untitled

Size: px

Start display at page:

Download "untitled"

효서 용
5 years ago
Views:

1 Review Article The Korean Journal of Sports Medicine 2018;36(2):63-70 pissn eissn 전방십자인대의기능성보조기 : 체계적문헌고찰 건국대학교병원정형외과 1, 올곧은병원정형외과 2 김두한 1,2 ㆍ이동원 1 ㆍ김진구 1 Functional Brace of Anterior Cruciate Ligament: Systematic Review Du Han Kim 1,2, Dhong Won Lee 1, Jin Goo Kim 1 1 Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, 2 Department of Orthopaedic Surgery, Allgoden Hospital, Daegu, Korea Functional knee braces are commonly prescribed to support anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the current literature on the use of functional knee braces of ACL with respect to biomechanical, clinical and functional outcomes. A literature search was conducted (2000 to 2017) by two independent reviewers using PubMed MEDLINE database. Articles were retrieved by an electronic search using keywords (anterior cruciate ligament, brace, and bracing) and their combinations. Current functional braces used to treat ACL injury were identified. Studies that met inclusion criteria were assessed for pertinent data. Fourteen studies met the inclusion criteria. Functional knee brace reportedly did not improve long-term clinical and functional outcomes following ACL reconstruction, but some studies suggest that functional brace may have some benefit with regard to biomechanics, proprioception, and subsequent injury rates. Functional knee brace after ACL reconstruction was found no significant difference in clinical and functional outcomes. But Further large-scale recent studies will be required to determine long-term outcomes of the brace. Keywords: Anterior cruciate ligament, Anterior cruciate ligament reconstruction, Braces, Ligaments, Review 서 론 Received: February 5, 2018 Revised: June 1, 2018 Accepted: June 4, 2018 Correspondence: Jin Goo Kim Department of Orthopaedic Surgery, Konkuk University Medical Center, Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: , Fax: boram107@hanmail.net Copyright 2018 The Korean Society of Sports Medicine CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 스포츠인구의증가로인해스포츠손상이늘어가면서무릎관절의전방십자인대손상또한증가하고있는추세이며, 미국, 덴마크, 스웨덴, 독일등에서는해마다인구 10만명당약 32 91명정도전방십자인대재건술을받는것으로조사되었다 1-3. 전방십자인대가손상되면슬관절의운동역학에영향을끼치게되고, 지속적인불안정성으로인해반월상연골판, 관절연골에추가적인손상이발생할수있으며, 근신경장애에따른운동능력저하도발생할수있어젊고활동적인환자에게서는전방십자인대재건술이많이시행되고있다. 최근중년이후에도스포츠참여가늘어감에따라중년이상의환자에게도전방십자인대재건술은점점더늘어가고있는추세이다 4,5. 제 36 권제 2 호

DH Kim, et al. Functional Brace of Anterior Cruciate Ligament: Systematic Review 전방십자인대재건술후기능성보조기의목적은스포츠활동시무릎에안정감을주어추가적인손상을예방하고, 이식건의회복을도우며, 슬관절의고유감각기능향상및수술후활동시자신감회복이다.

과거대퇴골의등장점 (isometric point) 에대퇴터널을만들어이식물을고정하는방식을선호하였는데, 이수술방법은전후방안정성은충분히얻을수있으나회전불안정성까지해결할수없다는사실이많은연구를통해증명되면서최근다시대퇴터널을전방십자인대의해부학적중심부로바뀌고있다.

