• Journal of Korean Foot and Ankle Society
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• v.21 no.1
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• pp.12-16
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• 2017

Purpose: Anterior drawer and varus stress radiographs are commonly to diagnose chronic lateral ankle instability. We compared the preoperative stress radiographs with the intraoperative radiographs under anesthesia to determine the accuracy and efficacy of stress radiographs in an outpatient clinical environment. Materials and Methods: Data was collected from patients who underwent a modified $Brostr{\ddot{o}}m$ operation for painful chronic unilateral lateral ankle instability between January 2014 and June 2016. Subjects were divided into three groups-complete tear, partial tear, and instability without rupture-according to the status of preoperative MRI findings of the anterior talofibular ligament. The anterior drawer and varus stress radiographs were taken preoperatively and intraoperatively under anesthesia. Results: Ninety-six patients, with a mean age of 29.63 years, were enrolled. There were 39, 46, and 11 patients in the complete tear, partial tear, and instability without rupture groups, respectively. On the anterior drawer and varus stress radiographs of the affected limb, talar anterior translation and varus tilting were significantly increased by 2.56 mm and $2.0^{\circ}$. The gaps between the unaffected limbs were also increased by 2.47 mm and $1.32^{\circ}$ after anesthesia. Although the stress radiographs were taken under anesthesia, the results were often smaller than the diagnostic value. Conclusion: Stress radiographs for painful chronic lateral ankle instability taken at the outpatient clinic might be inaccurate for diagnosis.

• Journal of the Korean Arthroscopy Society
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• v.17 no.1
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• pp.31-37
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• 2013

Purpose: This study performed to compare degree of joint stiffness and clinical results between early and delayed reconstruction of acute posterior cruciate ligament (PCL) injuries. Materials and Methods: Thirty-two Patients who underwent PCL reconstruction between March 2008 and October 2011 enrolled this study. We performed transtibial single bundle reconstruction using the allo-achilles tendon in all cases. We divided the patient into two groups, early reconstruction group underwent surgery before a week, delayed reconstruction group underwent surgery after 3 weeks, before 6 weeks. All the patients underwent aggressive joint motion exercise till surgery and enrolled post operative rehabilitation program. We checked posterior drawer stress radiography, range of motion, the Lysholm score, the International Knee Documentation Committee (IKDC) score and the Tegner score to evaluate the results. Results: At the final follow up the Lysholm score was 92.1 in the early group and 93.8 in the delayed group. All the cases were rated above B (near normal) on IKDC score (p=0.808, p=0.722). The Tegner score was 6.6 in the early reconstruction group and 6.2 in the delayed group (p=0.480), The average of maximum flexion and extension angle was $133.9^{\circ}$, $1.4^{\circ}$ in the early group and $133.6^{\circ}$, $1.1^{\circ}$ in the delayed group (p=0.560, p=0.581), no complication such as deep vein thrombosis or infection, no difference in posterior drawer stress radiography (p=0.750). Conclusion: We could obtain satisfactory clinical results in both the early and delayed reconstruction groups of acute PCL injuries. Therefore, the early reconstruction of PCL performed before a week could be one of the treatment options for acute PCL injury.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.45-52
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• 2008

Purpose: The purpose of the study is to provide the clinical results of arthroscopic posterior cruciate ligament(PCL) reconstruction with preservation of the original PCL using transtibial tunnel and posterior transseptal portal. Materials and Methods: 36 patients underwent PCL reconstruction with achilles tendon allografts. We tried to preserve of the original PCL.At the final follow-up, patients were evaluated retrospectively by four measurements: Lysholm knee scores, IKDC grades, Telos stress radiography, and second look arthroscopy.Follow-up periods were from 12 months to 30 months. Results: The average Lysholm knee score improved from $66.0{\pm}8.67$ to $87.9{\pm}5.04$. Preoperative IKDC grades were abnormal in 15(41.7%) and severely abnormal in 21(58.3%), postoperative IKDC grades were normal in 6(16%),nearly normal in 24(66%), abnormal in 5(16%) and severely abnormal in 1(2%).The average side to side difference in Telos stress test decreased from $12.5{\pm}2.61(7{\sim}20)$ mm to $3.9{\pm}1.34(7{\sim}1)$ mm (paired sample T test, p=0.001) Conclusion: Arthroscopic posterior cruciate ligament(PCL) reconstruction with preservation of the original PCL using transtibial tunnel and posterior transseptal portal is useful surgical method.

