• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.1-7
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• 2009

Purpose: To evaluate the 2 to 4-year follow-up results after arthroscopic anterior cruciate ligament (ACL) reconstruction using transtibial femoral tunnel at 10 or 2 O'clock position. Materials and Methods: Eighty-six ACL reconstructions could be evaluated. Evaluations included 2000 International Knee Documentation Committee (IKDC) subjective knee score, Lachman test, Pivot-shift test, KT-1000 arthrometer measurement, 2000 IKDC knee examination and second-look arthroscopy. Results: Seventy-five patients (87.2%) had over 80 in 2000 IKDC subjective knee score. Eighty-three patients (96.5%) had 1+firm end or negative Lachmann test. Seventy-eight patients (90.7%) had a negative Pivot-shift test. Eighty-three patients (96.5%) had less than 5 mm difference by KT-1000 arthrometer. Eighty patients (93.0%) were normal or nearly normal by 2000 IKDC knee examination. Second-look arthroscopy was done in fifteen cases. Nine cases showed good synovialization, four cases showed partial synovialization, two cases showed poor synovialization and graft failure was noted in one case. Conclusion: ACL reconstruction using transtibial femoral tunnel at 10 or 2 O'clock position resulted in a good outcome in terms of rotatory stability as well as antero-posterior stability.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.222-231
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• 2005

Purpose: This article describes a double-bundle ACL reconstruction technique using a five-strand hamstring tendon autograft with conventional anteromedial bundle reconstruction and additional posterolateral bundle reconstruction. Operative technique: For the tibial tunnel, the conventional single tunnel technique is performed and for the femoral tunnel, the double tunnel technique is performed with the anteromedial and posterolateral bundle. After minimal notchplasty, the anteromedial femoral tunnel is prepared with leaving one milimeter of posterior femoral cortex within the over-the-top, which if positioned at the 11-o'clock orientation for the right knee or at the 1-o'clock position for the left knee. The posterolateral femoral tunnel that is located 5 to 7 mm superior to the inner margin of the lateral meniscus anterior horn at $90^{\circ}$ of flexion is prepared with tile outside-in technique using a 4.5 cannulated reamer. The graft material for the double bundle reconstruction is made of the conventional four-strand hamstring autograft in the anteromedial bundle and of a single-strand semitendinosus tendon in the posterolateral bundle. The anteromedial bundle is fixed with using a rigid fix system on the femoral side and the posterolateral bundle is fixed to tie with the miniplate from the outside femur. Then, with the knee in $10^{\circ}\;to\;20^{\circ}$ of flexion, a bioabsorbable screw is simultaneously applied to achieve tibial fixation with tensioning of both bundles. Conclusion: A double bundle reconstruction with five-strand hamstring autograft, which is designed with a favorable conventional anteromedial bundle and an additional posterolateral bundle to restore rotation stability, seems to be a very effective method for the treatment for ACL instabilities.

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.7-13
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• 2002

Purpose : Preliminary report of the technique and trial of double bundle PCL reconstruction using Achilles allograft. Materials and Methods : From May 1999 to July 2000, 8 cases of PCL insufficient patients were treated with Achilles allograft reconstruction using the double bundle and double femoral tunnel technique. The tibial tunnel was prepared anteromedially. All other combined injuries within the knees were treated accordingly. Minimal follow-up period was 1 year. The results was assessed from the point of function and stability using Lysholm knee score and KT-2000 arthrometer. Results : Up to present follow up. 8 patients showed good sign of recovery with no instability (translation less than 2 mm) except olio that has been grafted-ligament rupture. In addition, none showed any sign of infection nor ROM limitation. Two complications were seen, which one had grafted-bone fracture and the other grafted-ligament rupture. The former occurred during operation and the latter occurred due to improper protection. Conclusion : Presently the follow up period is too short to draw any conclusive opinion but it is essential to select healthy and well sterilized allografts fur successful outcome. Double femoral tunnel technique seems to be more physiologic in PCL reconstruction. With these prerequisites, it seems to be a good alternative to use Achilles allografts fur the reconstruction of PCL. However, a longer follow-up is needed.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.32-39
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• 2008

