• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.112-115
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• 1997

While the cruciate ligament has a profuse vascular response following injury, spontaneous repair does not occur. This may result from the fact that synovial fluid dilution of the hematoma following injury prevents the formation of a fibrin clot and thus the initiation of the healing mechanism. Another theory suggests that the dynamic nature of the fascicles of the anterior cruciate ligament(ACL) through even small ranges of motion prohibits spontaneous union to these fibers. But we experienced two cases of spontaneous healing of partially injured ACL. Initially they showed more than grade II anterior instability. 6 mm difference by stress roentgenographs(pull view) and difference of 8 mm by KT 1000TM arthrometer between the ACL injured knee and normal side knee. Lax, nearly complete tear of ACL and synovial bleeding were noted during arthroscopic examination but the continuity of synovial membrane was seemed to be intact. These cases were treated by conservative management rather than reconstructive procedure. Postoperatively they showed excellent clinical results, no anterior instability and unlimited athletic activity. Based on our clinical experience. we think that cruciate ligament has the spontaneous healing potential in acute stage and middle aged patient. We consider the microfracture technique and initial immobilization for accelleration of healing response of the ACL.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.116-122
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• 1997

We have studied the results of reconstruction by freeze-dried patellar allografts or patellar autografts in ACL-deficient patients prospectively. From January 1995 to December 1995, we performed ACL reconstruction using an arthroscopic-assisted technique with patellar autografts in 21 patients and patellar allografts in 13 patients. Minimum followup time was 1 year(average 26 months). All patients were evaluated by using KT-2000 arthrometer and MRI as well as by physical examination. Final results were rated as satisfactory or unsatisfactory by using a modified Feagin knee scoring scale. Good or excellent were considered to have satisfactory results and fair or poor were considered to have unsatisfactory results. As measured by the KT-2000, 19 cases$(90.5\%)$ had a 5-mm or Jess side-to-side differential, a satisfactory results in autograft group, 2 cases of unsatisfactory results had joint instability. In allograft group, 10 cases$(76.9\%)$ had a 5-mm or less side-to-side differential, a satisfactory results, 3 cases of unsatisfactory results had joint instability including postoperative infection(1 case). In conclusion, the results of ACL reconstruction with autografts were better than those with allografts. The problem of allograft reconstruction were rehydration, aseptic control and improper mechanical tensioning. So, we thought that success of allograft reconstruction was depended on careful implant preparation including pretensioning technique.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.132-138
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• 1997

The purpose of this study is to compare the results between conventional and accelerated rehabilitation program following ACL reconstruction using bone-patellar tendon-bone. Conventional rehabilitation focused on protecting the new ligament by blocking terminal extension and avoiding active quadriceps function in the terminal degrees of extension. But there is current trend toward early postoperative mobilization and intensive. so called 'accelerated', rehabilitation stressing hyperextension of the knee. The results of intraarticular ACL reconstruction with conventional and accelerated rehabilitation were prospectively compared for one year postoperatively in a series of 27 patients. Range of motion and thigh circumference were checked preoperatively, and weekly up to 8 weeks, 3 months. 6 months, and 1 year postoperatively. Stress radiologic test, KT-1000 arthrometer. Cybex II dynamometer were checked in preoperatively, and 3 months, 6 months, and 1 year postoperatively. There were no differences of objective stability and restoration of muscle power. But the accelerated group had a low incidence of extension loss. excellent range of motion, and less difference of thigh circumference. We concluded that accelerated rehabilitation program is recommendable due to superiority in terms of range of motion, especially less extension loss without increasing laxity of knee joint.

• Journal of the Korean Arthroscopy Society
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• v.2 no.2
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• pp.129-134
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• 1998

The arthroscopic ACL reconstruction using the bone-patellar tendon-bone has been considered as the gold standard in the treatment of the ACL insufficiency. There are many reports about the good functional outcome and the restored stability of the knee joint. But there are a few reports showing whether this surgery has good results in the patients' satisfaction. The purpose of this study is to evaluate the patients' satisfaction in this surgery. Authors analysed 32 cases who had taken the ACL reconstruction from Jannuary, 1989 to June, 1997. The average follow-up was 40 months. At the last follow-up, 32 patients reported the patients' satisfaction degrees(four degrees; very satisfied, generally satisfied, improved, no change or aggravated), KT-1000 arthrometer test, Vastus atrophy(thigh circumference), and three kinds of the knee scores(Lysholm, HSS, IKDC). Among the 32 cases, 12 cases (37.5%) were very satisfied, 17 cases(53.1%) were generally satisfied and 3 cases(9.4%) were improved. No case showed no change or aggravated. The satisfaction degree in this surgery had little relation with the age, operation time, follow-up period, combination of meniscectomy, but had significant relations with anteroposterior stability evaluated by KT-1000, thigh circumference measurements and the functional scoring of the knee(Lysholm, HSS, IKDC scores).

