A variety of substitutes and numerous operative procedures have been described to stabilize the anterior cruciate ligament(ACL) deficient knee. OBJECTIVES: The purpose of this study has been to evaluated the remodelling process of bone-patef- lar tendon-bone(B-PTB) allograft(Tutoplast(r)) for ACL reconstruction by means of light microscopic(LM) and electron microscopic(EM) examinations from the biopsy specimens obtained at the time of second-look arthroscopy. The authors also have been grossly observed the width, vascularity, elasticity and stability of B-PTB allograft. MATERIALS AND METHODS: ACL reconstruction using B-PTB allograft was performed on 22 consecutive patients. Among them, 12 patients were reviewed and the average age at time of operation was 22.5 years ranging from 21 to 40 years. The second look arthroscopy was performed at 6 months, 12 months, 24 months in each of the 4 cases. The gross findings of allograft were observed, and biopsy was done by the method of Millonig. Results; The arthroscopic findings of the reconstructed ACL were partially covered with synovium and narrowed in diameter at 6 months follow up. At 12 months follow up after reconstruction, that grafted ligaments were covered with more synovial membrane, and observed the more thickness with normal strength similar to normal anterior cruciate ligament configuration. At 24 months, grafted ligaments were grossly similar to normal ACL. The LM findings demonstrated many fibroblasts with spindle shape nuclei and and hypercellularity at 6 months. At the 12 months, crimp pattern of collagen bundles and decreased hypercellularity observed. At 24 months, grafted ligament were similar to nomal ACL. The EM findings that fibroblasts were showed abundant cytoplasm which contained marked dilated rough endoplasmic reticulum(r-ER) and aggregates of microfilaments at 6 months. At 12 months, fibroblasts with folded nuclei and abundant cytoplasm were observed. At 24 months, demonstrated the fibroblasts with abundant cytoplasm and densely packed collagen fibrils. Collagen fibrils displayed parallel arrangement and characteristic cross striation with a periodicity. Scanning EM findings showed uniformly small diameter of collagen in the transeverse section. CONCLUSIONS: Gross & LM findings of B-PTB allograft were similar to that of normal ACL at 6 months, and at 12 months, postoperatively. But EM findings of B-PTB allograft were compared with the biopsy samples of normal ACLs, the allograft was still undergoing maturation 24 months postoperati vely.
Actin Cytoskeleton ; Allografts* ; Anterior Cruciate Ligament* ; Arthroscopy ; Biopsy ; Collagen ; Cytoplasm ; Elasticity ; Fibroblasts ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Patella* ; Patellar Ligament* ; Periodicity ; Prospective Studies* ; Surgical Procedures, Operative ; Synovial Membrane ; Transplants

The breakage of component is rare in TKA and usually restricted to hinges and linked design. Occasionally fracture of metal tibial component has been noted, but fracture of the femoral component has been rarely reported and occurred to be a significaot problem in TKA. This study reports 2 cases of femoral component fracture using Whiteside Ortholoc total knee system and analyzes the cause of this phenomenon. One pahent, a 67 years old female who weighed 74kg, was performed 1ke left TKA using Whiteside Ortholoc g system with cement. The size of feraoral component was small plus, and small tibial component, 14mm tibial insert and 28mm pateBa were used, The medial site of femoeal component fractured at 38 months postoperatively. A second female patient, who weighed 68kg and was 64 years old at the time of surgery, had also the left TKA using a medium sized femoral component of Whiteside Ortholoc modular system with cement. The small-Ex large tibial component, 8rrun tibial insert were used, but did not replace the pateBa. Also at 37 mainths postaperatively the medial site of femoral compcnent fractured, Ail cases were revised with using a cemented P,F.C. Modular Total Knee System (Johnson k Johnson). All two cases were kactured at the junction between the posterior bevel md distal surface of the medial femoral condyle. The thickness and length of Whiteside Ortholoc femoral component are thinner and shorter at posterior bevel surface compared with other TKA systems. So it is encouraging that a minor design modification of Whiteside Ortholoe femoral component and also should be edueated for the prohibihon of excessive flexion of the knee joint after TKA.
Aged ; Female ; Humans ; Knee Joint ; Knee* ; Middle Aged

