Current concepts in open-wedge high tibial osteotomy

Kyung Wook Nha 대한정형외과 스포츠의학회 2015 Arthroscopy and Orthopedic Sports Medicine Vol.2 No.1

High tibial osteotomy is the most widely used surgical method to treat osteoarthritis with combined varus deformity of the knee. This treatment is associated with a highly satisfactory clinical outcome providing that patient selection and surgery performance are carried out accurately. Commonly, the medial open-wedge or the lateral closed-wedge high tibial osteotomies are used. In this review, we give a thorough investigation of the factors related to the indications, preoperative assessment, execution, complications, rehabilitation process, and current opinions of medial open-wedge osteotomy of the high tibia.

Navigated versus Conventional Technique in High Tibial Osteotomy: A Meta-Analysis Focusing on Weight Bearing Effect

( Kyung Wook Nha ),( Young-soo Shin ),( Hyuk Min Kwon ),( Jae Ang Sim ),( Young Gon Na ) 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.2

Purpose: We aimed to determine whether navigated opening wedge high tibial osteotomy (HTO) is superior to the conventional technique in terms of accuracy of the coronal and sagittal alignment correction, functional outcome, and operative time. Methods: Studies comparing navigated and conventional HTO were included in this meta-analysis. We compared the incidence of radiological outliers in coronal alignment and tibial slope maintenance, mean differences in functional outcome scales, and operative time. Subgroup analyses were performed on coronal alignment accuracy based on the intraoperative method of alignment confirmation: fluoroscopy vs. gap measurement method. Results: Twelve studies were included: there were 434 knees in the navigated HTO studies and 405 knees in the conventional HTO studies. The risk of outlier was lower in navigated HTO than in conventional HTO; however, the difference was not significant when navigated HTO was compared with conventional HTO performed using the gap measurement method. Tibial slope maintenance was comparable or better in navigated HTO. No difference was found in the American Knee Society function and Lysholm scores. Navigated HTO necessitated a longer operative time of approximately 10 minutes. Conclusions: The use of navigation in HTO can improve accuracy in both coronal and sagittal alignments, but its clinical benefit is unclear.

Technical Note : Anatomical Single-bundle Anterior Cruciate Ligament Reconstruction Using a Freehand Transtibial Technique

( Kyung Wook Nha ),( Jae Hwi Han ),( Jae Ho Kwon ),( Kyung Woon Kang ),( Hyung Joon Park ),( Jae Gwang Song ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.2

Introduction: In anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel. Surgical Technique: We present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique. Materials and Methods: Between January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 12 months post-operatively. Clinical evaluation was done using the Lysholm score and International Knee Documentation Committee (IKDC) grade. All patients were analyzed by 3-dimensional computed tomography (3D CT) at 1 week after surgery. Results: The mean Lysholm score improved from 68.2±12.7 points preoperatively to 89.2±8.2 points at final follow-up. At final follow-up, the IKDC grade was normal in 42 patients and nearly normal in 13 patients. None of the patients had a positive pivot shift test, anterior drawer test and Lachman test at final follow-up. The anatomical position of the femoral tunnel was confirmed on 3D CT scans. Conclusions: The three-point freehand technique for SB transtibial ACL reconstruction is a simple, anatomic technique showing good clinical results.

Medial patellofemoral ligament reconstruction using an autograft or allograft for patellar dislocation: a systematic review

( Kyung Wook Nha ),( Ji Hoon Bae ),( Sun Chul Hwang ),( Young Jun Nam ),( Myung Jin Shin ),( Nikhl N. Bhandare ),( Aseem Kumar ),( Dong Geun Kang ),( Dong Yeong Lee ) 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.1

