• Clinics in Shoulder and Elbow
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• 제9권1호
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• pp.105-110
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• 2006

Purpose: This study reports the clinical results of the arthroscopic Bankart repair in traumatic anterior instability of the shoulder with bio-knotless anchor. Materials and Methods: 21 cases of 21 patients (20 male and 1 female) were included in this study. The average age was 24.8 years old and the period from the first injury to operation was average 37.2 months. All cases had Bankart lesion and 12 cases had Hill-Sachs' lesion. The SLAP lesion was associated in 6 cases. Preoperative Rowe score was average 29.1. Arthroscopic Bankart repair with bio-knotless anchor were performed in all cases; 3 anchors at 3, 4, 5 O'clock position of the glenoid were used in 11 cases and 2 anchors at 4, 5 O'clock position were used in 10 cases. All the associated SLAP lesions were repaired arthroscopically with bio-knotless anchor. Thermal capsular shrinkage at the anterior and inferior shoulder capsule after the Bankart repair was performed in 3 cases. The average follow up period was 20.2 months. Results: The Rowe score improved to 92.8, excellent in 17 cases and good in 4 cases, at last follow up period and 20 cases had full range of motion of the shoulder. 1 case had mild limited range of motion of the shoulder (150 degrees in flexion, 60 degrees in external rotation and T12 level in internal rotation) without any problem in normal activity. The arthroscopic revision surgery of the shoulder was performed in 1 case because of multiple traumatic injuries of the shoulder with pain postoperatively. Conclusion: Arthroscopic Bankart repair with bio-knotless anchor in traumatic anterior shoulder instability is one of the good methods because of the good clinical results.

• Clinics in Shoulder and Elbow
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• 제23권2호
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• pp.62-70
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• 2020

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8%±4.2% (range, 20.4%-37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24-86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.126-130
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• 2024

Anterior glenohumeral instability with an irreparable subscapularis tear is a challenging problem for the orthopedic shoulder surgeon. Current techniques, including tendon transfers, yield inconsistent results with high rates of recurrent instability. Acellular dermal allografting has been used in young patients with massive superior rotator cuff tears with early success, but acellular dermal allografting is comparatively unstudied in anterior deficiency. We present two cases of anterior capsular reconstruction with an acellular dermal allograft in patients ages 66 and 58 years with irreparable subscapularis tendon tears. Follow-up for both patients exceeded 4 years, with forward flexion >140°, external rotation exceeding 60°, a Single Assessment Numeric Evaluation score >90 points, a visual analog scale score of 0 points, and an American Shoulder and Elbow Score of 98 points. In conclusion, acellular dermal allografting can be used to reconstruct the anterior capsule in patients with massive irreparable subscapularis tears, similar to its use in superior capsular reconstruction in patients with massive posterosuperior rotator cuff tears.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2005년도 제13차 춘계학술대회
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• pp.61-61
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• 2005

• Clinics in Shoulder and Elbow
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• 제4권2호
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• pp.181-185
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• 2001

Purpose: We reviewed the bilateral anterior shoulder instability to evaluate the final outcomes and influencing factors that had effect on the final outcomes. Materials and Methods: Sixteen patients of the bilateral shoulder instability underwent the operative treatment and 15 patients could be followed up average 29 months. There were Bankart lesions in 28 cases and 46% retracted markedly onto the medial side of the glenoid neck. Capsular redundancy could be seen in 50%, but the generalized ligamentous laxity in only two patients. We performed open Bankart repair in 21 cases and arthroscopic repair in 9 cases. Inferior capsular shift was performed in 12 cases of 15 cases in patients who was shown the capular redundancy. Results: The average increment of the forward flexion was 4° postoperatively but the average decrement of the external rotation was 6° postoperatively. After the inferior capsular shift surgery, there were significantly the decrement in external rotation by 13° even though the forward flexion was at the same level comparing with preoperative motion. There were 13 cases(43%) in excellent result, 14 cases(47%) in good and 3 case(l0%) in poor. Rowe score improved from 53 to 87.3 postoperatively. Conclusion : Re-establishing a proper capsular tensioning in a bilateral anterior shoulder instability is critical to ultimate success because there was a redundant laxity in a half and majority of them had marked retraction of an anteroinferior glenohumeral ligament complex. Especially, it should be considered that an unexpected limitation of external rotation could be occurred in the inferior capsular shift surgery.

