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ABSTRACT: PURPOSE: During open-wedge high tibial osteotomy, fracture occurring in the insufficient osteotomy before distraction of the osteotomy gap is an important complication. The objective of this study was to evaluate bone mineral density (BMD) around the proximal tibiofibular joint (PTFJ) and the osteotomy hinge. The hypotheses of this study were (1) BMD would be higher in the level of PTFJ, compared with that of above-or below-the level of PTFJ, (2) BMD of the posterolateral side of the hinge would be higher than that of the anterior or lateral side. METHODS: Computed tomography was used to determine the BMD of the lateral aspect of the proximal tibia around the PTFJ and the osteotomy hinge. The means and standard deviations of the regions of interest were measured. To verify the first hypothesis, a coronal reconstructed image showing the beginning of the fibula head was used and an axial reconstructed image showing the beginning of the fibula head was used for verification of the second hypothesis. RESULTS: BMD of the lateral aspect of the proximal tibia at the level of the PTFJ was significantly higher, compared with that of above (P = 0.04)-or below (P < 0.01)-the level of the PTFJ in male patients. In addition, it was also significantly higher, compared with that of below the level of the PTFJ (P < 0.01). BMD of the posterolateral area of the proximal tibia was significantly higher than that of the anterior or lateral area in both male and female patients (P < 0.01). CONCLUSION: BMD of the level of the PTFJ was higher, compared with that of above-or below-the level of the PTFJ and that of the posterolateral area of the proximal tibia was significantly higher, compared with that of the anterior or lateral area. LEVEL OF EVIDENCE: II.
Knee Surgery Sports Traumatology Arthroscopy 02/2013; · 2.21 Impact Factor
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ABSTRACT: PURPOSE: The purposes of this study were (1) to evaluate the foot rotational effects on local and whole leg alignment and (2) to confirm the correlation between local and whole leg alignment. The hypotheses of this study were that (1) the alignment would become varus if the rotation of the foot changes from internal to external rotation, and (2) there would be some correlation between local and whole leg radiographs, and local knee radiographs could then be used indirectly for the assessment of whole leg alignment in patients with bilateral medial compartment knee osteoarthritis. METHODS: A total of 80 lower limbs with genu varum of patients who complained of medial knee pain were examined. The standing anterior-posterior view of whole leg radiographs was taken in the four foot positions, and a custom-made foot plate was used for the attainment of accurate radiographs: feet straight ahead with foot contact at the medial side (R: routine), feet straight ahead at shoulder width (N: neutral), 30° external rotated (ER) and 15° internal rotated (IR) position. In order to obtain a local radiograph of the knee, we took only whole leg radiographs and selected the area of interest on the whole leg radiograph. We evaluated the total width of the tibia plateau (Total), the length of the weight-bearing line, the ratio of weight-bearing line/Total and femorotibial angle (FTA). RESULTS: The absolute value of weight-bearing line was shifted laterally in the 30° ER position and shifted medially in the 15° IR position compared to the neutral position (1.8 mm lateral and 0.2 mm medial in the WLR; 3.5 mm lateral and 3 mm medial in the local radiograph). Significant statistical differences were observed in the local knee weight-bearing line; however, no significant statistical differences were observed in the weight-bearing line of the whole leg radiograph (n.s.). Results of the % (weight-bearing line/Total) were similar to those of weight-bearing line. The FTA of the local radiograph showed statistical differences, and it showed more valgus in the 30° ER position. In the correlation analysis between whole leg radiograph and local knee radiograph, moderate correlation (correlation coefficient = 0.67) was observed; however, significant statistical differences were observed in the comparison of weight-bearing line and % weight-bearing line/Total (p < 0.01 and < 0.01, respectively) between local knee and whole leg radiograph. CONCLUSIONS: Foot position of ER could show less varus alignment and the reverse could occur in the IR position, compared to the neutral foot position. The severity of varus alignment could be underestimated in the local radiograph, compared with that of whole leg radiograph. LEVEL OF EVIDENCE: Cohort study (diagnosis), Level II.
Knee Surgery Sports Traumatology Arthroscopy 02/2013; · 2.21 Impact Factor
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ABSTRACT: Little information exists on the intraoperative difficulties and complications of using a RetroButton (Arthrex, Inc, Naples, Florida), which is a new suspensory device. However, some difficulties are encountered, such as incomplete sitting, pulling at the outside portion of the iliotibial band, or slipping during distal pulling due to incomplete transverse flipping. These problems can be avoided if the mechanism can be understood and some technical tips are practiced. The goal of this study was to determine the difficulties encountered during RetroButton femoral fixation and prevent iatrogenic complications with the RetroButton devices by offering some technical tips.
