• The Journal of the Korean bone and joint tumor society
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• v.18 no.2
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• pp.72-77
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• 2012

Purpose: Unplanned excision of a soft tissue sarcoma is defined as the operation performed for gross removal of a soft tissue sarcoma without regard for preoperative imaging or the necessity to removal a margin of normal tissue covering the cancer. We report our experience of treating primary soft tissue sarcoma after an unplanned excision. Materials and Methods: We retrospectively reviewed 31 patients referred to our hospital after unplanned excision at other hospitals for treatment of a STS. The clinical information was reviewed with a focus on the patient's age, gender, tumor location, tumor size, tumor depth, presumptive diagnoses at the previous surgery, refer hospital, definitive diagnosis, interval between the initial and additional surgery and local recurrence. Results: There were 19 males and 12 females with a median age of 48 years (range, 17-75 years) at the time of referral. Seventeen patients (54.8%) had tumors in their lower limb, 6 (19.4%) had tumors in their upper limb, and 8 (25.8%) had tumors in their trunk. Tumor depth could be determined for 8 patients (25.8%), with superficial and 22 deep tumors (71%). The medial interval between unplanned excision to re-excision ranged from 2 weeks to 1 year (median, 5 weeks). Local recurrence was detected in 2 patients. All patients were alive without metastasis at last follow up. Conclusion: Even in upper class general hospital, many unplanned excision had been performed, which is considered to be avoided. When the relatively huge mass located in deeper layer it requires enough preoperative imaging studies and biopsy.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.2
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• pp.200-205
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• 2003

Purpose: To report our experiences of clinical features, treatment method and results of giant cell tumor of 5 patients in proximal fibula. Materials and Methods: Five patients managed with an en bloc resection preserving common peroneal nerve and lateral collateral ligament reconstruction with biceps femoris tendon followed up between January 1997 and July 2001. Preoperative plain radiograph and MRI and bone scan were checked. The recurrence of the tumor was judged by plain radiograph and clinical signs. Lateral instability of knee joint was checked during the outpatient follow-up. Results: The mean age of the patients at the time of operation was twenty- three (21-29). There were one male and four female patients. Dull pain was main symptom and palpable mass was seen in two patients. Peroneal nerve palsy and local recurrence were not observed except one case of temporary peroneal nerve palsy. During the outpatient follow up, one among 5 patients showed slight lateral instability and the other 4 patients showed no instabililty. Conclusion: Giant cell tumor in proximal fibula managed with an en bloc resection preserving common peroneal nerve and lateral collateral ligament reconstruction with biceps femoris tendon showed favorable results.

• The Journal of the Korean bone and joint tumor society
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• v.19 no.1
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• pp.20-27
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• 2013

Purpose: The purpose of this study was to evaluate the oncologic outcomes of parosteal osteosarcoma (POS) and to ascertain the fates of patients after local recurrence (LR). Materials and Methods: The authors retrospectively reviewed 22 POS patients with an average follow-up of 114 months (range: 36-235 months). Seven of the 22 patients were referred after LR. There were 17 Stage IB and 5 Stage IIB (G2, 2; dedifferentiation, 3). Tumors were located in the femur (11) and in other locations (11). Initial surgical margins were wide in 10, marginal in 5, and intralesional in 7. Correlations between clinico-pathologic variables and LR and clinical courses after LR were evaluated. Results: The 10-year overall survival rate was 85.7%. Three (14%) patients developed distant metastasis and all of them succumbed to the disease. Nine (41%) patients developed LR. Tumor location, resection type, and surgical margin were found to be correlated with LR. At final follow-up, 7 of the 9 patients that experienced local failure achieved no evidence of disease. Conclusion: A substantial risk of misdiagnosis exists, especially for POS in other than a femoral location. Recurrent tumor re-excision is possible in most cases; however, patients with an aggressive recurrence pattern deserve special attention.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.150-158
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• 2009

