The roentgenograms following arthroscopic ACL reconstruction show the enlargement of bone tunnels. Many authors hypothesized the cause of the tunnel enlargement, either mechanical or biological causes. The purpose of this study was to find the factors which affected the enlargement of the tibial tunnel following arthroscopic ACL reconstruction with bone-patellar tendon-bone or hamstring tendon. Sixty patients were reviewed retrospectively for radiographic measurement of tibial tunnel at post-operative one year (27 patients received bone-patellar tendon-bone autograft, 12 patients received bone-patellar tendon-bone autograft and Kennedy LAD-ligament augmentation device, 21 patients received Semitendinosus and Gracilis tendons with Endobutton). Roentgenographic anteroposterior and lateral films were checked and the tunnel was measured by two independent observers using a digital caliper. Statistical analysis was performed using a one-way analysis of variance (ANOVA) and t-test. The tibial tunnel enlargement was only related to the position of the fixation of the tibial tunnel. We concluded that tibial tunnel enlargement following arthroscopic ACL reconstruction is attributed to the mechanical effect rather than the properties of grafts and the clinical results.
Autografts ; Humans ; Retrospective Studies ; Tendons ; Transplants

In anterior cruciate ligament (ACL) deficient knee, several treatment methods were recommended. Recently, arthroscopic reconstruction is widely used as the best treatment method. As the graft materials, bone-patellar tendon-bone (BPB) unit is a gold standard material. Whereas, it has many problems. The purpose of this study was to introduce the new arthroscopic ACL reconstruction technique with quadrupled semitendinosus tendon and Endobutton and to evaluate its results. Twenty one patients were prospectively reviewed after ACL reconstruction with quadrupled semitendinosus tendon and Endobutton at one year post-operation. The surgery was performed in the series of graft tendon harvest, graft preparation, tunnel drilling and Endobutton fixation. The outcomes showed improved knee functions. Endobutton technique with quadrupled semitendinosus tendon is useful method for the arthroscopic ACL reconstruction. Stability and functional outcomes were similar to those with patellar tendon but it showed less donor site morbidity, less pitfall of fixation and simple procedure.
Anterior Cruciate Ligament ; Humans ; Knee ; Patellar Ligament ; Prospective Studies ; Tendons* ; Tissue Donors ; Transplants

Controversies about the posterior cruciate ligament continue with regards to total knee arthroplasty. There has been a long debate regarding PLC and its importance seems to be overrated in total knee arthroplasty. Twenty four patients had twenty six total knee replacements with insertion of the PCL substituting Press Fit Condylar modular total knee system with cement, and they were enrolled in a prospective study to assess the clinicoradiological results and measure the femoral roll-back postoperatively. Follow-up ranged from twenty four months to fifty months with an average of thirty two months. The mean HSS score was 92.1 points and the mean range of motion was 122.7 degrees. Twenty five cases(96.1%) showed excellent and good clinical results. The radiologic evaluation based on Knee Society roentgenographic system revealed proper alignment of all components and one significant radiolucent area. The mean femoral roll-back was 2.3mm posteriorly. In the present series, total knee arthroplasties with the Press Fit Condylar modular knee system resulted in excellent relief of pain, excellent range of motion and restoration of function.
Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Follow-Up Studies ; Humans ; Knee ; Posterior Cruciate Ligament ; Prospective Studies ; Range of Motion, Articular

Santonin-kainic acid complex was evaluated as a chemotherapeutic of the mass treatment of the Ascaris lumbricoides infection in Korea. The results could be summarized as follows: The negative conversion rate was 82.9% in average in 4 treated groups. Some variations of negative conversion rate among the treated groups were noticed. The egg reduciton rate was 97.7% in average and the results were rather uniform among the three evaluated groups. By the analysis of egg reduction, it seems that the lightly infected cases whose E.P.G. were under 5,000 were resistant to treatment with the less reduced egg output. After the treatment with this complex, the number of egg discharged cases were reduced to 1.84% and the average number of discharge eggs per incompletely treated or untreated cases were reduced to 12.5% compared with the level of before-treatment egg output. The successive observations of the pattern of worm expulsion after drug intake was made. The worms were mostly expelled in the stool within 3 days, and 58.9% of total expelled worms were collected within 24-hour stool. The minimum length of the immature worms expelled was 7.6cm. Among the 659 Ascaris collected in the first-day stool from 91 rural people, 8.5% were in the range of 7.6-12.2 cm-long, immature worms. The sex ratio, male: female= 0.69: 1.
parasitology-helminth-nematoda ; Ascaris lumbricoides ; chemotherapy ; Santonin ; kainic acid

