• Journal of the Korean Arthroscopy Society
• /
• v.12 no.2
• /
• pp.112-117
• /
• 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.

• The Journal of the Korean bone and joint tumor society
• /
• v.7 no.4
• /
• pp.139-143
• /
• 2001

Purpose : Limb salvage for osteosarcoma of proximal tibia is challenging problem due to difficulties in mobilizing or retracting the main neurovascular structure, inadequate soft tissue coverage, and unsolved problem of patellar tendon reattachment to endoprosthesis. The authors analyzed the functional result of limb salvage using tumor prosthesis with medial gastrocnemius rotation plasty for osteosarcama of the proximal tibia. Materials and Methods : Eleven patients with histologically proven osteosarcoma of the proximal tibia, treated with adjuvant and neoadjuvant chemotherapy and limb salvage operation with tumor prosthesis between January 1992 and December 1998 at our Medical Center, were selected. There were 6 male and 5 female. Age ranged from 15 years to 23.7 years with an average of 23.7 years. Follow-up period ranged from 1 year to 4.5 years with an average of 2.5 years. The final functional result was evaluated using the method by ISOLS, 1993. The factors include pain, functional activities, emotional acceptance, use of external supports, walking ability and gait. Each of the factors has been scored from 0 to 5 depending on the appropriate description or data. The rating score is determined by dividing the individual factor scores into the total score and indicates percentage of normal function. Results : The overall functional result ranged from 53,3% to 86.7% with an average of 68.3% of normal function. In details, the averages were 82.5% for pain, 62.5% for functional activities, 67.5% for emotional acceptance, 77.5% for use of external supports, 62.5% for walking ability, and 57.5% for gait. The average range of motion of the knee joint was $5^{\circ}$ extension and $85^{\circ}$ flexion. Five patients have extension lag ranged from $5^{\circ}$ to $15^{\circ}$ with an average of $10^{\circ}$. Two patients suffered postoperative infection. One was treated with antibiotics injection only, but the other needed removal of the prosthesis and knee fusion. Both of them showed unsatisfactory result. C o n c l u s i o n : The overall functional result after limb salvage using tumor prosthesis with medial gastrocnemius rotational flap for osteosarcoma of the proximal tibia was relatively satisfactory in case of no postoperative infection. The patients were less satisfactory in functional activities, emotional acceptance and gait than pain, use of external supports due to limitation of motion and extension lag. More aggressive postoperative physical therapy and protection with brace for 6~9 months as well as surgical technique is mandatory for more satisfactory result.

• Journal of the Korean Arthroscopy Society
• /
• v.9 no.2
• /
• pp.143-147
• /
• 2005

Purpose: In case of anterior cruciate ligament (ACL) reconstruction, graft tendon is generally fixed in tibial tunnel with knee extended. When reconstructing ACL using hamstring tendon, the authors aim to find out the effect of knee joint position during graft fixation on postoperative knee joint stability and range of motion. Materials and Methods: Prospective study was done on patients who have undergone ACL reconstruction using hamstring tendon from May 2002 to January 2003 We used Rigifix system (Mitek Product, Johnson and Johnson, USA) and Intrafix system for fixation. Thirty nine patients received ACL reconstruction during this period. Excluding 2 patients lost in the follow-up, 37 patients were analyzed. The mean follow-up period was 14 months $(13{\sim}25months)$. Knee position was decided alternatively without any bias. Clinical evaluation was based on Lachman test, pivot shift test, Lysholm score, IKDC(international knee documentation committee) assessment and side to side KT-1000 maximal manual arthrometer difference. Results: After the last follow-up, average postoperative Lysholm score was 93.1 poins(65-98points). According to IKDC score, 26 cases were normal, 10 cases were nearly normal, 1 case was abnormal and we had no case of severe abnormality. The mean difference from the normal side was 2.5 mm under maximal manual loading KT-1000 arthrometer. According to postoperative Lachman test, 32 cases were normal,2 cases were grade I and 1 case was grade II. There were 34 cases of normal, 2 cases of grade I and 1 case of grade II. When using maximal manual KT-1000 arthrometer side to side difference, the difference from the normal side while fixing the tibia at 20'knee flexion was 2.3 mm and at full extention the difference was 2.7 mm. The range of motion at postoperative 1 year showed 5 degree flexion contracture in 1 case at 20 degrees knee flexion and 10 degrees of flexion limitation was observed in 2 cases at full extension. Conclusion: When ACL reconstruction using autogenous hamstring tendon, anterior laxity showed no difference in its stability between two groups. Tibial side fixation at full extension may be helpful in preventing flexion contracture due to overconstrained graft tendon.

