• Journal of the Korean Arthroscopy Society
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• v.9 no.1
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• pp.65-69
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• 2005

It is well known that the two main variants of the anterior cruciate ligament (ACL) ruptures in an adolescent include tibial eminence fractures and midsubstance tears. Authors report a case of 17-year-old girl with simultaneous bilateral anterior cruciate ligament ruptures at the ligamento-osseus junction of tibial attachment which was treated with arthroscopic primary repair.

• Journal of the Korean Arthroscopy Society
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• v.11 no.1
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• pp.63-68
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• 2007

Purpose: The authors introduce a new technique of arthroscopic all inside repair using anterolateral and anteromedial portals for lateral meniscus root complete radial tear in patients who underwent concurrent anterior cruciate ligament (ACL) reconstruction. Operative technique: Arthroscope is placed through anteromedial portal and suture hook ($Linvatec^{TM}$, Largo, Florida, USA) is delivered through anterolateral portal. By rotating the suture hook, it penetrates posterior horn of the torn meniscus from femoral to tibial surface for vertical orientation. PDS No. 1 ($Ethicon^{TM}$, Somerville, NJ, USA) is delivered through the suture hook, and then it is withdrawn. Both end of PDS No. 1 are taken out through the anterolateral portal. MAXON 2-0 ($Syneture^{TM}$, Norwalk, Connecticut, USA) is used to penetrates remnant of tibial attachment of the torn meniscus from tibial to femoral surface in a same manner. MAXON 2-0 is changed for PDS No. 1 from tibial to femoral surface by shuttle relay technique. PDS No. 1 is tied using SMC (Samsung Medical Center) knot. Conclusion: All inside repair is a useful technique to achieve anatomical repair and to restore the hoop tension in lateral meniscus root complete radial tear.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.109-114
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• 1999

Purpose : The importance of meniscal repair is well recognized. But transeciton of the posterior horn of the medial meniscus at the posterior tibial attachment is rarely documented and known irreparable. We experienced 9 cases of transection, and present clinical features and pull out suture technique. Methods and Materials : There were 9cases of transection of the posterior horn of medial meniscus from September 1998 to July 1999 in our hospital. Age was 59.3 years in average and ranged from 38 to 70years. Clinical features and MRI made diagnosis in all cases. We confirmed the diagnosis with arthroscopy and repaired the transection with pullout suture technique. Clinical features : Transection of the posterior horn of the medial meniscus at the posterior tibia attachment occurred frequently in middle aged people. They complained posterior knee pain, but they have no history of definitive trauma. Characteristically they had difficulty in full flexion of the knee and in having a squatting position. MRI is very important in diagnosis of transection, especially in coronal view, there is separation of the posterior horn of the meniscus from the posterior tibial attachment. Surgical technique : Pullout suture technique includes debridement of fibrous or scar tissue, exposure of the subchondral bone of the posterior tibial attachment site, suture the transected end of the meniscus with PDS suture, bone tunnel formation from the anteromedial aspect of the proximal tibia, insertion of wire loop through the tibia tunnel, pull the PDS suture through the tibia tunnel out of the joint and stabilize the PDS with post-tie technique to the proximal tibia. Conclusion : Transection of the posterior horn of the medial meniscus at the posterior tibial attachment is not common clinically and rarely documented. Clinical features and MRI are very important in diagnosis of this type tear. Arthroscopic pullout sutures is useful for treatment of this type tear of the meniscus.

• Journal of the Korean Arthroscopy Society
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• v.16 no.1
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• pp.66-71
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• 2012

The posterior root of medial meniscus maintains normal meniscal function by circumferential hoop tension and prevents extrusion of meniscus and progression of osteoarthritis. A complete tear of posterior root of medial meniscus leads to loss of hoop tension, it is important to repair it and preserve the function of the medial meniscus. Recently, a variety of arthroscopic assisted reduction and repair techniques have been used. We create an arthroscopic all-inside suture technique using a 18 gauge spinal needle and suture anchor that is easier and more convenient compared with the previous techniques. So we report this technique with a review of current literatures.

