• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.147-152
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• 2003

Purpose : The purpose of this study was to evaluate the arthroscopic findings of the transplanted human allogenic meniscus including MRI changes at follow up. Materials and Methods : From Oct. 1999 to Jun. 2002, nine patients underwent arthroscopic evaluation at follow-up. We used nonirradiated cryopreserved meniscus allograft for 6 cases and fresh-frozen for 3 cases. We used bone-plug method for medial meniscus and bone-bridge method for lateral meniscus to fix the transplanted meniscus. The average follow-up time was 13 months. We evaluated the result by lysholm score, MRI and second-look arthroscopic finding. Results : The second-look arthroscopy after allogenic meniscal transplantation revealed that grafts were well incorporated with surrounding capsular tissue. But one case showed wear on the post horn and the other case which was operated at other local clinic showed tear of the anterior hem due to non-anatomic placement of bone bridge. There was improvement of average Lysholm score form 64 to 87. Conclusion : Second-look arthroscopy revealed excellent incorporation of the allograft with firm attachment and early clinical results are satisfactory. But further studies are necessary to assess whether meniscal transplantation can prevent progressive degenerative changes.

• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.412-418
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• 2010

Objective : To evaluate the clinical and radiological outcomes of lumbar interbody fusion and its correlation with various factors (e.g., age, comorbidities, fusion level, bone quality) in patients over and under 65 years of age who underwent lumbar fusion surgery for degenerative lumbar disease. Methods : One-hundred-thirty-three patients with lumbar degenerative disease underwent lumbar fusion surgery between June 2006 and June 2007 and were followed for more than one year. Forty-eight (361%) were older than 65 years of age (group A) and 85 (63.9%) were under 65 years of age (group B). Diagnosis, comorbidities, length of hospital stay, and perioperative complications were recorded. The analysis of clinical outcomes was based on the visual analogue scale (VAS). Radiological results were evaluated using plain radiographs. Clinical outcomes, radiological outcomes, length of hospital stay, and complication rates were analyzed in relation to lumbar fusion level, the number of comorbidities, bone mineral density (BMD), and age. Results : The mean age of the patients was 61.2 years (range, 33-86 years) and the mean BMD was -2.2 (range, -4.8 to -2.8). The mean length of hospital stay was 15.0 days (range, 5-60 days) and the mean follow-up was 23.0 months (range, 18-30 months). Eighty-five (64.0%) patients had more than one preoperative comorbidities. Perioperative complications occurred in 27 of 133 patients (20.3%). The incidence of overall complication was 22.9% in group A, and 18.8% in group B but there was no statistical difference between the two groups. The mean VAS scores for the back and leg were significantly decreased in both groups (p < 0.05), and bony fusion was achieved in 125 of 133 patients (94.0%). There was no significant difference in bony union rates between groups A and B (91.7% in group A vs. 95.3% in group B, p = 0.398). In group A. perioperative complications were more common with the increase in fusion level (p = 0.027). Perioperative complications in both groups A (p = 0.035) and B (p = 0.044) increased with an increasing number of comorbidities. Conclusion : Elderly patients with comorbidities are at a high risk for complications and adverse outcomes after lumbar spine surgery. In our study, clinical outcomes, fusion rates, and perioperative complication rates in older patients were comparable with those in younger populations. The number of comorbidities and the extent of fusion level were significant factors in predicting the occurrence of postoperative complications. However, proper perioperative general supportive care with a thorough fusion strategy during the operation could improve the overall postoperative outcomes in lumbar fusion surgery for elderly patients.

• Journal of Korean Physical Therapy Science
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• v.11 no.1
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• pp.14-19
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• 2004

