• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.242-248
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• 2009

Purpose: To evaluate the clinical and radiologic results of the arthroscopic rotator cuff repair for partial articular surface tendon avulsion lesion. Materials and Methods: Twelve patients with symptomatic, partial articular surface tendon avulsion underwent arthroscopic rotator cuff repair between Mar. 2006 and Sep. 2008. The mean follow-up period was 18.3 months(12~36 months), and the mean age at the time of surgery was 46.9-year-old(19~64 years). Three cases had underwent rotator cuff repair after conversion to full-thickness tear and nine cases had transtendon repair with preserving bursal side cuff. Results: The mean VAS during motion was 6.2 before treatment and 2.0 at final follow-up (p<0.001). The passive forward flexion improved from $163.3^{\circ}$ preoperatively to $169.8^{\circ}$ postoperatively (p=0.038). The mean UCLA score improved from 18.4 preoperatively to 30.1 with 2 excellent, 8 good and 2 fair results at final follow-up. The mean KSS improved from 61.8 preoperatively to 76.8 at final follow-up. By examining the postoperative MR images of 5 patients, complete healing was observed in all of them. Conclusion: Arthroscopic rotator cuff repair may be an effective procedure for partial articular surface tendon avulsion in pain relief and improvement of the range of motion. If the remaining bursal side cuff fibers are intact, transtendon repair procedure with preserving the intact bursal layer of the tendon can be considered. If the remaining bursal side cuff fibers are friable or little, completion from partial-thickness to full-thickness tears with subsequent cuff repair can be considered.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.61-68
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• 2011

Purpose: We evaluated the clinical outcome after arthroscopic repair in full thickness rotator cuff tears with and without delamination. Materials and Methods: From March 2006 to October 2008, we included 48 consecutive shoulders (31 males, 17 females; mean age 57.6 years; 45~68) who had arthroscopic double row repair for fullthickness tears of the rotator cuff. Mean rotator cuff tear size was 2.8 cm (range: 1.2~3.6) and the techniques of tendon-to-bone fixation varied according to the presence of delamination; separate row fixations of bursal and articular layer were used in delaminated tear. The mean follow-up was 26 months (range: 18~33) and functional and structural results were evaluated by American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA) scale, isokinetic strength testing and magnetic resonance imaging (MRI) obtained mean 8 months (range:6~13) postoperatively. The patterns of delamination, age, sex, symptom duration, size of tear, satisfaction rate, retear rate ware compared and significance was set at p values < 0.05. Results: Postoperative functional shoulder score improved significantly in 44 shoulders (91.7%). Delamination was observed in 15 shoulders (31%) and it extended proximally and posteriorly in the majority of shoulders, and the articular layer was thicker (8/15, 53%) and more retracted (9/15, 60%) compared with the superficial bursal layer. Final follow up functional shoulder scores showed no differences between non-delaminated and delaminated tears and the presence of delamination had no correlations with sex, symptom duration, tear size and satisfaction rate, however, older age had more delaminated tears (p=0.041). Follow up MRI in 29 shoulders revealed that fourteen (48%) shoulders had complete healing; nine (31%), partial healing; six (21%), complete retear but the half of the retear group showed favorable clinical results. 79% (15/19) in non-delaminated tear and 80% (8/10) in delaminated tear were judged as healed tendon on MRI and double-layer double row repairs in delaminated tears resulted in nearly same rate of structural integrity of single-layer double row repairs (p=0.165). Conclusion: The incidence of delamination in our series was 31% and older age had more delaminated tears. Sex, symptom duration, preoperative size of the tear, functional results and satisfaction rate had no significant correlations with the presence of delamination. Nearly the same postoperative structural integrity was noted in both delaminated and non-delaminated tears.