Purposes: The purpose of this study is to review the use of an allograft or autograft in medial patellofemoral ligament (MPFL) reconstruction. Materials and methods: Various electronic databases were searched for relevant articles published from January 2000 to September 2017 that evaluated clinical outcomes of MPFL reconstruction using an autograft or allograft. Data search, extraction, analysis, and quality assessments were performed based on Cochrane Collaboration guidelines. Results: The study of 21 autografts and one allograft was included in this review. Although direct comparative studies were unavailable, the Kujala score and subjective results were reported in the majority of these studies. While the use of an autograft for MPFL reconstruction yielded satisfactory clinical outcomes with few perioperative complications, no new outcome has been drawn from the use of allografts. Conclusions: Although many studies have shown favorable clinical results for MPFL reconstruction using an autograft, the clinical results of MPFL reconstruction using an allograft have not yet been sufficient to achieve meaningful clinical results due to low levels of evidence. Direct comparisons were not conducted because there were very few studies on allografts; thus, further research in this area should be performed in the future.

슬관절에 발생한 관절 주위 연골종

나경욱(Kyung Wook Nha),김한성(Han Seong Kim),오형근(Hyoung Keun Oh) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.1

관절 주위 연골종은 드문 질환으로 주로 슬관절에 발생하며 연골의 이형성 과정으로 발생하는 것으로 알려져 있다. 슬관절 주위 연골종은 방사선적으로 종양성 석회증 같은 석회화 연부조직 병변이나 연골육종 및 활액막 연골종증과 같은 연골성 병변과 감별해야 한다. 저자들은 Osgood씨 병이 동반된 환자에게서 발생한 슬관절 주위 연골종을 치험하였기에 보 고하는 바이다. Paraarticular chondroma of the knee is a very rare benign tumor that seems to develop from cartilageous metaplasia. This lesion should be differentiated from calcifying soft tissue lesions like tumoral calcinosis, and cartilageous lesions like chondrosarcoma and synovial chondromatosis. We experienced a case of paraarticular chondroma of the knee in an Osgood-Schlatter disease patient.

내측 반월상 연골 방사형 파열의 자기 공명 영상 소견

나경욱 ( Kyung Wook Nha ),오형근 ( Hyoung Keun Oh ),김동환 ( Dong Hwan Kim ),김용훈 ( Yong Hoon Kim ) 대한슬관절학회 2005 대한슬관절학회지 Vol.17 No.2

견갑하근 건에 발생한 석회화 건염

나경욱(Kyung Wook Nha),김진환(Jin Hwan Kim),박규원(Gyu Won Park) 대한견주관절의학회 2003 대한견주관절의학회지 Vol.6 No.1

관절경에서 세척 및 멸균

나경욱,Nha, Kyung-Wook 대한관절경학회 2010 대한관절경학회지 Vol.14 No.3

Open Posterior Approach versus Arthroscopic Suture Fixation for Displaced Posterior Cruciate Ligament Avulsion Fractures: Systematic Review

Jae­Gwang Song,Kyung Wook Nha,이세원 대한슬관절학회 2018 대한슬관절학회지 Vol.30 No.4

Purpose: To compare the clinical outcomes between the open posterior approach and arthroscopic suture fixation for displaced posterior cruciate ligament (PCL) avulsion fractures.Methods: A literature search was performed on MEDLINE, EMBASE, and the Cochrane Library databases. The inclusion criteria were as follows: papers written in English on displaced PCL avulsion fractures, clinical trial(s) with clear description of surgical technique, adult subjects, a follow­up longer than 12 months and modified Coleman methodology score (CMS) more than 60 points.Results: Twelve studies were included with a mean CMS value of 72.4 (standard deviation, 7.6). Overall, 134 patients underwent the open posterior approach with a minimum 12­month follow­up, and 174 patients underwent arthroscopic suture fixation. At final follow­up, the range of Lysholm score was 85–100 for the open approach and 80–100 for the arthroscopic approach. Patients who were rated as normal or nearly normal in the International Knee Documentation Committee subjective knee assessment were 92%–100% for the open approach and 90%–100% for the arthroscopic approach. The range of side­to­side difference was 0–5 mm for both approaches.Conclusions: Both arthroscopic and open methods for the treatment of PCL tibial­side avulsion injuries resulted in comparably good clinical outcomes, radiological healing, and stable knees.

