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Articles by J. H Ahn
Total Records ( 7 ) for J. H Ahn
  C Yoo , J. E Kim , J. L Lee , J. H Ahn , D. H Lee , J. S Lee , S Na , C. S Kim , J. H Hong , B Hong , C Song and H. Ahn
  Objective

The effects of sunitinib in a broad patient population, especially those of Asian ethnicity, have been rarely investigated. Here, we assessed the efficacy and safety of sunitinib in Korean patients with advanced renal cell carcinoma.

Methods

Between April 2006 and August 2008, 77 Korean patients with advanced renal cell carcinoma were treated with sunitinib. We performed retrospective analysis for efficacy in terms of survival outcomes and response rate. Toxicity profiles were also assessed.

Results

A total of 65 patients, including 39 (60%) patients without previous cytotoxic or immunotherapy, were eligible for the analysis. In 53 patients with measurable lesions, the objective response rate was 43% and disease control was achieved in 46 (86%) patients. The median time to treatment failure, time to progression and overall survival were 7.0, 11.8 and 22.8 months, respectively, with a median follow-up of 26.8 months in surviving patients. The most common treatment-related adverse events were fatigue (81%) and stomatitis (60%). The most common Grade 3 or 4 adverse events were hand–foot syndrome (16%), thrombocytopenia (16%) and stomatitis (10%). Dose reduction was required in 46% of patients.

Conclusions

The efficacy was similar to a previous Phase III trial and a safety profile of sunitinib was manageable in Korean patients with advanced renal cell carcinoma, although the incidence of dose reduction and Grade 3 or 4 adverse events were higher than those of western reports. Future studies should investigate the ethnic differences in toxicity profiles of sunitinib.

  J. C Yoo , J. H Ahn , S. H Lee and Y. C. Yoon
  Background

No consensus has been reached with regard to the ideal timing of anterior cruciate ligament reconstruction in terms of reducing secondary meniscal tears in anterior cruciate ligament–deficient knees.

Hypothesis

Delay in anterior cruciate ligament reconstruction increases the incidence and severity of medial meniscal tears.

Study Design

Case series; Level of evidence, 4.

Methods

Thirty-one patients were evaluated with arthroscopic all-inside suturing of medial meniscal tears with concurrent anterior cruciate ligament reconstruction who had at least 2 preoperative magnetic resonance imaging studies. Patients were evaluated during the acute phase of injury, but anterior cruciate ligament reconstruction surgery was delayed at least 6 months. Mean interval between first and second imaging studies was 36.8 months. Subsequent medial meniscal tears were identified as longitudinal or bucket-handle types. Relationships between medial meniscal lesions and patient age, time interval between the date of initial injury and surgery, repetitive injury, and patient activity level were evaluated.

Results

During the first preoperative magnetic resonance imaging studies, 14 knees had no medial meniscal tear, 15 a longitudinal tear, and 2 a bucket-handle–type tear; during the second preoperative imaging studies, 5 knees had no medial meniscal tear, 19 a longitudinal tear, and 7 a bucket-handle–type tear. The incidence of medial meniscal tears increased from 55% in first studies to 84% in second studies for chronic anterior cruciate ligament–insufficient knees (P = .0054). Eight knees without a tear during first studies had a longitudinal tear during second studies, 1 knee without a tear and 4 with a longitudinal tear in first studies had a bucket-handle–type tear in second studies. Thirteen knees (42%) had a worse meniscal status during the second studies.

Conclusion

Delayed anterior cruciate ligament reconstruction increases the likelihood of a medial meniscal tear, suggesting that early anterior cruciate ligament reconstruction should reduce or prevent additional medial meniscal injury. The findings show that further medial meniscal damage is common if surgery is delayed by 6 months or more.

  J. H Ahn , Y. S Lee , H. C Ha , J. S Shim and K. S. Lim
  Background

In the symptomatic discoid lateral meniscus, the effectiveness of preoperative magnetic resonance imaging (MRI) is not well documented.

Hypothesis

Magnetic resonance imaging classification will provide more information to the surgeon in choosing the appropriate treatment methods with the help of arthroscopic findings.

Study design

Cohort study (diagnosis); Level of evidence, 2.

Methods

Sixty-seven patients (82 knees) were reviewed. The preoperative MRI was checked in 76 of 82 knees. The Lysholm and Ikeuchi grading scales were evaluated. Images were analyzed from MRI, and findings were classified into 4 categories: no shift, anterocentral shift, posterocentral shift, and central shift. Tear pattern classifications were based on arthroscopic findings: horizontal tear, peripheral tear, horizontal and peripheral tear, posterolateral corner loss, and others. The correlations between MRI classification tear patterns and surgical methods were analyzed using the chi-square test or the Fisher exact test. The sensitivity, specificity, and accuracy of shift in preoperative MRI—according to the existence of peripheral tear when corroborated with arthroscopy—were also analyzed with the chi-square test. Inter- and intraobserver reliability was statistically analyzed by producing the inter- and intraclass correlation coefficient.

