Jae Chan Shim

Medial Meniscus Root Tear Refixation: Comparison of Clinical, Radiologic, and Arthroscopic Findings With Medial Meniscectomy

PURPOSE To investigate the clinical, radiologic, and arthroscopic findings of pullout repair in medial meniscus root tear (MRT) and to compare the results of pullout repair and partial meniscectomy. METHODS This study enrolled 58 consecutive patients with medial MRT who underwent partial meniscectomy (M group, n = 28) or pullout repair (R group, n = 30) between September 2003 and August 2007. The patients were evaluated by the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective knee score, joint space narrowing, and Kellgren-Lawrence grade on simple radiographs. Medial meniscal extrusion and the state of the meniscus and articular cartilage on magnetic resonance imaging (MRI) were documented. We performed second-look arthroscopy in 14 patients with pullout repair and evaluated fixation strength and hoop tension of the meniscus and the state of the articular cartilage. RESULTS There were no differences in demographic data (age, sex, and body mass index) between the 2 groups. The mean follow-up was 48.5 months in the R group and 46.1 in the M group. Lysholm and IKDC scores improved significantly in both groups (P < .05). However, the R group had better Lysholm and IKDC scores and less joint space narrowing and progression of the Kellgren-Lawrence grade than the M group did (P < .05). In a subgroup analysis of the R group, medial meniscal extrusion on MRI decreased from 3.13 to 2.94 mm. Of the patients, 28 (93.3%) showed complete or partial healing of the meniscus. On MRI, 6 (20%) showed arthrosis progression. On second-look arthroscopic examinations in 14 patients in the R group, 9 (64.3%) showed normal fixation strength, 10 (71.4%) had normal restoration of hoop tension, 5 (35.7%) showed arthrosis progression, and 2 (6.7%) had repeat tears of the meniscus. CONCLUSIONS Arthroscopic pullout repair of a medial MRT gave significantly better clinical and radiologic results than partial meniscectomy, and sound healing with restoration of hoop tension of the meniscus was observed on MRI and second-look arthroscopy. We propose that this method is an effective treatment for medial MRT. LEVEL OF EVIDENCE Level III, retrospective comparative study.

Relationships Among Tendon Regeneration on MRI, Flexor Strength, and Functional Performance After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft

Background: There are numerous reports on hamstring tendon regeneration after harvest for anterior cruciate ligament (ACL) reconstruction. However, few studies have evaluated the relationships among the magnetic resonance imaging (MRI) findings of hamstring regeneration, muscle strength, and functional results. Purpose: This study evaluates the correlations among the hamstring regeneration on MRI, flexor strength, and functional performance after hamstring tendon harvesting in ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled 45 patients who underwent primary ACL reconstruction using hamstring tendon autografts and in whom flexor strength, functional performance, and preoperative and postoperative MRI results were evaluated at least 2 years postoperatively. Isokinetic flexion strength was tested in the standard and prone positions. We evaluated the differences in flexor strength and functional performance according to the number of regenerated tendons. The correlation between the MRI findings (the number of regenerated hamstring tendons and proximal shift of the musculotendinous junction) and the functional performance and flexor strength was analyzed. Results: The patients were divided into 3 groups according to the regeneration of the hamstring tendons on MRI: both semitendinosus and gracilis tendons regenerated (group SG), only 1 tendon regenerated (group O), and no tendon regenerated (group N). Significant differences were found in the flexor deficit between group N and groups SG and O on the standard and prone position isokinetic tests. There was a significant correlation (ρ = –.472) between the number of regenerated hamstring tendons and the carioca test result. The proximal shift significantly correlated with the flexor deficit in the prone position isokinetic test (semitendinosus, r = .449; gracilis, r = .366). Conclusion: Hamstring tendons regenerated after harvest for ACL reconstruction in a high proportion of the patients. The flexor strength with both the standard and prone position isokinetic tests differed in the 3 groups. The number of regenerated hamstring tendons was significantly correlated with performance on the carioca test. Proximal shifting of the musculotendinous junction was significantly correlated with flexor deficit on the hyperflexion isokinetic test.