• Journal of the Korean Arthroscopy Society
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• v.8 no.2
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• pp.124-131
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• 2004

Purpose: To validate and introduce the technique of the arthroscopic repair for the treatment of the Subscapulris tendon tear. Materials and Methods: From April 2003 to April 2004, Arthroscopic repairs were performed in 8 patient with subscapularis tendon tear. The mean follow-up period was 11months. two cases involved only subscaplaris tendon tear. Four cases were associated small sized posterosuperir. rotator cuff tear and two cases were in large size. The type of subscapularis tendon showed upper portion full-thickness tear in 6 cases, partial-thickness tear localized at articular surface in 1 case, complete tear in 1 case. The results were analyzed by using subjective satisfaction, inferior movenent of superior displaced humeral head, Constant-Murley functional scoring Results: Constant-Murley scoring was improved from 55 point preoperatively to 75 point postoperatively following 11 months. Mean score was 71 point except 2 cases of large superoposterior rotator cuff tear, Most humeral heads were distaracted postoperatively. The subjective result for the 8 shoulders were very satisfying in 5 cases, satisfying in 1 case and dissatisfying in 2 cases. Therefore satisfactory results were noted in 6 cases (75%) of this overall treatment group. Conclusion: The arthroscopic repair for the subscapularis tendon tear is thought to be available method, which could reduce severe complications following the weakness of deltoid muscle and postoperative pain. Especially Partial Subscapularis tear not associated with superoposterior rotator cuff tear including PASTA lesion was the sutable indication of the Arthroscopic repair.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.155-160
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• 2009

Purpose: The purpose of this study was to evaluate the pain recovery pattern according to the integrity and to analyze the factors affecting the progress and level of pain postoperatively. Materials and Methods: We examined 153 patients, who were treated with arthroscopic rotator cuff repair. 101 rotator cuff tears were full-thickness tear and 52 were partial tear. The mean follow up duration was 20 months (12~30 months). We evaluated the visual analogue scale, range of motion, ASES (American Shoulder and Elbow Surgeons), and UCLA (University of California at Los Angeles) scores preoperatively and postoperatively. We analyzed the pain recovery pattern between partial and full thickness tear using Student T-test and the factors affecting the progress and level of postoperative pain using multiple regression analysis. Results: The change patterns of visual analogue scale after arthroscpoic repair were similar regardless of the tear integrity. The VAS showed a continuous decreasing pattern, but increased at first 3 weeks postoperatively and at 7 weeks postoperatively, and then, decreased thereafter. The average VAS was ${\leqq}2$ points by postoperative 3 months. The factor affecting the pain score at 3 months was related to the preoperative limitation in forward flexion ($r^2=0.377$, p=0.021). Conclusion: There was no differences of the pain recovery pattern according to the integrity, and the factor affecting the progress of postoperative pain was preoperative angle of forward elevation. So, the appropriate preoperative rehabilitation protocol that can improve motions of the shoulder joint would help to improve the level of postoperative pain and functional recovery.

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.68-72
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• 2006

Purpose: To demonstrate arthroscopically the presence of bilateral shoulder "mirror lesions" due to overhead work. Materials and Methods: A cross-sectional study was performed in a historical cohort of 10 male tire plant workers who underwent MRI studies of both shoulders. Bilateral intraarticular shoulder pathology was diagnosed by magnetic resonance imaging and confirmed by arthroscopy. "Mirror lesions" were defined as similar pathology between an individual patient's two shoulders. Results: We report on ten patients who had bilateral "mirror lesions." The most common mirror lesions were tears of the rotator cuff. Most patients (7 of 10) had more than one mirror lesion in their shoulders. There were two bilateral full thickness tears involving the supraspinatus and infraspinatus, four bilateral partial thickness supraspinatus tears, six bilateral partial or upper corner lesion complete subscapularis tears, and one bilateral complete supraspinatus tear. Conclusion: Occupational overhead work with simultaneous use of both arms is associated with bilateral shoulder lesions verified by arthroscopy. By demonstrating the work-related bilateral shoulder involvement, this study suggests an etiopathogenesis for these lesions and provides rational for developing worksite prevention strategies.

