• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.38-43
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• 2009

Purpose: The purpose of this study was to assess the efficacy of MR arthrography to detect partial thickness rotator cuff tears. Materials and Methods: One hundred and seventy seven patients with a high suspicion for rotator cuff disease were studied by performing MR-arthrography and subsequent arthroscopy. The ability of MR-arthrography to detect partial thickness tears was evaluated according to the location of the tears. We determined the correspondence between the measurements of the articular side partial tears on MR arthrography and those on the arthroscopic findings. Results: The arthroscopic diagnosis of partial thickness rotator cuff tears was divided into 3 groups according to their location. There were 63 cases on the articular side, 41 cases on the bursal side and 20 cases on both sides. The sensitivity of MR-arthrography was 82% for the articular side tears and 11% for the bursal tears. The specificity was 88% for the articular side tears and 100% for the bursal tears. MR-arthrographic measurement correctly predicted 72% in 28 repaired cases of 56 articular side partial thickness tears. Conclusions: MR-arthrography may be a reliable tool for diagnosing articular side partial thickness rotator cuff tears, but it has limitations for bursal side tears.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.141-146
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• 2008

퇴행성 변화에 의한 회전근 개 파열은 보통 관절면측에서 파열이 먼저 시작되어 전층 파열로 진행되는 것이 보편적인 반면 점액낭면 파열은 견봉하 충돌 증후군에 의해 주로 발생하지만 충돌 증후군에 의해 관절면 또는 건내 파열도 발생할 수 있다. 따라서 연령에 따른 퇴행성 변화와 더불어 생역학적 기전 등의 내적 요인과 충돌 증후군 또는 외상 등의 외적인 요인이 복합적으로 작용하는 회전근 개 파열은 관절면과 점액낭면에 파열이 공존할 수 있다. 결론적으로 회전근 개 파열은 보통 퇴행성 변화가 가장 기본적인 원인으로 생각되나 하나의 원인을 독립적으로 생각하기 보다는 다양한 원인이 동시에 혹은 단계적으로 작용하여 임상적으로 의미있는 병적인 상태로 진행한다고 보는 것이 타당하리라 생각된다.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.90-90
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• 2009

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.2
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• pp.78-85
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• 2008

Purpose: The findings of preoperative magnetic resonance imaging (MRI) and ultrasonography (US) examination in the diagnosis of rotator cuff tear were then compared with the findings of arthroscopic examination, and to evaluate the postoperative integrity of rotator cuff using serial US examination. Methods: Between February and May 2008, 29 patients with rotator cuff tear had undergone preoperative US and MRI examination and subsequent arthroscopic examination. And the results of MRI and US were compared with intra-operative results of the arthroscopic examination. We observed the postoperative integrity of rotator cuff using serial (postoperative 2 weeks, 6 weeks, 3 months) US examination. Results: The sensitivity of US and MRI for identifying rotator cuff tear were 100% and 100%. The sensitivity of US and MRI were 95% and 82% in full thickness tear, and 50%, 33% in partial thickness tear, respectively. Overall accuracy of US and MRI were 86%, 69%. Among 22 patients were operated for full thickness tear, intra-operative gap formation was identified in 11 patients (50%, small to medium 2 cases, large to massive 9 cases) which were identified at 2 weeks postoperative US. We could find 5 re-tears (23%, small to medium 1 case, large to massive 4 cases) on 6 weeks postoperative US after passive range of motion (ROM) exercise, and could also find 7 re-tears (32%, small to medium 2 cases, large to massive 5 cases)on 3 months postoperative US after active ROM exercise. Conclusion: Serial US after arthroscopic rotator cuff repair was useful to differentiate intra-operative gap formation from postoperative re-tear. We found 5 retears (23%) at 6 weeks and 7 retears (32%) at 3 months postoperative US, it was useful to make treatment plan during postoperative rehabilitation.

