No abstract available.
Diagnosis*

Total knee arthroplasty has been associated with marked blood loss despite the use of a tourniquet and minimal postoperative suction drainage. The purpose of this study was to determine the effect and complication of topically applied fibrin glue(Tisseel) on blood loss. Fibrin glue was used to coat the operative site with a fibrin clot to determine the effect on postoperative blood loss. We reviewed 71 cemented total knee arthroplasties from June, 1996 to April, 1998. 71 cases of the total knee arthroplasty was composed of 31 case without fibrin glue(Group I), 12 cases with 5cc fibim glue(Group II) and 28 cases with 10cc fibrin glue(Group III). Hemoglobin and hematocrit were assayed before surgery and 1 day after surgery, and we compared the amount of the total blood loss, autotransfusion in each groups. The average amount of total blood loss is 1362cc(775-2150) in group I,1164cc(505-1670) in Group II, 772 cc(380-1410) in Group III. The average amount of autotransfusion is 72.7%(990cc) of total blood loss in group I, 91.4%(1064cc) in group II, 90%(650cc) in Group III, and Group II & III can autotransfuse above 90% of total blood loss. No significant difference was noted in preoperative and postoperative hemoglobin and hematocrit between each groups. Administration of fibrin glue gives a significant reduction of blood loss, enables autotransfusion about 90% of total blood loss, and provide the advantages of safety from transmission of viral diseases and from immunologic reaction. In conclusion, fibrin glue is a safe and effective hemostatic agent for bleeding control after cemented total knee arthroplasty.
Arthroplasty* ; Blood Transfusion, Autologous ; Fibrin Tissue Adhesive* ; Fibrin* ; Hematocrit ; Hemorrhage* ; Knee* ; Postoperative Hemorrhage ; Suction ; Tourniquets ; Virus Diseases

Endoscopic anterior cruciate ligament reconstruction using central one-third of bone-patellar tendon-bone autografts were performed on 76 consecutive patients. 36 patients out of them were reviewed and evaluated with subjective and functional rating scales according to the Lysholm knee scoring system, physical examination and instrumented anterior laxity test. The average follow-up was 2 years and 1 month, ranging from 1 year and 6 months to 3 years and 8 months and the everage age at operation was 31 years old, ranging from 20 to 49 years old. At follow-up, the average Lysholm knee score was 87.2 compared to the average score of 49.5 prior to reconstruction. Physical examination and instrumented anterior laxity test showed that excellent anterior stability was regained in all patients but two. There were 4 cases of complication, a fibrous nodule anterior to reconstructed ACL, an effusion of knee, a thrombophlebits, and an inadequate placement of screw fixation with protrusion of bone peg out of tibial hole. In summary, endoscopic ACL reconstruction using central 1/3 of bone-patellar tendon-bone seems to be a good procedure, which leaves less operative scar, takes short operation time and gives a constant good result as far as the surgeon is familiar with the technique.
Anterior Cruciate Ligament Reconstruction ; Autografts ; Cicatrix ; Follow-Up Studies ; Humans ; Knee ; Lysholm Knee Score ; Physical Examination ; Weights and Measures

Partial meniscectomy was a common method of treatment for a meniscal injury and currently available instruments were scalpel, punch, electrocautery, CO2, laser, Nd: YAG laser, etc. However some methods could cause injuries to adjacent meniscal tissue after meniscectomy. An experimental study was conducted in order to examine the depth of injury to adjacent meniscal tissue according to above 5 different methods of meniscectomy. 25 medial menisci were harvested from Yorkshire pig knee immediately after the death of pig. Meniscal injury, 1.5cm long and 0.5cm wide, was made by using 5 different methods and was analysed macroscopically and microscopically. Average depth of injury was 237 in Nd: YAG laser group. 258um in electrocautery group, 307um in CO2, laser group, and nil in scalpel and punch group. The depth of meniscal injury of Nd: YAG laser and electrocautery group were less than that of CO2, laser group. Scalpel and punch were the most safe methods to adjacent meniscal tissue. CO2, laser, Nd: YAG laser and electrocautery should be carefully applied because they could cause the significant depth of injury in the adjacent meniscal tissue.
Electrocoagulation ; Knee ; Lasers, Solid-State ; Menisci, Tibial ; Methods

The purpose of this paper was to report clinical results and complications of high tibial osteotomy with fibular shaft osteotomy for medial unicompartmental osteoarthritis with varus deformity of the knee. Especially, the complications related to fibular shaft osteotomy were surveyed and analysed. Among one hundred and thirty-one cases which underwent high tibial osteotomy from Nov 1993 to May 1999, twenty-five cases underwent it combined with fibular shaft osteotomy and followed up at least more than 2 years. Average follow-up period were 47 months. Hospital for special surgery(HSS) knee score and femorotibial angle from weight bearing anteroposterior roentgenography of the knee were evaluated and measured. HSS knee score was improved from average 69 points preoperatively to 93 points in average at the final follow-up. Femorotibial angle was varus 2.9 degrees in average preoperatively and improved to valgus 8.1 degrees in average postoperatively and valgus 6.6 degrees at the final follow-up. Complications were tender- ness near to fibular shaft osteotomy in 9 cases, superficial peroneal nerve injury in 8 cases, non-union of fibu- lar osteotomy in 7 cases, non-union or delayed union of tibia osteotomy in 3 cases. High tibial osteotomy with fibular shaft osteotomy was a effective procedure in improving clinical results of osteoarthritis of the knee. However care must be taken to avoid complications rel#ated to fibular osteotomy
Congenital Abnormalities ; Follow-Up Studies ; Knee ; Osteoarthritis ; Osteotomy* ; Peroneal Nerve ; Radiography ; Tibia ; Weight-Bearing

