• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.255-263
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• 2009

Purpose: An osseous defect in the glenoid and humeral head is closely associated with recurrence of anterior shoulder instability. The purpose of this article is to describe the open surgical techniques and introduce our experiences with anterior instability with a significant osseous defect. Materials and Methods: We reviewed the articles that have focused on and/or mentioned the affect of osseous defects on anterior shoulder instability. The open surgical techniques and its related pearls are summarized in this review. Results: Accurate evaluation for the size and location of the osseous defect is critical for preventing recurrence after restoration of the anterior capsulolabral structure. The glenoid bone restoration techniques include the coracoids transfer (the Bristow procedure and the Latarjet procedure) and a structural iliac bone graft. Rotational humeral osteotomy and an osteoarticular allograft could be used for repairing a significant posterosuperior humeral defect (Hill-Sachs lesion). Shoulder arthroplasty may be tried for treating a humeral bone defect, but more study on this is needed. Conclusion: Open surgical restoration decreases the risk of recurrence anterior shoulder instability that is combined with a significant osseous defect. Arthroscopic surgery currently has limitations for treating an osseous defect, but it will become useful in proportion to the development of arthroscopic instruments and techniques in the future.

• Journal of the Korean Arthroscopy Society
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• v.5 no.2
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• pp.74-79
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• 2001

Purpose : The purpose of this study is to evaluate the clinical results after arthroscopic PCL reconstruction and to compare the clinical results after arthroscopic PCL reconstruction using BPTB(bone patellar tendon bone) autograft(Group I : 11 cases), Achilles tendon allograft(Group II : 7 cases) and BPTB allograft(Group 111.6 cases). Materials and Methods : We reviewed the result of 24 patients who had been managed with arthroscopic reconstruction using different graft materials such as BPTB autograft, Achilles tendon allograft and BPTB allograft. Twenty-four patients(average age, 37 years) with PCL rupture were retrospectively evaluated more than one year(average, 31 months) after having arthroscopic posterior cruciate ligament reconstruction. The clinical results were evaluated by IKDC ligament standard evaluation form, using $KT-2000^{TM}$ knee ligament arthrometer and also evaluated Lysholm knee scoring scale. Results : The final evaluation was nearly normal in 11 patients($45\%$ in Group I, $43\%$ in Group II, $50\%$ in Group III). The corrected posterior sagging was abnormal(side to side difference more than 6mm) in 8 patients($36\%$ in Group I, $29\%$ in Group II, $33\%$ in Group III). We could not find significant difference among three groups by IKDC scale. Conclusion : Comparing with other reports, our overall results were not satisfactory. And also, we could not find any remarkable difference among the three groups. Further research is necessary to evaluate new surgical approaches as well as improved techniques for capsular and collateral ligament injuries.

• Journal of Periodontal and Implant Science
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• v.35 no.4
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• pp.949-959
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• 2005