Orthopedics 10/2012; 35(10):861-4. · 2.66 Impact Factor
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ABSTRACT: To understand the relationship between tibial bone defect and extent of medial release in total knee arthroplasty.
We evaluated 32 knees in 22 patients with variable degrees of tibial bone defect on medial plateau has undergone total knee arthroplasty. In this study, 31 cases had been diagnosed as degenerative osteoarthritis and 1 case was osteonecrosis. We excluded cases with infection, traumatic arthritis, or neuropathic joints. With regard to gender, 29 cases were female and 3 cases were male. The following relationships were analyzed: preoperative degrees of tibial bone defect and varus deformity; the femorotibial angle of both weight-bearing whole extremity radiogram, distractive stress radiogram, and the extent of medial release.
Average tibial bone defect was 9.8±4.1 mm. Average femorotibial angle on weight-bearing whole extremity radiograph was varus 10.0°±6.2°. Average femorotibial angle on distractive stress radiograph was varus 0.7°±4.6°. Statistically the extent of medial release showed no significant relationship with the degree of tibial bone defect and femoro-tibial angle of whole extremity radiogram. However, it revealed a statistically significant relationship with the femorotibial angle on distractive radiogram (r=0.465, p=0.007).
Preoperative distractive stress radiograph might be a useful method to predict the extent of intraoperative medial release during total knee arthroplasty.
Knee surgery & related research. 09/2012; 24(3):146-50.
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ABSTRACT: The objectives of this study were (1) to compare locations of the femoral tunnels created by outside-in and transtibial techniques and the reference data and (2) to compare the diameter of the tunnel entrance based on the real reaming size.
A comparative study was performed with 20 outside-in and 22 transtibial double-bundle anterior cruciate ligament reconstruction patients. Computed tomography scans of the operated knees of the outside-in and transtibial groups were performed at 1.25 days (range, 1 to 3 days) and 2.7 weeks (range, 3 days to 4 weeks), respectively. Three-dimensional surface models were then produced. For all 3 plane data sets, the positions of the femoral tunnels were measured by an anatomic coordinate axis method. For comparison of the tunnel diameter at the entrance of tunnel, the difference between the real reaming and measured diameter was determined first on computed tomography images. Subsequently, the differences in the outside-in and transtibial techniques were compared.
In the comparison between outside-in and reference data, the posterior-anterior direction of the posterolateral (PL) tunnel showed an anterior position compared with reference data, even though it was positioned more posteriorly compared with that of the transtibial technique (P = .003). In the comparison between transtibial and reference data, the posterior-anterior direction of the anteromedial (AM) and PL tunnels showed an anterior position compared with reference data (P = .019 and P = .005, respectively). The transtibial technique showed significantly larger diameters in both AM and PL tunnels (P < .001 and P < .001, respectively).
The outside-in technique showed more accurate replication of the femoral tunnels than the transtibial technique, particularly the AM tunnel of the femur. The transtibial technique showed an ellipsoidal tunnel configuration at the entrance of the tunnel, which suggests that eccentric reaming is unavoidable because the reaming angle is determined by the tibial tunnel.
Level III, retrospective comparative study.
Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2012; 28(10):1417-23. · 3.02 Impact Factor
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ABSTRACT: PURPOSE: The purpose of this study was to evaluate the changes in the site-specific cartilage status after a double-bundle ACL reconstruction using preoperative and follow-up MR images. METHODS: Thirty-six knees that underwent a double-bundle ACL reconstruction from 2001 to 2009 with the available preoperative and follow-up magnetic resonance imaging were included. Patients with a meniscal injury were compared with those without a meniscal injury. The cartilage morphology was classified using a 6-grade scale [from 0 = normal thickness and signal, to 6 = diffuse full-thickness loss (>75 % of the region)]. The changes in cartilage status were evaluated at 14 sites. RESULTS: Cartilage changes were observed in all sites and were classified according to the site and degree of change. The majority of changes were grade 0 and 1, which accounted for 68 and 16.8 % of changes, respectively. The patella medial facet and anterolateral and centromedial femoral regions showed significantly more cartilage loss than the posteromedial, centrolateral, anterolateral, and anteromedial tibial regions. No significance was observed between the knees with or without combined injuries (n.s.). On the other hand, knees with or without combined injuries showed a different pattern of cartilage change, as demonstrated by different levels of grade change at sites. CONCLUSIONS: The change in cartilage status was minimal after a double-bundle ACL reconstruction. The patella medial facet, lateral femur anterior region, and medial femur central region showed significantly more cartilage loss than the medial tibia posterior, lateral tibia central, lateral tibia anterior, and medial tibia anterior regions. The presence of a combined injury did not affect the cartilage status changes, even though it was underpowered and too short term to assess the influence of the meniscal injury. LEVEL OF EVIDENCE: Case series, Level IV.