Purpose: To evaluate the effectiveness of MRI after ACL reconstruction with femoral tunnel at 10 o'clock position. Materials and Methods: MRI findings of 29 patients after ACL reconstruction using hamstring tendon autograft were evaluated. The mean period from operation to MRI was 18.9 months($7{\sim}40$ months). Signal intensity, morphology and continuity of graft, femoral insertion, graft angle, roof impingement, cross pin breakage and position were evaluated. Those findings were compared with KT-2000, Lysholm knee score and pivot shift test. Results: There was no significant correlation between signal intensity of graft and the duration to MRI. Most common pattern of the morphology was straight, and the continuity was well-preserved. 13 cases of femoral tunnel insertion were zone 4 and 16 were zone 3. There were no roof impingement. 10 cases showed cross pin breakages, of which 5 were found at the outside of distal femoral posterior cortex. 9 showed cross pin directed posteriorly in axial view. There was no significant correlation between clinical results and cross pin breakage. Conclusion: MRI examinations after ACL reconstructions are useful to evaluate the graft status, position of the graft and cross pins. Since the direction of the cross pin is important especially in 10 o'clock femoral position, care should be taken to avoid cross pin breakage.

• Journal of the Korean Orthopaedic Association
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• v.55 no.4
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• pp.305-310
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• 2020

The review provides updated concepts regard to the anatomy of the anterior cruciate ligament (ACL) footprints. The concept of anatomical ACL reconstruction, in which the graft is placed in the native ACL insertion area, has been introduced. However, there is still no consensus on the anatomical positioning of the femoral and tibial tunnel. In this study, authors review and update the literature regarding the tunnel position for anatomical ACL reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.8-13
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• 2009

Purpose: We used tibialis allograft for the reconstruction of ACL and used Hybrid femoral fixation utilizing $Endobutton^{(R)}$ and $Rigidfix^{(R)}$ for femoral fixation, and used $Retroscrew^{(R)}$ and additional fixation for tibial fixation to evaluate the clinical results. Materials and Methods: The ACL reconstruction were performed from February 2004 to February 2007 utilizing Hybrid femoral fixation and $Retroscrew^{(R)}$ and 32 patients, 32 cases which were available for year-long observation (12 to 25 months). The clinical results (Lysholm knee score, IKDC grade) and the radiologic results(bone tunnel expansion, Telos anterior displacement test) were evaluated. Results: The Lysholm knee score was improved from the average of $67.9{\pm}5.4$ points (range: 51~77) before operation and to $94.1{\pm}6.8$ points (range: 68~98) at the last follow up (p<0.05). 22 cases (69%) were evaluated normal (A), 9 cases (28%) were evaluated nearly normal (B) and only 1 case (3%) was evaluated not normal (C) at IKDC final evaluation and no case was evaluated abnormal. From $Telos^{(R)}$ stress x-ray evaluation, difference from the opposite knee was improved average 13.2 mm{\pm}5.8 (range: 6~21 mm) to average $3.4\;mm{\pm}2.8$ (range: 0~11 mm) after operation (p<0.05). The femoral and tibial tunnel were widened by 18.7% and 9.6% in the AP view and 12.4% and 8.5% in the lateral view, respectively (p<0.05). However, any statistic significance was not observed between bone tunnel expansion and knee joint functions (p>0.05). Conclusion: An ACL reconstruction with tibialis allograft using Hybrid femoral fixation and $Retroscrew^{(R)}$ enabled anatomical fixation of the graft tendon with satisfactory clinical results.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.125-131
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• 2011