Objective : This study obtained normative values for variable parameters of lumbar function with the isoinertial triaxial dynamometer in patients with chronic low back pain. Subjects and Methods : 30 patients(male 15, female 15) with chronic low back pain in this study. Variable parameters that were measured with the Isostation B-200 were lumbar range of motion, isometric maximum torques, and maximum velocities in three axis. Results : In patient male group mean R.O.M. was $82.9{\pm}12.5$ degrees in lumbar rotation, $76.5{\pm}17.1$ degrees in lumbar flexion/extension, and $64.3{\pm}14.5$ degrees in lumbar lateral flexion. In patient female group mean R.O.M. was $78.4{\pm}18.5$ degrees in lumbar rotation, $71.7{\pm}20.4$ degrees in lumbar flexion/extension, and $63.2{\pm}14.4$ degrees in lumbar lateral flexion. In patient male group mean isometric maximum torques was $64.7{\pm}23.8ft-lbs$ in lumbar rotation, $81.1{\pm}42.0ft-lbs$ in lumbar flexion, $122.2{\pm}43.6ft-lbs$ in lumbar extension, and $101.0{\pm}37.0ft-lbs$ in lumbar lateral flexion. In patient female group mean isometric maximum torques was $41.9{\pm}9.2ft-lbs$ in lumbar rotation, $49.9{\pm}23.9ft-lbs$ in lumbar flexion, $90.1{\pm}26.8ft-lbs$ in lumbar extension, and $62.0{\pm}16.7ft-lbs$ in lumbar lateral flexion. In patient male group mean maximum velocity of isoinertial exercise with low (25%) resistance was $102.4{\pm}28.8deg/sec$ in lumbar rotation, $108.9{\pm}32.2deg/sec$ in lumbar flexion/extension, and $103.5{\pm}30.4deg/sec$ in lumbar lateral flexion. In patient female group mean maximum velocity of isoinertial exercise with low (25%) resistance was $84.1{\pm}24.4deg/sec$ in lumbar rotation, $93.2{\pm}32.9deg/sec$ in lumbar flexion/extension, and $98.5{\pm}33.7deg/sec$ in lumbar lateral flexion. In patient male group mean maximum velocity of isoinertial exercise with high (50%) resistance was $74.0{\pm}20.9deg/sec$ in lumbar rotation, $98.7{\pm}32.8deg/sec$ in lumbar flexion/extension, and $85.0{\pm}25.8deg/sec$ in lumbar lateral flexion. In patient female group mean maximum velocity of isoinertial exercise with high (50%) resistance was $67.3{\pm}26.4deg/sec$ in lumbar rotation, $82.5{\pm}31.0deg/sec$ in lumbar flexion/extension, and $79.7{\pm}23.9deg/sec$ in lumbar lateral flexion. Conclusion : Maximum isoinertial velocities were more reliable and more significant than isometric maximum torque for the objective assessment of chronic low hack pain.

• The Journal of Korea CHUNA Manual Medicine
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• v.6 no.1
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• pp.157-167
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• 2005

Objective : There is hardly case report in oriental Medicine about the ossification of the posterior longitudinal ligament(OPLL). We experienced a patient(64-year-old male) with OPLL improved by oriental Medicine treatment, and we report it clinically. Methods : While the patient with OPLL was treated acupuncture, physical therapy, and CHUNA manual therapy, we evaluated the patient's symptoms and function by visual analogue scale(VAS), clinical criteria for evaluation of the cervical myelopathy by the japanese orthopaedic association(JOA Score) and cervical spine's range of motion(ROM) in three limes for the 17 days that were a hospitalization period. Results : VAS, JOA score and ROM in OPLL patient were improved. VAS in symptoms became lower from 10 to 5. JOA score increased from 12 points to 13 points. As for the ROM, it was improved in 30.1%. Conclusion : Oriental medicine treatment may be effective in conservative treatment of OPLL. We propose that more clinical studies and reaches are accomplished in oriental medicine.

• Journal of Korean Foot and Ankle Society
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• v.15 no.2
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• pp.51-57
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• 2011

