• Clinics in Shoulder and Elbow
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• 제27권2호
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• pp.149-159
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• 2024

Background: In rotator cuff repair, the long head of the biceps tendon (LHB) is commonly used as graft material. However, factors influencing LHB tear severity are poorly understood, and predicting grade II LHB tears is challenging. This study aimed to identify these factors preoperatively. Methods: The demographics, medical parameters, and pain severity of 750 patients who underwent arthroscopic surgery from January 2010 to February 2021 were evaluated to determine the factors associated with LHB tear severity and grade II tears. Both overall and large-to-massive rotator cuff tear (RCT) cohorts underwent ordinal and binary logistic regression analyses. Predictive accuracy for grade II LHB tears was determined using the area under the receiver operating characteristic curve (AUC). Results: In the overall cohort, high-sensitivity C-reactive protein (hs-CRP) >1 mg/L (P<0.001), subscapularis tear (P<0.001), hypothyroidism (P=0.031), and the tangent sign (P=0.003) were significantly associated with LHB tear severity, and hs-CRP>1 mg/L, subscapularis tear, and Patte retraction degree were significantly associated with grade II LHB tears (P<0.001). In the large-to-massive RCT cohort, hs-CRP>1 mg/L, hypertension, and age ≥50 years (P<0.05) were significantly associated with LHB tear severity, and hs-CRP>1 mg/L (P<0.001) and hypertension (P=0.026) were significantly associated with grade II LHB tears. In both cohorts, hs-CRP >1 mg/L demonstrated good predictive accuracy for grade II LHB tears (AUCs: 0.72 and 0.70). Conclusions: Serum hs-CRP >1 mg/L is associated with LHB tear severity and serves as a reliable predictor of grade II LHB tears, facilitating preoperative assessment of the LHB as potential graft material in arthroscopic rotator cuff repair. serves as a reliable predictor of grade II LHB tears, facilitating preoperative assessment of the LHB as potential graft material in arthroscopic rotator cuff repair. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.22-27
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• 2022

Background: In some patients with rotator cuff tear (RCT), the axial view of magnetic resonance imaging (MRI) shows subtle posterior decentering (PD) of the humeral head from the glenoid fossa. This is considered to result from a loss of centralization that is typically produced by rotator cuff function. There are few reports on PD in RCT despite the common occurrence of posterior subluxation in degenerative joint disease. In this study, we investigated the effect of PD in arthroscopic rotator cuff repair (ARCR). Methods: We conducted a retrospective study of consecutive patients who underwent ARCR at our institute and were followed-up for at least 1 year. PD was identified as a 2-mm posterior shift of the humeral head relative to the glenoid fossa in the axial MRI view preoperatively. The tear size and fatty degeneration (FD, Goutallier classification) were also evaluated using preoperative MRI. Retears were evaluated through MRI at 1 year postoperatively. Results: We included 135 shoulders in this study. Ten instances of PD (including seven retears) were observed preoperatively. Fifteen retears (three and 12 retears in the small/medium and large/massive tear groups, respectively) were observed postoperatively. PD was significantly correlated with tear size, FD, and retear occurrence (p<0.01 each). The odds ratio for PD in retears was 34.1, which was greater than that for tear size ≥3 cm and FD grade ≥3. Conclusions: We concluded that large tear size and FD contribute to the occurrence of PD. Furthermore, PD could be a predictor of retear after ARCR.

• Clinics in Shoulder and Elbow
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• 제9권2호
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• pp.176-180
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• 2006

Purpose: Although surgical arthroscopic repair of rotator cuff has become much more common as surgeons have developed proficient techniques, it is still technically difficult. The purpose of this study was to evaluate the clinical results and the usefulness of mini-open repair in large and massive size tears. Materials & Methods: From January 2000 to December 2004, sixteen patients were treated with mini-open repair. There were 10 male and 6 female patients with the average age of 62.5 years. The size of tear was massive in 4 cases and large in 12 cases. All tears were repaired with metal anchor sutures. The mean duration of follow-up period was 23 months. Postoperative results were evaluated based on American Shoulder and Elbow Society scoring system. Results: Five patients showed excellent results, five good, and two fair in large tears while one patient showed excellent result, one good, and two fair in massive tears. Poor outcome was not seen during the follow-up period. There was no significant relationship between the patient's age and the size of tear, and postoperative results. However, the relationship between the duration of symptomatic period in preoperation and postoperative results showed significant correlation. Conclusion: Mini-open repair combined with the preservation of deltoid and early rehabilitation is clinically useful in large and massive size rotator cuff tear patients treatment.

