From March 1992 to June 1994, we experienced five failed cases of anterior cruciate ligament reconstruction. Four out of five cases had reconstruction in other hospitals. Two of them had anterior cruciate ligament reconstruction using artificial ligament, one using bone-patellar tendon-bone auto- graft, and one using bone-patellar tendon-bone autograft augmented by artificial ligament. The remaining one case had arthroscopic anterior cruciate ligment reconstruction using bone-patellar ten- don-bone autograft in Asan Medical Center. We performed arthroscopic revision anterior cruciate ligament reconstruction using allograft in four cases and bone-patellar tendon-bone autograft in one case. All cases were treated with vigorous postoperative rehabilitation program including postoperative immediate range of motion(ROM) exercise and muscle strengthening exercise. Postoperative results were evaluated by Lysholm knee score in average 17.2 months(range from 12 months to 25 months). The average Lysholm score improved from 49.8 to 81.4. At follow-up study, anterior drawer test with Telos device revealed 2mm of average side to difference.
Allografts ; Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Arthroscopy ; Autografts ; Chungcheongnam-do ; Follow-Up Studies ; Ligaments ; Lysholm Knee Score ; Rehabilitation ; Transplants

PURPOSE: To obtain basic anatomical data of proximal humerus of Korean adult skeleton. MATERIALS AND METHODS: Fifty-two dry humeri of Korean adults were measured with a caliper and goniometer. Measured parameters were retroversion, angle of the bicipital groove, bicipital groove-shaft angle, neck-shaft angle, diameters of the humeral head, dimension of the greater tuberosity, distance between humeral head and greater tuberosity, and length of the humerus. All of the eight parameters were measured twice. The correlations between retroversion and diameters of the humeral head, retroversion and length of the humerus, retroversion and angle of the bicipital groove, diameters of the humeral head and length of the humerus were analyzed by student t-test using SAS system. RESULTS: Retroversion was 34.2 degree with high individual variation, ranging from 17.0 degree to 50.0 degree. The angle of the bicipital groove was 36.2 (22.0-54.0) degree. The bicipital groove-shaft angle was 7.4 (1.0- 16.0) degree. The neck-shaft angle was 136.3 (120.0-150.0) degree. The superior-inferior diameter of the humeral head was 43.3 (35.5-52.0) mm, and anterior-posterior diameter was 39.9 (33.5-46.0) mm. The dimension of the greater tuberosity was 29.8 (19.0-46.0) mm, and the distance between humeral head and greater tuberosity was 7.9 (4.5-12.0) mm. The length of the humerus was 303.7 (265.0-388.0) mm. There was significant correlation between the head diameters, the retroversion, and the length, but no correlation between the retroversion and the angle of the bicipital groove. CONCLUSIONS: It is suggested that high individual variation of retroversion should be considered in case of arthroplasty. The humeral head was elliptical in shape. The mean narrow diameter of the humeral head was about 40 mm. The greater tuberosity was about 30 mm in dimension, and located 8 mm inferior to the humeral head. The bicipital groove was not a reliable reference in determining retroversion.
Adult* ; Arthroplasty ; Head ; Humans ; Humeral Head ; Humerus* ; Skeleton*

STUDY DESIGN: A prospective study. OBJECTIVES: To introduce a new technique, direct vertebral rotation (DVR), and to compare the surgical results with those of a simple rod derotation (SRD). SUMMARY OF BACKGROUND DATA: Pedicle screw fixation, with a simple rod derotation maneuver, enables powerful coronal and sagittal plane corrections in scoliosis surgery. However, the ability for rotational correction is still unclear. METHODS: Thirty-eight AIS patients, treated with segmental pedicle screw fixation, were analyzed. The first group (n=17) was treated by DVR, and the second (n=21) by SRD. Having similar preoperative curve patterns, both groups were evaluated for the deformity correction and spinal balance. RESULTS: In the DVR group, the average preoperative AVR of 16.7 degrees was corrected to 9.6 degrees, showing a 42.5% correction, while in the SRD group, the correction was negligible, from 16.1 degrees to 15.7 degrees(2.4%). In the DVR group, the preoperative thoracic curve of 55 degreeswas corrected to 12 degrees(79.6%), and the lumbar curve from 39 degreesto 7 degrees(80.5%). In the SRD group, the preoperative thoracic curve of 53 degreeswas corrected to 17 degrees(68.9%), and the lumbar curve from 39 degreesto 16 degrees(62.2%). The average LIVT correction was 80.6 and 66.3% in the DVR and SRD group, respectively. There were statistically significant differences in the coronal curve, LIVT and rotational correction (p<0.05, Mann-Whitney u test). CONCLUSIONS: The segmental pedicle screw fixation with 'direct vertebral rotation'showed better rotational and coronal corrections than the 'simple rod derotation'.
Adolescent* ; Congenital Abnormalities* ; Humans ; Prospective Studies ; Scoliosis*