• Progress in Medical Physics
• /
• v.10 no.2
• /
• pp.63-71
• /
• 1999

For the purpose of utilization in 3-D conformal radiotherapy and whole body radiosurgery, the Whole Body 3-Dimensional Topographic Radiation Therapy System has been developed. Whole body frame was constructed in order to be installed on the couch. Radiopaque catheters were engraved on it for the dedicated coordinate system and a MeV-Green immobilizer was used for the patient setup by the help of side panels and plastic rods. By designing and constructing the whole body frame in this way, geometrical limitation to the gantry rotation in 3-D conformal radiotherapy could be minimized and problem which radiation transmission may be altered in particular incident angles was solved. By analyzing CT images containing information of patient setup with respect to the whole body frame, localization and coordination of the target is performed so that patient setup error may be eliminated between simulation and treatment. For the verification of setup, the change of patient positioning is detected and adjusted in order to minimize the setup error by means of comparison of the body outlines using 3 CCTV cameras. To enhance efficiency of treatment procedure, this work can be done in real time by watching the change of patient setup through the monitor. The method of image subtraction in IDL (Interactive Data Language) was used to visualize the change of patient setup. Rotating X-ray system was constructed for detecting target movement due to internal organ motion. Landmark screws were implanted either on the bones around target or inside target, and variation of target location with respect to markers may be visualized in order to minimize internal setup error through the anterior and the lateral image information taken from rotating X-ray system. For CT simulation, simulation software was developed using IDL on GUI(Graphic User Interface) basis for PC and includes functions of graphic handling, editing and data acquisition of images of internal organs as well as target for the preparation of treatment planning.

• Radiation Oncology Journal
• /
• v.25 no.4
• /
• pp.206-212
• /
• 2007

Purpose: Heterotopic ossification is a well-known postoperative and post-traumatic complication of the elbow. We reviewed the treatment outcome for the use of low-dose radiation after surgical intervention of the elbow to prevent recurrence of heterotopic ossification (HO). Materials and Methods: Forty-five patients with HO underwent surgical intervention and postoperative radiotherapy of the elbow. The median age of the patients was 29 years ($16{\sim}75$ years), and 27 of the patients were men and 18 were women. The occurrence of HO was mainly due to surgery after fracture (24/45) and traumatic injury (21/45). Limitation of the range of motion (ROM) was the most common symptom of the patients. Thirty-four patients received postoperative radiotherapy with a dose of 8 Gy in 2 fractions; 5 patients received a dose of 10 Gy in 5 fractions and 6 patients received a dose of 7 Gy in 1 fraction. Postoperative radiotherapy was given on the first two postoperative days for most of the patients. Sixteen patients were not given anti-inflammatory medication and 29 patients were given NSAIDs for $1{\sim}8$ months. Results: After a median follow-up period of 18 months (range $6{\sim}72$ months), 41 patients showed clinical improvement and two patients did not show improvement. Assessment of the ROM showed a mean improvement from $0{\sim}135^{\circ}$ to $60{\sim}145^{\circ}$ (p=0.028), and assessment of the functional outcome according to MEPI was from ($15{\sim}95$) to ($80{\sim}100$) (p<0.0001). Two of the 34 patients that were followed-up with radiography had mild radiological recurrence of heterotopic ossification. No complications were observed after the radiotherapy. Conclusion: These results suggested that low-dose radiation administered after surgical intervention is safe and effective to prevent the recurrence of HO in the elbow.

