• Clinics in Shoulder and Elbow
• /
• v.9 no.1
• /
• pp.27-33
• /
• 2006

Purpose: To investigate early complications after repair of massive rotator cuff tears and to find out factors that compromise the results. Materials and Methods: Fourteen patients who had two or more cuff tendons involved were included. All patients were operated by open acromioplasty and rotator cuff repair. At 3 months after operation, we investigated whether there were any early complications or not. We used ASES scoring system for preoperative and follow up evaluation. In addition, various preoperative factors, such as duration of symptom, degree of tendon retraction, degree of fatty degeneration, and acromio-humeral distance, were compared between the complicated patients and non-complicated patients. Results: At 3 months after operation, the ASES score and pain were improved in any degree in all patients. But 5 patients complained persisting pain, and three of them showed major complications such as re-rupture of rotator cuff or deltoid rupture. But no preoperative factors in complicated patients were significantly different from those in non-complicated patients. Conclusion: None of the preoperative factors were related to the complications. There was a tendency of overestimation of fatty degeneration in MRI. Some factors in surgical technique and rehabilitation were highly suspected to be related to the complications.

• The Journal of Korean Medicine
• /
• v.42 no.4
• /
• pp.133-149
• /
• 2021

Objectives: To lay the foundation for future research into Korean Medicine treatment for Rotator Cuff repair surgery patients by analyzing Korean Medical and Western Medical service utilization and treatment duration. Methods: Data sampling was performed on 2015's HIRA patient data (confidence level of 97%) to analyze patients' Korean Medical and Western Medical service usage tendency. Sampled groups were divided into two groups: i) Patients who completed their treatment within five months after the rotator cuff surgery (termination group), ii) Patients who were treated for more than five months after the surgery (continuation group). Then the patients' Korean Medical and Western Medical service usage tendency was investigated and information of these patients are arranged. Results: Out of 1,453,486 patients who were gathered for sampling, 2,461 patients in total had gone through rotator cuff repair surgery. The termination group had 517 patients and the continuation group had 541 patients. The proportion of patients who visited a Korean Medicine clinic was lower in the termination group than the continuation group. Conclusion: The continuation group received more treatments (both in Western Medicine and Korean Medicine) and spent more on medical expenses compared to the termination group. Further research is highly recommended for more efficient Western Medicine and Korean Medicine treatments and reduced medical expenditure.

• Clinics in Shoulder and Elbow
• /
• v.19 no.4
• /
• pp.192-196
• /
• 2016

Background: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. Methods: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. Results: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). Conclusions: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.

• Journal of the Korean Arthroscopy Society
• /
• v.12 no.1
• /
• pp.66-68
• /
• 2008

Recently, devices using radiofrequency energy have been developed for arthroscopic soft tissue ablation, cauterization and shrinkage. After ACL reconstruction operation, articular metallic foreign body was found in the post-operative radiographs. It was proven to be the tip of bipolar radiofrequency system after foreign body removal. After that we experienced 2 more cases during the acromioplasty procedure. We requires attention to prevent the separation of the tip from the body in the arthroscopic surgery using bipolar radiofrequency system.

• Clinics in Shoulder and Elbow
• /
• v.1 no.2
• /
• pp.160-166
• /
• 1998

The purpose of this study was to assess the results of arthroscopic subacromial decompression in patients with chronic impingement and to evaluate the results according to the rotator cuff pathology. We evaluated the clinical results of treatment for chronic impingement syndrome in 28 patients from Feb 1996 to Feb 1997. There were twenty men and eight women in age from 24 to 72 years (mean age 51) with dominant arm involvement in sixteen patients. Follow up evaluations averaged 15(range 12-24)months. The average duration of symptoms were 15(range 6­60)months. The final diagnoses which were based on the physical examination, plain radiographs and arthroscopic findings, were stage II impingement in 16 patients and stage ill impingement in 12 patients. We excluded the patients with acromioclavicular arthritis or glenohumeral instability in this study. All patients were managed non-operatively a minimum of six months. During the operation we performed contouring and smoothing the acromial undersurface and only resecting of the anterolateral band of the coracoacromial ligament. The clinical results were quantitated using UCLA shoulder rating score. Satisfactory results were obtained in 23(80%) patients. Unsatisfactory results were obtained in 5(18%) patients with posterior cuff tear. The average UCLA pain score showed significant improvement from 2.8(constant pain) to 7.2(present during heavy activities) at final follow up. The function and active forward flexion scores also increased from their preoperative value. There was no significant differences according to the surface and severity of tear and NeeI' stage (P>0.05). These results compared favorably with those reported following open acromioplasty. While arthroscopic subacromial decompression is a demanding technique with a learning curve, it is a reliable treatment for chronic impingement syndrome. A less aggressive approach to subacromial decompression and preserving the posteromedial band of the coracoacromialligament does not appear to compromise results.

