• Clinics in Shoulder and Elbow
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• 제20권1호
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• pp.3-9
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• 2017

Background: Many hyaluronic acid (HA)-based anti-adhesive agents have been commercialized for clinical use in the pharmaceutical market. But their efficacy in arthroscopic rotator cuff repairs remains elusive. To determine their efficacy, we performed a comparative analysis of the effects of two hyaluronate/carboxymethylcellulose (CMC)-based anti-adhesive agents, Protescal and Guardix. Methods: We recruited a total of 256 patients who had received an arthroscopic rotator cuff repair at our hospital between January 2014 and March 2015. Among them, 96 patients fulfilled the study's selection criteria and were enrolled as the final population sample. Thirty patients who had received a postoperative injection of Protescal were allocated into Group A. Another 30 patients who had received a postoperative injection of Guardix were allocated into Group B. As controls, 36 patients who did not receive any injection were allocated into Group C. The patients included in this study were aged between 19 and 75 years. For the clinical assessment, we measured the following clinical parameters-the visual analogue scale for pain (PVAS), the American Shoulder and Elbow Surgeons (ASES) score, and the constant score, as well as passive range of motions (ROMs)-at three time-points (preoperatively, 2-month postoperatively, and 6-month postoperatively). Results: We found that Group A compared to Group B tended to show a swifter recovery in passive anterior elevation and in internal rotation by the 2-month postoperative follow-up, but the differences were not statistically significant. Conclusions: We found that the effects of HA/CMC-based injections were minimal after arthroscopic rotator cuff repairs.

• Clinics in Shoulder and Elbow
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• 제26권1호
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• pp.10-19
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• 2023

Background: Tendon degeneration contributes to rotator cuff tears; however, its role in postoperative structural integrity is poorly understood. The purpose of this study was to investigate the factors associated with postoperative structural integrity after rotator cuff repair, particularly focusing on the histology of tendons harvested intraoperatively. Methods: A total of 56 patients who underwent primary arthroscopic rotator cuff repair between 2009 and 2011 were analyzed. A 3-mm-diameter sample of supraspinatus tendons was harvested en bloc from each patient after minimal debridement of the torn ends. Tendon degeneration was assessed using seven histological parameters on a semi-quantitative grading scale, and the total degeneration score was calculated. One-year postoperative magnetic resonance imaging was used to classify the patients based on retear. Results: The total degeneration scores in the healed and retear groups were 13.93±2.03 and 14.08±2.23 (P=0.960), respectively. Arthroscopically measured anteroposterior (AP) tear sizes in the healed and retear groups were 24.30±12.35 mm and 36.42±25.23 mm (P=0.026), respectively. Preoperative visual analog scale pain scores at rest in the healed and retear groups were 3.54±2.37 and 5.16±2.16 (P=0.046), respectively. Retraction sizes in the healed and retear groups were 16.02±7.587 mm and 22.33±13.364 mm (P=0.037), respectively. The odds of retear rose by 4.2% for every 1-mm increase in AP tear size (P=0.032). Conclusions: The postoperative structural integrity of the rotator cuff tendon was not affected by tendon degeneration, whereas the arthroscopically measured AP tear size of the rotator cuff tendon was an independent predictor of retear. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• 제25권3호
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• pp.173-181
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• 2022

Background: Healing of the tendon itself is not always related to successful clinical outcomes after rotator cuff repair. It was hypothesized that certain radiologic factors affecting clinical outcomes could exist in case of the retear after arthroscopic rotator cuff repair (ARCR) and the radiologic factors could help predict clinical process. The purpose of this study was to identify the radiologic factors associated with clinical outcomes of the retear after ARCR. Methods: Between January 2012 and December 2019, among patients with sufficient footprint coverage for ARCR, 96 patients with Sugaya classification 4 or higher retear on follow-up magnetic resonance imaging were included. The association between clinical outcomes such as American Shoulder and Elbow Surgeons (ASES) score, Constant score and range of motion and radiologic variables such as initial tear dimension, retear dimension, variance of tear dimension, critical shoulder angle, acromial index, and acromiohumeral distance was analyzed. Results: Preoperatively, the ASES and Constant scores were 59.81±17.02 and 64.30±15.27, respectively. And at the last follow-up, they improved to 81.56±16.29 and 78.62±14.16, respectively (p<0.01 and p<0.01). In multiple linear regression analysis, the variance of the mediolateral dimension of tear had statistically significant association with the ASES and Constant scores (p<0.01 and p=0.01). Conclusions: In patients with the retear after ARCR, the variance in the mediolateral dimension of tear had significantly negative association with the clinical outcomes. This could be considered to be reference as relative criteria and needed more sample and mechanical study.