2 DH Kim, et al. Functional Brace of Anterior Cruciate Ligament: Systematic Review 전방십자인대재건술후기능성보조기의목적은스포츠활동시무릎에안정감을주어추가적인손상을예방하고, 이식건의회복을도우며, 슬관절의고유감각기능향상및수술후활동시자신감회복이다. 따라서현재많은정형외과의사들이전방십자인대재건술후보조기를처방하고있으나비싼보조기의가격에비해임상적인또는기능적인효과가부족하다는의견또한있다. 전방십자인대재건술의수술기법이발전및변화에따라서보조기에대한인식또한변하고있다. 과거대퇴골의등장점 (isometric point) 에대퇴터널을만들어이식물을고정하는방식을선호하였는데, 이수술방법은전후방안정성은충분히얻을수있으나회전불안정성까지해결할수없다는사실이많은연구를통해증명되면서최근다시대퇴터널을전방십자인대의해부학적중심부로바뀌고있다. 따라서전방십자인대재건술시전방십자인대의해부학적대퇴골중심에대퇴터널을만들기에적합한부전내측삽입구를통한방법및 outside-in 방법이선호되고있다. 그러나이러한수술방식은해부학적중심부에대퇴터널을만들수있는장점에도불구하고, 대퇴터널과경골터널이별도로만들어지면서터널간의굴곡각도가발생하게되어이식건의부하를증가시키며 press-fit 방식을사용할수없으므로초기고정강도가약한단점이발생한다 이러한이유로수술초기에이식건을보호할수있는보조기의중요성이더커지게되었고이에수술후보조기의필요성에대하여다시신중히고려되고있다. 본연구의목적은전방십자인대재건술후착용하는기능성보조기에대한생역학적, 임상적및기능적연구들을비교 분석하고자하는것이다. 문헌검색참고문헌에대한검색은 PubMed MEDLINE database를통하여 2017년 10월에시행되었으며, 키워드는 anterior cruciate ligament, brace, bracing 을이용하였다. 2000년 1월부터 2017년 9월까지발행된논문을대상으로두명의연구자 (DHK, DWL) 가독립적으로데이터를검색하였으며, 연구방식, 전방십자인대재건술방법, 검사시기및검사방법, 연구결과의적절성을검토하였다. 전방십자인대재건술을하지않았더라도보조기의기능을전방십자인대와연관지어연구한논문은포함했지만영어가아닌논문, 종설및증례보고, 추시기간이 3개월이하, 보조기의성능이불확실하거나보조기에대하여명확히기재가되어있지않은경우는연구에서제외하였다. 검색을통하여총 219개의논문이검색되었으며, 제목과초록을검토한결과 25개의논문이포함되었다. 포함된논문의본문을검토한결과 13개의논문이배제되어총 12개의논문이연구에포함되게되었다. 최종포함된논문의인용논문을재검색하여, 추가로 2개의논문을연구에포함했으며, 본연구의마지막에같은방식으로한번더검색을시행하였다 (Fig. 1). 종류와원리기능성보조기는규격품으로바로살수있는제품화된 Fig. 1. Flow diagram of the systematic review process. Fig. 2. Photograph of four points of leverage system functional brace. 64 대한스포츠의학회지

