• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.1
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• pp.57-61
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• 2012

Pretibial cyst formation is a rare complication after anterior cruciate ligament (ACL) reconstruction and there are only few cases reported. Pretibial cyst can be caused by variable reasons. Foreign body reaction due to breakdown of bio-absorbable screw for fixation, graft necrosis at tibial site, joint fluid leakage to tunnel and incomplete incorporation of graft to bony tunnel. The authors experienced one case of massive pretibial cyst after arthroscopic ACL reconstruction using bio-absorbable interference screw in 38-year-old male patient. Thus, authors report this rare case with literature view.

• Proceedings of the KSME Conference
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• 2008.11a
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• pp.1527-1532
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• 2008

45% of the sports accidents is the knee damage and the representative case is the damage of an Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament(PCL). Although the past different views of ACL reconstruction comes to an agreement, the disputes of PCL is remained yet. The most important engineering approach for these various surgery techniques is accurately to understand and to evaluate the fatigue behavior depending on the stress flow and the stress distribution under the allotted load and the cyclic load, which are caused by the graft fixing device, the proximal tibia of the PCL reconstructing structure. Therefore, this study is the basic research of these above facts. The current transtibial tunnel surgery using the cadaveric Achilles tendon grafts is chosen for the various PCL reconstruction. The relationships between the slippage, the extension ratio, and the slippage ratio by the heel bone fixing method and the soft tissue fixing method of the Achilles tendon were also defined. This research will be the essential data to help the resonable operating techniques for the next PCL reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.3 no.1
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• pp.54-61
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• 1999

The current treatment of extensive meniscal injuries has resulted in numerous investigations and clinical trials to restore normal meniscal functions. A cryopreserved meniscal allograft transplantation is one of the successful methods available to restore the meniscus. All the procedures of 26 cases were performed in an minimal open fashion, though initial four cases were done with the aid of arthroscope. In all of the grafts, we used a bone bridge which was attached to meniscus for better stability and healing. Anterior cruciate ligament reconstructions were also performed simultaneously with the meniscal procedures. We attempted to minimize articular cartilage by employing so called the "Key-hole technique" for the medial meniscus transplantation. First, the meniscal cartilage bone bridge was shaped into a cylinder and a bone tunnel was made just beside the medial border of the anterior criciate ligament insertion of the recipient knee joint, and the bone bridge of the meniscal cartilage was push to press-fit. The inserted meniscal cartilage was sutured by the usually employed technique under arthroscopic control. The lateral meniscus was shaped different to the medial meniscus in that the bone bridge was semicylindrical and the bone trough was made beside the lateral border of the anterior criciate ligament insertion of the recipient knee joint. The meniscus was put into the bone trough and the leading suture was extracted anterior to the tibia and tied the knot. The inserted meniscus was sutured in the same manner as the medial meniscus transplantation. By the above described method, the authors were able to minimize the articular cartilage invasion and transplant the meniscus with relative accuracy.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.1
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• pp.41-47
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• 2010

Purpose: To compare the obliquity of femoral tunnels prepared with transtibial (TT) versus anteromedial portal technique (AM) using x-ray in single-bundle anterior cruciate ligament (ACL) reconstruction. Materials and Methods: Among one-hundred thirty two patients who were undergoing ACL reconstruction from January 2007 to December 2009, thirty patients using TT and twenty patients using AM, those who had single-bundle ACL reconstruction, were evaluated with plain radiographs including anteroposterior, intercondylar notch and lateral view to compare the obliquity of bone tunnels. Results: The mean coronal obliquity of femoral tunnel for TT was $71^{\circ}$ (range; $65^{\circ}{\sim}77^{\circ}$), while for AM was $51^{\circ}$ (range; $39^{\circ}{\sim}60^{\circ}$) and the mean sagittal obliquity of femoral tunnel for TT was $22.7^{\circ}{\pm}7.8$, while for AM was $30.2^{\circ}{\pm}6.9$, their differences between them were statistically significant (P<0.05). However, there were no differences between two techniques on the tibial tunnel obliquity in coronal and sagittal plane. Conclusion: Anterior cruciate ligament reconstruction using AM portal technique allows more horizontally oriented and divergent femoral tunnel compared to that of transtibial technique. This seems to enable the graft placement into the femoral footprint and preserve the posterior cortical wall.

