• Journal of the Korean Orthopaedic Association
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• v.52 no.1
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• pp.59-64
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• 2017

Purpose: To analyze the result of a repeat discectomy for ipsilateral recurrent lumbar disc herniation and to investigate the potential factors that influenced the outcomes for this surgery. Materials and Methods: Fifty-nine patients, who underwent reoperation after lumbar discectomy with a minimum follow-up period of 2 years, were reviewed. The surgical outcome was assessed using the visual analogue scale (VAS) and Macnab classification, and the recovery rate was calculated in accordance with VAS. A statistical analysis was carried out by SPSS to evaluate the possible factors that may have influenced the outcomes of the reoperation. Results: The rate of reoperation after lumbar disc surgery due to the recurrent disc herniation was 6.0% (59/983 cases). The average recovery rate of VAS from the 1st operation was approximately 77%, and from the 2nd operation was 71%. According to the Macnab criteria, the results were "excellent" or "good" in 96% of cases. Statistical analysis revealed that there was no difference of the average recovery rate (p<0.05). There is no additional instability after repeat discectomy. Factors, such as smoking, precipitating traumatic events, and diabetes mellitus did not have much influence on the average recovery rate after repeat discectomy for ipsilateral recurrent lumbar disc herniation. Conclusion: The outcomes of repeat discectomy were satisfactory. Moreover, factors, smoking, trauma history and diabetic mellitus, only had a minor impact on the outcomes of a repeat discectomy.

• 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.11 no.2
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• pp.92-98
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• 2007

Purposes: The purpose of this study was to report surgical technique of double bundle anterior cruciate ligament(ACL) reconstruction and to compare the short-term clinical results between arthroscopic single-bundle and double-bundle ACL reconstruction. Materials and Methods: From May 2005 to May 2006, ninety-eight patients were underwent ACL reconstruction. We designed prospective study with sixty-one patients who were revealed isolated ACL injury. We serially checked clinical and radiologic data preoperatively and postoperatively. We compared single-bundle with double-bundle ACL reconstruction patients with preoperative datas and postoperatively 1-year data. There were 30 single bundle reconstruction and 31 double bundle reconstruction. Stability was assessed objectively by anterior stress radiographs with the $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer. The clinical results were assessed by IKDC(International Knee Documentation Committee) and OAK(Orthopadische Arbeitsgruppe Knie) scores. Also, we evaluated postoperative thigh circumference and range of motion. All of operations were done by only one surgeon. Results: At single-bundle reconstruction group, preoperative AP instability which was checked by $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer was $7.9{\pm}3.3$ and $7.4{\pm}2.0$, respectively. At double-bundle reconstruction group, it was $8.3{\pm}3.5$ and $7.9{\pm}3.2$, respectively. Residual AP laxity checked at 1 year after operation was $1.9{\pm}1.2$ and $2.2{\pm}1.6$ in single-bundle reconstruction group, and $1.1{\pm}0.9$ and $1.0{\pm}1.0$ in double-bundle reconstruction group. So, double-bundle reconstruction had better results in both anterior stress radiographs with the $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer, and there were significant differences in statistics. But, clinical results such as IKDC(International Knee Documentation Committee) scores, OAK(Orthopadische Arbeitsgruppe Knie) scores, thigh circumference and range of motion had no significant difference between two groups. Conclusions: On the basis of stability, the side-to-side anterior laxity of double-bundle ACL reconstruction was significantly better than that of single-bundle reconstruction, although there were no significant differences in the other clinical measures among them.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.35-45
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• 2011

Purpose: The purpose of this study was to document the structural features of the tendinous portions within the non-pathologic subscapularis muscle by performing high resolution MR imaging of the shoulder. Materials and Methods: Between April 2007 and May 2010, we retrospectively obtained the MR scans of 88 consecutive young patients (88 shoulders) who were in their twenties. MRI and MR arthrography were performed using a 3.0-T system for the evaluation of glenohumeral instability and nonspecific shoulder pain. None of the patient in this study had any evidence of injury to the tendon or muscle belly of the subscapularis. On MR images, we recorded the transverse length of a stout tendinous band and the total tendinous portion of the subscapularis. In addition, we recorded the number of intramuscular tendinous slips of the susbscapularis. Results: The mean transverse length of the tendinous band was 15.0 mm (range: 8 to 20 mm). The mean transverse length of the total tendinous portion was 48.9 mm (range: 40 to 60 mm). The number of intramuscular tendinous slips on the base of the glenoid fossa was 3 in 20 (22.72%), 4 in 45 (51.14%) and 5 in 23 shoulders (26.14%). On the lateral portion, the intramuscular tendinous slips became gradually rounder and thicker and they gave converge in the superior direction. Conclusion: In this study, the structural features of the tendinous portions of the subscapularis on the MR scans were identified. This will in return give good justification for the lines to be pulled during biomechanical stimulation and also for the surgical approach to restore the biomechanical function.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.159-166
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• 2009

Purpose: We wanted to evaluate the surgical results of early mobilization after rigid fixation of small coronoid fracture using the tension band technique Materials and Methods: Eight cases of coronoid fracture were fixed with the tension band technique and using K-wire and wire through the medial approach. All the cases were Regan-Morrey type 2. According to O'Driscoll, they were classified as 5 cases of the tip type (subtype 2) and 3 cases of the anteromedial type (1 case of subtype 2, and 2 case of subtype 3). The associated collateral ligament injuries (6 cases) and radial head/neck fractures (4 cases) were managed simultaneously. After immobilization for 5~7 days, active ROM exercise with a fitted hinge brace started and continued till postoperative 6 weeks. The patients were assessed for pain, ROM and functional disability using the Mayo elbow performance score (MEPS) at an average of 11 months (range: 6~28 months). The ulnar nerve symptoms were also investigated. Results: We observed solid union in all the coronoid fractures without hardware failure. An average of 2.2 wires (range: 2~4) were used. The mean extension was $3^{\circ}$(range: $0^{\circ}\sim25^{\circ}$), the mean flexion was $137^{\circ}$(range: $130^{\circ}\sim140^{\circ}$), the mean pronation was $69^{\circ}$(range: $45^{\circ}\sim90^{\circ}$) and the mean supination was $78^{\circ}$(range: $45^{\circ}\sim90^{\circ}$). The mean MEPS was 96 (range: 65~100). Ulnar nerve symptoms occurred at postoperative one day and persisted in one patient with the terrible triad of taking radial head excision and residual medial instability. Conclusion: The tension band technique uses easily obtained, economic K-wires and the wire was strong enough to permit early elbow ROM exercise and the technique might improve the elbow function. It was especially useful for fixation of multiple small fragments.

• 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.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.895-900
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• 2001

Background : This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease( 75％ stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction 35％). Material and Method : One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. Result : There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5$\pm$0.9 vs 3.4$\pm$0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. Conclusion : IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients