• 대한관절경학회:학술대회논문집
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• 2009.10a
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• pp.145-146
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• 2009

• Journal of the Korean Arthroscopy Society
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• v.16 no.1
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• pp.17-25
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• 2012

Purpose: The aim of this retrospective study was to evaluate the relationship between appearance and size of bone bruise and severity of anterior cruciate ligament (ACL) injury with magnetic resonance imaging (MRI), furthermore, to identify the mechanism of ACL injury by analyzing the footprint of bone bruise. Materials and Methods: Sixty-five subjects who was taken an MRI within 6 weeks after acute ACL injury were studied. All MRI showed ACL injury and associated bone bruises. Bone bruises were analyzed using Costa-Paz classification based on appearance and location and also scored using Kornaat bone bruise grading system based on size and location. The severity of the ACL injury was graded using a 4-point system (ie, grade 0-3) with oblique coronal MRI. Results: There was statistically significant correlation between Costa-Paz classification of bone bruises in lateral femoral condyle and grade of ACL injury. There were more type 2 lesions in partial tear group (grade 1, 2), however, type 3 lesions of Costa-Paz classification in complete tear group (P=0.037). Significant positive correlations were observed between Kornaat total bone bruise score and grade of ACL injury (P=0.014). Most common ACL injury mechanism was pivot shift injury. Other mechanisms were clip valgus injury, phantom foot injury, and hyperextension injury. Conclusion: It is highly suggested that appearance and size of bone bruise is related to severity of ACL injury after acute ACL injury. The foot print of bone bruise provides valuable clues to identify ACL injury mechanism.

• IMMUNE NETWORK
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• v.24 no.2
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• pp.17.1-17.16
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• 2024

We have reported that anterior cruciate ligament (ACL) injury leads to the differential dysregulation of the complement system in the synovium as compared to meniscus tear (MT) and proposed this as a mechanism for a greater post-injury prevalence of post traumatic osteoarthritis (PTOA). To explore additional roles of complement proteins and regulators, we determined the presence of decay-accelerating factor (DAF), C5b, and membrane attack complexes (MACs, C5b-9) in discarded surgical synovial tissue (DSST) collected during arthroscopic ACL reconstructive surgery, MT-related meniscectomy, osteoarthritis (OA)-related knee replacement surgery and normal controls. Multiplexed immunohistochemistry was used to detect and quantify complement proteins. To explore the involvement of body mass index (BMI), after these 2 injuries, we examined correlations among DAF, C5b, MAC and BMI. Using these approaches, we found that synovial cells after ACL injury expressed a significantly lower level of DAF as compared to MT (p<0.049). In contrast, C5b staining synovial cells were significantly higher after ACL injury (p<0.0009) and in OA DSST (p<0.039) compared to MT. Interestingly, there were significantly positive correlations between DAF & C5b (r=0.75, p<0.018) and DAF & C5b (r=0.64 p<0.022) after ACL injury and MT, respectively. The data support that DAF, which should normally dampen C5b deposition due to its regulatory activities on C3/C5 convertases, does not appear to exhibit that function in inflamed synovia following either ACL injury or MT. Ineffective DAF regulation may be an additional mechanism by which relatively uncontrolled complement activation damages tissue in these injury states.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.147-152
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• 2012

Purpose: The purpose of this study was to compare the preoperative magnetic resonance image (MRI) findings with postoperative arthroscopic findings on meniscus injury with anterior cruciate ligament (ACL) rupture. Materials and Methods: We reviewed MRI images and arthroscopic findings of 225 patients treated by ACL reconstruction due to rupture, from February 2001 to November 2010. There were 154 cases of meniscus tear in arthroscopic findings. We examined the sensitivity for detecting meniscal tears varied with the presence of a rupture of the ACL, with the location of the tear within the meniscus, and among configurations of meniscal tears. Results: In the presence of a rupture of the ACL, the sensitivity of MRI was 0.88 for medial meniscal tears and 0.69 for lateral meniscal tears. And sensitivity of MRI was lowest in posterior horn and peripheral portion tears in lateral meniscus injury accompanying ACL rupture, sensitivity was low in anterior horn and flap shape tears in medial meniscus injury accompanying ACL rupture. Conclusion: In Meniscus injury with ACL rupture, a special attention shoulder given to the posterior horn and peripheral portion injury in lateral meniscus during arthroscopic surgery due to difficulty in detecting on MRI.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.109-114
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• 2002

Propose : The purpose of this retrospective study was to test the posterior cruciate ligament (PCL index) for diagnosis of a tear of the anterior cruciate ligament (ACL) by means of MR imaging. Materials and Methods : From Mar. 1997 to Feb. 2001, concomitant magnetic resonance imaging (MRI) and knee joint arthroscopy were performed in 56 patients of either pain or instability of the knee. The shortest distance between the femoral and tibial attachment of PCL (X) and the distance from that line to the tip of the arc marked by the PCL (Y) on the sagittal plane images were measured. The quotient of these two parameters (Y/X) defined the PCL index. Results : Using MRI diagnosis, there were 35 patients diagnosed with ACL rupture and 21 patients were ruled out of ACL injury. Using arthroscopy, 32 of the 35 patients diagnosed by MRI showed ACL rupture, and 20 of the 21 patients were ruled out of ACL injury. The mean PCL index was 0.40 in the 33 patients diagnosed with ACL rupture through arthroscopy. The mean PCL index was 0.23 in 23 patients with an uninjured ACL through arthroscopy. In 33 patients with ruptured ACL, this value exceeds 0.31. The index value was 0.31 in 3 patients with uninjured ACL. The value of the index was not above 0.31 with an uninjured ACL. PCL index on MRI had a sensitivity of $91\%$ and a specificity of $94\%$ for determining the status of the anterior cruciate ligament. Conclusion : Injury to the ACL changes the PCL index markedly. In diagnostically unreliable MR images, amelioration of the PCL index could help in the diagnosis of ACL injury.

