No abstract available.
Humans ; Venous Thrombosis*

Heterotrophic ossification (HO) is a reactive disease presenting the formation of mature lamellar bone in soft tissues. It is known to occur following surgery, soft tissue injury, or central nervous system anomalies. However, a definite cause has not yet been clearly addressed. During the process of approach, reduction, and fixation while conducting surgeries, partial injury of soft tissue is inevitable. Additionally, secondary injuries may be caused during the active and passive range of motion exercises that should be done for the recovery of joint motion after surgery. The authors experienced cases of HO that may occur during surgery and rehabilitation after surgery. The authors recognized that special care is required for patients complaining of severe pain during the early stage of rehabilitation immediately after surgery. This study aimed to reaffirm the principles of fracture treatment by reviewing the cases and to investigate the occurrence of HO after fracture surgery.
Central Nervous System ; Exercise ; Humans ; Joints ; Range of Motion, Articular ; Rehabilitation ; Soft Tissue Injuries

Gouty arthritis is a common crystal arthropathy, but gout tophus in the bipartite patella is a rare condition. This report presented a traumatic separation of bipartite patellar fragment caused by mild trauma in a patient with comorbid gout. When a patient with bipartite patella and underlying gouty arthritis complains of pain after trauma, clinical suspicion is needed about fragment separation of the bipartite patella.

PURPOSE: We wanted to evaluate the results of medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty. MATERIALS AND METHODS: We reviewed 32 cases of medial epicondylar osteotomy for treating varus deformity, and these cases underwent operation from December 2004 to December 2007. The average age of the patients was 71.0-years-old and the average follow-up period was 23.5 months. The clinical outcomes were measured, including the Knee Society score (KSS), the function score (FS) and the range of the motion (ROM). The radiological outcomes were measured by anteroposterior simple radiographs for assessing the union state of the osteotomy site, and the valgus stress radiographs and the whole extremity radiographs were used for assessing the femorotibial angle, the mechanical axis angle and the alignment. RESULTS: The KSS improved from 46.5+/-7.6 to 89.1+/-5.9 points (p<0.001) and the FS increased from 39.5+/-9.2 to 84.2+/-8.5 points (p<0.001). The range of motion increased from 101.5+/-28.2degrees to 116.0+/-10.8degrees (p=0.006). Bony union occurred in 22 knees and fibrous union occurred in 10 knees. The femorotibial angle was corrected from varus 8.2+/-5.0degrees to valgus 5.6+/-1.5degrees (p<0.001) and the mechanical axis angle was revised from varus 13.9+/-4.5degrees to varus 0.7+/-1.6degrees (p<0.001). There were 27 neutral, 4 varus and 1 valgus alignment. On the valgus stress radiographs, the difference compared with the opposite side was 1.0+/-0.6degrees and there was no significant difference between the bony union group and the fibrous union group (p=0.175). CONCLUSION: Medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty could be a useful ligament balancing technique for achieving medial stability of the knee.
Arthroplasty ; Axis, Cervical Vertebra ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Osteotomy ; Range of Motion, Articular

Nerve palsy after total knee arthroplasty is a rare complication and this is usually associated with local nerve compression or severe deformity of the knee. In many cases, the cause of nerve palsy was unknown and this is rarely associated with vascular complication. We report here on a case of the patient who had nerve palsy and delayed arterial occlusion after total knee arthroplasty.
Arthroplasty ; Congenital Abnormalities ; Humans ; Knee ; Paralysis

