The anterior cruciate ligament integrity is critical to the mechanics, stability, and protection of the joint and its periarticular structure. The insufficiency of the anterior cruciate ligament leads to a disintegration of the rolling/gliding movement, and followed by degenerative changes of the joint cartilage. Numerous surgical procedures have been designed to control the anterior cruciate ligament insufficiency. None has yet been generally accepted as the best procedure. Arthroscopy has added a new dimension to knee surgery and earned a rightful place in the diagnosis and mansgement of the anterior cruciate ligsment problems. In this article, we present the results in twenty two patients who were treated with staple by arthroscopic surgery from January, 1984 to December, 1985. The results obtained were as follows : 1. Type of surgery were 2 cases of primsry repair, 12 cases of pedicle graft, and 8 cases of semitendinosus graft. 2. Associated lesions were 17 cases(77.3%) of meniscal injuries and 3 cases(13.6%) of the injury to the articular cartilage. 3. Clinical results were excellent and good in 12 cases(54.5%) and fair in 8 cases(36.4%) by the Hospital for Special Surgery knee follow up score. 4. Advantages of using the Ligamentous and Cagsular Repair system for anterior cruciate ligament insufficiency were A) Minimal surgical exposure and trauma. B) Less painful. C) Utilized the patients own collagen tissue with vascularity and synovial covering. D) Close approximation of normal anterior cruciate attachment. E) Excellent bony fixation. F) Rapid rehabilitation. G) Minimal morbidity and few complications. On the basis of our findings, we advocate the arthroscopic repair % reconstruction with staple as a reliable and effective method of treating anterior cruciate ligament insufficiency.
Anterior Cruciate Ligament ; Arthroscopy ; Cartilage ; Cartilage, Articular ; Collagen ; Diagnosis ; Follow-Up Studies ; Humans ; Joints ; Knee ; Ligaments ; Mechanics ; Methods ; Rehabilitation ; Transplants

Various methods have been described for sugical management of patients who have recurrent anterior shoulder dislocation. In recent years, great advancements have been made in arthroscopic surgery of anterior shoulder dislocation. From June, 1987 to December, 1989, 10 shoulders in 10 patients who experienced recurrent traumatic anterior dislocation were repaired with the arthroscopic stapling technique. Among them, 6 cases which could be followed for more than 1 year were analyzed. Postoperstive follow-up averaged 21 months (range 1 year to 3 years). The results were summarized as follows: l. Average patient age was 24 years with an age range from 20 to 31 years. All 6 cases were male. 2. The orighinal dislocation involved an injury in all cases. It had occurred between 18 months and 6 years before surgery. Every patients had had 4 or more recurrences. 3. Among the 6 cases, 5 cases were found to have a Bankart lesion and 3 cases, a Hill-Sachs lesion at surgery. 4. There have been no postoperative recurrence up to date. 5. 7 and 10 degrees restriction in external rotation, as compared to the contralateral shoulder, was noted in 2 patients. 6. Clinical results of 6 cases, based on the Rowe shoulder rationg system, were 4 excellent and 2 good. 7. No instances of infection, instrument failure, or major neurovascular complications occurred in this series.
Arthroscopy ; Dislocations ; Follow-Up Studies ; Humans ; Male ; Recurrence ; Shoulder Dislocation ; Shoulder

Unilateral absence of the articular process at a lumbar vertebra is a rare anomaly. The etiology of the congenital absence of articular process is not precisely determined yet, but it was explained as some of the possible embryologic bases. Absence of the articular process at the level of L5-Sl have been reported a few, but anomaly above L4 is rare. We are reporting a case of absence of articular process at the level of the 4th lumbar vertebra.
Spine

