STUDY DESIGN: 3 cases report. OBJECTIVES: We present 3 cases of cervical myelopathy treated successfully by selective laminoplasty on 2 levels or less, using Kurokawa technique with a review of the relevant articles. SUMMARY OF LITERATURE REVIEW: As there were no clear criteria for the numbers of the laminae that require decompression in a standard laminoplasty, a wide level laminoplasty from C3 to C7 has been generally done. As a result, complications such as axial pain, C5 root paresis, and loss of range of motion have been reported commonly. To reduce these complications, recent studies have attempted less invasive procedures, such as selective laminoplasty or preservation of posterior ligament and muscle components. MATERIALS AND METHODS: There were two cases of developmental stenosis and one posterior compressive stenosis that underwent selective laminoplasty. The posterior shift of the spinal cord and the dural expansion were measured by magnetic resonance imaging at 3 or 4 weeks after surgery. Clinical outcomes were evaluated by Japanese Orthopedic Association (JOA) score. Axial pain was classified as follows; never: Grade 0; mild: Grade 1; moderate: Grade 2; and severe: Grade 4. RESULTS: The spinal cord had a tendency to shift posterioly and the dura mater was expanded in all cases. Clinical outcomes and axial pain were also improved in all. CONCLUSIONS: Selective laminoplasty that enabled the surgeon to perform a less invasive surgery preserving operative time and the patient to have a lower risk of C5 root paresis is effective for the developmental stenosis or posterior compressive stenosis less than 3 levels.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Dura Mater ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Muscles ; Operative Time ; Orthopedics ; Paresis ; Range of Motion, Articular ; Spinal Cord ; Spinal Cord Diseases

Functional knee braces are commonly prescribed to support anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the current literature on the use of functional knee braces of ACL with respect to biomechanical, clinical and functional outcomes. A literature search was conducted (2000 to 2017) by two independent reviewers using PubMed MEDLINE database. Articles were retrieved by an electronic search using keywords (anterior cruciate ligament, brace, and bracing) and their combinations. Current functional braces used to treat ACL injury were identified. Studies that met inclusion criteria were assessed for pertinent data. Fourteen studies met the inclusion criteria. Functional knee brace reportedly did not improve long-term clinical and functional outcomes following ACL reconstruction, but some studies suggest that functional brace may have some benefit with regard to biomechanics, proprioception, and subsequent injury rates. Functional knee brace after ACL reconstruction was found no significant difference in clinical and functional outcomes. But Further large-scale recent studies will be required to determine long-term outcomes of the brace.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament* ; Braces* ; Knee ; Ligaments ; Proprioception

Damage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. For these reasons, several techniques have been developed to repair the medial meniscus posterior root tear (MMPRT), many of which have shown complete healing of the repaired MMPRT. However, efforts to standardize or optimize the treatment for MMPRT are much needed. When planning a surgical intervention for an MMPRT, strict surgical indications regarding the effect of pullout strength on the refixed root, bony degenerative changes, mechanical alignment, and the Kellgren-Lawrence grade should be considered. Although there are several treatment options and controversies, the current trend is to repair the MMPRT using various techniques including suture anchors and pullout sutures if the patient meets the indications. However, there are still debates on the restoration of hoop tension and prevention of arthritis after repair and further biomechanical and clinical studies should be conducted in the future. The aim of this article was to review and summarize the recent literature regarding various diagnosis and treatment strategies of MMPRT, especially focusing on conflict issues including whether repair techniques can restore the main function of normal meniscus and which is the best suture technique to repair the MMPRT. The authors attempted to provide a comprehensive review of previous studies ranging from basic science to current surgical techniques.
Arthritis ; Diagnosis ; Humans ; Knee ; Menisci, Tibial ; Suture Anchors ; Suture Techniques ; Sutures

