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Journey So Far to Make More Perfect Anterior Cruciate Ligament Surgery
Korean J Sports Med 2023;41:181-184
Published online December 1, 2023;  https://doi.org/10.5763/kjsm.2023.41.4.181
© 2023 The Korean Society of Sports Medicine.

Kyu Sung Chung

Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
Correspondence to: Kyu Sung Chung
Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 11923, Korea
Tel: +82-31-560-2184, Fax: +82-31-557-8781
E-mail: drokokboy@hanmail.net
Received November 19, 2023; Accepted November 20, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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쟾諛⑹떗옄씤(anterior cruciate ligament)뒗 臾대쫷 愿젅 궡뿉 議댁옱븯뒗 꽟쑀꽦 떎諛쒕줈, 臾대쫷 援ъ“臾 以묒뿉꽌 쟾諛⑹떗옄씤 愿젴 뿰援ш 媛옣 留롮쓣 젙룄濡 以묒슂븳 씤뿉 빐떦븳떎. 쟾諛⑹떗옄씤쓽 湲몄씠뒗 룊洹 27–38 mm 젙룄1-3, 遺뵾뒗 빟 1,000 mm3 젙룄濡 떊泥 援ъ“臾 以묒뿉꽌 겕吏 븡 援ъ“臾쇱씠吏留4,5, 臾대쫷쓣 븞젙쟻쑝濡 쑀吏떆궎뒗 뜲뿉 留ㅼ슦 以묒슂븳 뿭븷쓣 븳떎. 쟾諛⑹떗옄씤뒗 눜怨⑥뿉 븯뿬 寃쎄낏쓽 쟾諛 쟾쐞瑜 젣븳븯뒗 씪李⑥쟻 젙쟻 援ъ냽臾(primary static restraint)씠硫 臾대쫷 援닿끝 떆 쉶쟾뿉 븳 씠李⑥쟻 援ъ냽臾(secondary restraint)濡 옉슜븯뒗 뿭븷쓣 븳떎.

쟾諛⑹떗옄씤뒗 二쇰줈 臾대쫷 愿젅씠 쇅諛(valgus) 샊 궡쉶쟾(internal rotation)릺硫댁꽌 넀긽릺硫, 븣濡쒕뒗 뒪룷痢 솢룞쓣 븯뒗 룄以묒뿉 怨쇱떊쟾(hyperextension)릺嫄곕굹 쟾諛 쟾쐞젰쓣 怨쇰룄븯寃 諛쏅뒗 벑쓽 썝씤쑝濡 넀긽쓣 諛쏅뒗떎. 理쒓렐 뱾뼱 슦由щ굹씪뿉 뒪룷痢 솢룞쓣 利먭린뒗 씤援ш 利앷븯怨 븰援먯껜쑁 諛 깮솢泥댁쑁뿉꽌룄 젏젏 뒪룷痢 솢룞쓣 媛뺤“븯硫댁꽌 쟾諛⑹떗옄씤쓽 넀긽씠 利앷븯뒗 異붿꽭瑜 蹂댁씠怨 엳떎. 쟾諛⑹떗옄씤 넀긽씠 諛쒖깮븯硫 臾대쫷 愿젅뿉 쟾諛 諛 쉶쟾 遺덉븞젙꽦씠 諛쒖깮븯湲 븣臾몄뿉6,7, 臾대쫷 湲곕뒫 諛 슫룞 뒫젰씠 쁽엳 媛먯냼븯怨 吏냽릺뒗 遺덉븞젙꽦쑝濡 愿젅뿼씠 吏꾪뻾븯뒗 벑 굹걶 寃곌낵濡 씠뼱吏寃 맂떎. 뵲씪꽌 臾대쫷 湲곕뒫쓣 쉶蹂듯븯怨 뒪룷痢 솢룞뿉 떎떆 蹂듦븯怨좎옄 븳떎硫 쟾諛⑹떗옄씤 옱嫄댁닠씠씪뒗 닔닠쟻씤 移섎즺瑜 떆뻾븳떎.

