• Journal of the Korean Orthopaedic Association
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• v.55 no.2
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• pp.127-134
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• 2020

Purpose: The aims of this study were (1) to investigate the relationship between the characteristics of allogenic bone block and the compressive strength of an allogenic bone block measured by biomechanical experiments, and (2) to compare the maximum pressure load of allogenic bone block with the gap pressure measured at the high tibial opening osteotomy. Materials and Methods: Ten patients who provided informed consent for gap pressure measurements during opening wedge high tibial osteotomy (OWHTO) were included. The gap pressures were measured at 1 mm intervals while opening the osteotomy site from 8 mm to 14 mm. Seventeen U-shaped allogenous wedge bone blocks were made from the femur, tibia, and humerus. The height, width, cross-sectional area, and cortex thickness of the bone blocks were measured, along with the maximum compressive load just before breakage. The relationship between these characteristics and the maximum pressure load of the bone blocks was evaluated. The gap pressures measured in OWHTO were compared with the maximum pressure loads of the allogenous wedge bone blocks to evaluate the possibility of inserting allogenous wedge bone blocks into the osteotomy site without a distractor in OWHTO. Results: The OWHTO gap pressure increased with increasing osteotomy site opening. The mean gap pressure, which occurred at a 14-mm opening, was 282±93 N; the maximum pressure was 427 N. The maximum pressure load of the allografts was 13,379±6,469 N (minimum, 5,868; maximum, 29,130 N) and was correlated significantly with the cortical bone thickness (correlation coefficient=0.693, p=0.002) and cross-sectional area (correlation coefficient=0.826, p<0.001). Depending on the sterilization method, the maximum pressure loads for the bone blocks were 13,406±5,928 N for freeze-dried and 13,348±7,449 N for fresh frozen. The maximum compressive load of the allogenous wedge bone blocks was 13.7-times greater than that in OWHTO opened to 14 mm (5,868 N vs. 427 N). Conclusion: The compressive strength of allogenous wedge bone blocks was sufficiently greater than the gap pressure in OWHTO. Therefore, allogenous wedge bone blocks can be inserted safely into the osteotomy site without a distractor.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.195-199
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• 2002

This article is to report a new technique for reconstruction of the anteromedial and posterolateral bundles of anterior cruciate ligament by separate tensioning and fixation of the each bundle. Method : Tibial and femoral tunnels were made with conventional technique of anterior cruciate ligament reconstruction. Tibial tunnel was enlarged $5\~7$ mm in anterior-posterior direction to make oval it in cross section. When preparing the Achilles tendon allograft, bone plug portion was trimmed as the conventional technique. The tendinous portion was trimmed as two separate bundles by dividing the tendinous portion longitudinally, so the graft is shaped like 'Y'. The bone plug portion of allograft was inserted into the femoral tunnel and fixed with absorbable cross pins. Two ligamentous portionss of the distal part of the grafts were tensioned separately at the external orifice. Anteromedial bundle was fastened under maximum tension with the knee flexed 90 degrees by post-tie method. The posterolateral bundle was fixed by the same technique with the knee in full extension. Then, an absorbable interference screw was inserted between the two bundles upto the upper end of the tibial tunnel, to get more initial rigidity of the reconstructed graft as well as to locate the two bundles in more anatomic position.

• Journal of the Korean Arthroscopy Society
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• v.11 no.2
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• pp.111-116
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• 2007

Purpose: To assess the clinical results of ACL reconstruction with a fresh frozen Achilles allograft, retrospectively and the findings of the graft in second look arthroscopy. Materials and Methods: Twenty-eight ACL reconstructions using fresh frozen Achilles tendon allograft were included in this study between March 1999 and February 2003. The average age was 31.2 years old and the average follow-up was 16.6 months(range: 12-26 months). The clinical evaluation was done by KT-1000 arthrometer, Lysholm knee score, range of motion, Lachman and pivot-shift test. Results: In the last follow-up of Lachman test, 21 cases showed normal, 5 cases grade 1, 2 cases grade 2 and 1 case grade1. The results of pivot-shift test data, 23 cases(82.1%) were normal, 4 cases(14.3%) grade 1, 1 case(3.6%) grade 2. The mean maximum side-to-side difference was improved from 6.75mm preoperatively to 2.46mm in the last follow-up. Lysholm knee score was improved from 73.5 preoperatively to 91.6 in last follow-up. Re-rupture of the ACL graft was found in one case and one case of wound infection in the tibial incision was found. The 6 cases showed the good synovialization of the ACL graft. Conclusion: The anterior stability was restored with ACL reconstruction using fresh frozen Achilles allografts and the good synovialization was found in the second-look arthroscopy

