• The Korean Journal of Pain
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• v.18 no.2
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• pp.198-203
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• 2005

Background: This study was designed to demonstrate the peripheral effect of ketamine on the synovia of the knee joint and evaluate the analgesic effect of an intraarticular ketamine injection following knee arthroscopy. Methods: In a double blind randomized study, 80 ASA class 1 or 2 patients were selected for elective arthroscopic knee surgery. The patients received either 20 ml of normal saline (Group C, n = 19), 20 ml of 0.5% ropivacaine (Group R, n = 21), 1 mg/kg of ketamine mixed with 20 ml of normal saline (Group K, n = 20) or 1 mg/kg of ketamine mixed with 20 ml of 0.5% ropivacaine (Group RK, n = 20), intraarticularly, just prior to wound closure. Postoperative pain was evaluated using a visual analogue scale (VAS 0 to 100) score at 1, 2, 6, 12, 24 and 48 hours after the intraarticular injection, with the side effects found in the four groups also evaluated. The patients' requests for rescue analgesic were recorded, total doses of tarasyn calculated and the overall patient satisfaction also evaluated. Results: The difference in the VAS scores for all time periods was not significant. The number of patients receiving rescue analgesics and the total doses received in Group C were greater than those for the other groups, but this was not significant. No side effects were observed in any of the patients. Conclusions: Ketamine and local anesthetics have been reported to have peripheral analgesic effects, with variable duration in the measurements of pain and hyperalgesia. However, we failed to demonstrate a peripheral analgesic effect on postoperative arthroscopic pain.

• The Korean Journal of Pain
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• v.28 no.3
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• pp.210-216
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• 2015

Background: Infusion methods during regional analgesia using perineural catheters may influence the quality of postoperative analgesia. This study was conducted to compare the effects of combined or bolus-only infusion of 0.2% ropivacaine on the postoperative analgesia in interscalene brachial plexus block (ISBPB) with perineural catheterization. Methods: Patients scheduled for arthroscopic rotator cuff repair were divided into two groups, one that would receive a combined infusion (group C, n = 32), and one that would receive intermittent infusion (group I, n = 32). A perineural catheter was inserted into the interscalene brachial plexus (ISBP) using ultrasound (US) and nerve stimulation, and 10 ml of 0.2% ropivacaine was administered. After the operation, group C received a continuous infusion of 4 ml/h, and a 4 ml bolus with a lockout interval of 60 min. Group I received only a 4 ml bolus, and the lockout interval was 30 min. Postoperative pain by the numeric rating scale (NRS) and the forearm muscle tone by the manual muscle test (MMT) were checked and evaluated at the following timepoints: preoperative, and postoperative 1, 4, 12, 24, 36, and 48 h. Supplemental opioid requirements, total consumed dose of local anesthetic, and adverse effects were compared between the two groups. Results: Sixty-four patients completed the study and the postoperative values such as operation time, time to discharge, and operation site were comparable. There were no differences in NRS scores and supplemental opioid requirements between the two groups. The MMT scores of group I at 4 and 12 h after surgery were significantly higher than those of group C (P < 0.05). The total consumed dose of local anesthetic was significantly lower in group I than in group C (P < 0.05). The adverse effects were not different between the groups. Conclusions: The bolus-only administration of 0.2% ropivacaine provided a similar analgesic effect with a lower total volume of local anesthetic and decreased motor weakness compared to combined infusion. Therefore, bolus-only administration is an effective postoperative analgesic method in ISBPB with perineural catheterization after rotator cuff repair.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.173-179
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• 2009

Purpose: On the hypothesis that the acromion morphology is changed according to the its site, we identified the morphology of the acromion on the oblique slices of MRI and we investigated the association of the acromial shape with the clinical stages of rotator cuff disorder on the magnetic resonance (MR) images. In addition, we compared the acromion morphology on MRI and simple X-rays. Material and Methods: The MR images of seventy one patients with rotator cuff disorder and who underwent arthroscopic surgery were compared with that of a control group of sixteen patients who didn't have rotator cuff disorder on MRI. On three subsequent oblique sagittal slices from the lateral edge of the acromion (S1, S2 and S3), each acromion morphology on the MRI slices was classified according to Epstein et al: flat, curved or hooked. We investigated the changing parttern of the acromion shape and we compared the acromion shape on MRI and that on simple X-rays. We classified the rotator cuff tear by the severity: bursitis, partial thickness tear or full thickness tear. We investigated which acromial type on the MRI oblique slice was associated with the severity of rotator cuff disease. Results: Changes of the acromial shape occurred in 54 patients (76.1%). The most frequent pattern was that the types are same on S1 and S2 and different on S3 (22 cases, 31.0%). The acromial type on S1 and S2 was significantly associated with the severity of rotator cuff disorder (p=0.001 and 0.022), respectively. There was no reliability of the acromial shape on MRI and roentgenography (p>0.05) Conclusion: The type of acromion changed from lateral to medial. Among the three positions, the shape of the acromion on S1 and S2 had meaningful correlation with the clinical stage of rotator cuff disorder. There was no statistical correlation of the acromial shape between MRI and simple X-ray.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.77-82
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• 2006

