Purpose: The association between the healing of an injured anterolateral ligament (ALL) and residual pivot-shift following anterior cruciate ligament (ACL) reconstructions is rarely reported. This study analyzed the relationship between unhealed ALL and residual pivot-shift after an ACL reconstruction. Materials and Methods: The inclusion criteria were patients who underwent autologous hamstring ACL reconstructions within 6 weeks after injury from January 2008 to March 2021. Preoperative ALL injuries and postoperative ALL healing were graded according to the magnetic resonance imaging classification, with postoperative magnetic resonance imaging performed 7.8 months after surgery on average. The patients were categorized based on postoperative ALL healing, and the clinical scores (Lysholm score and Tegner activity scale) and knee stability (Lachman test and pivot-shift test) were assessed at the 1-year postoperative follow-up. Results: One hundred and forty-five patients were enrolled in this study. One hundred and twenty-eight (88.3%) patients had a concomitant ALL injury. Among 86 patients with preoperative grade B, 16 (18.6%) patients showed grade 1 (good), and 70 (81.4%) showed grade 2 (partial) ALL postoperatively. Among the 42 patients with preoperative grade C (complete tear), 1 (2.4%) patient showed grade 1 (good), 21 (50.0%) showed grade 2 (partial), and 20 (47.6%) showed grade 3 (non-visualized) ALL. Preoperative grade C was significantly associated with a higher incidence of grade 3 (non-visualized) postoperatively than the other groups (p<0.001). Postoperatively, the Lachman test, KT-1000 (MEDmetric Corp.) arthrometer (side-to-side difference), Lysholm score, and Tegner activity scales did not show a significant difference among the intact, grade 1, grade 2, and grade 3 ALL groups. The pivot-shift test showed a significant difference between the ALL grades (p=0.001). Grade 3 ALL group showed a higher incidence of pivot-shift than the intact, grade 1, and grade 2 ALL groups. Conclusion Patients with preoperative grade C had a higher rate of grade 3 postoperatively compared to the other groups. In addition, the grade 3 group had a significantly higher incidence of a pivot-shift. Therefore, in cases of ACL injuries with concomitant complete ALL tears, ALL reconstruction should be considered during ACL reconstruction.

Purpose: The association between the healing of an injured anterolateral ligament (ALL) and residual pivot-shift following anterior cruciate ligament (ACL) reconstructions is rarely reported. This study analyzed the relationship between unhealed ALL and residual pivot-shift after an ACL reconstruction. Materials and Methods: The inclusion criteria were patients who underwent autologous hamstring ACL reconstructions within 6 weeks after injury from January 2008 to March 2021. Preoperative ALL injuries and postoperative ALL healing were graded according to the magnetic resonance imaging classification, with postoperative magnetic resonance imaging performed 7.8 months after surgery on average. The patients were categorized based on postoperative ALL healing, and the clinical scores (Lysholm score and Tegner activity scale) and knee stability (Lachman test and pivot-shift test) were assessed at the 1-year postoperative follow-up. Results: One hundred and forty-five patients were enrolled in this study. One hundred and twenty-eight (88.3%) patients had a concomitant ALL injury. Among 86 patients with preoperative grade B, 16 (18.6%) patients showed grade 1 (good), and 70 (81.4%) showed grade 2 (partial) ALL postoperatively. Among the 42 patients with preoperative grade C (complete tear), 1 (2.4%) patient showed grade 1 (good), 21 (50.0%) showed grade 2 (partial), and 20 (47.6%) showed grade 3 (non-visualized) ALL. Preoperative grade C was significantly associated with a higher incidence of grade 3 (non-visualized) postoperatively than the other groups (p<0.001). Postoperatively, the Lachman test, KT-1000 (MEDmetric Corp.) arthrometer (side-to-side difference), Lysholm score, and Tegner activity scales did not show a significant difference among the intact, grade 1, grade 2, and grade 3 ALL groups. The pivot-shift test showed a significant difference between the ALL grades (p=0.001). Grade 3 ALL group showed a higher incidence of pivot-shift than the intact, grade 1, and grade 2 ALL groups. Conclusion Patients with preoperative grade C had a higher rate of grade 3 postoperatively compared to the other groups. In addition, the grade 3 group had a significantly higher incidence of a pivot-shift. Therefore, in cases of ACL injuries with concomitant complete ALL tears, ALL reconstruction should be considered during ACL reconstruction.