이 연구는 임플란트를 식립하기를 원하는 전신건강상태가 양호하며 구강위생상태가 좋은 14명 환자(남자:8명, 여자:6명, 평균나이 : 44세)의 20개의 발치와 내에 흡수성 차폐막(BioMesh. Sam Yang Corporation, Korea)과 함께 탈회냉동 건조동종 골(dem-ineralized freezedried bone allografts, $250-500{\mu}m$. Pacific Coast Tissue Bank, U.S.A.)과 이종골(Bovine-Bone, Bio-Oss 0.25-1.0 mm, Geistlich, Biomaterials and Osteohealth, Switzerland)을 1:1(부피)로 혼합하여 이식한 후 그 치유양상을 관찰하고자 조직학적 및 면역조직화학적으로 평가하였다. 이직재가 탈락되는 것을 방지하기 위하여 발치한 후 1개윌이 경과된 후에 이식재와 차폐막을 위치시켰다. 표본제작을 위하여 이식술을 시행한 지 약 6개윌 후에 임플란트를 식립하기 직전 식립부위에서 trephine bur로 골을 채취하였는데, 20증례 중 7증례에서 임플란트를 식립하기 전에 차폐막이 노출되었다. 차폐막이 노출되지 않은 것을 대조군으로, 노출된 것을 실험군으로 설정하였다. 조직학적인 관찰을 위하여 통상적인 방법에 따라 탈회 표본을 제작하였고, alkaline phosphotase(ALP)틀 이용하여 면역조직화학적 염색을 시행한 후 골 형성 상태를 평가하여 다음과 같은 결과를 얻었다. 본 연구에서는 발치와내에서 골유도재생술 후 나타나는 치유 형태를 5가지 형태로 분류할 수 있었다. Type I, II와 III는 새로운 골 형성을 나타내지 않았고, 면역조직화학적 검사 시 ALP 음성 소견을 나타내었다. Type V는 새로운 골 형성과 ALP 양성 소견을 나타내었으나 염증, 괴사, 결합조직의 증식 등은 없었다. Type IV와 Type V의 차이는 결합조직의 증식여부로 구분되었다. 막이 노출되지않은 증례들 중 7 증례에서는 Type V의 치유 형태를, 2증례에서는 Type IV의 치유 형태를 나타내었다. 막이 노출되었던 증례에서는 Type I, II, III의 다양한 치유 형태를 나타내었다. 본 연구결과, 발치와 내에 골유도재생술을 시행한 후 차폐막의 노출 여부가 신생골 형성에 중요한 영향을 미칠 것으로 사료되며, 본 연구에서 분류한 치유 형태가 향후 골유도재생술 후의 결과 분석에 활용될 수 있을 것으로 사료된다.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.159-164
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• 2006

Purpose: To evaluate the clinical stability and function after one-stage revision anterior cruciate ligament (ACL) reconstruction using fresh-frozen Achilles tendon allograft Materials and Methods: Thirteen patients who underwent one-stage revision ACL reconstruction using Achilles tendon allograft could be evaluated. The average time from primary procedure to revision surgery was 61.8 months. The mean follow-up period was 38.4 months. The bone defects of pre-constructed femoral and tibial tunnels were filled with calcaneal bone attached to Achilles tendon and the new femoral and tibial tunnels were created. Evaluations included the causes of failure of primary ACL reconstruction, Lysholm knee score, Lachman test, pivot shift test and KT-1000 arthrometer measurement. Results: The most common causes of failure of ACL reconstruction were poor surgical techniques in 10 cases (76.9%). Ten patients (76.9%) were good or excellent on the Lysholm score. Twelve patients (92.3%) had negative or 1+firm end Lachman test. Eleven patients (84.6%) had negative pivot shift test. Nine patients (69.2%) had less than 3 mm difference of manual maximum by KT-1000 arthrometer. Conclusion: One-stage revision ACL reconstruction with fresh-frozen Achilles tendon allograft, creating new tunnels after filling bone defects, resulted in a reliable and predictable outcome in terms of stability.

• Proceedings of the Materials Research Society of Korea Conference
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• 2009.11a
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• pp.6.1-6.1
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• 2009

