• Journal of the Korean Orthopaedic Association
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• v.55 no.4
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• pp.294-304
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• 2020

Anterior cruciate ligament (ACL) reconstruction is a successful procedure independently by patient selection, timing of surgery, surgical technique, choice of graft, and fixation methods. Among these factors, graft selection and fixation methods might be the most critical yet controversial questions for surgeons. Although recent studies showed that grafts have advantages and drawbacks, there is still no ideal graft. Similarly, many fixation methods of femoral and tibial tunnels have been proposed over the last few decades, with no clear superiority of one technique over another. Surgeons should be familiar with a variety of grafts, fixation techniques, and their specific associated surgical procedures as well as the advantages and disadvantages of each. Therefore, this article summarizes the current literature and discusses the current state of graft selection and fixation methods in the treatment of an ACL injury.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.93-106
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• 2023

Reverse total shoulder arthroplasty (RTSA) emerged as a new concept of arthroplasty that does not restore normal anatomy but does restore function. It enables the function of the torn rotator cuff to be performed by the deltoid and shows encouraging clinical outcomes. Since its introduction, various modifications have been designed to improve the outcome of the RTSA. From the original cemented baseplate with peg or keel, a cementless baseplate was designed that could be fixed with central and peripheral screws. In addition, a modular-type glenoid component enabled easier revision options. For the humeral component, the initial design was an inlay type of long stem with cemented fixation. However, loss of bone stock from the cemented stem hindered revision surgery. Therefore, a cementless design was introduced with a firm metaphyseal fixation. Furthermore, to prevent complications such as scapular notching, the concept of lateralization emerged. Lateralization helped to maintain normal shoulder contour and better rotator cuff function for improved external/internal rotation power, but excessive lateralization yielded problems such as subacromial notching. Therefore, for patients with pseudoparalysis or with risk of subacromial notching, a medial eccentric tray option can be used for distalization and reduced lateralization of the center of rotation. In summary, it is important that surgeons understand the characteristics of each implant in the various options for RTSA. Furthermore, through preoperative evaluation of patients, surgeons can choose the implant option that will lead to the best outcomes after RTSA.

• Clinics in Shoulder and Elbow
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• v.21 no.2
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• pp.59-66
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• 2018

Background: Massive, irreparable rotator cuff tears (RCTs) are a challenging clinical problem in young patients. In recent years, arthroscopic superior capsular reconstruction (ASCR) is a popular treatment in the massive, irreparable RCTs. However, studies reporting clinical results of ASCR are rare in the literature. Methods: Between 2013 and 2015, six patients underwent ASCR. One patient treated with dermal allograft, while five patients with autogenous fascia lata graft. Demographic data, as well as preoperative and last follow-up clinical data including pain, range of motion (ROM), strength, American Shoulder and Elbow Surgeons system, the Constant system, the University of California at Los Angeles system, the Simple Shoulder Test, and the Shoulder Pain and Disability Index system were obtained. Acromiohumeral distances and Hamada classification were measured on standard anteroposterior x-ray. Results: All patients were men, and the average age was $59.5{\pm}4.18years$ (range, 53-65 years).The minimum follow-up was 18 months with a mean follow-up was $27.33{\pm}7.58months$ (range, 18-36). All patients had postoperative improvement in pain scores and functional scores. The ROM and strength did not improve after surgery. The Hamada score progressed of radiographic stage in 2 patients. In the case of dermal allograft, there was graft failure 6 weeks after ASCR. Conclusions: Our results support the ASCR as a viable treatment for surgical salvage in massive, irreparable RCTs. This treatment option may provide patients with decreased pain and increased function. And studying our case of dermal allograft failure provides opportunities to decrease graft failure in ASCR using dermal allograft.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.20-25
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• 2005

