• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.82-85
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• 2009

Purpose: In anterior cruciate ligament (ACL) reconstruction, preservation of the remnant original tissue might promote graft healing and be helpful in proprioception. But this procedure is difficult and causes the notch impingement. So we introduce a surgical technique that makes a transtibial femoral tunnel at 10 or 2 o'clock position with preservation of remnant tissue. Surgical approach: We tried to preserve the remnant tissue and synovium as much as possible, especially those of tibial attachment and extending to the posterior cruciate ligament (PCL), so as to have some tension and to prevent notch impingement. We set the tibial drill guide at 40~45 degrees and the intra-articular guide tip was 1 mm anterior and medial to the conventional site. The starting point of tibial guide pin was proximal to the pes anserinus and anterior to the medial collateral ligament. When the reamer approached the cortical bone of the tibial articular surface, the reamer must be advanced very carefully to minimize injury to the remnant tissue. The tibial and femoral tunnel at 10 or 2 o'clock position were made with the reamer, the diameter of which was same with that of the graft. Conclusion: We report a remnant preserving technique in ACL reconstruction that makes a transtibial femoral tunnel at 10 or 2 o'clock position

• Journal of the Korean Arthroscopy Society
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• v.4 no.1
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• pp.1-6
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• 2000

Purpose : The purpose of this study was to compare the results of ACL reconstruction using bone-patellar tendon-bone to hamstring. Materials and Methods : Thirty-two ACL reconstructions with autogenous BPTB and eighteen reconstructions with hamstring were compared in terms of functional outcome, stability and tunnel expansion. Results : The functional score of BPTB group was higher than hamstring group in OAK(Orthopadishe Arbeitsguppe Knie) and IKDC(International Knee Documentation Committee) system. In BPTB group, OAK scores were 71.6$({\pm}10.0)$ preoperatively and 88.5$({\pm}7.9)$ finally. In hamstring group, OAK scores were 73.9$({\pm}11.5)$ and 82.5$({\pm}12.9)$ respectively. There was no difference in stability checked by either $KT-1000^{TM}$ or stress view. Anterior tibial translation measured by $KT-1000^{TM}$ were 2.4$({\pm}1.8)$mm in BPTB and 2.3$({\pm}2.4)$mm in hamstring group. Anterior tibial translation in stress view were 2.8$({\pm}3.4)$mm in BPTB and 2.8$({\pm}2.5)$mm in hamstring group. There was no difference in tibial tunnel expansion but femoral tunnel was more enlarged in hamstring group than BPTB (P=0.03). Conclusion : As there was no difference in stability between two groups, it seems prudent to select either graft defend on such factors as anterior knee pain, skeletal maturity and cosmetic concern. Tunnel expansion seems not to affect stability, but further study is needed to confirm that decrease of which might improve stability.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.148-152
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• 2006

Purpose: The purpose of this study was to investigate the distribution of the diameter of four strand autologous hamstring tendon and to identify the factors related to the diameter. Materials and Methods: Between December 2004 and July 2006, 66 patients underwent anterior cruciate ligament reconstruction using autologous hamstring tendon. Sixty one patients were male and the other 5 patients were female. Both semitendinosus and gracilis tendon were harvested in every case. Harvested two tendons were folded once together to create a four strand double loop graft and were passed through cylindrical sizer to measure their diameter. Parameters such as sex, age, height and weight were analyzed for their correlation with the diameter of the graft. Results: The diameter of the graft ranged from 6 mm to 10 mm. The graft with the diameter of 8 mm was most common and the average diameter of all the grafts was $7.85{\pm}0.92mm$. Seven patients (10.6%) had a graft with the diameter of 6 mm, which is considered too thin to be ideal one. No statistically significant correlation was found between age of the patient and the diameter of the graft. However, the diameter of the graft was significantly correlated with sex, height and weight of the patient. Female patients had a significant tendency to have thinner hamstring tendons. Both small height and light weight of the patients were correlated with thinner hamstring tendons significantly. Conclusion: Sex, height and weight of the patients were the factors that had a statistically significant correlation with the diameter of the graft. Being aware of the risk factors related with harvesting exceedingly thin hamstring tendon prior to anterior cruciate ligament reconstruction, one can utilize wide range of options in selecting an optimal graft.

• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.212-219
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• 2009

Medially retracted large-sized rotator cuff tears includes large-sized tears, massive tears and irreparable tears. Generally arthroscopic repair or open repair of rotator cuff tears is used in reparable tears. However, arthroscopic repair requires long period practice and endurance. In irreparable tears, arthroscopic debridement, partial repair, latissimus dorsi transfer and retrograde arthroplasty can be the option. Arthoscopic debridement gives temporal relief who experienced improvement in pain and increase in range of motion after subacromial local anesthetic injection. Also arthroscopic partial repair gives good results in irreparable cases, especially in suprascapular nerve traction neurapraxia. Tendon transfer can be used in mild to moderate muscle weakness in shoulder abduction for long term treatment. Pectoralis major transfer can be used in anterosupeior tears and latissimus dorsi transfer can be used in posterosuperior tears. Reverse shoulder prosthesis is used in extreamly weakened shoulder pseudoparalysis. The authors discussed the method of arthroscopic repair in irreparable tears. The debridement, partial repair, and tendon transfer could be used in medially retracted large-sized rotator cuff tears.

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.105-110
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• 2000

Purpose : The purpose of this study was to evaluate the clinical results of fresh-frozen achilles allograft PCL reconstruction. Materials and Methods : 34 patients(35 cases) who was reconstructed PCL arthroscopically using achilles allograft were analyzed subjective and objective parameters, Telos stress arthrometer and Modified Feagin Scoring System. The average age was 36.2 years old($16\~57$ year) and average follow up period was 18.5 months($12\~27$ months). Result : The mean Lysholm Knee Scoring was improved from 47.5 to 87.4. Posterior translation by Telos arthrometer decreased to 2.3mm from 7.1mm. The modified Feagin scoring system showed 32 cases$(91.5\%)$ with excellent and good result. Conclusion : Clinical results of PCL reconstruction by Achilles allograft revealed good result as to scales. Achilles allograft provided enough initial tension with length and minimized the complication of using autograft. Therefore achilles fresh-frozen allograft in PCL reconstruction is a good substitute material for autograft.

• Journal of the Korean Orthopaedic Association
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• v.55 no.2
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• pp.135-142
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• 2020

Purpose: This paper presents the long term follow-up results of arthroscopic partial repair for massive irreparable rotator cuff tears using a biceps long head auto graft. Materials and Methods: Forty-one patients with massive irreparable rotator cuff tear, who underwent arthroscopic repair, were reviewed retrospectively. Patients who underwent arthroscopic partial repair using a biceps long head auto graft were assigned to group 1, and patients in group 2 underwent arthroscopic partial repair alone. Patients with a less than 50% partial tear of the long head biceps tendon were included in this study. The clinical scores were measured using a visual analogue pain scale (VAS) for pain, range of motion (ROM), The University of California, Los Angeles shoulder score (UCLA), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Korean Shoulder Scoring System (KSS) scores preoperatively and at the final follow-up. The acromiohumeral interval (AHI) was measured using plain radiographs taken preoperatively and at the final follow-up, and re-tear was evaluated using postoperative ultrasound or magnetic resonance imaging at the last follow-up. Results: The mean age of the patients was 62.1±12.7 years, and the mean follow-up period was 90.3±16.8 months. No significant differences in the VAS and ROM (forward flexion, external rotation, internal rotation) were found between the two groups (p=0.179, p=0.129, p=0.098, p=0.155, respectively). The UCLA (p=0.041), ASES (p=0.023), and KSS (p=0.019) scores showed functional improvements in group 1 compared to group 2. At the last follow-up, the measured AHI values were 9.46±0.41 mm and 6.86±0.64 mm in group 1 and 2, respectively (p=0.032). Re-tear was observed in six out of 21 cases (28.6%) in group 1 and nine out of 20 cases (45.0%) in group 2; the retear rate was significantly lower in group 1 than in group 2 (p=0.011). Conclusion: Arthroscopic partial repair for a massive irreparable rotator cuff tear using a biceps long head auto graft has significant clinical usefulness in functional recovery and decreases the re-tear rates after surgery than arthroscopic partial repair alone, showing favorable results after a long-term follow-up.

