• Journal of Korean Medicine Rehabilitation
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• 제28권1호
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• pp.175-184
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• 2018

The purpose of this study is to report the effectiveness of complex Korean Medicine treatment for anterior cruciate ligament (ACL) injuries with meniscus tear. Four patients were treated with complex Korean Medicine by acupuncture, pharmacopuncture and herbal medication. We evaluated the improvement of knee pain and function by Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC Index), EuroQol-5 Dimension Index (EQ-5D Index). After treatment, we found that knee pain was reduced and joint function was improved by NRS and WOMAC index in all cases. In the evaluation of health-related quality of life through EQ-5D index, there was no significant difference in patients with degenerative knee osteoarthritis and severe meniscal injury. This results show that complex Korean Medicine may be an effective option for ACL injuries with meniscus tear. Further clinical studies are needed to clarify the effect of Korean Medicine therapy on ACL injuries with meniscus tear.

• Journal of Microbiology and Biotechnology
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• 제22권2호
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• pp.274-282
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• 2012

The object of this study was to assess the efficacy of Polycan from Aureobasidium pullulans SM-2001, which is composed mostly of beta-1,3-1,6-glucan, on osteoarthritis (OA)-induced by anterior cruciate ligament transection and partial medial meniscectomy (ACLT&PMM). Three different dosages of Polycan (85, 42.5, and 21.25 mg/kg) were orally administered once a day for 84 days to male rats a week after ACLT&PMM surgery. Changes in the circumference and maximum extension angle of each knee, and in cartilage histopathology were assessed using Mankin scores 12 weeks after Polycan administration. In addition, cartilage proliferation was evaluated using bromodeoxyuridine (BrdU). As the result of ACLT&PMM, classic OA was induced with increases in maximum extension angles, edematous knees changes, and capsule thickness, as well as decreases in chondrocyte proliferation, cartilages degenerative changes, and loss of articular cartilage. However, these changes (except for capsule thickness) were markedly inhibited in all Polycan- and diclofenac sodium-treated groups compared with OA control. Although diclofenac sodium did not influence BrdU uptake, BrdU-immunoreactive cells were increased with all dosages of Polycan, which means that Polycan treatment induced proliferation of chondrocytes in the surface articular cartilage of the tibia and femur. The results obtained in this study suggest that 84 days of continuous oral treatment of three different dosages of Polycan led to lesser degrees of articular stiffness and histological cartilage damage compared with OA controls 91 days after OA inducement, suggesting that the optimal Polycan dosage to treat OA is 42.5 mg/kg based on the present study.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.413-419
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• 2018

Background: We aimed to examine the factors that influence synovialization of the grafted tendon after double-bundle anterior cruciate ligament (ACL) reconstruction based on second-look arthroscopic findings. Methods: Out of 205 knees that were treated between August 2008 and May 2016 with double-bundle ACL reconstruction using bio-absorbable cross-pins and Endobuttons for femoral tunnel fixation, we enrolled 65 knees (64 patients) that underwent second-look arthroscopy with hardware removal at 1 year postoperatively. Measured clinical outcomes included the Lysholm score and Tegner activity score that were evaluated preoperatively and during the final follow-up. We analyzed the relationship between synovial coverage and patient age, length of the preserved remnant tissue on the tibial side, type of bundle (anteromedial or posterolateral), type of graft (autograft or allograft), and time from injury to surgery. Results: The area of synovial coverage showed a significant statistical correlation with patient age and the length of the preserved remnant tissue on the tibial side. The average synovial coverage was significantly better for the anteromedial bundle than for the posterolateral bundle, better for the autograft than for the allograft reconstruction, and better when treated in the acute stage than in the chronic stage. However, synovialization of grafted tendon did not correlate to clinical outcomes. Conclusions: While we were able to identify several factors influencing synovialization of the grafted tendon after double-bundle ACL reconstruction, including patient age, length of preserved remnant tissue of the torn ACL, type of bundle, type of graft, and time from injury to surgery, we found no evidence that increased synovialization improves clinical outcomes at 1 year postoperatively.