• Clinics in Shoulder and Elbow
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• 제18권2호
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• pp.113-118
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• 2015

Rotator cuff tear is a common reason for shoulder pain. Although the surgical technique of rotator cuff repair is developing, high retear rate requires additional supplementary methods. Among these supplementary methods, as a kind of biologic augmentation, platelet-rich plasma (PRP) has been spotlighted and has recently been studied by many researchers. PRP, a concentrate of platelet extract obtained from whole blood, contains numerous growth factors. As this is known to play an important role in the tissue recovery process, it had been used for research in a variety of fields including orthopedics. Use of PRP has been attempted in surgical treatments of rotator cuff tear for better results; however, only a few large-scale research studies on the effect of PRP have been reported. Clinical results of each study are also variable. Therefore research using large-scale randomized, double-blind trials should be conducted in order to prove the application range, safety, and clinical effects of PRP.

• Clinics in Shoulder and Elbow
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• 제24권3호
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• pp.135-140
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• 2021

Background: We hypothesized in this study that the characteristics of retear cases vary according to surgeon volume and that surgical outcomes differ between primary and revision arthroscopic rotator cuff repair (revisional ARCR). Methods: Surgeons performing more than 12 rotator cuff repairs (RCRs) per year were defined as high-volume surgeons, and those performing fewer than 12 RCRs were considered low-volume surgeons. Of the 47 patients who underwent revisional ARCR at our clinic enrolled in this study, 21 cases were treated by high-volume surgeons and 26 cases by low-volume surgeons. In all cases, the interval between primary surgery and revisional ARCR, degree of "acromial scuffing," number of anchors, RCR technique, retear pattern, fatty infiltration, retear size, operating time, and clinical outcome were recorded. Results: During primary surgery, significantly more lateral anchors (p=0.004) were used, and the rate of use of the double-row repair technique was significantly higher (p<0.001) in the high- versus low-volume surgeon group. Moreover, the "cut-through pattern" was observed significantly more frequently among the cases treated by high- versus low-volume surgeons (p=0.008). The clinical outcomes after revisional ARCR were not different between the two groups. Conclusions: Double-row repair during primary surgery and the cut-through pattern during revisional ARCR were more frequent in the high- versus low-volume surgeon groups. However, no differences in retear site or size, fatty infiltration grade, or outcomes were observed between the groups.

• 대한정형외과스포츠의학회지
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• 제3권1호
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• pp.73-80
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• 2004

목적: 중범위와 대범위 전층 회전근 개 파열에서 관절경 하의 봉합술과 소절개 봉합술을 비교하기 위함이다. 재료 및 방법: 중범위와 대범위의 전층 회전근 개 파열 34예를 대상으로 하였으며, 관절경 하 봉합술을 시행한 13예를 제 1군으로, 소절개 봉합술을 시행한 21예를 제 2군으로 하였다. 파열 크기는 1 cm에서 5 cm까지 였다. 평균 추시 기간은 24(범위; 12$\~$36)개월과 28(범위;12$\~$36)개월이었다. VAS (Visual Analogue Scale) 동통 점수를 이용하여 주관적 통증을 비교하였고, ADL (Activity of Dally Living) 일상 생활 지수를 이용하여 비교하였으며, 기능 평가는 UCLA (University of California LA)점수를 이용하여 비교하였다. 양 군의 만족도를 측정하여 비교하였다. 결과: 최종 추시에서 동통과 기능 점수는 향상되었으나 통계적으로 의미있는 차이는 없었다(p>0.05). VAS 동통 점수, ADL 일상 생활 지수, UCLA 점수, 만족도는 차이가 없었다(p>0.05). 결론: 중범위와 대범위 전층 회전근 개 파열에서 관절경 하의 봉합술과 소절개 봉합술은 VAS, ADL, UCLA점수에서 통계적으로 의미 있는 차이가 없었으며, 비슷한 임상적 결과를 보였다.

• 대한정형외과스포츠의학회지
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• 제9권1호
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• pp.35-40
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• 2010