PURPOSE: This study examined the relationship between the findings of a second-look arthroscopy and clinical results in double bundle anterior cruciate ligament (ACL) reconstruction using hamstring tendons fixed with a Ligament Plate(R). MATERIALS AND METHODS: Twenty eight cases of a double bundle ACL reconstruction using hamstring tendons were retrospectively reviewed. The follow-up period was more than 1 year and all cases were reviewed by second-look arthroscopy. The average follow-up period was 20.6 months (range: 12-34 months). In second-look arthroscopy, the anteromedial (AM) bundle and posterolateral (PL) bundle of the grafts were evaluated based on the tension, rupture and synovial coverage. Clinical evaluation was assessed using the Lysholm score, international knee documentation committee score, Hop test, Lachman test, pivot shift test, KT-2000 arthrometer and anterior drawer stress radiograph using Telos(R) in 30degrees knee flexion. The correlation between the arthroscopic findings of the grafts and the instability tests was evaluated. RESULTS: The AM graft was evaluated as being taut in 89.3% and lax in 10.7%, and the PL graft was assessed as being taut in 71.4% and lax in 28.6% according to the tension. The AM and PL grafts were evaluated as 'no rupture' in 78.6% and 'partial rupture' in 21.4%. There was no 'complete rupture' in any graft. The AM grafts were found to be good in 53.6%, fair in 35.7% and poor in 10.7%; the PL grafts were assessed as good in 50.0%, fair in 28.6% and poor in 21.4% according to the synovial coverage. The AM graft tension showed statistically significant results regarding both the Lachman test (rho=0.743, p<0.001) and degree of rupture (rho=0.438, p=0.020). The PL graft tension showed statistically significant results regarding both the pivot shift test (rho=0.548, p=0.003) and the degree of rupture (rho=0.663, p<0.001). CONCLUSION: Double bundle ACL reconstructions using hamstring tendons show good biological and clinical results. The graft tension and the degree of rupture show a statistically significant relationship to the stability of the reconstructed joint. On the other hand, the synovial coverage did not show a significant result.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Arthroscopy ; Follow-Up Studies ; Hand ; Humulus ; Joints ; Knee ; Ligaments ; Retrospective Studies ; Rupture ; Tendons ; Transplants

PURPOSE: To evaluate the relationship between flexion-extension gap discrepancy and clinical results in total knee arthroplasty (TKA). MATERIALS AND METHODS: We evaluated the clinical results of 38 knees, which were performed TKA between March 2003 and June 2003, and followed up for at least 2 years. We divided all cases by the difference of medial and lateral joint gap in flexion and extension. Group A was no flexion-extension gap difference(17 cases) and group B was different gap(21 cases). We evaluated Knee Score, Function Score, range of motion and radiologic results RESULTS: The difference of group B was less than 2mm. In Knee Score and function score, Group A improved from preoperative 50.1 and 45.0 to the last follow up to 95.6 and 95.9, and those of Group B improved from 48.2 and 45.2 to 96.9 and 91.4. There was no statistical difference between two groups(p>0.05). Flexion angle of Group A increased from preoperative 108.2 degree to the last follow up 115.3 degree. That of Group B increased from preoperative 101.9 degree to the last follow up 113.6degree. But, there was no statistical difference between two groups(p>0.05). 2 cases of recurrent hemarthrosis were in Group B. CONCLUSION: We got good clinical results by flexion-extension gap difference within 2 mm. But long term followed up was needed.
Arthroplasty* ; Follow-Up Studies ; Hemarthrosis ; Joints ; Knee* ; Range of Motion, Articular

PURPOSE: To evaluate the clinical relationship between medial collateral ligament(MCL) complete detachment and mechanical alignment in total knee arthroplasty. MATERIALS AND METHODS: From February 2001 to December 2006, we performed 290 TKAs. 9 TKAs(0.03%) happened MCL complete detachment. 1 TKA was excluded for paraplegia. All cases were women. The mean age was 71.1 years old. The mean follow-up period was 41.1 months. There were 7 degenerative osteoarthritis and 1 rheumatoid arthritis. The clinical evaluation included Knee Society Score(KSS), function score and range of motion(ROM) at preoperative, postoperative 3 months, 6 months, 12 months and final follow-up. We measured the femoro-tibial angle and the mecha- nical axis by anterior-posterior and whole lower extremity radiograph. The medial instability obtained serial valgus stress radiograph. RESULTS: There were 4 neutral and 4 varus alignment. KSS, function score, ROM was significantly improved in both group, and there were no significant differences in both group. On serial valgus stress radiograph, the difference compared with normal side decreased from 5.2 degree(postoperative 3 months) to 3.4 degree(final follow-up) in neutral alignment group, from 2.9 degree to 0.9 degree in varus alignment group. In final follow-up, it revealed that the medial instability of varus alignment group was less than that of neutral alignment group. CONCLUSION: In MCL complete detachment, some stability obtained by repair of medial collateral ligament and bracing. Whole instability was not gone. Therefore, we should make the varus alignment of prosthesis in mechanical axis line position of 34 to 67% on the medial tibial plateau.
Arthritis, Rheumatoid ; Arthroplasty ; Axis, Cervical Vertebra ; Braces ; Collateral Ligaments ; Female ; Follow-Up Studies ; Humans ; Knee ; Lower Extremity ; Osteoarthritis ; Paraplegia ; Prostheses and Implants

