• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.84-93
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• 2013

Purpose: The purpose of this study was to evaluate the repair integrity and clinical outcomes of delaminated tears following arthroscopic layered suture bridge rotator cuff repair in a prospective fashion. Materials and Methods: A consecutive series of 67 patients with delaminated rotator cuff tears who underwent surgery using the arthroscopic Layered Suture Bridge Technique were followed prospectively. Of 67 shoulders, 26 patients were male and 40 patients were female (one patient had bilateral tears); the mean age was 58.8(40~76) years. The clinical evaluation was performed according to ASES, UCLA, and KSS (Korea Shoulder Scoring System) scores with an average follow up period of 33 months. Repair integrity was estimated using MRI, which was performed six months postoperatively. Results: The average clinical outcome in ASES, UCLA, and KSS scores showed significant improvement at the time of the final follow-up compared to preoperatively, from 50.2 to 92.3, 15 to 31.3, and 54.4 to 90.7, respectively (p<0.001 for all scores). Follow up by MRI showed that 16 shoulders had a type-I; 14, a type-II; five, a type-III; two, a type-IV; one, a type-V re-tear. The overall rate of re-tear (types IV and V) was 7.9%. Conclusion: Use of the Arthroscopic Layered Suture Bridge Technique can result in improved functional and structural outcome in cases of delaminated rotator cuff tear.

• Journal of the Korean Arthroscopy Society
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• v.9 no.1
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• pp.34-39
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• 2005

Partial thickness rotator cuff tears (PTRCTs) are now a well-established clinical entity, yrt there is no consensus in regards to surgical management. Recommended treatment varies widely from simple debridement of the torn tendon to subacromial decompression to excision of the degenerative tendon and repair. Surgery may be performed using an open, arthroscopically assisted (miniopen), or entirely arthroscopic procedure. The advantages and disadvantages of open and arthroscopic procedures may lie in the balance between precision and morbidity. Visualization of both the articular and bursal surfaces is mandatory to determine the level of rotator cuff disease and formulate a treatment strategy. Because these tear often are secondary finding, recognition of the primary pathology is critical. Treatment of the primary problem usually remedies the partial tear. However, when there is significant PTRCT, an arthroscopic or open repair of the diseased tendon will give the most consistent results.

• Physical Therapy Korea
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• v.24 no.1
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• pp.19-29
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• 2017

Background: Patients after rotator cuff (RC) surgery experienced pain, weakness and limited of motion of the shoulder. Physical therapists have used heat therapy, electrotherapy, range of motion (ROM) exercise and other methods to treat patients after RC surgery. In addition, functional taping is also used to support joint movement and to increase shoulder joint stability. Objects: The purpose of this study was to determine the initial effects of functional taping using non-elastic tape on pain, strength and ROM of the shoulder following RC surgery. Methods: Forty-eight patients with who underwent RC surgery volunteered for this study. The subjects were randomly divided into an experimental group (EG, $n_1=25$) and a control group (CG, $n_2=23$). First, non-allergic tape was applied to the shoulder to prevent skin irritation. The EG applied functional taping using non-elastic tape and the CG applied sham taping using elastic tape. Assessment tools included the shoulder pain and disability index for functional activity score, visual analog scale for level of pain, shoulder muscle strength, hand grip strength and ROM testing. Results: Pain score in the both group significantly decreased (p<.05), and change in pain score of in the EG increased significantly than in the CG (p<.05). Shoulder strength and ROM in the both group significantly increased (p<.05). Especially external rotation and extension of the shoulder ROM in the EG increased significantly more than in the CG (p<.05), but the rate of change in the two groups showed no significant difference. Conclusion: These results suggest that functional taping using non-elastic tape was initially effective in decreasing pain score level in patients with RC surgery.

• Clinics in Shoulder and Elbow
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• v.21 no.1
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• pp.3-14
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• 2018

Background: Platelet-rich plasma (PRP) stimulates cell proliferation and enhances matrix gene expression and synthesis. However, there have been no comparative study of the PRP effect on the normal and degenerative tenocytes. The purpose of this study was to compare the effect of PRP on tenocytes from normal and degenerative tendon. Methods: Tendon tissues were obtained from patients undergoing arthroscopic repair (n=9) and from healthy donors (n=3). Tenocytes were cultured with 10% (vol/vol) platelet-poor plasma, PRP activated with calcium, and PRP activated with calcium and thrombin. The total cell number was assessed at days 7 and 14. The expressions of type I and III collagen, decorin, tenascin-C, and scleraxis were evaluated by quantitative real-time reverse transcriptase polymerase chain reaction. The total collagen and glycosaminoglycan (GAG) synthesis was evaluated at days 7 and 14. Results: No differences were observed between the groups at day 7, but cell proliferation was remarkably increased in tenocytes from the degenerative tendon at day 14. In both tenocyte groups, the gene expressions of type I and III collagen were up-regulated. GAG synthesis was greater in the normal tendon, whereas the expressions of decorin and tenascin-C were increased in tenocytes from the degenerative tendon. Tenocytes from the degenerative tendon had higher fold-change of GAG synthesis and a lower collagen III/I ratio than normal tenocytes. Conclusions: PRP promoted the cell proliferation and enhanced the synthesis of tendon matrix in both groups. PRP has a greater positive effect on cell proliferation, matrix gene expression and synthesis in tenocytes from degenerative tendon.

• Clinics in Shoulder and Elbow
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• v.25 no.2
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• pp.112-120
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• 2022

Background: The prognostic factors for patients with full-thickness rotator cuff tears (RCTs) include tear size, muscle atrophy and fatty infiltration. However, the influence of early coexisting degenerative changes on RCT outcomes is unappreciated. The purpose of this study was to calculate the impact that pre-existing partial glenohumeral cartilaginous changes have on patients undergoing arthroscopic RCT repair. Methods: A study of 54 patients undergoing arthroscopic RCT repair was undertaken. The presence of co-existing patches of glenohumeral degenerative cartilaginous changes and RCT size was recorded at surgery. Pre- and postoperative outcomes were assessed using traditional (Oxford Shoulder Score [OSS], 5-level EuroQol-5D [EQ-5D-5L] questionnaire and EuroQol visual analog scale [EQ-VAS]) and patient-centric re-formatted prisms. Outcomes were assessed as an entire dataset, and sub-group analysis was performed according to the grade of co-existing arthritis and tear size. Results: Significant improvements (p<0.05) in clinical outcomes were recognized when assessed using either the traditional or reformatted prisms (average % improvements in OSS, EQ-5D-5L and EQ-VAS were 47%, 33% and 43%, respectively; average improvements in pain, function, and psychological well-being were 48%, 33% and, 29%, respectively). Positive gain was noted in all sub-groups of arthritic grading and tear size. Conclusions: Good clinical outcomes can be achieved following RCT repair even in the presence of local partial degenerative cartilage changes and advancing tear size. These benefits are patient-centered but require RCT repairability.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.406-415
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• 2023

Background: Surgical management of a massive rotator cuff tear (RCT) is always challenging. This study describes the clinical and radiological outcomes of patients who underwent bridging grafts using a plantaris tendon for an irreparable RCT. Methods: Thirteen patients with a massive RCT were treated with arthroscopic interposition of a folded plantaris tendon autograft between June 2017 and January 2020. For clinical evaluation, a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score, and range of motion values were collected. For radiographic evaluation, standardized magnetic resonance imaging and ultrasonography were performed to check the integrity of the interposed tendon. Results: A statistically significant improvement at the final follow-up was evident in scores for the VAS (-3.0, P=0.003), ASES (24.9, P=0.002), D ASH (-20.6, P=0.001), and Constant-Murley values (14.2, P=0.010). In addition, significant improvement was shown in postoperative flexion (17.3°, P=0.026) and external rotation (27.7°, P<0.001). In postoperative radiologic evaluations, the interposed tendons were intact at the last examination in 12 of the 13 patients. No complications related to donor sites were reported. Conclusions: An arthroscopic bridging graft for irreparable RCTs using a modified Mason-Allen stitch and a plantaris autograft resulted in improved short-term radiological and clinical outcomes. Graft integrity was maintained for up to 2 years in most patients. Level of evidence: IV.

