Ho Joong Jung

Transtibial double bundle posterior cruciate ligament reconstruction using TransFix tibial fixation

Previous transtibial double bundle posterior cruciate ligament (PCL) reconstruction methods have several problems in graft length and tibial fixation. We introduce new surgical method that is less restrictive by graft length and is more stable with single tibial fixation. After diagnostic arthroscopy, we prepare the graft, ream the tibial tunnel, and perform the procedure for TransFix tibial fixation. Femoral 2 tunnel is made and graft is passed via anteromedial (AM) portal. Tibial fixation is done and femoral 2 graft is fixed sequentially at each knee position. TransFix tibial single fixation method in double bundle PCL reconstruction provides more stable fixation, more free graft selection, and prevents graft damage by passing the graft via AM portal.

Remnant Preservation is Helpful to Obtain Good Clinical Results in Posterior Cruciate Ligament Reconstruction: Comparison of Clinical Results of Three Techniques

Background The purpose of the present study was to compare the clinical results of 3 posterior cruciate ligament reconstruction techniques according to the time from injury to surgery and remnant PCL status and to evaluate the efficiency of each technique. Methods The records of 89 patients who underwent primary PCL reconstructions with a posterolateral corner sling were analyzed retrospectively. Thirty-four patients were treated by anterolateral bundle (ALB) reconstruction with preservation of the remnant PCL using a transtibial tunnel technique in the acute and subacute stages of injury (group 1). Forty patients were treated with remnant PCL tensioning and an ALB reconstruction using the modified inlay technique in the chronic stage (group 2), and fifteen patients were treated with double-bundle reconstruction using the modified inlay technique (group 3). The double-bundle reconstruction was performed if there was a very weak or no PCL remnant. Results The mean side-to-side differences in posterior tibial translation on the stress radiographs were reduced from 10.1 ± 2.5 mm in group 1, 10.6 ± 2.4 mm in group 2, and 12.8 ± 3.2 mm in group 3 preoperatively to 2.3 ± 1.4 mm in group 1, 2.3 ± 1.5 mm in group 2, and 4.0 ± 2.5 mm in group 3 at the last follow-up (p < 0.001, p < 0.001, and p < 0.001, respectively). Statistical analyses revealed that group 1 and group 2 were similar in terms of side-to-side difference changes in posterior tibial translation on the stress radiographs; however, group 3 was inferior to group 1 and group 2 at the last follow-up (p = 0.022). The clinical results were not significantly different among the three groups. Conclusions Excellent posterior stability and good clinical results were achieved with ALB reconstruction preserving the injured remnant PCL in the acute and subacute stages and remnant PCL tensioning with ALB reconstruction in the chronic stage. The PCL injuries could be surgically corrected with different techniques depending on both the remnant PCL status and the interval between the knee trauma and operation.

Early Postoperative Analgesic Effects of a Single Epidural Injection of Ropivacaine Administered Preoperatively in Posterior Lumbar Interbody Spinal Arthrodesis A Pilot Randomized Controlled Trial

BACKGROUND Despite the suitable characteristics of ropivacaine as an epidural analgesic agent, such as better preservation of motor function and less neurotoxicity, we are aware of no data on its clinical application in pain management following lumbar spine surgery. The purpose of the present study was to evaluate the preemptive analgesic effects and safety of a single epidural injection of ropivacaine during lumbar arthrodesis. METHODS We performed a randomized, double-blinded, intention-to-treat study. Patients with planned one-level posterior lumbar interbody arthrodesis were randomly assigned to either the injection group (n = 32) or the control group (n = 34). The injection group received a 10-mL epidural injection of 0.1% ropivacaine twenty minutes before the skin incision at the planned vertebral level, and the control group received an epidural injection of 10 mL of 0.9% saline solution. A numeric rating scale (from 0 to 10) was measured at seven time points after surgery (at two, four, eight, twelve, twenty-four, and forty-eight hours and at the time of discharge), and the frequency of pushed-button patient-controlled analgesia and total fentanyl consumption were assessed at similar time points (up to two, up to four, up to eight, up to twelve, up to twenty-four, and up to forty-eight hours after surgery). Postoperative nausea and vomiting, the duration of the hospital stay, and the Likert satisfaction score at the time of discharge were evaluated. RESULTS There were no significant differences between the two groups preoperatively. The numeric rating scale score was higher until twelve hours (p < 0.05) and the frequency of button pushes was higher at every time point except eight to twelve hours (p < 0.05) in the control group as compared with the injection group. Fentanyl consumption until eight to twelve hours (p < 0.05) and total consumption (p < 0.001) at discharge were higher in the control group. There were no differences between the two groups in terms of postoperative nausea and vomiting, the duration of hospital stay, or the mean satisfaction score, and no transient motor weakness was seen in relation to epidural injection of ropivacaine. CONCLUSIONS A single-dose epidural injection of 0.1% ropivacaine before lumbar spine surgery is effective for reducing early postoperative pain without related complications such as transient motor weakness.

