족관절 내측 퇴행성 관절염의 방사선적 분류와 관절 연골 손상의 관계

이우천,문정석,이강,최홍준,Lee, Woo-Chun,Moon, Jeong-Suk,Lee, Kang,Choi, Hong-Jun 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.2

Purpose: To investigate the relationship between classification based on simple radiographic findings and arthroscopic findings of the cartilage lesions in medial degenerative arthritis of the ankle joint. Materials and Methods: We studied 41 ankles of 36 patients with asymmetrical narrowing of the medial joint space. Degenerative arthritis following fracture and those with generalized arthritic disease were excluded, but those with a history of ankle sprain were included. Standing radiographs of all patients were graded according to the Takakura classification and the Kellgren-Lawrence (K/L) classification. Arthroscopic findings were classified according to the depth, width, and anteroposterior dimension of articular cartilage damage. Results: According to the Takakura classification, 29 ankles were classified as stage II, 7 cases as stage IIIA and 2 cases as stage IIIB. According to our classification of arthroscopic findings of 29 ankles in stage II, 1 ankle was graded as Grade I, 3 ankles as grade II, 10 ankles as grade III, and 15 ankles as grade IV. Spearman correlation coefficient between Takakura classification and arthroscopic classification was 0.342 (P=0.028), and coefficient between K/L classification and arthroscopic classification was 0.480 (P=0.001). Conclusion: Degenerative changes of the articular cartilage are more advanced than radiographic findings in many patients with ankle degenerative arthritis with asymmetrical narrowing of medial joint space. Therefore, we conclude that more aggressive effort should be made for correct diagnosis and treatment of degenerative arthritis.

내반 퇴행성 족관절염에 대한 과상부 절골술

이우천,김정래,Lee, Woo-Chun,Kim, Jung-Rae 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.3

본 연구는 내반 족관절 퇴행성관절염에서 선열에 대하여 고찰하고, 과상부 절골술의 적응증과 수술술기에 대하여 고찰하였다. 초기 족관절 퇴행성 관절염에서 경골 천장 및 후족부의 선열은 상당히 다양한 형태를 보이며, 과상부 절골술은 거골 경사가 경미하고, 후족부 선열이 중립이거나 내반인 경우가 적응증이다. This article has reviewed the alignment of the ankle and hindfoot in varus ankle osteoarthritis. The indication and surgical technique of the supramalleolar osteotomy has been reviewed. Alignment of tibial plafond and hindfoot is variable in early stages of ankle osteoarthritis. Supramalleolar osteotomy is indicated for the treatment of ankle osteoarthritis in patients with minimal talar tilt and neutral or varus heel alignment.

족근 관절 연부조직 충돌 증후군에서 MRI의 진단적 의의 및 관절경적 치료 결과

이진우,문은수,김성재,한수봉,강응식,Lee, Jin-Woo,Moon, Eun-Su,Kim, Sung-Jae,Hahn, Soo-Bong,Kang, Eung-Shick 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.2

Introduction: Soft-tissue impingement syndrome is now increasingly recognized as a significant cause of the chronic ankle pain. As a method to detect soft-tissue ankle impingement, a characteristic history and physical examination, routine MR imaging, and direct MR arthrography were used. The efficacy of routine MR imaging has been controversial for usefulness because of low sensitivity and specificity. Direct MR artrhography was recommaned for diagnosis because of the highest sensitivity, specificity and accuracy, but it requires an invasive procedure. The purpose of this study is to investigate the diagnostic accuracy of Fat suppressed, contrast enhanced, three-dimensional fast gradient recalled acquisition in the steady state with rediofrequency spoiling magnetic resonance imaging(CE 3D-FSPGR MRI) and to evaluate the clinical outcome of the arthroscopic treatment in assessing soft-tissue impingement associated with trauma of the ankle. Materials and Methods: We reviewed 38 patients who had arthroscopic evaluations and preoperative magnetic resonance imaging studies(3D-FSPGR MRI) for post-traumatic chronic ankle pain between January 2000 and August 2002. Among them, 24 patients had osteochondral lesion, lateral instability, loose body, malunion of lateral malleoli, and peroneal tendon dislocation. The patient group consisted of 23 men and 15 women with the average age of 34 years(16-81 years). The mean time interval from the initial trauma to the operation was 15.5 months(3 to 40 months), The mean follow-up duration of the assessment was 15.6months(12-48 months). MRI was simultaneously reviewed by two radiologists blinded to the clinical diagnosis. The sensitivity, specificity and accuracy of MRI was obtained from radiologic and arthroscopic finding. Arthroscopic debridement and additional operation for associated disease were performed. We used a standard protocol to evaluate patients before the operation and at follow-up which includes American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results: For the assessment of the synovitis and soft tissue impingement, fat suppressed CE 3D-FSPGR MR imaging had the sensitivity of 91.9%, the specificity of 84.4 and the accuracy of 87.5%. AOFAS Ankle-Hindfoot Score of preoperative state was 69.2, and the mean score of the last follow-up was 89.1. These were assessed as having 50% excellent(90-100) and 50% good(75-89). The presence of other associated disease didn't show the statistically significant difference(>0.05). Conclusion: Fat suppressed CE 3D-FSPGR MR imaging is useful method comparable to MR arthrography for diagnosis of synovitis or soft-tissue impingement, and arthroscopic debridement results in good clinical outcome.

