• Journal of Korean Orthopaedic Sports Medicine
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• v.3 no.1
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• pp.81-86
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• 2004

Objectives: To assess the functional outcome of Bankart repair and rotator cuff repair using miniopen technique in patients with recurrent shoulder dislocation(8 cases) with rotator cuff tears and Bankart lesion of over 40 years. Materials and Methods: From May 1991 to January 2002, twenty two patients were available to participate in the study. Mean age was 52 years old(41-67), Follow-up evaluations averaged 50.5months(10-147). Results: The patients(22 cases) were divided into two groups. Group 1: with recurrent shoulder dislocation(8 cases) with rotator cuff tears and Bankart lesion in patients over 40 years old. Group 2: without Bankart lesion(14 cases). In Group 1, mean average of forward flexion and abduction improved from 122 degrees to 154 degrees at the final follow-up and from 115 degrees to 161 degrees respectively. In terms of University of Pennsylvania patient self-assessment of pain score and VAS, scores improved from 11.0 to 5.5 and from 5.4 to 2.5 respectively. In terms of UCLA score & Constant score, scores also improved from 20.2 to 29.6 and from 48.6 to 69.0 respectively. Functional outcome of Group 1: two patients with excellent, four patients with good, and two patients with fair. Functional outcome of Group 2: two patients with excellent, six patients with good, five patients with fair, and one patient with poor. But they had no statistical significance between the two groups. All cases were improved shoulder pain at the final follow up. And six patients were satisfied with the outcome of shoulder function. Conclusions: This study demonstrates the effectiveness of Bankart repair and rotator cuff repair using miniopen technique in patients with recurrent shoulder dislocation(8 cases) with tears of rotator cuff and Bankart lesion older than 40 years. We recommend Bankart repair and rotator cuff repair at the same time.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.92-98
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• 2007

Introduction: The treatment of proximal humeral fracture is traditionally determined by Neer's classification system. The severely displaced three-part or four-part fracture is an indication for primary hemiarthroplasty. The current authors report the clinical results of 10 patients who received hemiarthroplasty for proximal comminuted fractures. The minimum follow-up period was 12 months. Materials and Methods: The current authors studied 10 patients who, between July 1999 and March 2005, each received hemiarthroplasty for a proximal humeral fracture of one shoulder. According to Neer's classification system, 5 of the patients had three-part fractures, and 5 of the patients had 4-part fractures. The mean interval between trauma and hemiarthroplasty was 6.1 days. The mean age of the 6 female and 4 male patients was 67.4 years(range: 56 to 76). Shoulder function was evaluated using the Constant score, the Simple Shoulder Test, and the modified UCLA score. Results: The mean Constant score was 51.4(range: 34 to 60). The mean modified SST score was 7.8 out of 12 tasks. Excluding the one patient who had also sustained an axillary artery rupture and a brachial plexus injury after the initial trauma, the mean Constant score for the remaining 9 patients was 53.5(range: 44 to 60), and the mean SST score was 7.2 tasks. The modified UCLA score averages for pain, function, and active forward flexion and strength were, respectively, 8.2($6{\sim}10$), 6.6($2{\sim}8$), and 6.9($4{\sim}8$). The total UCLA score was an average of 21.7($12{\sim}26$). Patients' the modified UCLA ratings were as follows: Excellent: 3, Good: 6, and Poor: 1. The patient with the poor outcome was the one who had also sustained the neurovascular injury. Patient's subjective satisfaction rating were as follows: Excellent: 2, Good: 7, and Poor: 1. Conclusion: Based on short term follow-up results, this study indicates that hemiarthroplasty is the treatment of choice for proximal humeral fractures on which it would be difficult to perform open reduction and internal fixation. Hemiarthroplasty is a useful treatment modality to prevent shoulder stiffness and to allow daily living tasks in elderly patients. However, restoration of muscle power and range of joint motion were not recovered satisfactorily.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.47-53
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• 2011

