Byung-Ill Lee

Comparison of Clinical Results According to Amount of Preserved Remnant in Arthroscopic Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Graft

PURPOSEnThe purpose of this study was to analyze the clinical results of anterior cruciate ligament (ACL) reconstruction with the remnant-preserving technique by use of a hamstring graft and looped sutures according to the amount of the tibial remnant of the ACL.nnnMETHODSnSixteen subjects had undergone ACL reconstruction with the remnant-preserving technique by use of 4 strands of a hamstring tendon and a looped suture technique and were followed up for at least 12 months. The mean follow-up was 35.1 months. At the last follow-up examination, the patients were evaluated with the International Knee Documentation Committee scale and Hospital for Special Surgery score as subjective tests; stress radiographs, Lachman test, and anterior drawer test by use of the KT-2000 arthrometer (MEDmetric, San Diego, CA) as objective tests; and single-legged hop test, reproduction of passive positioning, threshold to detection of passive motion, and single-limb standing test as functional tests. On the basis of the extent of ACL remnant, patients were then divided into 2 groups. Group I comprised patients with more than 20%, and group II comprised those with less than 20%. For each of the 2 groups, a statistical comparison of the final results was made.nnnRESULTSnThe mean Hospital for Special Surgery score improved from 65.8 (preoperatively) to 95.2 (at last follow-up). Functional evaluation revealed that the difference was not significant in terms of mechanical stability, but a significant difference was detected in functional outcome and proprioception. Regarding the threshold to detection of passive motion at 30 degrees (P = .030) and reproduction of passive positioning at 15 degrees (P = .032) and 30 degrees (P = .024), group I (> 20%) showed better results than group II (< 20%).nnnCONCLUSIONSnWe confirmed that the remnant-preserving technique described showed good proprioceptive and functional outcomes with statistical significance. Therefore it may be expected that the more the tibial remnant is kept intact, the better the preservation of proprioceptive function will be.nnnLEVEL OF EVIDENCEnLevel IV, prognostic case series.

Migration to the popliteal fossa of broken wires from a fixed patellar fracture

Breakage of K-wires and wires which are used for fracture fixation is not uncommon, but migration is rare. The authors experienced two cases of symptomatic migration of broken K-wire and wires used for patellar fixation to the popliteal fossa. Migration of broken hardware happened 3 and 4 years after fixation. The broken hardwares were removed surgically. We would like to suggest that K-wire and wire fixation used for treatment of patella fractures can migrate into the posterior compartment of the knee and cause clinical symptoms. Correct surgical technique and fixative choice should be considered for treatment of the patellar fracture.

Bilateral symptomatic discoid medial meniscus: report of three cases

Discoid medial meniscus is very rare and bilateral discoid medial meniscus is extremely rare. We report symptomatic bilateral discoid meniscus with abnormal attachment to anterior cruciate ligament (ACL) in three patients and we think that our report is a combination of very rare conditions. The patients had symptoms in both sides and we performed magnetic resonance imaging (MRI) and operated five knees. The operation methods were different by the condition of menisci.

Clinical features and treatment outcomes of septic arthritis due to Mycobacterium massiliense associated with intra-articular injection: a case report

BackgroundThere are increasing reports on nosocomial Mycobacterium massiliense infection, but septic arthritis and osteomyelitis because of that microorganism is rare. This report focuses on the clinical aspects of M. massiliense arthritis outbreak concurrent with soft tissue infection.Case presentationAn outbreak of septic arthritis among patients who had been injected at a single clinic occurred in South Korea between April and September 2012. This may be associated with repeated injection of triamcinolone contaminated with M. massiliense. Nine of the Korean patients visited our hospital complaining of painful swelling of the knees. During treatment course, patients are suffered from soft tissue abscess around the injection site. Acid-fast bacilli culture for infected tissue was positive in five patients, and polymerase chain reaction for non-tuberculous mycobacteria was positive in four patients. They were treated with antibiotics, repeated arthroscopic surgeries, incision and drainage for a long time. All patients were eventually cured but three patients have suffered from a decreased range of motion.ConclusionEarly clinical suspicion and microbiological diagnosis are key factors in reducing morbidity since septic arthritis with M. massiliense manifests late after the injection and treatment of it is a laborious process.