종골 골절후 외상성 관절염에 대한 삼중 관절 고정술의 임상적 결과

정성택,노성만,정재윤,송은규,이근배,Jung, Sung-Taek,Rowe, Sung-Man,Chung, Jae-Yoon,Song, Eun-Kyoo,Lee, Keun-Bae 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.2

Purpose: To analyze the clinical outcome of triple arthrodesis for the posttraumatic arthritis after calcaneal fractures. Materials and Methods: We retrospectively reviewed 22 posttraumatic arthritis patients who underwent a triple arthrodesis from March 1991 to May 1998. The mean duration of follow up was 74 months(range, 36-123 months). The pain, function and alignment were evaluated by the modified ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society(AOFAS) clinically and the union rate, the duration of union and the degenerative change of adjacent joints radiographically were evaluated. Results: The mean duration from injury to arthrodesis was 33 months (range, 12-132 months). The AOFAS score improved from 36.4 points(range, 14-64) preoperatively to 67.6(range, 25-90) postoperatively. The union rate was 90.1% radiographically, the mean duration of union was 14.3 weeks(range, 12-21 weeks) and the degenerative change in the adjacent joint was showed in 12 patients(54.5%). There were 2 cases of talonavicular nonunion, one superficial wound infection and one partial skin necrosis. Conclusion: Triple arthrodesis for posttraumatic arthritis after calcaneal fractures is a useful method for relief of pain and correction of posttraumatic hindfoot deformity, as an evidenced by the satisfactory clinical outcome. Although a high prevalence of subsequent arthritis of the ankle and midtarsal joint was noted radiographically, we found that it was not clinically relevant.

족관절 관절염 치료 동향: 대한족부족관절학회 회원 설문조사 분석

Cho Byung-Ki,Cho Jaeho,Gwak Heui-Chul,Kim Hak Jun,Bae Su-Young 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.3

Purpose: Variations in the preferred conservative and operative treatment methods for ankle arthritis may be observed in the practice of orthopedic surgeons. This study is based on the Korean Foot and Ankle Society (KFAS) member survey and aims to report the current trend and changes in the management of ankle arthritis over the last few decades. Materials and Methods: A web-based questionnaire containing 24 questions was sent to all KFAS members in July 2021. The questions were mainly related to the preferred techniques and clinical experience in osteotomy, arthrodesis, and total ankle arthroplasty (TAA) for patients with ankle arthritis. Results: Sixty-three out of 550 surgeons (11.5%) responded to the survey. The responses to 6 out of the total of 24 questions (25.0%) achieved the levels needed to reflect a tendency. Answers that showed a tendency were related to the following: a surgical approach for arthrodesis (anterior approach), use of auto-bone graft for arthrodesis (iliac bone), a nonunion rate of more than 10% following arthrod- esis, main reason related to unsatisfactory results after arthrodesis (nonunion or delayed union), the main reason to change total ankle prosthesis (unstable supply of prosthesis), the unusualness of revision TAA and conversion of fusion to TAA. Diversity was found in sev- eral aspects of treatment (degree of experience and satisfaction in supramalleolar osteotomy, fixation method for arthrodesis, preferred TAA prosthesis and longevity, degree of experinece, annual number of TAA operation. Conclusion: This study proposes updated information with regard to the current trends in the management of ankle arthritis in Korea. Both consensus and variations in the approach to patients with ankle arthritis were identified through this survey. With an increasing preference for TAA, the need for the development of a prosthesis optimized for Koreans and a stable supply of prostheses were the sug- gestions made by the study.

