• Clinics in Shoulder and Elbow
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• 제27권2호
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• pp.212-218
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• 2024

Background: Rotator cuff tears commonly cause shoulder pain and functional impairment, prompting surgical intervention such as mini-open and arthroscopic methods, each with distinct benefits. This study aimed to compare the clinical outcomes and complications of these two approaches. Methods: A retrospective analysis was conducted on 165 patients who underwent rotator cuff repair using either arthroscopic-assisted mini-open or full arthroscopic approaches. Patient demographics, tear characteristics, clinical outcomes, and complications were assessed, with statistical analyses conducted to discern differences between the groups. Results: Among the patients, 74 (53.2%) received the mini-open approach, while 65 (46.8%) underwent arthroscopic repair, with a mean follow-up of 19.91 months. The mini-open group exhibited significantly higher postoperative American Shoulder and Elbow Surgeons (ASES) scores compared to the arthroscopic group (P=0.002). Additionally, the mini-open group demonstrated a more significant improvement in ASES scores from preoperative to postoperative assessments (P=0.001). However, the arthroscopic method had a significantly longer operative time (P<0.001). Complications, including anchor placement issues, frozen shoulder, infection, and re-rupture, occurred in 17.3% of patients overall. Re-rupture rates were 13.5% for mini-open and 6.2% for full arthroscopic repair, with no significant difference between the two methods (P=0.317). Conclusions: Both the mini-open and arthroscopic methods yielded favorable clinical outcomes for rotator cuff tear treatment, but the mini-open group exhibited superior results. Surgeons should consider patient characteristics, tear attributes, and surgical expertise when selecting the appropriate technique.

• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.269-271
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• 2015

Latissimus dorsi tendon transfer is a well-established method for treatment of irreparable posterosuperior rotator cuff tears. We report on an anterolateral mini-open technique with a porcine dermal patch augmentation for latissimus dorsi tendon transfer. Use of this technique would result in avoidance of deltoid damage by anterolateral mini-open approach and reduction of failure rate by patch augmentation.

• Clinics in Shoulder and Elbow
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• 제7권1호
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• pp.30-34
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• 2004

Purpose: To report our experience of treatment of rotator cuff tear and evaluate the mid-term outcome. Materials and Methods: We have performed 50 cases of mini-open rotator cuff repair from March 1996 to March 1999. Male to female ratio was 34：16, the average age 46.5(23∼57) years old, mean follow-up period was 78(62∼93) months. All-arthroscopic repair and open repair cases were excluded. Mean symptomatic period was 12.5(6∼38) months, operation was indicated in cases of no improvement by 6 months of conservative management. Preoperative simple radiographs and Magnetic resonance arthrography were obtained in all cases. We also observed the inflammation, synovitis, thickness of tear and associated pathology intraoperatively. We evaluated pain, function, and range of motion by UCLA score. Results: Overall UCLA score was mean 29.5 points. Excellent 25, good 18, poor 7 cases. Mean pain score was improved 2.6 to 7.5, 44 cases(88%) were improved and 6 cases(12%) were not improved. Mean functional score was improved 3.4 to 8.5, and activity at follow up, 25 cases(50%) were same, 8 cases(14%) were above, 17 cases(34%) were below compared with preoperative level. Mean active forward flexion was preoperative 112° to postoperative 160°, forward flexion strength was improved 3.8 to 4.7. 43 cases(86%) of patients were satisfied at the result, 7 cases(14%) were not satisfied or aggravated. Results: Mini-open rotator cuff repair was effective method in treating rotator cuff tear.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.110-114
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• 1999