• Clinics in Shoulder and Elbow
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• 제12권2호
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• pp.255-263
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• 2009

목적: 견관절 전방 불안정성에서 관절와 및 상완골 두의 골 결손은 재탈구와 밀접히 연관되어 있다. 의미있는 골 결손이 동반된 전방 불안정성에서 적용될 수 있는 개방적 술식을 고찰하고 저자들의 경험을 소개하고자 한다. 대상 및 방법: 전방 불안정성에서 골 결손에 대해 연구하고 발표된 논문을 조사하여 시술되고 있는 개방적 술식들 요약하고 정리하였다. 결과: 전방 관절낭 관절와 순을 복원한 후 재탈구를 예방하기 위해 수술 전에 방사선학적으로 골결손을 정확히 평가하는 것은 중요하다. 관절와 결손을 복원하기 위해 오구돌기 이전술(Bristow 술식 또는 Latarjet 술식)이나 자가 장골 이식을 사용할 수 있고, 상완골 두의 후상방골 결손 (Hill-Sachs병변)에 대해서는 회전 절골술이나 동종골 이식 등이 사용될 수 있다. 골 결손에 대한 인공 관절 치환술은 시도되고 있으나 아직 제한적이며 더 많은 연구가 필요하다. 결론: 개방적 술식을 통해 골 결손을 복원해야 재탈구의 위험을 낮출 수 있다. 관절경술을 통한 골 병변의 치료가 시도되고 있으나 아직도 장기간의 노력과 연구가 필요하다.

• Clinics in Shoulder and Elbow
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• 제3권2호
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• pp.87-94
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• 2000

Purpose : The purpose of this study was to evaluate the activity of the biceps brachii muscle in the vulnerable abduction and external rotation position of the shoulder in patients with anterior instability. Materials and Methods: This experimental study include a prospective analysis of the electromyographic(EMG) data on a group of patients with traumatic unilateral anterior instability of the shoulder. The EMG data of unstable shoulders was compared with those of opposite shoulders as control. The optimal sample size for the case-control study was calculated using an nQuery Advisor program(nQuery Adviser 3.0, Statisticl solutions Ltd., Ireland). The EMG analyses were conducted in 76 shoulders in 38 patients who had a traumatic anterior instability in one shoulder. The EMG records were obtained at different position of shoulder, which included 0° , 45° , 90° and 120° of shoulder abduction. In each angle of shoulder abduction, the arms were placed in an external rotation as tolerated by the anterior apprehension. The paired-sample T test was used to compare the difference of the root mean square(RMS) voltages between the stable and unstable shoulders in each degree of arm position. Results : The RMS voltage of the biceps muscle was significantly greater in the unstable shoulder than opposite stable shoulder in all position of the arm(p<0.001). The RMS voltage of the biceps was maximal at 90° and 120° of external rotation in the unstable shoulder(p<0.05). The RMS voltage of the supraspinatus muscle revealed no differences in any of the test conditions(p=0.904, 0.506, 0.119 and 0.781 in 0° , 45° , 90° and 120° , respectively) Conclusion: In the vulnerable abduction and external rotation position, the biceps muscle plays an active compensatory role in the unstable shoulder while not in the stable shoulder.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.117-122
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• 2010

목적: 본 증례 보고는 간질 발작과 동반된 심한 전방 관절와 골결손에 의한 견관절 불안정성에서 자가 삼면피질 장골 이식술을 통한 관절와 재건술 및 안정화 술식을 시행한 증례를 문헌 고찰과 함께 보고하고자 한다. 대상 및 방법: 간질 발작과 동반된 심한 전방 관절와 골결손을 가진 2예의 재발성 전방 탈구를 자가 삼면 피질 장골 이식술을 이용하여 관절와 재건술 및 안정화 술식을 이용하여 치료하였다. 결과: 수술 후 5개월째 단순방사선 촬영상 이식골의 유합 소견이 관찰되었고, 수술 전 소견과 비교해서 골관절염의 진행소견은 관찰되지 않았다. 수술 후 7개월 추시 관찰 상 통증은 거의 없었으며, 관절 운동 범위는 정상 운동 범위를 보였으며, 관절의 안정성을 확보하였다. 결론: 심한 전방 관절와 골결손을 가진 재발성 전방 탈구는 충분한 골 이식을 통해 전방 안정성을 얻을 수 있으며, 관절 면을 비교적 잘 일치시켜 정상 관절와의 오목함을 재건할 수 있고 관절염의 빈도를 줄일 수 있다.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2003년도 연수강좌
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• pp.111-120
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• 2003

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2004년도 학술대회
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• pp.27-27
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• 2004