• Biomaterials and Biomechanics in Bioengineering
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• v.3 no.1
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• pp.27-35
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• 2016

Anterior knee pain is a major problem among adolescents and young adults especially those who participates in sports. The most common pathogenesis of anterior knee pain can arise from compression and shear forces in the patellofemoral joint. It is also caused by impingement of infrapatellar fat pad. Fat pad impingement can occur when the fat pad becomes swollen and inflamed due to a direct blow or chronic irritation. As a result, the bottom tip (or inferior pole) of the patella can pinch the fat pad. One of the many causes of swollen fat pad can be secondary to anterior cruciate ligament (ACL) injury. The aim of this study was to compare the infrapatellar fat pad volume in patients with acute ACL injury and a group of age-, gender-, and activity- matched controls with intact ligament. Axial magnetic resonance (MR) images have been performed on 32 patients with torn ACL and 40 control patients. The volume of the fat pad was measured digitally from MR image by using a 3d Reconstruction software, ellipsoidal approximation, and a MATLAB code. The results were compared between patients with torn ACL and control group. Patients with a torn ACL had a significantly larger fat pad than the controls (P=0.01). There was no significant difference between the methods used to measure the infrapatellar fat pad volume (P=0.83-0.87). Thus, lesions of the infrapatellar fat pad is often associated with ACL injury.

• Journal of the Korean Arthroscopy Society
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• v.3 no.1
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• pp.24-29
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• 1999

Purpose : The purpose of this paper is to analyze the clinical results after meniscal repair using meniscal arrow. Materials and Methods : Between May 1997 and Aug 1998, we repaired 22 tom menisci in 22 patients using meniscal arrows. There were nineteen males and three females with an average age of 27 years. There were longitudinal tear in 14 cases, Bucket-handle tear were 7 cases and horizontal tear was in 1 case. In 22 meniscus tears, 16 cases were associated with anterior cruciate ligament tear. Average number of meniscal arrow that was used were 2.5(ranged 1 to 4). Average follow-up period was 14.7 months(ranged 6 to 22 months). We evaluated the clinical results by the Tapper and Hoover's grading system. Results : There were excellent in 16 cases, good in 4 cases and fair in 2 cases on the clinical results. At the last follow up, the range of the motion of the knee joint were average 135 degrees(ranged 125 to 140 degrees). Mean time elapsed for meniscal repair were 25 minutes(ranged 15 to 40 minutes). Conclusion : Meniscal arrow has many advantages such as short operative time, easy fixation technique, and less neurovascular injury. We think that arthroscopic meniscal repair using meniscal arrow is effective treatment method in selected patient who have longitudinal, bucket-handle tear at the posterior hom associated with anterior cruciate ligament tear.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.2
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• pp.122-127
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• 2008

Purpose: Evaluation and analysis of the incidence of postoperative complications after arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Materials and Methods: We reviewed 172 cases of arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft in anterior cruciate ligament tear without meniscal injury. We performed Lysholm knee score and KT-2000 testing, simple radiograph, physical examination as evaluation factor. Also, around knee pain, swelling, limitation of motion, patellofemoral crepitation, paresthesia and pain on kneeling were evaluated. Results: The average follow up period was 49.8 months. In 172 patients, 148 males and 26 femlaes were evaluated. The average age was 34.4 years. The Lysholm knee score improved from 51.9 points preoperatively to 90.8 points at final follow up. Clinical outcome was excellent in 83%, good in 11%, fair in 4% and poor in 2%. There were many cases of complications, 24 cases (14%) of around knee pain, 12 cases (7%) of swelling, 45 cases (26.2%) of patellofemoral crepitation, 52 cases (30%) of donor site paresthesia, 65 cases (38%) of pain on kneeling, 10 cases (5.8%) of limitation of motion at extension, 13 cases (8%) of limitation of motion at flexion and 2cases (1.2%) of patellar fracture. Conclusion: Although arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone had good clinical results, many complications were noted. Some factors in surgical technique were suspected to be related to the complications and long term follow up will be necessary to further evaluated.

• 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 Korean Physical Therapy Science
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• v.10 no.1
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• pp.222-231
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• 2003

The ACL(Anterior cruciate ligament) is the smallest of the four main ligaments of the knee, but it is the primary stabilizer. Injuries have a tendency to occur when the foot is firmly planted and the knee is twisted. Any sports that requires acceleration, change of direction and deceleration can increase the chances of suffering an ACL tear. The incidence of severe knee sprains that involve the ACL are at an all-time high. Since 1980, the number of these injuries have increased at least three-fold. Although the rate of increase has been much less dramatic since the middle 1980s, even the ultra-modem releasable ski binding has not been able to start reducing the incidence of ACL injuries. An ACL injury prevention program developed for downhill skiers by the Vermont Safety Research group emphasized increasing awareness of situations that can potentially result in an ACL injury and pre-planning strategies if events, leading to these situations, begin to fall in place. As part of the above study by Ettlinger et al., an educational prevent program was developed to teach these principles and thus reduce the rate of serious knee injuries. Four thousand instructors and patrol at 20 ski resorts who received the training had a 62% decline in serious knee injuries compared to a similar group that did not receive this training. Whenever you fall, try not to fully straighten your legs. Don't try to get up until you've stopped sliding(unless you are try to avoid an obstacle or other skier). When you're down, stay down. And don't land on your hand. So, if you feel yourself falling: arms forward, ski plates together, hands over knee. Then you will be able to save your ACL.