• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.167-174
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• 2010

Purpose: Anatomical repair of massive rotator cuff tear has been technically challenging because of medial retraction, muscle atrophy and fatty degeneration. Among several treatment options for massive rotator cuff tear, we reviewed rotator cuff repairs and investigated modalities for improvement of clinical outcomes, decreasing the re-tear rate, and increasing healing. Materials and Methods: Patient-related factors and rotator cuff-related factors were the two major groups of factors we considered when choosing a treatment plan. Results: Mobilization of a massive rotator cuff tear was increased by soft tissue release and by the interval slide technique. After meticulous soft tissue release, anatomical repair could be achieved. If the injury was not amenable to anatomical repair, alternative treatment options such as partial repair, the margin convergence technique and augmentation with a tenotomized biceps tendon were considered. Many reports of massive rotator cuff repair demonstrated satisfactory clinical outcomes, decreased pain, recovery of shoulder functions, and increases in muscle strength. However, the re-tear rate had been reported to be relatively high in long-term follow-up. Conclusion: Despite a high re-tear rate after massive rotator cuff repair, a better understanding of the pathogenesis, progression and clinical symptoms of massive rotator cuff tear and improved surgical materials and techniques will lead to satisfactory clinical outcomes.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.132-140
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• 2010

Purpose: Surgical treatment of massive rotator cuff tear is challenging and there are various surgical options. The purpose of this article is to describe arthroplasty for the treatment of massive rotator cuff tear. Materials and Methods: We reviewed all publications that focused on and/or mentioned arthroplasty as a treatment option for massive rotator cuff tear. Results: Arthroplasty can be used as primary treatment and represents a salvage option for irreparable rotator cuff tear. Hemi-arthroplasty can provide satisfactory results by Neer's limited goals criteria in patients with intact coracoacromial arch. In addition, reverse total shoulder arthroplasty can be a salvage option for pain relief and restoration of active flexion in elderly patients with pseudoparalysis. Conclusion: In patients with massive rotator cuff tear, proper selection of arthroplasty can provide pain relief and restoration of functional range of motion in shoulder joints.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.131-131
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• 2008

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2007.03a
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• pp.101-102
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• 2007

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.223-229
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• 2010

Purpose: The purpose of this study was to determine the correlation between the radiographic and clinical findings of massive rotator cuff tears. Materials and Methods: Forty-five diagnosed cases (35 patients) of massive rotator cuff tears were investigated in this study. Grade of arthritis in the massive rotator cuff tears was classified based on plain radiographs using the method of Hamada et al.. And we clinically evaluated cases using the UCLA scoring system. Results: No statistically significant correlation ($r_s$=0.220, p=0.151) was found between arthritis grades in massive rotator cuff tears and clinical features. Dominant arm involvement appeared to be related to a higher rate of surgical treatment and a lower UCLA score. Conclusion: In massive rotator cuff tear patients, radiographic findings of arthritis may not always correspond to clinical features relevant in daily life. Therefore, we suggest that treatment strategies should be carefully considered when considering treatment modalities.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.146-152
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• 2010

Purpose: The purpose of this article was to review the effectiveness of arthroscopic debridement and tuberoplasty, and to evaluate the clinical and radiologic results of our series for irreparable massive rotator cuff tears in the elderly. Materials and Methods: We reviewed articles that focused on the treatment options and decision making for irreparable massive rotator cuff tears. In particular, we summarized the reported results of arthroscopic debridement and tuberoplasty for irreparable massive rotator cuff tears in the elderly. Among consecutive patients who had arthroscopic tuberoplasty for irreparable massive rotator cuff tears in our series, thirty-two patients available for clinical and radiological evaluation at a mean follow-up of 29 months (range, 13-52 months) were enrolled and reviewed for the analysis. Results: At the last follow-up, the range of active forward flexion increased significantly with excellent pain relief and improvement in the ability to perform the activities of daily living. However, the group with less than 2 mm in preoperative acromiohumeral distance showed inferior postoperative results. Conclusion: Arthroscopic tuberoplasty may be an alternative option in irreparable massive rotator cuff tears for pain relief and improvement of range of motion. However, good results can not be expected if the acromiohumeral distance is less than 2 mm preoperatively and decreases postoperatively, or when the preoperative range of motion is less than $90^{\circ}$ on flexion and abduction.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.109-114
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• 2009

Purpose: This study evaluated the preoperative and postoperative radiologic findings of patients with complete repairs after massive rotator cuff tears along with the incidence of re-tear and the clinical outcomes. Materials and methods: This study evaluated 33 cases who had open complete repairs for massive rotator cuff tears and these patients were followed up for more than 24 months. The clinical evaluation was performed according to the shoulder joint function test of the American Shoulder and Elbow Surgeons (ASES), and the degree of arthritis related to the massive rotator cuff tears was evaluated using the Hamada classification. Results: The ASES scores improved from 37.6 preoperatively to 85.6 postoperatively. The mean preoperative acromio-humeral interval (AHI) score was 6.5 mm, which increased to 9.3 mm immediately after surgery, and there was a decreased to 6.5 mm noted at the last follow up. The lower radiology stages of arthritis according to the classification showed better preoperative and postoperative results. Conclusion: An open complete repair as the surgical treatment for a massive rotator cuff tear showed satisfactory results for pain relief and an improvement in the shoulder joint function though re-tear after surgery.

• 대한관절경학회:학술대회논문집
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• 2007.10a
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• pp.30-30
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• 2007

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

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.89-89
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• 2009