• Archives of Plastic Surgery
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• v.35 no.6
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• pp.637-644
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• 2008

Purpose: The survival of bone marrow derived stem cell was reported several times. But the survival of adipose tissue derived stem cells(hASCs) was not mentioned on. We studied the adipose tissue derived stem cell's survival and effect on articular cartilage in rabbits. Methods: Osteoarthritis was induced in twenty New Zealand white rabbits by intraarticular injection of monosodium iodoacetate(MIA). After four weeks, hASCs were also injected into the knee joints space without any vehicle, but the control group received phosphate buffered saline only. The histologic grade of articular cartilage was measured in 4 and 8 weeks after the transplantation of hASC and the viability of injected stem cells measured by Fluorescent in situ Hybridization (FISH) examination. Results: After 4 and 8 weeks from hASCs transplantation, histologic grade was not significantly difference between two groups(p>0.05), and the Y chromosome of the transplanted hASCs was not detected in articular cartilage. Conclusion: We found that direct injection of hASC in joint space didn't work on damaged articular cartilage repair.

• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.254-258
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• 2009

Tibial eminence fracture is caused by distortion, excessive flexion and extension, varus and valgus injury of the knee joint in the form of avulsion fracture. A failure over the exact anatomical reduction of fragment can lead to instability and limitation of joint motion. Recently, a variety of arthroscopic assisted reduction and fixation technique have been used. In the tibial eminence fracture, we created an arthroscopic pull-out wire fixation technique using a cannulated screw that is easy and more convenient than in the conventional technique. So we report this technique with a review of current literatures.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.691-698
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• 2021

Background The reverse sural artery (RSA) flap is widely used for lower extremity reconstruction. However, patients sometimes suffer from donor site complications such as scar contracture and paresthesia, resulting in dissatisfaction with the aesthetic outcomes. This study investigated the characteristics of donor site morbidity associated with RSA flaps and described our experiences of dealing with complications by performing resurfacing surgery using thoracodorsal artery perforator (TDAP) flaps. Methods From April 2008 to August 2018, a total of 11 patients underwent contracture release and resurfacing surgery using TDAP flaps due to donor morbidity associated with RSA flaps. All affected donor sites were covered with a skin graft, the most common of which was a meshed split-thickness skin graft (six cases). Results Eight of the 11 patients (72.7%) suffered from pain and discomfort due to scar contracture, and seven (63.6%) complained of a depression scar. The donor sites were located 6.3±4.1 cm below the knee joint, and their average size was 140.1 cm². After resurfacing using TDAP flaps, significant improvements were found in the Lower Extremity Functional Scale (LEFS) scores and the active and passive ranges of motion (AROM and PROM) of the knee joint. The LEFS scores increased from 45.1 to 56.7 postoperatively (P=0.003), AROM increased from 108.2° to 118.6° (P=0.003), and PROM from 121.4° to 126.4° (P=0.021). Conclusions Planning of RSA flaps should take into account donor site morbidity. If complications occur at the donor site, resurfacing surgery using TDAP flaps achieves aesthetic and functional improvements.

• Journal of Life Science
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• v.14 no.3
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• pp.484-489
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• 2004