• Journal of the Korean Arthroscopy Society
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• v.11 no.1
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• pp.24-31
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• 2007

Purpose: To evaluate any combined rotator cuff pathologies in adhesive capsulitis patients with magnetic resonance arthrography (MRA) or ultrasonography (USG), and to see any differences in findings between MRA and USG. Materials and Methods: From June to December 2005, 80 consecutive patients with adhesive capsulitis were prospectively evaluated with either MRA or USG. Two groups were randomly assigned for examination. Evaluation were focused on any combined rotator cuff pathologies especially supraspinatus tendon. Results: Small (less than 1 cm) full-thickness SSP tendon tear were seen in 6 patients (MRA 4, USG 2, 8%) and partial-thickness SSP tendon tears in 21 (MRA 12, USG 9, 26%). In addition, supraspinatus tendinopathy were seen in 15 patients (MRA 7, USG 8, 19%). Overall, various SSP pathologies were reported in 42 patients (53%) of the study objects (MRA 23, 68% and USG 19, 41%). Subscapularis tendon partial tears were reported in 9 patients (MRA 6, USG 3, 11%). There were no statistical differences of the findings between MRA and USG in detecting rotator cuff pathologies (p>0.5). Conclusion: Nearly one half of the adhesive capsulitis patients showed various supraspinatus tendon pathology in MRA or USG. Although MRA group showed slight higher percentage of associated rotator cuff pathology than USG group (without statistical significance), this could be attributed to better resolution capacity of MRA than USG.

• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.109-117
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• 1998

We evaluated the results of the surgery for impingement syndromes and partial thickness tears of the rotator cuff with an average follow-up period of 15 months. One group(group I) of 43 patients, 46 cases underwent arthroscopic subacromial decompression. The other comparable group(group Ⅱ) of 10 patients, II cases underwent open acromioplasty. The average age at operation was 48 years, old. Arthroscopic subacromial decompression achieved slightly better pain relief, the range of the acti ve forward flexion, function, strength and the overall score with improvement from the preoperative condition than open acromioplasty. The patient's satisfaction was better in group I as well. Using the UCLA Shoulder Rating Scale, 89% of group I and 82% of group n had good or excellent results. Preservation of the origin of the deltoid during an arthroscopic acromioplasty reduced the postoperative morbidity and made it possible to start rehabilitation sooner and to achieve the better and more predictable results.

• Clinics in Shoulder and Elbow
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• v.21 no.3
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• pp.127-133
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• 2018

Background: This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder. Methods: This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant's score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up. Results: Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34-74). Mean follow-up duration was 24 months (range, 12-40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up ($p{\leq}0.001$ for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up. Conclusions: Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.185-190
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• 2008

Purpose: The purpose of this study is to provide the clinical outcomes of arthroscopic type II SLAP repair in non-athletes, and to compare the clinical outcomes between those who had isolated type II SLAP lesion and those who had combined partial thickness supraspinatus tear that did not required a combined repair. Materials and Methods: From July 2005 to January 2007, 142 consecutive type II SLAP lesions were treated with arthroscopic surgery. The inclusion criteria for the study were; (1) younger than 50 years old; and (2) non-athletes. Exclusion criteria were; (1) prior surgery, fracture or combined recurrent dislocation history on the affected shoulder; (2) combined full thickness rotator cuff tear or PTST (>50% thickness) patient that needed repair; and (3) combined infection, arthritis or inflammatory disease. Remaining 19 patients meet the criteria. Among them, 13 had combined PTRCT that did not require repair (Group I), and 6 had isolated type II SLAP lesion without combined supraspinatus tear (Group II). The mean age was 36.7 years (29~49 years), mean symptom duration was 39.1 months (3~216 months) and mean follow-up was 19.0 months (12~27 months). In all patients, the range of motion of affected shoulder, pain and function visual analogue scale (PVAS, FVAS), the Constant score and UCLA score were evaluated preoperatively and postoperatively. Results: In group I, external rotation at side was decreased significantly (p=0.003),but there were no statistical significant change at the remains(p>0.05). And there were no differences between groups (p>0.05). At the final follow-up, all clinical outcome measurements improved after surgery with statistical significance (p<0.05): UCLA score, $22.8{\pm}5.2$ to $32.8{\pm}2.1$; Constant score, $79.4{\pm}8.6$ to $94.9{\pm}4.3$; PVAS $5.4{\pm}2.7$ to $1.1{\pm}1.4$; FVAS $63.2{\pm}15.3$ to $93.4{\pm}7.3$. But, in group comparison of the mean UCLA score and Constant score, there were no statistical significant differences between two groups. Conclusion: Arthroscopic repair of type II SLAP lesion provided good clinical outcomes in nonathletic population. Combined partial thickness supraspinatus tear does not seem to hamper the final outcome at minimal 1 year follow-up.