Osteochondroma is one of the most common benign tumor. But, intraarticular occurrence is very rare. This tumor have been thought not a true neoplasm hut a developmental malformation or harnartoma. The authors experienced a case of intaarticular osteochondroma arising from inferior pole of pateUa, projecting into the infrapatellar fat pad. The tumor was excised surgically, and symptoms were relieved.
Adipose Tissue ; Knee ; Osteochondroma* ; Patella*

An electron microscopic study was conducted in order to investigate the healing and maturation process of central one third of donor site patellar tendon which was used for endoscopic anterior cruciate ligament reconstruction. 17 patients among 118 consecutive series, which underwent ACL reconstruction from January 1990 to March 1995, were involved in this study according to various followup periods. At 6 months follow-up, hypercullular and randomly arranged fibrohlasts had abundant cytoplasm with marked irregular cytoplasmic borders and short cytoplasmic extensions. Thc, nuclei of fibroblasts had prominent nuclear indentation with chromatin condensation along the nuclear mernbrane and prominent nucleolus. The cytoplasm contained irregularly dilated rough endoplasmic reticulum, Golgi complex, and pinocytic vesicles. Intercellular space were occupied by newly-formed, immature col)agen fibrills without distinct parallel arrangement, and the diameter of collagen fibrils was unifoimly small. At 12 months, fibroblast and collagen fibrils showed a little matured findings except the small diameter of collagen fibrils. At 24 months, irregular-shaped fibroblasts were still present, which contained folded nuclei, ahundant cytoplasm with large amount of rough endoplasmic reticulum and Golgi complex. Collagen fihril showed also a unimodal distribution pattern with small diameter, however had a tendency to have a regular parallel arrangement. These finding suggest that the donor site of a patellar tendon was still quite different from normal patellar tendon in electron microscopic morphology even at 24 months postoperative follow-up regardless of considerable maturation of regular parallel arrangement pattern of collagen fibril.
Anterior Cruciate Ligament Reconstruction ; Chromatin ; Collagen ; Cytoplasm ; Dronabinol ; Endoplasmic Reticulum, Rough ; Extracellular Space ; Fibroblasts ; Follow-Up Studies ; Golgi Apparatus ; Humans ; Patellar Ligament* ; Tissue Donors*

An experimental study on the effect of the induced dislocation of the femoral head on the femoral anteversion was made in the hips of 55 rabbits, three to four weeks old. The results were as follows; l. In 49 of the 55 operated rabbits, a relative increase of anteversion was observed on the dislocated side, as compared with the nonoperated femur, the differences ranging from 3 to 55 degrees with an average of 20.0 degrees. 2. The anteversion angle of dislocated hip showed steady and gradual increase with the increase of age. 3. The anteversion increase was detected very early after operation; 3 of the 4 rabbits, belonging 4 to 7 days group after operation showed the anteversion increase. 4. The collapse of proximal femoral epiphysis was observed in 42 of the total 55 hips. The incidence of the collapse was higher in postoperative 4 weeks and more groups. 5. The color change, pale discoloration, of the articular cartilage was observed in 32 of the total 55 hips. The icnidence of pale discoloration was higher in the groups within 8 weeks after operation.
Cartilage, Articular ; Congenital Abnormalities ; Dislocations ; Epiphyses ; Femur ; Head ; Hip ; Incidence ; Rabbits

A histological and electron microscopic study were conducted in order to observe a morphological changing pattern of patellar ligament autograft after endoscopic ACL reconstruction. Seventeen patients among 117 consecutive series which underwent endoscopic ACL reconstruction from January 1990 to March 1995, were involved in this study according to the various follow-up periods. In second-look arthroscopic finding at 6 months follow-up after ACL reconstruction, reconstructed ACL was covered with synovium and round-shaped, and after the biopsy active bleeding could be seen. In histological study, 6 months follow-up, spindle or ovoid shaped fibroblast with hypercellularity, high crmp patterns of collagen fiber, and parallel arrangement of fibroblast to collagen fiber were noted. The cellularity of fibroblast decreased in according to periods of follow up. At 12 months follow up, spindle or ovoid fibroblast, its cellularity and arrangement pattern and crimp pattern of collagen fiber seemed to be almost similar to those of normal ACL. This similaryity continued up to 2 years and 2 months after reconstruction. In EM study, until 6 months follow-up after reconstruction, the graft showed randomly arranged fibroblasts with hypercellularity, which had abundant cytoplasm with marked irregular cytoplasmic borders and prominent nuclear indentation, Collagen fibrils were immature and showed a unimodel distribution with small diameter. At 12 months follow-up, elongated fibroblasts appeared, but these cells contained folded nuclei and abundant cytoplasm. Collagen fibrils had parallel arrangement and sparse cross striation, and comprised of mainly small fibrils and scattered large fibrils. After 24 months follow-up, the cellularity decreased more. The regular arrangement of collagen fibrils with wavy pattern similar to normal anterior cruciate ligament was noted. Two distinctive population of the small and large diameter of fibrils was also observed (bimodal distribution). At 26 months, the large and small collagen fibrils compresed a characteric bimodal pattern with parallel arrangement, but the majority of fibroblasts had irregular cytoplasmic contour, and abundant cytoplasm with increased organelles, which indicated the active function. These findings suggest that the graft are still immature even at 26 months in postoperative follow up despite considerable maturation of collagen fibril.
Anterior Cruciate Ligament ; Autografts ; Biopsy ; Collagen ; Cytoplasm ; Fibroblasts ; Follow-Up Studies ; Hemorrhage ; Humans ; Organelles ; Patellar Ligament ; Synovial Membrane ; Transplants

No abstract available.