Purpose: As the number of the anterior cruciate ligament (ACL) reconstruction has increased, the incidence of revision of ACL reconstruction due to reconstruction failure has been also increased. Therefore, authors analyzed the reason of the failure of ACL reconstruction and the clinical result of the ACL revision. Materials and methods: From February 1998 to July 2010, we selected 36 cases which was followed at least 12months after the ACL reconstruction failure. Duration from reconstruction to revision, the average duration was 60 months (5~334) and on first reconstruction, we used allograft on 23 cases (63.9%) and autograft on 13 cases (36.1%). For the main symptom of ACL reconstruction failure, instability was the most common symptom, and 35 cases (97.5%) were undergone only one reconstruction and 1case (2.5%) was undergone two reconstruction. Clinical results were evaluated by Lysholm knee joint score, pivot shift test, and Telos device. Results: Average follow-up duration of the patients was 21 months (12~40), and the reason for the ACL reconstruction failure, trauma was most common by 19 cases (52.8%), malposition of the femoral tunnel was 13 cases (36.1%), malposition of the tibia tunnel was 1case (2.8%), and failure of osteointegration was 3 cases (8.4%). On performing the ACL revision, we used allograft on 34 cases (94%) and autograft on 2 cases (6%), and 21 cases accompanied injury of the meniscus (medial meniscus 14 cases, lateral meniscus 7 cases). Lysholm knee joint score was improved from 66.5 points, preoperatively to 92 points on last follow-up (p<0.01). In most cases, patients were satisfied (92%) with the operation results. Tegner activity score was also improved from 2.0 points preoperatively to 6.2 points on the last follow-up. On Lachman and pivot sift test, 33 cases and 30 cases were improved to grade I respectively, and on stability test using Telos device, the bilateral difference was improved from mean 15.5 mm preoperatively to 4.5 mm on the last follow-up. Conclusion: After 1 year follow-up, Revision of ACL had a little anterior instability but it showed satisfactory result on clinical result and patient's subjective satisfaction.

• The Journal of the Korean bone and joint tumor society
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• v.19 no.2
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• pp.43-49
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• 2013

Purpose: We analyzed the treatment outcomes of patients with sacral giant cell tumor. Materials and Methods: We retrospectively reviewed 7 patients with giant cell tumor of the sacrum who were treated at out institution between 1990 and 2012. Results: There were 2 men and 5 women with mean age of 23.6 years. The average follow up was 52.3 months (range, 15-73 months). Six patients received surgical treatment. Intralesional curettage was performed for the 5 patients and marginal resection for another one patient. The remaining one patient was received radiation only. The patients who received radiation therapy and marginal excision had no residual or recurrent tumors. Of 5 patients with intra-lesional excision, one patient needs one more operation; two patients need two more operation for local control of the giant cell tumor. The remaining two patients failed to gain local control in spite of additional treatments. Conclusion: For the treatment of sacral giant cell tumor, intralesional resection can be one of the treatments option with minimal neurologic injury. Furthermore, radiation therapy can be recommended when complete excision or curettage is impractical.

• The Journal of the Korean bone and joint tumor society
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• v.15 no.1
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• pp.44-51
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• 2009

Purpose: We evaluated the results of surgical treatment for metastatic pathologic or impending pathologic fractures. Materials and Methods: From January 2004 to December 2007, 18 patients 19 cases were included. Male were 6 and female were 12. The mean age was 65.1. Mean follow up period was 15.2 months. Pathologic fractures were 14 and impending pathologic fractures were 5. MSTS score, periodic radiologic follow up and postoperative complications were evaluated. Results: The primary malignancies were 6 cases of multiple myeloma, 4 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of colon cancer, 2 cases of breast cancer and 2 cases of leiomyosarcoma. Metastatic lesions were 10 cases of femur, 4 cases of clavicle, 2 cases of humerus, 2 cases of tibia and 1 case of radius. Surgical options were curettage, cementation, internal fixation and arthroplasty. Mean MSTS score was 15.9. Postoperative complications were 1 case of infection, 1 case of local recurrence and 1 case of implant loosening. Ten patients were alive with disease, 8 patients died of disease. Conclusion: Surgical treatment of metastatic skeletal lesions allowed early ambulation and improving dexterity. It improved pain and emotional acceptance. Surgery is necessary for improving qualities of remaining lives.

• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.130-137
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• 2012

Purpose: To evaluate and report the clinical outcome after surgical treatment of intra-articular comminuted fracture of distal humerus in the elderly with osteoporosis. Materials and Methods: From January 2007 to October 2009, 24 patients aged older than 65 years with intra-articular comminuted fracture of distal humerus underwent surgical treatment. 18 patients (Group I) were managed using primary open reduction and internal fixation (OR IF) through the modified posterior approach and 6 patients (Group II) were taken primary total elbow arthroplasty. The average follow up period was 17.2 months. According to the AO classification, there were 8 C2, 16 C3 type fractures. All enrolled patients were evaluated radiographically and clinically. Clinical outcomes were assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires. Results: The bony union was observed in 18 patients in group I at average 14 weeks. There were 2 patients with neurapraxia of whom the ulnar nerve symptom did not improve despite of anterior transposition. And non-union at osteotomy sites was seen in 2 patients. The mean Mayo Elbow Performance score was 87.0. The mean DASH score was 32.4. The average arc of elbow flexion was $121.0^{\circ}$ (range, $95{\sim}145^{\circ}$) with mean flexion-contracture of $12.0^{\circ}$ (range, 0 to 35). 6 patients in Group II showed no complication during follow up periods. The mean Mayo Elbow Performance score was 89.1. The mean DASH score was 44.3. The average arc of elbow flexion was $125.1^{\circ}$ (range, $100{\sim}145^{\circ}$) with mean flexion-contracture of $12.6^{\circ}$ (range, 0 to 30). Conclusions: With careful patient selection, Total elbow arthroplasty as well as OR IF could achieve good outcomes in elderly of comminuted intra-articular distal humerus fracture with osteoporosis.