Knee Surgery Sports Traumatology Arthroscopy 05/2012; · 2.21 Impact Factor
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ABSTRACT: INTRODUCTION: This study examined the bone density around the fixation area during knee ligament reconstructions and assessed how this clinical relevance can be applied to a firm construction for a reconstructed ligament. MATERIALS AND METHODS: Fifty consecutive patients (25 healthy men and 25 healthy women) were enrolled in this study. A quantitative computed tomography was used to determine the trabecular bone density at the 7 clinically relevant areas (anteromedial area of proximal tibia, anterolateral area of proximal tibia, posteromedial area of the proximal tibia, posterocentral area of the proximal tibia, posterolateral area of the proximal tibia, near femoral tunnel entrance of the ACL, near the femoral funnel entrance of the PCL). The means and standard deviations of the areas of interest were measured using a 10mm diameter circle and the bone density was compared. RESULTS: A comparison of the fixation areas in the proximal tibia, anteromedial area of proximal tibia showed the highest bone density and posterocentral area showed the lowest bone density. A comparison of the PCL tibial fixation with interference screws or trans-condylar fixation revealed the posterocentral area to have the lowest bone density. A comparison of the femoral fixation areas in the ACL and PCL reconstruction revealed no differences in bone density. CONCLUSION: The anteromedial area of the proximal tibia was most acceptable in the interference screw fixation and the posterocentral area had the lowest bone density in the proximal tibia. There were no differences in the femoral fixation areas in the ACL and PCL reconstruction.
The Knee 03/2012; · 1.74 Impact Factor
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ABSTRACT: This study compared the results of rotating-platform high-flexion (RP-F) total knee arthroplasty with low contact stress (LCS) for clinical and radiographical assessment after a short-term period.
68 total knee arthroplasties using a RP-F and LCS system were analyzed retrospectively. Thirty-five of the 68 were osteoarthritic knees and were followed-up for more than 2 years. The clinical evaluation included range of motion (ROM), Knee Society Knee Score and Function Score (KSKS and KSFS), tailor position and kneeling. The radiographic evaluation included femorotibial angle, position of implants, radiolucent line and position of patella.
The postoperative ROM, KSKS, and KSFS improved statistically in both implants. Comparing RP-F with LCS there were statistically no differences in ROM (p=0.863), KSKS (p=0.835), KSFS (p=0.535) and tailor position (p=0.489). There were no significant radiographic differences.
Total knee arthroplasty with RP-F and LCS showed similar clinical and radiographic results; it also showed excellent and predictable results at the short-term follow up. However, in RP-F there was 1 case of early osteolysis, 1 case of patella clunk syndrome and 1 case of painful patella crepitus; therefore, further case studies and follow-up are needed.
Knee surgery & related research. 03/2012; 24(1):7-13.
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ABSTRACT: The purpose of this study was to evaluate the tunnel widening using a multi-planar reformation of MRI (Magnetic Resonance Imaging) in the orientation of the tunnel. The hypotheses of this study were as follows: (1) tunnel widening would be reduced with the above-mentioned technique, (2) the degree of tunnel widening would be different at the site of the tunnels, and (3) the time interval from surgery to MRI acquisition would affect the magnitude of tunnel widening.
Forty double-bundle ACL reconstructed patients who underwent postoperative MRI were enrolled in this study. The postoperative MRI was performed at 26.7 ± 7.4 months in terms of time. The tunnel widening was examined using a multi-planar reformation of MRI in the orientation of the tunnel. Site-specific analysis was performed according to the depth (the entrance, mid, and exit portion) and wall (anterior, posterior, medial, and lateral walls). The correlation between MRI and widening was also evaluated.
The mean tunnel widening of the femoral AM (Anteromedial), femoral PL (Posterolateral), tibial AM, and tibial PL in terms of the most widened diameter was 1.9 (25.4), 2.1 (30.8), 2.5 (32.8), and 3.2 mm (44.5%), respectively. The tibial PL tunnel showed significant widening than the other tunnels. At the entrance, tunnel widening occurred mostly, followed by the order of the mid and exit portion. Correlation analysis of the time interval of MRI acquisition and tunnel widening showed little association.