족관절 골관절염에서 히알루론산 관절 내 주사

박용욱,Park, Yong-Wook 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.3

족관절 내 히알루론산 주사 후 효과에 대한 참고 자료를 살펴 본 결과 대부분의 연구들이 족관절 내 히알루론산 주사에 대한 효과와 안전에 대해 긍정적으로 보고하고 있지만, 아직까지는 결론을 짓기는 어렵다고 하겠다. 추후 많은 환자를 대상으로 한 무작위 이중맹검 위약대조군 연구(randomized double-blind placebo-controlled trials)를 통해 그 결과를 평가해야 할 것으로 사료되며, 또한 장기 추시를 통해 효과 발현 시기 및 지속 기간을 평가해야 할 것이다. Treatment of osteoarthritis of the ankle joint is similar to that of any other large joint and includes conservative and surgical treatments. Surgical option in severe osteoarthritis is joint fusion or joint replacement, whereas conservative treatment is limited and includes mainly ankle supports, physical therapy, and oral medication. Hyaluronic acid was discovered in 1934 and now has been widely used in the knee and shoulder joints. We reviewed the articles about an intra-articular hyaluronic acid injection in the treatment of osteoarthritis of the ankle joint.

만성 족관절 불안정증에서 건이식을 이용한 외측 인대 재건술의 적응증

박재용,최기원,조재호,강찬,최경진,정진화,김학준,배서영,차승도,김기천,한승환,2015 대한족부족관절학회 보험장애판정위원회,Park, Jae Yong,Choi, Gi-Won,Cho, Jae-ho,Kang, Chan,Choi, Kyungjin,Chung, Jin-Wha,Kim, Hak Jun,Bae, Su-Young,Cha, Seung-Do,Kim, Ki Ch 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.1

Purpose: The purpose of this study is to review the indications of ankle lateral complex reconstruction using tendon graft. Materials and Methods: We searched PubMed using the index, "ankle, instability, lateral ligament, reconstruction" from 1990 to present (September 30, 2015). We excluded 1) modified Brőstrom operation (MBO), 2) conventional tenodesis surgery, 3) review article, 4) technical note, and 5) articles written in another foreign language. We reviewed 24 papers through the publication events, operational method, the indications of surgery, and the specific features of the patient group. Results: There were the indications of 1) previous ligament surgery failure, 2) situation when ligament repair is impossible due to the ligament defect, 3) severe instability (preoperative talar tilt >$15^{\circ}$, anterior draw >10 mm or the difference of contralateral side talar tilt >$5^{\circ}$, anterior draw >3 mm), and 4) overweight (body mass index >$30kg/m^2$). Other considerations included 1) generalized joint laxity and 2) workers, highly-demanded or athlete highly-affected by instability. Conclusion: The ankle lateral complex reconstruction using tendon graft could be indicated in patients with the possibility of MBO failure with several considerations.

거골하 관절염으로 오인된 골관절 결핵 (1예 보고)

이성준,이동철,김지훈,박강현,박철현,Lee, Sung Jun,Lee, Dong Chul,Kim, Jee Hoon,Park, Kang Hyun,Park, Chul Hyun 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.3

Osteoarticular tuberculosis is often misdiagnosed as other disease because of a rare incidence and nonspecific clinical and radiographic presentation. Therefore, it is important to know clinical and radiographic presentations of osteoarticular tuberculosis and to diagnose in early phase. Especially, fistula formation is one of the most important clinical features which suspects osteoarticular tuberculosis. We report a case of ankle tuberculosis to be misdiagnosed as subtalar osteoarthritis and performed subtalar arthrodesis.

