Biomedical subjects
Publications and source records attributed to Sung-Jae Kim.
Complications after meniscal repair have been associated with inside-out and outside-in techniques. After the introduction of devices for meniscal repair, reports of chondral damage have been increasing. However, meniscal cyst formation after use of suture materials for meniscal repair is a very rare complication. We report a case of meniscal cyst formation after use of nonabsorbable sutures for meniscal repair.
The unstable inferior leaf of the anterior horn in the horizontal tear of the lateral meniscus is a challenging lesion to the arthroscopist. However, there are no devices for it and no proper procedures are introduced. We describe a new arthroscopic technique of partial meniscectomy by using three portals. This technique uses a unique portal, extreme far anteromedially.
Tibial inlay posterior cruciate ligament (PCL) reconstruction was developed to avoid "killer turn" of the tibial tunnel. It requires a surgical dissection to popliteal fossa and changing of the patient's position during operation. We report an arthroscopic tibial inlay PCL reconstruction technique to avoid morbidity from an open procedure. Achilles tendon-bone allograft was used for reconstruction, and bone plug was designed in a cylindrical shape vertical to the tendon direction for tibial fixation. The intra-articular length of PCL is measured, and the proximal graft is prepared with a whipstitch and an EndoPearl (Linvatec, Largo, FL) is connected for enhancing femoral fixation. After tibial graft fixation with an absorbable interference screw, tibial site fixation was reinforced with suture anchoring to a washer on the anterolateral surface of the tibia. Femoral fixation was done with another screw. It was possible to reproduce the original concept of PCL tibial inlay graft with our arthroscopic technique.
We present three cases of a detached biceps pulley, which impinges on posterosuperior glenoid labrum.
Posterolateral instability of the knee is known as one of the most challenging injuries. Although several procedures have been designed for the posterolateral instability, there is no gold standard management as yet. We present a technique for posterolateral instability of the knee using a tibialis posterior tendon allograft, which reconstructs the lateral collateral ligament and popliteal tendon with its attachment to the tibia. This can correct not only varus, but also external rotary instability.
Snyder et al. coined the term superior labral anterior and posterior (SLAP) lesion and classified SLAP lesion into 4 types. Morgan et al. developed a secondary classification of Snyder type II lesions based on the anatomic location. Maffet et al. found that some lesions could not be classified according to classification of Snyder et al.; types V to VII were added to the 4-part classification. In this study, we present the case of a patient with a superior labral tear that could not be classified to any of the reported classification. The superior labrum was detached with cartilage exposing the underlying bone of the glenoid.
This article presents a method of bursoscopic examination with use of a glenohumeral air-infusion technique for the detection of full-thickness tears hidden by bursal tissue. We inflated the glenohumeral joint with 50 to 60 mL of air while simultaneously observing the joint with bursoscopy for the detection of air bubble leakage. The air-infusion technique is valuable in detecting full-thickness tears and useful for evaluating the patency of repair.
Abstract Recently, attention has been given to the double-bundle technique for treating the posterior cruciate ligament (PCL)-deficient knee. We present an arthroscopic PCL reconstruction using a double-bundle technique with 3-stranded tibialis posterior (TP) allograft that has not been described before. The anterolateral bundle of the PCL is reconstructed using 2-stranded TP allograft and the posteromedial bundle using 1-stranded TP allograft. Three-stranded TP allograft will be an alternative graft choice for PCL reconstruction.
Abstract Clinical features of the symptomatic mediopatellar plica (MPP) are nonspecific and the diagnosis has been troublesome for orthopaedic surgeons. We present a diagnostic test for symptomatic MPP.
We present an arthroscopic repair technique (all inside suture) for chronic capsular defect of posterolateral space of knee joint developed after previous popliteal cystectomy. We use a transseptal posteromedial viewing portal, and two posterolateral working portals. This procedure can be an alternative to an open repair technique for a posterior capsular defect after open cystectomy.
We present a case of synovial chondromatosis originating from the quadriceps tendon sheath, which caused a complete quadriceps tendon rupture. The patient was treated using marginal excision. The ruptured quadriceps tendon was repaired. This is the first description of a quadriceps tendon rupture associated with synovial chondromatosis.