• Journal of Chest Surgery
• /
• v.35 no.1
• /
• pp.27-35
• /
• 2002

Background: A perioperative myocardial infarction(PMI) is one of the major complications after CABG. Among diagnostic methods of PMI, CK-MB activity assays have been increasingly replaced by CK-MB mass assays, which have more sensitive, simple measurement. Also, new cardiac-specific and -sensitive marker, cardiac troponin I(cTnl), has been shown to be a marker of myocardial infarction. We report our evaluation of clinical significance of CK-MB mass and cTnl as a marker of PMI after CABG. Material and Method: We studied 32 patients who underwent CABG at Kangdong Sacred Hospital between April 2000 and April 2001. Postoperative serum CK-MB activity level, serum CK-MB mass, cTnl, electrocardiogram, echocardiogram, and clinical data were recorded prospectively The diagnosis of PMI was defined as positive 2 among 3 or all of the following , by a new Q wave on the electrocardiogram, by serum CK-MB activity higher than 200 lU/L within 72 hours after operation, and by new regional wall motion abnormality on the echocardiogram. Result: After CABG, 3 patients had sustained a PMI according to current diagnostic criteria. As serum CK-MB activity time course, a level of CK-MB activity 12 hours after CABG had very linear correlated significance with serum CK-MB mass 24hours(R=0.946) and cTnl 48 hours(R=0.933) after CABG(p=0.000). As we used a receiver operating characteristics curve(ROC curve) for a diagnostic cutoff value in patients with PMI, serum CK-MB mass levels higher than 30.05 ug/L 24 hours after CABG detected the presence of PMI with an area under the ROC curve of 1.0, a sensitivity of 100%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 100%. Also serum cTnl levels higher than 17.15 ug/L 48 hours after CABG detected the presence of PMI with an area under the ROC curve of 0.98, a sensitivity of 100%, a specificity of 96.6%, a positive preclictive value of 75%, and a negative predictive value of 100% Conclusion: We concluded that both the measurement of CK-MB mass and cTnl are the easier, accurate methods as a diagnostic marker of PMT after CABG, also as a proposal of diagnostic cutoff value enables to an early detection of PMI. However, a 1arger number of patient will be needed because of statistic limitation that a small number of participating patients, a small number of PMI.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.2 no.2
• /
• pp.85-89
• /
• 2009

Purpose: To analyze the clinical outcome after ultrasound guided multiple dry needlings and local steroid injection for acute calcific tendinitis of shoulder. Materials and Methods: Twenty patients with acute episode of pain by calcific tendinitis of shoulder with average age 58.2 (50~70 years) and follow-up of 18 months in average (range, 12~24) were included in study. There were 18 patients with right and 2 with left sided involvement. All patients had calcific deposits in the supraspinatus tendon. All patients underwent standardized nonoperative treatment protocol, consisting of 5~12 MHz high resolution ultrasound guided multiple dry needlings with 18 guage needle, followed by 2% lidocaine 1cc and 40 mg/ml depomedrol 1cc injection at site of calcific tendinitis. The outcome was assessed by UCLA shoulder score, range of motion and VAS score. A statistical analysis with ANOVA and Tukey's post-hoc test with the significance level at 5% was performed using SAS 9.1 software (SAS Institute, Cary, NC). Results: All patients got continuous relief of pain right after the procedures until final follow-up. Before the procedures, the UCLA scores were fair in 15 patients and poor in 5. After the procedures, the UCLA scores were excellent in 16 patients and good in 4. All cases revealed no limitation of shoulder function. The average VAS score decreased from 8.9 before the procedures to 0.5 at final follow-up (p<0.0001). No complication was encountered. Conclusion: An ultrasound guided local steroid injections following multiple dry needlings would be one of the useful treatment modality for the acute calcific tendinitis of shoulder.

