고령 환자의 불안정성 대퇴골 전자간 골절시 외측 및 후방 전위 정복을 이용한 치료

심재앙 ( Jae Ang Sim ),최장석 ( Jang Seok Choi ),문도현 ( Do Hyun Moon ),안승준 ( Seung Jun Ahn ) 대한골절학회 2005 대한골절학회지 Vol.18 No.4

이중 다발 전방 십자 재건술 후 이식건-골간 접촉면의 평가와 임상적 관계

심재앙 ( Jae Ang Sim ),곽지훈 ( Ji Hoon Kwak ),이신우 ( Shin Woo Lee ),김동환 ( Dong Hwan Kim ),이범구 ( Beom Koo Lee ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.3

Purpose: This study examined the relationship between an evaluation of the graft-bone interface using magnetic resonance (MR) arthrography and the clinical results after double bundle anterior cruciate ligament (ACL) reconstruction. Materials and Methods: From December 2005 to October 2007, 15 cases that underwent double bundle ACL reconstruction and that were evaluated by MR arthrography were reviewed. The mean follow-up period was 20 months. The graft-bone interface was assessed by the leakage of contrast medium seen on MR arthrography. Four groups were classified according to the degree of contrast media leakage: no contrast media leakage, the focal type, the crescent type and the circumferential type. A functional evaluation was made using the Lysholm score, the international knee documentation committee (IKDC) score, the difference in the midthigh circumference and the Hop test. The stability was evaluated using a Lachmann test, a pivot shift test, a KT-2000 arthrometer and an anterior drawer stress radiograph using Telos(R) with the knee in 30o flexion. Results: Ten cases showed no leakage of contrast media, five cases showed focal leakage and there was no case of crescent and circumferential leakage. The clinical results of the no leakage and focal leakage groups were compared. The functional evaluation such as the Lysholm score, the IKDC score, the difference in the midthigh circumference and the Hop test showed no significant difference between the two groups. The stability evaluation, such as the Lachmann test, the pivot shift test, the KT-2000 arthrometer and anterior drawer stress radiograph, also showed no significant difference. Conclusion: On MR arthrography after double bundle ACL reconstruction, adequate osteointegration and satisfactory clinical results could be obtained in the no leakage and focal leakage groups.

슬개골 친화적인 ADVANTIM(R)을 이용한 슬관절 전치환술 후 결과

심재앙 ( Jae Ang Sim ),이범구 ( Beom Koo Lee ),기용철 ( Young Chul Kee ),최광운 ( Kwang Woon Choi ) 대한슬관절학회 2005 대한슬관절학회지 Vol.17 No.1

전방십자인대 재건술 시 이식건의 봉합을 이용한 기둥 고정에서 적절한 요소: 봉합사 수, 매듭 수, 봉합 방법, 봉합 수 -돼지 건을 이용한 실험적 연구-

심재앙 ( Jae Ang Sim ),최석원 ( Suk Won Choi ),전창수 ( Chang Soo Chon ),김원석 ( Won Seok Kim ),이용석 ( Yong Seuk Lee ),이범구 ( Beom Koo Lee ) 대한스포츠의학회 2014 대한스포츠의학회지 Vol.32 No.1

We evaluated the conditions required for sutures tied to a post for tibial fixation during anterior cruciate ligament (ACL) reconstruction. Harvested porcine tendon was used as a graft material and nonabsorbable suture was used for sutures. Samples were tested for ultimate tensile load and elongation according to thread numbers, knot numbers, suture techniques and stitch numbers. As thread numbers were increased, ultimate tensile load was increased and elongation was decreased. However, more than 4 strands of threads provided the sufficient ultimate tensile load more than 454 N of normal ACL for daily activities. As knot numbers were increased, ultimate tensile load was increased, but elongation was decreased. In terms of failure mode, unraveling occurred 100% in 3 and 4 knots, 81.2% in 5 knots, 54.5% in 6 knots, and 0% in 7 knots. Suture techniques and stitch numbers didn`t significantly affect the ultimate tensile load and the elongation. For sutures tied to a post for tibial fixation in ACL reconstruction, more than 4 threads, more than 7 knots, and more than 4 stitches provide adequate ultimate tensile load and elongation.