목적: 관절경적 회전근 개 봉합술과 소 절개를 이용한 봉합술의 결과를 비교 분석하고자 한다. 대상 및 방법: 회전근 개 파열이 확인된 44명의 환자를 대상으로 하였다. 23예에서는 관절경적 봉합술을, 21예에서는 소 절개를 이용한 봉합술을 시행하였다. 수술 시 평균연령은 관절경적 봉합술군이 50.4세, 소 절개를 이용한 봉합술군이 56.7세였다. 평균 추시 기간은 관절경적 봉합술군이 24.1개월, 소 절개를 이용한 봉합술군이 26.1개월이었다. 양 군의 결과를 견관절 운동범위, VAS (Visual Analogue Scale), ASES (American Shoulder and Elbow Society), UCLA (University of California LA) 점수를 비교했으며 이를 통계적으로 검정하였다. 결과: 파열의 크기는 관절경적 봉합술군에서 소파열이 2예, 중파열이 10예, 대파열이 11예였으며, 소 절개를 이용한 봉합술군에서는 각각 1예, 8예, 12예 였다. 평균파열의 크기는 관절경적 봉합술군은 3.8 cm이었고, 소 절개 봉합술군이 4.2 cm이었다. 최종 추시 시에 양 군에서 동통과 기능점수가 향상되었으나 양 군간의 차이는 없었다. 양 군의 견관절 운동범위 (p=0.7493), VAS (p=0.9677), ASES (p=0.8032), UCLA (p=0.2289) 점수의 통계적 차이는 없었다. 결론: 관절경적 회전근 개 봉합술군은 파열의 크기가 최종 추시 시 임상 결과와 유의한 상관 관계를 보이지 않았으나, 소절개 봉합술군은 파열의 크기가 클수록 결과가 좋지 않았다. 회전근 개 전층파열에서 관절경적 봉합술군과 소 절개를 이용한 봉합술군 간에 임상 결과의 차이는 보이지 않았다.

• 대한관절경학회지
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• 제13권1호
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• pp.77-81
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• 2009

회전근 개의 전층 파열에서 건은 대결절 또는 소결절의 골 부착부에서 주로 분리된다. 저자들은 상완골 대결절에 1cm 이상의 잔여부가 부착된 회전근 개 건실질 부위에서 발생한 완전 파열을 가진 드문 2예의 회전근 개 파열을 경험하였다. 두 예에서 모두 잔여건을 제거하지 않고 관절경적 건 대 건 봉합술을 시행하였으나 술 후 6개월에 시행한 자기 공명 영상에서 이전 파열 부위에서 회전근 개의 재파열을 보였다. 회전근 개 건실질부 파열에서의 건 대 건 봉합술의 유용성을 증명하기 위해서는 더 많은 증례 검토와 생역학적 연구가 필요할 것으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제10권2호
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• pp.155-159
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• 2007

관절경적 일열 봉합법은 잘 정립된 회전근 개 봉합술로 우수한 임상성적을 보여왔다. 하지만, 수술 후 재파열의 빈도가 높은 것으로 알려져 있어 다양한 방법들이 술 후 재파열을 줄이기 위하여 시도되어왔다. 일부 연구들에서는 해부학적 회전근 개 부착부를 재건하면 봉합한 회전근 개의 치유 및 초기 역학적 강도를 증가시킬 수 있을 것이라고 보고하였고, 이열 봉합법이 해부학적 회전근 개 부착부 재건과 봉합부의 강도를 증가 시키고, 간격형성을 감소 시킬 목적으로 소개되었다. 하지만, 재부착된 회전근 개 건의 장력, 봉합된 건의 혈관 형성 등의 생물학적 치유환경이 일렬 봉합법에 비하여 우수함이 아직 입증되지 않았고 수술 후 기능적 개선도 측면에서도 두 봉합술간 차이가 없으므로, 수술 수기가 상대적으로 쉽고, 요구되는 기구 및 내고정물의 추가적 비용이 적어 경제적인 측면에 장점이 있는 일렬 봉합법은 여전히 추천되는 수술수기이다.

• Clinics in Shoulder and Elbow
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• 제14권2호
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• pp.222-228
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• 2011

서론: 회전근 개 대 파열 및 광범위 파열에 대한 관절경적 봉합술 군과 개방적 봉합술 군 간의 중기 임상적 결과를 비교 분석하였다. 대상 및 방법: 회전근 개 대 파열 및 광범위 파열에 대해 봉합술을 실시한 48예 를 후향적으로 분석하였다. 관절경적 봉합술을 시행한 군은 28예, 개방적 봉합술을 시행한 군은 20예 였다. 임상적 결과는 관절운동 범위, 통증과 기능에 대한 VAS, ASES 점수 및 KSS 점수를 평가하였다. 결과: 관절운동 범위, 통증에 대한 VAS 점수, 기능에 대한 VAS 점수 및ASES 점수는 두 군 모두 술 전에 비해 최종 추시상 의미있는 향상을 보였으나 최종 추시상 두 군간에 통계학적으로 유의한 차이는 없었다 (p>0.05). KSS 점수도 최종 추시상 두 군간에 통계학적으로 유의한 차이는 없었다 (p>0.05). 결론: 관절경적 봉합술과 개방적 봉합술 모두 향상된 중기 임상 결과를 얻을 수 있었으며 두 군간에 의미있는 차이는 없었다.