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

Purpose : Evaluation and analysis of the incidence and causes of intraoperative and postoperative complications after arthoscopic anterior cruciate ligament(ACL) reconstruction using bone-patella. tendon-bone (BPTB) auto graft. Materials and Methods : We reviewed 85 cases of arthroscopic ACL reconstruction using BPTB autograft which had been followed up for more than 1 year. Intraoperative complications had been recorded and corrected during the operation. Postoperative complications were analyzed and compared between 3 groups which were classified by the last follow-up period after the operation. Results : There were a few intraoperative complications including patellar fracture(1 case), contamination of harvested graft(1 case), impingement of graft(2 cases), blow-out of tile posterior wall of the femoral tunnel(1 case) and intraarticular retraction of the screw(1 case). The result of the comparison of postoperative complications among the groups shows that the incidence of anterior knee pain, donor site pain and patellofemoral crepitation were significantly decreased after 2 years. But there was no significant decrease in these complications after 3 years. Conclusion : Intraoperative complications after arthroscopic ACL reconstruction using BPTB autograft were due to incorrect technique and carelessness of the operation team, and can be prevented by improvement of surgical technique and accumulation of experience. Postoperative complication were somewhat unavoidable but gradually improved with time; hence, we should consider it for the selection of graft donor.

• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.189-195
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• 2003

Purpose : To evaluate the clinical results after anterior cruciate ligament (ACL) reconstruction with hamstring tendon and Ligament Anchor (LA) screw Materials and Methods : 103 patients (104 cases) who were followed up at least more than 2 years after ACL reconstruction were included in this study. The average period of follow-up was 36 months. The clinical results such as physical examination and Lysholm knee score and instrumented anterior laxity test with Telos were evaluated. Results : The Lysholm knee score was 57.9 in average preoeratively and improved to 95.2 in average at follow up. On the Lachman test, there were mild (+) instability in 46 cases $(45\%)$, moderate (++) in 33 $(31\%)$, severe (+++) in 25 $(24\%)$ preoperatively. 90 cases $(87\%)$ were converted to negative and 14 $(13\%)$ to mild at follow up. On Pivot-shift test, there were negative (-) instability in 22 cases $(22\%)$, mild (+) in 62 $(59\%)$, moderate (++) in 12 $(11\%)$ and severe in 8 $(8\%)$ preoperatively. 87 cases $(84\%)$ were converted to negative and 17 $(16\%)$ to mild at follow up. On instrumented anterior laxity test with $Telos^{\circledR}$, side to side difference on 20 lb was $13.4{\pm}5.6$ (7-25) mm in average preoperatively, and was decreased to $3.6{\pm}1.5$ (1-6) mm in average at follow-up. Complications were quadriceps muscle atrophy in 27 $(30.0\%)$, saphenous nerve paresthesia in 19 $(18.3\%)$, anterior knee crepitus in 13 $(12.5\%)$ and over-penetration of screw through lateral femoral cortex in 5 cases $(4.8\%)$. Conclusion : ACL reconstruction with hamstring tendon and LA screw was one of the choice of graft and fixatives in restoring knee stability and in improving clinical results with little complications such as anterior knee pain.

• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.169-175
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• 2003

Purpose : The purpose was to evaluate the early result of revision of failed anterior cruciate ligament (ACL) reconstruction. Materials and Methods : From August 1997 to February 2002, this report presents the findings of 18 patients who had revision surgery for failed ACL reconstruction. There was an average of 39 $(7\~120)$months from index procedure to the time of revision. Allografts were used in 14 $(78\%)$cases and autografts were used in 4 $(22\%)$cases and the revision procedures were assisted by arthroscopic technique. The majority of chief complaints were instability in 16 $(89\%)$cases. Sixteen $(89\%)$ cases had 1 previous reconstruction, 2 $(11\%)$ cases had 2. Before and after revision, patients were evaluated by Lachman test, pivot shift test, KT 2000, radiographs, Lysholm score and HSS score and subjective satisfaction. Results : Average length of followup was 27 $(12\~60)$months. Preoperatively, all cases were positive in Lachman test and pivot shift test. After revision the majority of cases were negative. Objectively improving stability was confirmed by KT 2000 and all average KT 2000 was 7.75 $(3.5\~12.5)$mm preoperatively and 2.36 $(1.0\~6.0)$mm at final followup. Lysholm score and HSS score were also improved from 72.6 $(66\~77)$ and 72.5 $(68\~78)$ preoperatively to 89.2 $(80\~92)$ and 88.2 $(81\~92)$ at final followup. Most $(89\%)$ of patients were satisfied with their results. The most common causes of failed ACL reconstruction were malposition of femoral tunnel in 11 $(61\%)$cases. Conclusion : Arthroscopic revision ACL surgery with adequate graft for failed ACL reconstruction was successful in objectively and subjectively improving stability. However, considering the most common causes of failure after ACL reconstruction were errors in surgical technique, it is important that the primary ACL reconstruction should be performed with correct surgical technique.

• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.206-214
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• 2003

Purpose : To analysis each clinical results after arthroscopic ACL reconstruction with using variable fixatives which are metallic and bioabsorbable interference screw, and RIGIDfix. Therefore, We reported the clinical reliability and safty of ACL reconstruction using RIGIDfix. Materials and Methods : We evaluated the results of arthroscopic ACL resconstruction with patellar tendon autograft among three groups, of which group 1 is used metal interference screw for 44 patients, group 2 used bioabsorbable interference screw for 47 patients, group 3 used RIGIDfix for 42 patients. We compared the clinical results by physical examination (anterior drawer test, Lachman test and pivot shift test), Lysholm score and KT-2000 arthrometer and compared the radiological results by measurement of tunnel and fixatives position and widening and by MRI findings. We analyzed the results by SAS 8.2 Ducan. Tukey and paired t-test Results : Physical instability was in 5 cases, which group 2 had 4 cases and group 3 had 1 case. Lysholm score improved from 59.8. 64.4, 61 to 90.1, 92.3. 92. KT-2000 arthrometer instability improved from 9.20, 10.2, 9.5 to 1.43. 1.62. 2.00 (p=0.478). Radiologically, all cases had excellent tunnel position and cyst change was observed the 8 cases in the group 2, but, all 20 cases 2nd MRI had signal change of peri-fixatives. But, no correlation of clinical results. Conclusion : No statistical difference of clinical instability was found among three groups. And femoral tunnel changes were much observed in group I, II than III. We considered the RIGIDfix has much advantages because the short operation time, better fixation position and much bone contact surface. But, further long term follow up study was needed.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.165-172
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• 2006

Purpose: The purpose of this study is to evaluate the effects of intratunnel fixation in the tibial side on the arthroscopic ACL reconstruction with quadruple hamstring tendon at the second look arthroscopy. Materials and Method: From Dec 1999 to May 2005, we arthroscopically reexamined 32 cases who had been done arthroscopic ACL reconstruction with quadruple hamstring tendons. Hamstring tendons of all cases were fixed at femoral side with RigidfixTM. At the tibial side hamstring tendons were fixed only Post-tie (Group I) or Post-tie combined with IntrafixTM (Group II). At the time of second look arthroscopy mean age of cases was 30 years and mean duration for second look arthroscopy was 21.3 months. We analyzed the results with IKDC score, KT-1000 arthrometer under anesthesia, Telos stress radiography, tibial tunnel widening on the radiography and second look arthroscopic findings. Results: Group II had more superior than group I at side to side differences with KT-1000 and Telos stress radiograph, IKDC score, but the differences were insignificant. At arthroscopic evaluation, Group ll also had more superior than group I at graft tension and graft appearance, graft synovialization, but the differences were insignificant. Tibial tunnel widening in the knee AP radiograph was 2.3 mm in Group I and 1.7 mm in Group II and the difference was significant. (P=0.042) Conclusions: Additional procedure of tibial intratunnel fixation in arthroscopic ACL reconstruction with autogenous hamstring tendon significantly prohibited from tibial tunnel widening but clinical results, radiologic joint stability, findings in second look arthroscopy were insignificantly different. We concluded that Post-tie itself induced satisfactory clinical results, joint stability and graft maturation and that tibial tunnel widening did not affect the results.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.160-166
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• 2012

