Purpose: This study examined the one-year mortality after locking plate fixation for distal femur fractures and the risk factors related to death. Materials and Methods: From July 2011 to June 2020, 128 patients who underwent locking plate fixation for distal femur fractures were analyzed retrospectively. Epidemiologic information of the patients, characteristics related to fracture and surgery, and death were investigated. The risk factors related to death were investigated using Cox analysis, and a subgroup analysis was also performed based on the age of 65 years. Results: The one-year mortality rate after locking plate fixation for distal femur fractures was 3.9%, and the mortality rates in patients younger than 65 years and older than 65 years were 0% and 6.7%, respectively. There were no significant risk factors related to death in the total population. On the other hand, in patients aged 65 years or older, however, high-energy fracture and high comorbidity index increased the risk of death after surgery by 6.9-fold and 1.9-fold, respectively. Conclusion The one-year mortality rate for the total patients was 3.9%, but the mortality rate for patients over 65 years of age increased to 6.7%. High-energy fractures and high comorbidity index were risk factors related to death after surgery for distal femur fractures in patients aged 65 years or older.

Background: We aimed to evaluate the effect of vitamin D levels on the functional outcome of elderly women who underwent total knee arthroplasty (TKA). Methods: Seven hundred and four patients (1013 knees) who underwent primary TKA were included in our retrospective study. Preoperative vitamin D levels were measured and the relationship analyzed between these and age, weight, height, body mass index, and bone mineral density. Two hundred and twenty patients (220 knees) who received unilateral TKA and were followed up for more than 1 year after operation were divided into two groups: Group 1, serum 25-hydroxyvitamin D3 (25(OH)D3) level < 20 ng/ml; and Group 2, 25(OH)D3 level ≥ 20 ng/ ml. Both groups were evaluated for the relationship between vitamin D levels and postoperative Visual Analogue Scale (VAS) score, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Results: The number of vitamin D-deficient patients (< 20 ng/ml of serum 25(OH)D3 level) was 556 (79.0%). In the correlation analysis, the vitamin D level was negatively correlated with weight only (pConclusions Vitamin D deficiency was highly prevalent in patients who underwent TKA. Vitamin D levels negatively correlated with weight. Low vitamin D level was not a risk factor for unsatisfactory TKA outcome in elderly women.

PURPOSE: The aim of this study was to analyze the causes of failure after a primary anterior cruciate ligament reconstruction (ACLR), associated injuries, and the clinical results of revision ACLR. MATERIALS AND METHODS: This study evaluated 46 patients (46 knees), who were followed at least two years after revision ACLR. The evaluations included the causes of failure after primary ACLR, associated injuries, 2000 International Knee Documentation Committee (IKDC) subjective knee scores, Lachman test, Pivot shift test, and KT-1000 arthrometer measurement. RESULTS: The most common cause of failure was trauma (27 patients, 58.7%) and 19 failures (19 patients, 41.3%) were caused using an inappropriate surgical technique. The associated injuries were meniscus tears in 29 cases (63.0%) and articular cartilage injuries of Outerbridge grade II to IV in 19 cases (41.3%). The IKDC scores, Lachman test, Pivot shift test, and KT-1000 arthrometer measurements were improved significantly at the final follow-up. CONCLUSION: The most common cause of failure after primary ACLR was trauma. One stage revision ACLR resulted in relatively satisfactory stability but less satisfactory clinical function than the primary reconstruction, as reported previously, which is believed to be due to the more associated injuries.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Cartilage, Articular ; Follow-Up Studies ; Humans ; Knee ; Tears

Hypoplasia of the meniscus is a very rare congenital abnormality, with only a few cases reported to date. A 9-year-old girl visited our hospital due to lateral knee pain following a hyperextension injury to the left knee. Magnetic resonance imaging showed hypoplasia of the medial and lateral menisci, as well as a posterior horn tear of the lateral meniscus, in both knee joints. To our knowledge, this is the first report of a patient with hypoplasia of the medial and lateral menisci in both knee joints.
Animals ; Child ; Congenital Abnormalities ; Female ; Horns ; Humans ; Knee ; Knee Joint ; Magnetic Resonance Imaging ; Menisci, Tibial ; Tears