3 김두한외. 전방십자인대의기능성보조기 : 체계적문헌고찰 종류와환자의다리크기에맞게주문제작할수있는종류가있다. 보조기를구성하는재료로는알루미늄, 탄소복합제, 탄소흑연제, 마그네슘제등이있으며, 디자인의원리는허벅지앞과뒤, 종아리, 그리고경골앞부위, 총네군데의안정성을주는 four points of leverage, 무릎주위전체를지지하는 total support system, 신축성이있는 flexible subshell 등이있으며, 강한고정력을가지는보조기는힌지 (hinge) 를이용하여슬관절의움직임을허용하고있다 (Fig. 2) 11. 전방십자인대재건술의수술과정 일반적으로전방십자인대파열이있는활동적인환자들은슬관절의불안정성으로인한이차적인퇴행성변화가발생할수있어재건술이시행되고있다. 전방십자인대재건술에흔히사용되는이식건으로는자가골-슬개건-골, 자가슬괵건, 자가대퇴사두건, 동종건 ( 골-슬개건- 골, 아킬레스건및전, 후경골건 ) 등이있다. 수술은대부분관절내시경으로이루어지며, 수술후전후방안정성뿐아니라회전불안정성까지안정화를얻으려면전방십자인대의해부학적부착점에이식건을정확하게위치시키는것이중요한데, 수술과정중에서대퇴골터널을생성하는방법에따라경경골 (transtibial) 방식, 전내측경삽입구 (anteromedial trans-portal portal) 방식, outside-in 방식으로나뉘게된다. 경경골방식은경골의터널을이용하여대퇴골의터널을만드는수술방식으로해부학적인대퇴골부착부에정확히위치시키기어려운단점이있다. 이러한단점을보완하기위해경골의터널과독자적으로해부학적위치에대퇴골터널을만들수있는전내측경삽입구방식이나 outside-in 방식이최근많은관심을받고있는데, 이방법들또한단점으로독자적인터널로인한이식건의굴곡각도증가하여이식건의부하가증가할수있다는의견들도있다 대한생역학적실험을하였다. Pierrat 등 13 은힌지가있는기능적보조기 3개와하나의슬리브 (sleeve) 형보조기의전방전위정도를관절측정기를이용하여측정하였을때, 기능적보조기가슬관절안정성에효과가있는것으로나타났다. 최근에는 3차원적인운동분석데이터를이용하여보조기착용후슬관절뿐만아니라고관절및족관절에대한지면반발력, 굴곡및신전각의변화, 모멘트 (moment) 등의다양한결과를분석하는연구도진행되고있다. 연구에따르면슬관절의기능적보조기는착지동작시슬관절뿐만아니라고관절의굴곡및신전각도에도의미있는영향을주어전방십자인대의부상과관련된중요한생역학적인인자를안정시켜줄수있다는의견도제시되었다 14. 또다른연구로자가슬개건을이용한전방십자인대재건술을시행한환자에게서계단하강및점프착지동작직후피벗 (pivot) 동작과같은비교적고강도의운동부하결과, 보조기착용군이미착용군보다과도한경골회전을제한하는것으로나타났지만전방십자인대손상이없는정상적인슬관절과는차이를보였다고발표하였다 15. 그러나 Jalali 등 16 은상반되는결과를발표하였는데, 전방십자인대의손상을받은슬관절에서투시조영분석기를이용하여런지운동시슬관절의각도에따른전방전위의정도를측정하였는데, 보조기착용군과미착용군에서의미있는차이는없는것으로확인되었다. Beynnon 등 17 은만성전방십자인대손상이있는환자를대상으로기능적보조기의안정성에대한역학적연구를한결과체중부하및비체중부하시에는전방불안정성을유의하게줄여주었으나, 비체중부하에서체중부하로슬관절의부하가이동할때는정상적인슬관절에비해 3.5배정도전방전위가발생함을보고하였다 (Table 1). 전방십자인대기능성보조기의임상적인결과 전방십자인대기능성보조의생역학적연구 전방십자인대의기능은일차적으로슬관절의전후안정성을, 이차적으로는내회전, 외회전및내반, 외반안정성을유지해주는것이다 12. 따라서전방십자인대기능성보조기도이와같은전방십자인대의본연기능을근간으로디자인되고있다. 본연구에포함된 14개의연구중 5개의연구에서보조기착용에따른경골의전방전위, 회전정도, 지면반발력등에 슬관절의임상적결과는 Lysholm 점수, Tegner 점수, International Knee Documentation Committee (IKDC) 점수등의주관적인평가와관절가동범위 (range of motion), 재손상빈도, 근력등과같은객관적인평가가있는데, 이를조사연구는총 6개가확인되었다. 그중 4개의연구에서기능성보조기가주관적인평가에영향을미치지는않는다고보고하였다. McDevitt 등 18 은다기관의 95명을대상으로한전향적인연구에서전방십자인대재건술후보조기를착용하는것이슬관절의안정성, IKDC 점수, Lysholm 점수, 관절운동범위, 제 36 권제 2 호