Optimal treatment of the torn posterior cruciate ligament (PCL) remains controversial. The type of tibial fixation (transtibial vs inlay), the femoral tunnel position within the femoral footprint (central, eccentric or isometric), and the number of bundles in the reconstruction (single-bundle vs double-bundle) are controversial issues. The PCL has a better chance of spontaneously healing than the anterior cruciate ligament (ACL) because of a rich blood supply (near the branch of the middle genicular artery) and coverage with a thicker synovium. In general, for easier passage of the graft and full visualization of the original ligament attachment site during the precise positioning of the tunnel, the remaining PCL fibers are usually debrided during reconstruction. However, the remaining remnant structures would significantly contribute to the posterior stability of the knee joint, the healing of the graft, preserving proprioceptive function of the mechanoreceptors in the PCL. Double bundle PCL reconstruction may result in some surgical complications because of increased complexity of making tunnel. Therefore, single bundle PCL reconstruction with remnant preservation seems to be an effective procedure.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.72-80
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• 1997

Numerous techniques of anterior cruciate ligament (ACL) reconstruction have been described in literature. All have inherent advantages and disadvantages. The central one-third patellar tendon and hamstring tendons are the most commonly used autogenous tissues for replacement of a torn anterior cruciate ligament. Although the central one-third patellar tendon is considered to be 'the gold standard' for replacement of torn ACL. equivalent results have been reported using hamstring tendon grafts. Autogenous hamstring grafts provide adequate strength while avoiding donor site morbidity associated with bone-tendon-bone harvest. $EndoButton^{\circledR}$ femoral fixation allows precise femoral tunnel placement without a second incison. The purpose of this article is to describe surgical techniques using a quadrupled semitendinosus tendon and $EndoButton^{\circledR}$ fixation, and review the results of replacement of ACL.

• Journal of the Korean Arthroscopy Society
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• v.2 no.2
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• pp.114-118
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• 1998

We retrospectively evaluated the changes in the diameter of the tibial tunnel over time following the reconstruction of the anterior cruciate ligament with a bone-patella tendon-bone(BPTB) autograft(25 cases) and quadruple semitendinosus(ST) graft(27 cases) in 52 patients at one year postoperatively. The changes in the geometry of the bony tunnel were measured with radiography. The demensions at final follow up were correated with the clinical results. An increased width of the tibial tunnel was noted in all cases. On the femoral side, however, no tunnel expansion was noted. In AP view, the average tibial tunnel enlargement in ST and BPTB graft groups were 1.30mm(13%) and 1.82mm(17%), respectively. In lateral view, the average tibial tunnel enlargement in ST and BPTB graft group was 1.30mm(13%) and 2.04mm(19%). The differences between two groups were not statistically significant, however, there was evidence of a borderline significance(P=0.0502). Although the tunnel enlargement does not appear to adversely affect the clinical outcome in the short term, the exact mechanism which are involved should be demonstrated. Furthermore histologic study is needed to evaluate graft replacements with emphasis on the graft-tunnel interface.

• Journal of the Korean Arthroscopy Society
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• v.5 no.1
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• pp.13-16
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• 2001

Purpose : To evaluate the types of the fibrous scar formation around graft after ACL reconstruction. Materials and Methods : Between Nov 1997 and Jun. 1999, the second look arthroscopy was performed on 15 knees of 14 patients. We evaluated the changes around graft and measured the tunnel position that the tibial tunnel position as a percentage along the length of the tibial plateau from the anterior-to-posterior as seen on a lateral radiograph and the femoral tunnel position as a percentage along Blumensaat's line from anterior-to-posterior as seen on a lateral radiograph. Results : The tibial tunnel position was from $27\%\;to\;58\%(mean\;41\%)$ and the femoral tunnel position was from $58\%\;to\;83\%(mean\;76\%)$, so the tunnel position was ideal in almost cases. By arthroscopic findings, the grafts were not impinged in all cases and tile fibrous scar was formed between intercondylar notch and graft in almost cases except 3 cases. The types of fibrous scar formation were 6 cases of fibrillated fiber and 5 cases of fibrous nodule and 1 case of fibrous band. Conclusion : There was no impingement on graft in all cases and various types of fibrous scars were formed around grafts.