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Double-bundle Anterior Cruciate Ligament Reconstruction using Autogenous Hamstring Grafts (이중 다발 자가 슬괵건을 이용한 전방십자인대 재건술)

  • Choi, Nam-Yong;Nam, Won-Sik;Yang, Young-Jun;Han, Chang-Hwan;Moon, Chan-Woong;Kwon, Jae-Young;Song, Hyun-Seok
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.2
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    • pp.112-117
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    • 2008
  • Purpose: Double-bundle reconstruction of anterior cruciate ligament(ACL) has the advantage of restoring the isometry and original function of ACL. The purpose of this study is to evaluate the clinical results following double-bundle reconstruction of ACL using autogenous hamstring grafts through an accessory anteromedial portal. Materials and Methods: From January 2005 to July 2006, sixty patients(52 males, 8 females) underwent double-bundle ACL reconstruction using autogenous hamstring tendons..The mean age was 31.7 years($20{\sim}51$ years). The mean follow up period was 13.4 months($12{\sim}16$ months). We made a horizontal-oblique skin incision just medial to tibial tuberosity and harvested semitendinosus and gracilis tendon. Tibial tunnel for posterolateral bundle was made near its anatomical position. By modifying an anatomic reconstruction of ACL by Yasuda et al., we made a femoral tunnel for posterolateral bundle through accessory anteromedial portal. Tunnels for anteromedial bundle were made with conventional method. We reconstructed anteromedial bundle with semitendinosus tendon and posterolateral bundle with gracilis tendon. Clinical results at last follow up were evaluated by range of motion, extent of anterior displacement(KT-1000 arthrometer), pivot-shift test. Functional evaluation of clinical outcomes were evaluated by Lysholm score and modified Feagin Scoring System. Results: There was no limitation of motion of knee joint at last follow up. Mean side to side difference of anterior displacement of tibia by KT-1000 arthrometer was improved from 8.4 mm preoperatively to 1.7 mm postoperatively(p<0.05). Average Lysholm score was improved from 64.1 preoperatively to 92.2 postoperatively(p<0.05). In modified Feagin Scoring System, 90% of cases were rated as good or excellent. Conclusion: Double-bundle reconstruction of ACL using autogenous hamstring grafts through accessory anteromedial portal results in good clinical outcomes.

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Comparison of the Incidence and Risk Factors for Developing Osteoarthritis after ACL Reconstruction - Patellar Versus a Hamstring Autograft - (전방 십자 인대 재건술 후 골관절염의 발생 빈도 및 위험 인자들에 대한 비교 - 자가 슬개건과 자가 슬괴건을 이용한 방법 -)

  • Song, Eun-Kyoo;Seon, Jong-Keun;Kim, Hyung-Soon;Kang, Kyung-Do;Byun, Jae-Wook
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.9 no.1
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    • pp.48-57
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    • 2010
  • Purpose: To compare the incidence and risk factors for osteoarthritis after anterior cruciate ligament (ACL) reconstruction between two groups using bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autograft. Materials and Methods: 53 cases of ACL reconstruction using patellar tendon and 40 cases using hamstring tendon were followed up at least 8 years. Radiographic evaluation was done according to the Kellgren and Lawrence's classification. Clinical functional testing (Lysholm Knee Scores, the Tegner activity scores) and laxity testing (Lachman, pivot shift tests), and the instrumented laxity testing with $Telos^{(R)}$ were all examined in relation to the development of osteoarthritis. Results: Radiographic osteoarthritic changes were detected in 24 patients (45.3%) in BPTB group and 14 patients (35.0%) in HT group. Accompanying meniscal injury (BPTB p<0.001; HT p=0.091), intervals from the injury to reconstruction of > 12 months (BPTB p=0.037; HT p=0.021), and patient's age at reconstruction of > 25 years (BPTB p=0.003; HT p=0.048) were found to be significant independent predictors of osteoarthritis. However, no statistically significant correlations were found between the development of osteoarthritis and the clinical outcome or the radiographic stability in both groups. Conclusion: Although ACL reconstruction using BPTB or HT autograft had good clinical results at an average follow-up of 10 years, considerable incidence of radiographic osteoarthritic changes were noted. Various factors such as accompanying meniscal injury, protracted time from injury to reconstruction, more than 25 years old at the time of reconstruction were related to radiographic osteoarthritic changes.