• Journal of the Korean Arthroscopy Society
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• v.14 no.1
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• pp.20-24
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• 2010

Purpose: To evaluate the long term outcomes of the ACL reconstruction from the standpoint of osteoarthritis. Materials and Methods: We evaluated 31 patients who underwent ACL reconstruction from April 1986 to April 1999 and could be followed-up more than 7 years. Mean follow-up period was 10.1 years (7~22 years). In terms of the graft, 11 cases were treated with the ACL reconstruction using a autologous hamstring tendon graft, 20 cases were treated with using a autologous bone patellar tendon bone graft. For femoral tunnel, 11 cases were placed through transtibial tunnel, 20 cases were placed through anteromedial portal using mini-open arthrotomy. Functional and radiographic evaluation was performed. Results: Mean Lysholm score was $89.2{\pm}11.7$ points. Patients had KT-2000 side-to-side differences were $2.1{\pm}1.9\;mm$. IKDC ligament evaluation showed 38.7% type A, 48.3% type B, 6.5% type C and 6.5% type D. Femoral tunnel were placed at 11 or 1 o'clock position in transtibial technique and placed 10 to 10:30 or 2 to 2:30 o'clock position in technique using anteromedial portal. Radiographic analysis for degenerative arthritis revealed that in group using anteromedial tunnel, 50.0% were excellent, 25.0% were good. In group using transtibial tunnel 18.2% were excellent, 18.2% were good. Conclusion: More than 87.1% of cases, long term result of the ACL reconstruction showed good and excellent result in IKDC score. Especially, the group using tunnel through anteromedial portal showed good results for degenerative arthritis.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.1
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• pp.27-34
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• 2011

Purpose: To evaluate the short term clinical result of ACL reconstruction with autologous hamstring tendon using Cross pin and Graft Tensioner and to seek way to resolve the experienced technical problems. Materials and Methods: From January 2008 to March 2009, 35 patients who had been treated arthroscopic ACL reconstruction were enrolled. The femoral side of ACL graft was fixed with Cross pin. The tibial side of graft was fixed with Intrafix and post-tie. The graft was tensioned with Graft Tensioner at 80N. We analyzed the clinical, radiographic results and complications. Results: IKDC subjective score and Lysholm score improved to 89.1 and 91.4 points. Also, Pivot shift test and One-leg hop test showed good results postoperatively. Side to side difference using KT-1000 arthrometer and Telos stress radiography improved compared with normal limb to $2.8{\pm}1.6$ mm and $2.6{\pm}1.3$ mm, respectively. The femoral tunnel enlarged to $2.3{\pm}1.1$ mm. Soft tissue irritation and femoral tunnel-graft harness length mismatch, femoral tunnel-cross pin tunnel mismatch were happened as peri-operative complications. Conclusion: Using of Cross pin and Graft Tensioner for ACL reconstruction with hamstring tendon is one of the good method for obtaining stability in short-term clinical result. But to reduce femoral tunnel-cross pin mismatch, it needs to shorten femoral bone tunnel and to create cross pin tunnel as vertical as possible. And to reduce femoral tunnel-graft harness mismatch, it needs to advance position rod further 3 mm when to create femoral tunnel.

• Journal of the Korean Arthroscopy Society
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• v.4 no.1
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• pp.1-6
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• 2000