Tunnel widening after a double-bundle ACL reconstruction using an outside-in technique with press-fitting of the graft was acceptable compared to previously published studies. The tibial PL tunnel showed the most widening among the 4 tunnels examined with the tunnel entrance being most widened area.
Therapeutic case series, Level IV.
Knee Surgery Sports Traumatology Arthroscopy 01/2012; 20(11):2243-50. · 2.21 Impact Factor
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ABSTRACT: We describe a case of delayed cyst formation that presented as intermittent knee locking after complicated anterior cruciate ligament (ACL) reconstruction using a Bio-TransFix implant in a 21-year-old male patient. During femoral fixation, we could not pull out the guide wire that was temporarily used for the femoral fixation. However, stability was good, and the guide wire was not removed. This was shown to be a wrong type of fixation in a later study. During follow-up, the patient was satisfied and stability was relatively good until 18 months post-operatively. From the 2nd post-operative year, he experienced intermittent knee swelling and locking and pain around the lateral femoral condyle. Follow-up magnetic resonance imaging showed a large cyst around the broken wire tip, but the reconstructed ACL was fine.
Knee surgery & related research. 12/2011; 23(4):236-9.
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ABSTRACT: Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascular assessment and treatment should be done to avoid critical complications. An individualized treatment plan should be established after consideration of the type of tear, time after injury, associated collateral ligament injuries, bony alignment, and status of remnant. The rehabilitation should be carried out slower than that after anterior cruciate ligament reconstruction.
Knee surgery & related research. 09/2011; 23(3):135-41.
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ABSTRACT: Habitual dislocation of patella is a rare disorder. Sometimes it is associated with angular deformity such as genu valgum. We experienced habitual patella dislocation associated with genu valgum that was treated with corrective osteotomy of distal femur and soft tissue realignment procedure including lateral release and medial reefing.
Knee surgery & related research. 09/2011; 23(3):177-9.
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ABSTRACT: This study examined the changes in knee alignment after an open wedge high tibial osteotomy before and after weight-bearing. From 2004 to 2006, 36 high tibial osteotomies were performed to treat unicompartmental arthritis with a varus deformity. Thirteen patients without instability and with an accurate radiographic evaluation were included. The changes in the deviation of the mechanical axis and femorotibial angle were evaluated retrospectively using whole extremity radiographs immediately after surgery (supine position) and 4 months after surgery (weight-bearing position). In the nonweight-bearing radiograph obtained immediately after surgery, the mean deviation of the mechanical axis was 22% laterally and the mean femorotibial angle was valgus 8.9 degrees . The weight-bearing radiograph at 4 months after surgery showed that the former shifted laterally 34% and the latter shifted valgus 10.6 degrees . The changes in the mechanical axis and femorotibial angle were significant (P < 0.001). During open wedge high tibial osteotomy, the surgeon should consider the increase in deviation of the mechanical axis and femorotibial angle after weight-bearing.
Knee Surgery Sports Traumatology Arthroscopy 07/2010; 18(7):874-8. · 2.21 Impact Factor
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ABSTRACT: We report 5 cases of a localized lesion (4 with osteomyelitis and 1 with an intraosseous ganglion cyst) that were treated successfully by medulloscopy. Medulloscopy is a standard arthroscopic technique for visualizing the intramedullary canal of the tibia. Two portals were created to allow easy access and triangulation to the lesion, one for the 5-mm arthroscope and the other for the instrument. Debridement, irrigation, and resection of the sequestrum were performed for the cases with osteomyelitis, and the intraosseous ganglion cyst was treated with biopsy, debridement, and autogenous bone grafting. All cases were treated successfully with medulloscopy and did not show recurrence at the last follow-up. In addition, there were no complications related to the procedure.
Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2009; 25(12):1500-4. · 3.02 Impact Factor
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ABSTRACT: This study evaluated the preoperative distractive stress radiographs in order to quantify and predict the extent of medial release according to the degree of varus deformity in primary total knee arthroplasty.
We evaluated 120 varus, osteoarthritic knee joints (75 patients). The association of the angle on the distractive stress radiograph with extent of medial release was analyzed. The extent of medial release was classified into the following 4 groups according to the stage: release of the deep medial collateral ligament (group 1), release of the posterior oblique ligament and/or semimembranous tendon (group 2), release of the posterior capsule (group 3) and release of the superficial medial collateral ligament (group 4).