• Knee surgery & related research
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• 제30권4호
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• pp.341-347
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• 2018

Purpose: Tunnel widening following anterior cruciate ligament (ACL) reconstruction is commonly observed. Graft micromotion is an important contributing factor. Unlike fixed-loop devices that require a turning space, adjustable-loop devices fit the graft snugly in the tunnel. The purpose of this study is to compare tunnel widening between these devices. Our hypothesis is that the adjustable-loop device will create lesser tunnel widening. Materials and Methods: Ninety-eight patients underwent ACL reconstruction from January 2013 to December 2014. An adjustable-loop device was used in 54 patients (group 1) and a fixed-loop device was used in 44 patients (group 2). Maximum tunnel widening at 1 year was measured by the L'Insalata's method. Functional outcome was measured at 2-year follow-up. Results: The mean widening was 4.37 mm (standard deviation [SD], 2.01) in group 1 and 4.09 mm (SD, 1.98) in group 2 (p=0.511). The average International Knee Documentation Committee score was 78.40 (SD, 9.99) in group 1 and 77.11 (SD, 12.31) in group 2 (p=0.563). The average Tegner-Lysholm score was 87.25 (SD, 3.97) in group 1 and 87.29 in group 2 (SD, 4.36) (p=0.987). There was no significant difference in tunnel widening and functional outcome between the groups. Conclusions: The adjustable-loop device did not decrease the amount of tunnel widening when compared to the fixed-loop device. There was no significant difference in outcome between the two fixation devices. Level of Evidence: Level 3, Retrospective Cohort.

• Journal of the Korean Orthopaedic Association
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• 제55권4호
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• pp.294-304
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• 2020

Anterior cruciate ligament (ACL) reconstruction is a successful procedure independently by patient selection, timing of surgery, surgical technique, choice of graft, and fixation methods. Among these factors, graft selection and fixation methods might be the most critical yet controversial questions for surgeons. Although recent studies showed that grafts have advantages and drawbacks, there is still no ideal graft. Similarly, many fixation methods of femoral and tibial tunnels have been proposed over the last few decades, with no clear superiority of one technique over another. Surgeons should be familiar with a variety of grafts, fixation techniques, and their specific associated surgical procedures as well as the advantages and disadvantages of each. Therefore, this article summarizes the current literature and discusses the current state of graft selection and fixation methods in the treatment of an ACL injury.

• Journal of the Korean Orthopaedic Association
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• 제55권5호
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• pp.444-449
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• 2020

An anterior cruciate ligament (ACL) avulsion fracture is an uncommon injury that occurs predominantly in the pediatric and adolescent population. Accurate reduction and fixation of an avulsed fragment are necessary to restore and maintain the length of the ACL and normal knee biomechanics. Several techniques are available to repair an ACL avulsion fracture. On the other hand, treatment is controversial in skeletally immature patients due to risk of physeal injury. This paper reports a case of an ACL avulsed fracture in a skeletally immature patient treated with arthroscopic all-inside suture bridge repair, in which an excellent result and firm stability were obtained without physeal injury.

• Journal of the Korean Arthroscopy Society
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• 제7권2호
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• pp.127-136
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• 2003

Posterolateral instability of the knee occurs more commonly in association with an injury to anterior and posterior cruciate ligament and combined injuries are severe injuries that result in significant functional instability and articular cartilage degeneration. Reconstruction of the anterior and posterior cruciate ligament without an appropriate treatment of posterolateral corner injury result in failure of the reconstructed cruciate ligaments. Meticulous physical examinations, imaging studies, lower limb alignment and gait pattern should be evaluated. Acute grade III isolated or combined injury of the posterolateral corner is best treated within three weeks by direct repair, or augumentation, or reconstruction. The appropriate surgical method or combined methods are selected among the several methods of posterior and posterolateal reconstruction, and all injuried posterolateral and cruciate ligament structures are anatomically reconstructed simultaneously or by stages. If a varus alignment and varus thrust is disclosed in chronic posterolateral instability of knee, soft tissue reconstructions laterally are highly unlikely to be able to correct tile problem. It is appropriate that valgus osteotomy should be done before soft tissue reconstruction and reevaluate the posterolateral instability about 6 months later.