Results

The mean preoperative Lysholm score was 77.3 (range, 43–97), and the last follow-up Lysholm score had increased to 96.8 (range, 84–100; P < .001). At last follow-up (100% follow-up), the Ikeuchi grading scale scored 48 knees as excellent, 30 as good, and 4 as fair. According to the MRI classification, 43 knees were no shift; 6, anterocentral shift; 15, posterocentral shift; and 12, central shift. Shift-type knees had a significantly larger number of peripheral tears, and repairs were performed in the shift-type knees (55%) more frequently than in the no-shift-type knees (28%). Among 82 knees, 31 were repaired simultaneously after a central partial meniscectomy.

Conclusion

Magnetic resonance imaging classification provides more information to surgeons in choosing the appropriate treatment methods, although the final decision regarding procedure is made during arthroscopy after thorough analysis of the tear.

  J. H Ahn , J. H Bae , Y. S Lee , K Choi , T. S Bae and J. H. Wang
  Background

An anterolateral approach to the tibial tunnel of posterior cruciate ligament reconstruction is used to reduce the sharpness of the graft-tunnel angle, the so-called killer turn effect. However, with the anterolateral approach, the tunnel might be widened into an ovoid shape because of the small angle between the tunnel and the anterolateral cortex.

Hypothesis

The fixation strength of the posterior cruciate ligament graft in the tibial tunnel will be weaker in the anterolateral approach compared with the anteromedial approach.

Study Design

Controlled laboratory study.

Methods

Twenty paired cadaveric tibias were used. Tibial tunnels were made using following approaches: an anteromedial approach for 10 tibias and an anterolateral approach for 10 tibias. The anterior cortex-tunnel angle and the diameter of the tunnel entrance were measured by 2-dimensional computed tomographic scans. After fixation of the Achilles tendon allograft with a biodegradable screw, the maximal strength of the graft at failure was measured using a materials testing machine.

Results

The mean cortex-tunnel angle was 47.5° ± 9.3° in the anteromedial approach group and 28.3° ± 7.4° in the anterolateral approach group. The mean long diameter of the tunnels in the anteromedial approach group was 10.6 ± 1.0 mm and in the anterolateral approach group it was 14.0 ± 1.5 mm. These two parameters showed statistically significant differences between the 2 groups (P < .01). The mean maximum load at failure for the anteromedial approach group was 385.4 ± 139.7 N, and for the anterolateral approach group it was 225.1 ± 144.1 N. This difference was statistically significant (P = .021).

Conclusion

The anterolateral approach resulted in a tunnel with a wider entrance, a more acute cortex-tunnel angle, and a lower maximal load at failure compared with tunnels created using the anteromedial approach.

Clinical Relevance

The use of additional fixation methods, such as post ties or ligament washers and screws, should be considered when using an anterolateral approach for tibial tunnel of posterior cruciate ligament reconstruction.

  J. H Ahn , Y. S Lee , J. C Yoo , M. J Chang , K. H Koh and M. H. Kim
  Background

Tears of the medial meniscus posterior horn (MMPH) are frequently found in knees with deficient anterior cruciate ligaments (ACLs). There are few studies that have evaluated healing of the menisci and the factors associated with healing.

Hypothesis

The repaired menisci would show good healing in the knees with reconstructed ACLs, and the healing capacity of the menisci would differ according to the size, type, and location of the tear as well as the age and gender.

Study Design

Case series; Level of evidence, 4.

Methods

From August 1997 to February 2007, 311 knees underwent MMPH repair using either a modified all-inside or inside-out technique with concomitant ACL reconstruction. Among these patients, a second-look arthroscopy was performed at a mean of 37.7 months postoperatively (range, 12–128 months) in 140 patients. Clinical parameters and outcomes were evaluated. The repaired menisci were divided into complete, incomplete, and failure-to-heal groups. The factors associated with meniscal healing were statistically assessed.

Results

Among 140 patients, 118 (84.3%) showed complete healing, 17 (12.1%) had incomplete healing, and 5 (3.6%) failed to heal. The clinical success rate was 96.4% (135/140) because patients in the incomplete group showed no clinical symptoms associated with meniscal tears. Healing was associated with the tear location (P <.001) and type of tear (P =.0237) on the univariate analysis and the location (P =.0401) only on the multivariate analysis.