슬관절 전치환술에서 신전 및 굴곡 간격과 임상적 결과

심재앙 ( Jae Ang Sim ),이범구 ( Beom Koo Lee ),김현민 ( Hyun Min Kim ) 대한슬관절학회 2006 대한슬관절학회지 Vol.18 No.1

Purpose: To evaluate the relationship between flexion-extension gap discrepancy and clinical results in total knee arthroplasty (TKA). Materials and Methods: We evaluated the clinical results of 38 knees, which were performed TKA between March 2003 and June 2003, and followed up for at least 2 years. We divided all cases by the difference of medial and lateral joint gap in flexion and extension. Group A was no flexion-extension gap difference(17 cases) and group B was different gap(21 cases). We evaluated Knee Score, Function Score, range of motion and radiologic results Results: The difference of group B was less than 2mm. In Knee Score and function score, Group A improved from preoperative 50.1 and 45.0 to the last follow up to 95.6 and 95.9, and those of Group B improved from 48.2 and 45.2 to 96.9 and 91.4. There was no statistical difference between two groups(p>0.05). Flexion angle of Group A increased from preoperative 108.2 degree to the last follow up 115.3 degree. That of Group B increased from preoperative 101.9 degree to the last follow up 113.6 degree. But, there was no statistical difference between two groups(p>0.05). 2 cases of recurrent hemarthrosis were in Group B. Conclusion: We got good clinical results by flexion-extension gap difference within 2 mm. But long term followed up was needed.

Ligament Plate(R)과 슬근건을 이용한 전방십자인대 재건술의 단기 추시 결과

심재앙 ( Jae Ang Sim ),이범구 ( Beom Koo Lee ),곽지훈 ( Ji Hoon Kwak ),이경찬 ( Kyung Chan Lee ) 대한슬관절학회 2007 대한슬관절학회지 Vol.19 No.2

내반 변형의 슬관절 전치환술시 내측 상과 절골술의 단기 추시 결과

심재앙 ( Jae Ang Sim ),곽지훈 ( Ji Hoon Kwak ),양상훈 ( Sang Hoon Yang ),김준엽 ( Joon Yub Kim ),이범구 ( Beom Koo Lee ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.3

Purpose: We wanted to evaluate the results of medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty. Materials and Methods: We reviewed 32 cases of medial epicondylar osteotomy for treating varus deformity, and these cases underwent operation from December 2004 to December 2007. The average age of the patients was 71.0-years-old and the average follow-up period was 23.5 months. The clinical outcomes were measured, including the Knee Society score (KSS), the function score (FS) and the range of the motion (ROM). The radiological outcomes were measured by anteroposterior simple radiographs for assessing the union state of the osteotomy site, and the valgus stress radiographs and the whole extremity radiographs were used for assessing the femorotibial angle, the mechanical axis angle and the alignment. Results: The KSS improved from 46.5±7.6 to 89.1±5.9 points (p<0.001) and the FS increased from 39.5±9.2 to 84.2±8.5 points (p<0.001). The range of motion increased from 101.5±28.2° to 116.0±10.8° (p=0.006). Bony union occurred in 22 knees and fibrous union occurred in 10 knees. The femorotibial angle was corrected from varus 8.2±5.0° to valgus 5.6±1.5° (p<0.001) and the mechanical axis angle was revised from varus 13.9±4.5° to varus 0.7±1.6°(p<0.001). There were 27 neutral, 4 varus and 1 valgus alignment. On the valgus stress radiographs, the difference compared with the opposite side was 1.0±0.6° and there was no significant difference between the bony union group and the fibrous union group (p=0.175). Conclusion: Medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty could be a useful ligament balancing technique for achieving medial stability of the knee.