怨쇨굅濡쒕꽣 쟾諛⑹떗옄씤 옱嫄댁닠뿉뒗 留롮 諛쒖쟾씠 엳뿀쑝硫, 쁽옱뿉룄 떎뼇븳 뿰援ш 吏꾪뻾릺怨 엳떎. 洹 寃곌낵臾쇱쓣 醫낇빀븯뿬 理쒓렐뿉 닔닠 寃쏀뼢씠 뼱뼡 뼇긽쓣 蹂댁씠뒗吏 뙆븙븯怨 뼢썑 諛쒖쟾 諛⑺뼢쓣 끉쓽븯뒗 寃껋 留ㅼ슦 以묒슂븯떎. 씠뿉 蹂 븰닠吏뿉꽌 洹몄뿉 嫄몃쭪寃 “쟾諛⑹떗옄씤 옱嫄댁닠쓽 理쒓렐 寃쏀뼢 諛 뼢썑 諛쒖쟾 諛⑺뼢-理쒖떊 吏寃 由щ럭8”씪뒗 醫낆꽕쓣 異쒓컙븯뒗 寃껋 겙 쓽誘몄 媛移섍 엳뒗 씪씠씪 븯寃좊떎.

븳誘쇨뎅쓽 쟾諛⑹떗옄씤 옱嫄댁닠 떆뻾 嫄댁닔 諛 씤援 10留 紐낅떦 쑀蹂묐쪧쓣 蹂닿퀬븳 鍮낅뜲씠꽣 뿰援ъ뿉 뵲瑜대㈃9, 2008뀈뿉뒗 珥 10,248嫄, 씤援 10留 紐낅떦 21.8嫄댁씠 떆뻾릺뿀쑝굹 2016뀈뿉뒗 珥 14,500嫄, 씤援 10留 紐낅떦 29.1嫄댁씠 떆뻾릺뼱 9뀈 룞븞 빟 33.5%媛 利앷븯뒗 뼇긽쓣 蹂댁뿬二쇱뿀떎. 씠以 궓꽦씠 빟 80%, 뿬꽦씠 빟 20% 鍮꾩쑉쓣 蹂댁쑝硫, 20뿉꽌 媛옣 留롮씠 떆뻾릺뿀怨 洹몃떎쓬씠 30, 40, 10 닚쑝濡 굹궗떎. 꽌뼇怨 鍮꾧탳븯硫 誘멸뎅 2006뀈 씤援 10留 紐낅떦 43.48嫄댁씠뿀쑝硫10, 遺곸쑀읇쓽 寃쎌슦 끂瑜댁썾씠뒗 씤援 10留 紐낅떦 34嫄, 뜶留덊겕뒗 38嫄, 뒪썾뜶 32嫄 젙룄濡11 슦由щ굹씪蹂대떎뒗 꽌뼇 援媛뿉꽌 뜑 넂 쑀蹂묐쪧쓣 蹂댁뿬二쇱뿀吏留, 슦由щ굹씪뿉꽌룄 쟾諛⑹떗옄씤 닔닠씠 袁몄엳 利앷븯怨 엳뒗 異붿꽭씠떎. 슦由щ굹씪뒗 꽌뼇怨쇰뒗 쓽猷 뿬嫄댁씠 떎瑜닿퀬 궗쉶臾명솕쟻씤 李⑥씠媛 엳쑝硫, 룞뼇씤怨 꽌뼇씤 궗씠뿉뒗 빐遺븰쟻 李⑥씠媛 議댁옱븯湲 븣臾몄뿉 슦由 떎젙뿉 留욌뒗 쟾諛⑹떗옄씤 옱嫄댁닠쓣 쐞븳 뜑 留롮 愿떖怨 뿰援ш 븘슂븷 寃껋씠떎.