4 DH Kim, et al. Functional Brace of Anterior Cruciate Ligament: Systematic Review Table 1. Summary of published biomechanical results of functional brace of anterior cruciate ligament Study Level of evidence (study design) No. of cases Brace type Tool of evaluation Outcomes measured Result Pierrat et al. 13 Ewing et al. 14 Giotis et al. 15 Jalali et al. 16 Beynnon et al. 17 III (Controlled laboratory III (Controlled laboratory II (Prospective comparative III (Controlled laboratory III (Controlled laboratory 16 Injured knees, no control group 15 Healthy knees, no control group 20 BPTB ACLR, 20 intact ACL 12 ACL deficient knees, no control group 9 ACL deficient knees, no control group 3 Fabric hinged braces and 1 knee sleeve Rigid polymer frames brace Prophylactic brace, sleeved brace, without a brace Rigid functional brace Rigid functional knee brace GNRB arthrometer Anterior tibial translation 3-Dimensional motion and force plate 8-Camera optoelectronic system Fluoroscopic images during lunge Vermont knee laxity device Ground-reaction force, joint angles, moments, power, and work Tibial rotation during pivoting motion Anterior tibial translation Anterior tibial translation Three fabric hinged braces may effectively replace the passive mechanical role of ACL. Braces may help reduce the risk of noncontact knee injuries. Bracing limited the excessive tibial rotation. However, full restoration to normative values was not achieved. Functional knee bracing is not sufficient to control the anterior tibial translation. Braces were not effective in reducing the abnormal anterior translations produced by the change from non-wb to WB. ACL: anterior cruciate ligament, BPTB: bone patella tendon bone, ACLR: anterior cruciate ligament reconstruction, WB: weight bearing. 근력등의임상적인결과에서차이를보이지않음을발표하였다. Harilainen과 Sandelin 19 은 60명의전방십자인대재건술을받은환자들을전향적으로 Lysholm 점수, Tegner 점수, 전후방불안정성및근력을평가한결과유의한차이가없음을보고하였고 Birmingham 등 20 도 150명을대상으로수술후기능성보조기착용한군과슬리브형보조기를착용한군에서전방십자인대- 삶의질평가 (Anterior Cruciate Ligament-Quality of Life Questionnaire) 및 Tegner 점수를비교한결과임상적으로기능성보조기의우월성을증명할수없었다. 관절가동범위에관해서긍정적인연구가있었다. Mikkelsen 등 21 은 0 o 고정신전보조기가슬관절의신전을지속적인유지를하지못하기때문에 5 o 과신전보조기를사용하였을때, 굴곡제한, 관절이완, 통증등의임상적인결과에는큰차이가없었으나신전소실을더예방할수있었다고보고하였다. 보조기의중요한기능중하나인재발방지효과에서는비교적좋은결과를보고하였다. 전방십자인대재건술을시행 한스키선수들을대상으로한연구에서재부상률은보조기착용군이 4%, 비착용군이 9% 로나타났으며그중에서도수술이필요할정도의부상이확인된군은보조기착용군이 1%, 비착용군이 4% 로조사되어스키운동시보조기착용이재발방지에도움이되는것으로나타났다 22. 유사한연구로전방십자인대가손상당하여결손이있는스키선수를대상으로한재부상률을조사하였을때도보조기착용군이 2%, 보조기미착용군이 13% 로훨씬더재부상률이낮은것으로확인되었다 23. 그러나이러한연구들이모두스키선수들을대상으로이루어졌기때문에, 더욱더다양하고폭넓은군에서의연구가향후필요하다 (Table 2). 전방십자인대보조기의기능적인결과 본연구에포함된논문중 5 개의논문에서전방십자인대 66 대한스포츠의학회지