Purpose: The association between the healing of an injured anterolateral ligament (ALL) and residual pivot-shift following anterior cruciate ligament (ACL) reconstructions is rarely reported. This study analyzed the relationship between unhealed ALL and residual pivot-shift after an ACL reconstruction. Materials and Methods: The inclusion criteria were patients who underwent autologous hamstring ACL reconstructions within 6 weeks after injury from January 2008 to March 2021. Preoperative ALL injuries and postoperative ALL healing were graded according to the magnetic resonance imaging classification, with postoperative magnetic resonance imaging performed 7.8 months after surgery on average. The patients were categorized based on postoperative ALL healing, and the clinical scores (Lysholm score and Tegner activity scale) and knee stability (Lachman test and pivot-shift test) were assessed at the 1-year postoperative follow-up. Results: One hundred and forty-five patients were enrolled in this study. One hundred and twenty-eight (88.3%) patients had a concomitant ALL injury. Among 86 patients with preoperative grade B, 16 (18.6%) patients showed grade 1 (good), and 70 (81.4%) showed grade 2 (partial) ALL postoperatively. Among the 42 patients with preoperative grade C (complete tear), 1 (2.4%) patient showed grade 1 (good), 21 (50.0%) showed grade 2 (partial), and 20 (47.6%) showed grade 3 (non-visualized) ALL. Preoperative grade C was significantly associated with a higher incidence of grade 3 (non-visualized) postoperatively than the other groups (p<0.001). Postoperatively, the Lachman test, KT-1000 (MEDmetric Corp.) arthrometer (side-to-side difference), Lysholm score, and Tegner activity scales did not show a significant difference among the intact, grade 1, grade 2, and grade 3 ALL groups. The pivot-shift test showed a significant difference between the ALL grades (p=0.001). Grade 3 ALL group showed a higher incidence of pivot-shift than the intact, grade 1, and grade 2 ALL groups. Conclusion Patients with preoperative grade C had a higher rate of grade 3 postoperatively compared to the other groups. In addition, the grade 3 group had a significantly higher incidence of a pivot-shift. Therefore, in cases of ACL injuries with concomitant complete ALL tears, ALL reconstruction should be considered during ACL reconstruction.

BACKGROUND: The choice of unicompartmental knee arthroplasty (UKA) vs . total knee arthroplasty (TKA) in the surgical treatment of knee osteoarthritis (KOA) remains controversial. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the clinical results of UKA and TKA for treating unicompartmental KOA. METHODS: PubMed, Embase, and the Cochrane Library were systematically searched for articles published up to January 2, 2023. The literature was rigorously screened to include only RCTs comparing UKA and TKA for unicompartmental KOA. A systematic review and meta-analysis were performed to calculate the mean difference (MD), relative risk (RR), and 95% confidence interval (CI) according to the Cochrane standards. RESULTS: Thirteen publications involving 683 UKAs and 683 TKAs were analyzed. Except for one study with a follow-up period of 15 years, all outcome measures reported were within 5 years of follow-up. Meta-analysis showed better knee recovery (MD: 1.23; 95% CI: 1.01-1.45; P  <0.001), greater knee function (MD: 1.78; 95% CI: 0.34-3.22; P  = 0.020), less pain (MD: 0.75; 95% CI: 0.43-1.06; P  <0.001), and better health status (MD: 3.75; 95% CI: 0.81-6.69; P  = 0.010) after UKA than TKA. However, considering the minimal clinically important difference values for these variables, the findings were not clinically relevant. Moreover, UKA patients had fewer complications (RR: 0.59; 95% CI: 0.45-0.78; P  <0.001) and shorter hospital stays (MD: -0.89; 95% CI: -1.57 to -0.22; P  = 0.009) than did TKA patients. There were no statistically significant differences in terms of postoperative range of movement, revision, failure, operation time, and patient satisfaction. CONCLUSIONS In terms of clinical efficacy, there was no obvious advantage of UKA over TKA in the surgical treatment of knee OA when considering the minimal clinically important difference. The main advantage of UKA over TKA is that it leads to fewer complications and a shorter length of hospital stay. It is ideal to perform prospective studies with longer follow-up periods to fully evaluate the long-term efficacy and safety of the two procedures in the future.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Osteoarthritis, Knee/surgery* ; Randomized Controlled Trials as Topic ; Treatment Outcome

OBJECTIVE: Despite the global decrease in influenza infections during the coronavirus disease 2019 (COVID-19) pandemic, seasonal influenza remains a significant health issue. South Korea, known for its robust pandemic response and high influenza vaccination rates, offers a unique context for examining changes in vaccination trends during the pandemic. Using nationally representative data, we aimed to understand the impact of the pandemic on influenza vaccination behavior over a 12-year period and to identify vulnerable groups. METHODS: We analyzed influenza vaccination rates in South Korea between 2011-2022, focusing on pandemic-related impacts. The data of 2,426,139 adults (≥ 19 years) from the Korea Community Health Survey were used to assess demographic and sociological factors influencing vaccination behaviors. RESULTS: We observed an increase in influenza vaccination rates during the pre-COVID-19 period from 2011-2013 (weighted prevalence: 46.68% [95% confidence interval ( CI): 46.55-46.82]) to 2017-2019 (weighted prevalence: 52.50% [95% CI: 52.38-52.63]). However, a significant decline was observed in 2022, the late-COVID-19 pandemic period (weighted prevalence: 55.78% [95% CI: 55.56-56.01]), compared with the mid-pandemic period in 2021 (weighted prevalence: 59.12% [95% CI: 58.91-59.32]), particularly among populations traditionally prioritized for influenza vaccination, including older adults (≥ 65 years) and patients with chronic diseases and low educational and income levels. CONCLUSION The influenza vaccination rate in South Korea was significantly affected by the COVID-19 pandemic, showing a notable decrease among vulnerable demographic groups. This suggests the need for targeted public health strategies to address vaccine hesitancy and improve vaccination rates, particularly among high-risk populations.
Humans ; Republic of Korea/epidemiology* ; COVID-19/epidemiology* ; Adult ; Middle Aged ; Influenza Vaccines/administration & dosage* ; Male ; Female ; Influenza, Human/epidemiology* ; Aged ; Vaccination/statistics & numerical data* ; Young Adult ; Pandemics ; SARS-CoV-2

Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines (mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.

Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines (mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.

Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines (mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.

Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.