• 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 Korean Orthopaedic Sports Medicine
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• v.8 no.2
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• pp.109-114
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• 2009

Purpose: The purpose of this study is to compare the clinical results of ACL reconstruction between two groups using hamstring tendon autograft and tibialis anterior tendon allograft. Materials and Methods: Between January 2006 and June 2007, we analyzed 68 cases of ACL reconstruction, 32 cases using hamstring tendon autograft and 36 cases using tibialis anterior tendon allograft, with a minimum follow-up of 24 months. For the clinical evaluation, we evaluated the Lysholm score, anterior laxity by Telos device and KT-2000 arthrometer. Results: The mean diameter of graft were 8.0 mm (7.0~9.0 mm) in autograft group and 9.1 mm (8.0~10.0 mm) in allograft group. In all cases, the range of motion was above 135 degrees. The average side to side difference in Telos stress test decreased from $7.3{\pm}1.0$ mm to $2.4{\pm}1.1$ mm in autograft group and from $7.4{\pm}1.2$ mm to $2.3{\pm}1.3$ mm in allograft group. The average Lysholm knee score improved from $72.6{\pm}3.4$ to $92.3{\pm}3.5$ in autograft group and from $72.3{\pm}3.5$ to $91.6{\pm}3.3$ in allograft group. There was no significant difference between two groups in clinical results. Conclusion: Both hamstring tendon autograft and tibialis anterior tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both hamstring tendon autograft and tibialis anterior tendon allograft will be considered as acceptable graft for anterior cruciate ligament reconstruction.

• Journal of Korean Foot and Ankle Society
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• v.20 no.4
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• pp.182-186
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• 2016

The tibialis anterior tendon functions as a major dorsiflexor of the ankle. A rupture in this tendon can cause serious problems in the ambulatory function. A closed traumatic rupture without open wound or an atraumatic rupture can delay diagnosis and treatment. There are not enough guidelines for an effective surgical treatment on this chronic condition. Herein, we report two cases of chronic tibialis anterior disruption successfully treated by semitendinosus autograft.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.1
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• pp.27-34
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• 2011

Purpose: To evaluate the short term clinical result of ACL reconstruction with autologous hamstring tendon using Cross pin and Graft Tensioner and to seek way to resolve the experienced technical problems. Materials and Methods: From January 2008 to March 2009, 35 patients who had been treated arthroscopic ACL reconstruction were enrolled. The femoral side of ACL graft was fixed with Cross pin. The tibial side of graft was fixed with Intrafix and post-tie. The graft was tensioned with Graft Tensioner at 80N. We analyzed the clinical, radiographic results and complications. Results: IKDC subjective score and Lysholm score improved to 89.1 and 91.4 points. Also, Pivot shift test and One-leg hop test showed good results postoperatively. Side to side difference using KT-1000 arthrometer and Telos stress radiography improved compared with normal limb to $2.8{\pm}1.6$ mm and $2.6{\pm}1.3$ mm, respectively. The femoral tunnel enlarged to $2.3{\pm}1.1$ mm. Soft tissue irritation and femoral tunnel-graft harness length mismatch, femoral tunnel-cross pin tunnel mismatch were happened as peri-operative complications. Conclusion: Using of Cross pin and Graft Tensioner for ACL reconstruction with hamstring tendon is one of the good method for obtaining stability in short-term clinical result. But to reduce femoral tunnel-cross pin mismatch, it needs to shorten femoral bone tunnel and to create cross pin tunnel as vertical as possible. And to reduce femoral tunnel-graft harness mismatch, it needs to advance position rod further 3 mm when to create femoral tunnel.