• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.407-412
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• 2018

Background: We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft. Methods: The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels - the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients. Results: There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients' height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001). Conclusions: Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.

• 대한관절경학회지
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• 제3권2호
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• pp.97-101
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• 1999

목 적 : 각 환자의 슬개건 길이, 터널간 길이, 경골 터널 길이, 경골 골편의 길이를 측정하여 이식물과 터널 길이의 부조화를 예방하는 수기를 찾고자 하였다. 대상 및 방법 : 1997년 3월부터 1999년 6월까지 골-슬개건-골을 이용하여 전방십자인대 재건술을 시행 받았던 환자 15례를 대상으로 하였다. 수술시 Tibial Tunnel Guide의 각도는 $40^{\circ}$(Acufex, MA, USA)로 고정하였으며, 터널간 길이(X), 경골 터널 길이(T), 슬개건 길이(N), 경골 골편 길이(Y)를 측정하였다. 대퇴골 터널 길이(F)와 슬개골 골편 길이(P)는 공히 25mm로 일치시켰다. 터널 길이 부조화를 예방하기 위해 임의적으로 조절이 용이한 경골 골편의 길이는 경골 터널 길이와 터널간 길이를 합하여 슬개건 길이를 뺀 단순 공식(Y=X+T-N)으로 계산하였다. 결 과 : 대상환자에게 측정한 지표들의 평균값은 터널간 길이(X) $23.4{\pm}1.4mm$, 경골 터널 길이(T) $43.6{\pm}1.7mm$, 슬개건 길이(N) $40{\pm}2.4mm$, 경골 골편 길이(Y) $27{\pm}2.4mm$였다. 결 론 : 저자들의 방법은 터널의 총길이를 측정한 후 이식물의 총길이를 경골 골편 길이로 조정함으로써 경골터널 내에서의 이식물-터널 길이 부조화를 방지할 수 있었다.

• 대한관절경학회지
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• 제1권1호
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• pp.55-62
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• 1997

Various surgical techniques has been advocated for reconstruction of anterior cruciate ligament using the bone-patella tendon-bone graft. Recently endoscopic technique provides good clinical results, with minimal skin incision, accurate positioning of the graft to the femoral tunnel, and decreasing wear rate of the graft. But the graft-tunnel mismatch remains problematic in endoscopic technique. The purpose of this paper is to described causes of the graft-tunnel mismatch and to provide important steps to prevent or minimize the graft-runnel mismatch following anterior cruciate ligament while using the endoscopic technique. Our guideline for prevention of the graft-tunnel mismatch are as follows: (1) The tunnel should he positioned closely to isometric point as much as possible. (2) Anterior placement of the tunnel should be avoided. (3) The change of graft length should be within 2mm between flexion and extension position.

• 대한의용생체공학회:의공학회지
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• 제26권2호
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• pp.101-110
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• 2005

Periosteum and periosteum-derived progenitor cells have demonstrated the potential for stimulative applications in repairs of various musculoskeletal tissues. It has been found that the periosteum contains mesenchymal progenitor cells capable of differentiating into either osteoblasts or chondrocytes depending on the culture conditions. Anatomically, the periosteum is a heterogeneous multi-layered membrane, consisting of an inner cambium and an outer fibrous layer. The present study was designed to elucidate the cellular phenotypic characteristics of cambium and fibrous layer cells in vitro, and to assess whether structural integrity of the tendon in the bone tunnel can be improved by periosteal augmentation of the tendon­bone interface. It was found the cells from each layer showed distinct phenotypic characteristics in a primary monolayer culture system. Specifically, the cambium cells demonstrated higher osteogenic characteristics (higher alkaline phosphatase and osteocalcin levels), as compared to the fibrous cells. Also in vivo animal model showed that a periosteal augmentation of a tendon graft could enhance the structural integrity of the tendon-bone interface, when the periosteum is placed between the tendon and bone interface with the cambium layer facing toward the bone. These findings suggest that extra care needs to be taken in order to identify and maintain the intrinsic phenotypes of the heterogeneous cell types within the periosteum. This will improve our understanding of periosteum in applications for musculoskeletal tissue repairs and tissue engineering.

• 대한관절경학회지
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• 제1권1호
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• pp.66-71
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• 1997

The all inside anterior cruciate ligament reconstruction technique places an anterior ligament substitutes within two bony sockets rather than hone tunnel. This approach is accomplished through arthroscopic three portal which avoids the surgical exposure and morbidity associated with creating traditional bone tunnel. This technique has several distinct advantages when compared with the traditional ACL reconstruction through the bone tunnels. It offers the surgeon a less morbid method for ACL reconstruction that positions an ACL substitute at the anatomic attachment sites of the original ACL with two bone sockets, obviating the need for traditional bone tunnels. Graft fixation at or near the anatomic attachment points of the original ACL minimizes creep with early range of motion and reduces the abrasive 'wind-shield wipe' motion of the graft which occur with bone plugs positioned inside bone tunnels. The sagittal posterior angle to the tibial socket increases fixation strength to pullout with anterior translation force for the tibia on the femur. This technique is not graft specific and can accomodate any graft in which graft length can be customized to the intraarticular native ACL length.

