• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.93-97
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• 2021

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.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.475-477
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• 2019

Stem cell research arose from the need to explore new therapeutic possibilities for intractable and lethal diseases. Although musculoskeletal disorders are basically nonlethal, their high prevalence and the relative ease of performing clinical trials have facilitated the clinical application of stem cells in this field. On the other hand, despite the plethora of in vitro and preclinical studies in stem cell research for regenerative medicine in the musculoskeletal system, few reliable clinical studies have been published. Stem cell therapy can be applied locally for bone, cartilage, and tendon regeneration. The candidate disease modalities in bone regeneration include large bone defects, nonunion of fractures, and osteonecrosis. Focal osteochondral defect and osteoarthritis are the current targets for cartilage regeneration. For tendon regeneration, bone-tendon junction problems, such as rotator cuff tears are hot topics in clinical research. To date, the literature supporting stem cell-based therapies comprises mostly case reports or case series.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.18 no.2
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• pp.43-52
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• 2023

Objectives This study aimed to investigate trends in domestic and international clinical approaches to the Korean medicine treatment of rotator cuff calcific tendinitis and to suggest future research directions. Methods We utilized nine electronic databases to identify domestic and international studies on Korean medicine treatment for rotator cuff calcific tendinitis. By analyzing the title, abstract, and main text, studies concerning Korean medicine treatment of rotator cuff tendinitis were included. Results Among the searched for studies, fourteen studies met our criteria. Eight of these were case reports and six were randomized controlled trials (RCTs). Across the studies, five treatment methods were employed, including acupuncture, herbal medicine, physical therapy, cupping therapy, and moxibustion. Acupuncture, used in all fourteen studies, was the most frequently utilized intervention. Thirteen evaluation tools were used to measure the effectiveness of Korean medicine treatment, and all studies reported positive outcomes. Conclusions We identified current trends in clinical approaches of Korean medicine treatment for rotator cuff calcific tendinitis and assessed the effectiveness of such treatment. However, further studies are warranted to establish a basis for Korean medicine treatment for rotator cuff calcific tendinitis.

• Journal of the Korean Orthopaedic Association
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• v.54 no.5
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• pp.418-426
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• 2019

Purpose: This study analyzed the features of humeral head decentralization in large to massive rotator cuff tears with a shoulder dislocation in the elderly. Moreover, shoulder instability and treatment were reviewed. Materials and Methods: From May 2005 to February 2017, Group A containing 45 cases (45 patients) over 65 years old accompanied by a large or massive rotator cuff tear with a shoulder dislocation and Group B containing 45 cases (45 patients) without a shoulder dislocation were enrolled. The mean ages in Groups A and B were 73.2 and 72.1 years old, and the mean follow-up periods were 30.7 and 31.3 months, respectively. Twenty-one cases (46.7%) in Group A underwent rotator cuff repair, and 8 cases (17.8%) underwent concomitant rotator cuff repair with Bankart repair. Sixteen cases (35.6%) underwent reverse total shoulder arthroplasty for cuff tear arthropathy. 45 cases (100%) in Group B underwent rotator cuff repair. The off-the center and head elevation were measured in the preoperative magnetic resonance imaging (MRI) of Groups A and B. The preoperative and postoperative visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score in Groups A and B were compared. Results: In Groups A and B, the mean off-the centers were posterior 7.41 mm and posterior 2.02 mm (p=0.03), and the mean head elevations were superior 6.66 mm and superior 2.44 mm (p=0.02), respectively. The mean ASES scores of Groups A and B were 32.8 and 33.4 before surgery, and 77.1 (p=0.02) and 78.1 (p=0.02) after surgery (p=0.18), respectively. The mean UCLA scores of Groups A and B were 13.1 and 12.8 before surgery, and 28.9 (p=0.02) and 29.5 (p=0.01) after surgery (p=0.15), respectively. Conclusion: Patients over 65 years old with a shoulder dislocation in large to massive rotator cuff tears had higher off-the center and head elevation on the preoperative MRI than those without a shoulder dislocation. This measurement can help predict preceding shoulder instability. Early rotator cuff repairs should be performed and other treatments, such as Bankart repair and reverse total shoulder arthroplasty, should also be considered.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.136-141
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• 2002