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Comparison of the Results between Anterior Cruciate Ligament Reconstruction alone and Combined with High Tibial Osteotomy for anterior Cruciate Ligament Ruptured Knees with Varus Alignment (전방 십자 인대 파열과 슬관절 내반 변형 동반시 근위 경골 절골술과 전방 십자 인대 재건술의 동반 치료와 전방 십자 인대 재건술의 단독 치료의 비교)

  • Kwak, Ji Hoon;Sim, Jae Ang;Lee, Yong Seuk;Hwang, Chul Ho;Lee, Beom Koo
    • Journal of the Korean Arthroscopy Society
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    • v.17 no.1
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    • pp.44-49
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    • 2013
  • Purpose: To compare of the results between anterior cruciate ligament (ACL) reconstruction alone and combined with high tibial osteotomy for ACL ruptured knees with varus alignment. Materials and Methods: We retrospectively reviewed 8 cases of ACL reconstruction combined with high tibial osteotomy (Group I) and 13 cases of ACL reconstruction alone (Group II) for varus angulated ACL ruptured knees (from March 2005 to February 2007). Mean age were 34.1 years (range: 20-53) in Group I, 34.9 years (range: 21-50) in Group II. Average follow up period were 22.6 months (range: 12-35) in Group I, 20 months (range: 13-33) in Group II. We analyzed clinical and radiological results. Results: There were no significant differences in clinical and radiologic results between two groups for IKDC scores, Lysholm knee scores, Lachman test, pivot shift test, KT-2000 arthrometer, $30^{\circ}$ and $90^{\circ}$ anterior drawer stress radiographs. Tegner activity scales and Cincinnati knee ligament rating scales were 4.9, 57.9 in Group I, and 5.6, 72.9 in Group II. Group I was statistically lower than Group II for Tegner activity scales and Cincinnati knee ligament rating scales (p<0.05). Conclusion: There were no significant differences in daily living between ACL reconstruction alone and combined with high tibial ostetomy for varus angulated ACL ruptured knees. However, ACL reconstruction combined with high tibial osteotomy could limit sport activity ability.

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ACL Reconstruction with Hamstring Tendon and LA (Ligament anchor) Screw (슬괵건과 LA나사를 이용한 관절경적 전방 십자 인대 재건술)

  • Song Eun-Kyoo;Seon Jong-Keun;Cho Sang-Gwon
    • Journal of the Korean Arthroscopy Society
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    • v.7 no.2
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    • pp.189-195
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    • 2003
  • Purpose : To evaluate the clinical results after anterior cruciate ligament (ACL) reconstruction with hamstring tendon and Ligament Anchor (LA) screw Materials and Methods : 103 patients (104 cases) who were followed up at least more than 2 years after ACL reconstruction were included in this study. The average period of follow-up was 36 months. The clinical results such as physical examination and Lysholm knee score and instrumented anterior laxity test with Telos were evaluated. Results : The Lysholm knee score was 57.9 in average preoeratively and improved to 95.2 in average at follow up. On the Lachman test, there were mild (+) instability in 46 cases $(45\%)$, moderate (++) in 33 $(31\%)$, severe (+++) in 25 $(24\%)$ preoperatively. 90 cases $(87\%)$ were converted to negative and 14 $(13\%)$ to mild at follow up. On Pivot-shift test, there were negative (-) instability in 22 cases $(22\%)$, mild (+) in 62 $(59\%)$, moderate (++) in 12 $(11\%)$ and severe in 8 $(8\%)$ preoperatively. 87 cases $(84\%)$ were converted to negative and 17 $(16\%)$ to mild at follow up. On instrumented anterior laxity test with $Telos^{\circledR}$, side to side difference on 20 lb was $13.4{\pm}5.6$ (7-25) mm in average preoperatively, and was decreased to $3.6{\pm}1.5$ (1-6) mm in average at follow-up. Complications were quadriceps muscle atrophy in 27 $(30.0\%)$, saphenous nerve paresthesia in 19 $(18.3\%)$, anterior knee crepitus in 13 $(12.5\%)$ and over-penetration of screw through lateral femoral cortex in 5 cases $(4.8\%)$. Conclusion : ACL reconstruction with hamstring tendon and LA screw was one of the choice of graft and fixatives in restoring knee stability and in improving clinical results with little complications such as anterior knee pain.

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Comparison of Results of ACL Reconstruction According to the Fixation Materials (Metal & Bioabsorbable Interference Screw and RIGIDfix) (금속, 흡수성 간섭 나사못 및 RIGIDfix를 이용한 전방 십자 인대 재건술의 결과 비교)

  • Lim Hong Chul;Wang Joon Ho;Rho Young Jin;Hwang Jin Ho
    • Journal of the Korean Arthroscopy Society
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    • v.7 no.2
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    • pp.206-214
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    • 2003
  • Purpose : To analysis each clinical results after arthroscopic ACL reconstruction with using variable fixatives which are metallic and bioabsorbable interference screw, and RIGIDfix. Therefore, We reported the clinical reliability and safty of ACL reconstruction using RIGIDfix. Materials and Methods : We evaluated the results of arthroscopic ACL resconstruction with patellar tendon autograft among three groups, of which group 1 is used metal interference screw for 44 patients, group 2 used bioabsorbable interference screw for 47 patients, group 3 used RIGIDfix for 42 patients. We compared the clinical results by physical examination (anterior drawer test, Lachman test and pivot shift test), Lysholm score and KT-2000 arthrometer and compared the radiological results by measurement of tunnel and fixatives position and widening and by MRI findings. We analyzed the results by SAS 8.2 Ducan. Tukey and paired t-test Results : Physical instability was in 5 cases, which group 2 had 4 cases and group 3 had 1 case. Lysholm score improved from 59.8. 64.4, 61 to 90.1, 92.3. 92. KT-2000 arthrometer instability improved from 9.20, 10.2, 9.5 to 1.43. 1.62. 2.00 (p=0.478). Radiologically, all cases had excellent tunnel position and cyst change was observed the 8 cases in the group 2, but, all 20 cases 2nd MRI had signal change of peri-fixatives. But, no correlation of clinical results. Conclusion : No statistical difference of clinical instability was found among three groups. And femoral tunnel changes were much observed in group I, II than III. We considered the RIGIDfix has much advantages because the short operation time, better fixation position and much bone contact surface. But, further long term follow up study was needed.

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Relationship between Graft Appearance on Follow-up MRI and Knee Stability after Double Bundle ACL Reconstruction (이중 다발 전방십자 재건술 후 이식건의 자기공명영상 추시와 슬관절 안정성과의 관계)

  • Sim, Jae Ang;Kwak, Ji Hoon;Lee, Yong Seuk;Kim, Kwang Hui;Nam, Shin Woo;Jun, Sung Soo;Lee, Beom Koo
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.2
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    • pp.128-133
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    • 2012
  • Purpose: This study examined the relationship between graft appearance on follow-up magnetic resonance imaging (MRI) and knee stability after double bundle anterior cruciate ligament (ACL) reconstruction. Materials and Methods: For each patient, 1.5 tesla MRI's were obtained. The signal intensity of grafts was divided into 3 grades by Sononda's classification. The course of grafts was divided into two patterns: straight and curved. We assessed Lachman test, KT 2000 arthrometer and anterior drawer stress radiograph using Telos$^{(R)}$ in $30^{\circ}$ knee flexion for anterior stability and evaluated pivot shift test for rotatory stability. The correlation between graft appearance on MRI and the results of knee stability tests was evaluated. Results: The anteromedial (AM) graft was evaluated as being grade 1 in 66.7%, grade 2 in 26.7%, and grade 3 in 6.7% of the cases and the posterolateal (PL) graft was assessed as being grade 1 in 63.3%, grade 2 in 33.3%, and grade 3 in 3.3% of the cases according to the signal intensity. The AM graft was evaluated as being straight in 83.3% and curved in 16.7% of the cases, and the PL graft was assessed as being straight in 86.7% and curved in 13.3% of the cases according to the course. The course of AM graft was correlated with the results of anterior stability tests and the course of PL graft was correlated with the result of rotatory stability test. However, the signal intensity of grafts was not correlated with the results of anterior stability and rotatory stability tests. Conclusion: The course of AM is correlated with anterior stability and the course of PL is correlated with rotatory stability on follow-up MRI after double bundle ACL reconstruction.

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Clinical Results of ACL Reconstruction in the Immature Adolescent via Transphyseal Approach in Tibia Based on a New Indication Paradigm (새로운 수술적응증에 의한 골 미성숙 전방십자인대 손상 환자에서의 성장판을 통과하는 전방십자인대 재건술의 결과)

