• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.2 no.1
• /
• pp.18-23
• /
• 2009

Purpose: To evaluate the relationship between the real pathology & abnormal finding found by ultrasonography. Without an MRI test being done beforehand, an arthroscopy is done after an ultrasonography to show abnormal lesions during a knee abnormality. Materials and Methods: The subjects were 42 patients out of 49 cases, excluding those with rheumatoid arthritis, septic arthritis and patients suspected with a ligament tear, which were examined by ultrasonography alone before receiving a knee arthroscopy in our hospital from July 2007 to July 2008. In every case, a physical examination, simple X-ray and knee ultrasonography was done. An arthroscopy was performed when there was ultrasonographic abnormal finding. Before the procedure, a MRI test was not performed and when abnormal findings were found by an arthroscopy, an appropriate surgery was done. Results: During the ultrasonographic examination, there were various sized effusions in the suprapatellar pouch. Also, in addition there were eleven cases of medial meniscus abnormalities, sixteen cases of lateral meniscus abnormalities, and two cases of cystic lesions. Throughout the arthroscopic examination, there were 14 cases of medial meniscus abnormalities, 20 cases of lateral meniscus abnormalities, 15 cases of cartilage damages, 9 cases of medial pathologic plica, 2 cases of intra-articular loose bodies, 5 cases of chondromalacia, 2 cases of cyst, and 2 cases of synovitis. When an effusion abnormality was found by the ultrasonography in a suprapatellar pouch, there was a 100% probability of knee pathology. When a medial meniscus abnormality was found with an ultrasonography, there was a 90.9% probability of a real pathology. When a lateral meniscus abnormality was found there was 81.2% probability of a real pathology. Ultrasonography was 100% accurate when it came to cystic lesions. Conclusion: Knee ultrasonography performed before an arthroscopy seems to be a very useful examination method when suspecting intra-articular lesions.

• Journal of the Korean Orthopaedic Association
• /
• v.55 no.4
• /
• pp.281-293
• /
• 2020

An anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgical procedures in the knee joint, but despite the better understanding of anatomy and biomechanics, surgical reconstruction procedures still fail to restore rotational stability in 7%-16% of patients. Hence, many studies have attempted to identify the factors for rotational laxity, including the anterolateral ligament (ALL), but still showed controversies. Descriptions of the ALL anatomy are also confused by overlapping nomenclature, but it is usually known as a distinctive fiber running in an anteroinferior and oblique direction from the lateral epicondyle of the femur to the proximal anterolateral tibia, between the fibular head and Gerdy's tubercle. The importance of the ALL as a secondary restraint in the knee has been emphasized for successful ACL reconstructions that can restore rotational stability, but there is still some controversy. Some studies reported that the ALL could be a restraint to the tibial rotation, but not to anterior tibial translation. On the other hand, some studies reported that the role of ALL in rotational stability would be limited as a secondary structure because it bears loads only beyond normal biomechanical motion. The diagnosis of an ALL injury can be performed by a physical examination, radiology examination, and magnetic resonance imaging, but it should be assessed using a multimodal approach. Recently, ALL was considered one of the anterolateral complex structures, as well as the Kaplan fiber in the iliotibial band. Many studies have introduced many indications and treatment options, but there is still some debate. The treatment methods are introduced mainly as ALL reconstructions or lateral extra-articular tenodesis, which can achieve additional benefit to the knee stability. Further studies will be needed on the indications and proper surgical methods of ALL treatment.

• Journal of the Korean Arthroscopy Society
• /
• v.13 no.1
• /
• pp.28-33
• /
• 2009

Purpose: To compare the clinical outcomes after meniscus allograft transplantation between lateral and medial or isolated and combined procedure groups. Materials and Methods: Of the patients who had undergone arthroscopic meniscal allograft transplantation between Dec. 1997 and Jun. 2007, 52 patients were available for retrospective evaluation. Patients were grouped into lateral(33 cases) and medial(19 cases) transplant groups as well as those with isolated(18 cases) and combined(34 cases) procedure. The average age was 34.2 years and the mean follow-up period was 42.2 months. Postoperative range of motion (ROM), visual analog scale (VAS), International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner score, patient's subjective satisfaction, $2^{nd}$ look arthroscopy and MRI were evaluated retrospectively. Results: Mean postoperative ROM was $130.3^{\circ}$. The VAS showed an improvement from 5.96 to 3.05 at the last follow up. IKDC subjective score and Lysholm score also showed an improvement from 46.5 to 64.5 and from 61.9s to 79.58 respectively. Tegner score was improved from 2.9 to 3.6. Overall, 61.5% of patients reported they were completely or mostly satisfied with procedure. There were no significant differences noted between lateral and medial groups as well as isolated and combined groups. In 2nd look arthroscopy, 10 of 18 cases showed good pheripheal healing and there were 6 cases of partial and 2 of complex tear. We observed graft subluxation or extrusion in 12 of 16 cases who were evaluated with follow-up MRI. Conclusion: Meniscus allograft transplantation alone or in combination with other procedure showed an improvement in knee pain and clinical score. But there were no significant difference between lateral and medial groups or isolated and combined procedure groups.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.4 no.2
• /
• pp.122-127
• /
• 2005