• Journal of the Korean Arthroscopy Society
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• v.17 no.1
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• pp.24-30
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• 2013

Purpose: To evaluate the outcome of arthroscopic posterior cruciate ligament (PCL) augmentation using an autogenous hamstring tendon graft and the posterior-posterior triangulation technique with preservation of ligament remnant or elongated ligament. Materials and Methods: From January 2002 to December 2009, we performed PCL augmentation using an autogenous hamstring tendon graft and the posterior-posterior triangulation technique in 32 patients. The mean age was 35.2 years. Twenty two cases were male and 10 cases were female. Average follow-up period was 5 years and 5 months (range: 2-7.9). Subjective and objective parameters were utilized in analyses, such as the mean range of motion, post. drawer test, Lysholm knee score, Tegner activity score, International Knee Documentation Cominittee (IKDC) grade, and second look arthroscopic examination. Results: At last follow up posterior displacement by the Telos stress test decreased from $10.8{\pm}5.1\;mm$ to $2.8{\pm}3.7\;mm$ (p<0.05). The final Lysholm knee score improved from $60.4{\pm}5.8$ to $84.6{\pm}4.8$. Tegner activity score improved from 3.2 to 4.8. The final IKDC grade was A in 18, B in 11, C in 3. Postoperative Lysholm knee score, IKDC grades, Tegner activity scale, and posterior displacement demonstrated statistically significant improvement compared to the preoperative state (p<0.05). Conclusion: Arthroscopic PCL reconstruction using an autogenous hamstring tendon with preservation of ligament remnant showed a good clinical results and posterior stability.

• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.8-13
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• 2009

Purpose: We used tibialis allograft for the reconstruction of ACL and used Hybrid femoral fixation utilizing $Endobutton^{(R)}$ and $Rigidfix^{(R)}$ for femoral fixation, and used $Retroscrew^{(R)}$ and additional fixation for tibial fixation to evaluate the clinical results. Materials and Methods: The ACL reconstruction were performed from February 2004 to February 2007 utilizing Hybrid femoral fixation and $Retroscrew^{(R)}$ and 32 patients, 32 cases which were available for year-long observation (12 to 25 months). The clinical results (Lysholm knee score, IKDC grade) and the radiologic results(bone tunnel expansion, Telos anterior displacement test) were evaluated. Results: The Lysholm knee score was improved from the average of $67.9{\pm}5.4$ points (range: 51~77) before operation and to $94.1{\pm}6.8$ points (range: 68~98) at the last follow up (p<0.05). 22 cases (69%) were evaluated normal (A), 9 cases (28%) were evaluated nearly normal (B) and only 1 case (3%) was evaluated not normal (C) at IKDC final evaluation and no case was evaluated abnormal. From $Telos^{(R)}$ stress x-ray evaluation, difference from the opposite knee was improved average 13.2 mm{\pm}5.8 (range: 6~21 mm) to average $3.4\;mm{\pm}2.8$ (range: 0~11 mm) after operation (p<0.05). The femoral and tibial tunnel were widened by 18.7% and 9.6% in the AP view and 12.4% and 8.5% in the lateral view, respectively (p<0.05). However, any statistic significance was not observed between bone tunnel expansion and knee joint functions (p>0.05). Conclusion: An ACL reconstruction with tibialis allograft using Hybrid femoral fixation and $Retroscrew^{(R)}$ enabled anatomical fixation of the graft tendon with satisfactory clinical results.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.43-48
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• 2002

Purpose : We evaluated radiographic changes and clinical manifestations of the elbow joint to identify the effects of the throwing between dominant and non-dominant arms. Materials and Methods : A hundred and five little leaguer’s baseball player in 5 elementary school and 2 middle school were evaluated for clinical symptoms and radiographic changes about elbow joint. Mean age was 12 years old and average periods of exercise were 32 months. Elbow functions were evaluated using ASES standardized assessment form and radiographic changes of medial epicondyle were examinated for enlargement, separation of the apophyses, fragmentation and irregularity. Results : Thirty seven players (35$\%$) were complained pain with throwing and the average score was 4.8 using visual analog scale. There were no significant differences in range of motion except flexion angle, valgus angle, and strength between dominant arm and non-dominant arm. Valgus laxity was more prominent in dominant arm. Ulnohumeral tenderness, radiocapitellar tenderness and medial flexor origin tenderness were in 18, 6, and 17 cases respectively in dominant arm. Medial epicondyle was enlarged in dominant arm with 13.0 by 6.3 mm compared to non-dominant arm with 11.7 by 6.1 mm. Apophyseal separation was 0.8 mm in dominant arm and 0.5 mm in non-dominant arm. Fragmentation and irregularity were 14 (13$\%$) and 25 (24$\%$) cases respectively in dominant arm. Conclusion : In little league baseball player, it needs usage of ball and bat with appropriate weight, and careful conditioning programs through throwing exercise in order to avoid elbow injuries.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.1
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• pp.27-32
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• 2008