紐⑤뱺 쟾諛⑹떗옄씤 넀긽뿉꽌 쓽궗媛 닔닠쓣 沅뚰빐빞 븯뒗吏 臾삳뒗떎硫 쁽옱源뚯쓽 뿰援 寃곌낵瑜 넗濡쒕뒗 “洹몃젃吏 븡떎”怨 떟븷 닔 엳떎. 븯吏留 닔닠쓣 떆뻾븯吏 븡븘룄 릺뒗 寃쎌슦뒗 젣븳쟻씠硫, 怨좊졊, 솢룞꽦씠 뼥뼱吏뒗 寃쎌슦, 쟻洹뱀쟻씤 슫룞 蹂듦瑜 썝븯吏 븡뒗 寃쎌슦, 궡怨 吏덊솚 諛 媛쒖씤 궗젙긽 닔닠쓣 諛쏄린 뼱젮슫 寃쎌슦 벑 씪遺쓽 寃쎌슦留 빐떦븯湲 븣臾몄뿉, 쐞쓽 湲곗뿉 빐떦븯吏 븡뒗 젇怨 솢룞꽦씠 넂쑝硫 쟻洹뱀쟻쑝濡 슫룞 蹂듦瑜 썝븯뒗 솚옄뿉寃뚮뒗 媛湲됱쟻 닔닠쟻 移섎즺瑜 沅뚰븯寃 맂떎. 洹몃━怨 쟾諛⑹떗옄씤 넀긽씠 엳뜑씪룄 臾대쫷쓽 湲곕뒫씠 쑀吏릺뒗 “coper”씤 寃쎌슦뒗 젇 솚옄씪룄 닔닠쓣 떆뻾븯吏 븡쓣 닔 엳吏留, 쓽븰쟻쑝濡 “coper”뿉 빐떦븯뒗 寃쎌슦瑜 李얜뒗 寃껋씠 돺吏 븡湲 븣臾몄뿉 “coper”瑜 李얘린 쐞븳 吏냽쟻씤 뿰援ш 븘슂븷 寃껋씠떎.

쟾諛⑹떗옄씤 넀긽 떆뿉 겕寃 넀긽맂 씤 議곗쭅쓣 轅곕ℓ二쇰뒗 遊됲빀닠(repair)怨 깉濡寃 씤瑜 留뚮뱾뼱 二쇰뒗 옱嫄댁닠(reconstruction)씠 엳떎. 愿젅寃쎌쓣 넻븳 옱嫄댁닠쓽 닠湲곌 留롮씠 蹂닿툒릺吏 紐삵븯뜕 1980뀈뿉뒗 愿젅쓣 젅媛쒗븯뿬 遊됲빀븯뜕 닔닠씠 留롮씠 떆뻾릺뿀떎12. 遊됲빀닠쓣 떆뻾븳 寃쎌슦 옱嫄댁닠蹂대떎 엫긽쟻씤 寃곌낵媛 뼥뼱吏꾨떎뒗 寃곌낵媛 떎닔 蹂닿퀬릺뿀湲 븣臾몄뿉 쁽옱源뚯 쟾諛⑹떗옄씤 넀긽뿉꽌뒗 遊됲빀닠蹂대떎뒗 옱嫄댁닠씠 뜑 쟻젅븳 닔닠踰뺤쑝濡 諛쏆븘뱾뿬吏怨 엳떎. 븯吏留 理쒓렐 뱾뼱 쟾諛⑹떗옄씤쓽 洹쇱쐞遺 넀긽 벑 씪遺 寃쎌슦뿉꽌뒗 遊됲빀닠룄 옱嫄댁닠怨 鍮꾩듂븳 젙룄쓽 寃곌낵瑜 蹂댁씤떎뒗 뿰援 寃곌낵瑜 蹂닿퀬븯怨 엳湲 븣臾몄뿉 異뷀썑 遊됲빀닠씠 뼱뼸寃 諛쒖쟾븷 寃껋씤吏 洹異붽 二쇰ぉ맂떎13.

꽦怨듭쟻씤 쟾諛⑹떗옄씤 옱嫄댁닠쓣 쐞빐꽌뒗 닔닠 닠湲, 씠떇嫄 꽑깮, 씠떇嫄댁쓽 怨좎젙 諛⑸쾿, 닔닠 썑 湲곕뒫 쉶蹂 슫룞 벑 留롮 遺遺꾩쓣 怨좊젮빐빞 븯뒗뜲, 닔떗 뀈 쟾遺꽣 씠윭븳 떎뼇븳 遺꾩빞뿉 븳 袁몄븳 뿰援щ 諛뷀깢쑝濡 愿꾨ぉ븷 留뚰븳 諛쒖쟾쓣 씠猷⑥뿀떎.

