가토에서 반월상연골판을 이용한 후십자인대 재건술에 대한 실험적연구 : An Experimntal Study in Rabbits

안진환,이은우 중앙대학교 의과대학 의과학연구소 1981 中央醫大誌 Vol.6 No.3

Clinically most of the surgical methods for reconstruction of posterior cruciate ligaments have proved not so successful and have therefore been abandoned. The reconstruction of posterior cruciate ligament using meniscus is technically simple and has theoretical advantage; meniscus is essentially avascular and receives its nourishment from the synovial fluid. But little is known about the fate and the strength of transferred meniscus. The present study was designed to observe the results of replacement ligament plasty of the posterior cruciate ligament with medial meniscus in rabbits. 37 rabbits were used as test animal. In all cases the posterior cruciate ligament of the right knee was removed and replaced by medial meniscus. The rabbits were sacrificed, and gross and microscopic changes of the transferred menisci were studied at one, two, three, four weeks, 3 and 5 months affer operation in 28 rabbits respectively. Measurement of tensile strength of operated and opposite normal knee using modified Clayton et al (1968) method were carried out at 4 weeks in 5 and 5 months in 4 rabbits. Results of the study were presented below. 1. Histologically, at two weeks, fibroblast and vessel from fibro-connective tissue invaded into the intra-articular portion of transferred meniscus. Collagen formation and realignment appeared in the transferred meniscus. At five months, the tranferred meniscus had essentially the appearance of a normal ligament except in some area having remnant of focal fibrocartilage. 2. Histologically, at 3 months, the transferred meniscus was incorporated into the femur much like the normal attachment of the posterior cruciate ligament. 3. The implanted meniscus within the substance of medial femoral condyle was accomplished by infiltration of cells from the surrounding bone marrow into degenerated meniscus, ultimately replaced by new bone. Remodeling of osseous tunnel noticed at 5 months postoperatively. 4. In all cases but one, in tensile strength test, the meniscus ruptured at its tibial attachment and did not pull loose at the femoral attachment, nor did rupture occur in the substance of the meniscus itself. 5. The percentile tensile strength of transferred menscus was averaging 23.35±1.30%, of normal posterior cruciate ligament at five months. As a result of this study, it is evident that transferred menisci rapidly incorporate to bone, become vascularized and histologically change to ligamentous structure, Therefore, the meniscus seems to be a useful substitute as a cruciate ligament.

Rupture of Posterior Cruciate Ligament: Diagnosis and Treatment Principles

( Beom Koo Lee ),( Shin Woo Nam ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.3

Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascular assessment and treatment should be done to avoid critical complications. An individualized treatment plan should be established after consideration of the type of tear, time after injury, associated collateral ligament injuries, bony alignment, and status of remnant. The rehabilitation should be carried out slower than that after anterior cruciate ligament reconstruction.

후방 십자 인대 급성 손상에서 일차 복원술의 결과

이동철,백승희 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.1

We analyze the functional evaluation, posterior stability after surgery of acute injuries in the femoral detachment and tibial avulsion fracture of posterior cruciate ligament. Materials and Methods: Twenty two patients who underwent primary repair were followed more than one year after operation (mean follow-up 33.7 months). The patients were evaluated with KT 2000 arthrometer and posterior stress test for posterior stability Lysholm knee score was used for knee function. Results: Lysholm score revealed 85.3 in femoral detachment group and 91.1 in tibial avulsion fracture group (p〈0.05). Posterior displacement of the posterior stress test showed 17.2 min at initial injury and 8.6 mm at last follow up in femoral detachment group, 16.8 mm at initial injury and 7.1 mm at last follow up in tibial avulsion fracture group. There revealed the tendency of the improved posterior stability of the tibial avulsion group compared with femoral detachment group, but there showed no statistical significance in KT 2000 arthrometer and posterior stress x-ray. Conclusion: Functional results of tibial avulsion fracture group revealed the better outcome compared with femoral detachment group, but the degree of posterior stability in tibial avulsion fracture group showed no statistical significance in posterior stability.