• Journal of the Korean Arthroscopy Society
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• 제9권2호
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• pp.132-136
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• 2005

Purpose: The purpose of this study was to compare the clinical results of the arthroscopic anterior cruciate ligament reconstruction used by Bone-Patella tendon-Bone autograft and Achilles tendon allograft. Materials and Methods: We reviewed the results of patients who had been managed with arthroscopic anterior cruciate ligament reconstruction using different graft such as Bone-Patella tendon-Bone autograft and Achilles les tendon allograft. 60patients (average age, 33.5 years)were retrospectively evaluated. The one group(average age, 33.4 years) was 32 patient who had been managed with arthroscopic anterior cruciate ligament reconstruction using Bone-Patella tendon-Bone autograft. The other group(average age, 32.1 years) was 28 patient who had been managed with arthroscopic anterior cruciate ligament reconstruction using Achilles tendon allograft. 2 groups were evaluated subjectively by Lysholm knee scoring scale and objectively by KT-2000 arthrometer. The follow-up period was more than a year(average, 18 month). An early rehabilitation protocol was instituted. Results: On Lysholm knee scoring scale, the final evaluation was nearly normal in all patients. We could not find statistical difference among the two groups by KT-2000TM arthrometer. Conclusion: The use of allografts may be an acceptable choice for ACL reconstruction.

• Journal of Korean Orthopaedic Sports Medicine
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• 제7권2호
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• pp.122-127
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• 2008

Purpose: Evaluation and analysis of the incidence of postoperative complications after arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Materials and Methods: We reviewed 172 cases of arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft in anterior cruciate ligament tear without meniscal injury. We performed Lysholm knee score and KT-2000 testing, simple radiograph, physical examination as evaluation factor. Also, around knee pain, swelling, limitation of motion, patellofemoral crepitation, paresthesia and pain on kneeling were evaluated. Results: The average follow up period was 49.8 months. In 172 patients, 148 males and 26 femlaes were evaluated. The average age was 34.4 years. The Lysholm knee score improved from 51.9 points preoperatively to 90.8 points at final follow up. Clinical outcome was excellent in 83%, good in 11%, fair in 4% and poor in 2%. There were many cases of complications, 24 cases (14%) of around knee pain, 12 cases (7%) of swelling, 45 cases (26.2%) of patellofemoral crepitation, 52 cases (30%) of donor site paresthesia, 65 cases (38%) of pain on kneeling, 10 cases (5.8%) of limitation of motion at extension, 13 cases (8%) of limitation of motion at flexion and 2cases (1.2%) of patellar fracture. Conclusion: Although arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone had good clinical results, many complications were noted. Some factors in surgical technique were suspected to be related to the complications and long term follow up will be necessary to further evaluated.

• Journal of the Korean Arthroscopy Society
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• 제8권1호
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• pp.26-30
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• 2004

Purpose: We analyzed the clinical results of ACL(anterior cruciate ligament) reconstruction of chronic anterior cruciate ligament injuries with a fresh frozen Achilles allograft, retrospectively. Methods: Thirty-eight patients(average age 32.4 years) who had an chronic injury of ACL reconstructed with an Achilles allograft between January 1999 and February 2001 were included. The mean follow-up was 19.2(12-36) months. The clinical evaluation was done by range of motion, Lachman and pivot-shift test, KT-1000 arthrometer, Lysholm knee score, and the modified Feagin score. Results: All patients recovered full range of motion of affected knees. With use of Lachman and pivot-shift test data, thirty seven(97.4%) were functional. When comparing KT-1000, we found mean maximum side-to-side differences less than 2.1 mm. According to Lysholm knee score, mean postoperative score was 90.4. Thirty four(89.5%) had good to excellent results in modified Feagin score. Conclusion: Results of ACL reconstruction using fresh frozen Achilles allografts were comparable to autografts. ACL reconstruction with Achilles allograft could be a reasonable altemative to autografts.