Purpose : The purpose of this study was to compare the results of ACL reconstruction using bone-patellar tendon-bone to hamstring. Materials and Methods : Thirty-two ACL reconstructions with autogenous BPTB and eighteen reconstructions with hamstring were compared in terms of functional outcome, stability and tunnel expansion. Results : The functional score of BPTB group was higher than hamstring group in OAK(Orthopadishe Arbeitsguppe Knie) and IKDC(International Knee Documentation Committee) system. In BPTB group, OAK scores were 71.6$({\pm}10.0)$ preoperatively and 88.5$({\pm}7.9)$ finally. In hamstring group, OAK scores were 73.9$({\pm}11.5)$ and 82.5$({\pm}12.9)$ respectively. There was no difference in stability checked by either $KT-1000^{TM}$ or stress view. Anterior tibial translation measured by $KT-1000^{TM}$ were 2.4$({\pm}1.8)$mm in BPTB and 2.3$({\pm}2.4)$mm in hamstring group. Anterior tibial translation in stress view were 2.8$({\pm}3.4)$mm in BPTB and 2.8$({\pm}2.5)$mm in hamstring group. There was no difference in tibial tunnel expansion but femoral tunnel was more enlarged in hamstring group than BPTB (P=0.03). Conclusion : As there was no difference in stability between two groups, it seems prudent to select either graft defend on such factors as anterior knee pain, skeletal maturity and cosmetic concern. Tunnel expansion seems not to affect stability, but further study is needed to confirm that decrease of which might improve stability.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.197-200
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• 2005

We performed lateral ankle ligament reconstructions using Achilles allograft on patients who had failed previous Brostrom repair. The bone plug is fixed with an interference screw into the calcaneus, the tendon graft is passed through a fibular tunnel, and then anchored into the talus with the biotenodesis screw. The graft is strong enough to maintain joint stability until graft incorporation and remodeling occurs. In patients with chronic failed lateral ankle instability requiring graft for ligament reconstruction, this technique allows anatomic reconstruction without the need to sacrifice autogenous peroneal tendons.

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.7-13
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• 2002

Purpose : Preliminary report of the technique and trial of double bundle PCL reconstruction using Achilles allograft. Materials and Methods : From May 1999 to July 2000, 8 cases of PCL insufficient patients were treated with Achilles allograft reconstruction using the double bundle and double femoral tunnel technique. The tibial tunnel was prepared anteromedially. All other combined injuries within the knees were treated accordingly. Minimal follow-up period was 1 year. The results was assessed from the point of function and stability using Lysholm knee score and KT-2000 arthrometer. Results : Up to present follow up. 8 patients showed good sign of recovery with no instability (translation less than 2 mm) except olio that has been grafted-ligament rupture. In addition, none showed any sign of infection nor ROM limitation. Two complications were seen, which one had grafted-bone fracture and the other grafted-ligament rupture. The former occurred during operation and the latter occurred due to improper protection. Conclusion : Presently the follow up period is too short to draw any conclusive opinion but it is essential to select healthy and well sterilized allografts fur successful outcome. Double femoral tunnel technique seems to be more physiologic in PCL reconstruction. With these prerequisites, it seems to be a good alternative to use Achilles allografts fur the reconstruction of PCL. However, a longer follow-up is needed.

• Journal of the Korean Arthroscopy Society
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• v.3 no.2
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• pp.102-108
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• 1999

Purpose : The purpose of this study was to evaluate the clinical results of bone-patellar tendon-bone(B-PTB) allograft for ACL reconstruction without mechanical tensioning device. Material and Method : Forty-six knees in 43 patients were reviewed and evaluated with subjective evaluation, objective evaluation, Telos stress arthrometer and modified Feagin Scoring System. The average age at the time of operation was 27 years(range, 18-42) and the average follow up period was 41 months(range, 22-79). Authors reconstructed ACL using B-PTB allograft which was prepared by rehydration preoperatively without tensioning by mechanical tensioning device. The tension for allograft was obtained by full flexion and extension intraoperatively. All operation were performed arthroscopically by two-tunnel method to avoid the mismatching of allograft tendon length. Result : The modified Feagin Scoring System revealed 39 cases(84.7%) with excellent or good results and 7 cases(15.3%) with fair or poor results. The mean follow-up Lysholm Knee Score was 84. Telos arthrometer revealed 41 cases had an injured-to-uninjured difference of 5 mm or less(mean 2.3mm). The range of motion of knee was nearly normal and there was no extension lag in any cases at last follow up. Conclusion : Clinical results using B-PTB allograft showed less morbidity than B-PTB autograft. The intraoperative tensioning method by full flexion and extension without mechanical tensioning device was not bad. Therefore, B-PTB allograft is a good substitute material in reconstruction of the ACL.