Purpose: With the better understanding of cuff function, partial repair or "force couple repair" for treating massive irreparable rotator cuff tear has gained some popularity. However, there were few reports on the results of partial repair. The purpose of this study was to report the clinical outcome of massive irreparable rotator cuff tears who received arthroscopic force-couple repair or partial repair. Materials and Methods: From June 2005 to Feb 2008, arthroscopic partial repairs were performed for 16 irreparable rotator cuff tears among the 101 large to massive rotator cuff tears that were operated on. Clinical and radiographic evaluation were done at the final follow-up. Results: There were 7 men and 9 women with a mean age of 66.6 years. The mean follow-up period was 27.3 month (range: 15-46). The pain VAS improved from 4.4 ($\pm2.50$) to 2.1 ($\pm2.26$) and the functional VAS improved from 46.9 ($\pm16.64$) to 70.0 ($\pm22.80$). The ASES score improved from 39.0 ($\pm10.80$) to 80.3 ($\pm16.78$) and the KSS score was 81.9 ($\pm16.74$) at the final follow-up. The acromio-humeral distance was 6.6 cm ($\pm1.74$) preoperatively and 6.2 cm ($\pm1.69$) postoperatively without significant change (p=0.3874). The degenerative changes had no statistically progressed (p=0.2663). Conclusion: Partial repair for massive rotator cuff injury patients showed improvement in the clinical score without progression of arthritic change at a mean of 2.3 years follow-up.

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.7-13
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• 2002

Purpose : Preliminary report of the technique and trial of double bundle PCL reconstruction using Achilles allograft. Materials and Methods : From May 1999 to July 2000, 8 cases of PCL insufficient patients were treated with Achilles allograft reconstruction using the double bundle and double femoral tunnel technique. The tibial tunnel was prepared anteromedially. All other combined injuries within the knees were treated accordingly. Minimal follow-up period was 1 year. The results was assessed from the point of function and stability using Lysholm knee score and KT-2000 arthrometer. Results : Up to present follow up. 8 patients showed good sign of recovery with no instability (translation less than 2 mm) except olio that has been grafted-ligament rupture. In addition, none showed any sign of infection nor ROM limitation. Two complications were seen, which one had grafted-bone fracture and the other grafted-ligament rupture. The former occurred during operation and the latter occurred due to improper protection. Conclusion : Presently the follow up period is too short to draw any conclusive opinion but it is essential to select healthy and well sterilized allografts fur successful outcome. Double femoral tunnel technique seems to be more physiologic in PCL reconstruction. With these prerequisites, it seems to be a good alternative to use Achilles allografts fur the reconstruction of PCL. However, a longer follow-up is needed.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.53-58
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• 2011

Purpose: We evaluated the minimal 1 year follow-up results (shoulder stability and the clinical and functional results) for the Remplissage technique to fill a Hill-Sachs lesion. Materials and Methods: The subjects were 12 patients who could be followed up for more than 12 months after the "Remplissage" procedures in our hospital from December 2008 to November 2009. Their mean age was 27.9 years old and the mean follow-up was 19 months. The evaluations included the ROM, the ASES score, the KSSI score, the ROWE score and postoperative MRI. Results: On the postoperative functional evaluation after an average of 16 months, the ASES score improved from 50.8 preoperatively to 78.3 postoperatively, the KSSI score improved form 44.5 preoperatively to 81.0 postoperatively and the ROWE score improved from 40.2 preoperatively to 84.3 postoperatively. After an average 14 months for all the cases, the range of movement was nearly in the normal range, which is 178.6${\pm}$18.6 (165~180) degrees for forward flexion and 49.3${\pm}$10 (43~60) degrees for external rotation. Conclusion: For recurrent shoulder instability with a large Hill-Sachs lesion, the Remplissage technique has a good outcome after more than 1 year follow-up in terms of the shoulder stability and the clinical and functional results.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.1
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• pp.37-44
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• 2008

Purpose: To purpose of this study was to review the long-term follow up results of surgical treatment of the localized pigmented villonodular synovitis in the knee. Materials and Methods: We evaluated and analyzed 6 patients (6 cases) who underwent arthroscopy and excisional biopsy as pigmented villonodular synovitis from March 1988 to June 2002. The clinical diagnosis was confirmed by pathologic findings. All patients had been managed with arthroscopic excision, but two patients underwent mini-open excision. The recurrence was evaluated by the loss of preoperative symptom and physical examination for range of motion, pain and finding of swelling. Results: According to the arthroscopic findings, all patients had localized form of pigmented villonodular synovitis. Three patients had pedunculated type (one of them had torsion) and the two patients had nodular type and one patient had mixed type. All patients had improvement in pain, swelling and range of motion and there was no evidence of recurrence. Conclusion: In terms of long term follow up results, precise preoperative diagnosis and the adequate surgical treatment, especially arthroscopic excision for the localized pigmented villonodular synovitis, would be considered one of the fundamental modality to expect the good results.