Purpose: The purpose of this study was to analyze the clinical results of symptomatic lateral discoid meniscus found in adults over 40 years old. Materials & Methods: From March 1994 to March 2004, 53 cases treated for lateral discoid meniscus in 48 patients aged over 40 years with the mean age $48.4(40{\sim}62)$ who were followed up more than 1 year, were analyzed by physical findings, simple X-ray, MRI and arthroscopic exam. Results: Most of the cases (42 cases, 79.2%) had symptoms for less than 1 year duration. 26 cases(49.1 %) out of 53 had trauma history. Simple radiologic evaluation showed that lateral condylar abnormality such as the flattening of lateral femoral condyle, marginal osteophytes, and subchondral sclerosis was seen in 37cases(69.8%). Also medial condyle showed degenerative changes in 16 cases (30.2%). Tear of discoid meniscus in 45 cases(84.9%) were examined by arthroscope and tear was not detected in 8 cases(15.1%). Type of tear was complex(18 cases), longitudinal(12 cases), horizontal(11 cases) and transverse(4 cases). Concomitant medial meniscal rupture was found in 7 cases(13.2%). The simple procedure done was reshaping(46 cases), subtotal resection(5 cases), total resection(1 case) and meniscal repair after reshaping in 6 cases, and arthroplasty was performed after arthroscopic examination in 1 case. Conclusion: Onset of symptom in adult lateral discoid meniscus is usually traumatic in origin. Most cases showed radiologic abnormality such as degenerative change in lateral condyles as well as medial condyles and the results of preservative surgical treatment was the most preferred option in most patients.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.115-120
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• 1999

Purpose : After the total or partial meniscectomy of the lateral discoid meniscus, many patients complain the residual pain or the recurrent symptoms of the meniscus, and some of them need reoperation. We analyzed the causes of the reoperation after initial meniscectomy. Material & Method : Two hundred seventy three patients with the symptomatic lateral discoid meniscus were treated by arthroscopic meniscectomy between October, 1989 and September, 1998. Of the 273 patients, 69 patients were treated by total meniscectomy and 204 patients were treated by partial meniscectomy. The male to female sex ratio was 1:1.04, and the average of the age was 23.1 years old(from 4 to 59 years old). The reoperation was done in 8 patients, of which 1 was the case of total meniscectomy at the initial operation, and the rest 7 were the case of partial meniscectomy. Results : Of the 8 reoperations, 3 patients recurred the meniscal symptoms within the 3rd week after the initial operation, and 5 patients recurred beyond the 3rd week after the initial operation. Among the 3 patients of carly recurrence, 2 patients showed inadequate sizes of the remnant meniscus, and 1 patient showed posterolateral instability of the remained meniscus. Among the 5 patients of late recurrence, 3 patients showed rerupture of the meniscus, and 2 patients showed associated pathology of degenerative arthritis following osteochondritis dissecans. Conclusions : The reoperation rate after initial meniscectomy of the lateral discoid meniscus was higher in partial meniscectomy than total meniscectomy. During the operation of the lateral discoid meniscus, we must determine the adequate resectional margin, confirm the remnant meniscus by probing, and look for the associated pathologies.

• Investigative Magnetic Resonance Imaging
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• v.3 no.1
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• pp.73-77
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• 1999

Purpose : The purpose of the study was to evaluate the sensitivity and specificity of proton-weighted fast spin-echo MR imaging in diagnosing the meniscal tear of knee as an reasonable substitute for conventional spin-echo imaging. Materials and Methods : 102 consecutive patients, proved by surgery, proved by surgery, were participated in this study. All of them were suspected internal derangement of knee, examined by fast spin-echo MR imaging including sagittal and coronal images on a 1.5T MR imager and underwent arthroscopic or open surgery of knee joint within 2 months. These images were reviewed retrospectively by three radiologists. The sensitivity and specificity of meniscal tear were calculated. Results : The sensitivity and specificity of meniscal tear using proton-weighted fast spin-echo MR imaging were 94%, 93% inmedialmeniscus and 92%, 88% in lateral meniscus. Conclusion : The sensitivity and specificity of meniscal tear using proton weighted fast-spin echo MR images were as high as those using conventional spin-echo images. The proton-weighted fast-spin echo MR imaging can be an alternative to conventional spin-echo MR imaging in diagnosing meniscal tear of the knee.

• Clinics in Shoulder and Elbow
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• v.2 no.1
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• pp.28-34
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• 1999

