Purpose: Medial meniscus posterior root tear (MMPRT) should be repaired to the correct position as possible to maintain hoop tension of the meniscus. In this study, we propose a comparison of the outcome between the medial tunnel and the lateral tunnel in the pullout suture technique using the tibial tunnel for anatomical repair of posterior root tear of medial meniscus. Methods: From April 2010, of patients who underwent pullout suture, 51 cases (24 medial tunnel group (MTG) and 27 lateral tunnel group (LTG)) were able to follow-up with second look arthroscopy. Original Coronal Ratio of Root Attachment (CRORA) was defined as the ratio of the distance from the medial edge of the tibial plateau to the root attach site divided by the entire tibial medial–lateral width on preoperative computed tomography. Error between postoperative CRORA and original CRORA was calculated. We compared this error, clinical outcome, and arthroscopic finding between MTG and LTG. Results: The mean error ratio of postoperative CRORA divided by original CRORA was 0.86 ± 0.11 in MTG, which was significantly ( p = 0.001) lower than that (1.02 ± 0.06) in LTG. The mean value of the root attach point in the MTG with a post/original CRORA value of 0.86 ± 0.11 means statistically significant medialization after the operation. There was no statistically significant difference in changes of International Knee Documentation Committee (IKDC) and Lysholom score between MTG and LTG. The difference between the two groups of arthritis progression was not statistically significant. Conclusion: In patients with MMPRT, CRORA may provide a basis for coronal assessment of root repair position before and after surgery, and lateral tibial tunnel technique can help anatomical repair by reducing technical error due to guide pin slip medially compared to medial tibial tunnel technique.
In an attempt to present a new surgical technique for arthroscopic bony Bankart fixation, the authors developed the pulled sutures technique. In executing the new method, the authors first passed several non-absorbable sutures through labroligamentous tissue with displaced articular fragment by mimicking transglenoid suture technique. Aimed at achieving a safe and stable fixation, using a knotless anchor rather than transglenoid suture, was deployed. Overall, this pulled sutures technique was shown to be effective with the result of direct reduction, stable, and safe fixation for bony Bankart's lesion.
mm, 30% 이하군에서는 평균 2.43 mm의 차이를 보였으나 두 군간의 통계학적 차이는 없었다. 고유수용감각 검사 상 운 동역치검사에서 30°시작시(p=0.031)와, 위치재생검사에서는 15°(p=0.032) 및 30°재생시(p=0.024) 30% 이상의 잔유조 직 보유군에서 통계학적 유의성이 있는 양호한 결과를 보였다. 기능적 검사인 Single leg hop test는 잔유조직을 많이 보 존했던 군에서 좀더 양호한 결과를 보였다(p=0.017). 결 론: 전방십자인대 재건술시 가능한 한 잔유조직을 보존하여 고유수용감각의 회복과 상대적으로 좀더 만족스러운 임상 결과를 얻을 수 있었으며 수술 후 이식건의 치유 및 기능회복에 도움을 줄 수 있는 한 방법으로 사료되었다.색인 단어: 슬괵건, 잔유조직, 고유수용감각, 전방십자인대재건술 Purpose: To analyze the clinical results in an ACL reconstruction according to the amount of the tibial remnant of the ACL using a hamstring graft and looped sutures. Materials and Methods: Sixteen patients who were followed up for at least 12 months after the ACL reconstruction with four strands of a hamstring tendon using a looped suture technique were enrolled in this study. The average follow-up was 35.1 months. At the last follow-up period, the patients were evaluated using the International Knee Documentation Committee (IKDC) scale and the HSS score, Lachman test, ant. drawer test, KT-1000, one-leg hoop test and proprioceptive function test (motion and position sense). They were then divided two groups according to whether they had more or less than 30% of the ACL remaining. The final results of the two groups were statistically compared. Results: Average HSS score improved from 65.8 (preoperative) to 95.2 (last follow-up). No significant
Rationale: Adequate stability of traumatic anterior shoulder dislocation without any obvious damage to the anterior capsulolabral structure in elderly patients can be achieved by treating the associated rotator cuff injuries. However, in case of recurrent shoulder dislocation despite rotator cuff repair, the repaired rotator cuff may be weakened or reruptured and is often impossible to repair again. Therefore, the role of the rotator cuff as a shoulder stabilizer cannot be expected. Even if the anterior joint capsule is left, it is too weak to imbrication either. An additional anterior structural reconstruction that can replace the rotator cuff and capsule is needed to prevent recurrence. Patient concerns: A 59-year-old man visited our clinic because of traumatic anterior dislocation of the right shoulder combined with anterior–superior rotator cuff tear. Because there was no obvious anterior capsulolabral injury, he underwent arthroscopic rotator cuff repair only. Postoperative rehabilitation was maintained; however, anterior shoulder dislocation recurred 10 months postoperatively. Diagnosis: Physical examination revealed anterior instability in abduction and external rotation of the shoulder joint. Magnetic resonance imaging suggested retear of the repaired anterior–superior rotator cuff and Hill–Sachs lesion of the humeral head. Interventions: Diagnostic arthroscopy was performed. The reruptured rotator cuff seemed impossible to repair; thus, arthroscopic remplissage procedure was performed for engaging the Hill–Sachs lesion. In addition, open pectoralis major tendon transfer for anterior stabilization was performed via the deltopectoral approach. Outcomes: At the 12-month follow-up, the patient showed good clinical outcomes, including internal rotation of the shoulder joint without recurrent instability. Lesson: Recurrent anterior shoulder dislocation after primary surgery in the elderly may be a challenging situation for surgeons. In patients with irreparable anterior rotator cuff tear and for whom reconstruction of the anterior glenoid is not indicated, pectoralis major tendon transfer is a good treatment option for satisfactory clinical outcomes without recurrence.
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