• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.287-295
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• 2023

Background: Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI. Methods: We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic). Results: Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation. Conclusions: Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.236-241
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• 1998

본 교실에서는 주관절에 발생한 후외측방 회전 불안정성에 의한 재발성 탈구 환자에 대해 Nestor 술식을 이용한 외측 척측부인대 재건을 1례 치 험하였다. 주관절의 재발성 탈구의 치료에 있어서는 병인중 가장 많은 후외측방 회전 불안정성에 대한 이해가 필요하며 그에 따른 외측 척측부인대 재건등의 수술적 수기와 술후 적절한 재활 치료가 치료결과에 큰 영향을 미치게 된다.

• Clinics in Shoulder and Elbow
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• 제17권4호
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• pp.190-193
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• 2014

Recurrent posterior shoulder instability is a debilitating condition that is relatively uncommon, but its diagnosis in young adults is increasing in frequency. Several predisposing factors for this condition have been identified, such as the presence of an abnormal joint surface orientation, an osteochondral fracture of the humeral head or glenoid cavity, and a postero-inferior capsuloligamentary deficit, but their relative importance remains poorly understood. Whilst, conservative treatment is effective in cases of hyperlaxity or in the absence of bone abnormality, failure of conservative treatment means that open or arthroscopic surgery is required. In general, soft-tissue reconstructions are carried out in cases of capsulolabral lesions in which bone anatomy is normal, whereas bone grafts have been required in cases where posterior bony Bankart lesions, glenoid defects, or posterior glenoid dysplasia are present. However, a consensus on the exact management of posterior shoulder instability is yet to be reached, and published studies are few with weak evidence. In our study, we report the reconstruction of the glenoid using iliac bone graft in a patient suffering recurrent posterior shoulder instability with severe glenoid bone defect.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.117-122
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• 2010

목적: 본 증례 보고는 간질 발작과 동반된 심한 전방 관절와 골결손에 의한 견관절 불안정성에서 자가 삼면피질 장골 이식술을 통한 관절와 재건술 및 안정화 술식을 시행한 증례를 문헌 고찰과 함께 보고하고자 한다. 대상 및 방법: 간질 발작과 동반된 심한 전방 관절와 골결손을 가진 2예의 재발성 전방 탈구를 자가 삼면 피질 장골 이식술을 이용하여 관절와 재건술 및 안정화 술식을 이용하여 치료하였다. 결과: 수술 후 5개월째 단순방사선 촬영상 이식골의 유합 소견이 관찰되었고, 수술 전 소견과 비교해서 골관절염의 진행소견은 관찰되지 않았다. 수술 후 7개월 추시 관찰 상 통증은 거의 없었으며, 관절 운동 범위는 정상 운동 범위를 보였으며, 관절의 안정성을 확보하였다. 결론: 심한 전방 관절와 골결손을 가진 재발성 전방 탈구는 충분한 골 이식을 통해 전방 안정성을 얻을 수 있으며, 관절 면을 비교적 잘 일치시켜 정상 관절와의 오목함을 재건할 수 있고 관절염의 빈도를 줄일 수 있다.

• Clinics in Shoulder and Elbow
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• 제7권2호
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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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• 제2권1호
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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.

• Clinics in Shoulder and Elbow
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• 제4권2호
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• pp.191-195
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• 2001

재발성 주관절 후외방성 회전 불안정성은 주관절의 아탈구, 탈구 또는 골절 등 외상, 수술 또는 외반주 변형이후 과부하등으로 인해 외측 척측 측부 인대 손상의 결과로서 발생하고, 주관절 pivot shift 검사는 주란절에 외반력, 종축 압박력과 회외전 모멘트로 후외방 아탈구를 유발하는 검사로서 주관절 후외방성 불안정성에 있어 가장 예민한 검사로 알려져 있다.

• Clinics in Shoulder and Elbow
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• 제12권1호
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• pp.76-79
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• 2009

목적: 견관절 전방 외상성 불안정증에서 관절 낭-순 재건술은 재발성 불완정증 예방 및 기능 회복에 있어 매우 성공적인 술식이다. 대상 및 방법: 그러나 관절 와의 30 % 이상의 심한 골 결손이 존재 할 때 관절 낭-순 재건술 만으로는 성공적인 결과를 가져오기 힘들다. 결과: 본 연구는 관절 와의 심한 골 결손을 가진 재발성 전방 외상성 불안정성 견관절에서 관절외자가 장골 이식으로 보강한 관절 낭-순 재건술의 술기와 결과를 보고하고자 한다.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2008년도 제16차 학술대회
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• pp.166-166
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• 2008

A 25-year-old man presented with a history of pain and crepitus in the right shoulder; he had been previously treated with arthroscopic anterior stabilization using four metallic suture anchors for recurrent traumatic anterior instability 1 year earlier. In this report, we present a patient with recurrent glenohumeral instability combined with anchor-induced arthropathy who was managed with modified arthroscopic transglenoid reconstruction following arthroscopic suture anchor retrieval.

• Clinics in Shoulder and Elbow
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• 제23권2호
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• pp.62-70
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• 2020

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8%±4.2% (range, 20.4%-37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24-86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.