• Journal of Korean Orthopaedic Sports Medicine
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• v.4 no.2
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• pp.79-85
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• 2005

The symptoms in patello-femoral joint can be occurred from various causes. Most of patients complained chronic discomfort and it is rare to have a characteristic acute pain. Initial management should be started conservatively and if it has no effect to relieve symptoms, surgical treatment would be considered. The selection of operative treatment should be decided in the consideration of patients age, activity and ability of performing rehabilitation. Before surgery, accurate diagnosis is essential and causative factors should be removed or corrected with surgery. Arthroscopic surgery is effective for the most of disease in the patello-femoral joint disorder with low morbidity and early rehabilitation. At arthroscopy, superomedial or superolateral portal can be used for the evaluation and treatment of articular surface in the patella. The structure of normal variants should be saved if it does not have pathological changes for prevention of post operative morbidity. If the arthroscopic surgery has difficulties during the procedure or no effect in removal of lesion, open surgery should be considered.

• Journal of The Korean Society of Integrative Medicine
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• v.4 no.4
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• pp.67-75
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• 2016

Purpose: The purpose of this study was to compare Hip-Knee-Ankle(HKA) angle and muscle activation ratio between vastus medialis(VM), rectus femoris(RF), and vastus lateralis (VL), and by this, to examine their relationship. It is aimed to explore how the activation ratio among the muscles involved in patellofemoral kinetics would vary in relation with the frontal alignment of the lower extremity. Subjects and Methods: 26 healthy subjects were recruited for the study. The HKA angles were measured with radiograph. The VM, RF, VL muscle activation level were measured by surface electromyography while each participant performed 4 different types of movement (isometric knee extension, squat, ambulation, step-up) and VM/RF, VM/VL, RF/VL ratios were calculated. Pearson correlation was used to estimate the relationship between the HKA angle and the muscle ratio. Results: There was significant moderate correlation between HKA angle and VM: RF on the left side during ambulation (p<0.05). Moderate correlations were also observed during step-up and squat with less significance (p<0.1). Conclusion: The frontal alignment of the knee measured by the HKA angle was conditionally associated with muscle activation ratio between VM and RF (VM:RF); On the left, during ambulation, step-up, and squat, the more valgus knee tended to correlate with the more VM muscle activation ratio, which is expected to induce more stabilizing effect to the patella and its tracking. It suggests that the frontal alignement measured by the HKA-angle can affect PF kinetics. It also indicates a possibility that increase in valgus alignment of the knee, by the HKA measurement, may not act unfavorably to generate PFP.

• Journal of the Korean Society of Physical Medicine
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• v.6 no.2
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• pp.165-175
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• 2011

Purpose: This study examined the effect of the strengthening exercise and stretching exercise to decrease symptom patellofemoral pain syndrome (PFPS). Methods: The Anterior Knee Pain Scale (AKPS) and Clark's test performed for diagnosis of intrinsic PFPS among young adults. Selected thirty young adults subjects who aged 20~26 years participated in the study. Participants were randomly assigned to strengthening, stretching, or control groups. Strengthening group consisted of quadriceps, hamstring and iliotibia band training used elastic band. Stretching group consisted of quadriceps, hamstring and iliotibia band trainings used stretching exercises program. Participants received 50-minute individualized exercise sessions, 3 times a week for 6 weeks. Results: The results were as follow: there were significantly difference stretching exercise group by all muscles on muscular strength test (p<.05). there were significantly difference both strengthening and stretching exercise group by all muscles on flexibility test (p<.05). There were significantly difference stretching exercise group by all muscles on step-down test (p<.05). There were significantly difference both strengthening and stretching exercise group by all muscles on visual analog scale (p<.05). Conclusion: Results suggest important implications for exercise programs of PFPS that stretching exercise is more improved knee pain, functional performance, patella mobility than strengthening exercise.

• Archives of Plastic Surgery
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• v.35 no.1
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• pp.20-27
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• 2008

Purpose: The anterolateral thigh flap has many advantages over other conventional free flaps. But the anterolateral thigh flap has yet to enter widespread use because perforating arteries exhibit a wide range of anatomic variations and are difficult to dissect when small. The aim of this study is to identify the vascular variability of perforating arteries and pedicle in the anterolateral thigh free flap. Methods: We studied 12 cadavers and dissected 23 thighs. An anterolateral thigh flap ($12{\times}12cm$) was designed and centered at the midpoint of the line drawn from anterior superior iliac spine to the superolateral border of the patella. After we identifed the perforating arteries we dissected up to their origin from lateral circumflex femoral artery along descending branch of lateral circumflex femoral artery. We then investigated the number and the position of perforating arteries, length and diameter of vascular pedicle and pattern of lateral circumflex femoral arterial system. Results: On average $2.3{\pm}1.1$ perforating arteries per thigh were identified. The musculocutaneous perforators were 63.1%. In those perforators five perforators were arose from transverse branch of lateral circumflex femoral artery and two were arose from rectus femoral artery. Most of the perforators were near the intermuscular septum between rectus femoris muscle and vastus lateralis muscle. The length and diameter of pedicle were $11.9{\pm}3.5cm$ and $3.1{\pm}0.8mm$ on average. Conclusion: This study will be helpful for the success in anterolateral thigh free flap.

• Transactions of the Korean Society of Mechanical Engineers A
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• v.35 no.7
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• pp.785-790
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• 2011

The goal of this study is to estimate the force acting on the knee joint in the human body by using the Hilltype muscle model based on a musculoskeletal model of the human lower extremity in the sagittal plane. For estimating the force applied, the human leg is modeled using multi-body modeling. This leg model comprises biarticular muscles acting on two joints of the upper and lower limbs, and the muscles include some of the major muscles such as the hamstring. In order to analyze the uncertainty of the applied forces acting on the knee joint, statistical distributions of human body, leg part, parameters are required and to obtain the parameter's statistical characteristic of the part sample survey method is employed. Finally, by using the sensitivity information of the parameters, the force acting on the knee joint can be estimated.

