• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.59-64
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• 2007

Purpose: The purpose of this study was to evaluate the results of bioabsorbable knotless suture anchoring for isolated type II SLAP. Materials and Methods: Fourteen patients with isolated type II SLAP underwent a surgical repair with bioabsorbable knotless anchor arthroscopically. Instability, rotator cuff tears or simple subacromial decompression were excluded. The UCLA and pain of VAS (Visual Analogue Scale), ADL (Activity of Daily Living, from the American Shoulder and Elbow Society) were evaluated and patients underwent a thorough shoulder examination at a minimum follow-up period of 2 years postoperatively. Results: At a mean of 27.1 months follow-up. The mean UCLA score improved from 14.4 pre-operatively to 31.2 on last follow-up. The mean VAS for pain was 4.9 and on last follow-up 1.0. The mean VAS for instability was 2.6 and on last follow-up 0.5. The mean ADL was 10.4 and on last follow-up 25.0. 12 patients reported their satisfaction as good to excellent and 10 of the 14 patients returned to their pre-injury level of activity (athletics) (P<0.05). Conclusion: Arthroscopic repair with bioabsorbable knotless suture anchors is an effective surgical technique for the treatment of an isolated unstable type II SLAP lesion. Overall satisfaction was only 85.7%. 1 patient had severe stiffness and 1 patient had shoulder pain.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.78-83
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• 2007

Purpose: This study reports the clinical results of the tenodesis of long head of the Biceps brachii tendon with bioabsorbable interference screw by minimal open procedure. Materials and Methods: Ten cases of 10 patients (7 male, 3 female) were included in this study. The average age was 45.8 years old and the average period from the symptom onset to operation was 13.7 months. Average preoperative ASES score was 38.5. The causes of injury was; sports activities in 4 patients, unknown in 4 patients, industrial accident in 1 patient and traffic accident in 1 patient. The average follow up period was 12.1 months. Tenodesis with bioabsorbable interference screw by minimal open precedure was performed in all cases. Results: The ASES score improved to 87.5 at last follow up period and 6 cases had full range of motion of the shoulder. 4 cases had mild limited range of motion of the shoulder without any problem in normal daily activity. Conclusion: It was assumed that tenodesis of long head of the biceps brachii tendon with bioabsorbable interference screw by minimal open precedure was one of the good methods with good clinical results.

• 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.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.84-91
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• 2007

Purpose: The aim of this study was to report seven cases of metallic radial head prosthesis and present the limit of use in Korea. Materials and Methods: Metallic radial head arthroplasty was performed on 7 patients between April 2006 and December 2006, who had complex elbow injury including comminuted radial head fracture. Indication, operative findings and outcome were assessed. Availability and payment of implant were investigated. Results: All of the patients had more than one associated injury including coronoid fracture, olecranoan fracture, and ligament ruptures. According to Mason classification, there were three type III and four type IV fractures. All radial head fractures were too comminuted to reconstruct. There were two excellent results, four good, and one poor, as graded by Mayo score. There were no patient with instability and implant related complications. Insufficient supply of implant did not enable to do scheduled surgery in 2 cases. Current medical insurance did not cover charge for radial prosthesis, five patients could not help paying for that by themselves. Conclusion: Metallic radial head implants are useful when the radial head cannot be repaired reliably. Preoperative preparing and coverage by medical insurance based on appropriate indication are helpful for decision for a treatment option.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.27-32
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• 2007

Purpose: To investigate the validity of positive signs of supraspinatus test. Materials and Methods: The empty can test and full can test were performed on 200 shoulders which were diagnosed with magnetic resonance imaging or surgical findings as full thickness tear, partial thickness tear and no tear. Presence of pain, weakness, pain or weakness, and both pain and weakness were recorded as positive signs separately. The two tests with positive signs were compared and analyzed. Results: Pain and weakness were severity-dependent, and the empty-can test had a higher incidence of pain. The sensitivities of the two supraspinatus tests in all positive signs were higher when including partial-thickness tears in the tear group; however, their specificities were higher when excluding partial-thickness tears. The sensitivities of an empty-can test in 'pain', 'pain or weakness', 'both pain and weakness' were higher than those of the full-can test, otherwise, the specificity of the full-can test for 'pain' and 'pain or weakness' were higher. Concordance rate between 'pain or weakness' and 'pain' was the highest in all categorization. Conclusion: Both empty can and full can test were valuable for detecting torn rotator cuff.