PURPOSE: The purpose of this study is to evaluate the morphometric differences of distal femoral cut surface between Korean males and females in total knee arthroplasty. MATERIALS AND METHODS: A total of 696 patients (1,008 knees: male 92, female 916) who underwent TKA using NexGen® legacy posteriorstabilized (LPS) (605 knees: male 41, female 564) and PS ADVANCE® medical pivot knee (MPK) (403 knees: male 51, female 352) implants were analyzed prospectively. After distal femoral resection, the mediolateral width (ML) was measured at four points (anterior [Ant], distal anterior [DA], distal posterior [DP], and posterior [Post]) and compared with the ML width of the implant respectively. The aspect ratio (AR=ML/anteroposterior width) and width ratio (WR=Ant ML/DP ML) were calculated. Differences in AR, WR, and fitness between male and female were analyzed. RESULTS: The AR of males was larger than that of females for both LPS and MPK; however, no differences in the WR were observed between males and females. The WR in MPK was larger than that in LPS. For both LPS and MPK, females showed greater anatomical fitness than males, and males had relatively greater incidence of undersize than females. For MPK, there were relatively more cases of overhang in Ant and DA cut surface. These results were consistent with the fact that the WR of implant in MPK was larger than that in LPS. CONCLUSION: Korean males tend to have larger AR and less anatomical fitness of the femoral component than females because of undersize. No difference in WR was observed between Korean males and females. However, the cut surfaces as well as femoral implant of MPK had larger WR than those of LPS. MPK has more overhang on the anterior cut surface than LPS, due to a wider Ant flange (larger WR) of the implant.
Ants ; Arthroplasty* ; Female* ; Humans ; Incidence ; Knee* ; Male* ; Prospective Studies

PURPOSE: The purpose was to analyze the relationship between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL) in patients with total knee arthroplasty. MATERIALS AND METHODS: Four hundred and twenty-four patients (24 males and 400 females; 636 knees) who received total knee arthroplasty for osteoarthritis were included. Their mean age was 68.9 years (range, 48 to 88 years). The patients were classified into three groups according to the status of ACL; normal ACL group (group I), mucoid degeneration of ACL group (group II) and ruptured or absent ACL group (group III). Plain lateral radiographs were used to measure the PTS and the values were compared among groups. RESULTS: There were no significant differences with regard to gender, age and left-to-right side ratio among groups (p>0.05). The mean PTS was 9.9degrees (range, 0.6degrees to 20.1degrees) in group I (161 knees), 10.8degrees (range, 0.2degrees to 21.8degrees) in group II (342 knees) and 12.3degrees (range, 2degrees to 22.2degrees) in group III (133 knees), which showed significant differences (p<0.001). CONCLUSIONS: The patients with mucoid degeneration of the ACL and those with ruptured or absent ACL had greater PTS than those with normal ACL. These findings suggest that an increased PTS may be one of the causative factors for mucoid degeneration of the ACL.
Anterior Cruciate Ligament ; Arthroplasty ; Female ; Humans ; Knee ; Male ; Osteoarthritis

