• 대한정형외과학회지
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• 제56권6호
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• pp.472-483
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• 2021

광범위 회전근개 파열의 치료는 일반적인 회전근개 파열에서와 같이 단순 봉합술을 시행하는 경우도 있으나 최근 패치의 개발이 활발해지면서 이를 이용한 봉합술 또한 시행되고 있다. 여러 종류의 패치의 성분에 대하여 이해하는 것은 패치를 이용한 봉합술 시행 시 종류의 선택에 도움을 줄 수 있으며, 광범위 회전근개 파열에 대한 보다 나은 치료를 위하여 단순 봉합술과 패치를 이용한 봉합술 사이의 임상 결과 비교, 그리고 패치의 종류에 따른 수술 후 결과 비교에 대한 최근까지의 연구결과 동향을 파악할 필요가 있다. 따라서 여기서는 광범위 회전근개 파열 환자에서 패치의 종류에 따른 치료 결과에 대한 다양한 연구들의 결과를 비교하여 보고자 한다.

• Clinics in Shoulder and Elbow
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• 제22권4호
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• pp.203-209
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• 2019

Background: Clinical outcomes and prognosis of large and massive rotator cuff tears are known to be unpredictable not only in degeneration of the rotator cuff, but also due to a high rate of retear. Methods: Totally, 81 patients who had undergone arthroscopic rotator cuff repair from May 2008 to February 2016 were evaluated in our study. Clinical and functional evaluations were performed with the Constant score and the University of California, Los Angeles (UCLA) score, as well as full physical examination of the shoulder. All patients were confirmed to have magnetic resonance imaging (MRI) of tendon healing at least 1 year postoperatively. Results: The average age at the time of surgery was 65 years (range, 47-78 years). The average duration of postoperative time in which a follow-up MRI was performed was 36.1 months (range, 12-110 months). Large tears were present in 48 cases (59.3%) and massive tears in 33 cases (40.7%). Overall, there were 33 retear cases (40.7%). All the average clinical outcome scores were significantly improved at the last follow-up (p<0.001), although repair integrity was not maintained. Compared to type A, types C, and D of the Collin's classification showed significantly higher retear rates (p=0.036). Conclusions: Arthroscopic rotator cuff repair yields improved clinical outcomes and a relatively high degree of patient satisfaction, despite the repair integrity not being maintained. Involvement of the subscapularis muscle or infraspinatus muscle had no effect on the retear rate.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.26-31
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• 2024

Background: The coracoacromial ligament (CAL) is frequently observed to be damaged during arthroscopy and it is unclear how demographic, anatomic, and radiographic factors are related to CAL degeneration in full-thickness rotator cuff tears. Methods: A prospective study was conducted of patients at a single institution undergoing shoulder arthroscopy for first-time, full-thickness rotator cuff tears. We evaluated preoperative anteroposterior radiographs to obtain critical shoulder angle, glenoid inclination, acromial index, acromiohumeral distance, lateral acromial angle, and acromial morphology. We documented CAL quality, rotator cuff tear size and pattern during arthroscopy. Multiple logistic regression was used to identify predictive factors for encountering severe CAL fraying during arthroscopy. Results: Shoulders had mild CAL degeneration in 58.1% of cases, whereas severe CAL degeneration was present in 41.9% of shoulders. Patients with severe CAL attrition were significantly older (62.0 years vs. 58.0 years, P=0.042). Shoulders with severe CAL attrition had large rotator cuff tears in 54.1% of cases (P<0.001), and tears involving the infraspinatus (63.2% vs. 29.6%, P=0.003). The severe degeneration group was more likely to have a larger critical shoulder angle measurement on preoperative radiographs than those in the mild attrition group (36.1°±3.6° [range, 30°-45°] vs. 34.1°±3.8° [range, 26°-45°], P=0.037). Conclusions: While the clinical impact of CAL degeneration remains uncertain, increased severity of CAL degeneration is associated with older age, larger rotator cuff tear size, presence of infraspinatus tearing, and increased preoperative critical shoulder angle. Level of evidence: III.