Conclusion

Repaired MMPH tears in knees with reconstructed ACLs healed without complications and had satisfactory clinical results. The tear location and type were factors associated with healing on the univariate analysis and location only on the multivariate analysis.

  J. C Yoo , J. H Ahn , J. R Yoon and J. H. Yang
  Background

Over 60 repair/reconstruction techniques have been described for the treatment of coracoclavicular (CC) ligament injuries.

Purpose

To report the functional and radiological outcomes of single-tunnel CC ligament reconstruction using autogenous semitendinosus tendon.

Study Design

Case series; Level of evidence, 4.

Methods

Between August 2005 and January 2008, a total of 21 patients, 16 patients (14 men, 2 women) with a Rockwood type IV, type V, or a chronic type III acromioclavicular (AC) dislocation and 5 patients (4 men, 1 woman) with a painful nonunited distal clavicle fracture with CC separation, underwent CC reconstructive surgery using a semitendinosus autograft. All 21 patients were followed up clinically and radiographically. The mean follow-up was 33 months (range, 18–47), and the mean patient age was 39.8 years (range, 18–70). Chronic type III AC dislocations and nonunited distal clavicle fractures with CC separation were scored using preoperative AC scoring (AC Joint Separation Questionnaire). Constant, University of California–Los Angeles (UCLA), and AC scores were evaluated for all patients at final follow-up.

Results

At the final follow-up, 10 patients achieved an "excellent" result and 11 a "good" result according to the AC scoring scheme. Mean final Constant and UCLA scores were 84.7 (range, 67–94) and 30.0 (range, 23–35), respectively. In the antero-posterior (AP) plane, 17 (81%) of the 21 patients maintained complete reduction, and 1 of the remaining 4, a manual laborer, had complete reduction loss. Of the 17 patients with an axillary view at final follow-up, 1 patient (5.9%) showed partial subluxation, although no subluxation was observed in the AP radiograph. The other 16 patients (94.1%) had a complete reduction state in axillary view.

Conclusion

Single-tunnel CC reconstruction with an autogenous hamstring tendon graft after a mean follow-up of 33 months (range, 18–47) appears to be a satisfactory means of treating acute Rockwood type IV, V, chronic type III, and painful nonunited distal clavicle fractures with CC separation.

  K. H Koh , J. H Ahn , S. M Kim and J. C. Yoo
 

Background: During rotator cuff repair, biceps tendon lesions are frequently encountered. However, there is still controversy about optimal treatment for these lesions.

Purpose: To compare the results of tenotomy and suture anchor tenodesis prospectively.

Study Design: Cohort study; Level of evidence, 2.

Methods: From January 2006 to June 2007, 90 patients (age, >55 years) with a rotator cuff tear and biceps tendon lesion (tear more than 30%, subluxation or dislocation, or degenerative superior labrum anterior to posterior lesion type II) were evaluated prospectively. The first 45 patients treated consecutively underwent biceps tenodesis, and the next 45 underwent biceps tenotomy. Postoperatively, patient evaluations were conducted with a focus on (1) "Popeye" deformity, (2) arm cramping pain, and (3) elbow flexion powers (measured with a hand dynamometer). Overall shoulder function was assessed with the American Shoulder and Elbow Surgeons (ASES) score and the Constant score.

Results: At final follow-up, 43 in the tenodesis and 41 in the tenotomy groups were available for evaluation. There was no difference between groups in demographic data such as age, sex, dominant arm, and the time from symptom to surgery and in preoperative ASES score, Constant score, and rotator cuff tear size. A Popeye deformity occurred in 4 (9%) in the tenodesis group and in 11 (27%) in the tenotomy group (P = .0360). Mild cramping pain was observed in 2 in the tenodesis group and 4 in the tenotomy group (P = .4274). Mean elbow flexor power ratio (vs the contralateral side) showed no difference between the 2 groups, with mean values of 0.92 ± 0.15 (tenodesis) and 0.94 ± 0.19 (tenotomy) (P = .7475). The ASES and Constant scores were improved from 38.9 ± 14.2 and 52.1 ± 21.3 to 84.7 ± 13.6 and 82.9 ± 13.5 in the tenodesis group (P < .0001) and from 35.2 ± 10.5 and 48.1 ± 21.3 to 79.6 ± 15.8 and 78.3 ± 14.1 in the tenotomy group (P < .0001), respectively.

Conclusion: Suture anchor tenodesis of the long head of the biceps tendon appears to lead to less Popeye deformity than tenotomy. No other clinical variables showed a difference between the 2 modalities.

 
 
 
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