• Journal of the Korean Arthroscopy Society
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• v.4 no.2
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• pp.105-110
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• 2000

Purpose : The purpose of this study was to evaluate the clinical results of fresh-frozen achilles allograft PCL reconstruction. Materials and Methods : 34 patients(35 cases) who was reconstructed PCL arthroscopically using achilles allograft were analyzed subjective and objective parameters, Telos stress arthrometer and Modified Feagin Scoring System. The average age was 36.2 years old($16\~57$ year) and average follow up period was 18.5 months($12\~27$ months). Result : The mean Lysholm Knee Scoring was improved from 47.5 to 87.4. Posterior translation by Telos arthrometer decreased to 2.3mm from 7.1mm. The modified Feagin scoring system showed 32 cases$(91.5\%)$ with excellent and good result. Conclusion : Clinical results of PCL reconstruction by Achilles allograft revealed good result as to scales. Achilles allograft provided enough initial tension with length and minimized the complication of using autograft. Therefore achilles fresh-frozen allograft in PCL reconstruction is a good substitute material for autograft.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.1
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• pp.48-54
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• 2007

Purpose: To evaluate clinical results of the tumor prosthetic replacement for pathologic fracture of the proximal femur with extensive bony destruction due to metastatic bone tumors. Materials and Methods: From 2005 October to 2006 October, resection of proximal femur and tumor prosthesis replacement was performed for metastatic bone tumors extensively involving trochanteric area in 6 patients. The mean age of overall patients was 61(range, 48~77). Mean clinical follow up was 10.5 months (range, 6~16). Primary tumor consisted with multiple myeloma in 2 patients, lung cancer in 1, breast cancer in 1, transitional cell carcinoma of the renal pelvis in 1, unknown origin in 1 patient. $MUTARS^{(R)}$ proximal femur (Implantcast, Munster, Germany) were used in all cases. The functional evaluation in the lower extremities was performed with Musculoskeletal Tumor Society 1993 scores. The degree of pain relief after surgical treatment was assessed with Visual Analogue Scale (VAS). Results: At the final follow up, all of the patients survived. The mean lower extremities functional score of Musculoskeletal Tumor Society 1993 was 17.8(59.3%)(range, 12~25). VAS was improved to 2.5 from 8.5 after the surgical treatment. Ambulation was encouraged as soon as possible and mean duration after surgery for ambulation was 7.3(range, 3~16) days. Post-operatively, there was no surgical infection, periprosthetic fracture or loosening. Dislocation occurred in one out of six cases. Conclusion: Resection of proximal femur and tumor prosthesis replacement for metastatic bone tumors around proximal femur extensively involving trochanteric area seems to be safe procedure in view of post-operative complication, and effective for functional restoration as well as pain relief. Thus, it is accordant to the treatment principle of the metastatic bone tumors.

• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.25-31
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• 2012

Purpose: The clinical and radiographic outcomes of the internal fixation, which were executed on patients over the age of 65 with proximal humerus fracture by using a polyaxial angular stable locking compression plate (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB), were evaluated. Materials and Methods: Thirty two patients over the age of 65 among the proximal humerus fracture treated with NCB plate, between August 2007 and January 2011, were chosen as the subjects. The average age of patients was 71 years, and the average postoperative follow-up period was 11.5 months. The fractures included 14 two-part and 18 three-part fractures. The clinical results were evaluated, using the visual analog scale (VAS) score and the Constant score. The radiological results were evaluated by time to union and Paavolainen method, which measures the neck shaft angle. Results: At the last follow-up examination, the mean VAS score was 3 points and the mean Constant score was 64.5 points, with bone union achieved after the average of 16.2 weeks following the surgery in all the cases. The mean neck shaft angle was 125.9 and 24 cases had good results, while 8 cases had fair results by Paavolainen method, at the last follow-up. There were 1 case of delayed union and cerclage wire failure, and 3 cases of subacromial impingement. There were no complications, such as loss of reduction, nonunion, screw loosening, or avascular necrosis of the humeral head. Conclusion: Internal fixation, using a NCB plate, was considered to be an effective surgical method in treating proximal humerus fracture in the elderly patients, on whom the fixation of the fracture and maintenance of reduction are difficult.