• 대한영상의학회지
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• 제82권6호
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• pp.1366-1387
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• 2021

회전근개 부분 파열의 자기공명영상 해석은 종종 애매한 경우가 있다. 이 종설에서는 회전근개 중 극상건과 극하건에 초점을 맞춰, 회전근개 부분 파열의 진단을 위한 해부학적 고려 사항을 설명하고, 회전근개 부분 파열의 분류를 요약하며, 박리(delamination)가 포함된 회전근개 부분 파열의 최신 개념을 개략적으로 설명하였다.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.126-130
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• 2024

Anterior glenohumeral instability with an irreparable subscapularis tear is a challenging problem for the orthopedic shoulder surgeon. Current techniques, including tendon transfers, yield inconsistent results with high rates of recurrent instability. Acellular dermal allografting has been used in young patients with massive superior rotator cuff tears with early success, but acellular dermal allografting is comparatively unstudied in anterior deficiency. We present two cases of anterior capsular reconstruction with an acellular dermal allograft in patients ages 66 and 58 years with irreparable subscapularis tendon tears. Follow-up for both patients exceeded 4 years, with forward flexion >140°, external rotation exceeding 60°, a Single Assessment Numeric Evaluation score >90 points, a visual analog scale score of 0 points, and an American Shoulder and Elbow Score of 98 points. In conclusion, acellular dermal allografting can be used to reconstruct the anterior capsule in patients with massive irreparable subscapularis tears, similar to its use in superior capsular reconstruction in patients with massive posterosuperior rotator cuff tears.

• Clinics in Shoulder and Elbow
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• 제22권1호
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• pp.9-15
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• 2019

Background: Latissimus dorsi (LD) tendon transfer is used as a treatment option for massive irreparable posterosuperior rotator cuff tears, and recently, an arthroscopic-assisted technique was introduced. This study was undertaken to evaluate the clinical and radiological outcomes of arthroscopic-assisted LD tendon transfer for the management of irreparable rotator cuff tears in active middle-aged patients. Methods: The records of five patients (two males) with irreparable tears involving the supraspinatus and infraspinatus tendons managed by arthroscopic-assisted LD tendon transfer were retrospectively reviewed. Clinical outcomes were assessed using the visual analogue scale (VAS) pain scale, American Shoulder and Elbow Surgeon's (ASES) scores, the University of California Los Angeles (UCLA) scale, and ranges of motion. Postoperative integrities of transferred tendon were evaluated by magnetic resonance imaging in 4 patients and by ultrasound in one. Results: Mean patient age was 55 years (range, 48-61 years), and mean follow-up period was 20 months (range, 12.0-27.2 months). Mean VAS score significantly improved from $6.6{\pm}2.6$ preoperatively to $1.8{\pm}2.5$ postoperatively (p=0.009), mean ASES score increased from $67.6{\pm}9.2$ to $84.6{\pm}15.1$, and mean UCLA score from $18.0{\pm}1.4$ to $28.8{\pm}8.5$ (all p<0.001). Postoperative imaging of the transferred LD tendon showed intact repair in 4 patients. The remaining patient experienced LD transfer rupture and a poor outcome. Conclusions: Arthroscopic-assisted LD tendon transfer improved shoulder pain and function in patients with massive, irreparable rotator cuff tears, and may be an option for this condition, especially in physically active patients.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.120-125
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• 1999