Purpose: To determine the locations and incidences of sesamoids and accessory bones of the forefoot in normal Korean adults. Materials and Methods: The plain radiographs of the forefoot of 400 volunteers, 200 males and 200 females, were taken. The three orthopedic surgeons participated in the radiographic evaluation independently. Persons who had history of foot problem or injury were excluded. Results: Sesamoids of first metatarsophalangeal joint were nearly always present; medial 99% and lateral 100%. The bipartite sesamoid was more common in medial (9.8%) and in female (17.0%) than in lateral (0.3%) and in male (2.5%). Sesamoids of the interphalangeal joint of the first toe were seen in 35.8%. Sesamoids of metatarsophalangeal joints in other four toes were rarely observed. Their incidences were 5% in second toe, 0.8% in third, 0% in fourth, and 2.8% (lateral) and 7.5% (medial) in fifth. Sesamoids of interphalangeal joint in four lesser toes were not observed except two cases (0.5%) in the fifth toe. Accessory bone was very rarely observed. Os vesalianum was observed in five feet (1.3%), Os intermetatarseum in 14 feet (3.5%), and Os cuneo-metatarsal I tibiale in none. Conclusion: We determined the location and incidences of sesamoids and accessory bones of the forefoot, and we expected this to help to diagnose the forefoot problem.

• Clinics in Shoulder and Elbow
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• v.23 no.3
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• pp.125-130
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• 2020

Background: To determine the prevalence of rotator cuff diseases in a population older than 40 years in or nearby Chuncheon city, Republic of Korea. Methods: Sixty shoulders of 30 people older than 40 years who participated in a health lecture were examined for free by an orthopedic surgeon. Visual analog scale of pain and American Shoulder and Elbow Surgeons scores were assigned, and routine physical examination was performed. Ultrasonography was performed on the shoulder. Results: On ultrasonographic examination, there were one shoulder with full thickness rotator cuff tear, 20 of 60 (33%) with partial thickness rotator cuff tear, five of 60 (8%) with calcific tendinitis, one of 60 (2%) with tear of the long head of the biceps, and five of 60 (8%) with tendinitis of the long head of the biceps. Participants older than 60 years showed significantly high proportions of lesion of the long head of the biceps and rotator cuff diseases (P=0.019 and P=0.015, respectively). Participants who performed physical labor had high proportions of rotator cuff tear and rotator cuff disease (P=0.001 and P<0.001, respectively). Conclusions: Rotator cuff diseases showed a high prevalence in aged persons and resulted in a decrease in shoulder function.

• Clinics in Shoulder and Elbow
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• v.24 no.2
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• pp.98-105
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• 2021

Background: Our aim is to determine the interobserver reliability for surgeons to detect Hill-Sachs lesions on magnetic resonance imaging (MRI), the certainty of judgement, and the effects of surgeon characteristics on agreement. Methods: Twenty-nine patients with Hill-Sachs lesions or other lesions with a similar appearance on MRIs were presented to 20 surgeons without any patient characteristics. The surgeons answered questions on the presence of Hill-Sachs lesions and the certainty of diagnosis. Interobserver agreement was assessed using the Fleiss' kappa (κ) and percentage of agreement. Agreement between surgeons was compared using a technique similar to the pairwise t-test for means, based on large-sample linear approximation of Fleiss' kappa, with Bonferroni correction. Results: The agreement between surgeons in detecting Hill-Sachs lesions on MRI was fair (69% agreement; κ, 0.304; p<0.001). In 84% of the cases, surgeons were certain or highly certain about the presence of a Hill-Sachs lesion. Conclusions: Although surgeons reported high levels of certainty for their ability to detect Hill-Sachs lesions, there was only a fair amount of agreement between surgeons in detecting Hill-Sachs lesions on MRI. This indicates that clear criteria for defining Hill-Sachs lesions are lacking, which hampers accurate diagnosis and can compromise treatment.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.2
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• pp.75-80
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• 2007

Purpose: To investigate the quality of training hospital based treatment, we evaluated the soft tissue sarcoma treatments afforded by general orthopedic surgeon rather than orthopedic oncologist. Materials and Methods: We reviewed the details of 25 patients with pathologically confirmed soft tissue sarcoma who registered in our hospital between July 1997 and 2006 September. We evaluated initial diagnoses, the surgical treatment (including adjuvant therapy) and the follow up method used and related these to the principles of soft tissue sarcoma treatment. Results: The study cohort comprised 16 men and 9 women of mean age of 50.2 years. A diagnostic biopsy was performed in 9(36%) cases before definitive surgical treatment. Wide excision was performed in 13(52%) cases. For the 12 cases in which the grade of sarcoma was estimated, adequate surgical treatment with adjuvant therapy was performed only in 4(33.3%) cases. In addition, an adequate follow up schedule was adopted in only 4(16%) of the 25 study subjects. Conclusion: Unexpectedly, many cases of soft tissue sarcoma were treated inadequately even in a training hospital. An intensive education program on the treatment of soft tissue sarcoma is necessary for all orthopedic surgeons.

