We report a case of 53-year-old woman with an injured popliteal artery due to excessive drilling with a drill bit during medial opening wedge high tibial osteotomy (MOWHTO). Pseudoaneurysm was diagnosed three days after surgery and confirmed by urgent computed tomography (CT) angiography. Open vascular surgery with resection of the perivascular hematoma and end-to-end anastomosis using ipsilateral saphenous vein interposition graft was performed. CT angiography at 8 months postoperatively showed that blood flow was maintained without obstruction of the graft site and active dorsiflexion of the foot was possible. To reduce neurovascular injury during MOWHTO, it is important not to drill the far cortex at the proximal part of the osteotomy site when using a drill bit, and the metal should be positioned posteromedially as much as possible.
Aneurysm, False ; Angiography ; Female ; Foot ; Hematoma ; Humans ; Knee ; Middle Aged ; Osteotomy ; Popliteal Artery ; Saphenous Vein ; Transplants

BACKGROUND: This study aimed to evaluate the clinical and radiological outcomes of arthroscopic bioabsorbable screw fixation in osteochondritis dissecans (OCD) in adolescent patients with unstable lesions causing pain. METHODS: The study included 11 patients (10 males and 1 female) with OCD who underwent arthroscopic bioabsorbable screw fixation between July 2007 and February 2014 and were available for follow-up for more than 12 months. The mean age at diagnosis was 16.3 years (range, 11 to 19 years), and the average follow-up period was 51 months (range, 12 to 91 months). Clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, and International Knee Documentation Committee (IKDC) score measured before surgery and at follow-up. Functional evaluation was made using the Tegner activity scale. Magnetic resonance imaging (MRI) and second-look arthroscopy were performed at the 12-month follow-up. RESULTS: Between the preoperative assessment and follow-up, improvements were seen in the KOOS (range, 44.9 to 88.1), Lysholm knee score (range, 32.6 to 82.8), and IKDC score (range, 40.8 to 85.6). The Tegner activity scale also improved from 2.8 to 6.1. Based on postoperative MRI, there were eight Dipaola grade I cases and three grade II cases. No complications due to fixation failure developed in any case. Second-look arthroscopy at 12 months postoperatively revealed that the lesion was covered with cartilage in all cases. CONCLUSIONS: For unstable OCD lesions causing pain in adolescents, arthroscopic bioabsorbable screw fixation provided favorable outcomes with reduced pain and restoration of movement. Therefore, it should be considered as an effective treatment for OCD.
*Absorbable Implants ; Adolescent ; Adult ; Arthroscopy/adverse effects/*instrumentation/methods ; *Bone Screws ; Child ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Osteochondritis Dissecans/*diagnostic imaging/*surgery ; Range of Motion, Articular ; Treatment Outcome ; Young Adult

PURPOSE: The purpose of this study is to provide information on the actual status and prevailing trend of prophylaxis for venous thromboembolism (VTE) following total knee arthroplasty (TKA) in South Korea. MATERIALS AND METHODS: The Korean Knee Society (KKS) developed a questionnaire with 6 clinical questions on VTE. The questionnaire was distributed to all members of KKS by both postal and online mail. Participants were asked to supply details on their specialty and to select methods of prophylaxis they employ. Of the total members of KKS, 27.9% participated in the survey. RESULTS: The percentage of surgeons who routinely performed prophylaxis for VTE was 60.4%; 19.4% performed prophylaxis depending on the patient's health condition; and the remaining 20.2% never implemented prophylaxis after surgery. The common prophylactic methods among the responders were compression stocking (72.9%), pneumatic leg compression (63.3%), perioral direct factor Xa inhibitor (46.9%), and low-molecular-weight heparin (39.5%). For the respondents who did not perform prophylaxis, the main reason (51.5%) was the low risk of postoperative VTE considering the low incidences in Asians. CONCLUSIONS: The present study involving members of the KKS will help to comprehend the actual status of VTE prevention in South Korea. The results of this study may be useful to design VTE guidelines appropriate for Koreans in the future.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Asian Continental Ancestry Group ; Factor Xa ; Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Knee ; Korea ; Leg ; Postal Service ; Stockings, Compression ; Surgeons ; Surveys and Questionnaires ; Thromboembolism ; Venous Thromboembolism

