• Title/Summary/Keyword: Joint instability

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Complications of PCL Reconstruction using Tibial Inlay Technique (경골 Inlay 방법을 이용한 후방 십자 인대 재건술의 합병증)

  • Kim Myung-Ho;Park Hee-Gon;Yoo Moon-Jib;Byun Woo-Sup;Shim Shang-Ho
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.3 no.2
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    • pp.128-133
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    • 2004
  • Purpose: This study was planned to evaluate complications? of posterior cruciate ligament (PCL) reconstruction with tibial inlay technique using autogenous bone-patellar tendon-bone graft. Materials and Methods: From September 1994 to January 2004, we analyzed surgical complications in fifty-seven patients with fifty-eight cases who underwent PCL reconstruction. Fifty of them were male and seven female. The mean age of the patients was 35(15$\~$73). Twenty eight cases of injury were isolated PCL, while thirty cases had associated injury of knee. The causes of injury were thirty-nine cases of traffic accident, seven sport injuries, seven fall down injuries, and five of others. The follow-up study was done at 4 weeks, 3 months,6 months and 1 year after surgery. KT-2000 arthrometer and posterior stress X-ray were used to examine the stability of the knee joint and the Lysholm Knee Score and a variety of clinical complications were evaluated. Results: Although the mean score of the preoperative Lysholm Knee Score was 43.2, the postoperative score was increased to 87.9. The preoperative mean value of knee stability using KT-2000 arthrometer was 8.75 mm(6.2$\~$14.3 mm) but the postoperative mean was 3.41 mm(2.1$\~$10.6 mm). The intraoperative complications were: one case of popliteal artery injury with compartment syndrome, one case of patellar fracture, two cases of 20$^{\circ}$ flexion loss, and two cases of anterior cortical penetration of the screw through proximal tibia during screw fixation. The postoperative complications were: eleven cases of knee instability, one case of patellar fracture, five cases of extension loss, thirteen cases of flexion loss, twenty-one cases of around knee pain and eight cases of kneeling pain. Conclusion: After PCL reconstruction with tibial inlay technique using autogenous bone-patella tendon-bone graft, complications were observed in this study. Careful attention during and after the operation, as well as rehabilitation must be required.

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Anterolateral Ligament of the Knee: Anatomy, Biomechanics, Techniques, and Clinical Outcome (슬관절 전외측인대의 해부학, 생역학, 수술법 및 임상적 결과)

  • Kim, Seong Hwan;Lee, Tae-Hyub;Park, Yong-Beom
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.4
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    • pp.281-293
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    • 2020
  • An anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgical procedures in the knee joint, but despite the better understanding of anatomy and biomechanics, surgical reconstruction procedures still fail to restore rotational stability in 7%-16% of patients. Hence, many studies have attempted to identify the factors for rotational laxity, including the anterolateral ligament (ALL), but still showed controversies. Descriptions of the ALL anatomy are also confused by overlapping nomenclature, but it is usually known as a distinctive fiber running in an anteroinferior and oblique direction from the lateral epicondyle of the femur to the proximal anterolateral tibia, between the fibular head and Gerdy's tubercle. The importance of the ALL as a secondary restraint in the knee has been emphasized for successful ACL reconstructions that can restore rotational stability, but there is still some controversy. Some studies reported that the ALL could be a restraint to the tibial rotation, but not to anterior tibial translation. On the other hand, some studies reported that the role of ALL in rotational stability would be limited as a secondary structure because it bears loads only beyond normal biomechanical motion. The diagnosis of an ALL injury can be performed by a physical examination, radiology examination, and magnetic resonance imaging, but it should be assessed using a multimodal approach. Recently, ALL was considered one of the anterolateral complex structures, as well as the Kaplan fiber in the iliotibial band. Many studies have introduced many indications and treatment options, but there is still some debate. The treatment methods are introduced mainly as ALL reconstructions or lateral extra-articular tenodesis, which can achieve additional benefit to the knee stability. Further studies will be needed on the indications and proper surgical methods of ALL treatment.