Correction of bony genu recurvatum combined with ligamentous instability of the knee: three case reports

We report our experiences for treating the bony genu recurvatum combined with ligamentous instability that needed both osteotomy and ligament reconstruction in three cases. The bony component was corrected according to normal tibial slope, patellar height and limb length. After the osteotomy, we reevaluated the instability of the knee and performed ligament reconstruction if the patients had ligamentous instability even though the osteotomy was done.

Effects of a Posterior Cruciate Ligament Resection on the Flexion-Extension Gap in Total Knee Arthroplasty

Purpose : To assess the effects of a posterior cruciate ligament resection on the tibiofemoral joint gap in total knee arthroplasty. Materials and Methods : The effect of a PCL resection on the tibiofemoral joint gap was analyzed prospectively in 58 patients (69 knees) who had undergone TKA between May 2003 and April 2006. The knee was exposed using a modified subvastus approach. The medial soft tissue was released and a tibial cutting was made first. The tibial insertion of a PCL was protected during the tibial resection by inserting a thin osteotome in front of the posterior spine. An extension and flexion gap were measured using a balancer/tensor device (Stryker Howmedica OsteonicsⓇ, Allendale, NJ, USA) under manual maximal stress before and after the PCL resection. The change of the joint line and the posterior inclination on preoperative and postoperative lateral roentgenograms was also assessed. Results : After the PCL resection, the flexion gap and extension gap increased by an average of 3.6±1.5 mm and 2.0±1.0 mm, respectively. Although the PCL resection resulted in an increasing a flexion gap and extension gap, the increase in the flexion gap was larger than that of the extension gap by 1.6 mm. Conclusion : A PCL resection resulted in an increase in the flexion and extension gaps by 3.6 mm and 2.0 mm, respectively. Therefore, a PCL resection would be a good alternative method for controlling the flexion-extension gap in TKA.

A Comparison of Fibular Head Tunnel and Tibial Tunnel in the Reconstruction of a Posterolateral Instability of the Knee

Purpose : This study compared the surgical results of various posterolateral corner sling methods performed through either the fibula head tunnel or tibia tunnel in patients with chronic PLRI (PosteroLateral Rotatory Instability). Materials and Methods : Between January 1999 and October 2003, 20 and 19 patients who had undergone surgery for PCL (posterior cruciate ligament) tensioning and an ALB (anterolateral bundle) reconstruction through the fibula head tunnel or tibia tunnel, respectively and were followed up more than 1 year were enrolled in this study. Results : The fibular head tunnel was found to be superior compared with the tibia tunnel method in terms of the operation time (36.5±7.5 versus 68.4±12.8) (p＜0.0001), rotational stability (p=0.0018) and IKDC objective score (p＜0.0001). In the fibula head tunnel group, 85% of patients had an equal to normal or tighter than normal rotational stability in the tibial tunnel group with 63% having an equal to normal or tighter than normal side at the last evaluation. In the IKDC objective score, 85% of patients in the fibula head tunnel group had a rating B or higher at the last evaluation compared with 79% in the tibial tunnel group (p＜0.0001). However there were no significant differences in anteroposterior stability and OAK score. Conclusion : The modified posterolateral corner sling through the fibula head tunnel produces better results in terms of a posterolateral rotational stability of grade II chronic PLRL in a combined PCL injury than that using the tibia tunnel method.