• Journal of the Korean Arthroscopy Society
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• v.5 no.1
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• pp.1-6
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• 2001

Purpose : The purpose of this study was to compare the postoperative success and stability of arthroscopically assisted anterior cruciate ligament(ACL) reconstructions using central one third bone-patellar-tendon bone(BPB) autograft versus quadrupled semitendinos-us(ST) autograft as the medium term review. Materials and Methods : Eighty patients(40 BPBs,40 STs) with isolated ACL injury were available for a mean follow up of 49.4 months(BPB) and 48.8 months(ST). There was no significant difference between the two groups with respect to age and sex. We compare the final results between two groups with respect to subjective Lysholm score, objective laxity including anterior drawer test, Lachman test, pivot shift test, KT-2000 measurements and International Knee Documentation Committee(IKDC) evaluation system. Results : Postoperatively, positive anterior drawer test was found in $22.5\%\;and\;27.5\%$, positive Lachman test was found in $30.0\%$ and $25.0\%$ and positive pivot shift test was found in $15\%\;and\;20\%$ of the ST and BPB group, respectively(p>0.05). Mean side to side difference of KT-2000 at 20 lbs was 2.2 mm for the ST group and 2.1 mm for the BPB group. There was no significant difference between the two groups about Lysholm score(>0.05). Anterior knee pain was knee common in the BPB group. Eighty-three percent of the patients were nearly normal according to the IKDC grade in both groups. Conclusion : We consider that autogenous semitendinosus tendon is a good alternative subsititute in ACL reconstruction together with the bone-patellar tendon-bone autograft.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.87-90
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• 2006

The complication caused by a bioabsorbable interference screw is rare after anterior cruciate ligament reconstruction. We report a case of delayed inflammatory reaction at the tibial tunnel and femoral tunnel where the graft tendon had been fixed with a bioabsorbable interference screw ($Bioscrew^{(R)}$) for anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft.

• Journal of the Korean Arthroscopy Society
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• v.14 no.1
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• pp.33-35
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• 2010

This is a case of the core reamer breakage during anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. A 19-year-old man with acute anterior cruciate ligament rupture had reconstruction surgery. During tunneling in the proximal tibia, the core reamer have been cracked open and broken. Rest of the procedure was performed routinely except the tibial sided fixation of bone block which was performed with larger interference screw than usual. The patient followed the accelerated rehabilitation program. The result was satisfactory at 2 years after surgery.

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.128-133
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• 2000

Purpose : To compare the changes of the patellar height, patellofemoral alignment and subjective symptom and to compare the effects of patellar tendon harvest after anterior cruciate ligament(ACL) reconstruction using autograft and allograft. Materials and Method : ACL reconstruction was performed on 87 patients who were followed up for minimum 1 year. The group I was 52 patients who were operated with bone-patellar tendon-bone autograft and the group II was 35 patients who were operated with bone-patellar tendon-bone allograft and achilles tendon allograft. At the time of follow-up, the authors evaluated the patellar height by Blackburne-Peel method, Merchant congruence angle, Lateral patellofemoral angle and subjective symptoms were assessed. Results : The patellar heights were significantly decreased from 0.86 preoperatively to 0.80 postoperatively in the group I and from 0.87 preoperatively to 0.83 postoperatively in the group II. There were no significant differences in the lateral patellofemoral angles between the both groups but in the Merchant congruence angle, significant differences were observed in the both groups, from$-1.43^{\circ}$ preoperatively to-$5.43^{\circ}$ postoperalively in the group I and from$-1.53^{\circ}$ preoperatively to$-3.65^{\circ}$ postoperatively in the group II. Conclusion : After ACL reconstruction, the patellofemoral alignment was changed and this kind of changes may be caused by multiple factorials such as harvest of autografts, ACL reconstruction itself, and quadriceps muscle atrophy.

• Journal of the Korean Arthroscopy Society
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• v.3 no.1
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• pp.40-43
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• 1999

Arthroscopic anterior cruciate ligament(ACL) reconstruction using four-strand hamstring tendon with looping around transfixing screw in femoral tunnel requires osteointegration between the grafted tendon and bone for stability of the knee. Authors have experienced a histologic finding of osteointegration between the grafted autogenous hamstring tendon and bone in femoral tunnel after arthroscopic ACL reconstruction. A patient received arthroscopic ACL reconstruction with autogenous four strand hamstring tendon for the ACL injury. Traumatic re-rupture of mid-substance of ACL graft was developed at thirteenth week after operation. During the procedures of arthroscopic revision at fifteenth week after initial ACL reconstruction, biopsy was performed at the site of interface between grafted tendon and bone in femoral tunnel. Integration between the grafted tendon and bone was evident by demonstrating the continuity of collagen fiber between bond and tendon. This histologic finding and the low incidence of early graft failure suggest that free tendon autograft attached to bone by looping around a transfixing screw in femoral tunnel undergoes adequate osteointegration between 12 and 15 weeks after surgery and authors thought that insertion of bone chip into the femoral tunnel would accelerate osteointegration procedure.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.2
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• pp.122-127
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• 2008

