• 대한관절경학회:학술대회논문집
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• 2009.10a
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• pp.153-153
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• 2009

The purpose of this study was to evaluate tibial tunnel widening prospectively after anterior cruciate ligament (ACL) reconstruction with hamstring tendon grafts using Rigidfix (DePuy Mitek, Raynham, MA) femoral fixation and Intrafix (DePuy Mitek) tibial fixation. 56 consecutive patients who underwent ACL reconstruction with a minimum of 2 years' postoperative evaluation were reviewed. On the anterior-posterior (AP) and lateral radiographs, the diameter of the tibial tunnel was measured at proximal, middle, and distal positions and the shape of the tibial tunnels were classified. Tunnel widening was defined as widening of greater than 2 mm. Group I was defined as cases with no tunnel widening and group II defined as cases with tunnel widening. Postoperative laxity evaluations were performed using Lachman test, pivot-shift test, and Instrumented laxity testing using the KT-1000 arthrometer. On the AP radiographs, the average diameter of the tibial tunnel increased 8.8% at 6 months and 8.5% at 12 months postoperatively compared to the immediate postoperative day. On the lateral radiographs, the average diameter of the tibial tunnel increased 7.2% at 6 months and 8.1% at 12 months year postoperatively compared to the immediate postoperative day. The tunnel shape evaluation revealed predominantly linear type in 53 patients (95%). Group I was 42 patients (75%) and group II was 14 (25%). The average KT-1000 measurement was 1.0~1.8 mm in group I and 2.1~2.8 mm in group II (p>0.05) The Lachman and pivot-shift showed tests no significant differences between the two groups. In conclusion, hamstring ACL reconstruction using Rigidfix and Intrafix fixation showed less widening of the tibial tunnels than observed in previously published studies.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.203-208
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• 2006

Purpose: Previous transtibial double bundle posterior cruciate ligament (PCL) reconstruction methods have several problems in graft length and tibial fixation. We introduce new surgical method that is less restrictive by graft length and is more stable with single tibial fixation. Operative technique: After diagnostic arthroscopy, we prepare the graft, ream the tibial tunnel and perform the procedure for TransFix tibial fixation. Femoral 2 tunnel is made and graft is passed via anteromedial (AM) portal. Tibial fixation is done and femoral 2 graft is fixed sequentially at each knee position. Conclusion: TtransFix tibial single fixation method in double bundle PCL reconstruction provides more stable fixation, more free graft selection and prevents graft damage by passing the graft via AM portal.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.165-172
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• 2006

Purpose: The purpose of this study is to evaluate the effects of intratunnel fixation in the tibial side on the arthroscopic ACL reconstruction with quadruple hamstring tendon at the second look arthroscopy. Materials and Method: From Dec 1999 to May 2005, we arthroscopically reexamined 32 cases who had been done arthroscopic ACL reconstruction with quadruple hamstring tendons. Hamstring tendons of all cases were fixed at femoral side with RigidfixTM. At the tibial side hamstring tendons were fixed only Post-tie (Group I) or Post-tie combined with IntrafixTM (Group II). At the time of second look arthroscopy mean age of cases was 30 years and mean duration for second look arthroscopy was 21.3 months. We analyzed the results with IKDC score, KT-1000 arthrometer under anesthesia, Telos stress radiography, tibial tunnel widening on the radiography and second look arthroscopic findings. Results: Group II had more superior than group I at side to side differences with KT-1000 and Telos stress radiograph, IKDC score, but the differences were insignificant. At arthroscopic evaluation, Group ll also had more superior than group I at graft tension and graft appearance, graft synovialization, but the differences were insignificant. Tibial tunnel widening in the knee AP radiograph was 2.3 mm in Group I and 1.7 mm in Group II and the difference was significant. (P=0.042) Conclusions: Additional procedure of tibial intratunnel fixation in arthroscopic ACL reconstruction with autogenous hamstring tendon significantly prohibited from tibial tunnel widening but clinical results, radiologic joint stability, findings in second look arthroscopy were insignificantly different. We concluded that Post-tie itself induced satisfactory clinical results, joint stability and graft maturation and that tibial tunnel widening did not affect the results.