류마토이드 관절염 환자의 족무지 외반증에 대한 제 1 중족 족지 관절 고정술 -지연 나사못과 배부 금속판을 이용한 치험-

성일훈,이형상,황건성,박기철,Sung, Il-Hoon,Lee, Hyung-Sang,Whang, Kuhn-Sung,Park, Kee-Cheol 대한족부족관절학회 2001 대한족부족관절학회지 Vol.5 No.2

Purpose: To investigate the short term result of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of rheumatoid arthritis, using a lag screw and dorsal mini-plate. Materials and Methods: From December 1999 to September 2001, The first metatarsophalangeal arthrodesis of 14 cases (9 patients) was underwent, using a lag screw and dorsal mini-plate. The follow-up period was averaged in 14.6 months. The subjective findings with respect to pain, functional aspect of ability to stand and walk, and to shoe-wearing were evaluated. The objective findings, such as the gross alignment and the radiological measurements for the hallux valgus angle, 1,2 intermetatarsal angle, and dorsiflexion angle were also studied. Results: After the arthrodesis of the first metatarsophalangeal joint, the subjective improvement in pain, function and alignment was graded as excellent in seven (50%) feet, good in seven (50%) feet, and fair or poor in none. The hallux valgus angle and 1,2 intermetatarsal angle were reduced from $44.1{\pm}7.1$ and $15.5{\pm}6.2$ degrees to $13.6{\pm}2.6$ and $10.2{\pm}2.2$ degrees respectively. The dorsiflexion angle was measured in $20.3{\pm}3.7$ degrees after the fusion. The radiological fusion was observed at average 8 weeks after the operation in all cases. The overall complication of the procedure was few, except the delayed wound healing in one. Conclusion: The arthrodesis of the first metatarsophalangeal joint using a lag screw and dorsal mini-plate was regarded as an excellent method of various operative modalities to correct the rheumatoid hallux valgus deformity.

족근 중족 관절의 특발성 골관절염에 대한 수술적 치료 및 임상적 결과에 대한 분석

Jung, Hong-Geun,Byun, Woo-Sup,Myerson, Mark S.,Schon, Lew C. 대한족부족관절학회 2004 대한족부족관절학회지 Vol.8 No.1

Purpose: The purpose of the study was to identify the subtypes of idiopathic osteoarthritis of the tarsometatarsal joints based on accompanying hindfoot, midfoot, or foot deformities and their corresponding surgical options and also to evaluate the overall clinical results. Materials and Methods: The study included 59 patients (67 feet) with idiopathic tarsometatarsal joint osteoarthritis. Tarsometatarsal fusion was performed for tarsometatarsal joint and accompanied secondary change was divided into subtypes and various bony reconstruction was carried out. The patients were evaluated with the AOFAS midfoot score and FFI. The average patient age was 60.2 years with 40.6 months follow-up. Fifty-four feet (80.6%) had been treated with realignment fusion. Twenty-six feet had first and second tarsometatarsal joint fusion, and 20 feet had first tarsometatarsal fusion only. Six subtypes were identified based on associated foot deformities: 1) in-situ without deformities (18%), 2) pes planovalgus (45%), 3) rockerbottom (15%), 4) cavus foot (1%), 5) hallux valgus (12%), and 6) hallux valgus with pes planovalgus or rockerbottom (9%). Plantar-medial closing-wedge resection was used in 10 feet to correct rockerbottom. For pes planovalgus, a medial sliding calcaneal osteotomy was done. Lateral column lengthening with medial sliding calcaneal osteotomy was done for severe pes planovalgus, and triple arthrodesis was done for rigid pes planovalgus. Hallux valgus was corrected with the Lapidus procedure (85.7%). Results: AOFAS midfoot scores improved from preoperative 34.1 points to postoperative 83.9 points (p<0.05). The Foot Function Index postoperatively also showed significant improvement (p<0.05), with a high satisfaction rate (86.6%). There were 29 complications, most commonly sesamoid pain. Conclusion: Idiopathic tarsometatarsal OA feet can be classified into six categories. Pes planovalgus feet should be treated with medial sliding calcaneal osteotomy, lateral column lengthening, or triple arthrodesis in addition to tarsometatarsal joint realignment fusion. Rockerbottom and hallux valgus deformities should also be addressed.