• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.66-71
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• 1997

The all inside anterior cruciate ligament reconstruction technique places an anterior ligament substitutes within two bony sockets rather than hone tunnel. This approach is accomplished through arthroscopic three portal which avoids the surgical exposure and morbidity associated with creating traditional bone tunnel. This technique has several distinct advantages when compared with the traditional ACL reconstruction through the bone tunnels. It offers the surgeon a less morbid method for ACL reconstruction that positions an ACL substitute at the anatomic attachment sites of the original ACL with two bone sockets, obviating the need for traditional bone tunnels. Graft fixation at or near the anatomic attachment points of the original ACL minimizes creep with early range of motion and reduces the abrasive 'wind-shield wipe' motion of the graft which occur with bone plugs positioned inside bone tunnels. The sagittal posterior angle to the tibial socket increases fixation strength to pullout with anterior translation force for the tibia on the femur. This technique is not graft specific and can accomodate any graft in which graft length can be customized to the intraarticular native ACL length.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.167-171
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• 2008

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.1
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• pp.28-34
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• 2010

Purpose: The aim of this study was to evaluate short-term clinical results and second-look arthroscopic findings after double-bundle anterior cruciate ligament (DB ACL) reconstruction. Materials and Methods: Forty-nine patients, who were followed up for at least 24 months after DB ACL reconstruction, were included. Clinical results, such as, Lysholm knee and Tegner activity scores, and manual laxity and instrumented anterior laxity test results were evaluated. In fifteen patients (15 knees), second-look arthroscopy with staple removal was performed. At second-look arthroscopy, the authors assessed about reconstructed ACL rupture, subjective graft tension and extent of synovial coverage. Results: Lysholm knee scores significantly improved from 67.4 preoperatively to 96.1 at last follow-up (p<0.01). Tegner activity scale improved from 2.0 to 6.1. The Lachman test, at last follow-up, showed normal laxity in 39 (of 49) patients, and the pivot-shift test showed normal laxity in 36 (of 49) patients. Mean side-to-side differences improved significantly from 10.8 mm to 3.3 mm (p<0.01). Second-look arthroscopic findings showed that all patients had a normal or a near normal anteromedial bundle. However, 8 patients (53.3%) were found to have partial or complete posterolateral bundle rupture. Conclusion: Even though double-bundle ACL reconstruction was clinically effective means of restoring knee rotational and anteroposterior stabilities, there were some ruptured posterolateral bundles observed in cases under arthroscopy after double-bundle ACL reconstruction.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.413-419
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• 2018

Background: We aimed to examine the factors that influence synovialization of the grafted tendon after double-bundle anterior cruciate ligament (ACL) reconstruction based on second-look arthroscopic findings. Methods: Out of 205 knees that were treated between August 2008 and May 2016 with double-bundle ACL reconstruction using bio-absorbable cross-pins and Endobuttons for femoral tunnel fixation, we enrolled 65 knees (64 patients) that underwent second-look arthroscopy with hardware removal at 1 year postoperatively. Measured clinical outcomes included the Lysholm score and Tegner activity score that were evaluated preoperatively and during the final follow-up. We analyzed the relationship between synovial coverage and patient age, length of the preserved remnant tissue on the tibial side, type of bundle (anteromedial or posterolateral), type of graft (autograft or allograft), and time from injury to surgery. Results: The area of synovial coverage showed a significant statistical correlation with patient age and the length of the preserved remnant tissue on the tibial side. The average synovial coverage was significantly better for the anteromedial bundle than for the posterolateral bundle, better for the autograft than for the allograft reconstruction, and better when treated in the acute stage than in the chronic stage. However, synovialization of grafted tendon did not correlate to clinical outcomes. Conclusions: While we were able to identify several factors influencing synovialization of the grafted tendon after double-bundle ACL reconstruction, including patient age, length of preserved remnant tissue of the torn ACL, type of bundle, type of graft, and time from injury to surgery, we found no evidence that increased synovialization improves clinical outcomes at 1 year postoperatively.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.115-122
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• 2005

With the increasing number of primary ACL reconstructions, revision surgery has become more frequent. Despite arthroscopic technique and treatment advancements, the current methods of reconstruction are far from perfect that a significant number of patients have an unsatisfactory. This article discusses the multiple mechanisms of failure of primary intra-articular ACL reconstruction and provides the orthopaedic surgeon with a systematic approach to the evaluation and treatment of failed ACL reconstructions.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.81-85
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• 1997

This article describes a modified arthroscopic technique of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendon graft. The autogenous semitendinosus and gracilis grafts are harvested without detachment of the tibial insertion. To obtain longer graft, the accessory tibial insertions of the hamstring tendons are dissected. The EndoButton(Acupex Microsurgical, Andover, MA) is used for femoral fixation and two spiked staples are used for tibial fixation in a belt buckle fashion. Then the residual anterior laxity is restored by additional absorbable interference screw fixations. In this technique. more viable graft is obtained and firmer distal fixation is achieved by preservation of the tibial insertion of hamstring tendons.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.116-122
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• 1997

We have studied the results of reconstruction by freeze-dried patellar allografts or patellar autografts in ACL-deficient patients prospectively. From January 1995 to December 1995, we performed ACL reconstruction using an arthroscopic-assisted technique with patellar autografts in 21 patients and patellar allografts in 13 patients. Minimum followup time was 1 year(average 26 months). All patients were evaluated by using KT-2000 arthrometer and MRI as well as by physical examination. Final results were rated as satisfactory or unsatisfactory by using a modified Feagin knee scoring scale. Good or excellent were considered to have satisfactory results and fair or poor were considered to have unsatisfactory results. As measured by the KT-2000, 19 cases$(90.5\%)$ had a 5-mm or Jess side-to-side differential, a satisfactory results in autograft group, 2 cases of unsatisfactory results had joint instability. In allograft group, 10 cases$(76.9\%)$ had a 5-mm or less side-to-side differential, a satisfactory results, 3 cases of unsatisfactory results had joint instability including postoperative infection(1 case). In conclusion, the results of ACL reconstruction with autografts were better than those with allografts. The problem of allograft reconstruction were rehydration, aseptic control and improper mechanical tensioning. So, we thought that success of allograft reconstruction was depended on careful implant preparation including pretensioning technique.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.187-191
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• 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 Korean Arthroscopy Society
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• v.13 no.1
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• pp.53-57
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• 2009

The pretibial cyst is a very rare complication after anterior cruciate ligament (ACL) reconstruction. It occurs whatever kind of graft choice or kind of graft fixation method at tibial side. It have been known such as graft necrosis at tibial side, extra-articular leakage of joint fluid through tibial tunnel, foreign body reaction due to breakdown of the bioabsorbable screw and incomplete incorporation of graft to bony tunnel as the cause of pretibial cyst. We experienced one case of pretibial cyst which had undergone ACL reconstruction with autogenous hamstring graft fixed with biodegradable interference screw. We report a rare case of pretibial cyst with literature review.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.1
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• pp.6-14
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• 2003

The goal of rehabilitation after ACL reconstruction are return the patient to a reinjury level of activity with stable joint, removing pivot shift phenomenon, preservation of meniscus, restoration of range of motion, and minimize patello-femoral complication. The ACL reconstruction should avoid immediate surgery. The preoperative phase emphasizes two important factors. (1) The patient should have a resolution of knee swelling, a return of full ROM, and a normal gait. (2) The patient should be mentally prepared for the operation and subsequent rehabilitation. The postoperative rehabilitation program emphasizes extension, closed kinetic chain function exercises. The regular follow-up is important.