The purpose of this study is to compare the effects of intraoperative fixation and postoperative rehabili-tation on postoperative results in arthroscopic PCL reconstruction. We analyzed the posterior stability of the knee on 47 patients(48 knees) with posterior cruciate liga-ment injury whose posterior cruciate ligament had been recostructed arthroscopically and followed for minimum 1 year period at Asan Medical Center from March 1993 to May 1998. The patients were divided into the two groups according to intraoperative fixation and postoperative rehabilitation. In A group, one interference screw or staple fixed in distal femur and proximal tibia irre-spective to bone quality and fixation strength during screw insertion, and rehabilitation was started as early as anterior cruciate ligament reconstruction. In B group, additional screw or staple was fixed if fixa-tion strength was weak during screw insertion, and delayed rehabilitation program was performed as schedule. Lysohm knee score was 65.3 in group A and 75.8 in group B preoperatively but 86.0 in group A and 86.5 in group B at last follow up postoperatively. posterior stability was determined by difference in pos-terior tibial translation between the injured and the opposite knee with Telos device. Differences in poste-rior tibial translation on average were 6.9 and 3.0 mmin group A and B, respectively. Conclusively, arthroscopic posterior cruciate reconstruction with firm fixation strength and delayed rehabilitation program is effective to restore more reliable posterior stability.
Anterior Cruciate Ligament Reconstruction ; Appointments and Schedules ; Chungcheongnam-do ; Femur ; Follow-Up Studies ; Humans ; Knee ; Ligaments* ; Posterior Cruciate Ligament ; Rehabilitation* ; Tibia

PURPOSE: To evaluate the clinical outcome after the over-the-top augmentation with ABC synthetic lig-ament for the treatment of acute rupture of anterior cruciate ligament at least two years follow up. MATERIALS AND METHODS: From January 1992, authors have treated acute rupture of ACL with this method on 91 cases. Among these, 46 cases were available for full data acquisition. At the last follow-up, clinical results were analyzed subjectively and objectively by Lachman, pivot shift test and presence of joint effusion. Functional evaluation was performed by various knee ligament scoring systems and the side-to-side differences were measured with KT-2000 arthrometer. RESULTS: On Lachman test, 82.7% were under grade Iⅈ grade 0 : 17 cases(37%), grade I: 21 cases(45.7%), grade III: 8 cases(17.3%). 89.3% were under grade 0 & Ion pivot shift test. On measure-ment of side-to-side difference, 25 cases(54.3%) were showed difference less than 3 mmand the differences of 16 cases(34.8%) were 3~5 mm. On six cases joint effusions were present. Among these six cases, four cases were accompanied by anterior instability which were brought to second look arthroscopy. Two cases were treated with several times of aspiration and steroid instillation. The one case was failed its continuity which solved with ACL reconstruction with patellar bone-tendon-bone autograft. The other three cases showed only lax ACL which was cared with retightening of ligament at the femoral attach-ment site. At the last follow up, 37 cases(80.4%) were resulted excellent and good on Lysholm score and 41 cases(89.1%) were group A & B on IKDC score. On Tegner scale, 34 cases(73.9%) were above five point. CONCLUSIONS: Authors suggest this over-the-top augmentation of ACL with synthetic polyester ligament would be good treatment option with several advantages; early rehabilitation is possible to get maximal function of knee and no tunnel in the lateral condyle would be good for late ACL reconstruction even though failure of this artificial ligament.
Anterior Cruciate Ligament* ; Arthroscopy ; Autografts ; Follow-Up Studies ; Joints ; Knee ; Ligaments* ; Polyesters ; Rehabilitation ; Rupture*

