전방십자인대 재건술의 합병증

송은규,김종석,Song Eun-Kyoo,Kim Jong-Seok 대한정형외과스포츠의학회 2003 대한정형외과스포츠의학회지 Vol.2 No.1

Although the number of anterior cruciate ligament reconstruction is increasing, complications after primary ACL reconstruction are more difficult to determine. Intraoperative and postoperative complications can lead to ultimate failure of a primary reconstructive procedure. Therefore, surgical success in ACL reconstruction requires detailed knowledge and technical advancements about ACL reconstruction. Preoperatively surgeon must pay attention to selection of grafts and methods of fixation, and intraoperatively, attention to the harvest of graft, passage of graft, intraarticuar placement of the graft, notchplasty, proper tensioning of the graft, and others. Postoperative complications must be detected early, including infection, abnormal healing responses, arthrofibrosis, graft rejection, and reflex sympathetic dystrophy. Careful patient selection, appropriate surgical timing, careful surgical technique, and supervised preoperative and postoperative rehabilitation can minimize postoperative complications.

전방십자인대 손상의 자기공명영상

송은규,Song, Eun-Kyoo 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

MRI(magnetic resonance imaging) is very useful to visualize the anterior cruciate ligament (ACL) injury of the knee. Differential features of ACL injury at MRI according to acute and chronic stage should be evaluated to enable accurate assessment of the integrity or ACL. Distinguishing features of normal anatomy. acute and chronic injuries or ACL at MRI will be reviewed.

골-슬개 건-골을 이용한 전방 십자 인대 재건술 - 중기 및 장기 추시 결과의 비교 -

송은규,윤택림,이영근,김종석,Song Eun Kyoo,Yoon Taek Rim,Lee Young Keun,Kim Jong Seok 대한관절경학회 2000 대한관절경학회지 Vol.4 No.2

Purpose : To compare the mid term with long term follow up results of the anterior cruciate ligament(ACL)> reconstruction using patellar tendon. Materials and Methods : Seventy-six cases, which could be followed up more than 2 years were included in this study. They were classified into two groups, mid-term group(41 cases) with mean follow-up periods of 2 years and 10 months and long-term group(35 cases) off years and 6 months. Clinical and radiological results and peripatellar complications were evaluated & compared. Results . There was no statistically significant difference in radiological finding and anterior instability between two groups. However, the incidence of anterior knee pain, paresthesia at incision site, kneeling pain, crepitus and quadriceps weakness was lower in long-term group than in mid-term group. Conclusion : ACL reconstruction using patellar tendon graft could successfully restone the stability of knee joint, but there are some complications in donor site and patellofemoral joint. However this complications were gradually decreased with long term follow-up.

전방 십자 인대 재건술 후 골관절염의 발생 빈도 및 위험 인자들에 대한 비교 - 자가 슬개건과 자가 슬괴건을 이용한 방법 -

송은규,선종근,김형순,강경도,변재욱,Song, Eun-Kyoo,Seon, Jong-Keun,Kim, Hyung-Soon,Kang, Kyung-Do,Byun, Jae-Wook Korean Orthopaedic Society for Sports Medicine 2010 대한정형외과스포츠의학회지 Vol.9 No.1

Purpose: To compare the incidence and risk factors for osteoarthritis after anterior cruciate ligament (ACL) reconstruction between two groups using bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autograft. Materials and Methods: 53 cases of ACL reconstruction using patellar tendon and 40 cases using hamstring tendon were followed up at least 8 years. Radiographic evaluation was done according to the Kellgren and Lawrence's classification. Clinical functional testing (Lysholm Knee Scores, the Tegner activity scores) and laxity testing (Lachman, pivot shift tests), and the instrumented laxity testing with $Telos^{(R)}$ were all examined in relation to the development of osteoarthritis. Results: Radiographic osteoarthritic changes were detected in 24 patients (45.3%) in BPTB group and 14 patients (35.0%) in HT group. Accompanying meniscal injury (BPTB p<0.001; HT p=0.091), intervals from the injury to reconstruction of > 12 months (BPTB p=0.037; HT p=0.021), and patient's age at reconstruction of > 25 years (BPTB p=0.003; HT p=0.048) were found to be significant independent predictors of osteoarthritis. However, no statistically significant correlations were found between the development of osteoarthritis and the clinical outcome or the radiographic stability in both groups. Conclusion: Although ACL reconstruction using BPTB or HT autograft had good clinical results at an average follow-up of 10 years, considerable incidence of radiographic osteoarthritic changes were noted. Various factors such as accompanying meniscal injury, protracted time from injury to reconstruction, more than 25 years old at the time of reconstruction were related to radiographic osteoarthritic changes.

