• Journal of the Korean Arthroscopy Society
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• v.7 no.1
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• pp.92-95
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• 2003

A 34-year-old man with ACL total rupture due to slip down injury, had received ACL reconstruction using autogenous hamstrings tendon with cross-pin femoral fixation. Postoperative course was as usual. But postoperative 3 months later, he complained posterolateral knee pain, recurrent effusion and mild instability. He was managed repeatitive aspiration and nonsteroid antiinflammatory drugs but was failed to relieve symptoms & signs. In CT scans, perforation of posteromedial femoral cortex of lateral femoral condyle was found. In second look arthroscopy, two pieces of broken femoral cross pin were found in between tibiofemoral Joint which was badly injured cartilage. We considered malposition of pins was the main cause of failure. We propose that femoral tunnel must be made more acute angle and femoral cross-pin guide must be positioned more external rotation 10-20 degree than transepicondylar axis made confirm the cross-pin tunnel position in order to avoid posterior cortex perforation and early failure.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1508-1515
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• 1992

Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.13 no.1
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• pp.67-72
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• 2007

Anatomy: The rotator cuff comprises four muscles-the subscapularis, the supraspinatus, the infraspinatus and the teres minor-and their musculotendinous attachments. The subscapularis muscle is innervated by the subscapular nerve and originates on the scapula. It inserts on the lesser tuberosity of the humerus. The supraspinatus and infraspinatus are both innervated by the suprascapular nerve, originate in the scapula and insert on the greater tuberosity. The teres minor is innervated by the axillary nerve, originates on the scapula and inserts on the greater tuberosity. The subacromial space lies underneath the acromion, the coracoid process, the acromioclavicular joint and the coracoacromial ligament. A bursa in the subacromial space provides lubrication for the rotator cuff. Etiology: The space between the undersurface of the acromion and the superior aspect of the humeral head is called the impingement interval. This space is normally narrow and is maximally narrow when the arm is abducted. Any condition that further narrows this space can cause impingement. Impingement can result from extrinsic compression or from loss of competency of the rotator cuff. Syndrome: Neer divided impingement syndrome into three stages. Stage I involves edema and/or hemorrhage. This stage generally occurs in patients less than 25 years of age and is frequently associated with an overuse injury. Generally, at this stage the syndrome is reversible. Stage II is more advanced and tends to occur in patients 25 to 40 years of age. The pathologic changes that are now evident show fibrosis as well as irreversible tendon changes. Stage III generally occurs in patients over 50 years of age and frequently involves a tendon rupture or tear. Stage III is largely a process of attrition and the culmination of fibrosis and tendinosis that have been present for many years. Treatment: In patients with stage I impingement, conservative treatment is often sufficient. Conservative treatment involves resting and stopping the offending activity. It may also involve prolonged physical therapy. Sport and job modifications may be beneficial. Nonsteroidal anti - inflammatory drugs(NSAIDS) and ice treatments can relieve pain. Ice packs applied for 20 minutes three times a day may help. A sling is never used, because adhesive capsulitis can result from immobilization.

• PNF and Movement
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• v.17 no.3
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• pp.441-450
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• 2019

Purpose: This study identified the co-activation of quadriceps and hamstring muscles during hamstring strengthening exercises in healthy adults. Methods: Twenty-one participants were required for the present study design to achieve 80% power, 0.8 effect size (η2), and an alpha level of 0.05. Thus, this study recruited 21 healthy adults. All participants performed Nordic exercises, bridge exercises, and one-leg deadlifts randomly. The activity of the rectus femoris, vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF), and semitendinosus (SM) were measured. In addition, the ratios of VM/VL and hamstring/quadriceps (HQ) were measured during the three hamstring strengthening exercises using electromyography. One-way ANOVA was used to compare the co-activation of quadriceps and hamstring muscles in the three exercises. Results: The activity of VM and VL during the performance of one-leg deadlifts was significantly higher than the other two exercises. The BF had significantly higher activity during the Nordic exercises compared to the other two exercises. In addition, the SM activation was significantly greater during Nordic exercises than one-leg deadlifts. Additionally, there was significant difference in HQ ratio among hamstring strengthening exercises. In specific, the one-leg deadlifts yielded a significantly lower HQ ratio. Conclusion: This study revealed that one-leg deadlifts are effective in rehabilitation for anterior cruciate ligament injury. In addition, Nordic exercises can be recommended to facilitate hamstring muscle activation.

• Journal of the korean academy of Pediatric Dentistry
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• v.40 no.2
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• pp.120-126
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• 2013

Preserving the pulp is important in the treatment of carious pulp exposure in young permanent teeth. Pulpotomy is a vital pulp therapy in which a portion of the coronal pulp tissue is surgically removed, and the remaining radicular tissue is covered with suitable material that protects the pulp from further injury and permits and promotes healing. It is important to develop biocompatible treatment directed at maintaining pulp vitality and increasing tooth longevity. Platelet-rich fibrin (PRF) has been referred to as a second-generation platelet concentrate. Two clinical cases in which PRF was applied as a medicament after pulpotomy of an immature permanent tooth are presented. After isolation, caries removal and pulpotomy with PRF was performed. A layer of mineral trioxide aggregate (MTA) was placed over the PRF, and the final restoration was performed. Postoperatively, the patient had no pain or discomfort, and follow-up radiographs revealed normal periodontal ligament space and trabecular bone pattern.