• 대한관절경학회:학술대회논문집
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• 2009.10a
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• pp.153-153
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• 2009

The purpose of this study was to evaluate tibial tunnel widening prospectively after anterior cruciate ligament (ACL) reconstruction with hamstring tendon grafts using Rigidfix (DePuy Mitek, Raynham, MA) femoral fixation and Intrafix (DePuy Mitek) tibial fixation. 56 consecutive patients who underwent ACL reconstruction with a minimum of 2 years' postoperative evaluation were reviewed. On the anterior-posterior (AP) and lateral radiographs, the diameter of the tibial tunnel was measured at proximal, middle, and distal positions and the shape of the tibial tunnels were classified. Tunnel widening was defined as widening of greater than 2 mm. Group I was defined as cases with no tunnel widening and group II defined as cases with tunnel widening. Postoperative laxity evaluations were performed using Lachman test, pivot-shift test, and Instrumented laxity testing using the KT-1000 arthrometer. On the AP radiographs, the average diameter of the tibial tunnel increased 8.8% at 6 months and 8.5% at 12 months postoperatively compared to the immediate postoperative day. On the lateral radiographs, the average diameter of the tibial tunnel increased 7.2% at 6 months and 8.1% at 12 months year postoperatively compared to the immediate postoperative day. The tunnel shape evaluation revealed predominantly linear type in 53 patients (95%). Group I was 42 patients (75%) and group II was 14 (25%). The average KT-1000 measurement was 1.0~1.8 mm in group I and 2.1~2.8 mm in group II (p>0.05) The Lachman and pivot-shift showed tests no significant differences between the two groups. In conclusion, hamstring ACL reconstruction using Rigidfix and Intrafix fixation showed less widening of the tibial tunnels than observed in previously published studies.

• Journal of the Korean Arthroscopy Society
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• v.5 no.2
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• pp.74-79
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• 2001

Purpose : The purpose of this study is to evaluate the clinical results after arthroscopic PCL reconstruction and to compare the clinical results after arthroscopic PCL reconstruction using BPTB(bone patellar tendon bone) autograft(Group I : 11 cases), Achilles tendon allograft(Group II : 7 cases) and BPTB allograft(Group 111.6 cases). Materials and Methods : We reviewed the result of 24 patients who had been managed with arthroscopic reconstruction using different graft materials such as BPTB autograft, Achilles tendon allograft and BPTB allograft. Twenty-four patients(average age, 37 years) with PCL rupture were retrospectively evaluated more than one year(average, 31 months) after having arthroscopic posterior cruciate ligament reconstruction. The clinical results were evaluated by IKDC ligament standard evaluation form, using $KT-2000^{TM}$ knee ligament arthrometer and also evaluated Lysholm knee scoring scale. Results : The final evaluation was nearly normal in 11 patients($45\%$ in Group I, $43\%$ in Group II, $50\%$ in Group III). The corrected posterior sagging was abnormal(side to side difference more than 6mm) in 8 patients($36\%$ in Group I, $29\%$ in Group II, $33\%$ in Group III). We could not find significant difference among three groups by IKDC scale. Conclusion : Comparing with other reports, our overall results were not satisfactory. And also, we could not find any remarkable difference among the three groups. Further research is necessary to evaluate new surgical approaches as well as improved techniques for capsular and collateral ligament injuries.