Arthroscopy of the stiff elbow joint is a technically difficult procedure because of the decreased joint space of the elbow joint, even to experienced surgeons. Problems encountered include limited access of instrument to the intra-articular space and an increased risk of cartilage injury in the contracted elbow joint. This study describes a novel transarticular approach for elbow arthroscopy that allows the safe and effective creation of the proximal medial and lateral portals.
The cyclops lesion at the tibial attachment of the reconstructed ligament has been known to cause loss of knee extension. We present a case of knee extension loss because of a cyclops lesion caused by Kennedy ligament augmentation device synovitis at 10 years after ACL reconstruction in a 33-year-old man.
Arthroscopic debridement and drainage was done in 10 patients with septic arthritis of the hip. Staphylococcus aureus was the most commonly identified organism. All patients were placed in the supine position on a fracture table and three arthroscopic portals were used during the procedure. No major complication related to the arthroscopy of the hip resulted. The average followup was 4 years 11 months. All patients had excellent results.
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The purpose of this article is to present the suitable location of portals during knee arthroscopy in various situations. It includes universal portal, meniscal lesions, discoid meniscus, 1-incision technique of posterior and of anterior cruciate ligament reconstructions, stiff knee, transseptal posterior portal, and far midpatellar portal. These specific descriptions in each situation are drawn from the accumulated experience of more than 4,000 cases of arthroscopy. Our philosophy on the positioning of knee portals can be emphasized from 2 perspectives: first, the location of portals should flexibly suit the surgeon's need rather than a fixed location; second, the higher the portal position is in knee arthroscopy, the wider view it generally provides inside the joint.
The fenestra type of infrapatellar plica was noted arthroscopically in a 57-year-old patient with flexion contracture of the knee. It was found to be thickened and fibrotic and to have lost its normal elasticity. The pathologic plica was impinged at the intercondylar notch and trochlea, blocking further extension beyond 25 degrees of knee flexion. After excising the plica, the knee gained a further extension of 17 degrees; however, full extension could not be obtained. The knee gained full extension after notchplasty on the roof at 2 months postoperatively. This is the first report of a pathological infrapatellar plica in an older patient.
PURPOSE: This study compared the clinical results of modified biceps femoris tenodesis with posterolateral rotatory instability (PLRI) injuries and PLRI combined with PCL injuries. TYPE OF STUDY: Case series. METHODS: Of 46 patients treated for PLRI, 21 had isolated PLRI (group 1), and 25 had PLRI with PCL injuries (group 2). The most common cause of injury was motor vehicle accident. The PCL was reconstructed using an arthroscopic 1-incision technique. The advantages of the modified Clancy technique include fixation of the biceps tendon to the isometric position and reduced surgical damage to the iliotibial band by dissection to the lateral femoral epicondyle through the interval between the iliotibial band and biceps muscle. RESULTS: All knees tested positive in the preoperative reverse pivot shift test, and 43 patients (93%) tested negative postoperatively. The side-to-side difference of an average external rotation thigh-foot angle (ERTFA) at both 30 degrees and 90 degrees of knee flexion was 15 degrees and 11 degrees in group 1 and 21 degrees and 26 degrees in group 2 preoperatively. Postoperative ERTFA tested at 30 degrees and 90 degrees of knee flexion were 10 degrees less than the uninvolved knee in both groups. At a mean follow-up of 40.3 months, the postoperative Lysholm knee score was 93.6 in group 1 and 90.4 in group 2. The postoperative HSS mean value was 91.1 in group 1 and 87.9 in group 2. A correction loss of more than 5 degrees was found in 3 patients of group 1 and in 5 patients of group 2 at an average 12 months after surgery. In 5 of 8 patients, severe scar tissues were found at the insertion site of the biceps tendon to the fibula during surgery. These tissues were associated with damage of the involved structures at the time of injury. CONCLUSIONS: Based on our experience, we recommend the modified biceps tenodesis for the reconstruction of both PLRI injuries and PLRI combined with PCL injuries except in patients with severe damage at the attachment site of the biceps tendon.