5 김두한외. 전방십자인대의기능성보조기 : 체계적문헌고찰 Table 2. Summary of published clinical results of functional brace after anterior cruciate ligament reconstruction Study McDevitt et al. 18 Harilainen and Sandelin 19 Birmingham et al. 20 Mikkelsen et al. 21 Sterett et al. 22 Kocher et al. 23 Level of evidence (study design) I (Prospective randomized multicenter I (Randomized prospective I (Randomized controlled I (Prospective randomized III (Cohort III (Cohort No. of cases 47 Braces, 48 no-brace 30 Braces, 30 no-brace 76 Braces, 76 sleeves 22 Study groups, 22 control groups 257 Braces, 563 no-brace 101 Braces, 79 no-brace Brace type and duration DonJoy IROM, 6 mo DonJoy IROM, 12 wk DonJoy Legend and Neoprene sleeve, 12 mo Hyperextensio n brace and straight brace, 3 mo CTi2 brace, NR CTi2 brace, NR Reconstruction technique BPTB autograft BPTB autograft Hamstring autograft BPTB autograft BPTB autograft, hamstring autograft, allograft NR Clinical outcomes measured IKDC, Lysholm score, and strength test Lysholm score, Tegner score, strength test ACL-quality of life questionnaire, Tegner score VAS and range of motion Subsequent knee injuries Subsequent knee injuries Result Bracing does not appear to change the clinical outcomes. Knee braces are not needed in the postoperative rehabilitation after ACLR. A functional brace does not result in superior outcomes compared with a sleeve. Hyperextension brace seems to be an easy way of ensuring full extension. The increased risk of subsequent knee injury in non-braced group The risk ratio for subsequent knee injury comparing non-braced with braced skiers was 6.4 (13% and 2%). BPTB: bone patella tendon bone, IKDC: International Knee Documentation Committee, ACLR: anterior cruciate ligament reconstruction, ACL: anterior cruciate ligament, VAS: visual analogue scale, NR: not reported. 재건술을받았거나전방십자인대의손상이있는환자에게보조기의착용과한발뛰기, 러닝, 민첩성, 고유감각기능등의기능적인결과와의연관성을보고하였으나보조기의착용이이러한기능적인결과에큰영향을끼치지는못했다. Wu 등 24,25 은전방십자인대재건술을시행받은환자를대상으로기능성보조기와 placebo 보조기, 보조기미착용군간의근력및고유감각신경에관한비교연구를한결과, 기능성보조기와 placebo 보조기에서고유감각신경검사에서는향상되는결과를보였으나다른검사결과에서는큰차이를보이지않았고, 마찬가지로전방십자인대재건술후 5개월째실시한달리기속도, 점프력, 방향전환등과같은기능적인검사에서도보조기의착용은큰효과가없는것으로보고하였다. 전향적인다기관연구에서도전방십자인대후보조기착용은한발뛰기와같은기능적인평가에서우월함을확인할수없었으며 18,20, 전방십자인대의손상이있으나재건술을받지않은환자에 대한연구에서도기능성보조기는슬리브형보조기에비해기능적인평가에서유의한차이가없었다 26. 고찰전방십자인대재건술후보조기의목적은스포츠활동으로복귀하였을때추가적인손상을예방하고, 치유되는동안이식건을보호하며, 슬관절의고유신경감각을더향상해환자의자신감을회복시키는데있다. 본연구의목적은전방십자인대재건술후착용하는기능성보조기가이식건에역학적인안정감을주고, 환자에게임상적및기능적으로긍정적인영향을주어재활에도움이되는지를알아보고자하였다. 많은연구에서기능성보조기는슬관절에역학적으로안정감을주는것으로보고를하였지만, 스포츠활동과관련된역동적인동작에서는그기능이아직은증명되지못하였고, 제 36 권제 2 호