Objectives : To evaluate the effects of arthroscopic acromioplasty and debridement for partial thickness articular side rotator cuff tears, Method: We divided 97 patients into 2 groups according to treatment protocol, with both groups having confirmed intra-articular partial tears of the rotator cuff. In group Ⅰ, we debrided the frayed and fibrotic cuff margin while in group II, we performed subacromial decompression in addition to debridement. After the surgery we checked all the patients with the modified UCLA shoulder rating scale. Results: The follow-up observation 12 months after surgery revealed that 44 patients in group I were rated as excellent in 32 cases, good in 10 cases, fair in 1 case, and poor in one case, while 53 patients in group II, were rated as excellent in 38 cases, good in 17 cases, and fair in 2 cases. Twenty-four month after surgery we observed that patients in group I were rated as excellent in 23 cases, good in 16 cases, fair in 4 cases, and poor in 1 case, while patients in group II were rated as excellent in 34 cases, good in 17 cases, and fair in 6 cases. Conclusion: The use of acromioplasty on partial thickness tears of rotator cuff, even in the cases of intra-articular nature, is preferable to the procedure performed without it.

• 대한관절경학회지
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• 제13권3호
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• pp.212-219
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• 2009

내측으로 퇴축된 대범위 이상의 회전근 개 파열은 대범위 파열과 광범위 파열, 봉합이 불가능한 파열을 포함한다. 봉합 이 가능한 경우 일반적으로 사용되는 관절경 하 봉합술이나 개방적 봉합술을 시행할 수 있다. 그러나 관절경 감시하의 봉 합법은 무척 인내를 요하며 장기간의 긴 학습곡선을 필요로 한다. 봉합이 불가능할 경우에는 관절경 하에서 변연절제술(debridement)이나 부분 봉합술(partial repair)을 시행할 수 있고, 때로 광배근 이전술이나 역형 인공관절술을 시행할 수 도 있다. 관절경 하에서 변연절제술(debridement)은 국소 마취제의 견봉하 주사후에 통증의 완화와 운동범위의 향상을 경험한 환자들에게 일시적인 호전을 얻을 수 있다. 역시 봉합이 불가능 할 경우에 관절경하에서의 부분 봉합술(partial repair)을 시행하여 좋은 결과를 얻을 수 있다. 상견갑 신경의 신연에 의한 생리적 신경차단(suprascapular nerve traction neurapraxia)이 있는 경우에 특히 좋은 결과를 얻을 수 있다. 건 이식은 수평까지 어깨를 들어 올릴 수 있을 정도의 경도에 서 중등도 근력 약화의 경우에 장기적인 치료로 사용될 수 있다. 전상방 회전근 개 파열에 대하여 대흉근(Pectoralis major sternal head)의 근 이전술이 사용될 수 있으며, 후상방 회전근 개 파열의 경우에는 광배근(Latissimus dorsi) 근 이전술이 사용되고 있다. 역 견관절 치환술(Reverse Shoulder Prosthesis)은 어깨 관절의 근력이 극도로 약화된 가성 마비 (pseudoparalysis)에서 유용한 치료로 사용될 수 있다. 저자들은 내측으로 퇴축된 대범위 이상의 회전근 개 파열에서 관절경하 봉합법의 시행에 대하여 고찰하고자 하였으며, 봉합이 불가능한 파열의 경우에 변연절제술, 부분 봉합 및 건 이전술과 역 견관절 치환술의 이용에 대하여 고찰하고자 하였다.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2009년도 제17차 학술대회
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• pp.157-158
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• 2009

• 대한정형외과스포츠의학회지
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• 제6권2호
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• pp.119-121
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• 2007

골퍼들의 만성적 견관절 손상은 보고 되고 있지만, 특히, 우성 상지의 급성 손상은 비교적 드문 것으로 알려져 있다. 본 증례는 중년기 여성에서 겨울철 잘못된 스윙 동작으로 발생한 우성 상지의 급성 회전근 개 파열을 보여 주었다. 따라서 겨울철에 골프를 시행하는 것은 근골격계 손상에 주의를 요하며 적절한 준비 운동과 스윙 동작의 개선으로 급성 회전근 개 파열을 예방할 수 있을 것이다.