Bone single photon emission computed tomography(SPECT) of the knees has been shown to be of diagnostic value for the investigation of intemal derangement of knees(IDK). This study compared bone SPECT and magnetic resonance image(MRI) with arthroscopic findings for the diagnosis of IDK. Fifty patients who had been performed arthroscopy in Seoul National University Hospital from January 1997 to September 1997 were studied with both the modalities preoperatively. There were 38 meniscal injuries, 26 cruciate ligament injuries and 8 cases of patellofemoral joint problems. In view of SPECT, the most remarkable results were from meniscal tears. In meniscal tears, the diagnostic values of SPECT were 89.5% of sensitivity, 66.7% of specificity, 84% of diagnostic accuracy, which were comparable to those of MRI, 97.4%, 91.7% and 96%, respectively. But SPECT showed inferior diagnostic values in cruciate ligament injuries. For anterior knee pain, SPECT was more sensitive than MRI for the detection of pathology. And for functionally related cases, such as ACL impingement to intercondylar notch, SPECT was far more valuable than MRI. Bone SPECT will not provide the anatomical detail of MRI but seems to be a useful tool for the detection of wide range of knee disorders including IDK. Further research is justified to investigate the precise role of bone SPECT in clinical practice and its value in relation to MRI.
Arthroscopy ; Diagnosis ; Humans ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Patellofemoral Joint ; Pathology ; Sensitivity and Specificity ; Seoul ; Tomography, Emission-Computed, Single-Photon*

No abstract available.

Methods of internal fixation for displaced intercondylar eminence fractures of tibia are percutaneous pinning, pull-out knot with wire or nylon and screw fixation. We tried experimental tensile test on four different fixation methods with 60 fresh pig knees. The results were as follows. 1. In our experimental study, the maximum tensile strength(M.T.S.) was recorded average 73.49N in the group of percutaneous pinning, 133.01N in Ethilon used group, 198.01N in wire used group and 275.05N in screw fixed group. 2. The group of percutaneous pinning with K-wires showed the lowest value of M.T.S., therefore, this method of fixation must be discarded. 3. The M.T.S of pull-out knot tie was about twice as high as that of percutaneous pinning. But the method of knotting should be improved because of the failure around the knot. 4. The group of screw fixation showed the highest value of M.T.S., but this method of fixation has some problems, like as arthrotomy or difficulty of removal of hardware.
Knee ; Nylons ; Tibia*

Arthroscopic ACL reconstruction using patellar BTB grafts were performed 1 1 consecutive patients (Group I) and double stranded gracilis-semitendinosus grafts were performed 7 cases (Group II) from April, 1995 to February, 1997. We analysed two groups that were reviewed and evaluated with subjective and functional rating scales according to Lysholm knee scales, physical examination, KT-2000 and manual anterior laxity test. On Group I, the average follow up was 17 months(14-30mo ), and on Group II, 14 months (12-18mo). The average age at operation was 32.2 year old of the Group I & 28.1 year old of the Group II. The average Lysholm score of Group I was improved from 45.3 to 89.2 and Group II was improved from 43.1 to 87.3 at the last follow-up. According to KT-2000 at the follow up, the average side to side difference in Group I at 20lb was 1.7+1.8 mm and in Group II was 2.2+2.0mm. In this study, there were no significant differences in overall outcome between the Group I & Group II (P>0.1) but, the follow-up was too short to define the result.
Follow-Up Studies ; Humans ; Knee ; Physical Examination ; Tendons* ; Transplants* ; Weights and Measures

To determine the usefulness of MR axial images for diagnosis ACL tears, we reviewed MRIs of 67 patients with ACL tear confirmed by arthroscopic examination, retrospectively. There were 53 acute and 14 chronic tears. The axial MR images had a 97% sensitivity(acute: 96%, chronic: 100%). Findings of acute ACL tears on sequential axial imaging could be categorized as 1) diffuse swelling with abnormal substance signal in 14 cases(27.5%), 2) focal bulging or irregularity of medial border in 11 cases(21.6%) or 3) combination of the two in 26 cases(50.9%). Findings of chronic ACL tears also could be categorized as abnormally irregular thin fibers in 6 cases(42.9%) or nonvisualization(empty lateral wall) in 8 cases(57.1%). We concluded that MR axial images could provide additional useful information in the diagnosis of ACL tear.
Diagnosis ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies

A prompt, accurate diagnosis is essential in the management of acute ligamentous injury of the kriee. With the advent of MRI, the reported accuracy of diagnosis of ACL rupture is as high as 95%. Most MRI studies on ACL injury, however, could not differentiate partial from complete ACL ruptures accurately. It is important to differentiate partial from complete rupture. Because this distinction could be influence the patient management and prognosis. The purpose of this study is to assess the utility of indirect MRI signs for detecting tears and differentiating partial from complete tears of ACL. The present study included 40 patients, who were suspicious ACL injury in MRI finding and underwent arthroscopic examination of knee within one month after injury. At arthroscopy, there were 1 patient of normal, 10 partial and 29 complete ACL ruptures. The radiologist who did not know the arthroscopic findings have reviewed retrospectively and noted indirect MRI signs; ACL angle, PCL index, bone bruise, popliteus muscle injury, posterior displacement of lateral meniscus. Indirect signs in MRI showed significantly improve the detection of ACL rupture from ACL intact knees and help to distinguish partial from complete tear. Especially, among indirect signs in MRI, we consider that the displacement of posterior horn of lateral meniscus(more than 2.0mm) or popliteus muscle injury are indicative of complete ACL rupture.
Animals ; Arthroscopy ; Contusions ; Diagnosis* ; Horns ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Prognosis ; Retrospective Studies ; Rupture

Peroneal nerve palsy after total knee arthroplasty is rare. Its etiology is multifactorial. Among them, stretching of the nerve by correction of severe preoperative valgus or flexion deformities, compression of the vascular supply of the nerve by the fascia, direct pressure on the nerve from the dressing are the well known factors which appear to cause development of peroneal nerve palsy. We experienced a case of the peroneal nerve palsy in infected total knee arthroplasty, which was accompanied with subsidence of the tibial prosthesis and report with review of the literature.
Arthroplasty ; Bandages ; Congenital Abnormalities ; Fascia ; Knee ; Paralysis* ; Peroneal Nerve* ; Prostheses and Implants

The objective of this study is to assess the role of articulating spacer in two stage reimplantation of infected TKA. Fifteen patients with deep infected total knee arthroplasties were treated by two stage reimplantation protocol between Jan. 1987 and Oct. 1997. Seven cases in Group A were treated by debridement, removal of the prosthesis and placement of antibiotic impregnated cement spacer before reimplantation. Eight cases in Group B were treated by debridement, and reinsertion of the retrieved implant after autoclaving with antibiotic impregnated cement fixation. The average follow-up period was 77 months(range, 28-141 months) in group A, and 25 months(range, 12-63 months) in group B. The average knee flexion after revision was 82 degrees in group A, and 106 degrees in group B. The average HSS knee rating score was 80 points in group A, and 88 points in group B. No patient had recurrence of infection during the follow-up period. In conclusion, our method using articulating spacer allowed emly range of motion and partial weight bearing during the spacer phase. This methods also delivered high local concentration of antibiotics and kept the functional joint before a second-stage reimplantation.
Anti-Bacterial Agents ; Arthroplasty* ; Debridement ; Follow-Up Studies ; Humans ; Joints ; Knee* ; Prostheses and Implants ; Range of Motion, Articular ; Recurrence ; Replantation* ; Weight-Bearing

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

The displacement of patellar components, such as dislocation or subluxation, causes polyethylene wear and further induces metallosis of the metal-backed patella. We compared two different patellar components, onset(Miller-Galante I) and inset(Whiteside-Ortholoc I)type, to understand the differences in patellar tracking according to their designs. Patellar prosthesis position in 43 primary total knee arthroplasties was evaluated with patellar tilt, patellar displacement from the center of the trochlear groove, medial placement, patellar thickness, and joint line height. For the MG(Miller-Galante I)group, the patellar displacement was laterally 50.0% and for the Ortholoc group, it was 33.3%. In the MG group, 4 cases of revision of the patellar component due to excessive polyethylene wear were performed, but there was no excessive wear of polyethylene in Ortholoc group. One of the primary factors which influence tracking of the patellofemoral joint is the difference in design between the patellar component and the femoral component. But in the opinion of the authors, the slope or lateral displacement of the patellar component have no correlation with each other under radiological measurements. However, the inset-type patellar component is a design that maintains the bony flange within the lateral flange, therefore relieving the shear stress and rotational forces loaded on the patellofemoral joint and protecting the metal-backing from exposure. Thereby, even if dislocation or subluxation of the patellar component should occur, polyethylene wear or metallosis caused by excessive wearing can be minimal.
Arthroplasty* ; Dislocations ; Joints ; Knee* ; Patella ; Patellofemoral Joint ; Polyethylene ; Prostheses and Implants