• Clinics in Shoulder and Elbow
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• v.7 no.2
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• pp.76-82
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• 2004

Purpose: In the traumatic anterior shoulder instability, the laxity of joint capsule and ligament is frequently demonstrated. Although a arthroscopic procedure to address anterior instability with joint capsular redundancy have generally provided good results, its recurrence rate is higher than open procedure. By reducing the capsular redundancy, thermal shrinkage is likely to improve the outcome of arthroscopic anterior stabilization. The objective of this study was to evaluate additional thermal capsular shrinkage as a treatment of joint capsular redundancy in anterior shoulder instability. Materials and Methods: From March 1999 to June 2000, 25 shoulders of 23 patients of recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with shrinkage procedure. The mean follow up was 29 months and average age at the time of operation was 26 years. Of these patients, 20 were male and 3 were female who had been experienced the average 8 times of dislocation before operation. Thermal shrinkage alone without Bankart repair was performed in two cases who did not have Bankart lesion. The clinical result was evaluated in according to Modified Rowe Score. Results: The Modified Rowe Score was improved from preoperative 35 points to postoperative 88 points. None of cases showed recurrence of dislocation. But, in two cases, temporary sensory hypesthesia of the axillary nerve was developed and in two cases of postoperative stiffness, arthroscopic capsular release and brisement were performed. Conclusion: Additional capsular shrinkage in arthroscopic technique to address recurrent anterior shoulder instability could treat effectively the capsular redundancy.

• Clinics in Shoulder and Elbow
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• v.8 no.1
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• pp.23-30
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• 2005

Purpose: This paper analyzes the results of arthroscopic bankart repair for anterior recurrent dislocation following a trauma on shoulder. Material and Methods: The subjects were twenty-three (23) cases that were available to follow up for more than eighteen months during the period from November 2001 to June 2003 and were chosen from patients to whom arthroscopic bankart repair was applied using a knotless suture anchor for their traumatic anterior recurrent dislocation on the shoulder. Their average age was 28 (ranging from 15 to 60) with 20 males and 3 females. The injury from sports activities accounted for the most cases with 14 subjects. The average follow-up period was 27 months (ranging from 18 months to 35 months). There were 19 cases of bankart lesions, 4 cases of ALPSA lesions and associated with 5 cases of partial tear in the rotator cuff. The anchors employed were knotless anchor (Mitek) for all the cases. Rowe scoring scale was adopted to judge the results after operations. Patients' subjective satisfaction and range of motion of external rotation were addressed together. Results: Rowe scores showed that 20 cases (87%) reaches the level of 'good' and hinger. The average patients' satisfaction accounted for 90 points out of 100. It was also found that external rotations averagely decreased by 6.5 degree when the range of motion was in at the side. Conclusion: There were satisfactory results of arthroscopic bankart repair using knotless suture anchors as an operative treatment for traumatic anterior recurrent dislocation on shoulder.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.117-122
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• 2010

Purpose: The purpose of this report was to assess a surgical technique-using an autogenous tricortical iliac crest bone graft in patients with epilepsy-for anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency. Materials and Methods: We studied two cases of recurrent anterior dislocation of the shoulder due to epilepsy. These cases were treated with anatomical glenoid reconstruction using an autogenous tricortical iliac crest bone graft. Results: Both cases achieved bone union in 5 months. There was no recurrence of instability and pain. Both cases had normal range of motion. Conclusion: Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency using an autogenous tricortical iliac crest bone graft is a successful surgical technique for achieving shoulder stability.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.215-220
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• 2009

Purpose: This study is to analyze the prevalence of various intra-articular lesions in patients with traumatic recurrent anterior dislocation of shoulder over 40 years and suggest clinical implications for treatment. Materials and Methods: We retrospectively studied 16 cases that underwent surgical treatment for recurrent anterior dislocation of shoulder from January 2001 to May 2009. There were 9 males and 7 females, and the mean age was 52.7years. We carried out arthroscopic exam for all patients based on standard protocol, which included labrum, capular lesion, cuff, bony lesions. Results: All 16 cases showed Hill-Sachs lesion, 3 patients (19%) had bony Bankart lesion, 6 patients (38%) had labral tear. Capsular tear were found 15 patients (94%). Twelve (75%) had ruptured supraspinatus and 5 (31%) had subscapularis tear. Only one (6%) had SLAP lesion. Conclusion: There was relatively higher incidence of capsular and rotator cuff tears in patients over age 40 years. Preoperative planning to address these lesions is highly recommended.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.98-101
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• 2009

Purpose: These case reports have been prepared to highlight the uncommon occurrence of anterior shoulder dislocation after an epileptic seizure, the recognition of which is important as this type of injury is associated with bony lesions and a high incidence of recurrence. Materials and Methods: We report two cases of recurrent anterior dislocation of the shoulder due to grand mal epilepsy. These cases were treated as usual anterior dislocations of the shoulder, and were regularly followed to detect any recurrence of shoulder instability. Results: Outcome of the surgery in the two cases was different because of the differences in seizure control. In the patient in whom seizures were well-controlled, there was no recurrence of instability, while the patient with poorly controlled seizures developed a recurrence of the dislocation following shoulder repair. Conclusion: The authors emphasize the need to control seizures in order to prevent injury recurrence in this subset of patients.

