PURPOSE: In total knee arthroplasty (TKA), it is important to restore neutral mechanical alignment. The purpose of this study was to assess whether the lower limb alignment is neutral in healthy Korean females and investigate the incidence of constitutional varus knees among them. MATERIALS AND METHODS: Weight-bearing full-leg standing radiographs were obtained from 118 healthy females between the ages of 20 to 39 years. One radiologist and two orthopaedic surgeons measured the hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), and femoral anatomic mechanical angle (FAMA) on the radiographs and compared with the traditional gold standard HKAA of 0degrees, MPTA of 3degrees varus, and FAMA of 6degrees. RESULTS: The interobserver reliability of the three independent observers was high (p<0.001). The HKAA of the study subjects (1.35degrees+/-2.04degrees) was significantly different from the standard HKAA of 0degrees (p<0.001), but no statistically significant difference was observed in the MPTA (-3.18degrees+/-1.61degrees) and FAMA (5.99degrees+/-0.70degrees) from the standard values (p=0.083 and p=0.887, respectively). The incidence of constitutional varus alignment was 20.34%. CONCLUSIONS: In Korean females, the mechanical axis of the lower limb was not neutral and the incidence of constitutional varus alignment was slightly higher than that in Western females. We believe that these findings should be taken into consideration in planning reconstructive surgery of the knee, such as TKA, unicompartmental knee arthroplasty, and high tibial osteotomy.
Arthroplasty ; Axis, Cervical Vertebra ; Female ; Humans ; Incidence ; Knee ; Lower Extremity ; Osteotomy ; Weight-Bearing

PURPOSE: This study evaluated mid-term results of anterior cruciate ligament (ACL) reconstruction using the PINN-ACL CrossPin system that allowed for short graft fixation. MATERIALS AND METHODS: Forty-three patients underwent single-bundle ACL reconstruction with a 4-strand semitendinosus tendon graft using the PINN-ACL CrossPin system. Femoral fixation was done using the PINN-ACL CrossPin system, and the tibial side was fixed with post-tie and a bioabsorbable interference screw. The mean follow-up period was 50 months. Evaluation was done using the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) score and grade. Anterior displacement was assessed. RESULTS: There was improvement in the Lachman test and pivot-shift test at final follow-up, form grade II (n=40) or III (n=3) to grade I (n=3) or 0 (n=40) and from grade I (n=20) or II (n=10) to grade I (n=8) or 0 (n=22), respectively. The mean IKDC score was 88.7, and grade A and B were 93.0% at final follow-up. Side-to-side difference was improved from 6.7 mm to 2.1 mm at final follow-up. Complications occurred in 3 patients, a re-ruptured due to trauma at 2 years after surgery and a deep infection and a superficial infection. CONCLUSIONS: The mid-term follow-up results of ACL reconstruction with the PINN-ACL CrossPin system were satisfactory. The PINN-ACL CrossPin can be considered as a useful instrument for short graft fixation.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Follow-Up Studies ; Humans ; Knee ; Tendons ; Transplants

PURPOSE: We evaluated the clinical and radiological outcomes of double-bundle anterior cruciate ligament (ACL) reconstruction using an outside-in technique with a follow-up of two- to six-years, especially in terms of the sports activity level and radiological degeneration. MATERIALS AND METHODS: Sixty-seven patients who were available for a minimum two-year follow-up after double-bundle ACL reconstruction using an outside-in technique were retrospectively evaluated. The mean follow-up period was 43.7 months. The knee function and stability were evaluated before the operation, one year after the operation (short-term follow-up), and more than two years after the operation (last follow-up). RESULTS: Regarding the knee function, the Lysholm score, International Knee Documentation Committee (IKDC) evaluation, and hop test showed significant improvement. Regarding the stability, the Lachman test, pivot shift test, KT-2000 arthrometer data, and anterior drawer radiographs using Telos showed significant improvement. Regarding the sports activity level, the patients who returned to pre-injury level activity was 68.7% according to the Tegner activity score and 76.1% according to the Cincinnati sports activity scale score. The incidence of aggravated degeneration or development of greater than IKDC grade A degeneration after surgery was 10.4%. CONCLUSIONS: Double-bundle ACL reconstruction using an outside-in technique showed favorable clinical and radiological outcomes with respect to the knee function and stability, joint degeneraion, and, especially, return to pre-injury sports activity.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Follow-Up Studies ; Humans ; Humulus ; Incidence ; Joints ; Knee ; Retrospective Studies ; Sports