슬관절 전치환술에서 발생된 내측 측부 인대 완전 분리와 역학적 정렬의 임상적 관계

심재앙 ( Jae Ang Sim ),이범구 ( Beom Koo Lee ),곽지훈 ( Ji Hoon Kwak ),양상훈 ( Sang Hoon Yang ) 대한슬관절학회 2007 대한슬관절학회지 Vol.19 No.1

Purpose: To evaluate the clinical relationship between medial collateral ligament (MCL) complete detachment and mechanical alignment in total knee arthroplasty. Materials and Methods: From February 2001 to December 2006, we performed 290 TKAs. 9 TKAs (0.03%) happened MCL complete detachment. 1 TKA was excluded for paraplegia. All cases were women. The mean age was 71.1 years old. The mean follow-up period was 41.1 months. There were 7 degenerative osteoarthritis and 1 rheumatoid arthritis. The clinical evaluation included Knee Society Score (KSS), function score and range of motion (ROM) at preoperative, postoperative 3 months, 6 months, 12 months and final follow-up. We measured the femoro-tibial angle and the mechanical axis by anterior-posterior and whole lower extremity radiograph. The medial instability obtained serial valgus stress radiograph. Results: There were 4 neutral and 4 varus alignment. KSS, function score, ROM was significantly improved in both group, and there were no significant differences in both group. On serial valgus stress radiograph, the difference compared with normal side decreased from 5.2 degree (postoperative 3 months) to 3.4 degree (final follow-up) in neutral alignment group, from 2.9 degree to 0.9 degree in varus alignment group. In final follow-up, it revealed that the medial instability of varus alignment group was less than that of neutral alignment group. Conclusion: In MCL complete detachment, some stability obtained by repair of medial collateral ligament and bracing. Whole instability was not gone. Therefore, we should make the varus alignment of prosthesis in mechanical axis line position of 34 to 67% on the medial tibial plateau.

자가 슬건과 Ligament Plate<SUP>®</SUP>를 이용한 이중 다발 전방 십자 인대 재건술의 단기 추시 결과

심재앙(Jae-Ang Sim),양상훈(Sang-Hoon Yang),안병근(Byoung-Keun Ahn),이범구(Beom-Koo Lee) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.3

목적: 자가 슬건과 Ligament Plate<SUP>®</SUP>를 이용한 이중 다발 전방 십자 인대 재건술 후 최소 1년 이상 단기 추시 결과를 보고하고자 하였다. 대상 및 방법: 50예를 대상으로 하였으며, 전내측 다발로 반건양건, 후외측 다발로 박건을 이용하였다. 대퇴부 전내측 다발은 Ligament Plate<SUP>®</SUP>에 현수 고정, 후외측 다발은 Mersilene tape<SUP>®</SUP>을 이용 고정, 경골부는 이중 post-tie 고정을 시행하였다. 평균 추시 기간은 16.5개월이었고, 임상적, 방사선학적으로 평가하였다. 결과: Lysholm 점수는 92.4±6.8점, IKDC 점수는 A 등급 35예, B 등급 14예, C 등급이 1예로 호전되었다. Lachman 검사는 음성 40예, 경도 9예, 중등도 1예, pivot shift 검사는 음성 45예, 경도 5예로 호전되었다. KT 관절계 검사는 건측에 비해 1.3±1.6 ㎜, 전방 전위 방사선 사진은 1.3±1.3 ㎜로 호전되었다. 터널 확장 정도는 대퇴부가 전내측 1.7±0.6 ㎜, 후외측 1.6±0.7 ㎜, 경골부가 전내측 1.2±0.4 ㎜, 후외측 1.4±0.5 ㎜였다. 결론: 자가 슬건과 Ligament Plate<SUP>®</SUP>를 이용한 이중 다발 전방 십자 인대 재건술은 충분한 조기 고정력과 outside-in 등의 술기를 통한 해부학적 재건으로 우수한 임상 결과를 얻을 수 있었다. Purpose: We wanted to evaluate the clinical outcomes at a minimum 1-year following anatomic double bundle ACL reconstruction with using autogenous hamstring tendons fixed with Ligament Plate<SUP>®</SUP>. Materials and Methods: We evaluated a total of 50 patients. Semitendinosus tendon was used for the reconstruction of the anteromedial bundle and the gracilis tendon was used for the reconstruction of the posterolateral bundle. For femoral fixation, we used an anteromedial bundle that was suspended in Ligament Plate<SUP>®</SUP> and a posterolateral bundle linked with Mersilene tape<SUP>®</SUP>. For tibial fixation, we used double post-tie. The average follow-up period was 16.5 months. We analyzed the clinical and radiographic results. Results: At the last follow-up, the Lysholm score was 92.4±6.8 points. For the IKDC score, there were 35 cases of grade A, 14 cases of grade Band 1 case of grade C. The Lachman test was negative for 40 cases, it was grade 1 for 9 cases and it was grade 2 for 1 case and the pivot shift test was negative for 45 cases and it was grade 1 for 5 cases. The side-to-side differences with the KT-2000 and the anterior drawer radiogram were 1.3±1.6 ㎜ and 1.3±1.3 ㎜, respectively. The femoral tunnel enlarged to 1.7±0.6 ㎜ in the anteromedial aspect and 1.6±0.7 ㎜ in the posterolateral aspect, and the tibial tunnel enlarged to 1.2±0.4 ㎜ in the anteromedial aspect and 1.4±0.5 ㎜ in the posterolateral aspect. Conclusion: Anatomic ACL reconstruction using autogenous hamstring tendons that are fixed with Ligament Plate<SUP>®</SUP> showed good clinical results due to the strong strength of early fixation and the anatomic restoration of the ACL.