• Journal of Veterinary Clinics
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• v.26 no.6
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• pp.655-658
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• 2009

An 11-year-old, female, Maltese dog was presented with abdominal distension and intermittent slight lameness on left hindlimb. Palpable abdominal pain and purulent vaginal discharge were observed on physical examination. Severe leukopenia with toxic change, and azotemia, hyperphosphatemia, and hyponatremia were identified on blood profile. On radiographs and abdominal sonograms, remarkable soft tissue mass containing echogenic material deviating intestines craniodorsally compatible with pyometra. On stifle radiographs, 4-5 fragmented sesamoid bone (fabella) was identified on both stifle joint with medial patella luxation. Immediate ovariohysterectomy was performed and the patient was recovered well with normal blood work. No specific treatment was attempted to the left hindlimb showing minimal and intermittent lameness. No remarkable abnormal gait was reported for 3-month follow-up period. The fragmented lateral fabella is considered congenital multipartite of lateral fabella not related to the lameness.

• Journal of Korean Orthopaedic Sports Medicine
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• v.3 no.1
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• pp.56-59
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• 2004

The hamstring tendons are popular for autografts in a variety of reconstructive procedures. The hamstring autografts are used widely for its potential advantages over the patella bone-tendon-bone(BTB) autograft, including lower graft site morbidity and easier harvesting technique. However, the use of hamstrings has potential disadvantages such as the damage of infrapatellar branches of the saphenous nerve, premature tendon amputation, and tendon split following inadequate hamstring identifications. In our studies, we used modified technique for harvesting the hamstring to decrease potential disadvantages. Reflected hamstring flap method seems to be easy and safe in avoiding nerve damage and tendon splitting. We recommend the reflected hamstring flap method for harvesting hamstring tendons.

• Journal of Institute of Control, Robotics and Systems
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• v.17 no.10
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• pp.1021-1028
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• 2011

The objective of this paper is to optimize the design parameters of a novel mechanism for a robotic knee orthosis. The feature of the proposed knee othosis is to drive a knee joint with independent actuation during swing and stance phases, which can allow an actuator with fast rotation to control swing motions and an actuator with high torque to control stance motions, respectively. The quadriceps device operates in five-bar links with 2-DOF motions during swing phase and is changed to six-bar links during stance phase by the contact motion to the patella device. The hamstring device operates in a slider-crank mechanism for entire gait cycle. The suggested kinematic model will allow a robotic knee orthosis to use compact and light actuators with full support during walking. However, the proposed orthosis must use additional linkages than a simple four-bar mechanism. To maximize the benefit of reducing the actuators power by using the developed kinematic design, it is necessary to minimize total weight of the device, while keeping necessary actuator performances of torques and angular velocities for support. In this paper, we use a SGA (Simple Genetic Algorithm) to minimize sum of total link lengths and motor power by reducing the weight of the novel knee orthosis. To find feasible parameters, kinematic constraints of the hamstring and quadriceps mechanisms have been applied to the algorithm. The proposed optimization scheme could reduce sum of total link lengths to half of the initial value. The proposed optimization scheme can be applied to reduce total weight of general multi-linkages while keeping necessary actuator specifications.

• Journal of Korean Medicine Rehabilitation
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• v.30 no.4
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• pp.203-217
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• 2020

The aim of this study was to propose our rehabilitation protocol involving Korean medicine for patients with patellar fracture and report its effectiveness. Further, for the same patellar fracture patients, we created different protocols for those who underwent surgical treatment and those who required conservative treatment. Among patients who received inpatient treatment at our hospital for three years from August 2017 to August 2020, we included three patients who underwent surgical treatment for patellar fracture and one patient who required conservative treatment for patellar fracture. The degree of improvement of the patients was evaluated using physical examination findings of the knee joint, numeric rating scale, pain disability index, Lysholm knee score, and walking state. After each treatments, we observed that the range of motion of the knee joint, numeric rating scale, pain disability index, Lysholm knee score, and walking state improved in the patient groups. Even with the same patellar fracture, we observed that different rehabilitation treatments involving Korean medicine should be applied to patients who underwent surgical treatment and those who required conservative treatment. However, further studies are needed to design a rehabilitation protocol involving Korean medicine.

• Biomaterials and Biomechanics in Bioengineering
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• v.3 no.1
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• pp.27-35
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• 2016

Anterior knee pain is a major problem among adolescents and young adults especially those who participates in sports. The most common pathogenesis of anterior knee pain can arise from compression and shear forces in the patellofemoral joint. It is also caused by impingement of infrapatellar fat pad. Fat pad impingement can occur when the fat pad becomes swollen and inflamed due to a direct blow or chronic irritation. As a result, the bottom tip (or inferior pole) of the patella can pinch the fat pad. One of the many causes of swollen fat pad can be secondary to anterior cruciate ligament (ACL) injury. The aim of this study was to compare the infrapatellar fat pad volume in patients with acute ACL injury and a group of age-, gender-, and activity- matched controls with intact ligament. Axial magnetic resonance (MR) images have been performed on 32 patients with torn ACL and 40 control patients. The volume of the fat pad was measured digitally from MR image by using a 3d Reconstruction software, ellipsoidal approximation, and a MATLAB code. The results were compared between patients with torn ACL and control group. Patients with a torn ACL had a significantly larger fat pad than the controls (P=0.01). There was no significant difference between the methods used to measure the infrapatellar fat pad volume (P=0.83-0.87). Thus, lesions of the infrapatellar fat pad is often associated with ACL injury.