Medial approach open reduction (MAOR) for congenital dislocation of the hip, as is well known, is the most anatomically direct approach to the major obstacle to reduction. For the study on this method of open reduction, the authors reviewed 15 children who underwent MAOR and followed up to at least 1 year after operation with an average of 3 years and 2 months. The results were as follows: 1. The age distributions of the 15 children were; 1 child in below 12 months of age, 10 in 13 to 18 months, and 4 in 19 to 24 months. 2. The acetabular index was high before operation with an average of 32.7° (25-43). This improved makedly in the follow-up period to an average of 20.6° (13-29) . 3. The average of acetabulum-head index was 70.6° and the average of CE angle was 19.7° in the follow-up. 4. The complications were 2 cases of avascular necrosis and 1 case of redislocation. No contracture of joint was observed. 5. For the residual dysplasia of acetabulum,innominate osteotomy of Salter was performed in 2 children and was scheduled in the other 5 children. 6. It can be stated that MAOR is a very safe, simple and effective method of open reduction.
Acetabulum ; Age Distribution ; Child ; Contracture ; Dislocations ; Follow-Up Studies ; Hip ; Humans ; Joints ; Methods ; Necrosis ; Osteotomy

The purpose of this study is to evaluate the short-term results of the reconstruction of acetabular bone defect radiographically. Twenty three reconstruction with bone graft and non-cemented porous hemispherical cup and one reconstruction with bone graft and cemented polyethylene cup that had been performed in 24 patients from 1991 at Wonkwang University Hospital and had followed more than one year were included in this study. Osseous union, resorption of the graft, the amount of the migration and angle change of the acetabular components and radiolucency were checked on plain X-ray. 9 morselized grafts for contained defect showed 100% union within 6 months, without severe resorption and loosening. Of the 15 structural grafts, 11 minor column or shelf grafts showed 100% union and remodeling, and one case of radiolucency around the cup. There were two collapses of the structural graft and one migration of the cup which suggest the failure among the 4 major column grafts. For the above 3 failed cases, non-cemented porous hemispherical cups were used. In conclusion, bone graft for reconstruction of the deficient acetabular bone stock seems to be suc- cessful, but the use of cement and the delay of weight bearing should be considered for the major column graft.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Humans ; Polyethylene ; Transplants* ; Weight-Bearing

No abstract available.
Anterior Cruciate Ligament* ; Magnetic Resonance Imaging*

Peripheral nerve injury is relatively common in post-trauma surgery. Although various microsurgical techniques and repair methods can recover the continuity of the injurcd nerve. But, functional recovery achive is difficult. The purpose of this study examines the effect of electrical stimulation on muscle strength or sensibility increase in hrachial plexus injury with clinical results. We have retrospectively analyzed 44 cases of brachial plexus injury. The group(20 cases) which received nerve surgery and electrical stimulation was compared with the group(24 cases) which received nerve surgery only. Electrical stimulation was performed to nerve for axonal regeneration-strength & sensibility(18 cases) and to muscle for strengh(2 cases). All cases had heen evaluated for motor power recovery by 24 months after nerve surgery. A significant difference(P<0.05) between the power of elhow flexion and shoulder abduction, hut not sensibility of forearm in the two groups suggests that electrical stimulation to nerve or muscle enhanced the progress of nerve regeneration or muscle strength respectively. The results suggest that electricai stimulation is promising supplementary method for functional recovery in brachial plexus injury.
Axons* ; Brachial Plexus* ; Electric Stimulation* ; Forearm ; Muscle Strength ; Nerve Regeneration ; Peripheral Nerve Injuries ; Regeneration* ; Retrospective Studies ; Shoulder