Medial Meniscus Allograft Transplantation Using a Modified Bone Plug Technique: Clinical, Radiologic, and Arthroscopic Results

PURPOSE To determine clinical, radiologic, and arthroscopic results of our meniscus allograft transplantation (MAT) by use of modified bone plug technique, which permits easy passage of the allograft by reducing the size of the posterior bone plug. METHODS From December 2004 to December 2008, 22 consecutive patients (20 men and 2 women) with a mean age of 35.9 years underwent medial MAT with the modified bone plug method. The Lysholm score and International Knee Documentation Committee subjective knee score were documented. Joint space narrowing and Kellgren-Lawrence grade changes were evaluated on radiographs, and graft healing status, arthrosis changes in cartilage, and meniscal extrusion were investigated by magnetic resonance imaging (MRI). RESULTS The mean follow-up was 24.9 months. The mean Lysholm score improved significantly, from 68.2 to 89.7 (P = .002). The International Knee Documentation Committee subjective knee score improved significantly, from 60.3 to 85.4 (P = .003). Joint space narrowing was insignificant, and arthrosis progression was observed in 3 of 22 cases (13.6%) on radiographs. On MRI, complete healing of the grafts was observed in 18 cases (100%), 15 cases (83.3%), and 17 cases (94.4%) at the anterior root, posterior root, and meniscal rim, respectively. Mean meniscal extrusion was 4.35 ± 1.76 mm, and arthrosis progression was observed in 4 of 18 cases (22.2%). During second-look arthroscopy, complete healing of the grafts was observed in 11 cases (100%), 9 cases (81.8%), and 10 cases (90.9%) at the anterior root, posterior root, and meniscal rim, respectively. Cartilage degeneration was advanced in 4 cases (36.4%). No significant correlations were found between meniscal extrusion and other outcomes. CONCLUSIONS Our modified bone plug method was an effective surgical method. MRI and second-look arthroscopic examinations showed sound evidence of graft healing. Meniscal extrusion was observed in most cases but was not correlated with other clinical and radiologic outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.

The Effects of Hamstring Harvesting on Outcomes in Anterior Cruciate Ligament–Reconstructed Patients: A Comparative Study Between Hamstring-Harvested and -Unharvested Patients

PURPOSE The purpose of this study was to evaluate the effects of hamstring harvesting in patients after anterior cruciate ligament (ACL) reconstruction by comparing groups with and without hamstring harvesting. METHODS We evaluated the effect of hamstring harvesting in 73 consecutive patients who underwent ACL reconstruction: 39 patients whose hamstrings were harvested for autografts (group H) were compared with 34 patients who received allografts during the same time period (group C [control]). The cases and controls were compared by analyzing the following variables: age, height, weight, mean follow-up period, type of tissue used, and meniscal surgery. Outcomes were assessed by the Lysholm knee score, Tegner activity score, and KT-2000 side-to-side difference (MEDmetric, San Diego, CA), as well as functional performance tests. The flexor deficit and isokinetic peak torque for knee flexion were measured in the sitting position (0° to 90°), and the flexion torque at 90° was measured in the prone position (60° to 120°). RESULTS Although significant knee flexion weakness after ACL reconstruction was observed, a significantly greater knee flexor deficit was found in autograft patients than in allograft patients (P < .001). No differences were found between groups in terms of clinical and functional results regardless of hamstring harvesting. The performance of both study groups in all 4 functional tests were significantly correlated with flexor deficit in the sitting position (P < .05) but not in hyperflexion. Significant flexor deficits in both normal and hyperflexed positions were noted in both groups when compared with the unaffected knee (group H, P < .001; group C, P = .002). CONCLUSIONS These results indicate significant knee flexion weakness compared with the unaffected knee after ACL reconstruction regardless of hamstring harvesting. Moreover, the greater increase in knee flexor deficit in the hamstring-harvested group compared with the allograft group was statistically significant. However, clinical and functional outcomes were similar between the groups. LEVEL OF EVIDENCE Level III, case-control study.

A Case Report of the Occurrence of a Rare Middle Mediastinal Thymoma in a Young Woman.

Thymomas are the most common form of primary tumor in the anterior mediastinum. However, the occurrence of thymomas in the middle mediastinum is rare. To the best of our knowledge, no cases have been reported in young patients. Here, we report the CT and MRI findings of a middle mediastinal thymoma case in a 21-year-old woman.

Metastatic Renal Cell Carcinoma to Unusual Locations: A Case Report

Renal cell carcinoma is a tumor that commonly occurs with distant metastases and typically metastasizes to the following distant sites, listed in order of descending frequency: the lung and mediastinum, bone, liver, contralateral kidney or adrenal gland, and brain. However, metastases to the face, skin, and skeletal muscle are extremely rare. We report here a case of a metastatic renal cell carcinoma involving the face, skeletal muscles and skin simultaneously.