PURPOSE: Our goals were to rigorously document and explore the interrelationships of various parameters in the aftermath of total knee arthroplasty (TKA), including patient characteristics, clinical scores, satisfaction levels, and patient-perceived improvements. MATERIALS AND METHODS: A questionnaire addressing sociodemographic factors, levels of satisfaction, and "wished-for" improvements was administered to 180 patients at least 1 year post primary TKA. Both satisfaction levels and wished-for improvements were assessed through nine paired parameters. Patients responded using an 11-point visual analogue scale (VAS) and the results were summarized as mean VAS score. Correlations between clinical scores and satisfaction levels and between satisfaction levels and desired improvements were analyzed. RESULTS: Patient satisfaction levels were only modest (mean score, 4-7) for eight of the nine parameters, including pain relief and restoration of daily living activities, the top two ranked parameters in wished-for improvement while high-flexion activity constituted the top source of discontent. Wished-for improvement was high in seven parameters, the top three being restoration of daily living activities, pain relief, and high-flexion activity. The effects of sociodemographic factors on satisfaction levels and wished-for improvement varied. Satisfaction levels correlated positively with functional outcomes, and satisfaction in pain relief and restoration of daily living activities correlated more often and most strongly with clinical scores. CONCLUSIONS: Following TKA, patient satisfaction is not high for a number of issues, with improvements clearly needed in restoring daily living activities and relieving pain. Continued efforts to achieve better surgical outcomes should address patient-perceived shortcomings.
Activities of Daily Living ; Arthroplasty ; Humans ; Knee ; Patient Satisfaction ; Surveys and Questionnaires

PURPOSE: To compare the incidence of overhang between two distinct femoral components and whether there is clinical and radiological benefit of gender-specific implants in short-term follow-up. MATERIALS AND METHODS: One hundred and four knees in consecutive 66 female patients who underwent primary total knee arthroplasty due to primary osteoarthritis were included in this study. Overhang was measured and recorded in every cut surface of femur with both gender-specific and traditional trial femoral components respectively in every patient. Then, the knees were divided into two groups according to the type of the permanent femoral component they received. Clinical and radiological outcomes were compared between 2 groups at minimum 3 years after operation. RESULTS: Mean follow-up duration was 41.3 months (range, 36 to 50 months). Sixty two knees (59.6%) showed femoral overhang at least in one area with a traditional trial component, while 26 knees (25.0%) did with a gender-specific trial component (p<0.001). In terms of range of motion, Hospital for Special Surgery knee score, radiographic result, patella tilt angle and displacement, no significant difference was observed between two groups. CONCLUSIONS: The use of gender-specific implants substantially reduced the incidence of femoral overhang but did not demonstrate any clinical, functional or radiologic benefit in short-term follow-up.
Arthroplasty ; Female ; Femur ; Follow-Up Studies ; Humans ; Incidence ; Knee ; Osteoarthritis ; Patella ; Range of Motion, Articular

PURPOSE: The Korean Knee score (KKS) was designed to reflect the floor-sitting lifestyle that necessitates high knee flexion. The purpose of this study is to assess whether the KKS reflects the floor-sitting lifestyle more accurately than the previously developed Knee Society clinical rating system. In addition, the presence of ceiling effects was compared between the two rating systems. MATERIALS AND METHODS: Eighty-one consecutive patients (120 knees) who were assessed regularly after total knee arthroplasty (TKA) on an outpatient basis between January 2012 and December 2012 were enrolled. All patients were asked to complete a questionnaire to assess the Knee Society Knee score (KSKS), Knee Society Function score (KSFS), and KKS. RESULTS: At the final follow-up, the mean KSKS, KSFS, and KKS were 91.2, 86.0, and 70.1, respectively, and the scores were similar between the > or =125degrees maximum flexion group and <125degrees maximum flexion group. However, the 'floor life' subdomain score of the KKS was significantly higher in the >125degrees maximum flexion group (15.13 vs. 11.24, p=0.001). The number of cases with the highest possible score was 24 (20%) for the KSKS and 47 (39%) for the KSFS, whereas none of the cases obtained the highest possible KKS. According to the standard deviation method, more substantial ceiling effects were present in the KSKS (83 cases, 69.1%) and KSFS (67 cases, 55.8%) than in the KKS (23 cases, 19.2%). CONCLUSIONS: Although, the KKS was effective in reducing the ceiling effect, it demonstrated limited improvement in assessing the ability to perform high knee flexion after TKA. However, the 'floor life' subdomain of KSS appeared to be valid for evaluating high flexion of the knee.
Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Life Style ; Outpatients ; Surveys and Questionnaires

Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. Supracondylar periprosthetic fractures frequently occur above a well-fixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. Periprosthetic tibial fractures are frequently associated with loose components and malalignment or malposition of implants. Fractures of the patella are much less common and associated with rheumatoid arthritis, use of steroid, osteonecrosis and malalignment of implants. Most patients with periprosthetic fractures around the knee are the elderly with poor bone quality. There are many difficulties and increased risk of nonunion after treatment because reduction and internal fixation is interfered with by preexisting prosthesis and bone cement. Additionally, previous soft tissue injury is another disadvantageous condition for bone healing. Many authors reported good clinical outcomes after non-operative treatment of undisplaced or minimally displaced periprosthetic fractures; however, open reduction or revision arthroplasty was required in displaced fractures or fractures with unstable prosthesis. Periprosthetic fractures around the knee should be prevented by appropriate technique during total knee arthroplasty. Nevertheless, if a periprosthetic fracture occurs, an appropriate treatment method should be selected considering the stability of the prosthesis, displacement of fracture and bone quality.
Aged ; Arthritis, Rheumatoid ; Arthroplasty ; Femur ; Humans ; Knee ; Osteonecrosis ; Patella ; Periprosthetic Fractures ; Prostheses and Implants ; Risk Factors ; Soft Tissue Injuries ; Tibia ; Tibial Fractures

Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Arthroscopy ; Bony Callus ; Follow-Up Studies ; Humans ; Knee ; Motorcycles ; Physical Examination

Patellar tendon rupture is a catastrophic complication following total knee arthroplasty (TKA). Though revision TKA has been suspected of being a predisposing factor for the occurrence of patellar tendon rupture, there are few reports on patellar tendon rupture after revision TKA. Here, we present a case of acute patellar tendon rupture that occurred after TKA revision. In the patient, the patellar tendon was so thin and could not be repaired, and accordingly was sutured end to end. We used the anterior tibialis tendon allograft to augment the poor quality patellar tendon tissue. Fixation of the allograft was done by using the bone tunnel created through tibial tuberosity and suturing the allograft to the patellar tendon and quadriceps tendon. The patient was instructed to wear a full extension knee splint and was kept non-weight bearing for 6 weeks after operation. Full knee extension could be achieved 6 weeks postoperatively.
Allografts ; Arthroplasty ; Causality ; Humans ; Knee ; Patella ; Patellar Ligament ; Rupture ; Splints ; Tendons

PURPOSE: In anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel. SURGICAL TECHNIQUE: We present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique. MATERIALS AND METHODS: Between January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 12 months post-operatively. Clinical evaluation was done using the Lysholm score and International Knee Documentation Committee (IKDC) grade. All patients were analyzed by 3-dimensional computed tomography (3D CT) at 1 week after surgery. RESULTS: The mean Lysholm score improved from 68.2+/-12.7 points preoperatively to 89.2+/-8.2 points at final follow-up. At final follow-up, the IKDC grade was normal in 42 patients and nearly normal in 13 patients. None of the patients had a positive pivot shift test, anterior drawer test and Lachman test at final follow-up. The anatomical position of the femoral tunnel was confirmed on 3D CT scans. CONCLUSIONS: The three-point freehand technique for SB transtibial ACL reconstruction is a simple, anatomic technique showing good clinical results.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Follow-Up Studies ; Humans ; Knee ; Tomography, X-Ray Computed