Purpose : The role of biceps pulley is stabilizing sling for the long head of the biceps tendon against anterior shearing stress in the rotator interval. The purpose of this study was to classify arthroscopic findings of biceps pulley and to evaluate the relationship with shoulder pathology. Materials and Methods : From January 2002 through July 2002, we observed biceps pulley in 49 cases of shoulder pathology treated with arthroscopically. There were 22 cases of anterior instability, 12 cases of rotator cuff tear, 5 of impingement syndrome, 6 of frozen shoulder, 2 of superior labral injury and 1 of each scapulothoracic bursitis and biceps dislocation. We classified biceps pulley as four types according to the arthroscopic appearance. Type I its stretched type. type II as sling type, type III at detached sling type, and type IV as concealed type. Results : We observed stretched type in 24 cases $(49\%)$, sling type in 5 cases $(10\%)$, detached sling type in 2 cases, concealed type in 1 case, and unidentified cases in 17 cases $(35\%)$. Conclusion : Development and variation of biceps pulley may have symptomatic correlation according to the degree of shoulder motion or pathologic status.

• Journal of the Korean Arthroscopy Society
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• v.8 no.2
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• pp.124-131
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• 2004

Purpose: To validate and introduce the technique of the arthroscopic repair for the treatment of the Subscapulris tendon tear. Materials and Methods: From April 2003 to April 2004, Arthroscopic repairs were performed in 8 patient with subscapularis tendon tear. The mean follow-up period was 11months. two cases involved only subscaplaris tendon tear. Four cases were associated small sized posterosuperir. rotator cuff tear and two cases were in large size. The type of subscapularis tendon showed upper portion full-thickness tear in 6 cases, partial-thickness tear localized at articular surface in 1 case, complete tear in 1 case. The results were analyzed by using subjective satisfaction, inferior movenent of superior displaced humeral head, Constant-Murley functional scoring Results: Constant-Murley scoring was improved from 55 point preoperatively to 75 point postoperatively following 11 months. Mean score was 71 point except 2 cases of large superoposterior rotator cuff tear, Most humeral heads were distaracted postoperatively. The subjective result for the 8 shoulders were very satisfying in 5 cases, satisfying in 1 case and dissatisfying in 2 cases. Therefore satisfactory results were noted in 6 cases (75%) of this overall treatment group. Conclusion: The arthroscopic repair for the subscapularis tendon tear is thought to be available method, which could reduce severe complications following the weakness of deltoid muscle and postoperative pain. Especially Partial Subscapularis tear not associated with superoposterior rotator cuff tear including PASTA lesion was the sutable indication of the Arthroscopic repair.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.50-57
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• 2006

Purpose: The purpose of this study was to evaluate the tendon healing of arthroscopic repair in full-thickness supraspinatus tears. We evaluate the effectiveness of the arthroscopic repair of full-thickness supraspinatus tears by assessing functional improvement. Materials and Methods: Thirty consecutive full-thickness supraspinatus tears were repaired arthroscopically in 19 patients with a one row of anchor and 11 patients with two rows of anchors. Patients ranged in age from 51 to 79 years (average 63 years). Average follow-up was 16 month (range, 12 to 28 months). To evaluate the effectiveness of the arthroscopic repair of full-thickness supraspinatus tears by assessing functional improvement, we calculate the Constant, ASES, UCLA scores. The 30 patients had either an MR Arthrogram (25 cases) or an MRI (5 cases), performed between 5 months and 20 months (mean 10 months) after surgery. Results: The cuff was healed in 21/30 cases (70%) and partially torn in 3 cases (10%) after the arthroscopic repair of full-thickness supraspinatus tear. Although the supraspinatus tendon was totally torn to the tuberosity in 6 cases(20%) after the arthroscopic repair, the size of the tear was smaller than the initial in 5 cases. The Constant score improved from an average of $55.7{\pm}7.1$ points preoperatively to $77.7{\pm}9.7$ points at the last follow-up (p<0.001), and the average ASES score improved from $39.2{\pm}7.4\;to\;72.4{\pm}12.6$ (p<0.001), and the average UCLA score improved from $17.9{\pm}2.2\;to\;26.8{\pm}5.0$ (p<0.001). Strength of elevation was significantly better $(7.1kgs{\pm}2.4)$ in the shoulders with a healed tendon that in those with an total or partial re-tear tendon $(4.5kgs{\pm}1.0)$ (p<0.05). Factors adversely affecting tendon healing were increasing age, Only 41.7% of the repairs completely healed in patients over 65 years (p<0.05). Conclusion: Arthroscopic repair of isolated full-thickness tear of the supraspinatus leads to completely healing in 70% of the cases. Total or partial re-tear of the repaired rotator cuff is associated with a decreased strength. Older patients had significantly lower healing rates.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.173-179
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• 2009

Purpose: On the hypothesis that the acromion morphology is changed according to the its site, we identified the morphology of the acromion on the oblique slices of MRI and we investigated the association of the acromial shape with the clinical stages of rotator cuff disorder on the magnetic resonance (MR) images. In addition, we compared the acromion morphology on MRI and simple X-rays. Material and Methods: The MR images of seventy one patients with rotator cuff disorder and who underwent arthroscopic surgery were compared with that of a control group of sixteen patients who didn't have rotator cuff disorder on MRI. On three subsequent oblique sagittal slices from the lateral edge of the acromion (S1, S2 and S3), each acromion morphology on the MRI slices was classified according to Epstein et al: flat, curved or hooked. We investigated the changing parttern of the acromion shape and we compared the acromion shape on MRI and that on simple X-rays. We classified the rotator cuff tear by the severity: bursitis, partial thickness tear or full thickness tear. We investigated which acromial type on the MRI oblique slice was associated with the severity of rotator cuff disease. Results: Changes of the acromial shape occurred in 54 patients (76.1%). The most frequent pattern was that the types are same on S1 and S2 and different on S3 (22 cases, 31.0%). The acromial type on S1 and S2 was significantly associated with the severity of rotator cuff disorder (p=0.001 and 0.022), respectively. There was no reliability of the acromial shape on MRI and roentgenography (p>0.05) Conclusion: The type of acromion changed from lateral to medial. Among the three positions, the shape of the acromion on S1 and S2 had meaningful correlation with the clinical stage of rotator cuff disorder. There was no statistical correlation of the acromial shape between MRI and simple X-ray.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.181-188
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• 2006

Purpose: To evaluate the integrity of repair & technical tip in use of Massive Cuff Stitch at arthroscopic repair of rotator cuff tear. Materials and Methods: Twenthy-nine cases of arthroscopically repaired full thickness tear of rotator cuffs which are medium sized were evaluated. Between December 2004 to September 2005 we have studied, the average age 53($42{\sim}69$) years old, mean follow-up was 15($12{\sim}21$) months. We analyzed the results statistically by paired t-test. The integrity of repair were verified by follow up MRI which were checked 11 cases and ultrasound which were checked 10 cases. Results: VAS of pain improved preoperative average 7.1 to postoperative 0.9, ADL improved 11.2 to 25.6 respectively, UCLA improved 13.7 to 32.9(all, P<0.05). 89.7% showed excellent & good results at the final follow-up. The satisfied rate was 93.1%(27 cases). There was re-rupture of the repaired rotator cuff in one case out of 11 cases which were checked by MRI, and in one case out of 10 cases which were checked by ultrasound, and there was one case of thinning of cuff which were checked by ultrasound. Conclusion: The use of Massive Cuff Stitch in arthroscopic repair of rotator cuff tear have been reduced technical failure. It will be good surgical technique which maintain the integrity of repairs.

• The Korean Journal of Pain
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• v.6 no.1
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• pp.40-48
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• 1993

There are many patients who complain of shoulder pain with stiffness. Sadly these patients are often neglected by many physicians. An effective treatment is necessary in clinical practice. In our pain clinic, the fifty patients who were diagnosed frozen shoulder were randomly selected and followed up from Oct. 1992 to Mar. 1993. Important factors affecting outcome include; time from onset of pain and stiffness until treatment, initial severity of the pain and stiffness. We found that appropriate treatment led overall to improved patient satisfaction. The results are as follows. For patients treated within 3 weeks of syndrome occurrence, the recovery rate was in excess of 80%. But, if the patients had suffered for more than 6 months prior to treatment, the recovery rate was below 70%. For problems present in excess of six years only slight improvement was observed. These patients were difficult to manage. If the condition of patients was class I, the recovery rate was 94.4%. But in the cases of class III, only 25% of patients were recovered. From our results, we believe that early treatment is the best choice in management of frozen shoulder patients.