• Journal of the Korean Orthopaedic Association
• /
• v.55 no.1
• /
• pp.38-45
• /
• 2020

Purpose: To examine the clinical and structural outcomes of an at least two-year follow-up of arthroscopic full-thickness rotator cuff repairs with a single-row or suture-bridge technique in patients more than 65 years of age. Materials and Methods: Patients diagnosed with a full-thickness rotator cuff tear who were more than 65 years of age, underwent arthroscopic rotator cuff repair after at least six months of conservative treatment, agreed to take a follow-up magnetic resonance imaging (MRI) six months postoperatively, and visited outpatient for at least two years were enrolled in this study. Clinical evaluations were done using The University of California Los Angeles score, Constant Shoulder Score, and visual analogue scale evaluated two years after the surgery. The structural integrity was analyzed using follow-up MRI. During surgery, a suture-bridge technique was used if the rotator cuff tendon could cover half of the footprint under constant tension. Otherwise, single-row repair was performed. Results: The samples were 158 cases, consisting of 93 single-repairs and 65 suture-bridge repairs. A preoperative comparison of the age distribution, fatty degeneration of supraspinatus and infraspinatus muscle, medial retraction of torn cuff tendon, and tear size between the two groups were not significant. The clinical scores were improved significantly in all cases. The distribution of the structural integrity by Sugaya classification were 49 cases in type 1 (31.0%), 62 cases in type 2 (39.2%), 30 cases in type 3 (19.0%), 11 cases in type 4 (7.0%), and six cases in type 5 (3.8%). The re-tear rate of the single-row group was 9.7% (nine out of 93 cases) and 12.3% (eight out of 65 cases) for the suture-bridge group. Conclusion: Satisfactory clinical and radiological outcomes were achieved after arthroscopic full-thickness rotator cuff repair in patients more than 65 years of age. Both single-row and suture-bridge techniques would be beneficial for the elderly.

• Clinics in Shoulder and Elbow
• /
• v.26 no.3
• /
• pp.276-286
• /
• 2023

Background: The transosseous anchorless repair (ToR) technique was recently introduced to avoid suture anchor-related problems. While favorable outcomes of the ToR technique have been reported, no previous studies on peri-implant cyst formation with the ToR technique exist. Therefore, this study compared the clinical outcomes and prevalence of peri-implant cyst formation between the ToR technique and the conventional transosseous equivalent technique using suture anchors (SA). Methods: Cases with arthroscopic rotator cuff repair (ARCR) between 2016 and 2018 treated with the double-row suture bridge technique were retrospectively reviewed. Patients were divided into ToR and SA groups. To compare clinical outcomes, 19 ToR and 57 SA cases without intraoperative implant failure were selected using propensity score matching (PSM). While intraoperative implant failure rate was analyzed before PSM, retear rate, peri-implant cyst formation rate, and functional outcomes were compared after PSM. Results: The intraoperative implant failure rate (ToR, 8% vs. SA, 15.3%) and retear rate (ToR, 5.3% vs. SA, 19.3%) did not differ between the two groups (all P>0.05). However, peri-implant cysts were not observed in the ToR group, while they were observed in 16.7% of the SA group (P=0.008). Postoperative functional outcomes were not significantly different between the two groups (all P>0.05). Conclusions: The ToR technique produced comparable clinical outcomes to conventional techniques. Considering the prospect of potential additional surgeries, the absence of peri-implant cyst formation might be an advantage of ToR. Furthermore, ToR might reduce the medical costs related to suture anchors and, thereby, could be a useful option for ARCR. Level of evidence: III.