Trevira Ligament 를 이용한 후방십자인대 재건술 - Preliminary Study -

권칠수,김용욱,최원호 ( Chil Soo Kwon,Young Uck Kim,Won Ho Choi ) 대한슬관절학회 1992 대한슬관절학회지 Vol.4 No.2

Treatment for the damage in the posterior eruciate ligament of knee are as con- troversial as they are diverse. The Trevira ligament is designed to be biologically more similar. Special ligament channels are made according to biomecahics and it is given appropriate tension as Where Contzen and others have been using it successfully and have reported desirable results in a follow period of over five years, The following are the results of follow-up period more than 12 months of the 25 cases to whom we have faithfully applied the treatment recommended by Contzen and others. 1. The age of patients were between 18 and 59. Four of them had an operation the anterior cruciate ligament and three an the collateral ligament. 2. During regular follow-ups after the operation, the Telos stress device was used to test the stability of the cruciate ligament of the knee. A deviation of 3 mm from the normal measurement was considered to be significant. 3. According to Clancy criteria, the results were Excellent in 9 cases (36 %), Good in 13 cases (52 %), Fait in 1 ease (4 %) and Failure in 2 cases 8 %). 4. We fognd sigDificant instability in 2 cases, wbich was due to rupture in the Tre- vira ligament. One case showed limited range of motion of the knee.

후방십자인대 손상과 동반된 내측 측부 인대 손상의 치료 결과 (내측부의 안정성은 후방 안정성에 의해 영향을 받는가)

서승석 ( Seung Suk Seo ),곽희철 ( Heui Chul Gwak ) 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.2

Purpose: The purpose of this study is to evaluate the results fo treatment of combined injury of PCL and MCL and to analysis the facotors affecting the MCL stability. Materials and Methods: The 10 patients of combined injury of posterior cruciate ligament and medial collateral ligament was evaluated after an average duration of follow up of 62.3 months. The age of the patients at the time of injury had twenty five to fifty five years (average 33.6 years) Posterior cruciate ligament were treated reconstructed (7case) or repaired (3case) Medial collateral ligament were treated repaired (8case) of nonoperatively (2case) of repaired (3case) Medial collateral ligament were treated repaired (8case) of nonoperatively (2 case) Postoperatively, all knees had been immobilized for 5~6weeks in 30degrees flexion with a plaster of cast. Results: Lysholm knee score were revealed Excellent (2), good (2). fair (3) poor (3). IKDC knee evaluation form were classified A (2), B (2), C (4), D(2). Materials were grouped according to posterior laxity on the stress x-ray. Group Ⅰ- less than 5 mm posterior translation (4 case), Group Ⅱ-more than 6 mm posterior translation (6case). MCL laxity were average 1.6 m in group Ⅰand 3.0 mm in group Ⅱ (P=0.05). The MCL laxity of PCL repair group was 2.5 mm and that of PCL reconstruction group was 2.4 mm (p>0.05). The MCL laxity of MCL non-operative group was 2.8 mm and that of MCL repair group was 2.4 mm (P>0.05). Conclusion: Lsxity of medial collateral ligament was more related to the PCL laxity than method of treatment PCL and MCL on combined injury of PCL and MCL. To obtain the excellent medial stability on the combined injury MCL and PCL needs a more sophisticated PCL reconstruction.

증상을 동반한 슬관절의 후방십자인대 실질부에 발생한 석회화

안길영(Gil Yeong),이태훈(Tae Hun Lee),황성현(Sung Hyun Hwang),이경진(Kyung Jin Lee) 대한정형외과학회 2021 대한정형외과학회지 Vol.56 No.1

인대의 석회침착은 비교적 흔히 발생하는 질병으로 주로 견관절의 회전근개에 호발하며 만성기에는 보존적 치료를 할 수도 있지만 급성기에는 수술적 가료를 요하기도 한다. 슬관절의 십자인대에서 발생하는 석회화 침착은 매우 드물게 보고되고 있으며 특히 후방십자인대 내에서 발생한 석회화 침착은 거의 없다. 저자들은 51세 여자에서 증상을 동반한 슬관절의 후방십자인대의 실질부에 발생한 석회화 1예에서 8개월간의 보존적 치료로 호전되지 않아 수술적 치료를 시행하였으며 관절경적 석회 침전물의 절제 시 인대의 심한 훼손으로 잔존 인대의 보존이 힘들어 후방십자인대 재건술을 시행하였다. 술 후 2년에 석회화 침착의 재발은 없었고 증상은 소실되었기에 이를 문헌 고찰과 함께 보고하는 바이다. Calcification in the tendon is a common disease especially in the rotator cuff. The condition can be treated conservatively in the chronic stage, but surgically in the acute stage. On the other hand there are few reports of calcification in the cruciate ligament of the knee joint, especially calcification of the posterior cruciate ligament. A 51-year-old patient with symptomatic calcification in the mid-substance of the posterior cruciate ligament was treated conservatively. The symptoms did not improve after eight months of conservative treatment, so arthroscopic surgery was performed. During arthroscopic removal of the calcification, the ligament was damaged beyond preservation. Eventually a posterior cruciate ligament reconstruction was performed. At two years after surgery, radiography confirmed no recurrence of the calcification, and the patient was free. We report this case study with a review of the relevant literature.