• Journal of Yeungnam Medical Science
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• v.18 no.1
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• pp.101-111
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• 2001

Background: We analyze the functional evaluation, posterior stability after surgery of acute injuries in the femoral detachment and tibial avulsion fracture of posterior cruciate ligament. Materials and Methods: Twenty two patients who underwent primary repair were followed more than one year after operation (mean follow-up 33.7 months). The patients were evaluated with KT 2000 arthrometer and posterior stress test for posterior stability. Lysholm knee score was used for knee function. Results: Lysholm score revealed 85.3 in femoral detachment group and 91.1 in tibial avulsion fracture group (P<0.05). Posterior displacement of the posterior stress test showed 17.2 mm at initial injury and 8.6 mm at last follow up in femoral detachment group, 16.8 mm at initial injury and 7.1 mm at last follow up in tibial avulsion fracture group. There revealed the tendency of the improved posterior stability of the tibial avulsion group compared with femoral detachment group, but there showed no statistical significance in KT 2000 arthrometer and posterior stress x-ray. Conclusion: Functional results of tibial avulsion fracture group revealed the better outcome compared with femoral detachment group, but the degree of posterior stability in tibial avulsion fracture group showed no statistical significance in posterior stability.

• Journal of the Korean Arthroscopy Society
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• v.9 no.1
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• pp.70-76
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• 2005

Purpose: We describe a new technique of arthroscopic repair with using autogenous hamstring tendon graft augmentation for the acute posterior cruciate ligament rupture. Operative technique: A routine arthroscopic examination of the knee joint is initially performed, then the posterior trans-septal portal is prepared with the using the posteromedial and posterolateral portals. The torn tibial stump that is retracted to the posterior compartment is repaired by a suture hook that is introduced through the anteromedial portal; visualization during this procedure is done with the arthroscope via the posteromedial portal. Using the retrieved suture, both suture ends are brought out to the anteromedial portal. The torn tibial stump is pulled to the intercondylar notch and then repaired with stitches at the anterior compartment. After the tibial and femoral tunnels are prepared without damaging the remnant PCL bundle, the combined torn PCL fibers and the autogenous single-bundle semitendinosus and gracilis tendon grafts are passed through the femoral tunnel and fixed together Conclusion: Arthroscopic repair of the torn tibial stump and autogenous hamstring tendon graft augmentation after preparing the tibial and femoral tunnels by using the trans-septal portal, without damaging the remnant PCL bundle, seems to be a very effective method for the treatment for acute PCL injuries, and especially for tears at the femoral attachment.

• Journal of the Korean Arthroscopy Society
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• v.17 no.1
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• pp.11-17
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• 2013

Purpose: The purpose of this study is to evaluate the effect of preservation of the tibial remnant on the synovialization of graft tendon after the reconstruction of anterior cruciate ligament (ACL) based on the second look arthroscopic findings. Materials and Methods: From May 2005 to May 2012, among sixty three patients having ACL reconstruction with the four-strand hamstring using a bioabsorbable cross pin (RigidFix$^{(R)}$) for the femoral tunnel, nineteen patients who had second look arthroscopy were analyzed. We classified them into three groups according to the tibial remnant of the torn ACL for arthroscopic findings. Group 1 had less than 5 mm of a remnant tissue, Group 2 had from 6 mm to 10 mm of it, and Group 3 had more than 11 mm. We estimated the percentage of synovial coverage on the graft tendon during second look arthroscopy. We evaluated Lysholm score and Tegner activity score preoperatively and in the last follow-up. Results: At the time of ACL reconstruction, the mean length of preserved tibial remnant of torn ACL was 2.3 mm in Group 1, 7.4 mm in Group 2, and 13.7 mm in Group 3. In the second look arthroscopy, the average percentage of synovial coverage was 55.4% in Group 1, and 77.9% in Group 2, and 89.7% in Group 3. Lysholm score and Tegner activity score improved from 74.2 and 7.3 preoperatively to 94.1 and 8.5 in the last follow-up. Conclusion: The preservation of tibial remnant of torn ACL influenced the synovial coverage of the graft tendon and the volume of preserved remnant in accordance with the surface of synovial coverage. It would have a good effect on graft healing and preservation of proprioceptive function.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.125-131
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• 2011

Optimal treatment of the torn posterior cruciate ligament (PCL) remains controversial. The type of tibial fixation (transtibial vs inlay), the femoral tunnel position within the femoral footprint (central, eccentric or isometric), and the number of bundles in the reconstruction (single-bundle vs double-bundle) are controversial issues. The PCL has a better chance of spontaneously healing than the anterior cruciate ligament (ACL) because of a rich blood supply (near the branch of the middle genicular artery) and coverage with a thicker synovium. In general, for easier passage of the graft and full visualization of the original ligament attachment site during the precise positioning of the tunnel, the remaining PCL fibers are usually debrided during reconstruction. However, the remaining remnant structures would significantly contribute to the posterior stability of the knee joint, the healing of the graft, preserving proprioceptive function of the mechanoreceptors in the PCL. Double bundle PCL reconstruction may result in some surgical complications because of increased complexity of making tunnel. Therefore, single bundle PCL reconstruction with remnant preservation seems to be an effective procedure.