• Clinics in Shoulder and Elbow
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• v.23 no.1
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• pp.3-10
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• 2020

Background: The aim of this study was to evaluate clinical experience with arthroscopic debridement for septic arthritis of the shoulder joint and to report on our patient outcomes. Methods: The retrospective analysis included 36 shoulders (male:female, 15:21), contributed by 35 patients (mean age, 63.8 years) treated by arthroscopy for septic arthritis of the shoulder between November 2003 and February 2016. The mean follow-up period was 14.3 months (range, 12-33 months). An additional posterolateral portal and a 70° arthroscope was used to access the posteroinferior glenohumeral (GH) joint and posteroinferior subacromial (SA) space, respectively. Irrigation was performed with a large volume of fluid (25.1±8.1 L). Multiple suction drains (average, 3.3 drains) were inserted into the GH joint and SA space and removed 8.9±4.3 days after surgery. Intravenous antibiotics were administered for 3.9±1.8 weeks after surgery, followed by oral antibiotic treatment for another 3.6±1.9 weeks. Results: Among the 36 shoulders, reoperation was required in two cases (5.6%). The average range of motion achieved was 150.0° for forward flexion and T9 for internal rotation. The mean simple shoulder test score was 7.9±3.6 points. Nineteen shoulders (52.8%) had acupuncture or injection history prior to the infection. Pathogens were identified in 15 shoulders, with Staphylococcus aureus being the most commonly identified pathogen (10/15). Both the GH joint and the SA space were involved in 21 shoulders, while 14 cases involved only the GH joint and one case involved only the SA space. Conclusions: Complete debridement using an additional posterolateral portal and 70° arthroscope, a large volume of irrigation with >20 L of saline, and multiple suction drains may reduce the reoperation rate.

• Clinics in Shoulder and Elbow
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• v.23 no.1
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• pp.11-19
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• 2020

Background: The purpose of this study was to evaluate and compare deltoid origin status following large rotator cuff repair carried out using either an open or an arthroscopic method with a propensity score matching technique. Methods: A retrospective review of 112 patients treated for full-thickness, large rotator cuff tear via either a classic open repair (open group) or an arthroscopic repair (arthroscopic group) was conducted. All patients included in the study had undergone postoperative magnetic resonance imaging (MRI) and clinical follow-up for at least 12 and 18 months after surgery, respectively. Propensity score matching was used to select controls matched for age, sex, body mass index, and affected site. There were 56 patients in each group, with a mean age of 63.3 years (range, 50-77 years). The postoperative functional and radiologic outcomes for both groups were compared. Radiologic evaluation for postoperative rotator cuff integrity and deltoid origin status was performed with 3-Tesla MRI. Results: The deltoid origin thickness was significantly greater in the arthroscopic group when measured at the anterior acromion (P=0.006), anterior third (P=0.005), and middle third of the lateral border of the acromion level (P=0.005). The deltoid origin thickness at the posterior third of the lateral acromion was not significantly different between the arthroscopic and open groups. The arthroscopic group had significantly higher intact deltoid integrity with less scarring (P=0.04). There were no full-thickness deltoid tears in either the open or arthroscopic group. Conclusions: Open rotator cuff repair resulted in a thinner deltoid origin, especially from the anterior acromion to the middle third of the lateral border of the acromion, at the 1-year postoperative MRI evaluation. Meticulous reattachment of the deltoid origin is as essential as rotator cuff repair when an open approach is selected.

• Clinics in Shoulder and Elbow
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• v.6 no.1
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• pp.55-66
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• 2003

Background: The purpose of this study was to evaluated results of arthroscopic treatment of the traumatic recurrent unidirectional posterior subluxation. Materials and Methods: We treated twenty-seven patients who had traumatic recurrent unidirectional posterior subluxation of the shoulder by arthroscopic labral repair and posterior capsular shift and prospectively evaluated for a mean of thirty-nine months (range,24 to 85 months). Patients who had posteroinferior instability, multidirectional instability, atraumatic onset, or revision cases were excluded. There were twenty-five male and two female patients with the mean age of twenty-one years (range, 14 to 33 years). All patients were involved in sports activity. All had a significant traumatic event prior to the onset of the instability. Stability, motion, three objective measurement (UCLA, ASES, and Rowe scores) and two subjective measurements (pain and function visual analogue scale) were evaluated. Results: The most common finding in magnetic resonance image-arthrogram was separation of the posteroinferior labrum without displacement in 9 patients, In arthroscopic examination, all patients had one or more lesions in the posterior inferior labrum and capsule. The most common finding was incomplete stripping of the posterior inferior labrum (18 patients). The posteroinferior capsule subjectively appeared to be stretched in twenty-two patients. At follow-up, all patients had improved shoulder function and scores(p < 0.01). All patients had stable shoulder by subjectivel and objectivel measurements, except one patient who had recurrent subluxation. All but one patient with postoperative recurrence were able to return to their prior sports activity with little or no limitation. Twenty-four patients were graded as having more than 90％ of shoulder function. Their were twenty-one excellent, five good, and one fair UCLA. scores. Pain sore improved from 4.5 to 0.2 point(p : 0.0001). Mean loss internal rotation was one vertebral level. None had operative complications. Conclusion: In conclusion, treatment outcomes of the traumatic unidirectional recurrent posterior subluxation are consistently reliable with respect to the stability, pain relief, and functional restoration by the arthroscopic posterior capsular shift procedure.