• Clinics in Shoulder and Elbow
• /
• v.17 no.1
• /
• pp.18-24
• /
• 2014

Background: To evaluate the efficacy of the subclavian portal approach for the arthroscopic repair of isolated subscapularis tendon tear. Methods: We used the subclavian portal to carry out arthroscopic repair of the isolated subscapularis tendon tear. The surgery was carried out in 18 cases (average age of 53) from May 2006 to December 2009 with a mean follow-up period of 35 months. Of these cases, 13 patients had the tear in their dominant arms, 16 were male, and 12 were from traumatic ruptures with on average 7.6 months of symptom period to operation. Additional surgery, acromioplasty and subacromial debridement, were carried out on 4 cases each during the subscapularis repair. The integrity of cuff status was assessed by ultrasonographic examination at 6 months and at 1 year after operation. Results: The initial average range of motion in forward flexion, external rotation, and internal rotation were $160^{\circ}$, $50^{\circ}$ and L4, respectively. At the 1 year follow-up period, these improved to $160^{\circ}$, $52^{\circ}$ and T12, respectively. The initial average functional scores were assessed by KSS, ASES, UCLA, and Constant scoring systems, which were 67, 60, 26, and 65, respectively. These scores improved progressively with time. At 3 months after operation, the scores were 74, 67, 27, and 74; at 6 months, 83, 77, 31, and 75; at 1 year, 88, 86, 32, and 79; and at the final follow-up of 35 months, 84, 92, 34, and 84. Conclusions: In the repair of isolated subscapularis tendon tear, the subclavian portal approach provided a good angle for anchor insertion and sufficient space to manage the upper portion of the tendon tear. In turn, these provisions resulted in satisfactory clinical results.

• Journal of the Korean Arthroscopy Society
• /
• v.8 no.1
• /
• pp.45-50
• /
• 2004

Purpose: The purpose of this study is to compare the outcome of operative results in the impingement syndrome of the shoulder with and without the stiffness. Material and Method: Seventy-six patients who had the impingement syndrome without stiffness were evaluated, and treated with the subacromial decompression and 24 patients who had the impingement syndrome with stiffness, were treated with the subacromial decompression and the manipulation. The average follow-up period was 32 months. Result: The impingement syndrome of the shoulder with stiffness was more severe in the preoperative pain and worse in ASES score than without stiffness. The postoperative pain and ASES score improved in the both group. The satisfactory groups were 67% in the group with stiffness and 80% without stiffness. The satisfactory rate was 83% in the group with stiffness and 93% without stiffness. The satisfactory groups with diabetes were 47% in the group with stiffness and 81% without stiffness. Forward elevation, exeternal rotation at the side and internal rotation improved in both groups postoperatively and there were no statistically significant differences postoperatively External rotation was restricted statistically in the group with stiffness. Conclusion: Although patients may not regain the full range of motion, the technique of manipulation followed by arthroscopic subacromial decompression offers good pain relief and satisfactory functional recovery for the impingement syndrome with stiffness. However preoperative counseling is necessary for the impingement syndrome combined with diabetes and stiffness due to poor out come.

• Journal of the Korean Arthroscopy Society
• /
• v.14 no.1
• /
• pp.49-52
• /
• 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
• /
• v.12 no.2
• /
• pp.126-136
• /
• 2009

Purpose: We evaluated the correlation of the anatomic parameters of the acromion those represent on the magnetic resonance image (MRI) of impingement syndrome. Materials and Methods: From June, 2004 to December, 2005, 71 cases were surgically proven to be impingement syndrome, and the anterior acromial hooking angle, the lateral acromial hooking angle (AAHA and LAHA) and the acromial hooking index (AHI: the sum of the AAHA and LAHA) were compared to 16 control cases. At the same period, 55 cases were surgically proven to be partial or full thickness rotator cuff tear, and age, gender and twelve anatomic parameters, including the acromial type, the acromial angle, the anterior covering, the acromial slope, the AAHA, the lateral acromial angle, the acromial torsional angle, the lateral acromial angulation, the LAHA, the lateral covering, the acromiohumeral distance and the AHI were assessed. Results: The AAHA and AHI were increased as impingement syndrome proceeded. The acromial type and acromial angle, and the AAHA, LAHA and AHI showed significant differences between the controls and the rotator cuff tear patients on univariant analysis. On multivariant analysis, gender was most strongly correlated with rotator cuff tear. Age, AAHA and the acromial angle showed similar correlation, respectively. Conclusion: The coronal acromial shape is correlated with rotator cuff tear, and it is important to correct the lateral acromial shape when performing acromioplasty.