• Journal of the Korean Arthroscopy Society
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• v.9 no.1
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• pp.51-55
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• 2005

Purpose: To compare the stability and clinical result after anterior cruciate ligament reconstructed knee after graft fixation using Intrafix in tibial tunnel with or without additional tibial post fixation. Materials and Methods: We analyzed 37 cases which were treated with four-strand hamstring tendon autograft during the period from May 2002 to January 2003. The grafts were fixed with Rigidfix system (Mitek Product, Johnson and Johnson, USA) in femur tunnel and Intrafix system (Mitek Product, Johnson and Johnson, USA) in tibial tunnel. After tibial fixation, additional tibial post fixation was done, which was determined by the serial case number prospectively. Patients were followed for average of fourteen months(range, thirteen to twenty-five months) At the time of final follow-up, patients were evaluated in terms of Lachman test, pivot shift test, Lysholm scores, IKDC (International Knee Documentation Committee) assessment, side-to-side KT-1000 maximum-manual arthrometer differences. Results: At last follow-up, Lysholm score was average 93.1(range: 65 to 98), IKDC assessment revealed that 26 cases had score of A, 10 cases had score of B and 1 case had score of C. The average maximum-manual KT-1000 arthrometer side ?to-side difference was 2.5 mm$(0{\sim}6mm)$. There was one case in which the Lachman test was graded as 2+ and four cases in which the Lachman test was graded as 1+ and the remaining thirty-two cases were normal by Lachman test. One case had a 2+ pivot-shift, and 2 cases had a 11 pivot-shift. The remaining 34 knees were normal on pivot -shift testing. The average maximum-manual KT-1000 arthrometer side-to-side difference was average 2.8 mm$(0{\sim}6mm)$ in Intrafix only group and average 2.2 mm$(0{\sim}4mm)$ in additional fixation group (P>0.05). Conclusion: Without additional tibial fixation, the stability of the anterior cruciate reconstructed knee with hamstring graft which was fixed with Intrafix was restored.

• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.53-57
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• 2009

The pretibial cyst is a very rare complication after anterior cruciate ligament (ACL) reconstruction. It occurs whatever kind of graft choice or kind of graft fixation method at tibial side. It have been known such as graft necrosis at tibial side, extra-articular leakage of joint fluid through tibial tunnel, foreign body reaction due to breakdown of the bioabsorbable screw and incomplete incorporation of graft to bony tunnel as the cause of pretibial cyst. We experienced one case of pretibial cyst which had undergone ACL reconstruction with autogenous hamstring graft fixed with biodegradable interference screw. We report a rare case of pretibial cyst with literature review.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.1
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• pp.57-61
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• 2012

Pretibial cyst formation is a rare complication after anterior cruciate ligament (ACL) reconstruction and there are only few cases reported. Pretibial cyst can be caused by variable reasons. Foreign body reaction due to breakdown of bio-absorbable screw for fixation, graft necrosis at tibial site, joint fluid leakage to tunnel and incomplete incorporation of graft to bony tunnel. The authors experienced one case of massive pretibial cyst after arthroscopic ACL reconstruction using bio-absorbable interference screw in 38-year-old male patient. Thus, authors report this rare case with literature view.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.66-71
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• 1997

The all inside anterior cruciate ligament reconstruction technique places an anterior ligament substitutes within two bony sockets rather than hone tunnel. This approach is accomplished through arthroscopic three portal which avoids the surgical exposure and morbidity associated with creating traditional bone tunnel. This technique has several distinct advantages when compared with the traditional ACL reconstruction through the bone tunnels. It offers the surgeon a less morbid method for ACL reconstruction that positions an ACL substitute at the anatomic attachment sites of the original ACL with two bone sockets, obviating the need for traditional bone tunnels. Graft fixation at or near the anatomic attachment points of the original ACL minimizes creep with early range of motion and reduces the abrasive 'wind-shield wipe' motion of the graft which occur with bone plugs positioned inside bone tunnels. The sagittal posterior angle to the tibial socket increases fixation strength to pullout with anterior translation force for the tibia on the femur. This technique is not graft specific and can accomodate any graft in which graft length can be customized to the intraarticular native ACL length.

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.60-63
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• 2002

Purpose : The purpose of this study was to introduce new femoral fixation technique using a cross-pin and a bioabsorbable interference screw in hamstring ACL reconstruction. Method : Semitendinosus and gracilis were harvested for quadrapled graft. After tibial tunnel had been made, femoral tunnel was made 35 mm in depth. Then the graft passed through the tunnels. Cross-pin was fixed through the drill hole which had been made through upper sleeve of the Rigidfix system. While pulling the graft, bioabsorbable interference screw was fixed through the anteromedial portal. Conclusion : We introduced the new femoral fixation technique using a cross-pin and a bioabsorbable interference screw as a good method with high fixation strength and tight graft-bone contact.

• 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.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.