Pilon fractures involving distal tibia remain one of the most difficult therapeutic challenges that confront the orthopedic surgeons because of associated soft tissue injury is common. To introduce and describe the diagnosis, current treatment, results and complications of the pilon fractures. In initial assessment, the correct evaluation of the fracture type through radiographic checkup and examination of the soft tissue envelope is needed to decide appropriate treatment planning of pilon fractures. Even though Ruedi and Allgower reported 74% good and excellent results with primary open reduction and internal fixation, recently the second staged treatment of pilon fractures is preferred to orthopedic traumatologist because of the soft tissue problem is common after primary open reduction and internal fixation. The components of the first stage are focused primarily on stabilization of the soft tissue envelope. If fibula is fractured, fibular open reduction and internal fixation is integral part of initial management for reducing the majority of tibial deformities. Ankle-spanning temporary external fixator is used to restore limb alignment and displaced intraarticular fragments through ligamentotaxis and distraction. And the second stage, definitive open reduction and internal fixation of the tibial component, is undertaken when the soft tissue injury has resolved and no infection sign is seen on pin site of external fixator. The goals of definitive internal fixation should include absolute stability and interfragmentary compression of reduced articular segments, stable fixation of the articular segment to the tibial diaphysis, and restoration of coronal, transverse, and sagittal plane alignments. The location, rigidity, and kinds of the implants are based on each individual fractures. The conventional plate fixation has more advantages in anatomical reduction of intraarticular fractures than locking compression plate. But it has more complications as infection, delayed union and nonunion. The locking compression plate fixation provides greater stability and lesser wound problem than conventional implants. But the locking compression plate remains poorly defined for intraarticular fractures of the distal tibia. Active, active assisted, passive range of motion of the ankle is recommended when postoperative rehabilitation is started. Splinting with the foot in neutral is continued until suture is removed at the 2~3 weeks and weight bearing is delayed for approximately 12 weeks. The recognition of the soft tissue injury has evolved as a critical component of the management of pilon fractures. At this point, the second staged treatment of pilon fractures is good treatment option because of it is designed to promote recovery of the soft tissue envelope in first stage operation and get a good result in definitive reduction and stabilization of the articular surface and axial alignment in second stage operation.

• Journal of Korean Foot and Ankle Society
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• v.18 no.1
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• pp.29-35
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• 2014

Purpose: The purpose of this study is to compare the radiologic and clinical results of syndesmotic screw fixation and posterior malleolar fixation for syndesmotic injury in Lauge-Hansen classification pronation-external rotation (PER) stage IV ankle fractures with posterior malleolus fracture. Materials and Methods: We designed a retrospective study that included patients with Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture. Of 723 patients who underwent ankle fracture surgery from March 2005 to November 2012, 29 were included in this study. In this study, syndesmotic injury was treated with syndesmotic screw fixation or posterior malleolus fixation. There were 15 cases of syndesmotic screw fixation and 14 cases of posterior malleolar fixation. We compared the radiologic and clinical results at one year postoperatively. Posterior malleolus fragment size on a pre-operative computed tomographic image, and tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, and Takakura classification on a postoperative one year followup radiograph were used for comparison of the radiologic results. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society score, visual analogue scale score, and patient subjective satisfaction score. Results: Posterior malleolar fragment size was $12.62%{\pm}3.01%$ of the joint space in the syndesmotic screw fixation group and $27.04%{\pm}4.34%$ in the posterior malleolar fixation group. A statistical difference was observed between the two groups. However, other results, including tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, Takakura classification, and clinical scores showed no statistical difference. Conclusion: In the Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture, if the posterior malleolus fracture can be reduced anatomically and fixated rigidly, syndesmotic screw fixation, which can cause several complications, is usually not required for achievement of a satisfactory syndesmotic stability; this would be a recommendable option for treatment of syndesmotic injury.

• Journal of Korean Foot and Ankle Society
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• v.17 no.1
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• pp.23-27
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• 2013

Purpose: The optimal management for ankle fracture in elderly patients remains controversial. This study was undertaken to review the results of surgical treatment of ankle fracture in the elderly and to compare with other studies. Materials and Methods: The participants in this study were 33 patients over the age of 65(average 71.5 years) who underwent surgical treatment of ankle fracture from January 2004 to December 2011. The study was a retrospective review of outcomes after open reduction and internal fixation (ORIF) of ankle fractures. To measure the clinical outcomes, we assessed postoperative complications, the pre- and post-operative mobility status, fracture union status, the time of fracture union and the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot scale. The level of patient satisfaction was also identified. Results: Delayed wound healing occurred in three patients(9.1%) but their wounds healed with repeated dressings without additional surgical treatment. Malunion occurred in one patient(3%). One patient(3%) had postoperative infection but healed with antibiotic treatment. 24 patients(96%) returned to preoperative mobility status. VAS score was lower than 2 in all patients. Bone union occurred with the 3.8 months (average months) after the surgery in all patients. Average AOFAS score was 87.4 and these were similar results as other studies of young patients. All patients were satisfied with surgical outcomes according to interviews. Conclusion: Surgical treatment of ankle fractures in the elderly can carry a significant risk of delayed wound healing and infection but incidence is relatively low. Internal fixation of ankle fractures in the elderly can be undertaken safely and the majority of patients can expect good outcome.