신경외과는 뇌수술과 척추수술로 나눈다. 이중뇌수술 분야에서는 두개강내압 항진시 감압술이라고 '머리의 뚜껑을 연다'라는 표현과 마찬가지로 두개골의 일부분(손바닥크기)을 절제하는 수술이 있다. 이때 과거에는 떼어낸 뼈를 복부의 피하지방밑에 심어서 보관을 하다가 3-6개월 후 환자의 뇌상태가 안정이 되면 다시 꺼내어 제자리에 놓았는데, 골편이 피하지방에서 녹는 경우가 다소 있고, 복부에 이식한 장소가염증이 생기는 경우도 있어서 요즘은 냉동고에서 -70도를 유지하여 보관 후 나중이 복원 수술을 할 때녹여서 사용한다. 이를 '자가골 두개성형술' 이라 한다. 하지만골편의 오염이나 소실 혹은 1차 두개성형술 후 감염 등 어쩔 수 없이 자가골을 사용 못하는 경우에는인공으로 두개골편 모형을 제작하여 '뚜껑'으로 사용해야 한다. 현재PMMA를 이용하여 수술 시 모형을 제작하는 방법이 많이 사용되며 최근 단단한 스펀지 형태의 인공제품이 사용되고 있으나 가격이 매우비싸지만 스펀지 기공내로 자가골이 자란다는 장점이 있다. 척추수술 분야에서는 뼈 대치품을 비교적 많이필요로 한다. 즉 척추 후방고정을 하는 경우 원래 수술의 목적인 감압술이나 교정술 등을 한 후 척추분절간 쇠(티타늄사용)고정을 한 뒤에 뼈조직(자가골이나 동종이식골, DBM, HA stick) 등을 충분히 사용하여덮어줌으로써 분절간 골유합을 유도할 때 많은 양이 필요하며, 척추 전방으로 수술을 하는 경우에도 디스크공간이 빈 상태에서 Cage(추체와 추체를 지지하는 작은 상자모양) 내에뼈조직을 넣어서 척추분절간 골유합이 일어나도록 한다. 최근 HA를 cage 대용품으로 사용한 경우에서 HA가 부서지는 경우가 기사화된바 있다. 또한 경추의 추체 내에 작은 구멍만 뚫고 디스크 수술을 한 후에 그 구멍에 HA+B-TCP 소재를 넣어 천연뼈의 성장 유도를 위해 사용되는 등 신경외과의 다양한 분야에서 생체소재들이 사용되고 있다.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.31-37
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• 2003

Introduction: The purpose of this study is to assess the efficacy of calcium sulfate as a bone graft substitute in the treatment of benign bone tumor. Materials and Method: Between December 2000 and November 2001, 18 patients with a benign bone tumor were treated with crettage and the defects were filled with calcium sulfate (Osteoset$^{(R)}$:Wright Medical Co. USA) as a bone graft substitute. Average age was 28.4 years and mean follow up period was 12.3 months. Calcium sulfate mixed with autograft was used in 6 cases, calcium sulfate with allograft in 2 cases, and calcium sulfate alone was used in 10 cases. The degree of absorption of calcium sulfate and new bone formation at plain radiograph was analyzed at immediate postoperative and postoperative 3 months and 6 months follow up. Results: At 3 months postoperatively, 92% of calcium sulfate was absorbed, and at 6 months postoperatively, 89% of new bone formation was observed. There was no difference in the resorption and new bone formation between the group using bone graft and the group osteoset$^{(R)}$ alone, different preoperative diagnosis and even different locations. There was no complication. Conclusion: Calcium sulfate(Osteoset$^{(R)}$) is a safe and effective bone graft substitute in the treatment of benign bone tumors, especially for the children in whom autograft is not recommandable.

• Journal of the Korean Orthopaedic Association
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• v.55 no.2
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• pp.169-177
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• 2020

Purpose: To assess the effectiveness of mixed grafts in lumbar posterolateral fusion (PLF) by comparing the bone union rates of an autobone with a bone substitute mixed graft. Materials and Methods: The patients were followed-up for at least two years after PLF and divided into four groups according to the mixed graft retrospectively. Group I was 48 cases using a femoral head allobone. Group II was 38 cases using β-tricalcium phosphate. Group III was 92 cases using biphasic calcium phosphate. Group IV was 38 cases using biphasic calcium phosphate and autologous bone marrow. Union was evaluated by the work up simple radiographs after two years from PLF. Union was defined if the radiographs demonstrated a bilateral continuity in the fusion mass between the cephalad and caudal transverse processes with less than 2° of angular motion and no translation between the vertebrae at the level of fusion on the lateral flexion-extension radiographs. Results: According to simple radiographs after two years from PLF, the rate of union was highest in Group IV using local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft. Conclusion: Biphasic calcium phosphate is an osteoconductive bone substitute that increases the bio-absorbability and mechanical strength. Autologous bone marrow has osteoinductive and osteogenic properties. These features can increase the rate of bone union. Therefore, a local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft can be considered an effective bone graft substitute for lumbar PLF instead of an autobone graft.