Artificial joint replacement is one of the major surgical advances of the 21th century. The primary purpose of a TKA (Total Knee Arthroplasty) is to restore normal knee Auction. Therefore, ideally, a TKA should: (a) maintain the natural leverage of the knee joint muscles to ensure generating adequate knee muscle moments to accomplish daily tasks such as rising from a chair or climbing stairs;(b) allow the same range of motion as an complete knee; and (c) provide adequate knee joint stability. Four individuals (2 peoples after surgery one year and 2 peoples after surgery three years) participated in this study. All they were prescreened for health and functional status by the same surgeon who performed the operations. Two days of accommodation practice occurred prior to the actual strength testing. The isometric strength (KIN-COM III) of the quadriceps and hamstring were measured at 60$^\circ$ and 30$^\circ$ of knee flexion, respectively. During isokinetic concentric testing, the range of motion was between 10$^\circ$ to 80$^\circ$ of knee flexion (stand-to-sit) and extension (sit-to-stand). for a given test, the trial exhibiting maximum torque was analyzed. A 16-channel MYOPACTM EMG system (Run Technologies, Inc.) was used to collect the differential input surface electromyographic (EMG) signals of the vastus medialis (VM), vastus lateralis(VL), rectus femoris (RF) during sit-to-stand and stand-to-sit tests. Disposable electrodes (Blue SensorTM, Medicotest, Inc.) were used to collect the EMG signals. The results were as follows; 1. Less maximum concentric (16% and 21% less for 1 yew man and 3 years mm, respectively) and isometric (12% and 29%, respectively) quadriceps torque for both participants. 2.14% less maximum hamstrings concentric torque for 1 year man but 16% greater torque for 3 years mm. However, 1 year man had similar hamstring isometric peak torque for both knees. 3. Less quadriceps co-contraction by 1 year man except for the VM at 10$^\circ$-20$^\circ$ and 30$^\circ$-50$^\circ$ range of knee flexion.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.11-18
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• 2002

Large soft tissue defects around the knee joint are known to significantly diminish joint function. Severe soft tissue defects on the anterior aspect of the knee joint especially bring on significant joint motion limitation. Although simple split skin grafts can cover the skin defect, the progressing scar contracture of the grafted skin causes joint stiffness. One of the best solutions of large soft tissue defects around the knee joint is covering the defect with a good quality skin flap. Separated flaps with one vascular pedicle are good candidates for covering anterior and posterior aspects of the joint for example. Authors performed 12 cases of combined scapular and latissimus dorsi free flaps from 1984 to 2000. Among them, we experienced 5 cases of knee joint defect covering using the double free flap for coverage of the soft tissue defect with preservation of the knee joint function and satisfactory results. The system of flaps based on the subscapular artery and vein provides a variety of composite free flaps. The possible flaps that can be harvested based on this single vascular pedicle include the scapular and parascapular skin flap, the serratus anterior and latissimus dorsi muscular flap, the lateral scapular bone flap, the latissimus dorsi-rib flap, and the serratus anterior-rib flap. This combined flap is available for multiple tissue defects or complex defects because it can be incorporated with skin, muscle and bone flaps. A main advantage is the independent vascular pedicles of each component, which allow freedom in orientation of each components. Consequently it can be freely applied to any form of three dimensional defects on the upper and lower extremities. The combination of scapular cutaneous flap and latissimus dorsi musculocutaneous flap can be resurfaced for massive cutaneous defects on the extremities. We report the use of the combined scapular and latissimus dorsi free flap in five patients to reconstruct massive defects on the extremities with resultant improved joint function. There was no flap failure and minimal complications and disadvantages. The anatomy of this flap is reviewed and the indication and advantages are discussed. All of the five flaps survived and there was no scar contracture affecting the joint motion.

• Journal of Korean Orthopaedic Sports Medicine
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• v.8 no.1
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• pp.19-25
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• 2009

Purpose: We report mid to long - term results of meniscal transplantation and evaluate the important factors for successful outcomes. Materials and Methods: Between December 1999 and September 2002, 25 meniscal transplantations were performed using fresh frozen allograft. The lateral meniscus was transplanted in 19 cases and medial meniscus in 6 cases. The mean age was 34 years (range, 17~50 years) and the mean follow up was 54.8 months (range, 6~85 months). Preoperative measurements were made using a ruler graded in millimeters. Lateral meniscus was fixed by keyhole technique and medial meniscus was fixed by double bone plug technique with suturing the periphery of the meniscal transplant. All patients were evaluated with Knee Assessment Scoring System (KASS), Lysholm knee score, and Tegner activity scale for daily activity. Results: Symptoms improved in all cases. The average KASS score increased from 61.7 preoperatively to 83.8 postoperatively. The average Lysholm knee score increased from 77.7 preoperatively to 87.7 postoperatively (excellent in 3 cases, good in 17 cases, fair 4 cases, poor 1 case). But painful swellings were 3 cases, numbness in 1 case, and granuloma due to non-absorbable suture material in 1 case. Peroneal nerve palsy in 1 case was recovered after 6 weeks postoperatively. Conclusion: Meniscal allograft transplantation after subtotal or total menisectomy can significantly relieve pain and improve function of the knee joint. The exact preoperative sizing and secure fixation are essential for successful outcomes.