Clinical Outcome and Arthroscopic Evaluation of Double-Bundle Anterior Cruciate Ligament Reconstruction

송은규,선종근,이경재,김형순,Song, Eun-Kyoo,Seon, Jong-Keun,Lee, Kyoung-Jai,Kim, Hyung-Soon Korean Orthopaedic Society for Sports Medicine 2010 대한정형외과스포츠의학회지 Vol.9 No.1

Purpose: The aim of this study was to evaluate short-term clinical results and second-look arthroscopic findings after double-bundle anterior cruciate ligament (DB ACL) reconstruction. Materials and Methods: Forty-nine patients, who were followed up for at least 24 months after DB ACL reconstruction, were included. Clinical results, such as, Lysholm knee and Tegner activity scores, and manual laxity and instrumented anterior laxity test results were evaluated. In fifteen patients (15 knees), second-look arthroscopy with staple removal was performed. At second-look arthroscopy, the authors assessed about reconstructed ACL rupture, subjective graft tension and extent of synovial coverage. Results: Lysholm knee scores significantly improved from 67.4 preoperatively to 96.1 at last follow-up (p<0.01). Tegner activity scale improved from 2.0 to 6.1. The Lachman test, at last follow-up, showed normal laxity in 39 (of 49) patients, and the pivot-shift test showed normal laxity in 36 (of 49) patients. Mean side-to-side differences improved significantly from 10.8 mm to 3.3 mm (p<0.01). Second-look arthroscopic findings showed that all patients had a normal or a near normal anteromedial bundle. However, 8 patients (53.3%) were found to have partial or complete posterolateral bundle rupture. Conclusion: Even though double-bundle ACL reconstruction was clinically effective means of restoring knee rotational and anteroposterior stabilities, there were some ruptured posterolateral bundles observed in cases under arthroscopy after double-bundle ACL reconstruction.

생체분해성 Meniscus Arrow를 이용한 반월상 연골 봉합술후 발생한 비세균성 활액막염 -증례보고-

송은규,이근배,이영근,Song, Eun-Kyoo,Lee, Keun-Bae,Lee, Young-Keun 대한관절경학회 1998 대한관절경학회지 Vol.2 No.2

This is a report on a aseptic synovitis diagnosed and treated arthroscopically following the meniscal repair using biodegradable Meniscus Arrow$^{(R)}$(Bionix Inc, Malvern, USA). Histological examination revealed chronic nonspecific synovitis and birefringent material. Immunohistochemical tests were positive in lysozyme, ${\alpha}$-1-antitrypsin and ${\alpha}$-1-antichymotrypsin. The patient was received arthroscopic synovectomy, and then pain and swelling of the knee joint was relieved. Range of motion was improved to full range. As far as we know, this is the first case of aseptic synovitis after meniscal repair using biodegradable Meniscus Arrow$^{(R)}$.

슬개대퇴관절 부정정렬증후군 - 병태생리학 및 진단 -

송은규,김형순 ( Eun Kyoo Song,Hyung Soon Kim ) 대한슬관절학회 1992 Knee Surgery and Related Research Vol.4 No.1

Anterior knee pain is known to be attributed mainly to patellofemoral malaligment. This malaligment syndrome usually presents three different patterns, patellar subluxation, abnormal patellar tilt and combination of both, According to each pat- tern, relatively unique symptoms and signs are developed. Clinical examination and radiographic studies are essential for the diagnosis of patellofemoral malalignment syndromes. Computerized Tomography or Magnetic Resonance Imaging is sometimes necessary in case of difficulties in the diagnosis with radiographic studies. Arthroscopy is a best way to assess the extent, location and degree of cartiligenous injury of patella.

사람 십자인대의 감각신경 지배

송은규,김형순,한홍준,배춘상,윤재룡 ( Eun Kyoo Song,Hyung Soon Kim,Hong Jun Han,Choon Sang Bae,Jae Rhyong Yoon ) 대한슬관절학회 1992 Knee Surgery and Related Research Vol.4 No.2