BACKGROUND: Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. METHODS: Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. RESULTS: The clinical success rate was 95.4% and the HSS scores were 93.9 +/- 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. CONCLUSIONS: The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.
Adolescent ; Adult ; Anterior Cruciate Ligament/*injuries/pathology/*surgery ; *Anterior Cruciate Ligament Reconstruction ; Arthroscopy/*methods ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial/*injuries/pathology/*surgery ; Middle Aged ; Rupture ; Second-Look Surgery ; Treatment Outcome ; Young Adult

OBJECTIVE: People with attention-deficit/hyperactivity disorder (ADHD) exhibit considerable impairment in social, academic, or occupational functioning. The present study aimed to examine the patterns of associations between ADHD symptoms, depression, and family functioning. METHODS: The sample consisted of 1,022 adults randomly selected from a district in Seoul, South Korea. Several self-assessment scales were utilized to rate ADHD symptoms (both past and current), current symptoms of depression, and level of family functioning. ADHD symptoms in the children of these participants were also assessed. Pearson's correlation and multiple linear regression analyses were performed; structural equation modeling (SEM) was conducted to determine the best fitting model. RESULTS: Adult ADHD symptoms were positively associated with depressive symptoms. Depressive symptoms, in turn, mediated the relationship between adult ADHD symptoms and cohesion among family members. In addition, depressive symptoms mediated the relationship between adult ADHD symptoms and their children's ADHD symptoms. CONCLUSION: The relationship between adult ADHD symptoms and family dysfunction may be influenced by depressive symptoms. When treating ADHD in adults, clinicians should pay attention to the presence or absence of depression.
Adult* ; Child* ; Depression* ; Humans ; Korea ; Linear Models ; Self-Assessment ; Seoul ; Weights and Measures

For most orthopedists, total knee arthroplasty (TKA) has been regarded as the most effective surgery for patients with severe knee diseases. Though seldom occur, postoperative infection certainly remains one of the most devastating and dreaded complications of TKA. Thus, careful and early diagnosis is needed. After diagnosis, categorize the infection type and choose a rightful and sequential step of treatment are recommended.
Arthroplasty ; Early Diagnosis ; Humans ; Knee

PURPOSE: The single-radius design of the knee implant was introduced to improve the results of total knee arthroplasty (TKA) by reducing maximum extensor forces, and it also represents more physiologic quadriceps force pattern, which could have a positive effect on knee function after TKA. We studied mid-term results of single-radius designed cruciate retaining (CR) TKA. MATERIALS AND METHODS: We analyzed the functional improvement and radiological osteolytic pattern after TKA using the single-radius Scorpio CR prosthesis. TKA was performed on 102 knees. The mean follow-up period was 73.8 months. For clinical assessment, the range of motion (ROM), Harris hip score, and functional outcome score were obtained preoperatively and at last follow-up. RESULTS: The average ROM was 100.2degrees preoperatively and 121.7degrees at last follow-up. The average knee score was 59.2 points preoperatively and 92.9 points at last follow-up. The average functional outcome score was improved from 51.9 points preoperatively to 85.4 points at last follow-up. Radiolucency was observed in four knees but all were non-progressive lesions smaller than 2 mm. CONCLUSIONS: The clinical outcome of TKA using the single-radius CR prosthesis was good during the mid-term follow-up and the incidence of osteolysis was very rare.
Arthroplasty ; Drugs, Chinese Herbal ; Follow-Up Studies ; Hip ; Incidence ; Knee ; Osteolysis ; Prostheses and Implants ; Range of Motion, Articular

