• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.140-145
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• 2011

후방십자인대 손상의 이상적 치료는 아직까지도 확립되지 않았다. 과거 몇 십 년간 후방십자인대에 대한 지식과 슬관절 안정성에 대한 후방십자인대의 생역학에 대한 지식이 증가하였다. 특히 이중 다발에 대한 지식이 증가하고 이러한 모든 노력들은 후방십자인대의 해부학적인 특징을 최대한 복원하기 위해 이루어졌다. 재건술의 수술 방법은 특정 손상 양상에 따라 그에 맞게 이루어지는데 만성 손상의 경우나 remnant가 거의 존재하지 않는 경우에는 이중 다발을 재건하는 것이 만족스러운 결과를 보인다. 아직까지 이중 다발 후방십자인대 재건술의 결과에 대해서는 논란이 많은 것은 사실이나 장기 추시가 가능해지면 이중 다발 후방십자인대 재건술이 해부학적으로나 생역학적으로 더욱 정상에 가깝기 때문에 더 나은 장기적 결과를 보여줄 것으로 예상된다.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.109-114
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• 2002

Propose : The purpose of this retrospective study was to test the posterior cruciate ligament (PCL index) for diagnosis of a tear of the anterior cruciate ligament (ACL) by means of MR imaging. Materials and Methods : From Mar. 1997 to Feb. 2001, concomitant magnetic resonance imaging (MRI) and knee joint arthroscopy were performed in 56 patients of either pain or instability of the knee. The shortest distance between the femoral and tibial attachment of PCL (X) and the distance from that line to the tip of the arc marked by the PCL (Y) on the sagittal plane images were measured. The quotient of these two parameters (Y/X) defined the PCL index. Results : Using MRI diagnosis, there were 35 patients diagnosed with ACL rupture and 21 patients were ruled out of ACL injury. Using arthroscopy, 32 of the 35 patients diagnosed by MRI showed ACL rupture, and 20 of the 21 patients were ruled out of ACL injury. The mean PCL index was 0.40 in the 33 patients diagnosed with ACL rupture through arthroscopy. The mean PCL index was 0.23 in 23 patients with an uninjured ACL through arthroscopy. In 33 patients with ruptured ACL, this value exceeds 0.31. The index value was 0.31 in 3 patients with uninjured ACL. The value of the index was not above 0.31 with an uninjured ACL. PCL index on MRI had a sensitivity of $91\%$ and a specificity of $94\%$ for determining the status of the anterior cruciate ligament. Conclusion : Injury to the ACL changes the PCL index markedly. In diagnostically unreliable MR images, amelioration of the PCL index could help in the diagnosis of ACL injury.

• Journal of the Korean Arthroscopy Society
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• v.12 no.2
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• pp.91-92
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• 2008

후방십자인대 및 후외측인대 재건술 후 결과는 많은 발전이 있었지만, evidence medicine의 측면에서 재활 방법에 관한 전향적 연구는 없다. 현재까지의 재활 방법은 다양하게 소개되었지만 전방십자인대 재건술처럼 가속 재활을 하는 것은 바람직스럽지 않다. 후방십자인대, 후외측인대 그리고 다발성 인대 재건술 후 재활은 수술 방법과 환자의 재건된 인대의 상태, 하지 정렬 등에 따라서 개별화하여 점진적으로 진행하여야 할 것이고, 재활기간 동안 의사의 세심한 관찰이 필요하다.

• 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.