We reviewed the results of arthroscopic surgery in patients with rotator cuff disease. Arthroscopic subacromial decompression(ASD) was performed on 22 patients with rotator cuff disease who had not responded to nonoperative measures. In the patients who had a complete tear of the rotator cuff(four of ten Neer's stage III patients), mini-open repair also was performed. Results were determined by questioning patients about their satisfaction with the outcome of surgery and by functional assessment of the shoulder with the parameters of pain, function, and range of motion according to the UCLA shoulder rating scale. The average follow-up was 21 months. The results were sixteen(72%) excellent, three(14%) good, two(9%) fair, and one(5%) poor. The following variables were analyzed to assess their influence on final outcome; duration of preoperative symptoms, Neer's stage(extent of damage to the cuff), type of acromion. Satisfactory results were achieved in thirteen of fourteen patients(93%) who had duration of preoperative symptoms below one year, and in four of six(67%) above 2 years. And satisfactory results were achieved in eleven of twelve patients(92%) who had Neer's stage II and in eight of ten(80%) stage III and achieved in six of seven patients(86%) who had Bigliani's acromion type I, in nine of eleven(82%) type II, and in four of four(100%) type III. There are multiple factors that may influence the recovery after ASD or the eventual outcome. However, although there is still a controversy about the pathogenesis of rotator cuff disease, We found that arthroscopic subacromial decompression and mini-open repair in patients with rotator cuff disease were well enough documented to be considered a standard treatment.

• 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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• 제17권3호
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• pp.145-150
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• 2014

In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis.

• Clinics in Shoulder and Elbow
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• 제6권1호
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• pp.50-54
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• 2003

Object: To evaluate the efficiencies of the arthroscopic rotator cuff surgery which is Performed without the traction system in the lateral decubitus position. Methods: Twenty-nine cases of the arthroscopic rotator cuff surgery performed without the traction system in the lateral decubitus position were studied from February, 2002 to January, 2005. We performed a repair using the arthroscopic debridement and the arthroscopic rotator cuff repair, or using the mini-open incision technique after the confirmation of rotator cuff tear, then, the arthroscopic subacromial decompression was performed after the confirmation of subacromial lesions Results: We could easily find the subscapularis tear which was often overlooked in the arthroscopic rotator cuff surgery performed with the traction surgery by the relaxation of the subscapularis, as the arm position was internally rotate about 45 to 70 degrees from abducted position. We found that the operation time was reduced 14 minutes shorter than the operation time of the controlled group which had the surgery with the traction system on the average. We also found that there were no neurovascular complications from all cases. Conclusions: The arthroscopic rotator cuff surgery without traction system in the lateral decubitus position provided the better visual field, easy manipulation of the joint and reducing operation time.

• Clinics in Shoulder and Elbow
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• 제5권2호
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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.

• 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.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.86-91
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• 2010

목적: 회전근 개 파열에서의 전외측 도달법을 이용한 소절개 봉합술을 소개하고 임상적 결과 및 그 효용성을 알아보고자 하였다. 대상 및 방법: 전외측 도달법을 이용한 소절개 봉합술을 시행하고 1년 이상 추시 관찰이 가능하였던 59예를 대상으로 하였다. 평균 연령은 56.6 (39~71)세였고, 남자가 39예, 여자가 20예였으며, 평균 추시 기간은 26 (12~41)개월이었다. VAS 점수 및 ADL 지수를 이용하여 동통 및 기능적 평가를 시행하였고, 임상적 결과의 판정은 ASES 점수를 이용하였다. 결과: VAS 점수는 술 전 7.04점에서 최종 추시시 1.02점으로, ADL 지수는 12.37점에서27.20점으로 호전되었으며, ASES 점수는 술 전 35.32점에서 최종 추시시 90.08점으로 향상되었다(p=0.000). 임상적 결과는 우수 41예, 양호 11예, 보통 2예, 불량 5예로 52예 (88.1%)에서 만족할 만한 임상적 결과를 나타내었다. 나이, 성별, 증상 기간, 파열의 크기, 술 전 견관절 강직과 최종 추시 ASES 점수와의 통계학적 유의성은 없었다 (p>0.05). 결론: 전외측 도달법을 이용한 소절개 봉합술은 만족할 만한 임상적 결과를 보였으며 시야 확보에 유리한 술식으로 사료된다.