• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.406-415
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• 2023

Background: Surgical management of a massive rotator cuff tear (RCT) is always challenging. This study describes the clinical and radiological outcomes of patients who underwent bridging grafts using a plantaris tendon for an irreparable RCT. Methods: Thirteen patients with a massive RCT were treated with arthroscopic interposition of a folded plantaris tendon autograft between June 2017 and January 2020. For clinical evaluation, a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score, and range of motion values were collected. For radiographic evaluation, standardized magnetic resonance imaging and ultrasonography were performed to check the integrity of the interposed tendon. Results: A statistically significant improvement at the final follow-up was evident in scores for the VAS (-3.0, P=0.003), ASES (24.9, P=0.002), D ASH (-20.6, P=0.001), and Constant-Murley values (14.2, P=0.010). In addition, significant improvement was shown in postoperative flexion (17.3°, P=0.026) and external rotation (27.7°, P<0.001). In postoperative radiologic evaluations, the interposed tendons were intact at the last examination in 12 of the 13 patients. No complications related to donor sites were reported. Conclusions: An arthroscopic bridging graft for irreparable RCTs using a modified Mason-Allen stitch and a plantaris autograft resulted in improved short-term radiological and clinical outcomes. Graft integrity was maintained for up to 2 years in most patients. Level of evidence: IV.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.1
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• pp.27-34
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• 2011

Purpose: To evaluate the short term clinical result of ACL reconstruction with autologous hamstring tendon using Cross pin and Graft Tensioner and to seek way to resolve the experienced technical problems. Materials and Methods: From January 2008 to March 2009, 35 patients who had been treated arthroscopic ACL reconstruction were enrolled. The femoral side of ACL graft was fixed with Cross pin. The tibial side of graft was fixed with Intrafix and post-tie. The graft was tensioned with Graft Tensioner at 80N. We analyzed the clinical, radiographic results and complications. Results: IKDC subjective score and Lysholm score improved to 89.1 and 91.4 points. Also, Pivot shift test and One-leg hop test showed good results postoperatively. Side to side difference using KT-1000 arthrometer and Telos stress radiography improved compared with normal limb to $2.8{\pm}1.6$ mm and $2.6{\pm}1.3$ mm, respectively. The femoral tunnel enlarged to $2.3{\pm}1.1$ mm. Soft tissue irritation and femoral tunnel-graft harness length mismatch, femoral tunnel-cross pin tunnel mismatch were happened as peri-operative complications. Conclusion: Using of Cross pin and Graft Tensioner for ACL reconstruction with hamstring tendon is one of the good method for obtaining stability in short-term clinical result. But to reduce femoral tunnel-cross pin mismatch, it needs to shorten femoral bone tunnel and to create cross pin tunnel as vertical as possible. And to reduce femoral tunnel-graft harness mismatch, it needs to advance position rod further 3 mm when to create femoral tunnel.

• 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 Korean Foot and Ankle Society
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• v.18 no.2
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• pp.72-75
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• 2014

We experienced a patient in whom rupture of the peroneus longus tendon occurred after ostectomy of the peroneus tubercle of the calcaneus. Acute rupture of the peroneus tendon can be managed by end-to-end anastomosis, while neglected cases can be treated by tenodesis, tendon transfer, or tendon graft. In the current patient, the tendon ends were mildly retracted, yielding a small gap. We successfully repaired the retracted tendon ends after lengthening by Z-plasty.

• Journal of Korean Foot and Ankle Society
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• v.22 no.3
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• pp.127-130
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• 2018

A 3rd degree burn on the heel including the Achilles tendon is vulnerable and requires active treatment to improve the functional outcomes. Previously, there have been a few treatments on severe burns, such as amputation, debridement or simple skin graft. The cooperative technique of an anterior lateral thigh flap with Achilles tendon reconstruction can be an innovative procedure that preserves the major arteries. The authors review a case and report the clinical outcome.

