• Journal of the Korean Arthroscopy Society
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• v.14 no.3
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• pp.180-187
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• 2010

Purpose: Rotator cuff tears involving the subscapularis are less common than those involving the superior and posterior rotator cuff. The purpose of the present study was to report the clinical results of repair of isolated traumatic tears of the subscapularis tendon. Materials and Methods: Fifteen patients (13 males, 2 females; mean age 46.2 years; range 35 to 52) with unilateral ruptures of the subscapularis tendon after trauma who underwent arthroscopic repair between February 2003 and October 2008 were reviewed retrospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon and were followed for at least two years (mean 28 months). The entire subscapularis was involved in 9 cases and the tear was localized to the upper two thirds in 6 cases. The preoperative and postoperative status of patients with isolated subscapularis tears were analyzed using the Constant Score, American Shoulder and Elbow Society Index (ASES Index) and postoperative integrity was determined through magnetic resonance imaging. Results: The average clinical outcome scores and strength were all improved significantly at the time of the final follow-up. The constant shoulder score improved from 41.5 to 81.3 points (P<0.05) compared to before surgery and ASES index improved from 46.4 to 89.6 points (P<0.05) postoperatively. Thirteen patients (87%) were satisfied with the result of the treatment. The total tears were significantly more improved by surgery than the partial tears. In 12 of 15 patients (80%) were judged to reveal healed tendon on magnetic resonance imaging at a mean of 13 months postoperatively. The postoperative score was significantly lower for the patients with a failed repair than it was for those with an intact repair (P<0.05). Conclusion: Repair of traumatic isolated subscapularis tears through arthroscopic techniques effectively restores patient function with regard to pain, mobility, strength and postoperative tendon integrity. The postoperative integrity of the repair correlates with the functional results and the total tears were more improved by surgery than the partial tears, but future studies may be needed.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2006.03a
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• pp.62-62
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• 2006

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.1
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• pp.1-5
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• 2008

Purpose: We studied the diagnostic value of dynamic US in the extensor tendon dislocation at the metacarpophalangeal joint. Materials and Methods: From January 2007 to October, we studied 6 cases that had been diagnosed and followed over 5 months (2-10) in average. US examination using a 10-MHz linear transducer were performed in three cases. The causes of dislocations were traumatic in 5 cases and congenital in one case. Results: In only 3 cases which could not be diagnosed clinically, we performed US. In dynamic US, all three cases showed the extensor tendon dislocation evidently. Operative findings were sagittal band rupture in 4 cases, capsular loosening in one case and sagittal band thinning in one case. Sagittal band repair was performed in 4 cases and capsular augmentation in one case. In case of congenital dislocation showing 4 digital extensor tendon dislocations in right hand, we operated only the second extensor by sagittal band repair with augmentation by looping. At last follow-up, no case showed recurrence or limitation of motion. Conclusion: In case of extensor tendon dislocation without apparent clinical finding, US with dynamic study has so great value that it can detect the dislocation in real time, which is superior to MRI.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.79-85
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• 2010

Purpose: To evaluate the results from arthroscopic repair versus debridement for full-thickness tears of the upper subscapularis tendon. Materials and Methods: Ninety-nine patient outcomes were evaluated and compared prospectively. Sixty-nine patients with full-thickness tears of the upper subscapularis tendon underwent arthroscopic repair (group I) and thirty patients underwent simple debridement (group II) between May 2003 and October 2007. In all patients, the tear was localized to the superior one third of the upper subscapularis tendon. The results of the treatment were assessed by evaluating the UCLA, ASES, and VAS for pain and internal rotation strength scores before and after the operation. Results: In groups I and II, UCLA, ASES, VAS, and internal rotation muscle power (perfect score = 5) scores were improved after surgery. In comparing group I and group II, the UCLA and VAS scores were not significantly different (p>0.05), while the ASES and internal rotation strength scores were significantly different (p<0.05). Conclusion: The arthroscopic repair of full-thickness tears of the upper subscapularis tendon was a better surgical method than simple debridement.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.180-188
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• 2009

Purpose: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. Materials and Methods: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. Results: Postoperative UCLA scores improved from 16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. Conclusion: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.

