Hyeong-Won Park

Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow-up study.

Background: The most common technique for posterior cruciate ligament (PCL) reconstruction is transtibial or tibial inlay. However, few studies have reported long-term outcome comparisons between the 2 techniques. Hypothesis: Tibial inlay PCL reconstruction with patellar tendon autograft will exhibit better clinical and radiographic outcomes than transtibial PCL reconstruction with hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 66 patients (66 knees) treated with PCL reconstruction for chronic injuries constituted the study cohort. Patients were divided into 2 groups: transtibial with hamstring (36 patients) and tibial inlay with patellar tendon (30 patients). The mean time from injury to reconstruction was 12.2 months (range, 2-60 months), and the mean follow-up was 148 months (range, 98-196 months). Outcomes were measured by use of Lysholm knee scores, Tegner activity scores, return to preinjury sports activity, posterior drawer test, laxity test with a Telos device, and development of osteoarthritis. Results: The preoperative mean Lysholm knee score was 59.9 (range, 37-70) in the transtibial group and 54.5 (range, 22-76) in the tibial inlay group, improving postoperatively to 89.9 (range, 74-100) and 92.1 (range, 80-100), respectively. The mean Tegner activity scores increased from 2.5 (range, 2-5) to 5.9 (range, 4-7) in the transtibial group and 2.3 (range, 2-4) to 6.0 (range, 3-8) in the tibial inlay group. Twenty-one patients (58.3%) in the transtibial group and 19 patients (63.3%) in the tibial inlay group were able to return to preinjury sports activity. In the posterior drawer test, 6 patients in the transtibial group and 4 patients in the tibial inlay group showed grade II laxity. The mean side-to-side difference was 10.1 mm (range, 7-12 mm) in the transtibial group and 10.4 mm (range, 9-13 mm) in the tibial inlay group, improving postoperatively to 4.1 mm (range, 0-8 mm) and 4.2 mm (range, 1-8 mm), respectively. There was significant improvement between preoperative and final follow-up values. However, there were no significant differences between the 2 groups in final follow-up outcomes. Final follow-up radiographs showed that 6 patients (16.7%) in the transtibial group and 3 patients (10.0%) in the tibial inlay group were rated grade C according to International Knee Documentation Committee guidelines. Conclusion: Clinical and radiographic outcomes between the 2 PCL reconstruction techniques were comparable. Osteoarthritis was observed in patients, with a significant proportion presenting loss of joint space. Examined factors, excluding meniscectomy, were not correlated with the development of osteoarthritis.

Comparison of the Outcomes of Distraction Osteogenesis for First and Fourth Brachymetatarsia

BACKGROUND Brachymetatarsia is the presence of an abnormally short metatarsal, and distraction osteogenesis has been used for its treatment. The purpose of the present study was to compare the outcomes of patients who underwent distraction osteogenesis for the treatment of first and/or fourth brachymetatarsia. METHODS The data from forty-eight patients (sixty-four feet, seventy-four metatarsals) who underwent distraction osteogenesis for the treatment of brachymetatarsia were reviewed. The indications for surgery included a metatarsal that was at least 10 mm shorter than the adjacent metatarsal and that had an unacceptable cosmetic appearance. The study group comprised thirty-two first brachymetatarsia in nineteen patients (Group A) and forty-two fourth brachymetatarsia in twenty-nine patients (Group B). The average age was twenty years in Group A and eighteen years in Group B. The average duration of follow-up was 58.1 months in Group A and 56.1 in Group B. Metatarsal length, lengthening gain, healing time and index, and the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal and lesser metatarsophalangeal-interphalangeal scores were evaluated. RESULTS All patients were satisfied with the final length of the metatarsal and all had achieved bone union at the time of the last follow-up. The mean lengthening gain was 17.2 mm (42.9%) in Group A and 16.3 mm (37.3%) in Group B. The mean healing index was 71.0 days/cm in Group A and 67.3 days/cm in Group B. The mean American Orthopaedic Foot and Ankle Society score was 91.2 points in Group A and 92.8 points in Group B at the last follow-up (twenty-two excellent, nine good, and one fair results in Group A, and twenty-nine excellent, eleven good, and two fair results in Group B). The most common complication was metatarsophalangeal joint stiffness, which occurred in thirteen rays in Group A and in twelve rays in Group B; malalignment of the lengthened metatarsal was observed six times in each group. No significant intergroup differences in the outcomes were found. CONCLUSIONS Distraction osteogenesis for first and/or fourth brachymetatarsia provided successful lengthening of a metatarsal with eventual osseous union and was associated with similar outcomes in terms of healing index, function score, and the prevalence of complications between the two groups, although frequent complications were encountered and no improvement in foot function was found.