No abstract available.
Posterior Cruciate Ligament*

No abstract available.
Olecranon Process* ; Ulna*

INTRODUCTION: The reconstructions of posterior cruciate ligament (PCL) has been increasing because of increased incidence of insufficiency of the PCL and improved surgical skill Arthroscopic operation is known better than open in cruciate ligamet reconstruction in many respects. Arthroscopic PCL reconstruction, especially using hanstring tendon has some benefits. This study is retrospective study analyzing 20 patients treated by arthroscopically assisted PCL reconstruction using hamstring tendon. ALATERIAL AND METHODS: From November 1993 to June 1996, 20 patients with PCL insufficiency had heen treated by arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon by first author. The isometric point was located slightly posterosuperior than anatomic attachment in femur and 0.8-1.0cm below articular margin in tibia. They were confirmed by intraoperative fluoroscopy. The remnants of intact PCL bundle and meniscofemoral ligaments were preserved and added to the graft. They were nineteen men and one women, with a mean age 31.8 years (range, 15-56 years). RESULTS: The results were as follows; 1. The patients were followed from 13 months to 44 months after operation (average 2years and 2months ). 2. Post operative neurovascular irjuries were not found. 3. No revision case was observed and second operations were made in two cases with posterolateral rotatory instability after primary reconstruction. 4. All patient has no symptom of instability after operation. S. At last follow up, Lyshohn knee scores improved from 62 preoperatively to 89 postoperati.vely on average. CONCLUSION: Arthroscopically assisted PCL reconstruction using double-looped hamstring (semitendinosus and gracilis) tendon is easier and less damage than using bone-patellar tendon-bone graft. It preserves intact meniscofemoral ligament, some intact fibers of PCL bundle and quadriceps mechanism. We think it is a effective treatment for PCL insufficiency patients."
Bone-Patellar Tendon-Bone Grafts ; Female ; Femur ; Fluoroscopy ; Follow-Up Studies ; Humans ; Incidence ; Knee ; Ligaments ; Male ; Posterior Cruciate Ligament* ; Retrospective Studies ; Tendons* ; Tibia ; Transplants

OBJECTIVE: Locking of the knee is usually attributed to a tear of meoiscus, or to a loose body that rnechanically obstructs the motion of joint. A less frequently recognized cause of a locked knee is a partial tear of the ACL. The purpose of this study is to report that the partial tear of,the ACL at the femoral attachment site of posterolateral bundle provided a mechanical obstruction in the knW, and it is convicted the injury mechanism of isolated ACL. MATEIRALS AND METHODS: The author presents 16 cases in which the torn ACL was observed knee locking under arthroscopy fram February 1993 to June 1996. Patients ages ranged from 22 to 54 years. The mechanism of injuries were 6 sports activity (Ski 4, Soccer 1, Badminton 1), 4 slip down, 3 pedestrian car accidents and 3 unknown causes with especially low velocity injuries. Although the chief complain in each case was knee pain, all had locking knee that, on physical examination, locked from 5 to 20 of full extension, and 4 locked full flexion. The positive Lachman test was obtained 3 of the 16 paiients. Associated intraarticular injuries were 2 tears of the medial meniscus, 1 lateral meniscus. RESULTS: The average time to arthroscopy was 3 nonths with a range of 1 month to 10 rnonths. An arthroscopic diagnosis and treatment were performed and meniscal tears were ruled out as the cause of locking in all patients. The injury mechanism of isolated ACL was the hyperextensioo of the knee with leg I/R and especially low velocity injuries. The ACL was found to have a partial tear at the site of femoral attachment of an estimated P-L bundle. The torn segment of the ACL to become interposed between the lateral femoral condyle and the latera1 tibial condyle and to act as mechanical block was demcinstrated. CONCLUSION: In all cases, the torn portion of the ACL was excised under arthroscopy and knee locking was resolved.
Arthroscopy ; Diagnosis ; Humans ; Joints ; Knee* ; Leg ; Menisci, Tibial ; Physical Examination ; Racquet Sports ; Soccer ; Sports