• Journal of the Korean Arthroscopy Society
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• v.12 no.2
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• pp.112-117
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• 2008

Purpose: Double-bundle reconstruction of anterior cruciate ligament(ACL) has the advantage of restoring the isometry and original function of ACL. The purpose of this study is to evaluate the clinical results following double-bundle reconstruction of ACL using autogenous hamstring grafts through an accessory anteromedial portal. Materials and Methods: From January 2005 to July 2006, sixty patients(52 males, 8 females) underwent double-bundle ACL reconstruction using autogenous hamstring tendons..The mean age was 31.7 years($20{\sim}51$ years). The mean follow up period was 13.4 months($12{\sim}16$ months). We made a horizontal-oblique skin incision just medial to tibial tuberosity and harvested semitendinosus and gracilis tendon. Tibial tunnel for posterolateral bundle was made near its anatomical position. By modifying an anatomic reconstruction of ACL by Yasuda et al., we made a femoral tunnel for posterolateral bundle through accessory anteromedial portal. Tunnels for anteromedial bundle were made with conventional method. We reconstructed anteromedial bundle with semitendinosus tendon and posterolateral bundle with gracilis tendon. Clinical results at last follow up were evaluated by range of motion, extent of anterior displacement(KT-1000 arthrometer), pivot-shift test. Functional evaluation of clinical outcomes were evaluated by Lysholm score and modified Feagin Scoring System. Results: There was no limitation of motion of knee joint at last follow up. Mean side to side difference of anterior displacement of tibia by KT-1000 arthrometer was improved from 8.4 mm preoperatively to 1.7 mm postoperatively(p<0.05). Average Lysholm score was improved from 64.1 preoperatively to 92.2 postoperatively(p<0.05). In modified Feagin Scoring System, 90% of cases were rated as good or excellent. Conclusion: Double-bundle reconstruction of ACL using autogenous hamstring grafts through accessory anteromedial portal results in good clinical outcomes.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.41-44
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• 2006

Purpose: To evaluate the short-term results of arthroscopic ACL reconstruction using fresh frozen Achilles allograft Materials & Methods: From March 2002 to March 2004, arthroscopic ACL reconstructions using fresh frozen Achilles allograft were performed in 25 knees of 25 patients. The average age at operation was 30.1 years (range, 18-50 years) and the average follow-up was 17 months (range, 12 to 27months). Preoperative and follow-up clinical results were evaluated using the Lysholm knee score, IKDC knee rating system, physical examination and KT-2000 arthrometer. Results: The Lachman test was positive in 25 patients preoperatively and 18 patients(72%) had negative results at latest follow-up. The average side-to-side differences of anterior tibial translation using KT-2000 arthrometer under loading of 301b were improved from $7.9{\pm}2.4mm\;to\;2.6{\pm}1.6mm$. The average Lysholm score was improved from $61.1{\pm}13.9\;to\;93.5{\pm}5.3$ points. The IKDC grade was abnormal(C) or severely abnormal(D) in 25 cases preoperatively They improved 22(88%) of normal(A) or nearly normal(B) and 3(12%) of abnormal. Conclusion: Short term results of ACL reconstruction using Achilles allograft was acceptable. Achilles allograft can be a reasonable graft alternative to autograft for ACL reconstruction.

• 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.

• Journal of the Korean Arthroscopy Society
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• v.8 no.1
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• pp.14-18
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• 2004

Purpose: To compare the mid-term follow-up results of anterior cruciate ligament(ACL) reconstruction with the bone-patellar tendon- bone(BTB) autograft to those with the BTB allograft. Materials and Methods: Retrospective study was performed in 59 cases with BTB autograft and 42 cases with BTB allograft. Evaluations include Lysholm score, 2000 IKDC subjective knee score, Shelbourne patello-femoral pain score , Lachman test, pivot shift test, KT-1000 arthrometer test and 2000 IKDC knee examination. Results: There were no significant statistic differences between two groups in Lysholm score and 2000 IKDC subjective knee score of more than 70 (p<0.05). Five cases(8.5%) showed the patello-femoral pain score less than 80 according to Shelboume with autograft group and two cases(4.8%) with allograft group (p<0.05). Lachman test, pivot shift test and KT-1000 arthrometer test showed no significant statistic differences between two groups(P<0.05). Fifty-four cases(91.5%) were normal or nearly normal according to the 2000 IKDC knee examination with autograft group and thirty-eight cases(90.4%) with allograft group(p<0.05).Conclusion: BTB allograft as well as BTB autograft is considered to be an acceptable choice for ACL reconstruction.