• Journal of the Korean Society of School Health
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• v.24 no.1
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• pp.12-22
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• 2011

Purpose: The purpose of this study was to identify incidence of nonfatal unintentional injuries (accidents) among students, and to investigate compensation payment for five years (2000~2004) in schools located in Seoul. Methods: Subjects were 14,783 students injured among elementary, middle and high school students. The accumulated data for 5 years (2000~2004) was from the Seoul School Safety and Insurance Association. Chi-square, ttest, logistic regression, and MANCOVA were conducted. Results: The most frequent accidents occurred among males (73.2%), and in special school students (3.86 per 1,000) followed by middle school students (3.05 per 1,000), in May (0.25 per 1,000) followed by June and October, in physical education classes (0.73 per 1,000) followed by special activities (0.40 per 1,000), recess (0.31 per 1,000) and lunch (0.29 per 1,000). Fractures (0.86 per 1,000) were followed by mild injuries (0.39 per 1,000), joint and ligament injuries (0.31 per 1,000), and teeth injuries (0.26 per 1,000). After adjusting for potential confounding variables, the highest means of final compensation payment was for burns (810 thousand KRW) followed by the teeth injuries (506 thousand KRW), cleaning injuries (550 thousand KRW) followed by injuries incurred during special activities (510 thousand KRW) and injuries incurred at special schools (556 thousand KRW). Conclusion: In school, the highest incidences of nonfatal unintentional injuries were in special schools, among males, fractures and physical education. However, the highest compensation payments were for burns, and injuries taking place at special schools and during cleaning hour. Proper health education including teaching healthy habits for safety/injury prevention is needed to prevent injuries and decrease compensation.

• Physical Therapy Korea
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• v.28 no.1
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• pp.27-35
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• 2021

A weak or dysfunctional gluteus medius (Gmed) is related to several pathologies, and individuals with hip abductor weakness have Gmed weakness. This study aimed to systematically review the literature associated with the anatomy and function of the Gmed, and the prevalence, pathology, and exercise of Gmed weakness. Papers published between 2010 and 2020 were retrieved from MEDLINE, Google Academic Search, and Research Information Sharing Service. The database search used the following terms: (glut* OR medius OR hip abduct*) AND weak*. The Gmed plays an important role in several functional activities as a primary hip abductor by providing pelvic stabilization and controlling hip adduction and internal rotation. Weakness of the Gmed is associated with many disorders including balance deficit, gait and running disorders, femoroacetabular impingement, snapping hip, gluteal tendinopathy, patellofemoral pain syndrome, osteoarthritis, iliotibial band syndrome, anterior cruciate ligament injury, ankle joint injuries, low back pain, stroke, and nocturia. Overuse of the tensor fasciae latae (TFL) as a hip abductor due to Gmed weakness can also cause several pathologies such as pain in the lower back and hip and degenerative hip joint pathology, which are associated with dominant TFL. Similarly, lateral instability and impaired movements such as lumbar spine lateral flexion or lateral tilt of the pelvis can occur due to compensatory activation of the quadratus lumborum for a weakened Gmed while exercising. Therefore, the related activation of synergistic muscles or compensatory movement should be considered when prescribing Gmed strengthening exercises.

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.140-147
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• 2023

Background: The management of acromioclavicular (AC) joint dislocation remains controversial. Recently, anatomic coracoclavicular (CC) fixation with a double clavicular tunnel and three flip-buttons has shown promising results. This study aimed to evaluate functional and radiological outcomes in patients with high-grade AC joint dislocation treated with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Methods: A retrospective, unicentric study was performed. The study included patients with high-grade AC joint dislocation who underwent surgery with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Demographic data were obtained from medical records. A functional evaluation using subjective shoulder value (SSV), visual analog scale (VAS), and disabilities of the arm, shoulder, and hand (DASH) questionnaires was performed, and an evaluation of preoperative and postoperative comparative Zanca view images was performed. Factors associated with functional outcomes and radiological AC reduction were analyzed. Results: A total of 83 patients completed follow-up and were included in the analysis. The mean SSV, VAS, and DASH scores were 92.8, 0.8, and 6.4, respectively. Patients who had complications experienced significantly worse functional outcomes (DASH: P=0.037). Suboptimal final AC reduction was observed in nine patients (11.1%), and significantly more frequently in patients older than 40 years (P=0.031) and in surgeries performed more than 7 days after injury (P=0.034). There were two reoperations (2.4%). Conclusions: Anatomic CC fixation with a double clavicular tunnel and three flip-buttons leads to good functional outcomes, low complication rates, and high rates of optimal AC reduction.

• Journal of Korean Foot and Ankle Society
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• v.27 no.4
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• pp.137-143
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• 2023

Purpose: Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs. Materials and Methods: Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evaluations comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation. Results: The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT. Conclusion: AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS.

• Journal of the Korean Arthroscopy Society
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• v.5 no.2
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• pp.124-130
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• 2001

Purpose : To identify occult intra-articular pathologies in the acute ankle fracture using arthroscopy and to investigate the factors to predict its possibility of occult injuries that could be occurred. Materials and Methods : This prospective study included fifty patients who got operation for the ankle fractures. Ankle arthroscopy was performed to document the type and anatomical location of occult lesion. We investigated the correlation between incidence of occult injuries and specific fracture type. Results : Of fifty ankles, 37 ankles had occult lesion. Twenty five loose bodies including displaced fragments were found and various cartilage lesions were found in 31 ankles. Tibial avulsion fragment by anterior inferior tibiofibular ligament was occurred in 6 cases. There was no correlation between the incidence of occult lesion and various factors including age, sex, injury mechanism and fracture type(p>0.05). Conclusion : The ankle arthroscopy had an effective role for the detection and treatment of occult injuries and it was difficult to predict the occurrence or associated accurately in all of th ankle fractures.