내측 반월상 연골 후각부 방사형 파열의 임상적 결과

나경욱,조진호,이동봉,Nha, Kyung-Wook,Jo, Jin-Ho,Lee, Dong-Bong 대한관절경학회 2007 대한관절경학회지 Vol.11 No.2

목적: 내측 반월상 연골 방사형 파열의 관절경적 연골판 절제술 후 임상 결과를 알아 보고자 하였다. 대상 및 방법: 내측 반월상 연골 방사형 파열을 가진 2년 이상($2{\sim}7$년)의 추적이 가능하였던 45례를 대상으로 하였다. 관절경 수술은 체중 부하 단순 방사선 사진에서 Kellgren과 Lawrence분류상 정상이나 초기 퇴행성 관절염(0-2군)으로 분류된 환자에 한하여 시행하였다. 연골 손상의 정도는 수술 중에 Outerbridge 분류를 사용하였으며, 임상적 결론은 Modified Lysholm score를 사용하였다. 결과: 술 전 평균 Lysholm점수는 위의 순서대로 79.1, 71.2, 68.5, 67.9, 67.2, 61.5 이였으며, 술 후 점수는 86.3, 75.1, 73.0, 73.1, 73.2, 66.2이였다. 술 후 통증 호전은 각각 61.5%, 62.5%, 60.0%, 50.0%, 50.0%, 25.0%이었고, 술 후 만족도는 69.2%, 75.5%, 70.0%, 66.6%, 75.0%, 75.0%이었으며, 30.7%, 25.0%, 20.0%, 50.0%, 25.0%, 50.0%에서 다시 수술을 해야 할 것으로 대답하였다. 추시 단순방사선 사진은 7례(15.5%)에서 Kellgren과 Lawrence분류상 3군의 퇴행성 관절염으로 전환되었다. 결론: 단순 방사선 사진에서 정상 이나 초기 퇴행성 관절염을 가진 군(Grade 0-2)에서 내측 반월상 연골 방사형 파열은 다른 형태의 파열과는 달리 관절경적 절제술 후 불량한 임상적 결과를 보였다. 우수한 결과를 위해서는 관절경적 절제술 보다는 긴장 장력을 복원하는 술식이나 퇴행성 관절염을 방지 할 수 있는 근위 경골 절골술 등이 고려되어야 한다. Purpose: To examine the clinical results after arthroscopic meniscectomy of radial tear of medial meniscus. Materials and Methods: We studied 45 cases with the radial tear of medial meniscus which follow up more than 2 years(range 2 to 7 years). Arthroscopic surgery was performed to the patients with grade 0-2 according to the Kellgren and Lawrence classification. Evaluation of cartilage damage was performed on surgical photos according to Outerbridge classification. Evaluation of clinical result was used the modified Lysholm score. Results: The mean pre-operation Lysholm score was 79.1, 71.2, 68.5, 67.9, 67.2, 61.5 and post-operation Lysholm score was 86.3, 75.1, 73.0, 73.1, 73.2, 66.2 and 61.5%, 62.5%, 60.0%, 50.0%, 50.0%, 25.0% improved knee pain and 69.2%, 75.5%, 70.0%, 66.6%, 75.0%, 75.0% were satisfied knee surgery and 30.7%, 20.5%, 20.0%, 50.0%, 25.0%, 50.0% required further surgery in patients respectively. According to Kellgren and Lawrence classification, 7 cases(15.5%) progress grade 3 osteoarthritis. Conclusions: The radial tear of medial meniscus showed the poor results with arthroscopic meniscectomy even if the grade 0-2 osteoarthritis. For the improvement of the clinical results, consider the technique to restore the hoop stresses or use the high tibia osteotomy for preventing the osteoarthritis.