• The Journal of the Korean bone and joint tumor society
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• v.6 no.1
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• pp.17-21
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• 2000

Purpose : Dermatofibrosarcoma protuberans(DFSP) is a rare tumor of the skin with a strong tendency of infiltration to surrounding tissues. Inadequate surgical intervention brings about frequent recurrence and poor prognosis. We attempted to find a guideline for adequate treatment for DFSP. Materials and Methods : Fourteen cases who had been treated in our department since Mar. 1993 and followed up for more than 12 months postoperatively were reviewed. Including nine cases who were transferred from other hospital after recurrence, thirteen cases underwent wide resection. One case was treated by intralesional resection followed by chemotherapy (CYVADIC) due to neurovascular abutment to the mass in the inguinal area. Results : The nine cases who were transferred due to recurrences experienced recurrence in average 1.3(1-2) times and the average period until first local recurrence from primary operation was 11.8(2-24) months. The thirteen cases with wide surgical margin showed no recurrence at the final follow up. One case treated by intralesional resection and chemotherapy showed multiple recurrence and died of the disease due to lung metastasis. Conclusions : From these data, we could find that primary wide resection can be the way of reducing recurrence and metastasis, and the follow up period for the detection of recurrence should be at least two years.

• Journal of the Korean Arthroscopy Society
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• v.11 no.1
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• pp.13-19
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• 2007

Purpose: We investigated the natural history of acute, isolated posterior cruciate ligament injuries treated conservatively. Materials and Methods: Between February 1999 and October 2006, we evaluated retrospectively the results of acute, isolated posterior cruciate ligament injuries treated conservatively. The subjects consisted of 21 patients. At initial and follow up visits physical examination, $KT-2000^{TM}$ arthrometer and MRI were performed to assess improvement on the knee stability and continuity of the posterior cruciate ligament. IKDC (International Knee Documentation Committee) knee scoring and quadriceps muscle strength were also checked in all population. Comparing the results of initial and follow up examinations we assessed the natural history of acute, isolated posterior cruciate ligament injuries treated conservatively. The mean follow up period was 22.7 months. Results: The posterior drawer test showed 14 cases of Grade I, 6 cases of Grade II and 1 case of Grade III progressing 18 cases of Grade I and 3 cases of Grade II. The mean difference of 5.7mm by $KT-2000^{TM}$ arthrometer was changed Into 2.7mm and the continuity of posterior cruciate ligament initially checked by 48.1% on MRI increased to 69.7%. The mean quadriceps muscle strength was grade 'Good' and mean IKDC knee score was nearly grade 'A'. Conclusion: Our study suggests that patients with acute, isolated posterior cruciate ligament injuries treated conservatively may get good clinical outcomes on clinical situation and MRI.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.181-187
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• 2010

Purpose: To determine clinical results for arthroscopic repair of a full-thickness rotator cuff tear using a suture bridge technique. Materials and Methods: Between November, 2007 and October, 2008, we evaluated 90 cases of arthroscopic middle, large rotator tear cuff repair. The mean follow-up period was 15 months (range, 12-23 months). Forty-three cases had medium-sized tears; 47 cases had large-sized tears. At the preoperative stage and again at last follow-up, functional results were assessed by the KSS, ASES, UCLA and the PVAS (Pain visual analogue score). Results: Pain score improved from 2.56 preoperatively to 0.96 at final follow-up; movement scores improved from 6.94 to 1.70. At. final follow-up, the average UCLA score improved from 17.08 to 31.17 with 31 excellent (34%), 49 good (54%) and 10 poor results (12%). The final UCLA score was 31.47 in the group less than 60 years of age and 30.69 in the group over 61 years of age (p=0.344). The UCLA score was 31.23 in those with medium-sized tears and 31.11 in those with large-sized tears (p=0.924). The UCLA score was 31.10 in non-trauma patients and 31.23 in trauma patients (p=0.929). Conclusion: Arthroscopic repair of a full-thickness rotator cuff tear using a suture bridge technique can produce excellent clinical results. These outcomes are not affected by age or trauma history.

• 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.