이중 다발 전방십자인대 재건술 후 이차 관절경 소견과 임상적 결과와의 관계

심재앙 ( Jae Ang Sim ),곽지훈 ( Ji Hoon Kwak ),김광희 ( Kwang Hee Kim ),이범구 ( Beom Koo Lee ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.2

Purpose: This study examined the relationship between the findings of a second-look arthroscopy and clinical results in double bundle anterior cruciate ligament (ACL) reconstruction using hamstring tendons fixed with a Ligament Plate(R). Materials and Methods: Twenty eight cases of a double bundle ACL reconstruction using hamstring tendons were retrospectively reviewed. The follow-up period was more than 1 year and all cases were reviewed by second-look arthroscopy. The average follow-up period was 20.6 months (range: 12-34 months). In second-look arthroscopy, the anteromedial (AM) bundle and posterolateral (PL) bundle of the grafts were evaluated based on the tension, rupture and synovial coverage. Clinical evaluation was assessed using the Lysholm score, international knee documentation committee score, Hop test, Lachman test, pivot shift test, KT-2000 arthrometer and anterior drawer stress radiograph using Telos(R) in 30˚ knee flexion. The correlation between the arthroscopic findings of the grafts and the instability tests was evaluated. Results: The AM graft was evaluated as being taut in 89.3% and lax in 10.7%, and the PL graft was assessed as being taut in 71.4% and lax in 28.6% according to the tension. The AM and PL grafts were evaluated as ``no rupture`` in 78.6% and ``partial rupture`` in 21.4%. There was no ``complete rupture`` in any graft. The AM grafts were found to be good in 53.6%, fair in 35.7% and poor in 10.7%; the PL grafts were assessed as good in 50.0%, fair in 28.6% and poor in 21.4% according to the synovial coverage. The AM graft tension showed statistically significant results regarding both the Lachman test (ρ=0.743, p<0.001) and degree of rupture (ρ=0.438, p=0.020). The PL graft tension showed statistically significant results regarding both the pivot shift test (ρ=0.548, p=0.003) and the degree of rupture (ρ=0.663, p<0.001). Conclusion: Double bundle ACL reconstructions using hamstring tendons show good biological and clinical results. The graft tension and the degree of rupture show a statistically significant relationship to the stability of the reconstructed joint. On the other hand, the synovial coverage did not show a significant result.