• Clinics in Shoulder and Elbow
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• 제9권1호
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• pp.83-88
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• 2006

Purpose: To evaluate the usefulness of arthroscopic decompression and miniopen repair that was related with large and massive sized full thickness rotator cuff tear and assess clinical result. Materials and Methods: Twenthy-nine cases of miniopen repaired full thickness tear of rotator cuffs that arthroscopically decompressed were studied. From October 1998 to December 2004 we have analysed 29 repairs of large and massive sized FTRCT, the average age 44 ($32{\sim}71$) years old, mean follow-up was 34 ($12{\sim}84$) months. We analyzed the results statistically by paired t-test. Results: Postoperative VAS of pain improved average 7.0 to 1.7, UCLA score improved 13.7 to 31.9, ADL improved 11.3 to 25.3 respectively (all, P=0.000). Twenty five cases(82.8%) of the patients showed excellent & good results at the final follow-up. The satisfied rate was 26 cases(89.7%). Conclusions: Arthroscopic decompression and miniopen repair in large and massive sized full thickness rotator cuff tears are effective surgical methods.

• Clinics in Shoulder and Elbow
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• 제15권2호
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• pp.91-98
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• 2012

목적: 65세 이상 고령 환자의 대형 및 광범위 회전근 개 파열에서 관혈적 회전근 개 봉합술의 결과를 평가하고자 하였다. 대상 및 방법: 1995년 9월부터 2010년 3월까지 대형 및 광범위 회전근 개 파열로 관혈적 견봉 성형술 및 회전근 개 봉합술을 시행 받은 환자 중 65세 이상이고 1년 이상 추시가 가능했던 147례를 대상으로 하였다. 대형 파열이 67예, 광범위 파열이 80예였으며 평균연령은 69.6세였다. 임상평가는 수술 전과 후 근력, 운동 범위, ASES 점수, Constant 점수를 측정하였고, 87예에 대해 자기공명영상 검사를 시행하여 건의 연속성을 평가하였다. 결과: ASES 점수는 50.4점에서 88.9점, Constant점수는 47.1점에서 75.2점, 극상근 근력은 51.1%에서 80.8%, 외회전근 근력은 64.5%에서 83.1%, 관절 운동범위는 전방거상이 117.4도에서 153도, 외회전은 23.64도에서 41.8도로 회복되었다. 자기공명영상 추시 검사를 시행한 87예 중 20예에서 재파열이 발생하였고, 1예를 제외하고 모두 광범위 파열에서 재파열이 발생하였다. 결론: 65세 이상 고령 환자에서 회전근 개 파열의 크기가 크더라도 적극적으로 봉합술의 시행을 고려하는 것이 임상적 결과를 호전시키기 위해 바람직할 것으로 사료된다.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2004년도 학술대회
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• pp.1-1
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• 2004

• Clinics in Shoulder and Elbow
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• 제21권4호
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• pp.207-212
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• 2018

Background: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears. Methods: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS). Results: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be $15.46{\pm}3.60mm$ and $14.17{\pm}3.16mm$ (p=0.013), and muscle atrophy of SS (occupation ratio) was $60.54{\pm}13.15$ and $56.55{\pm}12.88$ (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups. Conclusions: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.

• Clinics in Shoulder and Elbow
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• 제20권3호
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• pp.162-166
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• 2017

Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.

• Clinics in Shoulder and Elbow
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• 제11권2호
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• pp.104-111
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• 2008

서론: 관절경하 회전근개 봉합 시 상완 이두 근 장두를 회전근 개 건 결손부위에 포함한 봉합법의 임상적 결과에 대하여 평가하는 것이다. 재료 및 방법: 2005년 1월부터 2007년 1월까지 대파열 또는 거대파열의 회전근개 완전 파열을 가진 환자 총 21명을 대상으로 상완 이두 근 장두를 포함하여 관절경하 회전근 개 봉합술을 시행하였다. 남자 9명, 여자 12명이었으며 평균 나이는 60.3세(47~73세)이었다. 평균 추시 기간은 23개월(6~48)이었으며, 추시 된 모든 환자에게 University of California Los Angeles (UCLA), the shoulder index of the American Shoulder and Elbow Surgeons (ASES)와 simple shoulder test (SST)를 이용하여 술 전과 마지막 추시 시 점수를 비교하였다. 결과: 마지막 추시(평균 23개월)에서 VAS 점수, ASES, UCLA점수와 SST 점수는 통계적으로 의미 있게 향상되었다(p<0.05). 초음파와 MRI를 이용하여 추시 한 9예 중에서 2예 에서는 부분 파열의 소견을 보이며 건의 연결성이 관찰되었으나 나머지 7예에서는 모두 완전 파열된 소견이 관찰되었다. 결론: 회전근 개 대파열이나 광범위 파열 환자에서 상완 이두 근 장두를 관절와에서 분리시키지 않고, 회전근 개 봉합술을 시행하는 방법은 권장할 만한 술식으로 사료된다.

• 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.