The mean femorotibial angle on the preoperative distractive stress radiograph was valgus 2.4 degrees (group 1), valgus 0.8 degrees (group 2), varus 2.1 degrees (group 3) and varus 2.7 degrees (group 4). The extent of medial release increased with increasing degree of varus deformity seen on the preoperative distractive stress radiograph.
The preoperative distractive stress radiograph was useful for predicting the extent of medial release when performing primary total knee arthroplasty.
Clinics in orthopedic surgery 06/2009; 1(2):110-3.
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ABSTRACT: We report a case of knee fusion after a failed total knee arthroplasty (TKA) with severe osteolysis including the epicondyle and ipsilateral total hip arthroplasty (THA) with long Wagner revision stem (Sulzer Orthopedics, Baar, Switzerland). The conventional devices for arthrodesis were unavailable in this case because of the long Wagner revision stem and poor bone stock. A connector was made between the long Wagner revision stem and an intramedullary nail (IM nail; Solco, Seoul, Korea). The custom-made connector was coupled with a femoral stem by cylindrical taper fit with additional cement augmentation and an intramedullary nail by screws. Osseous fusion was achieved without pain or instability.
The Journal of arthroplasty 05/2008; 24(2):322.e19-22. · 1.79 Impact Factor
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ABSTRACT: Bioabsorbable interference screws have replaced metal interference screws in anterior cruciate ligament reconstruction surgery because they have several advantages. Poly-L-lactide (PLLA) is one of the commonly used materials for bioabsorbable interference screws. PLLA produces a lower inflammatory reaction than polyglycolide as a result of its slower degradation rate and better biocompatibility. We describe a case of a delayed intra-articular inflammatory reaction caused by a PLLA bioabsorbable interference screw used in anterior cruciate ligament reconstruction.
Arthroscopy The Journal of Arthroscopic and Related Surgery 03/2008; 24(2):243-6. · 3.02 Impact Factor
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ABSTRACT: We describe a new posteromedial portal through the bed of the posterior tibial tendon. It can be made easily with a 0.5-inch posteromedial skin incision along the course of the posterior tibial tendon just behind the posterior colliculus of the medial malleolus. After the flexor retinaculum is incised and the posterior tibial tendon is retracted anteriorly, a small bulging area of capsule can be seen as a result of saline inflation. The new posteromedial portal can then be made easily through this inflated capsule. This portal allows good access to the posterior joint surface and has a minimal risk of injury to the medial neurovascular bundle.
Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2006; 22(7):799.e1-2. · 3.02 Impact Factor
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ABSTRACT: Chronic multifocal closed rupture of the extensor hallucis longus tendon is an extremely rare injury. Previously, chronic multifocal partial rupture of the extensor hallucis longus tendon had not been reported. This case study reports one case of autogenous graft repair of a chronic multifocal rupture of the extensor hallucis longus tendon using a semitendinous tendon autograft.
The Foot and Ankle Online Journal 07/2003; 24(6):506-8. · 1.22 Impact Factor
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ABSTRACT: Purpose: We wanted to evaluate the clinical outcomes at a minimum 1-year following anatomic double bundle ACL reconstruction with using autogenous hamstring tendons fixed with Ligament Plate Ⓡ . Materials and Methods: We evaluated a total of 50 patients. Semitendinosus tendon was used for the reconstruction of the anteromedial bundle and the gracilis tendon was used for the reconstruction of the posterolateral bundle. For femoral fixation, we used an anteromedial bundle that was suspended in Ligament Plate Ⓡ and a posterolateral bundle linked with Mersilene tape Ⓡ . For tibial fixation, we used double post-tie. The average follow-up period was 16.5 months. We analyzed the clinical and radiographic results. Results: At the last follow-up, the Lysholm score was 92.4±6.8 points. For the IKDC score, there were 35 cases of grade A, 14 cases of grade B and 1 case of grade C. The Lachman test was negative for 40 cases, it was grade 1 for 9 cases and it was grade 2 for 1 case and the pivot shift test was negative for 45 cases and it was grade 1 for 5 cases. The side-to-side differences with the KT-2000 and the anterior drawer radiogram were 1.3±1.6 mm and 1.3±1.3 mm, respectively. The femoral tunnel enlarged to 1.7±0.6 mm in the anteromedial aspect and 1.6±0.7 mm in the posterolateral aspect, and the tibial tunnel enlarged to 1.2±0.4 mm in the anteromedial aspect and 1.4±0.5 mm in the posterolateral aspect. Conclusion: Anatomic ACL reconstruction using autogenous hamstring tendons that are fixed with Ligament Plate Ⓡ showed good clinical results due to the strong strength of early fixation and the anatomic restoration of the ACL.