6 DH Kim, et al. Functional Brace of Anterior Cruciate Ligament: Systematic Review 임상적인결과또한보조기착용군의우월함을증명하지못하였다. 이러한불확실한임상적인결과때문에전방십자인대수술후보조기의처방을꺼리는의사들도있지만, 재발의위험성을줄일수있고, 운동시자신감, 재손상에대한불안감과같은환자들의심리적인요인들은임상적인결과에반영이되지않기때문에임상적인결과의유의성이없다하더라도더욱더신중하게받아들여야한다. 고유감각기능과관련된연구에서는보조기가확실한도움이된다는보고는없으나기존의기능성보조기와는다르게슬리브형보조기는고유감각기능에도움이된다는연구들이있다. Palm 등 27 은전방십자인대재건술을받은 65명을대상으로한슬리브형보조기의기능을평가한결과, 보조기착용이고유감각기능을향상할수있음을보고하였다. 슬리브형보조기는일반적인슬관절보조기와는다르게많은부분의피부를덮을수있게제작되는데, 이는피부신경에추가적인자극을주고피부수용체에구심성유입을증가시키게된다. 그리고피부및근육과관절낭에압력을주어근육방추체와골지건기관 (Golgi tendon organ) 에적절한자극을주게된다. 이러한작용들이근육조절에피드백을주게되어기능적관절안정성을향상할수있게된다 28. 전방십자인대재건술후회복에는무릎주위근육의발달이중요하다. 그중에서도대퇴사두근은슬관절의안정성및역동적인기능, 재손상방지, 관절염의발생등에밀접한관련이있기때문에특히더중요하게여겨지고있다. 무릎주위부상이후대퇴사두근은신경계의억제를받게되는데이러한과정은관절기원성근억제 (arthrogenic muscle inhibition) 로알려져있다 29. 관절기원성근억제는관절의부종, 염증, 통증, 이완및구조적인손상이있을시활성화될수있어전방십자인대손상뿐만아니라골관절염, 타박상, 반월연골판손상, 수술후에도작용을한다 30,31. 그중에서도전방십자인대손상이있을시관절기원근억제는초기에활성화되고, 수상후약 2년전후에는거의작용하지않는것으로알려져전방십자인대손상및수술후초기재활이더강조되는이유이다 32. 대퇴사두근에작용하는관절기원근억제뿐만아니라대퇴사두근에길항하는햄스트링의활성화또한전방십자인대수술후흔히관찰된다. 이러한햄스트링공동활성화작용은경골의전방전위를막고슬관절의안정성을주기위한자연스러운보상작용으로설명되는데, 이것은전방십자인대재건술후슬관절의재활시관절운동제한과대퇴사두근근력향상에부정적인영향을줄수있다 33. 따라서앞으로전방십자인대재건술후필요한보조기는 단순히이식건에기계적인고정력만주는기능뿐만아니라슬관절의고유감각신경의보존, 수술받은환자의자신감회복및대퇴사두근의근력강화에필요한근-신경계에긍정적인영향을줄수있는보조기가연구되어야할것이다. 결 론 건강에대한관심이늘어나면서스포츠손상과밀접한관계가있는전방십자인대재건술은앞으로도많이시행될것이다. 전방십자인대재건술후기능적보조기착용이생역학적및기능적으로도움이된다는주장도있으나, 입증할만한충분한근거는부족한상황이다. 앞으로역동적인신체활동에서도본연의전방십자인대기능을재현할만한기능을함과동시에근-신경계적으로긍정적인작용을하여원활한재활을할수있는보조기에대한개발과더불어이에따른체계적인연구가지속해서이루어져야할것이다. Conflict of Interest No potential conflict of interest relevant to this article was reported. References 1. Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L. Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med 2008;36: Granan LP, Forssblad M, Lind M, Engebretsen L. The Scandinavian ACL registries : baseline epidemiology. Acta Orthop 2009;80: Lind M, Menhert F, Pedersen AB. The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 2009;17: Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P. Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013;21: Lawrence JT, Argawal N, Ganley TJ. Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Am J Sports Med 2011;39: Petersen W, Tretow H, Weimann A, et al. Biomechanical 68 대한스포츠의학회지