No abstract available.
Foot*

No abstract available.
Appendicitis* ; Barium* ; Enema*

No abstract available.
Appendicitis* ; Barium* ; Enema*

Three cases of orbital rhabomyosarcoma are reported here. Histological studies comfirmed the lesion 1:0 be the alveolar type in all cases. This tumor is a rare disease entity in Orient than Europe and America and accordingly, rarely encountered in our ophthalmologic practice, although it is the commonest primary malignant orbital tumor in children. Of the three cases reported here one occurred in adu1t and the other two in children. Case I. This 15 month old male showed a swelling of the left upper lid toward the medial side for 2 months and visited to our hospital on March 10, '69 with complaints of progressive swelling on the region with ptosis. The eye ball was slightly displaced toward the lower temporal side and ocular movement is limitted to upward. On palpation, the childthumb sized tumor was palpable in the upper nasal portion of the orbit. On excision of the tumor, the mass was found to be originated from the superior oblique muscle. The mass round measuring 2.5 X 2.5 X 1.5 cm in size. Histological diagnosis was alveolar rhabdomyosarcoma without cross-striation. No follow-up could be done. Case II. This patient of 15 month old male showed a swelling on the right lower lid existed 6 months and visited to our hospital on September 8, '69. The physical examination revealed that the left eye and the other routine examinations were within normal limits. The right eye showed the swelling of the lower lid, congestion of the palpebral conjunctiva, limitted movement of the eye ball toward the lower side and a palpable bean-sized mass on the region. The excision of tumor was performed under the general anesthesia. This mass was attached with the inferior oblique muscle with no other recognizable adhesion seemingly originating from that muscle. The mass was round and oval in shape, measuring 2 X 2 X 1 cm in size, diagnosis was alveolar rhabdomyosarcoma. The post-operative follow-up studies were unavailable. Case III. This case in one of adult alveolar rhabdomyosarcoma. At the age of 25 years, this man showed a proptosis of the right eye associated with migrain like headache, ocular pain and visual disturbance. This symptoms existed 6 months and gradually increased in intensity. On the physical examination, the left eye was found to be normal. The skull and orbit x-ray and c.b.c. were with in normal limits. The right eye revealed about 5mm proptosis compared with left eye and the adult thumb sized tumor was palpated on the inner side of the lower orbital rim. The visual acuity was in zero. The right optic disc was edematous and elevated about 4.0 D. The pupil showed marked dilatation and the light reflex was abscent and ocular movement was markedly limitted and eye ball is deviated toward the upper side. Under the general anesthesia, the exenteration of the orbit associated with the removal of tumor was carried out with no untoward complications. Origin of the mass was the inferior oblique muscle penetrating to the deeper part of the optic foraman and optic nerve was surrounded by the tumor completely Histology confirmed alveolar rhabdomyosarcoma. Follow-up study was impossible.
Adult ; Americas ; Anesthesia, General ; Child ; Conjunctiva ; Diagnosis ; Dilatation ; Estrogens, Conjugated (USP) ; Europe ; Exophthalmos ; Headache ; Humans ; Infant ; Male ; Optic Nerve ; Orbit* ; Palpation ; Physical Examination ; Pupil ; Rare Diseases ; Reflex ; Rhabdomyosarcoma* ; Rhabdomyosarcoma, Alveolar ; Skull ; Thumb ; Visual Acuity

The talus is a bone with unique biomechanical features and vascular supply. Although fractures of the talus are not common, the complications of the displaced fractures or dislocation are frequent and resulting disabilities are so severe that the importance of proper management is emphasized. Authors analyzed 17 cases of fracture-dislocation of the talus, treated at Soon Chun Hyang University Hospital from January 1983 to December 1988. The results were as follows:l. Among the 17 cases, there were 15 males and 2 females and the average age was 28 years old, ranged from 21 years to 58 years. 2. The causes were fall from height in 10 cases, traffic accident in 6 and others in one. 3. According to Marti-Weber classification, 2 cases were type I, 5 in type II, 7 in type III and 3 type IV. 4. Among the 17 cases, 9 cases in type I and II were treated conservatively, and 8 cases in thpe III and IV were treated operatively. 5. Complications were avascular necrosis in 3 cases, degenerative arthritis in 4 and nonunion in 1. 6. Final results, evaluated by the criteria of Mindell et al., were as follows: excellent in 7 cases, good in 5, fair in 3 and poor in 2.
Accidents, Traffic ; Classification ; Clinical Study ; Dislocations ; Female ; Humans ; Male ; Necrosis ; Osteoarthritis ; Talus