• Journal of the Korean Medical Association
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• v.61 no.12
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• pp.710-714
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• 2018

A law revised in May 2012 provided support to regional and emergency centers for reducing the risk of preventable deaths. In particular, regional trauma centers have been established throughout the nation, with the goal of ensuring that any trauma patient can reach a trauma center within an hour. As a multidisciplinary approach is particularly important in treating severe trauma patients, activation teams are currently organized at each center to perform multiple simultaneous treatments. Under the present system, only 7 departments can participate in these trauma teams; emergency medicine, cardiothoracic surgery, general surgery, orthopedic surgery, neurosurgery, radiology, and anesthesiology. Plastic surgeons also play an essential role in treating trauma patients, and in fact currently treat many such cases. Especially in reconstruction procedures in patients with head and neck trauma and wide tissue defects, plastic surgeons possess unique expertise. However, since plastic surgeons are excluded from the trauma response teams due to institutional limitations, we describe the role and necessity of plastic surgery for trauma and emergency patients, and urge that the system be improved.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.109-114
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• 2009

Purpose: This study evaluated the preoperative and postoperative radiologic findings of patients with complete repairs after massive rotator cuff tears along with the incidence of re-tear and the clinical outcomes. Materials and methods: This study evaluated 33 cases who had open complete repairs for massive rotator cuff tears and these patients were followed up for more than 24 months. The clinical evaluation was performed according to the shoulder joint function test of the American Shoulder and Elbow Surgeons (ASES), and the degree of arthritis related to the massive rotator cuff tears was evaluated using the Hamada classification. Results: The ASES scores improved from 37.6 preoperatively to 85.6 postoperatively. The mean preoperative acromio-humeral interval (AHI) score was 6.5 mm, which increased to 9.3 mm immediately after surgery, and there was a decreased to 6.5 mm noted at the last follow up. The lower radiology stages of arthritis according to the classification showed better preoperative and postoperative results. Conclusion: An open complete repair as the surgical treatment for a massive rotator cuff tear showed satisfactory results for pain relief and an improvement in the shoulder joint function though re-tear after surgery.

• Clinics in Shoulder and Elbow
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• v.20 no.4
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• pp.183-188
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• 2017

Background: To evaluate the clinical outcomes and associated repair integrity in patients treated with arthroscopic repair for a transtendinous rotator cuff tear followed by resection of the remnant rotator cuff tendon. Methods: Between July 2007 and July 2011, we retrospectively reviewed patients who were treated for transtendinous full-thickness tears in the tendinous portion of the rotator cuff by arthroscopic repair. Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant-Murley score, a visual analogue scale (VAS) pain score, and range of motion (ROM). The repair integrity was determined by magnetic resonance imaging or ultrasonography. Results: There were 19 shoulders with transtendinous full-thickness tears in the tendinous portion of the rotator cuff. The ASES, UCLA, Constant-Murley, and VAS pain scores showed significant improvements in function and symptoms (all p<0.001). The active ROM for forward flexion and abduction was also significantly improved (p=0.002 and p<0.001, respectively). The postoperative radiological examination showed cuff integrity without a re-tear in 68.4% of patients. However, the UCLA, ASES, and Constant-Murley scores were not significantly different between healed and re-torn group (p=0.530, p=0.885, and p=0.262, respectively). Conclusions: Although repair of transtendinous rotator cuff tears followed by resection of the remnant rotator cuff tendon in the footprint has a relatively high re-tear rate, no significant difference was observed in the short-term clinical results between the re-tear and healed groups.