슬관절 후방십자인대에 발생한 결절종 -증례보고-

조재영,유현종,이의형,이주연,Cho, Jae-Yeong,Yoo, Hyun-Jong,Lee, Eui-Hyong,Lee, Ju-Youn 대한관절경학회 1998 대한관절경학회지 Vol.2 No.2

슬관절 후방십자인대의 결절종은 드물게 발생하며, 이에 대한 보고도 적다. 특별한 외상의 병력 없이 발생한 2례의 후방십자인대 결절종을 발견하고, 관절경을 이용하여 생검 및 제거를 하였기에 그 경험을 보고하는 바이다. Ganglion cysts have been described in all joints. In the knee, although the finding of meniscal degenerative cysts is fairly common, a few cases have been reported concerning ganglion cysts of anterior cruciate ligament. However, ganglion cysts of posterior cruciate ligament are quite rare. We experienced two cases of ganglion cyst in the posterior cruciate ligament, which were treated successfully with arthroscopic debridement.

후방 십자 인대에서 발생한 건초성 거대 세포종 - 후격막 통과 도달법을 이용한 관절경적 절제 -

안진환,서재곤,하철원,Ahn, Jin Hwan,Seo, Jai Gon,Ha, Chul Won 대한관절경학회 1998 대한관절경학회지 Vol.2 No.1

The giant cell tumor of tendon sheath is very rarely present inside the knee joint. The authors report a case of intraarticular giant cell tumor of tendon sheath arising from posterior cruciate ligament which was successfully excised arthroscopically using posterior trans-septal portal at the time of arthroscopic reconstruction of anterior cruciate ligament.

Medial Meniscal Tears in Anterior Cruciate Ligament-Defi cient Knees: Effects of Posterior Tibial Slope on Medial Meniscal Tear

( Jae Jeong Lee ),( Yun Jin Choi ),( Keun Young Shin ),( Chong Hyuk Choi ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.4

Purpose: To evaluate the incidence of meniscal tears in patients with chronic anterior cruciate ligament (ACL) -deficient knees, and to determine the influence of posterior tibialslope (PTS) on medial meniscal tears in ACL-deficient knees. Materials and Methods: We reviewed 174 patients (174 knees) with a mean age of 30.7 years who underwent ACL reconstruction for chronic ACL tears. We divided the patients into two groups: low group (135 knees with a PTS<13o) and high group (39 knees with a PTS≥13o). Results: The incidence of medial meniscus tears was 44% (77/174), and that of lateral meniscus tears was 35% (61/174). The mean PTS in patients with medial meniscal tears was 11.4o±3.0o, whereas that in patients without medial meniscal tears was 9.8o±2.4o. The incidence of meniscal tears was 57.8% (78/135) in the low group and 89.7% (35/39) in the high group (p<0.001). Conclusions: Our data demonstrate that PTS≥13o is a risk factor for secondary medial meniscal tears in ACL-deficient knees. So, we suggest that PTS is one of the considerations for determining early ACL reconstruction to prevent secondary meniscal tears.

후방 십자 인대의 해부학과 생역학

김형수,Kim, Hyoung-Soo 대한관절경학회 1998 대한관절경학회지 Vol.2 No.1

As with anterior cruciate ligament reconstruction, posterior cruciate ligament(PCL) reconstruction requires a good understanding of the anatomy and biomechanical properties of the PCL to place the graft correctly as well as to choose the appropriate structure and material for the graft. The anatomy and function of the PCL can be somewhat confusing and continuing to evolve so far. Recent studies have focused on the insertion site anatomy and the identification of the functional components of the ligament. The issue of the ligament isometry and the role of PCL in knee kinematics are still totally resolved. This article can be provided an update on current concepts of the anatomy and biomechanics of the PCL through literature reviews. A clear understanding of these knowledges enables the clinicians to diagnose injuries to the PCL accurately and to reconstruct these structures successfully.