• 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.9 no.2
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• pp.181-188
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• 2006

Purpose: To evaluate the integrity of repair & technical tip in use of Massive Cuff Stitch at arthroscopic repair of rotator cuff tear. Materials and Methods: Twenthy-nine cases of arthroscopically repaired full thickness tear of rotator cuffs which are medium sized were evaluated. Between December 2004 to September 2005 we have studied, the average age 53($42{\sim}69$) years old, mean follow-up was 15($12{\sim}21$) months. We analyzed the results statistically by paired t-test. The integrity of repair were verified by follow up MRI which were checked 11 cases and ultrasound which were checked 10 cases. Results: VAS of pain improved preoperative average 7.1 to postoperative 0.9, ADL improved 11.2 to 25.6 respectively, UCLA improved 13.7 to 32.9(all, P<0.05). 89.7% showed excellent & good results at the final follow-up. The satisfied rate was 93.1%(27 cases). There was re-rupture of the repaired rotator cuff in one case out of 11 cases which were checked by MRI, and in one case out of 10 cases which were checked by ultrasound, and there was one case of thinning of cuff which were checked by ultrasound. Conclusion: The use of Massive Cuff Stitch in arthroscopic repair of rotator cuff tear have been reduced technical failure. It will be good surgical technique which maintain the integrity of repairs.

• Journal of Korean Medicine Rehabilitation
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• v.24 no.1
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• pp.77-82
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• 2014

Objectives Adhesive capsulitis (AC) is a restricted shoulder range of motion. Rotator cuff disease (RCD) has been believed to be a major etiologic factor of AC, however, how soon is the development time from RCD to AC (DTRA) has not been elucidated. The purpose of our study was to evaluate the correlation between the ultrasonographic characteristics of RCD and the DTRA. Methods Total 40 patients who were diagnosed as AC were recruited. The clinical characteristics of RCD were diagnosed by ultrasonography and classified with the Southern California Orthopedic Institute for Rotator Cuff Classification. The correlation was analyzed with Mann-Whitney U test and one-way analysis of variance. Results 60% of full thickness tear and 40% of partial thickness tear patients (10 male and 30 female, mean age of $54.0{\pm}8.4$ years) and 38% of bursitis and 21% of neovascularization were observed. The mean value of DTRA was $74.8{\pm}131.3$ days. There were no correlation between DTRA and gender (p=0.63), location of the partial tear (p=0.63), the severity of the partial thickness tear (p=0.63), full thickness tear (p=0.66) and completeness of the tear (p=0.16). The presence of bursitis or neovascularization was not associated with DTRA (p=0.60, p=0.61). Conclusions Although RCD is a major etiologic factor of AC, the severity, the type of RCD and the presence of bursitis and neovascularization were not statistically correlated with the DTRA in our study. Comprehensive consideration about etiologic factor analysis of AC will be needed with prospective study design for future study.

• Journal of Korean Orthopaedic Sports Medicine
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• v.3 no.1
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• pp.73-80
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• 2004

Purpose: To compare the results of a miniopen repair with those of complete arthroscopic repair in medium and large sized full thickness rotator cuff tears. Materials and Methods: The thirty four(34) patients with medium and large sized complete rotator cuff tear were observed, Group I (complete arthroscopic repair) were 13 cases and group II (miniopen repair) were 21 cases. The tear sizes are from 1cm to 5cm. The average follow up periods are 24(range;12$\~$36) and 28(range; 12$\~$36) months. Subjective pain was evaluated with VAS (visual analogue scale) in rest state. ADL (Activity of Daily Living) and UCLA scoring system were used to evaluate clinical results. Results: At last follow-up periods, pain and functional scores were improved but they had not been shown statistical significance (p>0.05). In the group I and group II, there are no significant difference in VAS, ADL; UCLA score, satisfaction (p>0.05). Conclusions: In medium and large sized full thickness rotator cuff tears, there are no significant clinical results between the arthroscopic and miniopen group.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.50-57
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• 2006

Purpose: The purpose of this study was to evaluate the tendon healing of arthroscopic repair in full-thickness supraspinatus tears. We evaluate the effectiveness of the arthroscopic repair of full-thickness supraspinatus tears by assessing functional improvement. Materials and Methods: Thirty consecutive full-thickness supraspinatus tears were repaired arthroscopically in 19 patients with a one row of anchor and 11 patients with two rows of anchors. Patients ranged in age from 51 to 79 years (average 63 years). Average follow-up was 16 month (range, 12 to 28 months). To evaluate the effectiveness of the arthroscopic repair of full-thickness supraspinatus tears by assessing functional improvement, we calculate the Constant, ASES, UCLA scores. The 30 patients had either an MR Arthrogram (25 cases) or an MRI (5 cases), performed between 5 months and 20 months (mean 10 months) after surgery. Results: The cuff was healed in 21/30 cases (70%) and partially torn in 3 cases (10%) after the arthroscopic repair of full-thickness supraspinatus tear. Although the supraspinatus tendon was totally torn to the tuberosity in 6 cases(20%) after the arthroscopic repair, the size of the tear was smaller than the initial in 5 cases. The Constant score improved from an average of $55.7{\pm}7.1$ points preoperatively to $77.7{\pm}9.7$ points at the last follow-up (p<0.001), and the average ASES score improved from $39.2{\pm}7.4\;to\;72.4{\pm}12.6$ (p<0.001), and the average UCLA score improved from $17.9{\pm}2.2\;to\;26.8{\pm}5.0$ (p<0.001). Strength of elevation was significantly better $(7.1kgs{\pm}2.4)$ in the shoulders with a healed tendon that in those with an total or partial re-tear tendon $(4.5kgs{\pm}1.0)$ (p<0.05). Factors adversely affecting tendon healing were increasing age, Only 41.7% of the repairs completely healed in patients over 65 years (p<0.05). Conclusion: Arthroscopic repair of isolated full-thickness tear of the supraspinatus leads to completely healing in 70% of the cases. Total or partial re-tear of the repaired rotator cuff is associated with a decreased strength. Older patients had significantly lower healing rates.

• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.77-81
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• 2009

In patients with full-thickness tears of the rotator cuff, the tendon is usually detached from its bony insertion in the greater or lesser tuberosity. We experienced an unusual pattern of rotator cuff tear in two cases, in which complete rotator cuff tears occurred at the tendinous portion (i.e., intrasubstance tears) with more than a 1cm remnant attached to the greater tuberosity. Arthroscopic tendon-totendon repair was performed without remnant removal in both cases. Follow-up MRI at 6 months showed re-tear of the rotator cuff at the previous tear site in both of our patients. To prove the availability of arthroscopic tendon-to-tendon repair in such cases, a larger case follw-up and biomechanical studies are required.

• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.26-31
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• 2024

Background: The coracoacromial ligament (CAL) is frequently observed to be damaged during arthroscopy and it is unclear how demographic, anatomic, and radiographic factors are related to CAL degeneration in full-thickness rotator cuff tears. Methods: A prospective study was conducted of patients at a single institution undergoing shoulder arthroscopy for first-time, full-thickness rotator cuff tears. We evaluated preoperative anteroposterior radiographs to obtain critical shoulder angle, glenoid inclination, acromial index, acromiohumeral distance, lateral acromial angle, and acromial morphology. We documented CAL quality, rotator cuff tear size and pattern during arthroscopy. Multiple logistic regression was used to identify predictive factors for encountering severe CAL fraying during arthroscopy. Results: Shoulders had mild CAL degeneration in 58.1% of cases, whereas severe CAL degeneration was present in 41.9% of shoulders. Patients with severe CAL attrition were significantly older (62.0 years vs. 58.0 years, P=0.042). Shoulders with severe CAL attrition had large rotator cuff tears in 54.1% of cases (P<0.001), and tears involving the infraspinatus (63.2% vs. 29.6%, P=0.003). The severe degeneration group was more likely to have a larger critical shoulder angle measurement on preoperative radiographs than those in the mild attrition group (36.1°±3.6° [range, 30°-45°] vs. 34.1°±3.8° [range, 26°-45°], P=0.037). Conclusions: While the clinical impact of CAL degeneration remains uncertain, increased severity of CAL degeneration is associated with older age, larger rotator cuff tear size, presence of infraspinatus tearing, and increased preoperative critical shoulder angle. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.53-56
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• 2008

Periarticular cysts in the shoulder joint are relatively rare. The most common are paralabral cysts, which can cause suprascapular nerve entrapment syndrome. Acromioclavicular juxtaarticular cysts have been described in association with full-thickness rotator cuff tears and a degenerated acromioclavicular joint. Intramuscular cysts of the rotator cuff are a relatively rare and unknown type of periarticular cyst. We report a case of an intramuscular cyst of the rotator cuff that was associated with a tear of the rotator cuff.

• Clinics in Shoulder and Elbow
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• v.5 no.2
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• pp.88-97
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• 2002

The purpose of this study was to compare the outcomes between arthroscopir repair and mini-open repair of medium and large rotator cuff tears in which arthroscopic repair was technically unsuccessful. We evaluated 76 patients of full-thickness rotator cuff tears, among them 42 patients had all-arthroscopic and 34 patients had mini-open salvage repairs. Patients who had acromioclavicular arthritis, subscapularis tear, or instability were excluded. There were 39 males and 37 females with mean age of 56 years (range,42 to 75 years). At a mean follow-up of 39 months (range, 24 to 64 months), the results of both groups were compared with regard to the UCLA and ASES shoulder rating scale s. Shoulder scores improved in all ratings in both groups (p > 0.05). Overall, sixty-six patients showed excellent or gr)of and ten patients showed fair or poor scores by the UCLA scale. Seventy-two patients satisfactorily returned to prior activity. Four showed unsatisfactory return. The range of motion, strength, and patient's satisfaction were improved postoperatively. There were no difference in shoulder scores, pain, and activity return between the arthroscopic and mini-open salvage groups (p > 0.05). However, Patients with larger size tear showed lower shoulder scores and less predictive recovery of the strength and function (p < 0.05). Postoperative pain was not different with respect to the size of the tear (p : 0.251). Arthroscopic repair of medium and large full-thickness rotator cuff tears had iln equal outcome to technically unsuccessful arthroscopic repairs, which were salvaged by conversion to a mini- open repair technique. Surgical outcome depended on the size of the tear, rather than the method of repair.

• Clinics in Shoulder and Elbow
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• v.18 no.4
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• pp.211-216
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• 2015

Background: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. Methods: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. Results: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. Conclusions: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.