STUDY DESIGN: This is a retrospective study evaluating the efficacy of new surgical technique for treatment of fixed lumbosacral kyphosis. OBJECTIVES: To report a new method of vertebral column resection and to determine its efficacy in the treatment of fixed lumbosacral kyphosis. SUMMARY OF BACKGROUND DATA: The treatment of fixed severe spinal deformity is very difficult and only a few surgical methods are reported. The vertebral column resection from anterior and posterior is a radical method to treat the severe deformity but it has many problems with anterior and posterior approachs. MATERIALS AND METHODS: A new surgical method of vertebral column resection from posterior approach only(PVCR) was carried out in 5 patients of fixed lumbosacral Tb kyphosis from October 1997 to March 1998. The mean age was 43.4 years(range 35-61 years), and four were female and one male. The average postoperative follow-up period was 5.5 months(ranged from 2 months to 12 months). An average of 2.6 vertebrae was resected. The degree of sagittal curves was measured using the Cobb technique preoperatively and postoperatively. the rejional lumbosacral kyphotic angle and compensatory thoracic curvature from 74 to 712. The sagittal imbalance was measured by distance from C7 plumb line to postero-superior corner of 51 using 14 x 36 inch standing lateral radiograph. RESULTS: The sagittal deformities were corrected from an average of kyphosis 37.4 to lodosis 8.4 at lumbosacral level and from an average of lodosis 31.6 to lodosis 8.2 at thoracic level. The sagittal imbalance was improved from an average of +11.7cm to +2.2cm, for a posterior immigration of 9.5cm. The mean operating time was 334 minutes and with an average blood loss of 4338m1. Complication comprised of motor weakness with deep wound infection in one case and superficial wound infection in another case. The transient hip flexor weakness was seen in all the patients. The hip flexor power recovered in 3-4 weeks. The patient of motor weakness and deep infection showed partial motor improvement and complete wound healing at last 2 month follow-up. CONCLUSION: one-stage posterior vertebral column resection is a promising technique for treatment of the severe fixed lumbosacral kyphosis.
Congenital Abnormalities ; Emigration and Immigration ; Female ; Follow-Up Studies ; Hip ; Humans ; Kyphosis* ; Male ; Retrospective Studies ; Spine* ; Wound Healing ; Wound Infection

STUDY DESIGN. This is a retrospective study. OBJECTIVES. To verify the advantage of segmental pedicle screw fixation in restoration of thoracic kyphosis in hypokyphotic patients. SUMMARY OF BACKGROUND DATA. Restoration of thoracic kyphosis is essential for a satisfactory three dimensional correction in thoracic AIS. However, with significant preoperative hypokyphosis, the result of multiple hook fixation was often unsatisfactory. METHODS. Fifty-one patients with thoracic AIS treated by posterior instrumentation and followed up for more than 2 years were divided into 3 groups each comprising 17 patients. Hypokyphosis- Hook(HH) group comprised patients with thoracic kyphosis less than 15degrees treated by multiple hooks. Hypokyphosis-Screw(HS) group comprised hypokyphotic patients treated by segmental pedicle screws. Normal kyphosis-Screw(NS) group comprised patients with kyphosis greater than 15degrees treated by segmental pedicle screws. Preoperative thoracic kyphosis was 4.1+/-8.6degrees, 8.1+/-5.6degrees and 27.3+/-9.8degrees in the HH, HS and NS group respectively. There was no significant difference between the HH and HS groups(p=0.39). Three groups were compared for restoration of thoracic kyphosis. Results. At the final follow up, the thoracic kyphosis was 14.5+/-10.2degrees, 27.3+/-11.3degrees and 28.3+/-3.7degrees in the HH, HS group and NS group showing correction of 10.0+/-10.0degrees, 19.2+/-14.0degrees and 0.4+/-12.3degreesrespectively. There was a significant difference between HH and HS group(p=0.0008). However there were no difference between tile HS and the NS group(p=0.8). CONCLUSIONS. Segmental pedicle screw fixation was more effective than multiple hooks in restoring the thoracic kyphosis in AIS patients with hypokyphosis. The restored kyphosis was similar to that obtained in patients without hypokyphosis.
Adolescent* ; Follow-Up Studies ; Humans ; Kyphosis* ; Retrospective Studies