愿젅寃(arthroscopy)씠 媛쒕컻릺湲 쟾뿉뒗 옣寃쎈(iliotibial band), 눜씠몢嫄(biceps femoris) 벑 愿젅 쇅 援ъ“臾쇱쓣 씠슜븯뿬 쟾諛⑹떗옄씤쓽 뿭븷쓣 떊빐 以 닔 엳룄濡 븯뒗 愿젅 쇅 닔닠踰뺤씠 二쇰줈 떆뻾릺뿀떎. 븯吏留 1960–1970뀈遺꽣 젏李 臾대쫷 愿젅寃쎌씠 蹂닿툒릺硫댁꽌 臾대쫷 愿젅 궡 援ъ“臾쇱뿉 븳 씠빐룄 닔닠 諛⑸쾿씠 젏李 諛쒖쟾븯湲 떆옉븯쑝硫, 씠썑뿉뒗 愿젅 궡뿉꽌 떆뻾븯뒗 닔닠濡 諛쒖쟾븯硫댁꽌 쁽옱뿉 씠瑜닿퀬 엳떎.

쟾諛⑹떗옄씤 옱嫄댁닠 떆 쟾諛⑹떗옄씤씪뒗 씤 援ъ“臾쇱쓣 嫄(tendon)쓣 씠슜븯뿬 옱嫄댄븯怨 엳뒗뜲, 씤뿉 鍮꾪빐 깂젰꽦씠 뼥뼱吏뒗 嫄댁쑝濡 옱嫄댄븯湲 븣臾몄뿉 媛湲됱쟻 嫄댁쓽 湲몄씠瑜 씪젙븯寃 쑀吏븷 븘슂媛 엳떎뒗 媛쒕뀗씠 1990뀈 留먮꽣 2000뀈 珥덈컲源뚯 諛쏆븘뱾뿬議뚮떎. 臾대쫷쓣 援щ由ш퀬 렣뒗 룞븞 嫄댁쓽 湲몄씠媛 蹂븯吏 븡뒗 벑옣젏(isometry point)뿉 옱嫄댄븯뒗 寃껋씠 씠떇嫄댁쓽 옱뙆뿴쓣 삁諛⑺븷 닔 엳떎뒗 뿰援 寃곌낵뿉 洹쇨굅븳 諛⑸쾿씠吏留, 벑옣젏뿉 옱嫄댁쓣 븯뒗 寃껋 쟾諛⑹떗옄씤媛 썝옒 遺李⑸맂 쐞移섏뿉 옱嫄댄븯뒗 빐遺븰쟻씤 옱嫄댁닠씠 븘땲뿀쑝硫, 씠뒗 쟾諛 遺덉븞젙꽦뿉뒗 슚怨쇱쟻씠吏留 쉶쟾 遺덉븞젙꽦쓣 留됯린뒗 뼱젮썙 옱닔닠濡 씠뼱吏뒗 寃쎌슦媛 留롮븯떎.

