Seung Suk Seo

Unfavorable Results of Partial Meniscectomy for Complete Posterior Medial Meniscus Root Tear With Early Osteoarthritis: A 5- to 8-Year Follow-Up Study

PURPOSE The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of arthroscopic partial meniscectomy for complete posterior medial meniscus root tear (PMMRT) in patients with early radiographic evidence of knee osteoarthritis at a minimum follow-up of 5 years. METHODS Forty-six cases had complete PMMRT with follow-up of at least 5 years and were treated with arthroscopic partial meniscectomy. On the basis of medical records, we reviewed the arthroscopic findings of joint degeneration (Outerbridge grading), clinical results using the modified Lysholm (ML) knee score and a patient questionnaire, and radiographic evaluation of degeneration using Kellgren-Lawrence (KL) grading. RESULTS The incidence of complete PMMRT in the study population was 15%. At a mean follow-up of 78 months (range, 60 to 103 months), the mean ML score significantly improved from 72 (range, 62 to 78) preoperatively to 77 (range, 70 to 98) at final follow-up (P < .01), 16 patients (35%) showed progression of degeneration from KL grade 0 to 2 preoperatively to KL grade 2 to 4, 56% of patients indicated improvement in pain, 67% of patients were satisfied with the results of the procedure, and 19% of patients underwent reoperation. There was a significant negative correlation between chondral wear during arthroscopy (ρ = -0.516, P = .002) and preoperative KL grade (ρ = -0.429, P = .004) with ML score at final follow-up. CONCLUSIONS Although arthroscopic partial meniscectomy for complete PMMRT significantly improved ML scores postoperatively, only 56% of patients had improvement in pain, 67% were satisfied with the outcome of the procedure, and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months. LEVEL OF EVIDENCE Level IV, therapeutic study.

Clinical Results Comparing Transtibial Technique and Outside in Technique in Single Bundle Anterior Cruciate Ligament Reconstruction

Purpose To compare the clinical results of single-bundle anterior cruciate ligament (ACL) reconstruction using the conventional transtibial technique and the anatomical outside-in technique for femoral tunneling. Materials and Methods From 2007 to 2011, 89 patients who received ACL reconstruction were followed for ≥1 year were enrolled in the study. The conventional transtibial technique was used in 41 patients and the outside-in technique, in 48 patients. Femoral tunnel angle measurement and three-dimensional computed tomography (3D CT) were used for radiologic assessment of the location of femoral tunnel and Lysholm score and other tests were used for clinical assessment. Results Both techniques did not reveal statistical differences in the clinical assessment. However, in International Knee Documentation Committee subjective knee evaluation, the sum of two questionnaire items regarding instability showed a statistically significant difference (p=0.01). In the pivot shift test, the anatomical outside-in technique showed outstanding rotational stability over the transtibial technique (p=0.04). The mean femoral tunnel inclination in coronal plane were 69.2° and 30.3°, respectively, for both techniques, and 21.6° and 50.8°, respectively in sagittal plane, showing statistically significant differences on simple radiography (p=0.04, 0.05). A 3D CT was performed in 17 patients with the conventional transtibial technique and 25 patients with the outside-in technique. Coefficients of variation were 0.33 and 0.13, respectively, from dorsal border of the condyle and 0.67 and 0.24, respectively, from the roof of intercondylar notch. Conclusions Femoral tunnels created with the outside-in technique have superior knee joint rotational stability compare to the transtibial technique. Therefore, the outside-in technique could be considered as a valuable technique in single-bundle ACL reconstruction.

Management of Focal Chondral Lesion in the Knee Joint

Articular cartilage does not contain vascular, nervous and lymphatic tissue and chondrocytes hardly participate in the healing or repair process of chondral tissue because of being surrounded by plenty of extracellular matrix. Therefore, the injury to articular cartilage frequently requires an operative treatment. The goal of surgical repair of articular cartilage is to regenerate nearly normal chondral tissue and prevent degenerative arthritis caused by the articular cartilage defect. Microfracture is a kind of cartilage repair procedure that makes a fibrin clot containing mesenchymal stem cells in the chondral lesion. Microfracture is a simple procedure but it has a disadvantage that the repaired tissue is fibrocartilage. Autologous chondrocyte implantation has an advantage that it implants fully differentiated chondrocytes to the lesion, which theoretically produces hyaline cartilage. Its disadvantages are that it is a two stage and a costly procedure. Osteochondral autograft transplantation is a one stage procedure and repairs the lesion with hyaline cartilage. But its limitation is the lack of donor site availability. Surgeons who understand the theoretical background, indications, surgical methods, rehabilitation, complications, and clinical course of cartilage repair procedures can achieve the goal of preventing degenerative arthritis.