• Journal of the Korean Arthroscopy Society
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• v.16 no.1
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• pp.92-97
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• 2012

Purpose: The reparability of rotator cuff tears is very important to establish the indication of the surgical treatment of rotator cuff tears. We reviewed the factors that effect to reparability of rotator cuff tears, and considered about the surgical indication of rotator cuff tears. Materials and Methods: The reparability was considered by the surgical reparability and the postoperative healing potentials of rotator cuff. The natural history of rotator cuff tear gives us the information to make decision about the surgical treatment or the conservative treatment. Results: There are 3 general categories of factors that help predict the healing potential of a rotator cuff tear. These include surgical technique, biology, and environmental issues. Surgeon can control the surgical technique by himself. The control of biology comes from careful operative indications by age, acute trauma history, chronicity, and tear size. And the control of environmental factor can give better outcomes by cessation of smoking and nonsteroidal anti-inflammatory drug (NSAID). Conclusion: A better understanding of the natural history and the reparability of rotator cuff tear will help us to estabilish the indication of surgical treatement of rotoator cuff tears, and lead to satisfactory clinical outcomes.

• 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.

• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.77-81
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• 2009

In patients with full-thickness tears of the rotator cuff, the tendon is usually detached from its bony insertion in the greater or lesser tuberosity. We experienced an unusual pattern of rotator cuff tear in two cases, in which complete rotator cuff tears occurred at the tendinous portion (i.e., intrasubstance tears) with more than a 1cm remnant attached to the greater tuberosity. Arthroscopic tendon-totendon repair was performed without remnant removal in both cases. Follow-up MRI at 6 months showed re-tear of the rotator cuff at the previous tear site in both of our patients. To prove the availability of arthroscopic tendon-to-tendon repair in such cases, a larger case follw-up and biomechanical studies are required.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.131-135
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• 2002

Object : To evaluate the prognostic factors of the rotator cuff tear after anterior dislocation of the shoulder over the 5th decades of age. Methods : We evaluated twelve patients who had rotator cuff tears combined with primary anterior dislocation of the glenohumeral joint between May 1995 and October 1998. Their age were ranged from 42 to 67-years-old. Two of them were initially presumed to have an injury of the axillary nerve and associated with avulsion fracture of the greater tuberosity. Among twelve patients who had rotator cuff tears, 8 cases had massive, 3 cases had medium and one case had a small sized tear. Results : All the tears of the rotator cuff were repaired and the results were obtained by UCLA shoulder rating scale. Ten cases of them revealed more than good results except for 2 cases who had been unhappy triad of the shoulder injury. Conclusions : In the case of anterior dislocation of shoulder, it is necessary to check the injury of rotator cuff and axillary nerve in the middle age group. If these injuries are combined, proper rotator cuff repair and axillary nerve rehabilitation program would be asked for better results.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.119-125
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• 2009

The primary purposes of revision repair for a failed rotator cuff repair are a relief of pain and functional improvement. Therefore, revision repair is most proper in patients with the functional deficit accompanied with the shoulder weakness as well as the persistent pain. The important factor that is considered in revision repair is a quality of torn cuff. Especially, Care must be taken to ensure that the revision repair is possible, considering the size of tendon defect, atrophy of the muscle, fatty infiltration and extent of the retraction of tendon. Revision repair of a failed rotator cuff repair is more difficult, and the functional results are less satisfactory than those of primary repair, because excessive bursal scarring and tendon retraction may be exhibited, a large or massive tear is often detected, tear has usually been present for a long time, and a quality of muscle-tendon may be poor. So, we discuss our experiences related to revision repair after a failed cuff repair that has been recently introduced through the articles.

• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.212-219
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• 2009

Medially retracted large-sized rotator cuff tears includes large-sized tears, massive tears and irreparable tears. Generally arthroscopic repair or open repair of rotator cuff tears is used in reparable tears. However, arthroscopic repair requires long period practice and endurance. In irreparable tears, arthroscopic debridement, partial repair, latissimus dorsi transfer and retrograde arthroplasty can be the option. Arthoscopic debridement gives temporal relief who experienced improvement in pain and increase in range of motion after subacromial local anesthetic injection. Also arthroscopic partial repair gives good results in irreparable cases, especially in suprascapular nerve traction neurapraxia. Tendon transfer can be used in mild to moderate muscle weakness in shoulder abduction for long term treatment. Pectoralis major transfer can be used in anterosupeior tears and latissimus dorsi transfer can be used in posterosuperior tears. Reverse shoulder prosthesis is used in extreamly weakened shoulder pseudoparalysis. The authors discussed the method of arthroscopic repair in irreparable tears. The debridement, partial repair, and tendon transfer could be used in medially retracted large-sized rotator cuff tears.