• Journal of Korean Orthopaedic Sports Medicine
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• v.8 no.1
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• pp.26-32
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• 2009

Purpose: This study was performed to compare the strength of ligamentous attached sites of cadaveric distal femur and to obtain reliable biomechanical data to use in ligamentous reconstruction or augmentation. Materials and Methods: Fifteen cadaveric distal femurs were used for this study. After measuring the bone density, 5.0 mm cannulated screw (Experiment 1) or reconstructed porcine ligament (Experiment 2) was inserted into the each ligamentous attached sites of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). In experiment 2, reconstructed porcine graft was fixed with bioabsorbable screw in ligamentous insertion sites. And we measured the maximal pullout force of each ligamentous attached sites of cadaveric distal femur. Results: Average bone mineral density was $1.205{\pm}0.137\;g/cm^2$ in experiment 1, $1.236{\pm}0.089\;g/cm^2$ in experiment 2, which showed no statistically significant differences. In experiment 1, average pull-out strength of ACL, PCL, MCL and LCL group were $519.1{\pm}111.7$ N, $638.9{\pm}144.4$ N, $169.7{\pm}56.0$ N, $225.6{\pm}61.5$ N respectively. In experiment 2, the average pull-out strength were $310.6{\pm}31.0$ N, $379.9{\pm}47.4$ N, $104.0{\pm}14.4$ N, $131.5{\pm}21.9$ N respectively. In experiment 1, there was no significant difference between ACL and PCL group and between MCL and LCL group. However, the maximal pullout strength of MCL and LCL group were significantly lower than that of ACL and PCL group (p<0.01). Experiment 2 showed the same results of experiment 1. Conclusion: Because stiffness of MCL and LCL attached sites are much lower than that of ACL and PCL attached sites, we may consider augmented fixation in ligamentous reconstructions of MCL and LCL.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.58-62
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• 2008

Posterior cruciate ligament reconstructions are dangerous procedure in terms of neurovascular complication. But deep vein thrombosis and associated compartment syndrome after posterior cruciate ligament reconstruction has not been reported, yet. We have experienced a patient who developed a deep vein thrombosis and compartment syndrome after revision posterior cruciate ligament reconstructive surgery, and report the importance of diagnosis and management with the discussions.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.55-60
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• 2002

Purpose : To assess the change in the number of mechanoreceptors of posterior cruciate ligament(PCL) after transecting posterior cruciate ligament of the rabbit. Materials and Methods : We selected 10 skeletally-matured New Zealand white rabbits and one of the two posterior cruciate ligaments was transected and the other underwent sham-operation on each rabbit. Afterward, PCLs with synovium were obtained at femoral attach area in both knees in 20 weeks postoperatively, but in one of the cases, the transected PCL did not heal and had to be excluded from this study. Consequently, histologic examination of the ligament for the remaining 9 cases was done after being prepared with modified gold chloride stain. Results : The study showed a little bit more decrease in the number of mechanoreceptors in the transected group compared with that in the sham-operated group, but the number was statistically negligible. Conclusions : It is considered that the knee joint with injured PCL may still maintain proprioception since the decrease in the number of mechanoreceptors is not considerable, but further study on biomechanical role and function of mechanoreceptor of healed PCL is required.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.1
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• pp.69-71
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• 2010

Ganglionic cyst formation within the posterior cruciate ligament (PCL) of knee has not been reported. We describe a case of an intraligamentous ganglionic cyst of PCL. Arthroscopic technique through both the posteromedial and posterolateral portals was used for approach. Using probe, PCL was splitted and perforated ganglionic cyst at tibial attachement side. At 2 years follow up, the patient was free of symptoms with a full range of motion and follow-up MR image showed that there was no recurred ganglionic cyst.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.187-191
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• 2006

Few cases have been reported in which the femoral interference screw has migrated into the posterior compartment after an ACL reconstruction. It usually requires removal, because it leads usually to mechanical symptom. However, the arthroscopic removal of a screw is a technically demanding procedure, especially in the case of an intact integrated ACL graft or one that is encapsulated around the screw. We present a case in which a displaced femoral interference screw migrated within the posterior compartment 11 years postoperatively, after the graft had been successfully incorporated at the femoral site and showed good continuity on MRI and arthroscopic examination. Although it is often technically challenging, through the use of a posterior trans-septal portal, we can successfully remove a displaced femoral interference screw even in the most difficult locations in the posterior compartment without damage to ACL 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.