• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.212-219
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• 2009

Medially retracted large-sized rotator cuff tears includes large-sized tears, massive tears and irreparable tears. Generally arthroscopic repair or open repair of rotator cuff tears is used in reparable tears. However, arthroscopic repair requires long period practice and endurance. In irreparable tears, arthroscopic debridement, partial repair, latissimus dorsi transfer and retrograde arthroplasty can be the option. Arthoscopic debridement gives temporal relief who experienced improvement in pain and increase in range of motion after subacromial local anesthetic injection. Also arthroscopic partial repair gives good results in irreparable cases, especially in suprascapular nerve traction neurapraxia. Tendon transfer can be used in mild to moderate muscle weakness in shoulder abduction for long term treatment. Pectoralis major transfer can be used in anterosupeior tears and latissimus dorsi transfer can be used in posterosuperior tears. Reverse shoulder prosthesis is used in extreamly weakened shoulder pseudoparalysis. The authors discussed the method of arthroscopic repair in irreparable tears. The debridement, partial repair, and tendon transfer could be used in medially retracted large-sized rotator cuff tears.

• Journal of the Korean Arthroscopy Society
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• v.16 no.1
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• pp.98-103
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• 2012

The repair technique of rotator cuff tear has been markedly developed in recent years. When the natural history of rotator cuff tear was followed, the size of rotator cuff tear increased with time. The fatty infiltration which would come at the later period of rotator cuff tear and the rotator cuff tear arthropathy which would be occurred after massive rotator cuff tear may be the important factors in predicting the prognosis of rotator cuff tear or determining the timing of surgery. Because moderate supraspinatus fatty infiltration appeared an average of 3 years after onset of symptoms, the repair of rotator cuff tear was recommended to be performed before that. And if there was massive rotator cuff tear with cuff tear arthropathy, it was recommended that the rotator cuff repair should be performed before the occurrence of the narrowing of acromiohumeral interval. The techniques of arthroscopic rotator cuff repair were mainly the single row repair and the double row repair. The former is good in view of time consuming and cost, but the latter is superior in view of biomechanics. To maintain the benefit in biomechanics of double row technique and reduce the time of surgery, the suture-bridge technique was invented and widely used recently. There are several modified techniques in arthroscopic suture-bridge technique according to the characteristics of rotator cuff tear.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.8-12
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• 2006

회전근 개 파열이 왜 통증을 일으키며 어떤 경우 통증을 일으키는가에 대해 아직도 모르는 부분이 많다. 그러나 생 역학적으로 회전근 개 질환을 이해하고 접근하면 순리적으로 풀어져 나가는 부분도 많다. 회전근 개가 파열되었어도 통증이 미약하다면 수술보다는 적극적인 보존적 치료가 원칙이다. 만약 수술을 하는 경우 고식적인 방법으로 충분한 경험을 쌓은 후 관절경술을 시도하여야 한다. 물론 최근 관절경술로 파열된 회전근 개를 봉합하여 주는 것이 선호되고 있으며 치료 결과 역시 관절경술이 더 좋을 수는 있으나 불안정성과 마찬가지로 전례에서 가능한 것도 아니고 만족한 결과를 모든 정형외과 의사가 공히 얻는 것은 아니다. 특히 회전근 개 봉합술은 고도의 관절경술 수기가 요구되는 것이므로 충분한 연마가 요구된다.

• Journal of Korean Orthopaedic Sports Medicine
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• v.3 no.1
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• pp.73-80
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• 2004

Purpose: To compare the results of a miniopen repair with those of complete arthroscopic repair in medium and large sized full thickness rotator cuff tears. Materials and Methods: The thirty four(34) patients with medium and large sized complete rotator cuff tear were observed, Group I (complete arthroscopic repair) were 13 cases and group II (miniopen repair) were 21 cases. The tear sizes are from 1cm to 5cm. The average follow up periods are 24(range;12$\~$36) and 28(range; 12$\~$36) months. Subjective pain was evaluated with VAS (visual analogue scale) in rest state. ADL (Activity of Daily Living) and UCLA scoring system were used to evaluate clinical results. Results: At last follow-up periods, pain and functional scores were improved but they had not been shown statistical significance (p>0.05). In the group I and group II, there are no significant difference in VAS, ADL; UCLA score, satisfaction (p>0.05). Conclusions: In medium and large sized full thickness rotator cuff tears, there are no significant clinical results between the arthroscopic and miniopen group.

