Primary repair of anterior cruciate ligament is superior to late reconstruction procedures for two reasons; objective stability is more easily restored due to intact secondary restraints not subjected to chronic stress, and the quality of the joint is superior with greater chance of intact menisci and normal articular cartilage not yet damaged through recurrent subluxation. We present the result of thirty-eight kness in thirty-seven patients who had been treated with primary repair of augmented repair for acute ACL rupture from March, 1984 to August, 1990. Twenty-one knees were treated with primary repair and seventeen knees augmented repair. At an average 33 months follow up, the results obtained were as follows: 1. The patients were 23 males and 14 females with an average age of 27.1 years. 2. Twenty four knees were injuried during athletic endeavors, 9 knees by automobile accident, and 5 knees by landing from height. In 18 knees anterior cruciate ligament was ruptured at the proximal attachment, in 17 knees at the midsubstance tear and in 3 at the near distal attachment. 3. The average interval from injury to operation was 7.5 days (ranged from 1 to 14 days). 4. The results were evaluated by Hospital for Special Surgery knee rating scale (modified by Marshall) at an average 33 months (range from 13 months to 7 years and 6 months) follow-up study. 16 (76%) out of 21 knees treated with primary repair were rated as good or excellent. 12 (86%) out of 14 knees treated with augmented repair were rated as good or excellent. As the result of this study, acutely torn anterior cruciate ligaments appear to be successfully treated with primary repair or augmented repair according to torn site and shape of ligaments.
Anterior Cruciate Ligament ; Automobiles ; Cartilage, Articular ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Ligaments ; Male ; Rupture ; Sports ; Tears

The anterior cruciate ligament injury is one of the most common ligament injury of the knee joint, and anterior cruciate ligament is as important structure for stabilization as a primary restraint. Noyes reported that the diagnosis of a tek of the anterior cruciate ligament was made by the original treating physician in only 6.8%. And there are many controversies in its treatment. It is certain thatearly diagnosis and treatment are th most important clue. Authors studied 48 patients of isolated anterior cruciate ligament injury who were diagnosed by same physician from Jan. 1983 to Dec. 1985 after follow ups ranging from six mnths to 4 years, average beimng one year and two months. The results were as followings: 1. The most common cause was sports injury. 2. The most common sign and symptom were hemarthrosis in acute injury and giving way in chronic injury. 3. Anterior drawer test without anesthesia had 25% of diagnostic accuracy but pivot shift test under anesthesia 95.8%. 4. 31 cases in 48 cases (64.8) had associated meniscal injury. 5. In acute torn ACL, the primajy repair was preparable but conservative treatment with arthroscopic partial menisectomy was eful in chronic case.
Anesthesia ; Anterior Cruciate Ligament ; Athletic Injuries ; Clinical Study ; Diagnosis ; Follow-Up Studies ; Hemarthrosis ; Humans ; Knee ; Knee Joint ; Ligaments

The face and notably the lips are important structures not only of aestheticvalue but also for expression, vibrancy and vitality. Sometimes we are encountered with the functional and aesthtetic lip problems especially in the patients with mandibular prognathism, such as excessive vermilion exposure, lip incompetence and hyperactivity of mentalis muscle. The etiologic factors are usually related to excessive anterior facial height, secondary to the abnormal development of perioral muscle, salivary gland and the swelling of lymphatic gland. Sometimes orthognathic surgery (mandibular setback osteotomy) alone is not accepted regarding to aesthetic value, there is likely to be a corresponding interest in adjunctive procedures such as genioplasty and soft tissue procedures. This article urges the incorporation of reduction cheiloplasty. It is a relatively minor procedure that can be easily reproducible and yields excellent, predictatable results with few complications. We treated two patients who have excessive vermilion exposure and marked abnormal lip eversion using reduction cheiloplasty combined with mandibular setback osteotomy, followed by improved facial harmony and patients were pleased.
Genioplasty ; Humans ; Lip ; Orthognathic Surgery ; Osteotomy* ; Prognathism ; Salivary Glands