Purpose: To study the mechanism of injuries or discomfort during kendo and to analyze the causes of injury, injured parts of body, treatments modalities, and degree of return to the pre-injury activity level. Materials and Methods: We studied ninety-eight kendo players who had played at three gymnasium of Korean Kumdo Association, were older than high-school age, had been playing kendo for more than six months, and had any pain or discomfort after playing kendo. We analyzed the questionnaire and interviewed the patients concerning the injured parts of body, symptoms, treatments. Results; The mean age was 30.2 years old, and the onset of symptoms was between two weeks and six months after starting the kendo. Many of them were injured during attacking(32.2%). The injuries of feet were increased on players who exercised for less than 1 year. Only fifty-nine players(60.2%) were treated within one month. Among them, thirty-eight percent were treated by oriental medicine or other departments and only thirty-six percent were treated by orthopaedic surgeons. The prevalence of injuries of the foot and ankle was highest(38.8%), and there were the wrist(13.1%), shoulder(11.9%), knee(11.9%) in order of prevalence. Fifty percents of them could return to the pre-injury activity level. Conclusion: The prevalence of injuries of the foot and ankle was highest(38.8%), and were increased on players who exercised for less than 1 year. Sixty percents of players were treated with any proper modalities, and only thirty-six percent were treated by orthopaedic surgeons.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.3 no.2
• /
• pp.128-133
• /
• 2004

Purpose: This study was planned to evaluate complications? of posterior cruciate ligament (PCL) reconstruction with tibial inlay technique using autogenous bone-patellar tendon-bone graft. Materials and Methods: From September 1994 to January 2004, we analyzed surgical complications in fifty-seven patients with fifty-eight cases who underwent PCL reconstruction. Fifty of them were male and seven female. The mean age of the patients was 35(15$\~$73). Twenty eight cases of injury were isolated PCL, while thirty cases had associated injury of knee. The causes of injury were thirty-nine cases of traffic accident, seven sport injuries, seven fall down injuries, and five of others. The follow-up study was done at 4 weeks, 3 months,6 months and 1 year after surgery. KT-2000 arthrometer and posterior stress X-ray were used to examine the stability of the knee joint and the Lysholm Knee Score and a variety of clinical complications were evaluated. Results: Although the mean score of the preoperative Lysholm Knee Score was 43.2, the postoperative score was increased to 87.9. The preoperative mean value of knee stability using KT-2000 arthrometer was 8.75 mm(6.2$\~$14.3 mm) but the postoperative mean was 3.41 mm(2.1$\~$10.6 mm). The intraoperative complications were: one case of popliteal artery injury with compartment syndrome, one case of patellar fracture, two cases of 20$^{\circ}$ flexion loss, and two cases of anterior cortical penetration of the screw through proximal tibia during screw fixation. The postoperative complications were: eleven cases of knee instability, one case of patellar fracture, five cases of extension loss, thirteen cases of flexion loss, twenty-one cases of around knee pain and eight cases of kneeling pain. Conclusion: After PCL reconstruction with tibial inlay technique using autogenous bone-patella tendon-bone graft, complications were observed in this study. Careful attention during and after the operation, as well as rehabilitation must be required.

• Journal of the Korean Arthroscopy Society
• /
• v.5 no.2
• /
• pp.92-98
• /
• 2001

Purpose : To analyze the clinical results of isolated lateral meniscus injury according to discoid versus non-discoid, athletes versus non-athletes and repaired cases versus cases treated with meniscectomy. Materials and Methods : Between January 1997 and June 2000, arthroscopic lateral meniscus surgery was performed in 329 cases. We reviewed 80 cases of isolated lateral meniscus injury without associated ligament injury or other pathologic condition retrospectively. The study population was composed of 54 males and 26 females with average age of 30.2 years(range, $17\~40$ years). Average follow up period was 15 months(range, $12\~39$ months). Eighty cases were classified into three categories; discoid group versus non-discoid group, athletes versus non-athletes, repaired cases versus cases treated with meniscectomy. Clinical evaluation was performed using Lysholm knee score and Tegner activity. Results : Non-discoid group had higher incidence of longitudinal tear than discoid group. Athletes group had higher incidence of repaired cases than non-athletes group. The repaired group had better clinical result than patient treated with meniscectomy group. Conclusion : Although lateral meniscus has some special features including anatomic mobility which can cause instability after meniscectomy and technical difficulties in repairing, it is recommended repairing meniscus tear not only longitudinal but also horizontal and complex tear to obtain better clinical results.