Purpose: We studied magnetic resonance imaging of acromion morphology and superior displacement of the humeral head in the patients with diagnosis of rotator cuff impingement syndrome, and also documented the relationship of type Ⅲ acromion to the rotator cuff tear. Materials and Methods: We reviewed retrospectively 40 patients(40 shoulders) who had arthroscopic treatment for the diagnosis of stage II impingement or rotator cuff partial tear and did not have other risk lesions except acromion factor. The mean age was 48.7 years at operation. 21 men(2l shoulders), mean age of 26 years, were used as controls. Acromial type, tilt, and superior displacement of humeral head in sagittal plane, and acromial lateral angulation in coronal plane were measured. Four parameters of the patients were compared with those of control group. And then, the data were subdivided and analyzed with respect to acromial type and patient age in the impingement group. Student t test and multi-way ANOVA were used. Results: In impingement group, Farley's type I acromion, 33%, type Ⅱ, 38%, type Ⅲ, 27% and type Ⅳ, 2%. Superior displacement of humeral head( 4.8mm) were characteristic in the impingement group compared with the control group(1.3mm)(p<0.05). But acromial tilt and lateral angulation were not statistically different. In the analysis of the impingement group, the change of 4 parameters was not significant with respect to age(p>0.05), but lateral angulation in type I acromion(18 degree) and superior displacement of humeral head in type Ⅲ acromion(6.3mm) were significantly increased(p<0.05). All 4 parameters were not different between two subdivided types of type Ⅲ acromion. Conclusion: All types of acromian and large lateral angulatian cauld develop impingement syndrame, but acromial tilt was nat risk factar. Appearance of type Ⅲ acromian and increased superiar displacement of humeral head were characteristic findings in the impingement syndrame. Superiar displacement of humeral head as a result of degenerative change of rotatar cuff was probably primary cause far impingement. The type Ⅲ acromian might be an acquired farm, which cauld be expected to accelerate the tear of rotatar cuff as a cansequence.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.154-161
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• 2005

Purpose: to describe the histologic appearance of the type III bone bruise in knees which had sustained an acute anterior cruciate ligament (ACL) rupture. Materials and Method: Twenty-five patients who sustained acute ACL rupture were prospectively enrolled in this study. On MRI, 14 patients demonstrated type III bone bruise on lateral femoral condyle, and 11 patients didn't demonstrated bone bruise. Arthroscopic evaluation and biopsy of the articular cartilage and subchondral bone wert performed before ACL reconstruction. Histologic and immunohistochemical evaluations were done. Results: There was no difference between the bone bruise and control group in the hematoxylin-eosin staining for cell distribution, Masson's trichrome staining for collagen and immunohistochemical staining for type I and type II collagen (p>0.05). But in the safranin-O staining for glycosaminoglycan distribution, the bone bruise group had an evidence of decreased staining at the superficial and middle layers, compared with the control group (p<0.05). We also found fatty change of bone marrow in calcified zone of the bone bruise group with safranin-O staining. Conclusion: We suggest that the type III bone bruise found on MRI indicates a substantial damage to normal articular cartilage homeostasis, and may induce further damage of the articular cartilage.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.97-101
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• 1999

Purpose : The purpose of this study is to prevent thc graft-tunnel mismatch by measuring the patellar tendon length, intertunnel distance, tibial tunnel length and by obtaining appropriate bone block length. Materials and Methods : Authors analyzed 15 patients who had taken the anterior cruciate ligament reconstruction from March 1997 to June 1999. Tibial guide was always set on the "endo" $40^{\circ}$ position(Acufex, MA, USA). We measured the following indices, intertunnel distance(X), tibial tunnel length(T), patellar tendon length(N), tibia bone plug length(Y). Both of the femoral tunnel length(F) and the patellar bone plug length(P) were made in 25mm. The appropriate tibial bone plug length was simply calculated by subtracting the patellar tendon length from the sum of the intertunnel distance and thc tibial tunnel length(Y=X+T-N). Results : The average indices were as follows ; the intertunnel distance(X) was $23.4{\pm}1.4mm$, the tibial tunnel length(T) was $43.6{\pm}1.7mm$, the patellar tendon length was $40{\pm}2.4mm$, and the tibia bone plug length was $27{\pm}2.4mm$. Conclusion : In authors' endoscopic technique, establishment of individually determined optimal tibial bone plug length, based on total tunnel length and patellar tendon length could prevent the problem of graft-tunnel mismatch.

• Journal of the Korean Arthroscopy Society
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• v.3 no.1
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• pp.24-29
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• 1999

Purpose : The purpose of this paper is to analyze the clinical results after meniscal repair using meniscal arrow. Materials and Methods : Between May 1997 and Aug 1998, we repaired 22 tom menisci in 22 patients using meniscal arrows. There were nineteen males and three females with an average age of 27 years. There were longitudinal tear in 14 cases, Bucket-handle tear were 7 cases and horizontal tear was in 1 case. In 22 meniscus tears, 16 cases were associated with anterior cruciate ligament tear. Average number of meniscal arrow that was used were 2.5(ranged 1 to 4). Average follow-up period was 14.7 months(ranged 6 to 22 months). We evaluated the clinical results by the Tapper and Hoover's grading system. Results : There were excellent in 16 cases, good in 4 cases and fair in 2 cases on the clinical results. At the last follow up, the range of the motion of the knee joint were average 135 degrees(ranged 125 to 140 degrees). Mean time elapsed for meniscal repair were 25 minutes(ranged 15 to 40 minutes). Conclusion : Meniscal arrow has many advantages such as short operative time, easy fixation technique, and less neurovascular injury. We think that arthroscopic meniscal repair using meniscal arrow is effective treatment method in selected patient who have longitudinal, bucket-handle tear at the posterior hom associated with anterior cruciate ligament tear.