• Journal of Chest Surgery
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• v.36 no.7
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• pp.504-509
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• 2003

Although arterial grafts are widely used due to the advantage of long-term patency in coronary bypass surgery, greater saphenous vein is still an important additional conduit. It was reported that preservation of the adventitia of vein graft and the adjacent tissues may bring the improved long-term graft patency. The aim of this study is to look for a harvest technique that can reduce vein injury and wound complications. Material and Method: In thirty-four patients that vein grafts were used for coronary bypass surgery, 50 harvest sites were included for the study. In 25 harvest sites in calf below knee (group 1), vein was exposed through a long incision and then clearly dissected from the adjacent tissue. Ten endoscopic vein harvests were performed in the thighs (group 2). Fifteen other vein grafts that were bluntly dissected were harvested from the thighs through three separate incisions (group 3). Result: Vein harvest time was longest in endoscopic harvest group (44.7$\pm$9.8 minutes) and shortest in group 3 (24.2$\pm$5.9 minutes) (p＝0.000). Most avulsion injuries of vein branches happened in the endoscopic group. Sequential grafting numbers per vein were 1.72$\pm$0.98 with thigh vein graft and 1.16$\pm$0.37 with calf vein (p＝0.02). Swelling of foot and/or leg, which was the most common wound complication after vein harvest, was most commonly presented in group 1 (20/25 sites; p＝0.000). Tingling, the most common neurologic complication, was also most prevalent in group 1 (7/25 sites; p＝0.013). The risk factor of the wound complication was vein harvest from calf, and the vein harvest technique was not a risk for wound complication. Conclusion: Vein harvest technique through three separate incisions from thigh presented shorter harvest time and less vein injury and wound complication compared with the endoscopic harvest technique from thigh or the harvest through a long incision from calf.

• Journal of the Korean Arthroscopy Society
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• v.14 no.1
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• pp.7-12
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• 2010

Purpose: To evaluate the effects of total or subtotal meniscectomy on anterior cruciate ligament reconstruction. Materials and Methods: We reviewed the 455 cases of arthroscopic ACLR (anterior cruciate ligament reconstruction) from February, 2003 to February, 2007 and followed-up more than 1 year. The 93 cases were enrolled. The 45 cases who underwent only ACLR were included and the 48 cases who underwent ACLR with total or subtotal meniscectomy were included in this study except grade 3 or 4 chondral lesion, partial meniscetomy or meniscal repair. We divided the patient into 4 groups which were isolated ACLR group (group I, 45cases), ACLR with lateral meniscectomy group (group II, 10cases), ACLR with medial meniscectomy group (group III, 28cases) and ACLR with both medial and lateral meniscectomy group (group IV, 10cases). The clinical evaluation was done by range of motion (ROM), IKDC subjective score, Lysholm score, anterior drawer test, Lachman test, Pivot shift test and KT-1000 arthrometer. Results: At final follow up, group IV was inferior than group I in IKDC subjective score and Lysholm score, and inferior than group II in IKDC subjective score. In KT-1000 arhtometric test, group I had better results than group III and group IV. Also in anterior drawer test and Lachman test, group 1 had better result than group III and group IV. In pivot shift test, there was no significant difference among four groups. Conclusion: Medial or both medial and lateral meniscectomy had greater laxity in anterior drawer test, Lachman test and KT-1000 arthrometric test and both medial and lateral meniscectomy had a lower subjective score than both meniscus intact group.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.1
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• pp.44-50
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• 2012