• Journal of the Korean Arthroscopy Society
• /
• v.6 no.2
• /
• pp.115-120
• /
• 2002

Purpose : To compare the functional evaluation with the posterior translation after arthroscopic PCL reconstruction in isolated and combined PCL-deficient knees. Materials and Methods : We retrospectively evaluated 45 patients with PCL-deficient knees who were treated by arthroscopic PCL reconstruction using Achilles tendon allograft from June 1994 to June 2000. The differences of posterior translation were measured with posterior stress lateral radiographs and KT-2000 arthrometer. The functional results were evaluated using the Lysholm knee score and IKDC evaluation form. Results : Preoperative mean side to side differences of the posterior translation were 11.83 mm in isolated PCL-deficient knees and 12.7 mm in combined PCL-deficient knees respectively. At the last follow-up in isolated and combined PCL-deficient knees, the mean radiographic side to side differences of the posterior translation were 6.38 mm and 6.7 mm, the average corrected 20 Ib posterior displacements using KT-2000 arthrometer were 3.5 mm and 4.1 mm, the mean Lysholm score were 87.4 and 81.2, the grade A and B of IKDC evaluation form were 16 cases $(88.9\%)$ and 23 cases $(85.2\%)$, respectively. Conclusion : The functional results had no relationship with the degree of posterior translation after arthroscopic PCL reconstruction. Tendency of posterior translation may be influenced by associated injury of the knee.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.10 no.2
• /
• pp.86-93
• /
• 2011

Purpose: The purpose of this study was to analyze the characteristics of the injuries of the national elite Taekwondo players with the best performance in the international championship competition. Materials and Methods: Fifty-two athletes who got the injury in the 2011 Gyeongju World Taekwondo Championship competition were included in this sturdy. 950 members of national team of 146 countries participated in this game, 1,063 matches were performed. We analyzed the characteristics of the injuries such as injury rate by gender, age, weight class, injured region and injury type. Results: Fifty-two athletes of 950 athletes in 1,063 matches got injured and injury rate was 5.47 per 100 participants and 24.47/1,000 athlete-exposures. Injury rate of female athletes was higher than mail, but there was no significant statistical difference (p=0.512). Injury rate of over 30 years old was 17.39 per 100 participants, and injury rate of over 87 kg in male weight class and 68 to 73kg in female weight class were highest than other groups, but there was no significant statistical difference (p=0.838). Overall injury rate of the lower extremity was 13.17/1,000 A-E, higher than upper extremity or head and neck or trunk, but injury rate of the hand was 5.17/1,000 A-E, highest as a specific injured region, followed by the knee, 4.70/1,000 A-E (p=0.714). Injury rate of the sprain was 10.81/1,000 A-E, highest as an injury type, the second most common injury type was the fracture, 5.40/1,000 A-E in men, and was the contusion, 9.63/1,000 A-E in women (p=0.033). As one of the most serious injury, 4 of 8 fractures were occurred in hand. Conclusion: Overall injury rate of the elite Taekwondo players in 2011 Gyeongju World Taekwondo Championship was 5.47 per 100 participants and 24.46 per 1,000 athlete exposures. Although the most common type of injury was the sprain of the knee and ankle, the fractures were more commonly occurred in hand.

• Journal of the Korean Arthroscopy Society
• /
• v.9 no.1
• /
• pp.46-50
• /
• 2005

Purpose: The purpose of this study is to evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of acute anterior cruciate ligament (ACL) injury and its tear pattern in comparison with arthroscopic finding. Materials and Methods: Sixty consecutive patients with acute ACL injury were taken NRI followed by arthroscopic examination between January 2002 and June 2004. MRI findings were reviewed according to the presence of ACL discontinuity, diffuse swelling or thickening, focal edema, collapse on distal end, and any combined tear. The pathologic findings were then confirmed arthroscopically. The diagnostic accuracy of MRI on ACL tear pattern was analyzed by obtaining its positive predictive value. Results: All fifty two cases with presence of discontinuity on MRI showed ACL rupture arthroscopically. The location of ACL tear, diffuse swelling and focal edema on MRI also corresponded with arthroscopic findings respectively. However, the diagnostic accuracy of MRI was relatively lower in the presence of other ACL patterns such as collapses and combined tear. Conclusion: Preoperative MRI findings seem to be in accordance with arthroscopic findings and is significantly accurate in detection of location and diffuse swelling and focal edema of ACL tear.

• Journal of Yeungnam Medical Science
• /
• v.18 no.2
• /
• pp.187-198
• /
• 2001

Background: The purpose of this study was to evaluate the relationship between variable factors and clinical results following the operative treatment of the tibial plateau fractures. Materials and Methods: The clinical and radiological analysis was performed on 29 cases of the tibial plateau fractures who had been treated with operative treatment and followed up for more than 1 year from January 1991 to December 1997. The analysis of clinical results was performed dividing into age, cause of injury, fracture type of Schatzker classification, associated soft tissue injury and method of operative treatment. Results: According to Schatzker classification, 2 cases(6.9%) were type I, 11 cases(37.9%) were type II, 1 case(3.5%) was type III, 5 cases(17.2%) were type IV, 4 cases(13.8%) were type V, and 6 cases(20.7%) were type VI. In all cases, bony unions were obtained. According to Blokker evaluation, 23 cases(79.3%) of 29 cases were acceptable. Conclusion: We could expect good clinical results if early knee joint mobilization following minimal invasive open reduction and internal fixation could be obtained. Bad clinical results were related with young age group under 30, more than Schatzker classification type IV of high energy trauma and associated injury of anterior cruciated ligment or meniscus.