A Comparison of Patella Retention versus Resurfacing for Moderate or Severe Patellar Articular Defects in Total Knee Arthroplasty: Minimum 5-year Follow-up Results

Purpose The purpose of this study is to assess the clinical and radiological results of patients who underwent patellar retention or resurfacing for moderate or severe patellar articular defects during total knee arthroplasty and evaluate the clinical efficacy of patellar resurfacing according to the articular defect of the patella. Materials and Methods From May 2003 to March 2006, 252 patients (277 cases) underwent total knee arthroplasty by one surgeon. Intraoperatively, we divided these patients into a moderate articular defect group (50-75%: group I) and a severe articular defect group (75-100%: group II) and randomly performed patellar resurfacing. The average age was 67.2 years. There were 234 female and 17 male patients. The average follow-up period was 74.6 months. Clinical outcomes were analyzed using the Knee Society (KS) knee score. Functional score, Hospital for Special Surgery (HSS) score, Feller patellar score and range of motion (ROM). Radiological outcomes were analyzed using the congruence angle, Insall-Salvati ratio and patella tilt angle. Results The KS knee score and functional score at the last follow-up were 84.4/73.1 in the retention group and 85.2/71.8 in the resurfacing group (p=0.80, p=0.63) in group I. In group II, the values were 82.1/75.1 and 87.0/71.2, respectively (p=0.51, p=0.26). The HSS score and Feller patella score were 86.7/20.3 in the retention group and 84.3/21.7 in the resurfacing group (p=0.31, p=0.29) in group I. In group II, the values were 91.6/21.2 and 85.5/22.1, respectively (p=0.37/p=0.30). The knee ROM (p=0.36/p=0.41), congruence angle (p=0.22/p=0.16), Insall-Salvati ratio (p=0.16/p=0.21) and patella tilt angle (p=0.12/p=0.19) were not statistically different between the two groups. Conclusions In this study, we could not find any correlations between the degree of patellar articular defect and patellar resurfacing in terms of the clinical and radiological results. Therefore, patellar articular defects is thought to be less meaningful in determining patellar resurfacing.

Translation and validation of the korean version of the international knee documentation committee subjective knee form.

Purpose To perform a cross-cultural adaptation and to test the measurement properties of the Korean version of International Knee Documentation Committee (K-IKDC) Subjective Knee Form. Materials and Methods According to the guidelines for cross-cultural adaptation, translation and backward translation of the English version of the IKDC Subjective Knee Form were performed. After translation into the Korean version, 150 patients who had knee-related problems were asked to complete the K-IKDC, Lysholm score, and Short Form-36 (SF-36). Of these patients, 126 were retested 2 weeks later to evaluate test-retest reliability, and 104 were recruited 3 months later to evaluate responsiveness. Construct validity was analyzed by investigating the correlation with Lysholm score and SF-36; content validity was also evaluated. Standardized mean response was calculated for evaluating responsiveness. Results The test-retest reliability proved excellent with a high value for the intraclass correlation coefficient (r=0.94). The internal consistency was strong (Cronbachs α=0.91). Good content validity with absence of floor not ceiling effects and good convergent and divergent validity were observed. Moderate responsiveness was shown (standardized mean response=0.689). Conclusions The K-IKDC demonstrated good measurement properties. We suggest that this instrument is an excellent evaluation instrument that can be used for Korean patients with knee-related injuries.

Clinical Results Associated with Changes of Posterior Tibial Slope in Total Knee Arthroplasty

Purpose The purpose of this retrospective study is to investigate the effect of posterior tibial slope (PTS) on clinical results in total knee replacement arthroplasty (TKA). Materials and Methods We analyzed 801 knees in 768 patients who underwent TKA using a cruciate-retaining prosthesis for osteoarthritis from July 2003 to July 2009. PTS was measured on simple X-ray films and patients were divided into 5 groups, according to the change in PTS that was calculated by subtracting the preoperative from the postoperative PTS: group 1, >3°; group 2, 3° to 1°; group 3, 1° to -1°; group 4, -1° to -3°; and group 5, <-3°. We analyzed the correlations between the change in PTS and clinical results, such as Knee Society knee score, Knee Society functional score, Feller patella score, Kujala score, visual analog scale score, range of motion, and complications. Results There was no statistically significant intergroup difference; however, Feller patella score and Kujala score were significantly different in groups 2 and 3. There were no complications, such as progressive loosening of implants, fractures of polyethylene inserts and wears. Conclusions Clinically meaningful improvement was observed in all patients after TKA. Groups 2 and 3 (3° to -1°) showed significant improvement compared to the other groups.