Authors treated 86 cases of patella fracture during 3 year period from June 1989 to March 1992 at the Dept. of Orthopaedic surgery, Soonchunhyang University. Forty cases of patella fracture showed hypertrophy of longitudinal and transverse diameter of patella during follow-up which were checked by simple radiographs. Completely documented cases were only forty-six, which were followed more than a year and preop. and postop. and final follow-up radiographs were reviewed. Authors measured longitudinal and transverse diameter of patella using preop. and postop and final simple radiographs to observe the morphological changes of patella after treatemnt. The purpose of this paper is to observe. 1. How much the patella was hypertrophied. 2. What kind of factors influence the hypertrophy of the patella, 3. What is the clinical correlation between the hypertrophy of patella and the clinical outcome. The results were as follows 1. Average hypertrophy of longitudinal and transverse diameter were 1.0±2.3mm and 2.5±1.2mm respectively. 2. Only fracture type(simple. vs comminuted.) was significantly related with the changes of longitudinal and transverse diameter of patella(p < 0.1), Other factors(cast immobilization period, operation method and age) show no significant relationship statistically(p>0. 5). And there is no relationship between longitudinal and transverse diameter statistically(p>0.4). 3. Those who showed change of longitudinal diameter between 0-10mm had good knee joint motion(99°±2). But those who showed shortening or lengthening over 10mm of longitudinal diameter had poor knee joint motion(37°±3, 60°±8 respectively). And change of transverse diameter was not related with the clinical result (p>0. 7).
Clinical Study ; Follow-Up Studies ; Hypertrophy ; Immobilization ; Knee Joint ; Methods ; Patella

Surgical reconstruction of the anterior cruciate ligament is undergoing constant evolution. The variable success of these procedures can be attributed to many factors including graft selection, graft placement, graft tensioning, graft remodelling and rehabilitation program. Rigid fixation is probably the most important factor in the success of these procedures during the initial stages of healing. Arthroscopically assisted reconstruction of the ACL-deficient knee using a bone-patellar tendon-bone graft(two-incision technique) is a reliable and evolving technique. Rosenberg et al, described a one-incision technique that allows endosteal fixation of bone plugs within their femoral tunnels intraarticularly via the intercondylar notch. These two techniques are different from their femoral tunnel direction and bone plug placement. The present study was designed to develop a swine model for in vitro biomechanical testing of the bone-patellar tendon-bone ACL autograft to compare the pull-out strength of Outside-In technique and Inside-Out technique. The result were as follows: 1. Normal ACL(N=10 knees) pull-out tensile strength tests showed a maximum tensile strength of 1295.34(N), a stiffness of 120.95(N/mm), and a linear load of 1104.26(N). The failure sites were all tibial attachments. 2. Femoral and Tibial interference fit pull-out tensile strength tests(N=10 knees) showed a maximum tensile strength of 463.23±42.27(N), a stiffness of 33.62±3.18(N/mm), and a linear load of 392.51±95.42(N). The failure sites were all in the tibial tunnel area(N=9 knees), except for one which femoral tunnel area. 3. Inside-Out technique(N=15 knees) showed a maximum tensile strength of 1250.64±75.67(N), a stiffness of 94.31±26.44(N/mm), and a linear load of 1046.92±367.55(N), but the Outside-In tech-nique(N=15 knees) showed a maximum tensile strength of 805.35±54.61(N), a stiffness of 83.33±10.98(N/mm), and a linear load of 685.99±86.32(N)(p < 0.0001). The failure sites were all in the femoral tunnel area. 4. Tensile testing demonstrated that the Inside-Out technique was significantlly stronger than Outside-In technique for maximum tensile strength, stiffness and a linear load.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; In Vitro Techniques ; Knee ; Rehabilitation ; Swine ; Tensile Strength ; Transplants