PURPOSE: To investigate the patterns of medial meniscus (MM) tears in patients with varus knee osteoarthritis who underwent total knee arthroplasty and analyze the factors that could affect MM tears. MATERIALS AND METHODS: The patients (365 knees, 268 patients) were classified into three groups; group I with MM posterior horn (PH) tear only; group II with MM root tear only; and group III with MMPH plus root tear. The following factors were evaluated: age, gender, body mass index, varus deviation of the mechanical axis, medial proximal tibial angle, posterior tibial slope (PTS), and anterior cruciate ligament (ACL) integrity (normal, degeneration, and tear or absence). RESULTS: MM tears were identified in all knees. The patterns of the combined MMPH tears in group III were less complex than those in group I. Varus deviation and PTS were significantly greater in group III than groups I and II. In group III, there were significantly more cases of ACL tear or absence than groups I and II. The others showed no differences among three groups. CONCLUSIONS: Severe varus knee osteoarthritis was always accompanied by MM tears. Risk factors for MMPH plus root tears were severe varus deformity, great PTS, and ACL tear or absence.
Animals ; Anterior Cruciate Ligament ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Congenital Abnormalities ; Horns ; Humans ; Knee ; Menisci, Tibial ; Osteoarthritis ; Osteoarthritis, Knee ; Risk Factors ; Tears

PURPOSE: To evaluate minimum 5-year follow-up clinical and radiological results of total knee arthroplasty (TKA) using a posterior cruciate ligament sacrificing (PS), non-substituting Advance Medial Pivot Knee. MATERIALS AND METHODS: One hundred and twenty knees in 80 patients who could be followed up for more than 5 years after TKA using the PS Advance Medial Pivot Knee were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemoral angle, Knee Society (KS) knee and function scores, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. The Kaplan-Meier method was used for survival analysis. RESULTS: The ROM increased from a preoperative mean flexion contracture of 7.6degrees and further flexion of 115.1degrees to a postoperative mean flexion contracture of 1.5degrees and further flexion of 120.5degrees. The tibiofemoral angle was changed from 4.6degrees varus preoperatively to 5.8degrees valgus postoperatively. The KS knee and function scores as well as WOMAC score significantly improved after surgery (p<0.05). Complications developed in 4 cases (3.3%): 2 cases of periprosthetic patellar fracture (1.7%) and 2 cases of aseptic loosening (1.7%). The seven-year survival rate was 98.1% in the Kaplan-Meier survival analysis. CONCLUSIONS: The minimum 5-year follow-up results of TKA using the PS Medial Pivot Knee were satisfactory.
Arthritis ; Arthroplasty ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Ontario ; Posterior Cruciate Ligament ; Range of Motion, Articular ; Retrospective Studies ; Survival Rate

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient's magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.
Anterior Cruciate Ligament/*pathology/radiography ; Arthralgia/etiology ; Humans ; Joint Diseases/diagnosis/*pathology/radiography ; Knee Joint/*pathology/radiography ; Male ; Middle Aged ; Posterior Cruciate Ligament/*pathology/radiography

The purpose of this study was to evaluate the relationship between the second-look arthroscopic findings of synovialization and the clinical results after the arthroscopic anterior cruciate ligament (ACL) reconstruction with the fresh-frozen tibialis tendon allograft. Fifty-seven patients could be examined with the second-look arthroscopy after the ACL reconstruction with tibialis tendon allograft. The average duration from reconstruction to second-look arthroscopy was 18.4 months (range, 4-48 months). The patients were classified, according to the extent of synovialization, into 3 groups; 37 cases (64.9%) in group A (good), 15 cases (26.3%) in group B (partial), and 5 cases (8.8%) in group C (poor). The clinical results were compared in each group. The 2000 International Knee Documentation Committee (IKDC) subjective knee score was 80 or more in 31 cases (83.8%) in group A, 9 (60%) in group B, and 1 (20%) in group C respectively. All thirty seven cases (100%) in group A had negative or 1+firm end-point Lachman test and negative pivot shift test, however, only 2 cases (40%) in group C. KT-1000 arthrometer measurement was less than 5 mm in 37 (100%) in group A, 14 (93.3%) in group B, and 2 (40%) in group C. According to the 2000 IKDC knee examination form, 37 (100%) in group A, 14 (93.3%) in group B, and 2 (40%) in group C respectively were normal or nearly normal. The synovialization of the graft had positive correlation with the clinical results after the ACL reconstruction with fresh-frozen allograft.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Arthroscopy ; Humans ; Knee ; Tendons ; Transplantation, Homologous ; Transplants