STUDY DESIGN: The treatment of a stable fracture around thoracolumbarjunction is a controversial subject. OBJECTIVES: To evaluate the result from long term follow-up of the stable spinal fracture around thoracolumbar junction according to the operation, osteoporosis and in situ extension bar, respectively. SUMMARY OF BACKGROUND DATA: The thoracolumbar junction is a transitional zone in which the kyphotic angle of thoracic spine is continued to the lordotic angle of lumbar splne. So it is prone to be injured biomechanically, and the stability of the spine around thoracolumbar junction is not determined yet. METHODS: We studied retrospectively 105 cases of the stable fracture around thoracolumbar junction from January 1985 to December 1995. The criteria of the stability were a compression fracture by Denis F., a bursting fracture without involvement of posterior column, a neural enchroachment of bony fragment below 30%, fracture without subluxation or dislocation in spinal junction. RESULTS: The most common cause was traffic accident and, the first lumbar vertebrate was common site. Below 30% of initial compression, the progression was not exceded 5% in operative group. But in nonoperative group, anterior compression was more progressed than initial compression over 5%. The degree of anterior compression was affected by osteoporosis and in situ extension bar just after injury. CONCLUSIONS: We suggest an anterior compression abode 30% in spinal body of thoracolumbar junction for an additional operative indication. The prognosis may be affected by osteoporosis and in situ extension bar.
Accidents, Traffic ; Dislocations ; Follow-Up Studies* ; Fractures, Compression ; Osteoporosis ; Prognosis ; Retrospective Studies ; Spinal Fractures ; Spine ; Vertebrates

The superficial palmar arch of the hand is formed by the anastomosis of the palmar branch of the radial artery and the distal part of the ulnar artery. The variation of the superficial palmar arch and its branches have been known to occur frequently. There are many reports about the formation of the arch and the branches of it and the incidence of the median artery. These variations of the arch are considerablly valuable in the surgical management of the hand injuries, especially in vascular injury. This study deals with the Korean hands. The author observed the pattern of the superficial palmar arch, the presence of the median artery and the pattern of the common palmar digital arteries and the results are as followings; 1. The superficial palmar arch was complete type in 97.2% and incomplete type in 2.8%, The majority of the complete arch was type 1 and type 2. 2. The median artery was present in 2.8%. 3. The common palmar digital artery was present as type 1 in 65.3% type 2 in 13.9% type 3 in 4.2%, type 4 in 5.5%, type 5 in 6.9% and type 7 in 1.4%.
Arteries ; Hand ; Hand Injuries ; Incidence ; Radial Artery ; Ulnar Artery ; Vascular System Injuries

The relative rarity and anatomical position of presacral tumors may lead to difficulty in diagnosis and surgical treatment. The clinical features and surgical approach of 4such tumors(teratocarcinoma 1, endodermal sinus tumor 1, chordoma 1, neurilemmoma 1) have therefore reviewed. Low back pain or sacral pain was present in 3patients although all tumors were palpable on rectal examination. Surgical resection was carried out using the posterior transverse approach in Kraske's prone position. Complete surgical excision was performed in 3cases(chordoma, teratocarcinoma, neurilemmoma) and incomplete excision in 1 case(endodermal sinus tumor). A review of literature concerning these tumors and the surgical approach are presented.
Chordoma ; Diagnosis ; Endodermal Sinus Tumor ; Low Back Pain ; Neurilemmoma ; Prone Position ; Teratocarcinoma

Chymopapain and collagenase are well known chemonucleolytic agents for lumbar disc herniation. However, these enzymes have serious problems occasionally, such as severe neurotoxicity or anaphylaxis even fatal to patients. Chondroitinase ABC, a metabolic product of Proteus vulgaris, has a specific action on the proteoglycans of the nucleus pulposus, but rarely no effect on the intrathecal nerve tissues of vessels. Seventy eight rabbit lumbar discs were evaluated radiographically and histologically after injection of chondroitinase ABC 40U/ml per disc and compared with buffer injected group and nonigected control group. There was considerable disc space narrowing of the chondroitinase ABC injected group which was verified radiographically and histologically(p < 0.01). A zone of Safranin 0 depletion was present in the ventral anulus fibrosus adjacent to the nucleus pulposus in all treated discs, indicating proteoglycan loss. On electron microscopic findings there were collapse of chondrocytes and notochordal cells. All of these findings are corresponding to the evidence that chondroitinase ABC may be another chemonucleolytic agent by decreasing disc volume and thereby decompressing spinal cord or nerve roots. All histologic effects of chondroitinase ABC were confined to intervertebral disc tissues. Chondroitinase ABC deserves to be a study object for the alternative of chemonucleolysis.
Anaphylaxis ; Chondrocytes ; Chondroitin ABC Lyase ; Chymopapain ; Collagenases ; Humans ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Nerve Tissue ; Notochord ; Proteoglycans ; Proteus vulgaris ; Spinal Cord