PURPOSE: To analyze the anterior stability and functional results after the arthroscopic ACL reconstruc-tion with bone patellar tendon bone autograft in the ACL deficient knee. MATERIALS AND METHODS: From March 1993 to May 1998, 24 patients were treated by arthroscopic ACL reconstruction with BPTB autograft and followed more than 1 year(range, 12~82 months, average: 30.5 months). Objective stability was estimated under the loading of 15 lb and 20 lb using KT 2000 arthrometer. Functional evaluation system of OAK knee score and Lysholm knee score was used. RESULTS: Average anterior displacement under the loading of 15 lb was 5.4+/-2.4 mmin the reconstructed knee, 4.2+/-1.8 mmin the normal side and under the loading of 20 lb, 8.3+/-3.1 mmin the reconstructed knee, 6.0+/-2.5 mmin the normal side. The percentage of anterior displacement within 3 mmdifference compared with normal side revealed 75% under the loading of 20 lb(89 N) and 87.5% under the loading of 15 lb(68 N). Functional results according to OAK system showed an average 83.8 score, and excellent in 9 cases, good in 9. Lysholm score revealed an average score of 80 and excellent in 5, good in 8. CONCLUSIONS: The arthroscopic ACL reconstruction with BPTB autograft results in good stability and functional results. Effective quadriceps muscle strengthening exercise and rehabilitation is necessary to prevent limitation of range of motion, quadriceps muscle atrophy and anterior knee pain post-operatively.
Atrophy ; Autografts* ; Humans ; Knee* ; Patellar Ligament ; Quadriceps Muscle ; Range of Motion, Articular ; Rehabilitation

PURPOSE: We introduce the management protocol of medial structures-ACL combined injury patients in Asan Medical Center and evaluate the results of the management according to severity of medial injuries. MATERIALS AND METHODS: From Jan.1994 to May 1998, we treated 30 cases of acute combined injuries of medial structures and ACL. Unless the medial structures shows grade IIIwithout end point, we man-aged the medial structures conservatively and conducted ACL reconstuction . After that, we analysed the results of the management. Evaluation was based on the Lysholm knee scoring system, physical examina-tion and stress radiographs. RESULTS: The functional result by Lysholm knee scoring revealed 92.4/95.3(medial structures conserva-tive / repair groups) respectively. Except 1 case of persistent medial laxity in medial structures repair group, there was no severe complication in both groups. CONCLUSIONS: There was no significant medial laxity after conservative management in grade I,II,III with end point injury of medial supporting structures and we had good results in severe medial injury involving MCL, posterior oblique ligament in terms of ROM and stability with open repair of medial structures and delayed arthroscopic ACL reconstruction.
Anterior Cruciate Ligament* ; Chungcheongnam-do ; Humans ; Knee* ; Ligaments