Comparison of Arthroscopic Microfracture for Osteochondral Lesions of the Talus With and Without Subchondral Cyst

Background: Although various treatment modalities for an osteochondral lesion of the talus (OLT) with a subchondral cyst have been recommended previously, the primary treatment methods for such conditions have yet to be conclusively determined. Moreover, few comprehensive studies have compared the outcomes of cases where patients were treated with microfracture for OLT with and without subchondral cysts. Purpose: To evaluate the clinical outcomes after arthroscopic microfractures performed as a primary treatment for OLT with a subchondral cyst. Study Design: Cohort study; Level of evidence, 2. Methods: The study cohort consisted of 102 patients (102 ankles) who underwent arthroscopic microfracture for small to midsized OLT. The ankles were divided into a cyst group (45 ankles) and a noncyst group (57 ankles).The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS), and Ankle Activity Score (AAS) were used to compare the clinical outcomes between the groups over a mean follow-up period of 48 months. Results: The mean AOFAS ankle-hindfoot scores were 64.8 in the cyst group and 66.2 in the noncyst group preoperatively. These improved to 91.8 and 91.3, respectively, at the final follow-up. The mean VAS scores were 7.5 in the cyst group and 7.3 in the noncyst group preoperatively; these improved to 2.3 and 2.2, respectively, at the final follow-up. The mean AAS in the cyst group and the noncyst group improved from 2.7 and 2.6 preoperatively to 6.7 and 6.5 at the final follow-up, respectively. In terms of radiographic stage improvements, the cyst group showed no change in 18 ankles (40%) and showed improvements of 1 grade in 13 ankles (28.9%), 2 grades in 9 ankles (20%), 3 grades in 3 ankles (6.7%), and 4 grades in 2 ankles (4.4%). The noncyst group showed no change in 17 ankles (29.8%) and showed improvements of 1 grade in 11 ankles (19.3%), 2 grades in 11 ankles (19.3%), 3 grades in 14 ankles (24.6%), and 4 grades in 4 ankles (7.0%). No significant differences were found between the groups in terms of the AOFAS score, VAS score, AAS, or radiographic stage improvements. Conclusion: OLT with and without subchondral cysts treated with arthroscopic microfracture showed similarly good clinical results. The study results suggest that microfracture could be a primary treatment strategy for treating small to midsized OLT regardless of the existence of subchondral cysts.

Giant nevus lipomatosus cutaneous superficialis with intramuscular lipomatosis

that anticentromere antibodies, which are also associated with calcinosis, were concomitantly detected in the current patient. She had none of the other symptoms of CREST syndrome. This case suggests that anti-NXP-2 antibodies might be a useful marker for calcinosis not only in JDM, but also in adult-onset DM, although we do not have any information on the prevalence of anti-NXP2 autoantibodies in adult-onset DM to date. Correlations between the anti-NXP-2 antibodies and calcinosis or other clinical manifestations, including interstitial pneumonia and internal malignancies, in DM should be clarified in the near future.

Treatment of a severe neglected valgus deformity after excision of the distal fibula for Ewing’s sarcoma

In distal fibular resection without reconstruction, the stabilising effect of the lateral malleolus is lost. Thus, the ankle may collapse into valgus and may be unstable in varus. Here, we describe a child who underwent successful staged surgical correction of a severe neglected valgus deformity after excision of the distal fibula for a Ewings sarcoma.

Multicentric giant cell tumor in adolescents: three case reports.

The presentation of multicentric giant cell tumor in adolescents with an open physis is very rare. We report three cases of a multicentric giant cell tumor of the bone in adolescents, and a review of the literature is also presented.