Purpose: The aim of this study was to determine the patterns of the stress distribution within the reconstructed anterior cruciate ligament (ACL) double bundles in response to an anterior tibial load and rotatory load at $45^{\circ}$ flexed knee model by use of a 3-dimensional finite element analysis (FEM). Materials and Methods: The $0^{\circ}$ and $45^{\circ}$ flexed 3-D knee model were reconstructed based on the high resolution computed tomography (CT) images from the right knee of a healthy male subject. To simulate double bundle ACL reconstruction, in $0^{\circ}$ analytic model, four 7 mm diameter tunnels were created at the center of each anteromedial (AM) and posterolateral (PL) footprints on the femur and tibia. The grafts were inserted into the corresponding bone tunnels and then reconstructed knee model was flexed to $45^{\circ}$. As a next step, the 5 mm anterior tibial load and internal rotational load of $10^{\circ}$ were applied on the final Computer aided design (CAD) model. And then stress patterns of each bundle were assessed using a finite element analysis. Results: In response to the 5 mm of anterior tibial load, the AM bundle showed increased stresses around the tibial and femoral attachment sites; especially in the anterior aspect of the bundle. In the PL bundle, the highest stress concentration was also noticed on the anterior aspect of the bundle. Under $10^{\circ}$ internal rotational load, the stress concentration was predominant around the anterior aspect of the tibial attachment site within the AM bundle. The PL bundle also showed highest stress concentration on the anterior aspect of the bundle. Conclusion: Although the stress patterns were not identical among the AM and PL bundle, there were common trends in the stress distribution. The stress concentration was predominant on the anterior aspect of both bundles in response to the anterior tibial load and rotatory load.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.63-72
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• 2003

Although a variety of synthetic vascular grafts are available in modern vascular surgery, no ideal prosthesis ha,4 yet been developed. Small-caliber vascular grafts with low flow, as used in the lower extremity, continue to become thrombosed at unacceptable rates. We have developed and evaluated the new antithrombogenic blood contacting surfaces in canine model. Material and Method: Two now antithrombogenic blood contacting surfaces(Polyvinylalcohol -Polyurethane(PVA-PU) blend and natural Graphite-polyurethane(G-PU) blend) have been developed and evaluated in canine model, using vascular grafts and patches. The luminal surfaces of the test vascular grafts(5 mm ID) were fabricated by dipping a glass rod in PVA-PU blend solution(50 % PVA) using phase separation method. Mongrel dogs of either sex weighing 18-22 kg were anesthetized by endotracheal intubation using halothane and their lungs were ventilated with a volume-cycled ventilator, Maintenance anesthesia with 0.5-1.0% halothane and supplemental oxygen was used. Two pairs were used for comparison in the bilateral femoral arteries for both vascular grafts(PVA-PU vs. PU) and vascular patches(G-PU vs. PU). Bilateral groin incisions were made and the arteries were exposed and clamped. After an excision of 1 cm of the artery between clamps, a grail of 2.5 cm in length was implanted end-to-end using 6-0 polypropylene suture. The vascular patch was implanted as a form of on-lay patch. Animals were sacrificed at 1, 2, 4, 6, 8 and 16 weeks for vascular grafts and 1, 2. 4 and 6 weeks for vascular patches. Result The vascular grafts of PVA-PU blends showed patent lumina in the 2 and 16 weeks animals, while those of PU showed a patent lumen in 2 weeks animal. PVA-PU graft of 16 weeks showed a fairly clean luminal surface. A light microscopic finding of this graft demonstrated good tissue infiltration through porosity, The animals with vascular patches showed patent arteries in both groups except 2 weeks animal. Scanning electron microscopy of the luminal surfaces of G-PU patches in 4 and 6 weeks animals showed endothelial cell covering with microvilli. PU patches showed qualitatively less endothelial cell covering. Conclusion: In conclusion, PVA-PU and G-PU blends can be a promising blood contacting surfaces for application in a synthetic vascualr graft. However, further animal study is needed to determine the real long-term effects of these methods of surface modifications.