PURPOSE: To evaluate prognostic factors for arthritis and usefulness of bone SPECT in reconstructed joint. MATERIAL AND METHOD: ACL reconstruction using bone-patellar tendon-bone graft was performed in fourteen patients from March 1996 to March 1997, and follow-up bone SPECT was done. The mean duration from ACL reconstruction to SPECT was 23 months. The knee was defined to be unstable when the difference of displacement measured using KT-2000 arthrometer was greater than 3 mm. Lesions were evaluated in sub-divided five compartments ; patello-femoral joint, anteromedial, anterolateral, postero-medial and posterolateral compartment of tibio-femoral joint. RESULT: Geographic bone bruise was found in 9 cases(15 compartments) of 14 patients and bone SPECT revealed increased uptake in all the compartments. Reticular type bone bruise was found in 6 cases(7 compartments) and no compartment revealed increased uptake. Partial meniscectomy was done in 9 cases(16 compartments), and 8 cases(13 compartments) of them revealed increased uptake. Six cases were unstable and four of them revealed increased uptake in the patello-femoral joint. Activity level was not correlated with hot uptake. CONCLUSIONS: Bone SPECT is a useful method to predict osteoarthritis after ACL reconstruction. Geo-graphic bone bruises at injury, meniscectomy and instability are important factors for prognosis after ACL reconstruction.
Arthritis* ; Bone-Patellar Tendon-Bone Grafts ; Contusions ; Follow-Up Studies ; Humans ; Joints ; Knee ; Osteoarthritis ; Prognosis ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To analysis clinical results after arthroscopic ACL reconstruction between bioabsorbable interference screw fixation and metallic interference screw fixation. MATERIALS AND METHODS: We evaluated the results of arthroscopic ACL reconstruction with patellar tendon autograft between two groups, of which group 1 is used metallic interference screw, group 2 is used bioabsorbable interference screw. All of 53 patients underwent arthroscopic patellar tendon auto-grafts with one incision technique. A minimum 12 months follow-up is available on 31 patients in group 1 and 22 patients in group 2. The average age was 28.4 years(19 to 47 years) in group 1 and 29.7 years(18 to 55 years) in group 2. The average period, from trauma to operation, was 20.7 months in group 1 and 24.6 months in group 2. The average follow-up period was 24.1 months in group 1 and 13.1 months in group 2. In terms of the results of pivot shift test, Lachman test, anterior drawer test, Lysholm score, Arthrometer(KT-2000), Cybex test, simlpe X-ray and MRI findings of group 1 compared with group 2. RESULTS: At the final follow-up, KT-2000 test showed that average maximum manual side-to-side dif-ference(STSD) was 2.7mm for group 1 and 2.7mm for group 2. Average muscle power of injured quadri-ceps muscle compared with normal leg by Cybex test was average 82% for group 1 and 79% for group 2. Lysholm score was average 90 for group 1 and 89 for group 2. 3 cases of group 1 and 2 cases of group 2 were showed instability in physical examination, but there were no evidence of synovitis of knee joint or rerupture of anterior cruciate ligament in the follow-up MRI. CONCLUSIONS: No statistical difference was found between the bioabsorbable interference screw fixation group and the metallic interference screw fixation group. Short-term data support that bioabsorbable interference screw is a reasonable alternative to metallic interference screw.
Anterior Cruciate Ligament ; Autografts ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Leg ; Magnetic Resonance Imaging ; Patellar Ligament ; Physical Examination ; Synovitis

PURPOSE: The purpose of this study was to correlate radiological analysis(as divergence of femoral tun-nel and interference screw and tunnel placement) with clinical results(as physical examination, Lysholm knee scoring scale, and side to side difference of anterior displacement in an arthrometer). MATERIALS AND METHODS: This study reviewed radiological and clinical results in 48 endoscopic single-incision ACL reconstruction, using autogenous bone-patellar tendon-bone graft and interference screw fixation, between January 1995 and October 1997. We measured the femoral divergence in antero-poste-rior and lateral views of the knee(APD/LD), the angle between a line through the longitudinal axis of dis-tal femoral shaft, and the axis of femoral tunnel in antero-posterior and lateral views(APFT/LFT). We also measured the placement of a tunnel in antero-posterior and lateral views. RESULTS: Significant correlation was present between APD and APFT(negatively) and between LD and LFT(positively), while other variables had no significant correlation. Furthermore, there was no signifi-cant correlation between divergence and clinical results. Clinical results correlated positively with posteri-or femoral tunnel placement on lateral radiographs and negatively with excessive anterior tibial tunnel placement. Therefore, when femoral tunnels were placed at least 60% posterior along the Blumenssat's line and tibial tunnels were placed at least 20% posterior along the tibial plateau, 77.1% of the patients had good or excellent Lysholm score and 80% of the patients had a KT-2000 Arthrometer maximum manual side-to-side difference of 3 mmor less. When the above criteria were not met, however, only 53.8% of the patients had good or excellent Lysholm score and 53.8% had a KT-2000 Arthrometer maximum manual side-to-side difference of 3 mmor less. CONCLUSIONS: This close correlation indicated that satisfactory radiographic tunnel position influences the outcome of an ACL reconstruction.
Anterior Cruciate Ligament* ; Axis, Cervical Vertebra ; Bone-Patellar Tendon-Bone Grafts* ; Humans ; Knee ; Physical Examination