• Journal of the Korean Arthroscopy Society
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• v.11 no.1
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• pp.13-19
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• 2007

Purpose: We investigated the natural history of acute, isolated posterior cruciate ligament injuries treated conservatively. Materials and Methods: Between February 1999 and October 2006, we evaluated retrospectively the results of acute, isolated posterior cruciate ligament injuries treated conservatively. The subjects consisted of 21 patients. At initial and follow up visits physical examination, $KT-2000^{TM}$ arthrometer and MRI were performed to assess improvement on the knee stability and continuity of the posterior cruciate ligament. IKDC (International Knee Documentation Committee) knee scoring and quadriceps muscle strength were also checked in all population. Comparing the results of initial and follow up examinations we assessed the natural history of acute, isolated posterior cruciate ligament injuries treated conservatively. The mean follow up period was 22.7 months. Results: The posterior drawer test showed 14 cases of Grade I, 6 cases of Grade II and 1 case of Grade III progressing 18 cases of Grade I and 3 cases of Grade II. The mean difference of 5.7mm by $KT-2000^{TM}$ arthrometer was changed Into 2.7mm and the continuity of posterior cruciate ligament initially checked by 48.1% on MRI increased to 69.7%. The mean quadriceps muscle strength was grade 'Good' and mean IKDC knee score was nearly grade 'A'. Conclusion: Our study suggests that patients with acute, isolated posterior cruciate ligament injuries treated conservatively may get good clinical outcomes on clinical situation and MRI.

• Transactions of the Korean Society of Mechanical Engineers B
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• v.35 no.12
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• pp.1301-1307
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• 2011

Electrosurgical knee wand (EKW) is a high-frequency thermocautery instrument and is often used for coagulation, ablation, excision, and extirpation of knee ligaments and tissues. In order to maximize the success rate, ease, and safety of knee surgery using EKW and radiofrequency ablation, it is necessary to ensure that the EKW selectively approaches the lesion with utmost accuracy and safety. The key feature of this instrument is its excellent maneuverability. Hence, the authors constructed a tensile spring model based on a shape memory alloy (SMA), which exhibits the shape memory effect. This model can be used in knee surgery as it is considered the most biocompatible femorotibial surgical actuator. The changes in external temperature with current and the thermoelectric characteristics of the SMA were investigated. The relationship between the restoring force and the typical stroke (TS) in response to the conditions in the SMA tensile spring design were evaluated. In conclusion, as the diameter of the SMA tensile spring decreased, the maximum temperature increased. The strain in the actuator caused a stable and proportional increase in the force and induced current for up to 15s, but this increase became very unstable after 30s. Moreover, the relationship between the current and the TS was more stable than that between the current and the restoring force.

• Clinics in Shoulder and Elbow
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• v.17 no.4
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• pp.201-204
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• 2014

Pulmonary embolism is a serious complication, which is well known in patients undergoing total hip or total knee arthroplasty or lower extremity fracture surgery. But, there are few literatures concerning pulmonary embolism after upper extremity surgery. Pulmonary embolism after minor upper extremity fracture surgery is extremely rare. We report a case of 66-year-old female patient that developed pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the proximal humerus with literature review.

• Journal of Chest Surgery
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• v.48 no.4
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• pp.302-305
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• 2015

Pseudoaneurysm with arteriovenous fistula is a rare complication of arthroscopy, and can be diagnosed by ultrasonography, computed tomography, magnetic resonance imaging, or angiography. This condition can be treated with open surgical repair or endovascular repair. We report our experience with the open surgical repair of a pseudoaneurysm with an arteriovenous fistula in a young male patient who underwent arthroscopy five months previously.