• Clinics in Shoulder and Elbow
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• 제9권2호
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• pp.176-180
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• 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.

• Investigative Magnetic Resonance Imaging
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• 제22권4호
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• pp.229-239
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• 2018

Purpose: To assess the diagnostic performance in detecting rotator cuff tears at 3T of non-arthrographic shoulder magnetic resonance imaging (MRI) using 3D isotropic turbo spin-echo (TSE-SPACE) sequence as compared with 2D sequences. Materials and Methods: Seventy-four patients who were arthroscopically confirmed to have underwent non-arthrographic shoulder MRI with 2D sequences and TSE-SPACE were included. Three independent readers retrospectively scored supraspinatus and infraspinatus tendon (SST-IST) and subscapularis tendon (SCT) tears on 2D sequences and TSE-SPACE. Results: The mean sensitivity, specificity, and accuracy of the three readers were 95%, 100%, and 95% on TSE-SPACE and 99%, 93%, and 98% on 2D sequences for detecting SST-IST tears, respectively, whereas those were 87%, 49%, and 68% on TSESPACE and 88%, 66%, and 77% on 2D sequences for detecting SCT tears, respectively. There was no statistical difference between the two sequences, except for in the specificity of one reader for detecting SCT tears. The mean AUCs of the three readers on TSE-SPACE and 2D sequences were 0.96 and 0.98 for detecting SST-IST tears, respectively, which were not significantly different, while those were 0.71 and 0.82 for detecting SCT tears, respectively, which were significantly different (P < 0.05). Conclusion: TSE-SPACE may have accuracy and reliability comparable to conventional 2D sequences for SST-IST tears at non-arthrographic 3T shoulder MRI, whereas TSE-SPACE was less reliable than conventional 2D sequences for detecting SCT tears.

• Clinics in Shoulder and Elbow
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• 제25권4호
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• pp.296-303
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• 2022

Background: A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. Methods: Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, Western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. Results: Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05). Conclusions: We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.

• Clinics in Shoulder and Elbow
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• 제13권2호
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• pp.223-229
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• 2010

목적: 본 연구의 목적은 광범위 회전근 개 파열에서 방사선학적 소견과 임상 소견 간의 관계를 알아보고자 하였다. 대상 및 방법: 광범위 회전근 개 파열로 진단된 45예 (35명)를 대상으로 하였다. Hamada의 분류법을 사용하여 광범위 회전근 개 파열 환자의 방사선학적 소견을 분석하고, 임상적 평가는 UCLA 점수를 이용하였으며, 서로 간의 결과를 비교하였다. 결과: 광범위 회전근 개 파열에서 관절염 등급과 임상 소견 사이에 유의한 연관성은 확인되지 않았다($r_s$=0.220, p=0.151). 우세수 측 침범이 더 높은 수술적 치료의 비율과 더 낮은 UCLA 점수와 관련이 있었다. 결론: 광범위 회전근 개 파열 환자에서 관절염의 방사선학적 소견이 일상 생활에 영향을 미치는 임상적 소견과 항상 관련이 있는 것은 아닌 것으로 사료된다. 따라서, 광범위 회전근 개 파열 환자의 치료 방법의 결정에 있어서는 신중한 고려가 필요할 것으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제18권1호
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• pp.47-51
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• 2015

Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.

• Clinics in Shoulder and Elbow
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• 제19권1호
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• pp.51-58
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• 2016

The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.