• Journal of the Korean Arthroscopy Society
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• v.9 no.1
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• pp.70-76
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• 2005

Purpose: We describe a new technique of arthroscopic repair with using autogenous hamstring tendon graft augmentation for the acute posterior cruciate ligament rupture. Operative technique: A routine arthroscopic examination of the knee joint is initially performed, then the posterior trans-septal portal is prepared with the using the posteromedial and posterolateral portals. The torn tibial stump that is retracted to the posterior compartment is repaired by a suture hook that is introduced through the anteromedial portal; visualization during this procedure is done with the arthroscope via the posteromedial portal. Using the retrieved suture, both suture ends are brought out to the anteromedial portal. The torn tibial stump is pulled to the intercondylar notch and then repaired with stitches at the anterior compartment. After the tibial and femoral tunnels are prepared without damaging the remnant PCL bundle, the combined torn PCL fibers and the autogenous single-bundle semitendinosus and gracilis tendon grafts are passed through the femoral tunnel and fixed together Conclusion: Arthroscopic repair of the torn tibial stump and autogenous hamstring tendon graft augmentation after preparing the tibial and femoral tunnels by using the trans-septal portal, without damaging the remnant PCL bundle, seems to be a very effective method for the treatment for acute PCL injuries, and especially for tears at the femoral attachment.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.148-152
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• 2006

Purpose: The purpose of this study was to investigate the distribution of the diameter of four strand autologous hamstring tendon and to identify the factors related to the diameter. Materials and Methods: Between December 2004 and July 2006, 66 patients underwent anterior cruciate ligament reconstruction using autologous hamstring tendon. Sixty one patients were male and the other 5 patients were female. Both semitendinosus and gracilis tendon were harvested in every case. Harvested two tendons were folded once together to create a four strand double loop graft and were passed through cylindrical sizer to measure their diameter. Parameters such as sex, age, height and weight were analyzed for their correlation with the diameter of the graft. Results: The diameter of the graft ranged from 6 mm to 10 mm. The graft with the diameter of 8 mm was most common and the average diameter of all the grafts was $7.85{\pm}0.92mm$. Seven patients (10.6%) had a graft with the diameter of 6 mm, which is considered too thin to be ideal one. No statistically significant correlation was found between age of the patient and the diameter of the graft. However, the diameter of the graft was significantly correlated with sex, height and weight of the patient. Female patients had a significant tendency to have thinner hamstring tendons. Both small height and light weight of the patients were correlated with thinner hamstring tendons significantly. Conclusion: Sex, height and weight of the patients were the factors that had a statistically significant correlation with the diameter of the graft. Being aware of the risk factors related with harvesting exceedingly thin hamstring tendon prior to anterior cruciate ligament reconstruction, one can utilize wide range of options in selecting an optimal graft.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.539-542
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• 2005

Reconstructions of soft tissue defect of the posterior ankle including Achilles the tendon should take into account not only coverage but functional outcome. Various methods of tendon transfer and tendon graft have been reported as a single-stage procedure. With advances and refinements in microsurgical techniques, several free composite flaps including tendon, fascia, or nerve have been used in single-stage reconstructions of large defects in this area minimizing further damage to the traumatized leg. However, when free flap is not feasible for some reasons, this cannot be accomplished successfully. Here we present a patient with Achilles tendon and circumferential large soft tissue defect. Because of circulatory compromise of the lower extremity, free flap reconstruction could not be applied. Instead, cross-leg composite flap of the dorsalis pedis flap including the extensor hallucis brevis musle and tendon, and tendon strips of the Second, third and fourth extensor digitorum logus were employed, Functional reconstruction of the tendon and resurfacing were obtained at the same time. The flap was detached 3 weeks postoperatively, and the transplanted flap has survived without any complications. By 3 months after surgery, full weight bearing, tip-toe standing and even walking without crutch assistance was possible. When functional reconstruction with the free flap is unattainable in the large defect of the posterior ankle including the Achilles tendon, cross-leg composite island flap of dorsalis pedis flap and tendon strips of the extensor digitorum longus tendon is a viable alternative.

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

• Journal of Veterinary Clinics
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• v.39 no.6
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• pp.378-383
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• 2022

A 3-year-old, 24-kg intact female Border Collie was referred for a toe-touch weight-bearing stance, intermittent weight-bearing lameness, and moderate pain reaction of the right forelimb on physical examination and right humerus olecranon avulsion fracture on diagnostic imaging examination. Surgical repair was performed using tension band wiring to re-attach the triceps tendon and distal olecranon. Migration of the distal olecranon fragment was observed due to comminuted fracture of the fragment 5-days after surgery, and revision surgery was performed. The tension-relieving sutures were passed through the pre-drilled hole in the olecranon, and the polyester mesh was augmented to the suture region, covering the triceps tendon and olecranon drilling hole using the Krackow suture pattern. The elbow joint was immobilized using a type IA transarticular external fixator, which was removed 8 weeks after surgery. Fourteen weeks after surgery, no lameness was observed on gait evaluation. At follow-up after 7 months, the distal olecranon fragment had stabilized, and no lameness was observed.