Purpose: Evaluation and analysis of the incidence of postoperative complications after arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Materials and Methods: We reviewed 172 cases of arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft in anterior cruciate ligament tear without meniscal injury. We performed Lysholm knee score and KT-2000 testing, simple radiograph, physical examination as evaluation factor. Also, around knee pain, swelling, limitation of motion, patellofemoral crepitation, paresthesia and pain on kneeling were evaluated. Results: The average follow up period was 49.8 months. In 172 patients, 148 males and 26 femlaes were evaluated. The average age was 34.4 years. The Lysholm knee score improved from 51.9 points preoperatively to 90.8 points at final follow up. Clinical outcome was excellent in 83%, good in 11%, fair in 4% and poor in 2%. There were many cases of complications, 24 cases (14%) of around knee pain, 12 cases (7%) of swelling, 45 cases (26.2%) of patellofemoral crepitation, 52 cases (30%) of donor site paresthesia, 65 cases (38%) of pain on kneeling, 10 cases (5.8%) of limitation of motion at extension, 13 cases (8%) of limitation of motion at flexion and 2cases (1.2%) of patellar fracture. Conclusion: Although arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone had good clinical results, many complications were noted. Some factors in surgical technique were suspected to be related to the complications and long term follow up will be necessary to further evaluated.

• Journal of Korean Orthopaedic Sports Medicine
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• v.3 no.1
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• pp.56-59
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• 2004

The hamstring tendons are popular for autografts in a variety of reconstructive procedures. The hamstring autografts are used widely for its potential advantages over the patella bone-tendon-bone(BTB) autograft, including lower graft site morbidity and easier harvesting technique. However, the use of hamstrings has potential disadvantages such as the damage of infrapatellar branches of the saphenous nerve, premature tendon amputation, and tendon split following inadequate hamstring identifications. In our studies, we used modified technique for harvesting the hamstring to decrease potential disadvantages. Reflected hamstring flap method seems to be easy and safe in avoiding nerve damage and tendon splitting. We recommend the reflected hamstring flap method for harvesting hamstring tendons.

• 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.1-6
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• 2002

Purpose : Evaluation and analysis of the incidence and causes of intraoperative and postoperative complications after arthoscopic anterior cruciate ligament(ACL) reconstruction using bone-patella. tendon-bone (BPTB) auto graft. Materials and Methods : We reviewed 85 cases of arthroscopic ACL reconstruction using BPTB autograft which had been followed up for more than 1 year. Intraoperative complications had been recorded and corrected during the operation. Postoperative complications were analyzed and compared between 3 groups which were classified by the last follow-up period after the operation. Results : There were a few intraoperative complications including patellar fracture(1 case), contamination of harvested graft(1 case), impingement of graft(2 cases), blow-out of tile posterior wall of the femoral tunnel(1 case) and intraarticular retraction of the screw(1 case). The result of the comparison of postoperative complications among the groups shows that the incidence of anterior knee pain, donor site pain and patellofemoral crepitation were significantly decreased after 2 years. But there was no significant decrease in these complications after 3 years. Conclusion : Intraoperative complications after arthroscopic ACL reconstruction using BPTB autograft were due to incorrect technique and carelessness of the operation team, and can be prevented by improvement of surgical technique and accumulation of experience. Postoperative complication were somewhat unavoidable but gradually improved with time; hence, we should consider it for the selection of graft donor.

• Journal of the Korean Arthroscopy Society
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• v.5 no.2
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• pp.74-79
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• 2001

Purpose : The purpose of this study is to evaluate the clinical results after arthroscopic PCL reconstruction and to compare the clinical results after arthroscopic PCL reconstruction using BPTB(bone patellar tendon bone) autograft(Group I : 11 cases), Achilles tendon allograft(Group II : 7 cases) and BPTB allograft(Group 111.6 cases). Materials and Methods : We reviewed the result of 24 patients who had been managed with arthroscopic reconstruction using different graft materials such as BPTB autograft, Achilles tendon allograft and BPTB allograft. Twenty-four patients(average age, 37 years) with PCL rupture were retrospectively evaluated more than one year(average, 31 months) after having arthroscopic posterior cruciate ligament reconstruction. The clinical results were evaluated by IKDC ligament standard evaluation form, using $KT-2000^{TM}$ knee ligament arthrometer and also evaluated Lysholm knee scoring scale. Results : The final evaluation was nearly normal in 11 patients($45\%$ in Group I, $43\%$ in Group II, $50\%$ in Group III). The corrected posterior sagging was abnormal(side to side difference more than 6mm) in 8 patients($36\%$ in Group I, $29\%$ in Group II, $33\%$ in Group III). We could not find significant difference among three groups by IKDC scale. Conclusion : Comparing with other reports, our overall results were not satisfactory. And also, we could not find any remarkable difference among the three groups. Further research is necessary to evaluate new surgical approaches as well as improved techniques for capsular and collateral ligament injuries.