PURPOSE: To evaluate clinical and radiographic results for screw and cement fixation of tibial bone defect in total knee replacement arthroplasty(TKRA) retrospectively. MATERIALS AND METHODS: From march 1995 to May 1998, 23 total knee replacement arthroplasties were performed in 19 adults with screw and cement fixation for tibial bone defect. They were followed retrospectively for at least 12 months at mean 28 months(12~50). The average age of the patients at the time of operation was 64 years. The American Knee Society clinical rating system was used for the assessment of the results. We also used Knee Society roentgenographic evaluation and scoring system in all cases for assessment of radiolu-cent line between bone and cement interface, prothesis and cement, and around the threads of the screw within the bone. RESULTS: The average 37.6 preoperative knee rating score and 41 functional score were improved to 94.9 and 95 retrospectively at the last follow-up. Roentgenographic evalua- tion revealed that no radiolu-cent line was detected between prothesis and cement, around the threads of the screws within the bone. Between bone and cement interface, we observed radiolucent line in 8 of 23 cases(34.8%) and they had no progression during follow-up. CONCLUSIONS: Screw and cement fixation may be tried when tibial bone defect are small and situated peripherally. But, we considered that more long-term follow-up evaluation must be needed.
Adult ; Arthroplasty ; Arthroplasty, Replacement, Knee* ; Follow-Up Studies ; Humans ; Knee ; Retrospective Studies

INTRODUCTION: Although most stable total knee arthroplasties remain so for many years, recently asep-tic loosening of prosthesis due to osteolysis which are induced by polyethylene wear is one of important causes in TKA failure. The authours experienced two cases of TKA revision due to aseptic loosening, and analysed wear particles in association with aseptic loosening. MATERIALS AND METHODS: From Oct 1988 to July 1999, two cases among 400 TKA underwent revision TKA due to aseptic loosening. The periprosthetic interface membrane tissues were collected for analysis of wear particle. After enzymatic digestion, EDS and FT-IR employed for chemical and physical charac-teristics and SEM employed for size and morphology of particle. RESULTS: Radiolucent line were seen around tibial component and aseptic loosening were observed also. At revision operations, hypertrophy of synovium and interface membrane between prosthesis & host bone were confirmed. Pathology showed synovial hypertrophy and giant cell which impressed chronic inflammation due to foreign body. The isolated particles were mainly polyethylene debris. And the size of the particle was variable. Some were identified grossly, several mm, others were several micrometer. Also, submi-cron particles were seen. CONCLUSIONS: If aseptic loosening was developed in TKA, polyethylene wear particle should be consid-ered as a cause of loosening. The wear particles were variable in sized and more bigger than that in previ-ous reports of THA.
Arthroplasty* ; Digestion ; Foreign Bodies ; Giant Cells ; Hypertrophy ; Inflammation ; Knee* ; Membranes ; Osteolysis ; Pathology ; Polyethylene ; Prostheses and Implants ; Synovial Membrane

PURPOSE: For the study for patellar tendon which can be a cause of joint stiffness and weakness, we analysed the biomechanical and the histological changes of patellar tendon according to each immobiliza-tion period after cast immobilization of knee joint of rabbits. MATERIALS AND METHODS: The knee joints of 36 rabbits were immobilized with long leg cast and K-wire fixation for 4, 8, 12, and 16 weeks. The tensile tests were carried out on 6 pairs of the patellar ten-dons obtained from the rabbits which were immobilized for each periods, and the histological study was done for 3 pairs of patellar tendons. RESULTS: The immobilization changed the mechanical properties of the patellar tendon significantly; it decreased the tangent modulus and tensile strength to 26 percent of control values after 16 weeks immo-bilization. The cross-sectional area and tendinous length were not changed significantly. Remarkable changes were also observed in the histologic properties; histological studies showed that the immobiliza-tion has increased the number of fibroblasts and decreased the longitudinally aligned collagen bundles. CONCLUSIONS: These results imply that mechanical weakness and histological changes of patellar tendon due to cast immobilization are one of the causes of stiffness and weakness of knee joint after cast immo-bilization.
Collagen ; Fibroblasts ; Immobilization* ; Joints ; Knee ; Knee Joint ; Leg ; Patellar Ligament* ; Rabbits* ; Tensile Strength