• Journal of Korean Foot and Ankle Society
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• v.20 no.1
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• pp.12-18
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• 2016

Purpose: The purpose of this study is to review the indications of ankle lateral complex reconstruction using tendon graft. Materials and Methods: We searched PubMed using the index, "ankle, instability, lateral ligament, reconstruction" from 1990 to present (September 30, 2015). We excluded 1) modified Brőstrom operation (MBO), 2) conventional tenodesis surgery, 3) review article, 4) technical note, and 5) articles written in another foreign language. We reviewed 24 papers through the publication events, operational method, the indications of surgery, and the specific features of the patient group. Results: There were the indications of 1) previous ligament surgery failure, 2) situation when ligament repair is impossible due to the ligament defect, 3) severe instability (preoperative talar tilt >$15^{\circ}$, anterior draw >10 mm or the difference of contralateral side talar tilt >$5^{\circ}$, anterior draw >3 mm), and 4) overweight (body mass index >$30kg/m^2$). Other considerations included 1) generalized joint laxity and 2) workers, highly-demanded or athlete highly-affected by instability. Conclusion: The ankle lateral complex reconstruction using tendon graft could be indicated in patients with the possibility of MBO failure with several considerations.

• Journal of Korean Foot and Ankle Society
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• v.23 no.3
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• pp.100-104
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• 2019

Purpose: This study examined the clinical outcomes and assessed the average time to return to play following a peroneal tendon repair in Korean athletes. Materials and Methods: Between March 2004 and February 2017, a total of 30 athletes underwent peroneal tendon repair for a peroneal tendon tear. The indications of surgical treatment were chronic pain or intractable symptoms after a previous ankle sprain affecting sports activity refractory to conservative treatment for at least six months. The patient underwent tubulization for a longitudinal tendon rupture. Peroneus longus to peroneus brevis tenodesis was performed when tendon repair was impossible due to total rupture or multiple longitudinal rupture. Results: Twenty patients not included in this study were as follows: insufficient follow-up, previous surgery, and additional bone surgery. All 10 patients had a previous ankle sprain history, tenderness and swelling on the retromalleolar area. In the 10 patient population, there were five peroneus brevis tendon tears, three peroneus longus tendon tears, one peroneus longus and brevis tendon tear, and one peroneus brevis and superior peroneal retinaculum tear. In the 10 patients, six cases of peroneal brevis tendon repair and four cases of peroneal longus to brevis tenodesis were performed. The preoperative American Orthopaedic Foot and Ankle Society score was improved from a mean of 60.6 (standard deviation [SD], 8.64) to a mean of 90.2, postoperatively (SD, 4.4; p<0.012). The preoperative visual analogue scale was improved from a mean of 5.43 (SD, 1.2) to 0.5 (SD, 0.16), postoperatively (p<0.023). The mean length of time to return to play was 12.2 weeks (range, 8~16 weeks). Conclusion: Peroneal tendon tear can occur due to sports injuries. If there is tenderness at the retromalleolar area, the surgeon should consider a peroneal tendon lesion. Surgical repair of the peroneal tendon can be an effective treatment to help athletes to return to play.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.4 no.1
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• pp.15-19
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• 2011

Purpose: The purpose of this study was to evaluate usefulness of ultrasonography for the follow up of the repair of peripheral lateral meniscal tear compared to MRI. Materials and Methods: Fourteen patients who underwent repair of peripheral lateral meniscus tear were followed for at least 1 year (1 to 2.5 years). Ten cases were male, four cases were women, and average age was 36.1 years (19~53 years). After surgery ultrasonography and physical were performed at 6 weeks, 3 months, 6 months and 1 year. Results: Three cases had joint line tenderness or swelling on physical examination until 3 months, but after then, it disappeared. There is no re-tear in ultrasonograhic examination. Conclusion: The ultrasonography was useful for the follow-up study of the peripheral lateral meniscus tear.