• Journal of Oral Medicine and Pain
• /
• v.38 no.4
• /
• pp.357-366
• /
• 2013

This study is designed to evaluate the treatment outcome of occlusal stabilizing splint and to assess follow-up study of condylar bony changes using cone beam computed tomography(CBCT) in adolescents patients (12-19 years) with TMJ osteoarthritis(OA). 167 eroded condyles in 149 subjects were chosen among the patients who presented to the Department of Oral Medicine of Pasan National University Hospital, diagnosed as TMJ osteoarthritis by clinical exam, x-ray and CBCT from 2009 to 2012. They were treated conservatively with physical therapy, medication, behavioral therapy and occlusal stabilizing splint therapy. After average 9 months, CBCT was retaken and subjective symptoms and clinical findings were investigated. Condyle bony changes were classified by unchanged, less severe and more severe. The obtained results were as follow: 1. Pain, Noise, LOM(Limitation of motion) and MCO(Maximum comfortable opening) measurement of TMJ OA patients were markedly improved after conservative treatment. 2. In the occlusal stabilizing splint therapy group, Pain and LOM were statistically significant improved than non-occlusal stabilizing splint therapy group. 3. In the acute occlusal stabilizing splint therapy group, Pain and LOM were remarkably improved. 4. In comparison of CBCT1 and CBCT2 images, the transition of bone changes to lesser severe was most commonly in joint with erosive change. 5. In the non-occlusal stabilizing splint therapy group, the transition of condylar bone changes from erosion to more severe was many than occlusal stabilizing splint therapy group.

• Journal of the Korean Arthroscopy Society
• /
• v.13 no.2
• /
• pp.155-160
• /
• 2009

Purpose: The purpose of this study was to evaluate the pain recovery pattern according to the integrity and to analyze the factors affecting the progress and level of pain postoperatively. Materials and Methods: We examined 153 patients, who were treated with arthroscopic rotator cuff repair. 101 rotator cuff tears were full-thickness tear and 52 were partial tear. The mean follow up duration was 20 months (12~30 months). We evaluated the visual analogue scale, range of motion, ASES (American Shoulder and Elbow Surgeons), and UCLA (University of California at Los Angeles) scores preoperatively and postoperatively. We analyzed the pain recovery pattern between partial and full thickness tear using Student T-test and the factors affecting the progress and level of postoperative pain using multiple regression analysis. Results: The change patterns of visual analogue scale after arthroscpoic repair were similar regardless of the tear integrity. The VAS showed a continuous decreasing pattern, but increased at first 3 weeks postoperatively and at 7 weeks postoperatively, and then, decreased thereafter. The average VAS was ${\leqq}2$ points by postoperative 3 months. The factor affecting the pain score at 3 months was related to the preoperative limitation in forward flexion ($r^2=0.377$, p=0.021). Conclusion: There was no differences of the pain recovery pattern according to the integrity, and the factor affecting the progress of postoperative pain was preoperative angle of forward elevation. So, the appropriate preoperative rehabilitation protocol that can improve motions of the shoulder joint would help to improve the level of postoperative pain and functional recovery.

• Journal of the Korean Arthroscopy Society
• /
• v.4 no.1
• /
• pp.61-66
• /
• 2000

Purpose : The diagnosis of the causes of residual pain after ankle fractures and the treatment is not simple. The authors analyzed the clinical results of the patients with residual pain after ankle fracture fur whom ankle arthroscopy was undertaken, for the purpose of evaluating the efficacy of arthroscopic diagnosis and treatment. Materials and Methods : From January 1997 to June 1998, ankle arthroscopy was done for the seventeen patients suffering from residual ankle pain and limitation of motion after ankle fracture. Their symptoms were not improved despite conservative treatment. There were sixteen men and one woman, and their mean age was 37.4 years. Result : Radiological examination revealed loose bodies in two patients, and osteophytes at the anterior rim of the tibia in fourteen patients. By the classification of osteoarthritic change, three ankles were assigned to grade 0, eight to grade I, six to grade II, and none to grade III. On arthroscopic examination, soft tissue impingement was found In thirteen cases, loose bodies in five cases, and osteochondral lesions in four cases. For arthroscopic treatments, removal of soft tissue, abrasion of osteophytes, cartilage shaving and removal of loose bodies were done. Clinical results were evaluated using Evanski and Waugh score. Preoperative overall score of 58.7 points jumped to 74.6 points after the operation, and in fourteen patients$(82\%)$ the symptoms were improved. Conclusion : Ankle arthroscopy is considered to be a very useful diagnostic and treatment method fer the patients with residual complaints after ankle fracture.