• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.187-191
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• 2006

Few cases have been reported in which the femoral interference screw has migrated into the posterior compartment after an ACL reconstruction. It usually requires removal, because it leads usually to mechanical symptom. However, the arthroscopic removal of a screw is a technically demanding procedure, especially in the case of an intact integrated ACL graft or one that is encapsulated around the screw. We present a case in which a displaced femoral interference screw migrated within the posterior compartment 11 years postoperatively, after the graft had been successfully incorporated at the femoral site and showed good continuity on MRI and arthroscopic examination. Although it is often technically challenging, through the use of a posterior trans-septal portal, we can successfully remove a displaced femoral interference screw even in the most difficult locations in the posterior compartment without damage to ACL graft.

• Journal of the Korean Arthroscopy Society
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• v.2 no.1
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• pp.80-84
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• 1998

The isometric position for the graft is important in the anterior cruciate ligament reconstruction surgery. It is well known that the femoral position is more critical than tibial side. But, there is few deciding method of proper graft position after the anterior cruciate ligament reconstruction surgery. So we planned to evaluate the ideal femoral isometric position with 6 adult cadavaric femurs and exact radiographs. After the insertion of femoral interference screw on ideal isometric position, we obtained roentgenograms of true lateral view and 10, 20, 30, 45 degree internal and external rotation views. Then we measured the shortest distance from the posterior cortical margin of lateral femoral condyle to posterior border of interference screw on the radiographs. We also measured true distance between posterior cortical margin of lateral femoral condyle to the posterior margin of femoral tunnel after cutting of distal femur. Based on this study, we could not determine the permissible rotation degree of radiographs. But we concluded that if the distance between posterior cortical margin of lateral femoral condyle and posterior border of interference screw ranges 4.5-6.5mm on the lateral view, the femoral position is considered as a relatively ideal isometric good position.

• Journal of the Korean Arthroscopy Society
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• v.2 no.1
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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 the Korean Arthroscopy Society
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• v.6 no.1
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• pp.60-63
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• 2002

Purpose : The purpose of this study was to introduce new femoral fixation technique using a cross-pin and a bioabsorbable interference screw in hamstring ACL reconstruction. Method : Semitendinosus and gracilis were harvested for quadrapled graft. After tibial tunnel had been made, femoral tunnel was made 35 mm in depth. Then the graft passed through the tunnels. Cross-pin was fixed through the drill hole which had been made through upper sleeve of the Rigidfix system. While pulling the graft, bioabsorbable interference screw was fixed through the anteromedial portal. Conclusion : We introduced the new femoral fixation technique using a cross-pin and a bioabsorbable interference screw as a good method with high fixation strength and tight graft-bone contact.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.87-90
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• 2006

The complication caused by a bioabsorbable interference screw is rare after anterior cruciate ligament reconstruction. We report a case of delayed inflammatory reaction at the tibial tunnel and femoral tunnel where the graft tendon had been fixed with a bioabsorbable interference screw ($Bioscrew^{(R)}$) for anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.109-114
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• 2005

Recently, the interest on anatomical ACL reconstruction with double bundle technique is increased to reproduce the original load distribution, and kinematics of the knee. We developed an arthroscopic double bundle ACL reconstruction technique using autogenous quadriceps tendon with 2 splitted graft and patellar bone plug. The anteromedial bundle and posteolateral bundle of the ACL is replicated with each splitted graft of quadriceps tendon and fixed with biodegradable interference screw on the 2 femoral tunnels. The patellar bone plug of quadriceps tendon is fixed with biodegradable interference screw within the 1 tibial tunnel. We suggest that our technique using quadriceps tendon may be an alternative in arthroscopic double bundle ACL reconstruction.

