• Investigative Magnetic Resonance Imaging
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• v.20 no.2
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• pp.95-104
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• 2016

Purpose: To evaluate the knee joint after double-bundle anterior cruciate ligament (ACL) reconstruction with three-dimensional (3D) isotropic magnetic resonance (MR) image, and to directly compare the ACL graft findings on 3D MR with the clinical results. Materials and Methods: From January 2009 to December 2014, we retrospectively reviewed MRIs of 39 patients who had reconstructed ACL with double bundle technique. The subjects were examined using 3D isotropic proton-density sequence and routine two-dimensional (2D) sequence on 3.0T scanner. The MR images were qualitatively evaluated for the intraarticular curvature, graft tear, bony impingement, intraosseous tunnel cyst, and synovitis of anteromedial and posterolateral bundles (AMB, PLB). In addition anterior tibial translation, PCL angle, PCL ratio were quantitatively measured. KT arthrometric values were reviewed for anterior tibial translation as positive or negative. The second look arthroscopy results including tear and laxity were reviewed. Results: Significant correlations were found between an AMB tear on 3D-isotropic proton density MR images and arthroscopic proven AMB tear or laxity (P < 0.05). Also, a significant correlation was observed between increased PCL ratio on 3D isotropic MRI and the arthroscopic findings such as tear, laxities of grafts (P < 0.05). KT arthrometric results were found to be significantly correlated with AMB tears (P < 0.05) and tibial tunnel cysts (P < 0.05). Conclusion: An AMB tear on 3D-isotropic MRI was correlated with arthroscopic results qualitatively and quantitatively. 3D isotropic MRI findings can aid the evaluation of ACL grafts after double bundle reconstruction.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.1
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• pp.28-34
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• 2010

Purpose: The aim of this study was to evaluate short-term clinical results and second-look arthroscopic findings after double-bundle anterior cruciate ligament (DB ACL) reconstruction. Materials and Methods: Forty-nine patients, who were followed up for at least 24 months after DB ACL reconstruction, were included. Clinical results, such as, Lysholm knee and Tegner activity scores, and manual laxity and instrumented anterior laxity test results were evaluated. In fifteen patients (15 knees), second-look arthroscopy with staple removal was performed. At second-look arthroscopy, the authors assessed about reconstructed ACL rupture, subjective graft tension and extent of synovial coverage. Results: Lysholm knee scores significantly improved from 67.4 preoperatively to 96.1 at last follow-up (p<0.01). Tegner activity scale improved from 2.0 to 6.1. The Lachman test, at last follow-up, showed normal laxity in 39 (of 49) patients, and the pivot-shift test showed normal laxity in 36 (of 49) patients. Mean side-to-side differences improved significantly from 10.8 mm to 3.3 mm (p<0.01). Second-look arthroscopic findings showed that all patients had a normal or a near normal anteromedial bundle. However, 8 patients (53.3%) were found to have partial or complete posterolateral bundle rupture. Conclusion: Even though double-bundle ACL reconstruction was clinically effective means of restoring knee rotational and anteroposterior stabilities, there were some ruptured posterolateral bundles observed in cases under arthroscopy after double-bundle ACL reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.222-231
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• 2005

Purpose: This article describes a double-bundle ACL reconstruction technique using a five-strand hamstring tendon autograft with conventional anteromedial bundle reconstruction and additional posterolateral bundle reconstruction. Operative technique: For the tibial tunnel, the conventional single tunnel technique is performed and for the femoral tunnel, the double tunnel technique is performed with the anteromedial and posterolateral bundle. After minimal notchplasty, the anteromedial femoral tunnel is prepared with leaving one milimeter of posterior femoral cortex within the over-the-top, which if positioned at the 11-o'clock orientation for the right knee or at the 1-o'clock position for the left knee. The posterolateral femoral tunnel that is located 5 to 7 mm superior to the inner margin of the lateral meniscus anterior horn at $90^{\circ}$ of flexion is prepared with tile outside-in technique using a 4.5 cannulated reamer. The graft material for the double bundle reconstruction is made of the conventional four-strand hamstring autograft in the anteromedial bundle and of a single-strand semitendinosus tendon in the posterolateral bundle. The anteromedial bundle is fixed with using a rigid fix system on the femoral side and the posterolateral bundle is fixed to tie with the miniplate from the outside femur. Then, with the knee in $10^{\circ}\;to\;20^{\circ}$ of flexion, a bioabsorbable screw is simultaneously applied to achieve tibial fixation with tensioning of both bundles. Conclusion: A double bundle reconstruction with five-strand hamstring autograft, which is designed with a favorable conventional anteromedial bundle and an additional posterolateral bundle to restore rotation stability, seems to be a very effective method for the treatment for ACL instabilities.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.203-208
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• 2006

Purpose: Previous transtibial double bundle posterior cruciate ligament (PCL) reconstruction methods have several problems in graft length and tibial fixation. We introduce new surgical method that is less restrictive by graft length and is more stable with single tibial fixation. Operative technique: After diagnostic arthroscopy, we prepare the graft, ream the tibial tunnel and perform the procedure for TransFix tibial fixation. Femoral 2 tunnel is made and graft is passed via anteromedial (AM) portal. Tibial fixation is done and femoral 2 graft is fixed sequentially at each knee position. Conclusion: TtransFix tibial single fixation method in double bundle PCL reconstruction provides more stable fixation, more free graft selection and prevents graft damage by passing the graft via AM portal.

• 대한관절경학회:학술대회논문집
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• 2006.11a
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• pp.89-89
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• 2006

• 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.

• Knee surgery & related research
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• v.30 no.4
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• pp.348-355
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• 2018

Purpose: To evaluate the clinical effects of using anatomical bony landmarks (Parsons' knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. Materials and Methods: We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. Results: Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. Conclusions: Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.167-171
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• 2008

• 대한정형외과스포츠의학회:학술대회논문집
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• 2007.04a
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• pp.26-30
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• 2007

• 대한정형외과스포츠의학회:학술대회논문집
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• 2004.09a
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• pp.14-14
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• 2004