• Journal of the Korean Arthroscopy Society
• /
• v.17 no.1
• /
• pp.1-5
• /
• 2013

Purpose: To evaluate the clinical results of arthroscopic repair with Ulsan University - Mason Allen - Suture Bridge (UU MA SB) stitch for the full thickness rotator cuff tear. Materials and Methods: Fifteen patients with full thickness rotator cuff tear underwent arthroscopic repair with UU MA SB stitch between September 2010 and December 2010. Clinical and functional evaluations were made according to Korean shoulder score (KSS), American shoulder and elbow surgeon (ASES), University of California, Los Angeles (UCLA), visual anabgue scale (VAS) and the range of motion. Results: The mean KSS improved from 51.4 preoperatively to 92.0 at final follow-up (p<0.05). The mean UCLA score improved from 15.07 preoperatively to 31.93 postoperatively, the mean VAS of pain during the motion was 7.2 before treatment and 0.93 at final follow-up (p<0.001). At last follow-up, the mean range of motion was improved but they had not shown statistical significance (p>0.05). Conclusion: The arthroscopic repair with UU MA SB stitch may be an effective procedure in the full thickness rotator cuff tear for pain relief and improvement of the range of motion.

• Clinics in Shoulder and Elbow
• /
• v.10 no.1
• /
• pp.106-111
• /
• 2007

Purpose: The purpose of this paper is to clinically evaluate the usefulness of all arthroscopic repair with biceps incorporation in massive sized full thickness rotator cuff tears. Materials and Methods: This is a prospective comparative outcome study evaluating a series of all arthroscopic rotator cuff repairs with biceps incorporation on massive(range: $5{\sim}\;cm6$ sized) from March 2003 to May 2006. Group I was twenty two cases of arthroscopically repaired with biceps incorporation, twenty cases of group II without biceps incorporation were analyzed. The average age of the patients was 58 years(range, $41{\sim}74$ years), and mean follow-up was 24 months(range, $12{\sim}36$ months). Results were statistically compared by Mann-Whitney test. Results: Average VAS for pain, ADL, UCLA score were not significantly different between group I and group II (P>0.05 for each). Forward elevation strength was 4.3 in group I, 3.5 in group II(P<0.05). On postoperative follow up ultrasound, retear was 10 cases in the middle of 19 cases at group I, 15 cases in the middle of 17 cases at group II (P<0.05). Conclusion: This study reveals that all arthroscopic repairs with biceps incorporation in massive sized full thickness rotator cuff tears is an effective surgical method and reduced retear and enhanced strength.

• Clinics in Shoulder and Elbow
• /
• v.9 no.2
• /
• pp.176-180
• /
• 2006

Purpose: Although surgical arthroscopic repair of rotator cuff has become much more common as surgeons have developed proficient techniques, it is still technically difficult. The purpose of this study was to evaluate the clinical results and the usefulness of mini-open repair in large and massive size tears. Materials & Methods: From January 2000 to December 2004, sixteen patients were treated with mini-open repair. There were 10 male and 6 female patients with the average age of 62.5 years. The size of tear was massive in 4 cases and large in 12 cases. All tears were repaired with metal anchor sutures. The mean duration of follow-up period was 23 months. Postoperative results were evaluated based on American Shoulder and Elbow Society scoring system. Results: Five patients showed excellent results, five good, and two fair in large tears while one patient showed excellent result, one good, and two fair in massive tears. Poor outcome was not seen during the follow-up period. There was no significant relationship between the patient's age and the size of tear, and postoperative results. However, the relationship between the duration of symptomatic period in preoperation and postoperative results showed significant correlation. Conclusion: Mini-open repair combined with the preservation of deltoid and early rehabilitation is clinically useful in large and massive size rotator cuff tear patients treatment.