  • Lee, Dong Chul;Shon, Oog Jin;Park, Chul-Hyun;Kwon, Moon Soo
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.1
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    • pp.1-8
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    • 2012
  • Purpose: To evaluate clinical and radiologic outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes who were selected with authors' new operative indications. Materials and Methods: We evaluated 15 patients with open physes who underwent a transtibial ACL reconstruction and were followed up for 4~6 years after surgery. Our operative indications involved 1) choronologic age of ${\geq}$ 16 in male and ${\geq}$ 14 in female, 2) open physes of ${\leq}$ 2 mm width, and 3) Risser sign and Tanner stage of ${\geq}$ 3. Tibialis anterior tendon allograft was used in all patients, and endobutton and bioscrew were used for femoral and tibial fixations, respectively. Functional outcomes were evaluated using Lysholm Knee Scoring scale, Tegner activity scale, and International Knee Documentation Committee (IKDC) 2000 subjective score. Physical examinations to evaluate stability involved Lachman and pivot shift tests. For radiographic results, we evaluated side to side differences of anterior displacement in stress views. In addition, with use of scannograms taken at last follow-up, we examined side to side differences of femorotibial angles, anatomical and mechanical lateral distal femoral angles, mechanical medial proximal tibial angles and leg lengths. Results: The mean Lysholm Knee score was 51(40-61) points preoperatively and 97(94-100) points at last follow up. The mean Tegner activity score was 2.6 points preoperatively and 7.1 points at last follow up. The mean IKDC score was 32.6 points preoperatively and 88.3 points at last follow up. The mean anterior displacement of the tibia was improved from 6.7(${\pm}1.0$) mm to 1.9(${\pm}0.9$) mm. There were no leg length discrepancies over 5 mm and no statistically significant differences in all the radiographic variables representing growth disturbance. Conclusion: This study suggests that patients with open physes who selected by authors' new indication would safely undergo transphyseal ACL reconstruction with successful outcomes.

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MRI Findings of the Repaired Anterior Cruciate Ligament (전방 십자 인대의 일차 봉합술 후 MRI 소견)

  • Kim, Jung-Man;Koh, In-Jun;Lee, Dong-Yeob;Lee, Yoon-Min
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.1
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    • pp.14-21
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    • 2009
  • Purpose: To investigate MRI findings of the repaired anterior cruciate ligament (ACL). Materials and Methods: Seventeen of arthroscopic ACL primary repair with sutures pull-out technique were followed for 21.4 months (range: 12 to 60 months). Stability was assessed with physical examination and KT-1000 arthrometer (MED metric, San Diego, CA) and postoperative MRI checked with time. The patients were divided into 2 groups according to the location of tear which was defined with the location of remained synovial sleeve. Group I (11 patients) comprised that the tear was located within proximal 1/3 of ACL substance and group II (6 patients) comprised below proximal 1/3. MRI findings of the repaired ACL were evaluated by its course, sharpness, thickness and signal intensity using 3 grade system and correlated with its location of tear. Results: In all cases, Lachman test and flexion-rotation drawer test were negative, pivot-shift test was less than grade 1 and the mean side-to-side difference by use of KT-1000 arthrometer was 1.4 mm (range: -1.0 to 2.5 mm). The overall continuity of the repaired ACL was well maintained in all cases. However, mild sagging was observed in 10 cases(58.8%), mild obscure contour in 6 cases (35.3%), increased thickness in 8 cases (47.1%) and slight increased signal intensity in 5 cases (29.5%). There was no statistical significance in all parameters between 2 groups. And a focal defect at the femoral attachment site in sagittal image was observed in 7 cases (41.2%) of all patients which comprised 2 cases (18.2%) of group I and 5 cases (83.3%) of group II. It was observed more frequently in group II with statistical significance (p=0.035). Conclusion: Some abnormal MRI findings such as mild sagged course, obscure contour, increased thickness and signal intensity, the focal defect at femoral attachment site could be observed even though the stability was well maintained clinically. We thought that the focal defect was affected by the location of tear of ACL.

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The Symbolism and Significance of the Dao Flag in Daesoon Jinrihoe (대순진리회 도기(道旗)의 상징과 의미)

  • Choi Chi-bong
    • Journal of the Daesoon Academy of Sciences
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    • v.43
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    • pp.103-137
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    • 2022
  • In religious symbology, an emblem is a symbolic mark, which differentiates a religion from other groups. In addition, it holds a symbolic or conceptual character that enables viewers to recognize a certain religion. Daesoon Jinrihoe, a representative order among Korean religious traditions, also has a symbolic mark; however, it has not been designated with an official name as symbol despite its usage dating back to May 11, 1978. At the time, that mark has served as an emblem. Afterwards, the emblem was printed and has been officially used as a flag (unofficially known as the Dao Flag, the Fellowship Flag, etc.) since October 20th of that same year. The emblem of Daesoon Jinrihoe which is not only printed in the flag but has been utilized as a symbolic mark representing the order. Nevertheless, it is hard to find research related to this symbol. Consequently, this study aims to apprehend the existing materials about the flag's emblem and its meaning, as well as attempt to interpret its various implications. Indeed, this work will suggest another point of view about the emblem given that it embraces ambiguity. This research suggests that the emblem symbolically depicts the Daesoon (Great Itineration), Samwon (三圓, Three Circles), Sadae (四大, Four Dae), and the Center, and that, all together, this can imply more profound meanings than were expressed in previously posited explanations. As such, this study draws further significance from Daesoon Thought and find: first, the circle in the center of the emblem signifies the pivot of Daesoon; not just the earthly circle (地圓) or the human circle (人圓). This opens up the possibility that the circle symbolizes Mugeuk (Limitlessness) and Taegeuk (Great Ultimate), which include the pivot of Heaven, Earth, and Humanity. Secondly, the symbol of soil (土) in the center is separated from the human circle and reveals the symbol of harmony and creation as the rod shape of Four Dae. Thirdly, the protuberances in the circle point to specific directions and this allows for additional layers of meaning.