Compression of the Popliteal Artery after Posterior Cruciate Ligament Reconstruction Using the Tibial Inlay Technique.

Popliteal artery compression rarely occurs after posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique that allows for direct visualization of the surgical field. However, we experienced a popliteal artery compression after PCL reconstruction performed using the technique, which eventually required re-operation. Here, we report this rare case and discuss reasons of popliteal artery compression.

Differences in Measurement of Lower Limb Alignment Among Different Registration Methods of Navigation and Radiographs in TKA Using the OrthoPilot System

The purposes of this study were (1) to compare lower limb alignment measurements between radiographs and computer-assisted surgery and (2) to evaluate the discrepancy in lower limb alignment between computer-assisted surgery with a high tibial osteotomy protocol and computer-assisted surgery with a total knee arthroplasty (TKA) protocol in the same knee. Seventy-one TKAs were performed on patients with primary osteoarthritis using computer-assisted surgery. Preoperative lower limb alignment was measured using the mechanical axis during bipedal, weight-bearing, whole-leg anteroposterior radiography (measure 1). The intraoperative mechanical axis was measured with computer-assisted surgery according to the high tibial osteotomy protocol before joint exposure (measure 2). After changing the software and joint exposure, the intraoperative mechanical axis was measured with computer-assisted surgery according to TKA protocol (measure 3). After final TKA implantation, the lower limb mechanical axis was measured with computer-assisted surgery following the TKA protocol (measure 4). Postoperative lower limb alignment was measured using the mechanical axis on whole-leg standing anteroposterior radiographs (measure 5). The mechanical axis and median value from each group were compared. Factors affecting the mechanical axis measurement were also analyzed. The difference in the mechanical axis between measures 1 and 2, measures 1 and 3, and measures 2 and 3 was significant (P<.0001, <.0001, and =.0007, respectively). The difference between measures 4 and 5 was also significant (P<.0001). Factors affecting the mechanical axis measurement, such as age, height, weight, and range of motion, showed no correlation (R(2)=.07244 and adjusted R(2)=.01622). The pre- and postoperative radiological measurements of limb alignment using the mechanical axis were different from the intraoperative measurements with navigation.

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty

Background This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. Methods Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. Results No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. Conclusions The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.

Monitoring Method for Deep Infection after TKA - Significance of Intraoperative Synovial Fluid Culture and Postoperative Suction Drainage Tip Culture

Purpose : The aim of this study was to evaluate the usefulness of the intra-operative synovial fluid culture and post-operative suction drainage tip culture as a method for predicting the development of a deep infection after primary TKA. Materials and Methods : Between July 1998 and July 2002, 324 primary total knee arthroplasty procedures were performed and aerobic and anaerobic bacterial cultures for intra-operative synovial fluid and post-operative suction drainage tip were obtained. The results of culture of intra-operative synovial fluid and post-operative suction drainage tip of total 324 primary TKA cases were analyzed. The sensitivity, specificity and predictive value were calculated. positive culture rate for osteoarthritis was compared with rheumatoid arthritis and the results of a single TKA was compared with both simultaneous TKA. Results : 14 out of 324 knees showed a positive intra-operative synovial fluid culture and 10 cases showed a positive post-operative suction drainage tip culture. Only 1 case out of the 4 deep infection cases showed a positive on suction drainage tip culture with S. aureus being isolated. The specificity of the intra-operative synovial culture was 95.6% and the negative predictive value was 98.7%. The sensitivity of the post-operative suction drainage tip culture was 25%, the specificity was 97%, the positive predictive value was 10% and the negative predictive value was 99%. The positive culture rate was similar in the osteoarthritis and rheumatoid arthritis cases (respectively p=0.4717, p=0.6550). However, the culture positive rate between single and both simultaneous TKA was numerically different, approximately 2 times (3.2% vs 6.31% for intra-operative synovial culture and 4.0% vs 9.47% for post-operative suction drainage tip culture) but it was not statistically significant (respectively p=0.311, p=0.1051). Conclusion : In primary TKA, a culture of intra-operative synovial fluid and post-operative suction drainage tip cannot predict a postoperative deep wound infection. It is recommended that careful observation for other signs of a deep infection be examined when a clinically significant true pathogen isisolated.