Purpose: The purpose of this study is to analyze the relationship between acute anterior cruciate ligament (ACL) injury and bone bruise using the survey for location and incidence of bone bruise. Materials and Methods: From Jan. 2006 to Feb. 2010, 87 knees from who had complaint a traumatic knee pain were diagnosed as acute ACL tear using MRI evaluation. Associated injury, location and incidence of bone bruise were analyzed using MRI. The location of bone bruise on the MRI was classified as medial, central and lateral area on anteroposterior and lateral view of femur and tibia. The bone bruise was classified with Costa Paz classification. Results: Bone bruise of injury during daily living activity were located at medial area on coronary view and anterior area on sagittal view of distal femur, at medial area on coronary view and anterior area on sagittal view of proximal tibia (p=0.024, p=0.021, p=0.025 and p=0.029, respectively). Bone bruise of injury during sports activity were located at lateral area on coronary view and central area on sagittal view of distal femur, at lateral area on coronary view and posterior area on sagittal view of proximal tibia (p=0.014, p=0.015, p=0.018 and p=0.017, respectively). Bone bruise patterns due to traffic accident were inconclusive (p=0.264, p=0.254, p=0.229 and p=0.267, respectively). Conclusion: Injury mechanism of acute ACL injury from activities of daily living or sports activities compared to that of traffic accident showed a more consistent bone bruise patterns. Special attention to acute ACL tear must be paid in case of bone bruise at lateral tibial plateau and lateral femoral condyle.

• The Journal of the Korean bone and joint tumor society
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• v.16 no.1
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• pp.1-7
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• 2010

Purpose: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. Materials and Methods: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. Results: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. Conclusion: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.

• Journal of the Korean Arthroscopy Society
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• v.7 no.2
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• pp.201-205
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• 2003

Purpose : Authors experienced cases of chronic ACL tear with spur-like lesion on the tibial condyle which is different from the lateral capsular sign and degenerative change and evaluated the significance of 'spur-like lesion' in relations with chronic ACL injury. Material and Method : We have 5 patients with spur-like lesion on the lateral tibial condyle in simple radiogram. The location, shape and size of the lesion were studied using radiogram and MRI. Cause of injury, associated injury and chronicity of the ACL tear were analyzed. All 5 patients were male, and mean age was 33.8 $(17\~46)$ years. Result : The spur-like lesion was located from 3.8 mm(avg.) below the articular surface of the lateral tibial condyle to the apex of the fibular head and protruded laterally or inferolaterally from just posterior to the Gerdy's tubercle with a round or sharp-end triangular shape. Average length was 6 mm and average width ortho base was 9.2 mm. The cause of injury were sports jnjury 4 cases and traffic accident in one. The chronicity of the ACL tear was average 10.7(8 months$\~$23 years) years and medial meniscus tear was shown in all cases and lateral meniscus tear in three. Conclusion : We suggest that a patient who has a history of trauma with spur-like lesion on the lateral tibial condyle of the knee is expected to have chronic ACL tear.

• 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 Korean Orthopaedic Sports Medicine
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• v.1 no.2
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• pp.131-137
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• 2002

Purpose: To evaluate and compare the functional results, activity status, and anterior stability between conservative group with partial ACL injury and reconstruction group with bone-patellar ten-don-bone autograft in ACL total rupture. Materials and Methods: Thirty-eight patients with ACL injury were diagnosed and treated with arthroscopy and followed for more than two years. The number of patients with partial injury was 12(mean age; 38.3) and reconstruction group was 26 (mean age; 25.3). Objective stability was estimated under anterior loading of 15 lb and 20 lb by KT-2000 Arthrometer (MED metric, USA). Functional evaluation using Lysholm score and Tegner activity score were performed. Results: Average functional score of Lysholm was 88.5 in partial injury group and 89.3 in reconstruction group. Average score of Tegner was 5.3 in partial injury group and 5.1 in reconstruction group(P<0.05).Average anterior displacement compared with normal side. Under loading of 20lb, 1.7$\pm$4.3 mm in partial injury group, 2.3$\pm$1.9 mm in reconstruction group were anterior displaced (P<0.05). Under loading of 15lb, 1.2$\pm$1.0 mm in partial injury group, 1.4$\pm$1.5 mm in reconstruction group were dis-placed (P<0.05). There were giving way, effusion, instability and anterior knee pain in complication. Giving way was the frequent complication in the partial injury group. Conclusions: Clinical results of both group were similar. Functional evaluation of Lysholm was good and status of Tegner activity was maintained to physical fitness activites (jogging, regular bik-ing) in both groups on average. The results of conservative treatment for the partial ACL injury (less than 50$\%$) was satisfactory and equivalent to that of reconstructive treatment for the total ACL injury.