• Journal of Oral Medicine and Pain
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• v.38 no.4
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• pp.319-324
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• 2013

Dislocation of the temporomandibular joint (TMJ) occurs when the mandibular condylar head is displaced completely out of the glenoid fossa and cannot be reduced by the patient. The occurrence of bilateral anterior dislocation is the most common. Dislocations can be classified into three types in terms of duration and frequency of dislocation, i.e., acute, chronic and recurrent. There are various treatment modalities for dislocation from conservative try to surgical intervention. The selection for the appropriate modality mainly depends on the types of dislocation as previously stated. The authors report three cases of dislocation with different treatment modalities according to the duration of dislocation. In particular, we tried prosthetic approach instead of surgical intervention in the patient with chronic dislocation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.1
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• pp.16-20
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• 2014

Mandibular condylar hyperplasia is an uncommon condition of excessive unilateral growth of the condyle causing facial asymmetry and occlusal alterations. The etiology of condylar hyperplasia is unclear, but several factors are suspected, including previous trauma, hormonal disturbances, and abnormal functional loadings. Acute or chronic recurrent dislocation of temporomandibular joint (TMJ) is common, but long-standing dislocation is rare. We present two cases of the exophytic condylar hyperplasia that lasted for over 20 years with TMJ dislocation. In both cases, we performed a condyloplasty to restore normal occlusion and facial symmetry, with satisfactory results.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.420-426
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• 2018

Background: The tibial tuberosity-trochlear groove (TT-TG) distance is used to determine the necessity of tibial tubercle osteotomy. We conducted this study to determine the extent to which each of the tibial tuberosity lateralization, trochlear groove medialization, and knee rotation angle affects the TT-TG distance in both normal and patella dislocated patients and thereby scrutinize the rationale for tuberosity transfer based on the TT-TG distance. Methods: Retrospective analysis of rotational profile computed tomography was done for patella dislocated and control group patients. Femoral anteversion, tibial torsion, knee rotation angle, tuberosity lateralization, and trochlear groove medialization were assessed in all patients. Relationship of these parameters with the TT-TG distance was investigated to evaluate their effects on the TT-TG distance. Results: We observed that the patellar dislocation group, compared to the control group, had increased TT-TG distance (mean, 19.05 mm vs. 9.02 mm) and greater tuberosity lateralization (mean, 64.1% vs. 60.7%) and tibial external rotation in relation to the femur (mean, $7.9^{\circ}$ vs. $-0.81^{\circ}$). Conclusions: Tuberosity lateralization and knee rotation were factors affecting patellar dislocation. These factors should be considered in addition to the TT-TG distance to determine the need for tibial tubercle osteotomy in patients with patellar dislocation.

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.42-49
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• 2006

Purpose: This study evaluated clinical results, and recommended treatment protocol of traumatic anterior shoulder dislocation in the patients older than 60 years of age. Materials and Methods: Thirty-eight patients with first traumatic anterior shoulder dislocation aged over 60 years were included. The average age was 69.4 (range, 60 to 87 years). There were 8 men (average age of 71.6) and 30 women (average age of 69). Most common cause of injuries was a fall on the outstretched hand. The additional injuries were evaluated using MRI or CT arthrogram in the patients with significant pain and weakness while movements after 2 weeks sling immobilization. Results: Fifteen patients (39%) had rotator cuff tears and 5 patients (14%) had greater tuberosity fractures. The sizes of rotator cuff tears were diverse; 2 partial tears, 1 small tear, 4 medium tears, 3 large tears and 5 massive tears. Among 5 massive cuff tears, 3 patients revealed cuff arthropathy after reduction. 4 patients (11%) had recurrent dislocation more than one time during 1 month after the first dislocation. Bankart lesions revealed in 5 patients and three of them had associated rotator cuff tears. 3 out of 5 patients with Bankart lesions, 13 out of 15 patients with rotator cuff tears and 3 patients with displaced greater tuberosity fracture had operations. Conclusion: The injury mechanism of shoulder dislocation in patients older than 60 years of age seems to have either anterior or posterior mechanism. The diagnosis and treatment should be approached 2 weeks after dislocation.

• Clinics in Shoulder and Elbow
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• v.2 no.1
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• pp.60-73
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• 1999

Purpose : The purpose of this study was to compare patients with anterior shoulder instability who were treated with an open Bankart procedure with those treated with an arthroscopic procedure, and to evaluate factors influencing the final outcomes and recurrence. Materials & Methods : One hundred seven shoulders underwent open Bankart repair, and fifty-one shoulders were treated arthroscopically. Average followup for open group was 34 months, and for arthroscopy group was 25 months. The Bankart Rating System by Rowe was used to evaluate the clinical outcome of the procedure. And, the patients were asked about any changes concerning their sports and professional activities. Results: According to Bankart Rating system by Rowe, open group had 97% fair to excellent results with 2 recurrent dislocation(1.8%) and 4 recurrent subluxation(3.6%), and arthroscopy group had 94% fair to excellent results with 3 recurrent dislocation(5.8%) and 4 recurrent subluxation(8%). In open group, 9 shoulders(8.4%) had the mild limitation of range of motion at the time of followup, and 2 shoulders(3.9%) in arthroscopy group. Age and gender do not seem to be a significant factor contributing to an increased re-recurrence rate. The incidence of re-recurrence seems to be affected by dominance, frequency, and patient's activity. The size of Bank art lesion might be also considered as a contributing factor. Conclusion: Either open or arthroscopic Bankart procedures are safe and effective methods with acceptable results if an adequate patient's selection, precise surgical technique and proper postoperative care are done. And arthroscopic surgery could be considered if the anterior instability is non-dominant, non-athlete, traumatic unidirectional and Bankart lesion has minimal erosion of the glenoid and it has thick and mobile labrum.