The medial collateral ligament(MCL) of the knee is the well established secondary restraint to the anterior displacement of the knee joint. However, there has been no report about the estimation of the anterior displacement in combined ACL(anterior collateral ligament) and MCL injures according to period when they were treated with conservative measures. This prospective study evaluated the changes of anterior displacement over time in combined ACL/MCL injury as the MCL injury heals after initial conservative measures. 19 patients who had combined ACL/MCL injury were followed during twelve months after injury. All patient had a positive Lachman test and were evaluated the side to side differences on KT-2000 knee arthrometer(Medmetric, San Diego, California) testing under 20 Ibs anterior tibial loading at 30 degree knee flexion. The stability of the knee was assessed using KT-2000 knee arthrometer every 8 weeks with clinical examination prospectively. They were treated with CI (Combined instability) brace (Smith & Nephew, Carlsbad, California) as conservative measures. Overall, Initial side to side difference of the anterior displacement was averaged 5.21mm (range,4.0-7.0mm) and 3.30mm (range,2.0-5.5mm) finally. According to the classification of MCL injury, in Grade III groups, they had the greatest initial anterior displacement about 6.4mm, but tight- ened the most to 3.08mm finally. In Grade II and Grade I groups they showed 2.97mm and 2.13mm side to side difference (p>0.01). However in Grade I, the anterior displacement were decreased by 4 months after injury but, it were increased at 6 months after injury. In Grade II and III, the decrement of the anterior displacement were continued by 6 months after injury, but they were not changed after that. The data was analyzed by General Linear Model Procedure method. Conclusively, the anterior displacement of knee in patients with combined ACL/MCL injury was diminished with the time in the majority of patients as the MCL healed. It means that the MCL was the stabilizer to the anterior displacement of the knee under the anterior tibial loading.
Braces ; Classification ; Humans ; Knee Joint ; Knee* ; Linear Models ; Prospective Studies

The spinal fusion is used for correcting malformations, stabilizing unstable segments, and suppressing the progression of disease, but it causes more load on the adjacent segment and as a result, the degenerative changes accelerate. Furthermore, the accelerated changes case spinal stenosis, degradation of nucleus pulposus, degenerative spondylolisthesis, acquired isthmus defect, and arthritis of articular facet, it rarely needs surgical treatment. The purpose of this study is to know the effect of the fusion level and range on the adjacent segment, to be a standard for determining the fusion range prior to operation, and to help to find the complication like degenerative changes by measuring the range of motion on the adjacent segment after the spinal fusion. Authors analyzed the result of 29 cases of posterolateral lumbar spinal fusion which were operated from February 1989 and January 1994. The intervertebral angle was measured on the flexion and extension lateral radiographs, and the calculated angular motion and sagittal plane rotation at follow-up periods were compared with those of preoperative values. The results were as follows; 1. Among the adjacent segm0ent, the increment of angular motion of superior adjacent segment was 2.6°(-5°~15°) which was higher than that of inferior one with 1.5°(-3°~7°) 2. The increment of angular motion of superior adjacent segment for 1 segment rather than 2 or 3 segments was more than two times with 3.9°(-2°~15°) 3. Regardless of level and range of fusion, the increment of angular motion was 3.0°(-2°~8°) on 4.5th lumbar segment which was increased mostly and 1.5°(-3°~7°) on 5th lumbar and 1st sacral segment which was increased leastly. 4. There were 3 cases showed instability at the superior adjacent segment and no cases showed instability at the inferior adjacent segment among all the cases showing stability prior to operations. In conclusion, the sagittal plane rotation was increased in adjacent segment after posterolateral spine fusion. So, we would recommend that the adjacent segment is very important to the decision of fusion extent and level.
Arthritis ; Follow-Up Studies ; Range of Motion, Articular ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis

Ossifications of the ligamentum flavum(OLF) and the posterior longitudinal ligament(OPLL) are uncommon clinical entities as a cause of the progressive compression myelopathy or radiculopathy. Although there are considerable literatures concerning OPLL or OLF in cervical and thoracic spine, there are only a few references about OPLL or OLF in the lumbar spine. OLF and OPLL have been reported that they may lead to severe complication only with a minor trauma or even without trauma, such as paraplegia. The authors have experienced 2 cases of OLF accompanied by OPLL In the lumbar spine, who were treated with decompressive laminectomy and excision of ossified ligaments. For its rarity of OLF and OPLL in the lumbar region, we report here with review of literature.
Laminectomy ; Ligaments ; Ligamentum Flavum* ; Longitudinal Ligaments* ; Lumbosacral Region ; Paraplegia ; Radiculopathy ; Spinal Cord Diseases ; Spine*