• Clinics in Shoulder and Elbow
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• v.6 no.1
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• pp.72-79
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• 2003

Purpose: To compare the results of arthroscopic rotator cuff repair and subacromial decompression in partial thickness rotator cuff tear (PTRCT) with those in full thickness rotator cuff tear (FTRCT). Subjects and method: Of the 46 patients who were rested of the rotator cuff tear based on the operational findings, 42 patients who were able to receive a serial follow-up for 2 years were selected as the study subjects. The average age of the patients at the time of the operation was 55 years, and the mean duration of the follow-up was 34 months. The subjects included 22 cases of PTRCT and 20 cases of FTRCT. In terms of rotator cuff repair, the average number of tendon to tendon repair (TTR) was 1 in both PTRCT and FTRCT, and that of tendon to bone repair (TBR) was 1 and 3 in PTRCT and FTRCT, respectively. The average number of use of suture anchor was 1 and 2 in PTRCT and FTRCT, respectively. The level of shoulder pain and function of the subjects were measured using shoulder functional evaluation score of American shoulder and elbow society (ASES score) at before and 2 years following the operation. Results: At the final follow-up following the operation, PTRCT group showed changes in scores from 7.2 to 0.9 on average pain score and 34 to 91 on ASES score, whereas FTRCT group showed changes in scores from 7.6 to 1.2 on pain score and 29 to 88 on ASES score. There were no significant differences between the two groups (P > 0.05). The average range of motion of shoulder significantly increased in both groups at the final follow-up in comparison with the pre-operative time point. The evaluation at the final follow-up showed that 93% of the total subjects showed good or excellent results, and 95％ showed satisfactory results from the procedure with regard to pain reduction and functional outcomes. Two cases of the 3 fair results were caused by acromioclavicular arthritis. Conclusion: It may be anticipated that arthroscopic rotator cuff repair and subacromial decompression may bring satisfactory post-operative outcomes in both PTRCT and FTRCT on pain relief and functional recovery. However, careful preoperative examination of the acromioclavicular joint is critical to avoid failures of these procedures.

• Clinics in Shoulder and Elbow
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• v.6 no.2
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• pp.143-148
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• 2003

Objectives: To analyze the postoperative functional outcome of shoulder in patients with arthroscopically assisted repair of large to massive rotator cuff tears with or without acromioplasty and role of acromioplasty. Materials and Methods: From June 1996 to June 2002, twenty six patients with large to massive rotator cuff tears were undergone arthroscopically assisted repair. Mean follow up was over one year. Fourteen were male and twelve were female. Mean age was 51 years old(39-66). Mean duration was 9 months. Acromioplasty was done in 14 cases concomitantly. They were divided into two groups. Group I: arthroscopic cuff repair with acromioplasty(14 cases). Group II: arthroscopic cuff repair without acromioplasty(12 cases). Each shoulder was evaluated at preoperative and final follow-up with Visual Analogue Scale(VAS), University of Pennsylvania Patient self-assessment of pain, University of Pennsylvania Patient self-assessment of function, ASES standardized shoulder assessment form, Simple Shoulder Test, UCLA score and range of motion(ROM). We analyzed the differences between the two groups. Shoulder ROM and acromioplasty were determining factors. Statistics was tested by correlation analysis and repeated measure ANOVA test. Results: At the final follow up, functional outcome and pain were improved but they had no statistical significance between the two groups(p>0.05). Combined procedure, acromioplasty, didn't affect on VAS. UCLA score, University of Pennsylvania Patient self-assessment of pain, University of Pennsylvania Patient self-assessment of function, ASf:S standardized shoulder assessment form and Simple Shoulder Test(p>0.05). In group II, forward flexion and abduction were statistically improved at the final follow up than in group I(p<0.05). Conclusions: It appears that arthroscopic repair is satisfactory procedure in patients with large to massive cuff tears. Combined procedure, acromioplasty, doesn't affect on postoperative functional outcome of shoulder.