PURPOSE: To evaluate the clinical outcomes at a minimum of 1 year following the ACL reconstruction with use of Liga- ment Plate(R) which was invented for secure fixation of hamstring tendon graft into femoral tunnel. MATERIALS AND METHODS: Seventy-six patients who could followed up for minimum 12 months were treated with the ACL reconstruction fixed with Ligament Plate(R) using a four-stranded autologous hamstring tendon graft. For femoral fixation, we used Ligament Plate(R), and for tibial fixation, we used suture-post strengthened with cortical screw. Average follow up period was 18.6 months. Prior to surgery and at the follow-up examination, we evaluated the clinical results with Lachmann test, pivot shift test, Lysholm score and the difference of mid-thigh circumference, and KT 2000 arth- rometer was perfomed. For radiographic evaluation, we analyzed knee radiographs including anterior drawer radiographs and evaluated the degree of tunnel enlargement. RESULTS: Lysholm score improved from 61.6 points to 93.8 points. Lachman test revealed negative findings for sixty- three cases, and ten cases with grade 1 laxity and another three cases with grade 2 at last follow-up. Pivot shift test showed negative findings except six cases with grade 1 laxity at last follow-up. The results of KT 2000 arthrometer improved from 5.4mm difference compared with normal limb to 2.1mm respectively. The difference of mid-thigh circumference compared with normal limb showed 1.7cm. Radiographic analysis of anterior drawer view revealed 6.5 mm difference compared with normal limb preoperatively and 1.1 mm difference at last follow-up. Femoral and tibial tunnel enlarged to 2.7mm and 1.8 mm compared with immediate postoperative radiographs. CONCLUSION: ACL reconstruction using hamstring tendon grafts fixed with Ligament Plate(R) could provide sufficient strength of early fixation, and then could show good clinical results. However, long term follow-up was necessary.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Extremities ; Follow-Up Studies* ; Humans ; Knee ; Ligaments* ; Tendons* ; Transplants*

PURPOSE: To evaluate mid- and long- term follow-up results after total knee arthroplasty (TKA) with patella-friendly ADVANTIM(R) Total Knee System. MATERIALS AND METHODS: 46 cases out of 88 knee arthroplasty which was done from October 1997 to December 2000 were analyzed retrospectively, average follow-up period was 61 months. Patella was not resurfaced in all cases. Clinical results were evaluated using The Knee Society Clinical Rating System and patellar score, radiologic results using The Knee Society Roentgenographic Evaluation and Scoring System, patellar tilt and patellar shift. RESULTS: The average range of motion increased from 96 degrees preoperatively to 112.8 degrees at the last follow-up, the average flexion contracture decreased from 9.6 degrees preoperatively to 3.6 degrees at the last follow-up. The average knee score increased from 57.8 points preoperatively to 90.7 points at the last follow-up, the average function score from 39 points to 86 points. The average patellar score increased from 16.3 points preoperatively to 28.1 points at the last follow-up. Radiologic evaluation revealed a radiolucency of 18 knees(39.1%) which were not significant clinically. The incidence with patellar shift more than 5~10 mm were 9 knees(15.2%), but the average patellar score of these cases were 27.6 points. CONCLUSION: The mid- and long-term results of TKA with ADVANTIM(R) were reliable and satisfactory in terms of improvements of range of motion and restoration of function without patellar resurfacing.
Arthroplasty* ; Contracture ; Follow-Up Studies ; Incidence ; Knee* ; Patella ; Range of Motion, Articular ; Retrospective Studies