• Journal of Veterinary Clinics
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• v.26 no.6
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• pp.539-546
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• 2009

The effect of hemorrhage on the electroencephalogram(EEG) was investigated in fifteen mixed-breed dogs anesthetized with ketamine, propofol and isoflurane. Animals were randomly allocated to three groups (n = 5) by anesthetic agents; group 1 (ketamine 5 mg/kg, IV), group 2 (propofol $156\;{\mu}g$/kg/min, IV) and group 3 (isoflurane 2.0% end-tidal concentration). Medetomidine ($40\;{\mu}g$/kg, IM) was used in all dogs as a preanesthetic agent. Recording electrode for EEG was positioned at CZ. EEG, heart rate, systolic/diastolic blood pressure, $pCO_2$, $pO_2$ and blood pH were measured before anesthesia, after anesthesia and after every bleedings. Three bleedings were accomplished by drawing blood through the femoral artery catheter at a rate of 7 ml/kg (10% of total blood volume) for 10 minutes. In the course of hemorrhage, a systolic/diastolic pressure continuously decreased in all groups. The $pCO_2$ values and heart rates were increased in all groups. The $pO_2$ values were most significantly increased in group 1 compared with those in other groups. The pH values were not significantly changed. On statistical analysis of EEG, there was no significant changes in group 1 and 3. But in group 2, band 3, 4 and 7 were significantly altered after 2nd and 3rd bleeding. Power alterations of band 3, 4 and 7 were thought to be related with hemorrhage over 20% of total blood volume in group 2. In conclusion, the regulation of infusion rate would be considered when a dog, anesthetized with propofol, bleed over 20% of total blood volume.

• The Korean Journal of Nuclear Medicine
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• v.29 no.4
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• pp.504-510
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• 1995

Avascular necrosis(AVN) of bone can be resulted from various causes that distrub vascular supply to bone tissue, including steroid therapy after renal transplantation. In this study, we determine the prevalence of the avascular necrosis of bone after renal transplantation and compare the role of the bone scan, SPECT and MRI. In 301 patients with transplanted kidney, the prevalence of avascular necrosis was deter-mined clinically. Site of bone necrosis was evaluated by clinical symptom, bone scan, SPECT and MRI. Bone scan was done in all patients with AVN. Bone SPECT and MRI were done in six cases; and MRI was done in two cases. The prevalence of AVN was 3.3% (10/301), and the site of AVN was 16 femoral heads in 10 patients (bilateral: 60%) and bilateral calcaneal tuberosity in one patient. Bone scan showed typical AVN (cold area with surrounding hot uptake) in 13 lesions, only hot uptake in three lesions (including two calcaneal tuberosities), decreased uptake in one lesion, and normal in one lesion. Decreased uptake and normal lesion showed an equivacal cold area without surrounding hot uptake on SPECT. A symptomatic patient with positive bone SPECT showed normal finding on MRI. The prevalence of AVN of bone after renal transplantation was 3.3%, and whole body bone scan showed multiple bone involvement. Two symptomatic hip Joints without definite lesion on whole body bone scan or MRI showed cold defect on SPECT. Therefore, we conclude that bone SPECT should be perfomed in a symptomatic patient with negative bone scan or MRI in case with high risk of AVN after renal transplantation.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.4
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• pp.317-325
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• 2007

Purpose: Biological parameters can be quantified using dynamic PET data with compartment modeling and Nonlinear Least Square (NLS) estimation. However, the generation of parametric images using the NLS is not appropriate because of the initial value problem and excessive computation time. In irreversible model, Patlak graphical analysis (PGA) has been commonly used as an alternative to the NLS method. In PGA, however, the start time ($t^*$, time where linear phase starts) has to be determined. In this study, we suggest a new Multiple Linear Analysis for irreversible radiotracer (MLAIR) to estimate fluoride bone influx rate (Ki). Methods: $[^{18}F]Fluoride$ dynamic PET scans was acquired for 60 min in three normal mini-pigs. The plasma input curve was derived using blood sampling from the femoral artery. Tissue time-activity curves were measured by drawing region of interests (ROls) on the femur head, vertebra, and muscle. Parametric images of Ki were generated using MLAIR and PGA methods. Result: In ROI analysis, estimated Ki values using MLAIR and PGA method was slightly higher than those of NLS, but the results of MLAIR and PGA were equivalent. Patlak slopes (Ki) were changed with different $t^*$ in low uptake region. Compared with PGA, the quality of parametric image was considerably improved using new method. Conclusion: The results showed that the MLAIR was efficient and robust method for the generation of Ki parametric image from $[^{18}F]Fluoride$ PET. It will be also a good alternative to PGA for the radiotracers with irreversible three compartment model.