An Essay on the Change of Jinju Sword Dance after being designated as an Important Intangible Cultural Asset (<진주검무> 중요무형문화재 지정 이후의 변화에 관한 소고)

  • Lee, Jong Sook
    • Korean Journal of Heritage: History & Science
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    • v.49 no.1
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    • pp.4-21
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    • 2016
  • The purpose of this study is to investigate changes of Jinju Sword Dance, characteristics of the changes, and the current condition of its preservation and succession after the designation as the important intangible cultural property no. 12 in January 16th, 1967. In other words, this study understands the situation which has established the present state of after changes over generations. As of now. the year of 2015, the 3 generation holders have been approved since 1967. In 1967, 8 members of $1^{st}$ generation holders were selected from gisaengs of Gwonbeon. However, the succession training was incomplete due to conflicts among the holders, the deaths of some holders, and economic activities of the individuals. As the need of a pivot for succession training and activities was rising, Seong, Gye-Ok was additionally approved as the $2^{nd}$ generation holder on June $21^{st}$, 1978. Seong, Gye-Ok who had never been a gisaeng had dramatically changed with a lot of new attempts. After the death of Seong, Gye-Ok in 2009, Kim, Tae-Yeon and Yu, Yeong-Hee were approved as the $3^{rd}$ generation holders in February, 2010. Based on the resources including the "Cultural Research Reports of Important Intangible Cultural Properties" in 1966 and videos up to 2014, the changes of the dance and surroundings are as follow. 1. The formation of musical accompaniment has been changed during the 3 generations. In the video of the $1^{st}$ generation(in 1970), the performance lasted about 15 minutes, whereas the performance lasted 25 minutes in the video of the $2^{nd}$ generation. Yumbuldoduri rhythm was considered as Ginyumbul(Sangryeongsan) and played more slowly. The original dance requiring only 15 rhythms was extended to 39 rhythms to provide longer performance time. In the $3^{rd}$ generation, the dance recovered 15 rhythms using the term Ginyumbul. The facts that Yumbul was played for 3 minutes in the $1^{st}$ generation but for 5 minutes in the 3rd generation shows that there was tendency pursuing the slowness from the $2^{nd}$ generation. 2. For the composition of the Dance, the performance included additional 20 rhythms of Ginyumbul and Ah(亞)-shaped formation from the $2^{nd}$ generation. From the $3^{rd}$ generation, the performance excluded the formation which had no traditional base. For the movement of the Dance, the bridge poses of Ggakjittegi and Bangsukdoli have been visibly inflexible. Also, the extention of time value in 1 beat led the Dance less vibrant. 3. At the designation as an important intangible cultural property (in 1967), the swords with rotatable necks were used, whereas the dancers had been using the swords with non-rotatable necks since late 1970s when the $2^{nd}$ generation holder began to used them. The swords in the "Research Reports" (in 1966) was pointy and semilunar, whereas the straight swords are being used currently. The use of the straight swords can be confirmed from the videos after 1970. 4. There is no change in wearing Jeonlib, Jeonbok, and Hansam, whereas the arrangement of Saekdong of Hansam was different from the arrangement shown in the "Research Reports". Also, dancers were considered to begin wearing the navy skirts when the swords with non-rotatable necks began to be used. Those results showed that has been actively changed for 50 years after the designation. The $2^{nd}$ generation holder, Seong, Gye-Ok, was the pivot of the changes. However, , which was already designated as an important intangible cultural property, is considered to be only a victim of the change experiment from the project to restore Gyobang culture in Jinju, and it is a priority to conduct studies with historical legitimacy. First of all, the slowing beat should be emphasized as the main fact to reduce both the liveliness and dynamic beauty of the Dance.