• Journal of the Korean Arthroscopy Society
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• v.12 no.2
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• pp.118-124
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• 2008

Purpose: Recent development and advances in the arthroscopic surgical techniques for anterior cruciate ligament(ACL) reconstruction have led to the ideal location for more oblique anatomic point of the femur from 10 to 10:30 o'clock(in the right knee) and from 2 to 1:30 o'clock(in the left knee) in the frontal plane. This study was performed to compare the operative methods and the radiologic results of the femoral tunnels made through the tibial tunnel(trans-tibial approach) and the anteromedial portal. Materials and Methods: From January 2003 to May 2004, on hundred reconstructions of ACL were performed. Group I(the femoral tunnel made through the tibial tunnel) consisted of 50 cases and group I(the femoral tunnel made through the anteromedial portal) consisted of 50 cases. The operative methods and the radiographic results of the femoral tunnels were compared. Results: Femoral tunnel was made more easily at more oblique anatomic point in group II than in group I. In group II, better visual field was achieved at the angle of 100? flexion of the knee joint, the risks of the posterior cortical breakage and the tunnel-graft mismatching were reduced more, and the divergence of femoral interference screw from the radiograph decreased more than in group I(p<0.05). The angle between the femoral tunnel and the longitudinal axis of ACL increased in group II. Conclusion: Anteromedial portal technique was useful for femoral tunneling toward 10 to 10:30 o'clock(in the right knee) and 2 to 1:30 o'clock(in the left knee) in ACL reconstruction. Level of Evidence:Level III, case-control study.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.81-85
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• 1997

This article describes a modified arthroscopic technique of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendon graft. The autogenous semitendinosus and gracilis grafts are harvested without detachment of the tibial insertion. To obtain longer graft, the accessory tibial insertions of the hamstring tendons are dissected. The EndoButton(Acupex Microsurgical, Andover, MA) is used for femoral fixation and two spiked staples are used for tibial fixation in a belt buckle fashion. Then the residual anterior laxity is restored by additional absorbable interference screw fixations. In this technique. more viable graft is obtained and firmer distal fixation is achieved by preservation of the tibial insertion of hamstring tendons.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.21-25
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• 2002

Purpose: To evaluate the clinical results after anterior cruciate ligament (ACL) reconstruction with hamstring tendon and Ligament Anchor (LA) screw, which is newly designed for fixation of graft into femur. Materials and Methods: Fifty eight patients who were followed up at least more than 2 years after ACL reconstruction with four strands of Hamstring tendon and LA screw were included in this study. The graft was fixed with LA screw at femoral tunnel and with only bioabsorbable interference screw at tibial tunnel. The mean follow-up period was 28 months. The clinical results were evaluated by physical examination and Lysholm knee score. Widening of bony tunnel and anterior laxity difference compared with normal side by instrumented anterior laxity test with Telos(R) (Telos stress device; Austin & Associates, Inc., Polston, US) were evaluated. Results: The Lysholm knee score improved from 60.0 points preoperatively to 94.0 points at last follow up. On the Lachman test, there were mild (+) instability in 16 cases, moderate (++) in 24,severe (+++) in 18 preoperatively. 50 cases were converted to negative and 8 to mild instability at postoperative follow up. On instrumented anterior laxity test with Telos(R), difference between normal and affected knee on 20 lb was 12.9 mm in average preoperatively, and was decreased to 3.1mm at last follow-up. The femoral tunnel was widened from 10.6 mm postoperatively to 12.7 mm (21.1$\%$) at follow up on antero-posterior plane and from 10.7 mm to 12.4 mm (16.5$\%$) on lateral plane. Tibial tunnels was also widened from 9.8mm to 11.8mm (20.7$\%$) on antero-posterior plane and from 9.9mm to 11.7 mm ($18.9\%$) on lateral plane. Complications were: anterior knee crepitus in 17 case, quadriceps muscle atrophy(>3 cm) in 6, penetration of screw over the lateral femoral cortex in 5, saphenous nerve paresthesia in 2.Conclusions: ACL reconstruction with hamstring tendon and LA screw was one of the choice of grafts and fixation devices in restoring knee stability and in improving clinical results with little complications such as excessive widening of bony tunnel and anterior knee pain

• 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.