• Journal of the Korean Arthroscopy Society
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• v.14 no.1
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• pp.49-52
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• 2010

Purpose: We introduce arthroscopically assisted mini-open rotator cuff repair using anterolateral approach. Operative Technique: Placing lateral decubitus position on general anesthesia, a standard arthroscopic glenohumeral examination is performed to evaluate lesions of shoulder joint through posterior and anterior portal. And then arthroscope is placed in the subacromial space and we evaluate the size of the torn tendon and perform arthroscopic acromioplasty through lateral portal. A 3 to 4 cm skin incision is performed from anterolateral edge of acromion to distal and dissected along to raphe between anterior and middle deltoid. A deltoid retractor is then placed, allowing direct visualization of the rotator cuff and humeral head. As torn tendon is tagged by traction suture, we try to anatomical reduction on the footprint and then perform single row or double row repair of the rotator cuff using suture anchors. To prevent avulsion of the deltoid from the acromion, additional sutures by bone tunnel with acromion and deltoid is performed. Conclusion: This technique is useful procedure to get direct approach to anterior portion of supraspinatus tendon and to need lesser deltoid retraction than portal extension approach due to dividing along to raphe between anterior and middle deltoid. Also it provide better visualization of the superior portion of subscapularis and infraspinatus.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.112-117
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• 2008

Purpose: This study prospectively evaluated the outcome of arthroscopic transtendinous repair as a treatment for partial articular side tears of the rotator cuff. Materials and Methods: Fifteen patients with symptomatic, partial articular side tears of the rotator cuff underwent modified transtendinous repair. The patient's mean age was 52.5 years and the mean duration of symptoms was 33.7 weeks. The visual analogue scale (VAS), the ASES score, the active ROM of the shoulder and the patient's satisfaction were evaluated both preoperatively and postoperatively. The clinical results were analyzed using the Wilcoxon's signed rank test. Results: The mean VAS was $6.6\pm1.1$ before treatment and $0.4\pm0.6$ at 6 month, and the ASES scores for all the patients were significantly better over the six-month period of follow-up (p<0.05). The mean active ROM in abduction was $94.3\pm22.3$ before treatment, $108.7\pm16.3$ at 1 month (p=0.0041) and $164.3\pm5.3$ at six months (p=0.0006). In flexion, it was $105.0\pm23.8$ before treatment, $119.0\pm17.4$ at 1 month(p=0.0075) and $174.3\pm5.3$ at six months (p=0.0006). At the final follow-up, 94% of patients were satisfied or very satisfied after operation. Conclusion: We experienced satisfactory clinical results after a short-term follow-up of arthroscopic transtendinous repair, and we believed this to be an effective procedure for patients with partial articular side tears of the rotator cuff.

• Journal of the Korean Orthopaedic Association
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• v.55 no.5
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• pp.436-443
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• 2020

The main treatment of infections following the repair of a ruptured Achilles tendon is debridement of the infected tissue and reconstruction of the Achilles tendon after controlling the infection. On the other hand, some studies recently reported excellent clinical results after the debridement of the infected Achilles tendon without a reconstruction of the tendon. This paper reports four cases of a competent result after the debridement of an infected Achilles tendon without reconstructing the tendon with a review of the relevant literature.

• Journal of Korean Orthopaedic Sports Medicine
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• v.6 no.2
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• pp.88-91
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• 2007

Persistent instability following an acute lateral ankle sprain eventually require ligamentous reconstruction in some cases. Over 50 surgical procedures have been described to reestablish lateral ankle stability varying from direct in situ repair of the anterior talofibular ligament and the calcaneofibular ligament to augmented reconstructions with either autograft or allograft tissue. The author describes the rationale and the technique of anatomic ankle ligament reconstruction with the 4th extensor digitorum longus tendon.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.130-134
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• 2013

A painful pseudoarthrosis will develop due to a delay in diagnosis and treatment, and surgical care is required. Treatment of pseudoarthrosis is really difficult because the acromion is a thin flat bone that is difficult to be fixed firmly. A 52-year-old woman with multiple trauma had an acromial fracture that was not detected until it had caused pain after ambulation. Open reduction and internal fixation with a variable angle locking compression plate for distal radius and autogenous iliac bone graft were performed. At nine months after the operation, there was partial tear in the supraspinatus tendon, and arthroscopic repair of the supraspinatus tendon was performed. At nine months after the operation, radiographs showed a complete union. At three months after tendon repair, the patient had excellent function of the shoulder. We have reported a case of a successful treatment of nonunion and pseudoarthrosis of acromial fracture that is difficult to be fixed.