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        Analysis of Impingement between Patella Bone and Bearing Post in Cruciate-Substituting High-Flexion Total Knee Arthroplasty

        Jegyun Chon,Bongju Lee,Sangyeop Shin,Gunil Jang,Taehyeon Jeon 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.2

        Background: We investigated the causes of impingement between the patella bone and the bearing post during high flexion in cruciate-substituting total knee arthroplasty and proposed a treatment strategy. Methods: This prospective cohort study included 218 cases that had undergone cruciate-substituting total knee arthroplasty from February 2014 to January 2015; a single surgeon performed the operation using the same method without patellar resurfacing in all patients. Results: In these patients, the occurrence of impingement was determined by performing more than 120° high knee flexion after inserting a bearing perioperatively. The incidence of impingement was significantly associated with bearing design, femoral implant size, patella bone length, and patella inferior pole angle (p < 0.05). The impingement was resolved by resection of the lower articular side of the patella bone. Conclusions: In the cruciate-substituting high-flexion total knee arthroplasty, impingement between the patella bone and bearing post was more common in patients with mobile bearing, small-size femoral component, and a long patella or a large inferior pole angle. In cases of intraoperative impingement between the patella bone and the bearing post, resection in the lower portion of the patella prevented impingement of the bearing with soft tissue or the patella by widening the space between the patella and the bearing post, which in turn prevented postoperative reduction in range of motion.

      • KCI등재

        Modified Tension Band Wiring Using FiberWire for Patellar Fractures

        Bongju Lee,Jegyun Chon,윤자영,정덕희 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.2

        In comminuted patellar fractures, we performed modified tension band wiring using a FiberWire (Arthrex) instead of the conventional methods. From March 2016 to March 2018, 63 patients with patellar fractures who needed surgical treatment were treated with modified tension band wiring using two Kirschner wires (K-wires) and FiberWire. We inserted two 1.6-mm K-wires perpendicular to the fracture line after accurate reduction. With the knee flexed over 90°, we sutured around the patella using a FiberWire. Visual analog scale score and Levack’s score were improved postoperatively. The mean bone union time was 5.6 months. None of the patients had breakage of wires, and nonunion with deformity occurred in one patient. We think that our method can be easier to handle and reduce irritation or breakage of the wires than conventional methods. In addition, early rehabilitation can be allowed. Therefore, we suggest that this method could be a useful method for the treatment of patellar fractures.

      • 내측 반월상 연골판 후각 기시부 파열 봉합 후 추시 자기공명영상 검사의 유용성

        전재균,김준범,이봉주,Chon, Jegyun,Kim, Jun-Beom,Lee, Bong-Ju 대한관절경학회 2013 대한관절경학회지 Vol.17 No.1

        목적: 슬관절 내측 연골판 후각 기시부 파열에 대하여 관절경적 봉합 수술을 시행한 후 유합 유무를 평가하기 위한 magnetic resonance imaging (MRI)의 유용성에 대하여 보고 하고자 한다. 대상 및 방법: 2007년 11월부터 2011년 6월까지 내측 반월상 연골판 후각 기시부 파열을 봉합한 환자 중 술후 MRI와 관절경검사를 모두 시행하였던 17명을 대상으로 하였다. 관절경검사와 MRI 검사를 시행하여 비교하였다. 결과: 술전 Lysholm knee score는 평균 56.4에서 평균 79.0으로 visual analogue scale (VAS) score는 8점에서 3점으로 호전되었다. 2차적 관절경 검사상 17예 모두 섬유화 재생 후 안정화된 소견이 확인되었다. 그러나 MRI 검사에서 내측 반월상 연골판 후각 기시부 파열을 시사하는 수직 직선 결함(cleft sign)은 술전후 모두 관찰되었고, 음영 손실(ghost sign)은 술전 10예에서 술후 9예, 방사선 직선 결함(radial linear defect) 소견은 술전 17예에서 술후는 15예에서 확인되었다. 결론: 내측 반월상 연골판 후각 기시부 파열의 관절경적 봉합술을 시행한 환자를 대상으로 비해부학적 위치에 봉합한 경우 술후 추시 MRI 검사는 유합 여부 판단에 유용하지 않았다. 유합 여부를 정확하게 평가하기 위해서는 관절경적 검사가 필요한 것으로 판단된다. Purpose: This study intends to verify the usefulness of magnetic resonance imaging (MRI) for estimate recovery after arthroscopic pull-out repair at root tears of medial meniscus. Materials and Methods: We performed 17 patients who examined MRI and arthroscopy among patients who had received repair of medial meniscus from November, 2007 to June, 2011. To determine restoration meniscus, we performed arthroscopy and MRI. Results: Lysholm knee scores before and after operation were average 56.4 and 79.0 and visual analogue scale (VAS) score was improved from 8 points to 3 points. From secondary look arthroscopy performed after operation, 17 cases showed stabilization after regeneration. However, In MRI, cleft sign implying root tears of medial meniscus was observed in all cases before and after operation, ghost sign was observed in 10 cases and 9 cases respectively, radial linear defect was showed 17 cases and 15 cases respectively. Conclusion: It was not useful that MRI after medial meniscus repair in non-anatomical site, to consider restoration of medial meniscus. To evaluate for recovery medial meniscus after repair more exactly, secondary arthroscopy would be required.

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