• 대한관절경학회:학술대회논문집
• /
• 2007.10a
• /
• pp.28-29
• /
• 2007

• Clinics in Shoulder and Elbow
• /
• v.25 no.1
• /
• pp.15-21
• /
• 2022

Background: This study was performed to identify the incidence of screw in-type lateral anchor pull-out in patients older than 60 years who underwent rotator cuff repair for large to massive rotator cuff tear (RCT). Methods: We reviewed 25 patients over 60 who were diagnosed with large to massive RCT and underwent arthroscopic rotator cuff repair in our hospital from March 2017 to February 2021. Preoperative tear size (anterior to posterior, medial to lateral) was measured via preoperative magnetic resonance imaging (MRI). All 25 patients underwent MRI scanning on postoperative day 1 and at 3 months after surgery. The change of anchor position was measured in axial views on MRI images postoperative day 1 and 3 months after surgery. And it was statistically compared according to bone mineral density (BMD), sex, and number of lateral anchors. Results: Two MRIs (postoperative day 1 and 3 months) in 25 patients were compared. Anchor pull-out occurred in six patients during 3 months (6.7%), and the mean pull-out length difference was 1.56 mm (range, 0.16-2.58 mm). There was no significant difference in the number of pull-out anchors, degree of pull-out difference by comparing BMD (A, BMD≤-2.5; B, BMD>-2.5), sex, or number of anchors used in each surgery (C, two anchors; D, three anchors) (p>0.05). Conclusions: Pull-out of screw in-type anchors was rarely observed and the mean pull-out length difference was negligibly small in our study. The screw in-type lateral anchor seems to be a decent option without concern of anchor pull-out even in elderly patients.

• Clinics in Shoulder and Elbow
• /
• v.18 no.2
• /
• pp.80-85
• /
• 2015

Background: This study measured the rate of adrenal insufficiency among rotator cuff tear patients, and determined the roles of steroid treatment and herbal medicine as specific risk factors of adrenal insufficiency. Methods: We prospectively evaluated the 53 patients who agreed to participate in the study and underwent arthroscopic rotator cuff repair due to a chronic full-thickness tear from March 2012 to September 2013. The diagnosis of adrenal insufficieny was made by rapid adrenocortical hormone test before the operation. We collected information regarding their history of steroid and herbal medicine treatment within the last 12 months. Results: The rate of adrenal insufficiency among the rotator cuff tear patients in our study was 18.9% (10 of 53 patients). Steroid treatment (p=0.034), frequency of local steroid injection (p=0.008), and herbal medicine treatment (p=0.02) showed significant association with the risk of adrenal insufficiency. Conclusions: In this study, careful taking of a patient's medical history, such as the use of steroids and herbal medicine, is important when investigating adrenal function before surgery.

• Clinics in Shoulder and Elbow
• /
• v.9 no.1
• /
• pp.111-118
• /
• 2006

Most pigmented villonodular synovitis (PVNS) is occurred in knee joint and finger of hand. PVNS is rarely occurred in shoulder joint. In English and French literatures, less than 30 cases were reported. We report 3 PVNS cases with rotator cuff tears, which was treated by arthroscoic extensive synovectomy, debridement and rotator cuff repair. The PVNS with rotator cuff tear in shoulder joint was rarely reported in the Korean literature.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.1 no.2
• /
• pp.78-85
• /
• 2008

Purpose: The findings of preoperative magnetic resonance imaging (MRI) and ultrasonography (US) examination in the diagnosis of rotator cuff tear were then compared with the findings of arthroscopic examination, and to evaluate the postoperative integrity of rotator cuff using serial US examination. Methods: Between February and May 2008, 29 patients with rotator cuff tear had undergone preoperative US and MRI examination and subsequent arthroscopic examination. And the results of MRI and US were compared with intra-operative results of the arthroscopic examination. We observed the postoperative integrity of rotator cuff using serial (postoperative 2 weeks, 6 weeks, 3 months) US examination. Results: The sensitivity of US and MRI for identifying rotator cuff tear were 100% and 100%. The sensitivity of US and MRI were 95% and 82% in full thickness tear, and 50%, 33% in partial thickness tear, respectively. Overall accuracy of US and MRI were 86%, 69%. Among 22 patients were operated for full thickness tear, intra-operative gap formation was identified in 11 patients (50%, small to medium 2 cases, large to massive 9 cases) which were identified at 2 weeks postoperative US. We could find 5 re-tears (23%, small to medium 1 case, large to massive 4 cases) on 6 weeks postoperative US after passive range of motion (ROM) exercise, and could also find 7 re-tears (32%, small to medium 2 cases, large to massive 5 cases)on 3 months postoperative US after active ROM exercise. Conclusion: Serial US after arthroscopic rotator cuff repair was useful to differentiate intra-operative gap formation from postoperative re-tear. We found 5 retears (23%) at 6 weeks and 7 retears (32%) at 3 months postoperative US, it was useful to make treatment plan during postoperative rehabilitation.