• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.47-53
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• 2011

Purpose: As the number of the anterior cruciate ligament (ACL) reconstruction has increased, the incidence of revision of ACL reconstruction due to reconstruction failure has been also increased. Therefore, authors analyzed the reason of the failure of ACL reconstruction and the clinical result of the ACL revision. Materials and methods: From February 1998 to July 2010, we selected 36 cases which was followed at least 12months after the ACL reconstruction failure. Duration from reconstruction to revision, the average duration was 60 months (5~334) and on first reconstruction, we used allograft on 23 cases (63.9%) and autograft on 13 cases (36.1%). For the main symptom of ACL reconstruction failure, instability was the most common symptom, and 35 cases (97.5%) were undergone only one reconstruction and 1case (2.5%) was undergone two reconstruction. Clinical results were evaluated by Lysholm knee joint score, pivot shift test, and Telos device. Results: Average follow-up duration of the patients was 21 months (12~40), and the reason for the ACL reconstruction failure, trauma was most common by 19 cases (52.8%), malposition of the femoral tunnel was 13 cases (36.1%), malposition of the tibia tunnel was 1case (2.8%), and failure of osteointegration was 3 cases (8.4%). On performing the ACL revision, we used allograft on 34 cases (94%) and autograft on 2 cases (6%), and 21 cases accompanied injury of the meniscus (medial meniscus 14 cases, lateral meniscus 7 cases). Lysholm knee joint score was improved from 66.5 points, preoperatively to 92 points on last follow-up (p<0.01). In most cases, patients were satisfied (92%) with the operation results. Tegner activity score was also improved from 2.0 points preoperatively to 6.2 points on the last follow-up. On Lachman and pivot sift test, 33 cases and 30 cases were improved to grade I respectively, and on stability test using Telos device, the bilateral difference was improved from mean 15.5 mm preoperatively to 4.5 mm on the last follow-up. Conclusion: After 1 year follow-up, Revision of ACL had a little anterior instability but it showed satisfactory result on clinical result and patient's subjective satisfaction.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.53-60
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• 2006

Purpose: This study is to analyze the clinical and radiological results after arthroscopic reduction and internal fixation of intra-articular fractures of lateral tibial plateau. Materials and Methods: The subject of the study are the 13 cases of the patients visited orthopedics surgery during March year 2000 to August year 2004 because of intra-articular fractures of lateral tibial plateau and were treated with arthroscopic reduction and internal fixation. X-rays and CT or MRI were both carried out to identify the precise pattern of fracture and the degree of depression which showed out to be all type 2 by Schatzker fracture classification. And in 9 of the cases, autogenous and allogenous bone grafts were given as bone loss were severe. The average age was 48, age group between 31 and 66, and average follow up period of about 38 months ($13{\sim}65months$). Radiological ratings were given by comparing the X-rays of degree of joint congruency before and after the operation, functional ratings by analyzing IKDC score and Lysholm score. Combined injuries observed after arthroscopy were posterior cruciate ligament injury in 1 case, meniscus injury in 4 cases and medial collateral ligament in 2 cases. Results: During follow up, X-rays showed well-maintained reduction of articular surface in all cases and no complications such as joint depression, fracture reduction loss, angular deformity or malunion were found. Average Lysholm score at last follow up was 87 points ranging from 65 to 97, in 8 of the cases excellent, 3 good, 1 fair and 1 poor according to Lynsholm classification. Average IKDC score was 92 (from 82 to 99). Conclusion: Not only does arthroscopic reduction of lateral tibial plateau fracture bring exact reduction of articular surface, but also, is considered to be a good way of operation to diagnose and treat combined injuries of knee joint using arthroscopy.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.195-199
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• 2002

This article is to report a new technique for reconstruction of the anteromedial and posterolateral bundles of anterior cruciate ligament by separate tensioning and fixation of the each bundle. Method : Tibial and femoral tunnels were made with conventional technique of anterior cruciate ligament reconstruction. Tibial tunnel was enlarged $5\~7$ mm in anterior-posterior direction to make oval it in cross section. When preparing the Achilles tendon allograft, bone plug portion was trimmed as the conventional technique. The tendinous portion was trimmed as two separate bundles by dividing the tendinous portion longitudinally, so the graft is shaped like 'Y'. The bone plug portion of allograft was inserted into the femoral tunnel and fixed with absorbable cross pins. Two ligamentous portionss of the distal part of the grafts were tensioned separately at the external orifice. Anteromedial bundle was fastened under maximum tension with the knee flexed 90 degrees by post-tie method. The posterolateral bundle was fixed by the same technique with the knee in full extension. Then, an absorbable interference screw was inserted between the two bundles upto the upper end of the tibial tunnel, to get more initial rigidity of the reconstructed graft as well as to locate the two bundles in more anatomic position.