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results of diabetic and non-diabetic patients who had undergone decompression and postero-lateral fusion with instrumentation. OBJECTIVE: To determine whether diabetes affected the outcome of surgery and to identify the clinical features associated with a poor outcome. SUMMARY OF BACKGROUND DATA: Symptoms of peripheral angiopathy and neuropathy as long-term complications of diabetes closely mimic those of lumbar stenosis and there may be a risk of inappropriate surgical intervention in patients with both diabetes and spinal stenosis. In the presence of diabetes, a poor surgical outcome might be expected. But only a few literatures have been documented. MATERIALS AND METHODS: We reviewed 21 diabetic(mean age 58.2 years) and 21 non-diabetic patients(mean age 61.3 years) who had undergone decompression and postero-lateral fusion with instrumentation for lumbar spinal stenosis at a mean of 32 months after operation by reviewing the medical records such as clinical symptoms and results of objective examination(including electrophysiologic study). RESULTS: The preoperative symptoms were similar in the two groups except that abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. The level of decompression, co-morbidity rate, and intra-operative blood loss were similar in two groups, too. Nerve-conduction velocity was lowered in 66.7% of the diabetic and in 25% of the non-diabetic patients. Polyneuropathy, which are highly suspicious of diabetic neuropathy was detected 46.7% in only diabetic group. The long-term result was excellent or good for thirteen(61.9%) of the twenty-one diabetic patients and for nineteen(90.5%) of the twenty-one non-diabetic patients. CONCLUSIONS: Thus diabetic patients who haute spinal stenosis cannot be expected to have same clinical outcome as non-diabetic patients, which is consistent with the general belief of impression. Therefore, the selection of patient according to clinical and electrophysiologic findings would be the most important factor in determining the rate of success of surgical treatment.
Constriction, Pathologic ; Decompression ; Diabetes Mellitus* ; Diabetic Neuropathies ; Humans ; Medical Records ; Peripheral Vascular Diseases ; Polyneuropathies ; Spinal Stenosis*

SUMMARY OF LITERATURE REVIEW: Many authors haute described the association between lumbar disc degeneration and segmental instability but it has not been delineated in detail. OBJECTIVES: To compare the MRI assessment of disc degeneration with the conventional plain X-ray evaluation of the intervertebral disc, in order to study lumbar segmental instability. MATERIALS AND METHODS: In 75 patients with low back pain and/or sciatica, we analyzed disc space height, angular displacement, and horizontal displacement on plain radiographs of the lumbar spine. These parameters were compared with the grade of disc degeneration as evaluated by magnetic resonance Imaging. STUDY DESIGN: We analyzed the association between grade of disc degeneration as evaluated by magnetic resonance imaging assessment and segmental instability as evaluated by plain radiographs of the lumbar spine. RESULTS: Disc space height was decreased In proportion to the grade of disc degeneration. Angular displacement was increased according to the grade of disc degeneration, but significantly less with severe degeneration, accompanied by a tendency to stabilization of the motion segment. Horizontal displacement was not correlated with the grade of disc degeneration CONCLUSIONS: The incidence of lumbar segmental instability increased in proportion to the grade of disc degeneration but significantly decreased with severe disc degeneration.
Humans ; Incidence ; Intervertebral Disc ; Intervertebral Disc Degeneration* ; Low Back Pain ; Magnetic Resonance Imaging ; Sciatica ; Spine

Enlargement of bone tunnels has been noted on plain X-rays following arthroscopic ACL reconstruction. The cause of this widening is unclear, but it has been hypothesized that it may be due to either mechanical or biological cases. Ishibashi et al. reported anatomical proximal fixation resulted in the most stable reconstructed knee, with increasing instability as the level of fixation moved away from the tibial plateau. The purpose of this study is to determine if any difference exists in the amount of enlargement of the femoral tunnel following arhotoscopic ACL reconstruction with position of interference screw fixation and instability, and to know the factors which affected to the enlargement of the femoral tunnels. Total 39 patients were retrospectively reviewed for tunnel measurements radiologically at one year post-operation. (27 patients received bone-patellar tendon-bone autograft, 12 patients received bone-patellar tendon-bone autograft and Kennedy LAD-ligament augmentation device). The surgery was performed using an arthroscopic single and double incision technique. AP and lateral X-rays were obtained and the tunnels were measured by two independent observers using a digital caplper. The measurements were made at the widest part of the tunnel. Correction for magnification was performed by comparing the measured width of the interference screw used for fixation of the graft with its actual width. Statistical analysis was performed using a one-way analysis of variance(ANOVA) and t-test. 1. Radiographic tunnel enlargement of femoral side was average 2.42 mm (bone-patellar tendon-bone autograft : 2.36 mm, Kennedy-LAD and autograft : 2.56 mm)(p>0.05). 2. According to the position of the interference screw, the femoral tunnel enlargement were 2.25 mm in anatomical fixation, 2.40 mm in mid-tunnel fixation, 2.62 mm in mid-tunnel fixation, 2.62 mm in outer-tunnel fixation(p < 0.05). 3. The femoral enlargement according to the overall results(Clancy, 1982) were 2.39 mm in above good result group and 2.50 mm in below fair result group(p < 0.05). Tunnel enlargement group of femoral side was related to a distance between femoral articular surface and the position of interference screw. We conclude that femoral tunnel enlargement following arthoscopic bone tendon-bone ACL reconstruction is related to the mechanical effect rather than the properties of grafts and the clinical results.
Autografts ; Humans ; Knee ; Retrospective Studies ; Transplants