The degenerative arthritis following total menisectomy has led to consideration of the need for meniscal transplantation, this study evaluates the morphologic and histologic changes fol lowing fresh meniscal autograft and allograft in therabbits. Transplantation of the medial meniscus was carried out in two groups of 32 rabbits(autograft group=16 rabbits, allograft group=16 rabbits). The morphological and histological changes of the transplanted auto-and allografted menisci and the articular cartilage of the medial femoral and tibial condyle were observed at 2,4,6,8,10,12,22,28 weeks postoperatively. There were no significant differences between auto and allograft groups in gross appearance. Histologically, the fibrous adhesion was noted between grafted meniscus and joint capsule 2 weeks after operation, but complete healing was seen at the suture sites without rejection phenomenon at 6 weeks in both groups. There were prominent inflammatory reactions such as lymphocytes and inflammatory cells infiltration during early postoperative stages(2,4 weeks) only in the allograft group, and more prominent fibrotic reactions in the allograft group than auto-graft group. The results of this study suggest that meniscal allografts are able to adapt to the host tissues, survive within the joint environment, and provide a functional replacement for the removed meniscus, but further studies for graft-host immune response and a method to take the maintenance and deposits of graft must be needed to perform the meniscal allograft in human.
Allografts ; Autografts ; Cartilage, Articular ; Humans ; Joint Capsule ; Joints ; Knee Joint ; Knee ; Lymphocytes ; Menisci, Tibial ; Methods ; Osteoarthritis ; Rabbits ; Sutures ; Transplants

The intramedullary nailing is a good method of treatment in femur shaft fracture but it is not available in some fracture pattern or fracture level. And it is very difficult with conventional Kiintscher nailing to prevent torsional stress and fix rigidly in unstable fracture of the femur shaft. The unstable fracture by comminuted fracture or segmental fracture, nonunion and pathologic fracture needed the rigid fixation. Interlocking Kuntscher IM nailing can provide antitorsional stability, good axial alignment and prevent shortening of the fracture site, also allow early ambulation and joint exercise. We analysed 51 patients 52 cases of interlocking Kiintscher IM nailing from May 1981 to March 1988. The interlocking Kuntscher IM nailing prevents the rotational and axial roading. The interocking Kuntscher IM nailing has expanded its application in fracture pattern and fracture site. The interlocking IM nailing provides rigid fixation in severe comminuted fracture. segmental fracture, long spiral fracture, and other several unstable fractures and eliminates splinting or external supports, so it is possible doing early joint exercise. The interlocking Kuntscher IM nailing was also considered best internal fixation method in pathologic fracture or sever osteoporosis. The static interlocking for rigid fixation and the dynamic interlocking method for axial compression to fracture site during weight bearing can be adapted appropriately to fracture pattern. Radiation hazard during the interlocking nailing is not considerable.
Early Ambulation ; Femur ; Fracture Fixation, Intramedullary ; Fractures, Comminuted ; Fractures, Spontaneous ; Humans ; Joints ; Methods ; Osteoporosis ; Splints ; Weight-Bearing

There are several methods available to check bone masses. One of them is Singhs index which is singlest way with grading trabecular pattern of the proximal femur on anteroposterior X-ray film and the other is recently developed Dual Photon X-ray Absorptiometry which measures bone mineral contents. Some authors proclaim that Singh's index has low accuracy, objectiveness and reproducibility. So we studied for reliability of Singh's index and correlation between Singh's index and bone mineral contents measured by Dual Photon X-ray Absorptiometry in 65 patients. There are significant differences between 3 orthopedic surgeons in interpreting Singh's index (interpersonal difference). There are significant differences between first and second interpretation out of same surgeons (intrapersonal difference). There are significant differences interpretating among interpreted Singh's indices from films of different radiological exposures in the same radiograph. There are fair correlations(0.60-0.66) between Singhs index and bone mineral density. The Singh's index was overestimated in low bone mineral density with under-exposed radiograph, but Singh's index was under-estimated in high bone mineral density with over-exposed radiograph. Singh's index can be useful in clinical application by some modification.
Absorptiometry, Photon ; Bone Density ; Femur ; Humans ; Orthopedics ; Surgeons ; X-Ray Film