PURPOSE: This study was conducted for evaluation of clinical uses of anterior cruciate ligament (ACL) reconstruction with an Achilles allograft using the remnant technique by comparison and analysis stability, functional assessment and results of second-look arthroscopy between the remnant technique and the non-remnanat technique. MATERIALS AND METHODS: A total of 48 patients who underwent ACL reconstruction using an Achilles allograft were selected and divided into two groups depending on the presence of remnant. The preserving group included 26 patients and non-preserving group included 22 patients. The two groups were compared and analyzed with regarding to stability (Stress view Lachman test, pivot shift test), functional assessment (International Knee Documentation Committee, Lysholm score, Tegner score, single hoop test, shuttle turn, carioca test), and the result of second-look arthroscopy (study design: prosepective cohort study). RESULTS: In the final result, the remnant group showed significant improvement in the Tegner and carioca tests compared with the non-remnant group (p<0.05). In second-look arthroscopy, the remnant group showed better coverage of synovium (p<0.05). CONCLUSION: ACL reconstruction with an Achilles allograft using the remnant technique showed better results in functional assessment and finding in second-look arthroscopy compared with the non-remnant technique group.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Arthroscopy ; Cohort Studies ; Humans ; Knee ; Synovial Membrane ; Transplantation, Homologous*

Recently, rising curiosity on remnant preservation technique of anterior cruciate ligament (ACL) reconstruction, there is much interested in being and distribution of the mechanoreceptor of ACL. So, we performed histologic analyzing and mapping of sensory nerve fiber of the human ACL in this study. Total of 20 anterior cruciate ligaments were obtained from total knee replacement. Each ACL samples was divided into seven specimens; tibial insertion site, mid transitional site, femoral insertion site, and in between the sites, and total of 140 tissue samples were stained with hematoxylin-eosin and immunohistochemical, and observed with light microscope. Five hundred thirty-four fine neuroparticle structures, Ruffini corpuscles, and free nerve endings were observed in 20 ACL samples. The mean of fibers observed were 1.88, 1.71, 1.15, 1.08, 1.15, 1.55, and 1.82, respectively from tibial insertional site to femoral insertional site. With immunohistochemical stain, S-100 protein was strong positive at nerve cells, but was weak positive or negative at neurofilament. Mapping of sensory nerve distribution were done based on the results. We identified the mechanoreceptor of the human ACL using optical and immunohistochemical methods and mapped the histologic distribution of that.
Anterior Cruciate Ligament ; Arthroplasty, Replacement, Knee ; Exploratory Behavior ; Humans ; Light ; Mechanoreceptors ; Nerve Endings ; Nerve Fibers ; Neurons ; Proprioception ; S100 Proteins

The purpose of remnant preserving technique in anterior cruciate ligament (ACL) reconstruction is to preserve mechanoreceptor and accelerate revascularization. In this study, we compared a group who underwent remnant preserving technique using Achilles tendon allograft with the other group of conventional ACL reconstruction in terms of proprioception, kinematic analysis, knee strength test and dynamic postural stability. Twenty-four patients were followed up for longer than 12 months after ACL reconstruction. They were separated into two groups; remnant preserving group (n=12) and non-remnant group (n=12). Proprioception test was conducted through joint position sense (JPS) and threshold to detection of passive motion. The remnant preserving group showed significantly less difference from the normal side than the non-remnant group. In kinematic analysis, there was statistically significant difference in peak flexion angle during the swing phase. However the 60degrees JPS, knee strength test, performance capacity test and dynamic postural stability did not showed the significant difference. Remnant preserving technique of ACL reconstruction was meaningful in preserving proprioception and the result showed akin to the unaffected gait.
Achilles Tendon ; Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Biomechanics ; Gait ; Humans ; Joints ; Knee ; Knee Joint ; Mechanoreceptors ; Proprioception ; Transplantation, Homologous