The optimal treatment for combined osteochondritis dissecans (OCD) with considerable bony defect of the lateral femoral condyle (LFC) and torn discoid lateral meniscus is unclear. We present a case of a 15-year-old female who was a gymnast and had a large OCD lesion in the LFC combined with deficiency of the lateral meniscus. The patient underwent the "one-step" technique of osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation after a failure of meniscectomy with repair at another hospital. Twenty-four months postoperatively, clinical results were significantly improved. Follow-up imaging tests and second-look arthroscopy showed well incorporated structured bone graft and fibrous cartilage regeneration as well as stabilized lateral meniscus allograft. She could return to her sport without any pain or swelling. This "one-step" surgical technique is worth considering as a joint salvage procedure for massive OCD lesions with torn discoid lateral meniscus.
Adolescent ; Allografts ; Arthroscopy ; Autografts ; Cartilage ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Menisci, Tibial ; Osteochondritis Dissecans ; Regeneration ; Sports ; Tears ; Transplantation ; Transplants

BACKGROUND: The purpose of this study is to report a modified transtibial technique to approach the center of anatomical femoral footprint in anterior cruciate ligament (ACL) reconstruction and to investigate the accurate femoral tunnel position with 3-dimensional computed tomography (3D-CT) and radiography after reconstruction. METHODS: From December 2010 to October 2011, we evaluated 98 patients who underwent primary ACL reconstruction using a modified transtibial technique to approach the center of anatomical femoral footprint in single bundle ACL reconstruction with hamstring autograft. Their femoral tunnel positions were investigated with 3D-CT and radiography postoperatively. Femoral tunnel angle was measured on the postoperative anteroposterior (AP) radiograph and the center of the femoral tunnel aperture on the lateral femoral condyle was assessed with 3D-CT according to the quadrant method by two orthopedic surgeons. RESULTS: According to the quadrant method with 3D-CT, the femoral tunnel was measured at a mean of 32.94% +/- 5.16% from the proximal condylar surface (parallel to the Blumensaat line) and 41.89% +/- 5.58% from the notch roof (perpendicular to the Blumensaat line) with good interobserver (intraclass correlation coefficients [ICC], 0.766 and 0.793, respectively) and intraobserver reliability (ICC, 0.875 and 0.893, respectively). According to the radiographic measurement on the AP view, the femoral tunnel angles averaged 50.43degrees +/- 7.04degrees (ICC, 0.783 and 0.911, respectively). CONCLUSIONS: Our modified transtibial technique is anticipated to provide more anatomical placement of the femoral tunnel during ACL reconstruction than the former traditional transtibial techniques.
Adolescent ; Adult ; Anterior Cruciate Ligament Reconstruction/*methods ; Female ; Femur/*radiography/surgery ; Humans ; Imaging, Three-Dimensional/*methods ; Male ; Middle Aged ; Surgery, Computer-Assisted/*methods ; Tibia/radiography/surgery ; Tomography, X-Ray Computed/*methods

Anterior cruciate ligament (ACL) rupture leads to weakened quadriceps muscle strength and a decline in proprioception, impairing the neuromuscular control of the lower extremities. ACL reconstruction, aimed at addressing such structural and functional instability, has become a primary treatment method for young and active patients. Consequently, there have been significant advancements in surgical techniques, resulting in improved clinical outcomes. However, achieving successful outcomes after ACL reconstruction is not solely dependent on the surgery itself; pre- and postoperative rehabilitation and management are equally crucial. A well-designed functional recovery program based on medical evidence before and after ACL reconstruction plays a vital role in restoring function to preinjury levels. The process of the functional recovery program, from presurgery to sports return, should adhere to certain principles. These principles involve prompt and accurate clinical diagnosis and patient classification after injury, systematic programs addressing joint swelling and inflammation control, reduction of arthrogenic muscle inhibition, restoration of range of motion, muscle strength recovery, and proprioception restoration. Postoperatively, it is essential to go beyond traditional methods (such as range of motion restoration and muscle strengthening) by implementing a functional recovery program that includes enhancement of proprioception and neuromuscular control system from the early stages, considering the biological healing response of the graft. This comprehensive approach is vital for achieving optimal outcomes in the recovery of function after ACL reconstruction.

n patients who have undergone knee joint surgery or suffer from osteoarthritis, weakened quadriceps muscle strength is often observed. This can lead to various pathological issues in the long term, such as abnormal gait and persistent knee pain. Due to the need to protect against pain or surgical site complications, high-intensity exercise is often restricted for most patients with muscle atrophy in the knee joint due to surgery or osteoarthritis or surgery. To overcome this challenge, various methods are being attempted, including exercise combined with neuromuscular electrical stimulation, blood flow restriction (BFR) exercise, and biofeedback exercise. Recently, BFR exercise has garnered attention in line with these strategic trends. Applying low-intensity BFR exercise to patients who have undergone anterior cruciate ligament reconstruction surgery or suffer from knee joint osteoarthritis, most studies report improvements in strength, muscle mass, and functional enhancement of the knee joint. Compared to non-BFR high-intensity exercise, it has been reported that increases in maximal strength and muscle mass are similar, but pain reduction is superior with BFR exercise. Engaging in low-intensity BFR exercise for a sufficient duration can minimize the risk of injury associated with high-intensity exercise while maximizing the exercise’s effectiveness, leading to symptom improvement and enhancement of knee joint function. Furthermore, when conducted according to specified manuals, the likelihood of cardiovascular imbalance, muscle damage, thrombosis, and embolism due to BFR is low, making it a safe rehabilitation method.

BACKGROUND: This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. METHODS: ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). RESULTS: The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. CONCLUSIONS: The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Arthroscopy ; Follow-Up Studies ; Joints ; Knee ; Lysholm Knee Score ; Magnetic Resonance Imaging ; Regeneration ; Tendons ; Transplants ; Ultrasonography

BACKGROUND: The present study aimed to evaluate the prevalence of patellofemoral osteoarthritis (PFOA) and identify the factors that affect PFOA development after single-bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft. We hypothesized that detecting these factors could be helpful in establishment of a rehabilitation strategy to focus on the modifiable factors. METHODS: Of the 324 patients who underwent primary ACL reconstruction between January 2010 and June 2013, 92 patients who were available for follow-up for a minimum of 36 months after the surgery and underwent second-look arthroscopy were enrolled. Subjective assessments and clinical outcome evaluation were conducted. Arthroscopic cartilage evaluation was done using the Outerbridge classification. Univariable and multivariable logistic regression analyses were used. RESULTS: Ninety-two patients were evaluated at an average of 38.9 ± 5.4 months of follow-up. PFOA above grade 2 was observed in 19 patients (20.7%) at the second-look arthroscopy. Of them, three patients with pre-existing PFOA (3.3%) showed progression of the Outerbridge grade, and 16 (17.4%) had newly developed PFOA. According to the multivariable logistic regression analysis, isokinetic extensor deficit at 60°/sec at the last follow-up (odds ratio [OR], 2.193; 95% confidence interval [CI], 1.081 to 12.439; p = 0.031), age at primary surgery (OR, 1.118; 95% CI, 1.019 to 1.227; p = 0.018), and concurrent meniscectomy at primary surgery (OR, 0.091; 95% CI, 1.012 to 1.177; p = 0.023) were the significant predictors of PFOA development. CONCLUSIONS: Significant predictors of PFOA after ACL reconstruction with hamstring autograft were decreased quadriceps strength at last follow-up, increased age, and concurrent meniscectomy at primary surgery. Quadriceps weakness as a modifiable factor should be considered in the establishment of a rehabilitation strategy to prevent PFOA after ACL reconstruction, especially in older age.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Arthroscopy ; Autografts* ; Cartilage ; Classification ; Follow-Up Studies ; Humans ; Logistic Models ; Osteoarthritis* ; Prevalence* ; Rehabilitation ; Risk Factors ; Tendons*

Epicanthoplasty with or without double-eyelid operation is one of the most commonly performed aesthetic procedure in Korea. Although many techniques have been described for the elimination of epicanthal folds, scarring and complexity in design are still barriers for surgeons to overcome. Epicanthoplasty using Hiraga's method was used to minimize these problems. From September of 1996 to July of 2002, the authors performed epicanthoplasty using Hiraga's method on the eyelids of 117 Asian patients to correct epicanthal folds. Results were satisfactory in almost all patients, with no significant complications. Scarring was acceptable. Mean reduction of intercanthal distance was 3.7 mm and mean operation time was within 10 minutes. Hiraga's method is most effective in patients with mild to moderate epicanthal fold. The advantages of this procedure are simplicity in design and short operation time. Most of all, it's technically simple and easy to perform.
Asian Continental Ancestry Group ; Cicatrix ; Eyelids ; Humans ; Korea