• 대한관절경학회지
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• 제3권1호
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• pp.40-43
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• 1999

대퇴 터널 속에 횡고정 나사로 네가닥의 자가 슬괵건을 고정하는 전방십자인대 재건술은 이식된 건과 골이 만나는 부위에서 건-골 융합 과정(골통합, osteo-integration)이 필요하다. 본 증례는 외상성 전방십자인대 파열 환자에서 자가 슬괵건을 이용한 전방십자인대 재건술후 13주째에 수술한 전방십자인대 실질부(substance)의 외상성 재파열이 생겨 이를 관절경적 재수술을 시행하는 과정에서 대퇴 터널 내 골-이식건 결합부를 채취하여 조직학적 관찰을 시행하였다. 조직학적 소견은 이식건과 골 사이에 콜라젠 섬유의 연속성이 존재하는 이식건의 골통합 소견을 관찰할 수 있었다. 본 증례의 조직학적 소견과 전방십자인대 재건술후 초기에 이식건 파열의 낮은 발생율은 수술후 대퇴 터널에서의 자가 이식건-골의 융합이 수술후 12주에서 15주 사이에 완성된다는 주장을 뒷받침할 수 있을 것으로 사료된다.

• 한국생산제조학회지
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• 제18권3호
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• pp.321-327
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• 2009

This paper studied the influences of the main design parameter-the expansion angle and the material properties of the self-expansion anterior cruciate ligament fixation device on the contact condition with the bone and the initial stability of the device. Using finite element analysis, the stress distributions of the ring part of the device and the wall of the bone tunnel were calculated. And the micro-migration of the device by the pull-out force was calculated. From the analysis results, it was found that when designing the self-expansion type anterior cruciate ligament fixation device, it is desirable to use the material having higher Young's modulus and to design the fixation device that all wedges uniformly maintain contact with bone to obtain initial stability after operation.

• 대한관절경학회지
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• 제2권2호
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• pp.114-118
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• 1998

We retrospectively evaluated the changes in the diameter of the tibial tunnel over time following the reconstruction of the anterior cruciate ligament with a bone-patella tendon-bone(BPTB) autograft(25 cases) and quadruple semitendinosus(ST) graft(27 cases) in 52 patients at one year postoperatively. The changes in the geometry of the bony tunnel were measured with radiography. The demensions at final follow up were correated with the clinical results. An increased width of the tibial tunnel was noted in all cases. On the femoral side, however, no tunnel expansion was noted. In AP view, the average tibial tunnel enlargement in ST and BPTB graft groups were 1.30mm(13%) and 1.82mm(17%), respectively. In lateral view, the average tibial tunnel enlargement in ST and BPTB graft group was 1.30mm(13%) and 2.04mm(19%). The differences between two groups were not statistically significant, however, there was evidence of a borderline significance(P=0.0502). Although the tunnel enlargement does not appear to adversely affect the clinical outcome in the short term, the exact mechanism which are involved should be demonstrated. Furthermore histologic study is needed to evaluate graft replacements with emphasis on the graft-tunnel interface.

• 대한관절경학회지
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• 제2권1호
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• pp.85-92
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• 1998

Various methods for fixation of graft have been widely used for reconstruction of anterior cruciate ligament. However, the biomechanical strength of each fixation techniques are not fully understood. The purpose of this study is to compare the pull out strength of different fixation techniques which is probably the most important factor for the success at the initial stage of healing. Biomechanical test was carried out to measure and compare the pull out tensile strength of five different fixation techniques in 35 pig(Yorkshire) knees. ANOVA and Duncan multiple comparison test was applied for statistical analysis. In the two fixation techniques with bone patellar tendon bone graft, the mean maximum tensile strength was $1333.4{\pm}148.5N$ with titanium interference screw, while it was $1310.1{\pm}168.9N$ with biodegradable interference screw. The failure mode were pulled out of bone plugs from the femoral tunnel in majority cases. In the fixations with hamstring tendon, the mean maximum tensile strength were $1405.9{\pm}135.1N$ with SemiFix screw, $820.3{\pm}104.5N$ with biodegradable interference screw, and $682.1{\pm}54.2N$ with Endobutton. The mode of failure was variable in each technique. The tendon was pulled out from the tunnel in biodegradable interference screw fixation, the screw was bent in the SemiFix system, and the polyester tape were ruptured or the buttons were pulled into tunnel in Endobutton fixation. The mean maximum tensile strength of two interference screws with bone patellar tendon bone was statistically comparable to that of SemiFix with hamstring tendon. However biodegradable interference screw and Endobutton with hamstring tendon showed weaker maximum tensile strength than above three fixation techniques (P<0.05).

• Journal of Periodontal and Implant Science
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• 제38권3호
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• pp.521-528
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• 2008

Purpose: Tunneling is a periodontal surgical procedure that creates access for patient cleansing and maintenance within the furcal area of a molar tooth with severe furcation involvement. Up to date, there are few studies about a long term clinical and radiographic stability of tunneling. The purpose of this retrospective study is to evaluate the long term prognosis after tunnel preparation of molars with through and through furcation. Material and Methods: 25 teeth of 23 patients aged 36 to 70 (mean age 51.7) were treated surgically with tunnel preparation. These cases were followed for 2 to 13 years (mean 6.5years) after surgery. Patients were recalled for an evaluation which was based on a questionnaire, a clinical examination, and radiographic analysis. Clinical assessment included plaque index, caries registration, probing pocket depth, bleeding on probing, tooth mobility. Baseline and over 2-year follow-up radiographs were collected and evaluated for this study. Result: 3 teeth(12%) had been extracted and 1 tooth(4%) hemisected. Root caries was detected in 3 teeth(12%). Thus 72% of the teeth were still caries tree and in function. Clinical parameters including PI, PD, BOP, mobility showed somewhat favourable results. Radiographic furcal bone loss showed no statistically significant difference compared to interproximal crestal bone loss ($3.59{\pm}1.69%$ vs $3.42{\pm}2.95%$) when root length was used as reference. There was no correlation between root trunk length and furcal bone loss. Conclusion: Over 2 years after tunneling procedure, teeth showed a clinically and radiographically stable condition, despite of slight root caries and alveolar bone loss within clinically acceptable range. The tunnel procedure may be considered as a viable periodontal treatment option for molar teeth with severe furcation involvement in individuals following a regular maintenance program.