The knowledge of distribution of nociceptive and proprioceptive nerve fibers in cruciate ligaments in human knee joint would provide insight in understanding the sensory role of cruciate ligaments. Th ligaments have been mainly considered as mechanical and structural joint stabilize However, ligaments and other joint structures may serve as more refined sensors. The innewation of 24 human an rior and posterior cruciate ligaments obtained during total knee arthroplasty, mainly total knee arthroplasty, was studied. Immunocytochemical technique using monoc1 nal antibody to substance-P (SP), leucine-enke- phalin (leu-Ehk), neurofilament (NF) 00 and glial fibrillary acidic protein (GFAP) and acetylcholindsterase (AChE) histoche istry were employed to identify sensory nerve fibers. The nerve fibers and nerve ending were found in synovium, fat pad and intrafascicular connective tissue of cruciate ligaments. The nerve fiber was myelinated showing GFAP-immunoreactive and/or unmy inated showing GFAP-nonreactive. The nerve fiber was immunoreactive to SP, leu-E k and NF 200 and had terminal nerve structures with free nerve endings providing noc' eption and supplying blood vessels, Ruffini cor- puscles and 'Pacinian cofpuscles. Bat of the corpuscles were known to be mechanozeceptors. These three kind of nerve e dmgs were observed in all cruciate ligaments and distributed denser in both end of cr ciate ligaments. AChE-positive nerve fibers and Ruffini corpuscles were observed, m re common in posterior cruciate ligament than anterior. In intrafascicular space of c uciate ligament, Pacinian corpuscles was noted, but other t%o neirve endings not, Gal organ was not found in every cruciate ligament. The pre8ence of nociceptive recep ors and nerve fibers in the anterior and posterior cruciate ligspents were confirmed by a immunocytochemical method using monoclonal antibody for SP, leu-Enk, NF 200 nd GFAP and AChE histochemistry.

전방십자인대 재건술의 조직학적 연구

송은규,정재윤,박재형 ( Eun Kyoo Song,Jae Yoon Chung,Jae Hyung Park ) 대한슬관절학회 1994 Knee Surgery and Related Research Vol.6 No.2

Macroscopic and microscopie examination were conducted after endoscopic anterior cruciate ligament (ACL) reconstmction to ohserve a histological findings of reconstructed ACL in accordance with periods of follow-up, 2nd look arthroscopy and biopsy from the reconstructed ACL was performed from 12 cases out of 82 endoscopic ACL reconstructions using central 1/3 bone-patellar tendon-bone autografts, which were followed up for from 4 months to 2 years and 2 months after reconstruction. At 4 months afiter reconstruction, spindle or ovoid shaped fibroblast with hypercellularity, crimp patterns of collagen fiber, patallel arrangement of fibroblast to collagen fiber were noted. And the oel 'ty of fibroblast decreased in according to periods of follow up. At 12 months follow up, spindle or ovoid fibmblast, it's cellularity arrangement pattern and crimp pattern of collagen fiber were almost similar to those of normal ACL and continued unbl up to 2 years and 2 months after reconstruction.

슬괵건을 이용한 전방십자인대 재건술의 임상적 결과

송은규,이근배,신상규,김현종,Song Eun Kyoo,Lee Keun Bae,Shin Sang Gyoo,Kim Hyun Jong 대한정형외과스포츠의학회 2002 대한정형외과스포츠의학회지 Vol.1 No.1

Purpose: To evaluate the clinical results after anterior cruciate ligament (ACL) reconstruction with hamstring tendon and Ligament Anchor (LA) screw, which is newly designed for fixation of graft into femur. Materials and Methods: Fifty eight patients who were followed up at least more than 2 years after ACL reconstruction with four strands of Hamstring tendon and LA screw were included in this study. The graft was fixed with LA screw at femoral tunnel and with only bioabsorbable interference screw at tibial tunnel. The mean follow-up period was 28 months. The clinical results were evaluated by physical examination and Lysholm knee score. Widening of bony tunnel and anterior laxity difference compared with normal side by instrumented anterior laxity test with Telos(R) (Telos stress device; Austin & Associates, Inc., Polston, US) were evaluated. Results: The Lysholm knee score improved from 60.0 points preoperatively to 94.0 points at last follow up. On the Lachman test, there were mild (+) instability in 16 cases, moderate (++) in 24,severe (+++) in 18 preoperatively. 50 cases were converted to negative and 8 to mild instability at postoperative follow up. On instrumented anterior laxity test with Telos(R), difference between normal and affected knee on 20 lb was 12.9 mm in average preoperatively, and was decreased to 3.1mm at last follow-up. The femoral tunnel was widened from 10.6 mm postoperatively to 12.7 mm (21.1$\%$) at follow up on antero-posterior plane and from 10.7 mm to 12.4 mm (16.5$\%$) on lateral plane. Tibial tunnels was also widened from 9.8mm to 11.8mm (20.7$\%$) on antero-posterior plane and from 9.9mm to 11.7 mm ($18.9\%$) on lateral plane. Complications were: anterior knee crepitus in 17 case, quadriceps muscle atrophy(>3 cm) in 6, penetration of screw over the lateral femoral cortex in 5, saphenous nerve paresthesia in 2.Conclusions: ACL reconstruction with hamstring tendon and LA screw was one of the choice of grafts and fixation devices in restoring knee stability and in improving clinical results with little complications such as excessive widening of bony tunnel and anterior knee pain