• Clinics in Shoulder and Elbow
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• 제23권2호
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• pp.86-93
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• 2020

Background: Several systematic reviews have reported on the conservative treatment of full-thickness rotator cuff tears; however, clinical results of this treatment still remain determined. Methods: PubMed, Cochrane Library, PEDro, and CINAHL databases were systematically searched for randomized clinical trials and observational studies. Two independent researchers reviewed a total of 2,981 articles, 28 of which met the criteria for inclusion in the study. Clinical outcome measures included Constant score, visual analog scale score for pain, range of motion, and short-form 36 questionnaires. The meta-analysis used a linear mixed model weighted with the variance of the estimate. Results: The meta-analysis showed a significant improvement after surgery. Pain score is 26.2 mm (1 month) to 26.4 mm (3 months), and 24.8 mm (12 months) (P<0.05); active abduction: 153.2° (2 months), 159.0° (6 months), 168.1° (12 months) (P<0.05); Constant score: 67.8 points (2 months) to 77.2 points (12 months) (P<0.05); short-form 36 questionnaires "vitality" section: 57.0 points (6 months) to 70.0 points (12 months) (P<0.05). Conclusions: Our data confirmed the effectiveness of conservative treatment in patients with full-thickness rotator cuff tears 12 months post-intervention. The results suggest that conservative treatment for patients with full-thickness rotator cuff tears should be the first line of treatment before considering surgery.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2008년도 제16차 학술대회
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• pp.122-122
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• 2008

• Clinics in Shoulder and Elbow
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• 제9권1호
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• pp.73-82
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• 2006

Purpose: The purpose of the present study was to evaluate the diagnostic efficacy of CT arthrography (CTA) in the assessment of various shoulder pathologies, compared with MR arthrography (MRA) and MRI with arthroscopic correlation. Materials and Methods: CTA in 84 patients, MRA in 70 patients, and MRI in 27 patients were obtained. A radiologist interpreted each image for 5 pathologies: Bankart, SLAP, Hill-Sachs lesion, full-thickness, and partial-thickness rotator cuff tear. Detailed arthroscopic reports were compared with CTA, MRA, and MRI. The sensitivity, specificity, predictive values, and accuracy were calculated. The agreement between each diagnostic modality and arthroscopy was calculated. Diagnostic efficacy was assessed by the areas under the receiver operating characteristic (ROC) curves. Results: The diagnostic values of all three imaging groups were comparable to each other for Bankart, SLAP, Hills-Sachs, and full-thickness cuff tear lesions, but those of CTA were lower than MRI and MRA for partial-thickness cuff tears. The areas under the ROC curves for CTA, MRA, and MRI were not significantly different for all pathologies, except for partial-thickness cuff tears. Conclusion: CTA was equally competent to MRA or MRI in demonstrating Bankart, Hill-Sachs lesions, SLAP, and full thickness rotator cuff tears but not as efficient in diagnosing partial thickness rotator cuff tears.

• Clinics in Shoulder and Elbow
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• 제11권2호
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• pp.96-103
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• 2008

목적: 다발성 건을 침범한 관절경적 회전근 개 복원 술 후 재 파열의 발생률 및 관련된 요인을 알아 보고자 하였다. 대상 및 방법: 극상건과 극하건을 포함한 회전근 개 파열을 보인 22예의 관절경적 복원 술 후(평균 파열크기 3.2 cm, 평균 연령: 58세) 평균 10개월 후 자기공명영상으로 조사 하였다. 복원된 건의 상태 평가는 Sugaya의 분류를 이용하였으며 근육의 상태 변화는 Goutallier의 등급을 이용하였다. 결과: 총 22예 중 7예(32%)에서 재파열을 보였다(Sugaya 분류 IV, V형). 3 cm이상의 파열에서 높은 재파열률 을 보였으며(67%) 반면 3 cm 이하에서는 8%의 재파열률 을 보였다. 재파열을 보인 경우 수술 후 Goutallier II등급 이상의 근육의 변성을 보였다. 반면 재파열이 발생하지 않은 군에서도 근 위축이 호전된 경우는 볼 수 없었다. 결론: 다발성 건을 침범한 회전근 개 파열에서 관절경 적 복원 술 후 32%의 재파열을 보였다. 파열의 크기가 재파열의 중대한 요소이며 파열의 크기가 3 cm 이상인 경우 재파열이 더 자주 발생하였다. 재파열을 보인 경우 근 위축은 진행 하였으며 복원상태가 유지 되어도 근 위축이 호전된 경우는 볼 수 없었다.