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the surgical results between anterior-posterior surgery and posterior eggshell procedures in post-traumatic kyphosis with neurologic compromised osteoporotic fracture. SUMMARY OF LITERATURE REVIEW: Combined anterior-posterior surgery is usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, it is associated with significant morbidity in elderly patients. MATERIALS AND METHODS: Twenty-six post-traumatic kyphosis with neurologic compromised osteoporotic fracture patients subjected to either anterior-posterior surgery (n=11) or posterior egg-shell procedure (n=15) were analyzed. The average age at the operation was 62.6 years (range: 50-82), male : female ratio was 12 : 14, and the average follow up was 2.9 years (range:2.0-4.9). Preoperative interval from injury to operation was 15.4 months (range: 1-36). Thoracolumbar (T12-L1) fracture was in 20 and lumbar fracture was in 6. RESULTS: There was no significant difference in age, sex, preoperative and postoperative Frankel grade, and preoperative vertebral collapse between two groups(p<0.05). In anterior-posterior group, the mean operation time was 351 minutes with a mean blood loss of 2892 ml, and preoperative kyphosis of 22 degrees was corrected to 11 degrees at latest follow-up with 7 cases of neurologic improvement. In the eggshell group, the mean operative time was 215 minutes with blood loss of 1930 ml, and preoperative kyphosis of 34 degrees was corrected to 8 degrees at latest follow-up with 11 cases of neurologic improvement. Egg-shell group showed significantly less operation time and blood loss with beter kyphosis correction. In anterior-posterior group, postoperative pneumonia was developed in 2 and superficial infection in 1. Distal screw loosening was detected in 4, 2 in anterior-posterior group and 2 in posterior eggshell group. One of them was treated by revision and others were treated by brace more than 6 months. CONCLUSIONS: Posterior eggshell procedure showed a better kyphosis correction with significantly less operation time and blood loss. It is a preferable alternative to anterior-posterior surgery in post-traumatic kyphosis with neurologic compromised osteoporotic fracture.
Aged ; Braces ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Kyphosis* ; Male ; Neurologic Manifestations ; Operative Time ; Osteoporosis ; Osteoporotic Fractures* ; Pneumonia ; Retrospective Studies

STUDY DESIGN: A retrospective study. OBJECTIVES: To report the results and techniques of posterior vertebral column resections for fixed lumbosacral deformity. SUMMARY OF LITERATURE REVIEW: Fixed lumbosacral deformity results in gross imbalance and progressive compensatory thora-columbar deformity due to the absence of a mobile spine caudally. MATERIAL AND METHODS: Twenty-five consecutive fixed lumbosacral deformity patients subjected to PVCR were reviewed after a minimum follow-up of 2 years. The offending vertebra was below the L4 in all cases. The etiological diagnoses were congenital scoliosis, congenital kyphoscoliosis, post-traumatic kyphosis and post-infectious kyphosis in 6, 3, 2 and 14 patients, respectively. The average age at the time of operation was 38 years, with a male:female ratio of 7:18. The indication for PVCR was fixed lumbosacral deformities that could not be brought to a reasonable balance on traction or forced side bending. RESULTS: On average 2.1, ranging from 1 to 5, vertebrae were removed, with 52 removed in all. The average fusion extent was 4.5 vertebrae, ranging from 2 to 8. An anterior column reconstruction was carried out with an autogenous bone graft in all patients, with the additional insertion of titanium mesh in 12. The distal anchor went down to the L5, S1 and S2 in 4, 12 and 9 patients, respectively. A preoperative scoliosis of 3812 was corrected to 158 (60% correction), and a preoperative kyphosis of 3525 was corrected to -511 (40% correction). A preoperative coronal imbalance of 2.0cm was improved to 0.9cm, and a preoperative sagittal imbalance of 9.3 cm was improved to 4.6 cm. The mean operation time and blood loss were 280 minutes and 2810ml, respectively. Following complications were encountered in 5 patients: 2 transient neurologies, 2 compression fractures at proximal adjacent vertebra and 1 pseudoarthrosis. CONCLUSIONS: A posterior vertebral column resection is an effective procedure for the management of a fixed lumbosacral deformity. It provides satisfactory correction and improved functional outcomes. However, it is a technically demanding and exhausting procedure, with possible risks for complications
Congenital Abnormalities* ; Diagnosis ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphosis ; Pseudarthrosis ; Retrospective Studies ; Scoliosis ; Spine* ; Titanium ; Traction ; Transplants