7 김두한외. 전방십자인대의기능성보조기 : 체계적문헌고찰 evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am J Sports Med 2007;35: Seon JK, Gadikota HR, Wu JL, Sutton K, Gill TJ, Li G. Comparison of single-and double-bundle anterior cruciate ligament reconstructions in restoration of knee kinematics and anterior cruciate ligament forces. Am J Sports Med 2010; 38: van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH. Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. Am J Sports Med 2012;40: Kim JG, Wang JH, Lim HC, Ahn JH. Femoral graft bending angle and femoral tunnel geometry of transportal and outsidein techniques in anterior cruciate ligament reconstruction: an in vivo 3-dimensional computed tomography analysis. Arthroscopy 2012;28: Tashiro Y, Irarrazaval S, Osaki K, Iwamoto Y, Fu FH. Comparison of graft bending angle during knee motion after outside-in, trans-portal and trans-tibial anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017;25: Smith SD, Laprade RF, Jansson KS, Aroen A, Wijdicks CA. Functional bracing of ACL injuries: current state and future directions. Knee Surg Sports Traumatol Arthrosc 2014;22: Andersson D, Samuelsson K, Karlsson J. Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy 2009;25: Pierrat B, Oullion R, Molimard J, et al. Characterisation of in-vivo mechanical action of knee braces regarding their antidrawer effect. Knee 2015;22: Ewing KA, Begg RK, Galea MP, Lee PV. Effects of prophylactic knee bracing on lower limb kinematics, kinetics, and energetics during double-leg drop landing at 2 heights. Am J Sports Med 2016;44: Giotis D, Zampeli F, Pappas E, Mitsionis G, Papadopoulos P, Georgoulis AD. Effects of knee bracing on tibial rotation during high loading activities in anterior cruciate ligamentreconstructed knees. Arthroscopy 2013;29: Jalali M, Farahmand F, Mousavi SM, et al. Fluoroscopic analysis of tibial translation in anterior cruciate ligament injured knees with and without bracing during forward lunge. Iran J Radiol 2015;12:e Beynnon BD, Fleming BC, Churchill DL, Brown D. The effect of anterior cruciate ligament deficiency and functional bracing on translation of the tibia relative to the femur during nonweightbearing and weightbearing. Am J Sports Med 2003; 31: McDevitt ER, Taylor DC, Miller MD, et al. Functional bracing after anterior cruciate ligament reconstruction: a prospective, randomized, multicenter study. Am J Sports Med 2004;32: Harilainen A, Sandelin J. Post-operative use of knee brace in bone-tendon-bone patellar tendon anterior cruciate ligament reconstruction: 5-year follow-up results of a randomized prospective study. Scand J Med Sci Sports 2006;16: Birmingham TB, Bryant DM, Giffin JR, et al. A randomized controlled trial comparing the effectiveness of functional knee brace and neoprene sleeve use after anterior cruciate ligament reconstruction. Am J Sports Med 2008;36: Mikkelsen C, Cerulli G, Lorenzini M, Bergstrand G, Werner S. Can a post-operative brace in slight hyperextension prevent extension deficit after anterior cruciate ligament reconstruction? A prospective randomised study. Knee Surg Sports Traumatol Arthrosc 2003;11: Sterett WI, Briggs KK, Farley T, Steadman JR. Effect of functional bracing on knee injury in skiers with anterior cruciate ligament reconstruction: a prospective cohort study. Am J Sports Med 2006;34: Kocher MS, Sterett WI, Briggs KK, Zurakowski D, Steadman JR. Effect of functional bracing on subsequent knee injury in ACL-deficient professional skiers. J Knee Surg 2003;16: Wu GK, Ng GY, Mak AF. Effects of knee bracing on the functional performance of patients with anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 2001;82: Wu GK, Ng GY, Mak AF. Effects of knee bracing on the sensorimotor function of subjects with anterior cruciate ligament reconstruction. Am J Sports Med 2001;29: Mortaza N, Abu Osman NA, Jamshidi AA, Razjouyan J. Influence of functional knee bracing on the isokinetic and functional tests of anterior cruciate ligament deficient patients. PLoS One 2013;8:e Palm HG, Brattinger F, Stegmueller B, Achatz G, Riesner HJ, Friemert B. Effects of knee bracing on postural control after anterior cruciate ligament rupture. Knee 2012;19: Strutzenberger G, Braig M, Sell S, Boes K, Schwameder H. Effect of brace design on patients with ACL-ruptures. Int J Sports Med 2012;33: Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum 2010;40: 제 36 권제 2 호

8 DH Kim, et al. Functional Brace of Anterior Cruciate Ligament: Systematic Review 30. Urbach D, Awiszus F. Impaired ability of voluntary quadriceps activation bilaterally interferes with function testing after knee injuries: a twitch interpolation study. Int J Sports Med 2002;23: Suter E, Herzog W, Bray RC. Quadriceps inhibition following arthroscopy in patients with anterior knee pain. Clin Biomech (Bristol, Avon) 1998;13: Urbach D, Nebelung W, Becker R, Awiszus F. Effects of reconstruction of the anterior cruciate ligament on voluntary activation of quadriceps femoris a prospective twitch interpolation study. J Bone Joint Surg Br 2001;83: Pamukoff DN, Pietrosimone BG, Ryan ED, Lee DR, Blackburn JT. Quadriceps function and hamstrings co-activation after anterior cruciate ligament reconstruction. J Athl Train 2017;52: 대한스포츠의학회지

황지웅

황지웅 Comparison of Laparoscopy and Exploration in the Distal Pancreatectomy BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic