• 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.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.6 no.1
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• pp.1-9
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• 2013

Purpose: The purpose is to perform objective evaluation for rotator cuff using ultrasonography and validate factors influencing cuff integrity as well as efficacy of follow-up ultrasonography after unreamed antegrade intramedullary nailing for humerus fracture. Materials and Methods: Seventeen patients with an average age of $55.7{\pm}18.6$ years underwent antegrade intramedullary nailing for humerus fracture and follow-up ultrasonography of shoulder joint. Mean follow-up period was $43.5{\pm}32.2$ months. Intraoperative evaluation for preoperative cuff tear was performed, of which four cuffs were repaired by single row repair technique. Clinical evaluation included visual analogue scale (VAS), range of motion, Korean Shoulder Scoring System (KSS) and American Shoulder and Elbow Society (ASES) score. Ultrasonographic evaluation was performed on cuff integrity and protrusion of proximal nail tip as well. Radiographic evaluation included time to union, protrusion of proximal nail tip and migration of proximal interlocking screw which could affect shoulder joint function. Results: Mean VAS at last follow-up was $1.65{\pm}1.84$ points. Range of motion showed forward flexion of $137.0{\pm}33.5^{\circ}$, external rotation of $43.5{\pm}12.7^{\circ}$ and internal rotation of $16.4{\pm}2.0^{\circ}$ while KSS score and ASES score were $79.6{\pm}20.7$ and $83.7{\pm}17.0$ points, respectively. Bone union was demonstrated in all cases and average time to union was $3.4{\pm}1.3$ months. Migration of proximal interlocking screw was shown in 6 cases (35%). On ultrasonographic evaluation, there were normal in 8 (47%), weaving in 4 (24%), partial tear in 5 cases (29%), but no complete tear. Protrusion of proximal nail tip was demonstrated in 8 cases (47%) on plain radiographs whereas in 11 cases (65%) on ultrasonography and was associated with increasing age (p=0.038). Ultrasonographic weaving and partial tear was associated with protrusion of proximal nail tip (p=006), but not with repair of preoperative tear (p>0.05). Conclusion: Because weaving and partial tear on ultrasonography originated from protrusion of proximal nail tip, careful insertion of nail and meticulous repair of cuff during operation lead to stable fixation with satisfactory recovery of shoulder function follow-up ultrasonography can be a useful tool for evaluating protrusion of nail tip and rotator cuff tear, of which diagnosis is difficult on plain X-ray after antegrade intramedullary nailing for humerus fracture.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.232-235
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• 2009

Purpose: We report here on a solution for the case of a 71 year old lady with cartilage destruction in the left shoulder and the loss of the rotator cuff secondary to post-septic arthritic sequelae. Materials and methods: After thorough laboratory, clinical and radiological investigation of the patient to rule out any foci of active infection, we contemplated performing reverse total shoulder arthroplasty as a primary procedure. Results: At 22 months follow up, the patient had an excellent result according to the UCLA and ASES scales. Conclusion: Reverse total shoulder arthroplasty seems to be an efficient procedure to improve pain and function in the post-septic shoulder accompanying severe rotator cuff injury.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.4
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• pp.25-34
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• 2021

Objectives This study was conducted to evaluate the therapeutic effect of acupuncture after rotator cuff surgery. Methods Key words such as rotator cuff surgery and acupuncture were searched in 10 databases (Ovid-Medline, Ovid-EMBASE, Ovid-AMED, Cochrane Library, China National Knowledge Infrastructure [CNKI], National Digital Science Library [NDSL], Koreanstudies Information Service System [KISS], Oriental medicine Advanced Searching Integrated System [OASIS], KoreaMed, KMBASE), and only suitable randomized controlled trials (RCTs) were selected. Results 6 RCTs were finally selected, and acupuncture showed positive results for pain relief and functional recovery after rotator cuff surgery. However, the analyzed 6 RCTs showed a high overall risk of bias. Conclusions In the future, RCTs with a higher level of evidence on the effect of acupuncture after rotator cuff surgery need to be continuously conducted.

• 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.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.73-83
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• 2013

Purpose: The goal of this study is to evaluate the minimum three-year follow-up results of reverse total shoulder arthroplasty (RTSA) for glenohumeral (GH) arthritic and pseudoparalytic patients with severe rotator cuff deficiency. Materials and Methods: We evaluated 13 patients (three males and 10 females) who underwent RTSA from July 2007 to July 2010. The average follow-up duration was 54.2 months (range, 37~74 months). Clinical results were evaluated using the Visual Analog Scale (VAS) for pain, active Range of Motion (ROM): active forward flexion (aFF); active external rotation at the side (aERs); active internal rotation to the back (aIRb), American Shoulder and Elbow Surgeons (ASES) score, Korean Shoulder Score (KSS), and intraoperative and postoperative complications. Results: VAS score improved from 7.5(6~10) points to 1.5(0~4), and ROM of active forward elevation improved from $42.7(10{\sim}100)^{\circ}$ to $129.1(110{\sim}180)^{\circ}$. In addition, ASES score improved from preoperative 32.9 (11.7~46.7) points to 80.2(58.3~95.0) postoperatively, and KSS score improved from 36.8(24~47) points to 78.4 (61~92). Twelve out of 13 cases showed various degrees of scapular notching at the last follow-up. There was one case of intraoperative anterior glenoid fracture and two cases of temporary nerve injury. Revision surgery was performed in two cases for treatment of delayed postoperative deep infection. Conclusion: According to minimum three-year follow-up results, RTSA may be an effective treatment option for glenohumeral (GH) arthritic and pseudoparalytic patients. However, considering the possibility of complications related to delayed deep infection or surgeon's technique, RTSA should be judiciously and carefully indicated by expert surgeons.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.205-211
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• 1998

The comminuted fracture and dislocation of the proximal humerus occur more frequently in older patient group and operative treatment is difficult due to poor bone quality. Based on Neer's work, hemiarthroplasty has now become widly accepted for the management of the three-part fracture and four-part fracture-dislocation of the proximal humerus in old age group. The purpose of this study is to evaluate function, pain relief, and patient satisfaction after hemiarthroplasty for proximal humerus fractures and dislocations. Authors reviewed and analyzed 14 prosthetic replacement in comminuted proximal humeral fracture and dislocation at the Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine from March, 1988 to May, 1997. The results were as follows the average age was 58.9years and the ratio of males and females was 5:9. The most common cause of injury was traffic accident(43%). According to the classification of Neer, three part fracture were three(21%), four-part fracture and four-part fracture-dislocation were eleven(79%). The prosthetic replacement was performed within two weeks in eight patient and six were performed after two weeks. The results were analysed according to Neer's criteria and five cases showed satisfactory results. We concluded that hemiarthroplasty for fracture and dislocation of the proximal humerus facilitated the restoration of humerus length and pain relief, thereby allowing earlier motion to prevent the development of painful shoulder: stiffness.

• 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.

• Journal of Korean Orthopaedic Sports Medicine
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• v.8 no.2
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• pp.83-88
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• 2009

Purpose: To evaluate the efficacy of arthroscopic Bankart repair using metal suture anchors for treatment of chronic traumatic anterior instability of shoulder joint. Materials and Methods: 85 patients (80 male and 5 female) were included in this study. The average age was 26 (15~52) years old and the period from the first injury to operation was average 20 (6~38) months. All cases had Bankart lesion and 44 cases had Hill-Sachs lesion. The SLAP lesion was associated in 10 cases and 7 cases had partial rotator cuff tear. The average follow-up period was 89 (68~108) months. Results: Preoperative Rowe score was average 29.3 (25~50) and Rowe score improved to 86.8 (40~100), excellent in 28 cases (32.9%) and good in 46 cases (54.1%) at last follow up period and 70 cases (82.4%) had full range of motion of the shoulder. The arthroscopic revision surgery of the shoulder was performed in 3 cases (3.5%) because of postoperative re-dislocation. Conclusion: We concluded that arthroscopic Bankart repair with metal suture anchors is one of the reliable and effective method for recurrent anterior shoulder dislocation with Bankart lesion.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.179-182
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• 2009

Purpose: Point fixation at the margin of the glenoid is a limitation of conventional arthroscopic stabilization using suture anchors, and does not afford sufficient footprint healing, especially in glenoid bone deficiency. So, we introduce an arthroscopic suture bridge transosseous-equivalent technique for bony Bankart lesions to avoid the technical disadvantage of point contact with anchor fixation and to improve mechanical stability through cross compression of the labrum. Surgical approach: The technique was adapted from the transosseous-equivalent rotator cuff repair technique using suture bridges, which improved the pressurized contact area and mean pressure between the tendon and footprint. After preparation of the glenoid bed by removal, reshaping, or mobilization of the bony lesion, two anchors (3.0 mm Biofastak, $Arthrex^{(R)}$, Naples, FL) were inserted into the superior and inferior portion of the bony Bankart lesion. Using a suture hook, medial mattress sutures were applied around the capsulolabral portion of the IGHL complex to obtain sufficient depth of glenoid coverage. A 3.5 mm pushloc anchor ($Arthrex^{(R)}$, Naples, FL) hole was made in the articular edge of the anterior glenoid rim. distal, suture bridge was applied, and proximal was inserted to mobilize the labrum in the proximal direction. This avoided the technical disadvantage of point contact with anchor fixation and decreased the level of gap formation through cross-compression of the labrum.