• Journal of the Korean Arthroscopy Society
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• v.11 no.1
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• pp.24-31
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• 2007

Purpose: To evaluate any combined rotator cuff pathologies in adhesive capsulitis patients with magnetic resonance arthrography (MRA) or ultrasonography (USG), and to see any differences in findings between MRA and USG. Materials and Methods: From June to December 2005, 80 consecutive patients with adhesive capsulitis were prospectively evaluated with either MRA or USG. Two groups were randomly assigned for examination. Evaluation were focused on any combined rotator cuff pathologies especially supraspinatus tendon. Results: Small (less than 1 cm) full-thickness SSP tendon tear were seen in 6 patients (MRA 4, USG 2, 8%) and partial-thickness SSP tendon tears in 21 (MRA 12, USG 9, 26%). In addition, supraspinatus tendinopathy were seen in 15 patients (MRA 7, USG 8, 19%). Overall, various SSP pathologies were reported in 42 patients (53%) of the study objects (MRA 23, 68% and USG 19, 41%). Subscapularis tendon partial tears were reported in 9 patients (MRA 6, USG 3, 11%). There were no statistical differences of the findings between MRA and USG in detecting rotator cuff pathologies (p>0.5). Conclusion: Nearly one half of the adhesive capsulitis patients showed various supraspinatus tendon pathology in MRA or USG. Although MRA group showed slight higher percentage of associated rotator cuff pathology than USG group (without statistical significance), this could be attributed to better resolution capacity of MRA than USG.

• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.302-305
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• 2023

The authors present a case of transient postoperative inferior subluxation of the shoulder after arthroscopic surgical stabilization for recurrent anterior dislocation. The patient was a 61-year-old woman with myasthenia gravis (MG). The first anterior shoulder dislocation occurred because of a fall to the ground. Despite a successful closed reduction, two more dislocations occurred in 3 weeks. Magnetic resonance imaging revealed an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion, an engaging Hill-Sachs lesion, and large tears of the supraspinatus and infraspinatus tendons. The patient underwent arthroscopic rotator cuff repair and ALPSA repair with a remplissage procedure. Intraoperatively, no tendency for instability was found; however, a widened glenohumeral joint space and inferior subluxation of the humeral head without functional compromise was observed on the day after surgery and disappeared spontaneously on radiographs 2 weeks later. To the authors' knowledge, this is the first report documenting the occurrence of transient postoperative inferior subluxation of the shoulder in a patient with MG.

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.68-72
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• 2006

Purpose: To demonstrate arthroscopically the presence of bilateral shoulder "mirror lesions" due to overhead work. Materials and Methods: A cross-sectional study was performed in a historical cohort of 10 male tire plant workers who underwent MRI studies of both shoulders. Bilateral intraarticular shoulder pathology was diagnosed by magnetic resonance imaging and confirmed by arthroscopy. "Mirror lesions" were defined as similar pathology between an individual patient's two shoulders. Results: We report on ten patients who had bilateral "mirror lesions." The most common mirror lesions were tears of the rotator cuff. Most patients (7 of 10) had more than one mirror lesion in their shoulders. There were two bilateral full thickness tears involving the supraspinatus and infraspinatus, four bilateral partial thickness supraspinatus tears, six bilateral partial or upper corner lesion complete subscapularis tears, and one bilateral complete supraspinatus tear. Conclusion: Occupational overhead work with simultaneous use of both arms is associated with bilateral shoulder lesions verified by arthroscopy. By demonstrating the work-related bilateral shoulder involvement, this study suggests an etiopathogenesis for these lesions and provides rational for developing worksite prevention strategies.

• Clinics in Shoulder and Elbow
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• v.21 no.4
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• pp.186-191
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• 2018

Background: To determine the normal range of humeral head positioning on magnetic resonance imaging (MRI). Methods: We selected normal subjects (64 patients; group A) to study the normal range of humeral head positioning on the glenoid by MRI measurements. To compare the MRI measurement method with the computed tomography (CT), we selected group B (70 patients) who underwent both MRI and CT. We measured the humeral-scapular alignment (HSA) and the humeral-glenoid alignment (HGA). Results: The HSA in the control group was $1.47{\pm}1.05mm$, and the HGA with and without reconstruction were $1.15{\pm}0.65mm$ and $1.03{\pm}0.59mm$, respectively, on MRI. In the test group, HSA was $2.67{\pm}1.47mm$ and HGA with and without reconstruction was $1.58{\pm}1.16mm$ and $1.49{\pm}1.08mm$, on MRI. On CT, the HSA was $1.72{\pm}1.01mm$, and HGA with and without reconstruction were $1.54{\pm}0.96mm$ and $1.59{\pm}0.93mm$, respectively. HSA was significantly different according to image modality (p=0.0006), but HGA was not significantly different regardless of reconstruction (p=0.8836 and 0.9234). Conclusions: Although additional CT scans can be taken to measure decentering in patients with rotator cuff tears, reliable measurements can be obtained with MRI alone. When using MRI, it is better to use HGA, which is a more reliable measurement value based on the comparison with CT measurement (study design: Study of Diagnostic Test; Level of evidence II).