씠썑 2000뀈 以묓썑諛섎꽣 쟾諛⑹떗옄씤媛 썝옒 遺李⑸맂 쐞移섏뿉 옱嫄댄븯뒗 빐遺븰쟻씤 옱嫄댁닠씠 媛뺤“릺뿀떎. 珥덇린뿉뒗 쟾궡痢 떎諛(anteromedial bundle)怨 썑쇅痢 떎諛(posterolateral bundle) 紐⑤몢 옱嫄댄븯뒗 씠以 떎諛 옱嫄댁닠씠 二쇰ぉ諛쏆븯떎. 寃쎄낏 쟾諛⑹쟾쐞 諛 쉶쟾, 寃쎄낏-눜愿젅쓽 젒珥 硫댁쟻 諛 븬젰 벑 깮뿭븰쟻 뿰援(biomechanical study)뿉꽌 씠以묐떎諛 옱嫄댁닠씠 떒씪떎諛 옱嫄댁닠蹂대떎 뜑 젙긽쟻씤 湲곕뒫쓣 븯뒗 臾대쫷쑝濡 쉶蹂듭떆궓떎怨 븯떎14-16. 븯吏留 씠以묐떎諛쒓낵 떒씪떎諛 옱嫄댁닠쓽 엫긽 寃곌낵瑜 鍮꾧탳븳 硫뷀 遺꾩꽍쓣 궡렣蹂대㈃ 臾대쫷 븞젙꽦, 湲곕뒫쟻씤 痢〓㈃, 씠떇嫄댁쓽 떎뙣, 愿젅뿼 諛쒖깮 벑 媛곸쥌 엫긽 寃곌낵뿉꽌 씠以묐떎諛 옱嫄댁닠怨 떒씪떎諛 옱嫄댁닠 겙 李⑥씠媛 뾾뿀쑝硫, 삤엳젮 씠以묐떎諛 옱嫄댁닠 닔닠쓽 궃씠룄媛 넂怨 몢 媛쒖쓽 꽣꼸씠 빀爾먯졇꽌 諛쒖깮븯뒗 媛곸쥌 臾몄젣 벑 빀蹂묒쬆 諛쒖깮 媛뒫꽦씠 넂湲 븣臾몄뿉 쁽옱뒗 떒씪떎諛 옱嫄댁닠씠 二쇰줈 떆뻾릺怨 엳떎17,18.

理쒓렐뿉뒗 쟾諛⑹떗옄씤쓽 빐遺븰쟻 뿰援ъ뿉 븳 깉濡쒖슫 궡슜씠 蹂닿퀬릺뿀떎. 눜怨 遺李⑸뒗 눜쇅怨 궡痢〓㈃뿉꽌쓽 긽쟻씤 쐞移섎줈 援щ텇븯뿬 吏곸젒 遺李⑸(direct insertion) 媛꾩젒 遺李⑸(indirect insertion)濡 援щ텇븯뒗 諛⑸쾿씠 냼媛쒕릺뿀쑝硫19, 寃쎄낏 遺李⑸뒗 쟾궡痢 떎諛쒓낵 썑쇅痢 떎諛쒖쓽 援щ텇씠 뾾뒗 醫곴퀬 湲 紐⑥뼇쓽 由щ낯 紐⑥뼇씠씪뒗 뿰援 寃곌낵媛 蹂닿퀬릺湲곕룄 븯떎20. 삉븳 寃쎄낏 遺李⑸媛 썝삎, 궪媛곹삎, C-shape 벑 꽌濡 떎瑜 뼇긽쓣 蹂댁씤떎뒗 뿰援щ뱾씠 엳湲 븣臾몄뿉 寃쎄낏 遺李⑸ 꽣꼸쓣 留뚮뱾 븣 떎뼇븳 遺李⑸ 紐⑥뼇뿉 븳 怨좊젮媛 븘슂븯硫21, 썝삎쓽 솗怨듦린(reamer)瑜 씠슜븳 옱嫄댁닠蹂대떎 吏곸궗媛곹삎 紐⑥뼇쓽 솗怨듦린瑜 궗슜븯뿬 옱嫄댄븯뒗 寃껋씠 뜑 빐遺븰쟻씪 닔 엳쓬쓣 떆궗븯뒗 벑 떎뼇븳 二쇱옣씠 엳뼱 븵쑝濡 吏냽쟻씤 뿰援ш 븘슂븷 寃껋쑝濡 뙋떒맂떎.