• Journal of the Korean Arthroscopy Society
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• v.14 no.1
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• pp.49-52
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• 2010

Purpose: We introduce arthroscopically assisted mini-open rotator cuff repair using anterolateral approach. Operative Technique: Placing lateral decubitus position on general anesthesia, a standard arthroscopic glenohumeral examination is performed to evaluate lesions of shoulder joint through posterior and anterior portal. And then arthroscope is placed in the subacromial space and we evaluate the size of the torn tendon and perform arthroscopic acromioplasty through lateral portal. A 3 to 4 cm skin incision is performed from anterolateral edge of acromion to distal and dissected along to raphe between anterior and middle deltoid. A deltoid retractor is then placed, allowing direct visualization of the rotator cuff and humeral head. As torn tendon is tagged by traction suture, we try to anatomical reduction on the footprint and then perform single row or double row repair of the rotator cuff using suture anchors. To prevent avulsion of the deltoid from the acromion, additional sutures by bone tunnel with acromion and deltoid is performed. Conclusion: This technique is useful procedure to get direct approach to anterior portion of supraspinatus tendon and to need lesser deltoid retraction than portal extension approach due to dividing along to raphe between anterior and middle deltoid. Also it provide better visualization of the superior portion of subscapularis and infraspinatus.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.250-259
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• 2010

Purpose: The purpose of this study was to evaluate the usefulness and clinical results of arthroscopic double row repair with UU stitches for massive, full-thickness, rotator cuff tears. Materials and Methods: Between January 2007 and July 2009, we consulted on 36 massive tears in which it was possible to repair the middle area of the greater tuberosity by arthroscopy. One group consisted of 11 cases that had a double row repair with UU stitches. A second group consisted of 20 cases that had a single row repair with simple stitches. We compared the 2 groups for pain, Activities of Daily Living, UCLA score, and KSS score. We did this pre operatively, and at 6 months, 1 year and final follow-ups. Statistical analysis included Student's t test and a paired t est. Mean age was 59 (48~70); mean follow-up was 28 (12~43) months Results: VAS scores decreased from 7.5 pre operatively to 1.5 post operatively at the last f/u in the $1^{st}$ group (p<0.05). In the $2^{nd}$ group, the score decreased from 7.6 in pre op to 1.8 post operatively at the last f/u (p<0.05). There was no significant difference between the two groups (p>0.05). Mean ADL increased from 11.5 to 25.1 at the last f/u in the $1^{st}$ group (p<0.05); in the $2^{nd}$ group the ADL score increased from 11.3 to 27.5 (p<0.05). There was no significant difference between the two groups (p>0.05). The UCLA score increased from 13.9 to 31.6 in the $1^{st}$ group (p<0.05), while in the $2^{nd}$ group the score increased from 13.8 to 30.1 (p<0.05); there was no significant difference between the two groups (p>0.05). Comparing MRIs at 3 and 6 months post op, there were retears in 3 of 9 cases in the first group, and in 8 of 15 cases in the second group; there was no significant difference between the two groups (p>0.05). Conclusion: Arthroscopic double row repair with UU stitches for massive, full-thickness rotator cuff tears showed no differences in clinical results. However, it was associated with a significant difference in the incidence of retears.

• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.99-108
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• 2012

Purpose: To evaluate the clinical results of arthroscopic repair with UU-Tension Band suture for full thickness rotator cuff tear above 4 cm sized. Materials and Methods: From January 2006 to October 2011, in 71 full thickness tears above 4 cm sized which is possible to arthroscopic repair to medial margin of greater tuberosity. The group I is 71 patients which is arthroscopic repair with UU-Tension Band suture, and the group II is 20 cases which is arthroscopic repair with simple suture. Both groups were compared with a VAS score for pain, Activity of Daily Living, UCLA score, KSS score in pre operation, 7 months, 1 year and last follow-up. Statistical analysis was performed by student t test and paired t est. Mean age was 63.2 (52~80) year old, mean follow-up was 38.4 (13~62) months. Results: The VAS scores for pain decreased from 8.1 at preoperative period to 1.6 at postoperative last follow-up period in group I (p<0.05), the score decreased from 7.6 at preoperative period to 1.8 postoperative last follow-up period in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). Mean ADL scores increased from 12.5 at preoperative period to 29.0 post operative last follow-up period in group I (p<0.05), the score increased from 11.3 in pre op to 27.5 post-operative last follow-up in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). The UCLA score increased from 12.9 at preoperative period to 28.7 postoperative last follow-up period in group I (p<0.05), the score increased from 13.8 at preoperative period to 30.1 postoperative last follow-up period in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). In comparing of retear which was checked by MRI and ultrasound evaluated at postoperative period 7 months (mean: 27.5 weeks), the retears were 28% in the group I, and 11 shoulders out of 20 shoulders in the group II. The significant differences were noted between two groups (p<0.05). Conclusion: Arthroscopic repair with UU-Tension Band suture and simple suture for full thickness rotator cuff tear above 4 cm sized were not different clinical result between both groups. However, the significant differences were noted in point of failure rate between both groups.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.207-214
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• 2009

Purpose: In arthroscopic rotator cuff repairs there are generally weak link in tendon suture interface, arthroscopic rotator cuff repairs can have higher retear rates than open repairs. The purpose of this study was to compare the strength of UU (Ulsan University) suture than open modified MA (Mason-Allen) suture when suture anchored into bone. Materials and Methods: The human supraspinatus tendons were harvested from the shoulder of the cadaver and split in 2 times, producing four tendons per one shoulder, for a total of 24 specimens. Two suture configurations (UU, MA) were randomized and checked on each set of tendons. Specimens were cyclically loaded under force control between 5 and 30 N at 0.25 Hz for fifty cycles. Each specimen was loaded to failure under displacement control at 1 mm/sec. Cyclic elongation, peak to peak displacement, stiffness, ultimate tensile load, mode of failure were checked. Results: No significant difference was found between two suture configuration with respect to peak to peak displacement, cyclic elongation, and stiffness. With regard to ultimate failure load, there were no significant difference statistically between the UU suture and modified MA suture (109.4 N, 110.6 N). The most common mode of failure between both sutures was suture pull-out through the tendon. Conclusion: The UU suture and modified MA suture produced similar biomechanical properties.

• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.1-7
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• 2012

Purpose: The purpose of this study was to identify the effectiveness of multimodal pain control method in an early phase after arthroscopic rotator cuff repair, under interscalene brachial plexus block, this study was performed. Materials and Methods: The study was progressed with the 80 cases of arthroscopic rotator cuff repair. Interscalene brachial plexus block was used to all of the 80 cases and patients were divided into 2 groups. Group A consisted of patients injected with bupivacaine, through subacromial space catheter after surgery, and group B consisted of patients with additional method of multimodal pain control using oral opioids, acetaminophen-tramadol complex and selective COX2 inhibitor. Subacromial cathter was removed after injection in both groups. The pain during the day time and night time was compared on the operation day, postoperative 1st, 2nd, 3rd day and 2nd weeks, and it was measured with VAS (visual analogue scale) score. Additionally, the number of ketolorac injection and side-effect related to analgesics was compared between the 2 groups. Results : The mean VAS score of night time on the operation day and day/night time pain of the 1st, 2nd, 3rd day and 2nd weeks was 7.4, 7.0/6.8, 4.5/5.2, 4.8/5.0, 2.2/2.7 on group A and 6.5, 4.3/5.4, 3.2/4.3, 3.0/4.1, 2.4/2.5 on group B, respectively. Significant difference was observed in the night pain on the operation day, 1st, 2nd, 3rd day time and 1st night time pain (p<.05). The average number of ketololac injection was 1.1 and 0.5 in each group, and there was no difference in the frequency of side effects. Conclusion: Multimodal pain control method, after arthroscopic rotator cuff repair, showed an effective early pain control and improved patients' satisfaction.