Monitoring and Preventive Preservation of Cultural Heritages to Maintain Original Wooden Architectural Cultural Heritage (목조건축문화재 원형유지를 위한 문화재돌봄 모니터링과 예방보존)

  • CHUN Kyoungmee
    • Korean Journal of Heritage: History & Science
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    • v.56 no.4
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    • pp.192-214
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    • 2023
  • Wooden architectural cultural heritages are one of the visible legacies that show the national's identity. Even when the concept of 'the original' of cultural heritages was not accurately understood, the emphasis of preservation and management of cultural heritages was placed on 'preservation of the original form' or 'maintenance of the original form'. Moreover, these days, following the trend of international preservation principles, cultural heritages are considered important as "values as historical objects." This paper is the result of an attempt to determine the scope and content of what parts should be monitored to maintain the original form of wooden architectural cultural heritage. The first thing to be done in monitoring wooden architectural cultural heritage is to check the condition of the ground and foundation. The second is the column. This is because the instability of the column causes damage to the joint with each member and the fitting part, resulting in physical changes leading to damage to the wall. The third is monitor the roof tiles. If the leak continues into the building due to the separation or damage of the roof, the defect should be partially dismantled and repaired, so it should be monitored to maintain its original shape as much as possible. The monitoring range of the base, column, and roof serves as a reference point for identifying what damage is being done to the relevant cultural heritages. In other words, the data at the time when monitoring began becomes the 'original' for the year. Alternatives based on the analysis of monitoring for the preservation of original cultural heritages should be actively introduced. In addition, by sharing the current state and situation of cultural heritages as a result of monitoring with various related organizations, preventive preservation should be established rather than preservation of cultural heritages by "intervention."

The Outcome of Anterior Cruciate Ligament Reconstruction in Patients with Meniscal Injury (반월판 연골 손상이 동반된 환자에서 전방 십자 인대 재건술의 임상적 결과)

  • Lee Kwang Won;Park Jae Guk;Jung Yu Hun;Kim Byung Sung;Kim Ha Yong;Choy Won Sik
    • Journal of the Korean Arthroscopy Society
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    • v.7 no.2
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    • pp.160-168
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    • 2003
  • Purpose : To analyze the anterior stability and functional results after the arthroscopic ACL reconstruction and meniscectomy based on meniscus status at the time of surgery. Materials and Methods : From October 1997 to October 2002, 78 patients (male 64 female 14) were treated by arthroscopic ACL reconstruction and meniscectomy and followed more than 12 months (range, $12\~72$ months, average: 32 months). Average age was 32 years old (range, $18\~57$ years old). We divided the patients into 4 groups; Both menisci was intact (BMI, control group), lateral meniscus removed (LMR), medial meniscus removed (MMR) and both menisci removed (BMR). Anterior passive displacement (objective stability) was estimated using KT-2000 arthrometer under the loading of 15lb,20lb and 30lb and evaluated anterior drawer test, Lachman test, range of motion, thigh circumference. Functional evaluation system of IKDC, OAK and Lysholm knee score was used. Results : Average anterior displacement under the loading of 30lb were 2.47 mm, 2.96 mm, 2.96 mm and 3.57 mm in each group(BMI, LMR, MMR, BMR) and it was statistically significant difference (p<0.05). There is no statistically significant difference in average anterior displacement under the loading of 15lb and 20lb in each group but it has showed decreasing tendency in meniscal removed groups. The mean anterior displacement was within 3 mm in 21 cases, 15 cases, 24 cases and 12 cases (total 72 cases, $94\%$) under the loading of 15lb and 20 cases, 15 cases, 24 cases and 11 cases (total 70 cases, $91\%$) under the loading 20lb of in each group and postoperative knee joint stability has showed increasing tendency (p>0.05). The mean score was 94.5, 93.2, 92.2 and 90.4 points in each group and 71 cases $(91\%)$ were more than excellent or good with a OAK score and fair results were noted 4 cases in both meniscal removed group. There were 65 cases $(83\%)$ with a Lysholm knee score more than excellent or good, and IKDC grading were more than normal or nearly normal in 74 cases $(95\%)$ except 4 cases (2 cases in MMR group and 2 cases in BMR group). Conclusion : Long-term anterior stability and functional results of a successful ACL reconstruction affected by tile status of the menisci at the time of surgery and KT-2000 arthrometer was good for estimation of objective follow up.

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