Purpose: To evaluate the clinical results of the patients who underwent radiofrequency thermal shrinkage (RFTS) for treatment of anterior cruciate ligament (ACL) laxity after ACL reconstruction. Material and Methods: From October 1999 to March 2006, we performed 133 cases of ACL reconstruction. Among them we experienced 16 patients who had the laxity of reconstructed ACL in second look arthroscopy. Mean follow-up was 20.4 months. Mean age was 33.5 years. 12 cases were male and 4 cases were female. The elongated ACL were treated by bipolar radiofrequency energy with an output of grade II. Subjective and objective parameters were utilized in analyses, such as: the mean range of motion, Lysholm knee score, Tegner activity score, Lachman test, IKDC score. Wilcoxon signed-rank test was used to perform the data analysis. P<0.05 was considered to be statistically significant. Results: Postoperative mean Lysholm knee score (preop: $82.2{\pm}5.2(77{\sim}85))$ (P=0.04), postop: $85.2{\pm}4.8$(82-90)) and anterior displacement by the Telos stress test (preop: $5.4{\pm}4.6(3{\sim}10)mm$, postop: $2.1{\pm}1.9(0{\sim}4)mm)$ (P=0.02), Lachman's test, and IKDC scores (P=0.04) demonstrated significant differences statistically compared to the preoperative. There were no statistical differences in mean range of motion, Tegner activity scale. Conclusions: Arthroscopic shrinkage for the ACL laxity after ACL reconstruction with radiofrequency device showed good clinical results and was applicable operative technique.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.1
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• pp.18-26
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• 2011

Purpose: This study is to compare the clinical results of ACL reconstruction between three groups using hamstring tendon autograft, mixed and tibialis tendon allograft. Materials and Methods: Between August 2003 and August 2008, we analyzed 169 cases of ACL reconstruction, 66 cases used hamstring tendon autograft, 42 cases used mixed graft and 61 cases used tibialis tendon allograft, with a minimum follow-up of 12 months. For the clinical evaluation, we evaluated the Lysholm score, Telos stress test device and IKDC score. Results: The average side to side difference in Telos stress test decreased from $7.5{\pm}1.0$ mm to $1.6{\pm}1.0$ mm in autograft group, from $7.6{\pm}1.1$ mm to $1.4{\pm}1.1$ mm in mixed graft group and from $7.4{\pm}1.3$ mm to $2.5{\pm}1.3$ mm in allograft group. The average Lysholm knee score improved from 58.6 to 92.3 in autograft group, from 60.6 to 92.6 in mixed graft group and from 55.3 to 91.5 in allograft group. There was no significant difference between three groups in clinical results. At second look arthroscopy, tension of ligament and synovial coverage were good result in autograft and mixed graft than allograft group. Conclusion: All hamstring tendon autograft, mixed graft and tibialis tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. Both hamstring tendon autograft and mixed graft showed good synovial coverage in second look arthroscopy. So mixed graft will be considered as good alternative in case of shorter or thin harvested hamstring tendon.

• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.196-200
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• 2003

Purpose : To evaluate clinical outcomes after anterior cruciate ligament (ACL) reconstruction in middle-aged patients and determine the factors affecting the outcome. Subjects and Methods : Clinical results obtained from 60 cases (60 patients) older than 40 years of age at the time of surgery and 58 cases (58 patients) younger than 40 years of age who underwent ACL reconstruction between August 1988 to January 2002, return to sports activity, and stress radiographs using Telos instrument were compared. Results : The Lysholm knee score was improved from the preoperative score of 54.0 points to the postoperative score of 92.9 in patients older than 40 years of age and was improved from 56.2 points to 92.2 points in patients younger than 40 years of age. Clinical outcome was excellent in 51 cases $(85\%)$ and good in 9 cases $(15\%)$ in patients olde. than 40 years of age and was excellent in 47 cases $(81.0\%)$ and good in 11 cases $(19.0\%)$ in patients younger than 40 years of age. There was a significant difference in the rate of returning to preoperative sports activity between patients older than 40 years of age ($60\%$, 36 cases) and younger than 40 years ($82.8\%$, 48 cases). According to Telos stress radiography, the preoperative difference of 11.2 mm was decreased to the postoperative difference of 3.1 mm in patients older than 40 years of age and the preoperative difference of 10.7 mm was decreased to the postoperative difference of 2.9 mm in patients younger than 40 years of age. Clinical outcome did not show significant correlation with age, gender, surgery method, the presence of additional injury, and the rate of return to sports activity before receiving injury (p>0.05). Conclusion : Age didn't have a significant influence on the final outcome of ACL reconstruction and good results could be obtained with ACL reconstruction even in middle-aged patients.

• 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.