理쒓렐뿉뒗 쟾諛⑹떗옄씤 옱嫄댁닠 씠썑 닔닠 떎뙣쓽 솗瑜좎쓣 궙異붽퀬 쉶쟾 븞젙꽦쓣 뼢긽븯怨좎옄 쟾쇅痢 援ъ“臾(anterolateral structure) 넀긽 諛 닔닠뿉 븳 뿰援ш 솢諛쒗엳 吏꾪뻾릺怨 엳떎. 쟾쇅痢 씤(anterolateral ligament) 옱嫄댁닠 삉뒗 쇅痢 愿젅쇅 嫄닿퀬젙닠(lateral extraarticular tenodesis) 벑 愿젅쇅 援ъ“臾쇱뿉 븳 닔닠씠 젏李 二쇰ぉ諛쏄퀬 엳쑝硫 떎뼇븳 닔닠 諛⑸쾿씠 蹂닿툒릺怨 엳떎. 泥닿퀎쟻 臾명뿄 怨좎같 뿰援ъ뿉꽌 愿젅쇅 援ъ“臾 닔닠 쉶쟾 븞젙꽦怨 二쇨쟻 엫긽 寃곌낵瑜 뜑 뼢긽븯뿬 二쇰ʼn, 쟾쇅痢≪씤 옱嫄댁닠씠 쇅痢 愿젅쇅 嫄닿퀬젙닠蹂대떎 뜑 슚怨쇱쟻씤 寃 媛숇떎怨 븯떎22. 愿젅쇅 援ъ“臾 닔닠 쟻쓳利앹 뼱뼡 寃껋씤吏, 쟾쇅痢 씤 옱嫄댁닠怨 쇅痢 愿젅쇅 怨좎젙닠 以 뼱뼡 닔닠씠 뜑 슚怨쇱쟻씤吏 벑뿉 븳 떎뼇븳 끉웳씠 엳怨, 愿젅쇅 援ъ“臾 닔닠 썑 臾대쫷 쇅痢 援ы쉷뿉 媛빐吏뒗 븬젰쓽 利앷濡 2李⑥쟻씤 눜뻾꽦 蹂솕媛 諛쒖깮븷 슦젮룄 엳湲 븣臾몄뿉 異뷀썑 씠 愿젴븯뿬 떎뼇븳 뿰援ш 뜑 븘슂븷 寃껋씠떎.

쁽옱源뚯쓽 寃곌낵瑜 醫낇빀븯硫, 쟾諛⑹떗옄씤쓽 빐遺븰쟻 냼寃ъ쓣 넗濡 솚옄留덈떎 빐遺븰쟻 援ъ“媛 떎瑜대떎뒗 젏쓣 씤吏븯怨 쟾諛⑹떗옄씤 넀긽쓽 쐞뿕 슂냼瑜 룊媛븯뿬, 씠윭븳 솚옄쓽 媛쒕퀎쟻씠怨 李⑤퀎솕맂 슂냼瑜 怨좊젮븳 옱嫄댁닠쓣 떆뻾븷 븘슂媛 엳떎怨 寃곕줎吏쓣 닔 엳寃좊떎.

쁽옱源뚯 臾대쫷 愿젅寃 닔닠쓽 諛쒖쟾 怨 쟾諛⑹떗옄씤 옱嫄댁닠쓽 諛쒖쟾怨 沅ㅻ 媛숈씠븯쑝硫 쐞쓽 寃곕줎쓣 뼸湲 쐞븯뿬 吏궃 닔떗 뀈 룞븞 留ㅼ슦 留롮 뿰援ъ 끂젰씠 엳뿀떎. 蹂 븰닠吏뿉꽌뒗 씠踰 샇뿉 蹂 醫낆꽕8쓣 異쒓컙븯뿬 怨쇨굅濡쒕꽣쓽 뿰援 寃곌낵瑜 醫낇빀븯怨 理쒓렐뿉 닔닠 寃쏀뼢씠 뼱뼡 뼇긽쓣 蹂댁씠뒗吏 뙆븙븯뿬 뼢썑 諛쒖쟾 諛⑺뼢쓣 끉쓽븯怨좎옄 븯떎. 씠뒗 슦由щ굹씪 뒪룷痢 쓽븰쓽 諛쒖쟾뿉 엳뼱꽌 겙 쓽誘몄 媛移섍 엳뒗 씪씠씪怨 옄룊븯硫댁꽌 렪吏묒옄 끉룊쓣 留덉튂怨좎옄 븳떎.

Conflict of Interest

Kyu Sung Chung is a member of Editorial Board of The Korean Journal of Sports Medicine and was not involved in the review process of this article.

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