was correlated with the result of rotatory stability test. However, the signal intensity of grafts was not correlated with the results of anterior stability and rotatory stability tests. Conclusion: The course of AM is correlated with anterior stability and the course of PL is correlated with rotatory stability on follow-up MRI after double bundle ACL reconstruction.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.1
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• pp.18-26
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• 2011

Purpose: This study is to compare the clinical results of ACL reconstruction between three groups using hamstring tendon autograft, mixed and tibialis tendon allograft. Materials and Methods: Between August 2003 and August 2008, we analyzed 169 cases of ACL reconstruction, 66 cases used hamstring tendon autograft, 42 cases used mixed graft and 61 cases used tibialis tendon allograft, with a minimum follow-up of 12 months. For the clinical evaluation, we evaluated the Lysholm score, Telos stress test device and IKDC score. Results: The average side to side difference in Telos stress test decreased from $7.5{\pm}1.0$ mm to $1.6{\pm}1.0$ mm in autograft group, from $7.6{\pm}1.1$ mm to $1.4{\pm}1.1$ mm in mixed graft group and from $7.4{\pm}1.3$ mm to $2.5{\pm}1.3$ mm in allograft group. The average Lysholm knee score improved from 58.6 to 92.3 in autograft group, from 60.6 to 92.6 in mixed graft group and from 55.3 to 91.5 in allograft group. There was no significant difference between three groups in clinical results. At second look arthroscopy, tension of ligament and synovial coverage were good result in autograft and mixed graft than allograft group. Conclusion: All hamstring tendon autograft, mixed graft and tibialis tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. Both hamstring tendon autograft and mixed graft showed good synovial coverage in second look arthroscopy. So mixed graft will be considered as good alternative in case of shorter or thin harvested hamstring tendon.

• 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.14 no.1
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• pp.20-24
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• 2010

Purpose: To evaluate the long term outcomes of the ACL reconstruction from the standpoint of osteoarthritis. Materials and Methods: We evaluated 31 patients who underwent ACL reconstruction from April 1986 to April 1999 and could be followed-up more than 7 years. Mean follow-up period was 10.1 years (7~22 years). In terms of the graft, 11 cases were treated with the ACL reconstruction using a autologous hamstring tendon graft, 20 cases were treated with using a autologous bone patellar tendon bone graft. For femoral tunnel, 11 cases were placed through transtibial tunnel, 20 cases were placed through anteromedial portal using mini-open arthrotomy. Functional and radiographic evaluation was performed. Results: Mean Lysholm score was $89.2{\pm}11.7$ points. Patients had KT-2000 side-to-side differences were $2.1{\pm}1.9\;mm$. IKDC ligament evaluation showed 38.7% type A, 48.3% type B, 6.5% type C and 6.5% type D. Femoral tunnel were placed at 11 or 1 o'clock position in transtibial technique and placed 10 to 10:30 or 2 to 2:30 o'clock position in technique using anteromedial portal. Radiographic analysis for degenerative arthritis revealed that in group using anteromedial tunnel, 50.0% were excellent, 25.0% were good. In group using transtibial tunnel 18.2% were excellent, 18.2% were good. Conclusion: More than 87.1% of cases, long term result of the ACL reconstruction showed good and excellent result in IKDC score. Especially, the group using tunnel through anteromedial portal showed good results for degenerative arthritis.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.156-160
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• 2002

Purpose : To evaluate the results and usefulness of meniscal repair using meniscal arrows with ACL reconstruction. Material and Methods : Among cases of the simultaneous meniscal arrow fixation and ACL recontruction performed between May, 1997 and September, 2000, 17 cases could be evaluated. The average follow-up were 18.5 months. Twelve cases were medial meniscus, 5 cases, lateral meniscus. All cases were longitudinal tear. Meniscal tear were seen at red-red zone in 13 cases, red-white zone in 5 cases. The results were analyzed by pain, joint line tenderness, locking, McMurray test, the Marshall knee scoring scale and complications. Results : Postoperatively two patients had mild joint line tenderness without pain on joint motion or weight bearing. No patient had locking or positive McMurray test. At last follow-up, 15 cases $(88\%)$ were 'excellent' or 'good' according to the Marshall knee score scale. There were two complications which are soft tissue irritation sign on active knee motion and a femoral chondral injury due to protruded T-shaped head of meniscus arrow. Conclusion : Meniscus arrow can be one of the options in repairing the associated meniscus tear, especially the posterior horn of medial meniscus, during ACL reconstruction. However, surgeons using meniscus arrow should be aware of its potential complications such as pain due to soft tissue irritation and chondral damage of the femoral condyle.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.41-44
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• 2006

Purpose: To evaluate the short-term results of arthroscopic ACL reconstruction using fresh frozen Achilles allograft Materials & Methods: From March 2002 to March 2004, arthroscopic ACL reconstructions using fresh frozen Achilles allograft were performed in 25 knees of 25 patients. The average age at operation was 30.1 years (range, 18-50 years) and the average follow-up was 17 months (range, 12 to 27months). Preoperative and follow-up clinical results were evaluated using the Lysholm knee score, IKDC knee rating system, physical examination and KT-2000 arthrometer. Results: The Lachman test was positive in 25 patients preoperatively and 18 patients(72%) had negative results at latest follow-up. The average side-to-side differences of anterior tibial translation using KT-2000 arthrometer under loading of 301b were improved from $7.9{\pm}2.4mm\;to\;2.6{\pm}1.6mm$. The average Lysholm score was improved from $61.1{\pm}13.9\;to\;93.5{\pm}5.3$ points. The IKDC grade was abnormal(C) or severely abnormal(D) in 25 cases preoperatively They improved 22(88%) of normal(A) or nearly normal(B) and 3(12%) of abnormal. Conclusion: Short term results of ACL reconstruction using Achilles allograft was acceptable. Achilles allograft can be a reasonable graft alternative to autograft for ACL reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.128-131
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• 1997

전방십자인대의 일차수복술이나 재건술후에 장기간의 비체중부하가 필요한지를 결정하기 위해서 일차수복술을 시행한 96례와 재건술을 시행한 82례등 총 178례를 대상으로 술후 체중부하시기에따라 두군으로 나누어 비교분석 하였다. 모든 례에서 술후 보조기를 착용하였고 120례에서는 술후 첫6주간 점차적으로 관절운동범위를 증가를 시키고 다음 6주간은 완전운동범위 회복상태에서 유지후 술후 12주에 체중부하를 허용하였으며 나머지 58례에서 술후 완전신전상태에서 즉시 체중부하를 시켜서 정기적으로 Lachman검사, KT 2000을 이용하여 불안정성여부를 관찰하였다. 평균 추시기간은 4.2년(2년$\~$6년)이었고 불안정성에 대한 평가는 AMA 분류에 따랐다. 최종추시상 모든환자에서 1+이상의 불안정성은 발견되지 않았으며 술후 12주에 체중부하를 한군에서 1a+가 104례$(86.7\%)$, 1b+군이 16례$(13.3\%)$로 관찰되고 즉시 체중부하를 한 군에서 1a+가 51례$(87.9\%)$, 1b+가 7례$(12.1\%)$에서 보였으나 통계적으로 의미있는 차이는 없었다(P>0.05). 본연구의 결과로 전방십자인대 일차수복술이나 재건술후 신전보조기를 착용시키고 즉시 보행을 시키는 것이 술후 슬관절의 불안정성에 영향을 주지 않으며 안전한 재활방법으로 생각된다.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.198-204
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• 2008

Purpose: The purpose of this study is to analyze the merits and demerits of double bundle reconstruction and achieve improvements hereafter, by comparing the results of double bundle and single bundle reconstruction using tibialis anterior allograft. Materials and Methods: Twenty seven patients were divided to undergo either double bundle(n=14) or single bundle(n=13) reconstruction with tibialis anterior allograft tendon. The evaluation methods were AP laxity with KT-2000 arthrometer, isokinetic knee strength measurements, pivot-shift test, IKDC subjective score, Lysholm knee score, Tegner activity score, radiographic evaluations with postoperative MRI, and second look arthroscopy. Results: Lysholm knee score and Tegner activity score were significantly better in double bundle reconstruction. In pivot-shift test, single bundle reconstruction was evaluated as grade 0 in 10 of the knees, grade 1 in 1, and grade 2 in 2. Double bundle reconstruction was evaluated as grade 0 in 13, and grade 2 in 1. In second look arthroscopy, single bundle was evaluated as excellent in 6 of the knees, fair in 7, anteromedial bundle of double bundle reconstruction was excellent in 13 and fair in 1, and posterolateral bundle was excellent in 4, fair in 9, and poor in 1. There were no significant differences in other evaluations. Conclusion: Favorable outcome may be expected with double bundle reconstruction of ACL. However there are still need for improvement in terms of reconstruction technique and rehabilitation protocol to reduce PL bundle injury.