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.97-104
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• 2000

Purpose : The majority of PCL deficient knees have some intact remnant PCL bundles. In these cases, the remnant PCL bundles were removed fur easy passage of graft(especially in bone-patellar tendon-bone graft). The purpose of study is to report the results of PCL reconstruction by posterior transseptal portal technique and by preserving the remnant posterior cruciate ligament bundles. Materials & Methods : From November 1993 to June 1999, 44 arthroscopic posterior cruciate ligament reconstructions have been performed by one surgeon. We studied 37 knees those were followed up over 1 year among them. The mean age($14\~56$ years) was 31.8 years. The average follow-up period was 17.8 months($12\~61$ months). The graft materials were 29 double-loop hamstring autografts, 4 double-loop hamstring allografts and 4 Achilles tendon-bone allograft. Results : There are significant improvement of the preoperative subjective symptoms. The last follow-up shows that the average Lysholm knee score was markedly improved from 59.8 pre-operation to 89.2 post-operation and the average KT 2000 side difference was decreased from 11.1mm pre-operation to 2.3 mm post-operation. Follow-up MRI showed that the graft was healed with remnant posterior cruciate ligament bundles as one ligament. Conclusion : The posterior trans-septal portal makes it possible to locate the exact tibial tunnel. The arthroscopic PCL reconstruction preserving the remnant of original PCL bundles seems to provide the good result.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.99-107
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• 2011

Purpose: The purpose of this study was to investigate the clinical results after a anatomical double bundle ACL reconstruction using a longitudinally split tibialis anterior allograft. Materials and Methods: We evaluated 24 patients with a minimum follow-up of 12 months who had undergone anatomical double bundle ACL reconstructions. The grafts utilized in all cases were tibialis anterior allografts which were longitudinally split into two strands. A standard rehabilitation protocol was applied in all patients. The pre- and post-operative data including Lysholm scores, International Knee Documentation Committee (IKDC) scores, Lachman test, pivot shift test and the side-to-side differences of anterior laxity measured by KT-2000 arthrometer were analyzed by use of a statistical method Results: The mean side-to-side instrumented laxity measured by the KT-2000 arthrometer significantly improved to a mean of $1.04{\pm}0.80\;mm$ (P < 0.001). The Lysholm knee scores also improved from $58.34{\pm}15.32$ to $86.25{\pm}6.48$ after surgery (P < 0.001). The patients exhibited improved IKDC scores (A: 15 cases, B; 9 cases) at the final follow-up, compared to preoperative scores (B: 5, C: 10, D: 9). Conclusion: Our data demonstrated that clinical results of anatomical double bundle ACL reconstruction with a split tibialis anterior allograft are encouraging with excellent side-to side laxity, significantly improved Lysholm knee score, IKDC score, Lachman and pivot shift data.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.2
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• pp.133-144
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• 1995

After resection of intraarticular, periacetabulum(P2) and pubic rami(P23) and extraarticular, proximal femur(P2-H12) by Enneking classification, reconstruction is very difficult. We experienced three cases of saddle prostheses for reconstruction after P2, P23, and P2-H12 resection in pelvic malignancies. Case 1 was a high grade chondrosarcoma in 36 year-old-man and P2 resection was done. But he died of disease 19 months after operation. Case 2 was a malignant giant cell tumor in 32 year-old-woman. P23 resection was given and she is disease-free 32 months after operation. Case 3 was an osteosarcoma of 27-year-old-man and P2-H12 resection was performed and he is disease-free postoperative 12 months now. According to MSTS functional evaluatin system, all three patients showed no pain(5), intermediate function(2), emotinally satisfied(3), one cane or crutch supported(1), limited walking(3), and minor cosmetic gait(3). There was no significant complication and no dislocation except intermittent inguinal hernia in case 2. All patients started crutch walking 3 weeks after operation. Around 6 months postoperatively, the preserved iliac wing(P1 component) was hypertrophied enough to endure the full weight bearing. All could have squating and kneeling positions. In conclusion, saddle prosthesis would be a very useful method of reconstruction after P2, P23, and/or H1-2 resection to shorten the operation time and to reduce the infection rate without significant loss of function.