PURPOSE: To clarify whether the bone resorption in femur measured by the expression of OPG & RANK-L was increased in tail suspended rat. MATERIALS AND METHODS: Four-week-old female Sprague Dawley rats were divided into two groups. The experimental group (n=79) was housed and fed with 2 weeks of tail suspension, and reloaded for 8 weeks without tail suspension. The control group (n=46) was housed and fed for 10 weeks without tail suspension. Bone mineral densities, serum levels of ALP and TRAP were measured in both groups. The expressions of the mRNAs of OPG and RANK-L were analyzed by RT-PCR. RESULTS: The ALP and TRAP were increased in the experimental group during both tail suspension and reloading, which reflected the increased bone metabolism in the experimental group. In femur of the experimental group, the expression of the mRNA of RANK-L was increased during tail suspension, and the expression the mRNA of OPG was decreased. With reloading, the expression of the mRNA of RANK-L in femur was decreased, while the expression of the mRNA of OPG was increased.
Animals ; Bone Density ; Bone Resorption ; Female ; Femur ; Hindlimb Suspension ; Humans ; Metabolism ; Osteoclasts ; Osteoporosis* ; Osteoprotegerin ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Tail*

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The purpose of the study was to determine the efficacy of pedicle screw fixation in treatment of congenital scoliosis. SUMMARY OF BACKGROUND DATA: Surgical correction of rigid congenital scoliosis often ends up in less than satisfactory results. Pedicle screw fixation, enabling a rigid fixation with improved holding power may enhance the correction of these tenacious deformities. METHODS: Twenty one congenital scoliosis treated by combined anterior release and posterior correction were analyzed after minimum follow up of 2 years (range 2-9 years). There were 11 males and 10 females. The mean age was 21.1 years (range: 11.2-29.4 years). They were divided into two groups by the posterior fixation method used. The group treated by multiple hook fixation (HF) comprised 11 patients with an index curve of 67+/-2 0degree. The group by multiple pedicle screw fixation (SF) comprised 10 patients with an index curve of 61+/-26degree. There was no statistical difference in the preoperative index curve characteristics between the two groups. RESULTS: Immediately after the surgery, the mean index curve was 37.0degreein the HF group and 29.9degreein the SF group showing a correction of 44.7+/-19% and 49+/-17% respectively. At the final follow up, the curve was 46.9degreein the HF group and 32.3degreein the SF group showing a loss of correction of 21+/-22% and 7+/-2% respectively. CONCLUSIONS: Pedicle screw fixation is an effective method of treating congenital scoliosis, offering an improved correction and maintenance.
Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Scoliosis*

STUDY DESIGN: A retrospective study of perioperative complications was performed in elderly patients undergoing posterior decompression and fusion for lumbar degenerative conditions. OBJECTIVES: To identify the perioperative complications and to analyze the influence of posterior decompression and fusion on the occurrence of the morbidity. SUMMARY OF BACKGROUND DATA: Because of the better long-term results, the decompression and fusion with instrumentation have been recently recommended for treatment of degenerative lumbar disease in the elderly. However, the perioperative complication rate and their correlating factors have not been adequately defined. MATERIALS AND METHODS: A retrospective review of the medical charts of fifty-one patients aged 65 years or older operated during June 1997 to July 1998 was undertaken. The minimum follow-up required for inclusion was three months. All medical and surgical perioperative complications directly related to the surgical procedure were noted. The association of fusion levels and other factors with the occurrence of perioperative complications were analyzed. RESULTS: Perioperative complications occurred in 17(33.3%) of the 51 patients. Seven patients(13.7%) had at least one major complication, 5(9.8%) had at least one minor complication and 9(17.6%) had insignificant complications. Hematoma and wound infection were the most common surgical complications. Paralytic ileus was the most common medical complication. There was no difference in the rate of perioperative complications between the long and short fusion groups. An age of more than seventy-five years at the time of surgery was associated with a higher risk of complications. There was no statistically significant relationship between the perioperative complications and sex diagnosis, operative time, type of bone grafting, amount of blood transfusion, or preoperative comorbidity of the patients. CONCLUSION: Perioperative complications were quite common in the present series, occurring in 33.3% of the patients. An age over seventy-five years was a risk factor for associated with morbidity. The number of levels fused and the comorbidity did not associated the development of the complications.
Aged* ; Blood Transfusion ; Bone Transplantation ; Comorbidity ; Decompression ; Diagnosis ; Follow-Up Studies ; Hematoma ; Humans ; Intestinal Pseudo-Obstruction ; Operative Time ; Retrospective Studies ; Risk Factors ; Wound Infection