• Clinics in Shoulder and Elbow
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• 제11권1호
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• pp.29-36
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• 2008

목적: 회전근 개 파열의 개방적 봉합술 후 임상적 결과와 회전근 개 연속성의 연관성을 알아보고 재파열 발생의 요인을 분석하고자 하였다. 대상 및 방법: 2004년부터 2006년까지 회전근 개 파열로 수술적 봉합술을 시행받은 78명의 환자를 대상으로 하였다. 모든 환자는 최소 1년 이상 추시하여 자기 공명 영상(MRI)을 촬영하고 재파열 유무를 확인하였다. 임상 결과는 재파열된 군과 유지된 군으로 나누어 평가하였다. 재파열의 원인 분석을 위해 수술전 파열의 크기, 유병 기간 등을 양군에서 비교하였다. 결과: 회전근 개 재파열군(n=22)의 수술후 임상결과는 수술전에 비하여 의미있게 호전되었으나(p<0.001, p<0.001). 근력은 수술후 의미있게 호전되지 않았다(p=0.099, p=0.243). 수술전 파열의 크기가 컸던 환자에서 재파열이 많았으며(p<0.001), 재파열된 군은 수술전 유병기간이 길었다(p=0.027). 결론: 회전근 개 개방적 봉합술 후 재파열이 되더라도 임상 결과는 호전되나 극상근과 외회전근의 근력은 의미있게 호전되지 않았다. 수술전 파열의 크기가 크고 유병 기간이 긴 경우에 수술후 재파열의 빈도가 높았다.

• 대한관절경학회지
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• 제12권2호
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• pp.82-86
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• 2008

최근 회전근개 질환을 수술적으로 치료하는 경우가 점점 많아지고 있다. 회전근개 파열의 술후 재활 치료는 진단, 수술만큼이나 중요하며 성공적인 치료 결과에 결정적 영향을 미친다. 또한 적절한 재활 치료를 위해서는 견관절의 해부학적, 생역학적 이해를 필요로 한다. 술후 재활은 추가 손상을 방지하고, 염증을 줄이며, 교원질의 회복을 도모하고 약해진 근육을 강화시키며 유착, 구축 등에 의해 감소된 관절 운동을 회복하고, 쉽게 피로한 근육의 지구력을 기르면서 봉합 부위와 삼각근을 보호해야 한다. 이러한 치료 지침은 환자의 조건에 따라서 개별화 되어야만 할 것이다.

• Clinics in Shoulder and Elbow
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• 제16권2호
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• pp.153-162
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• 2013

관절경적 회전근 개 복원술 시에 시행하게 되는 골 처치에는 견봉 성형술, 원위 쇄골 절제술, 건 부착부(대결절 부위) 처치 및 오구 성형술 등이 있다. 각각의 골 처치는 여러 이론적 근거에 의해 적응증을 가지며, 수술방법 또한 다양하게 알려져 있다. 이에 관절경적 회전근 개 복원술 시에 사용되는 여러 골 처치의 적응증 및 방법에 대해 기술하고자 하였다.

• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.254-260
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• 2015

With the advancement of shoulder arthroscopy, use of biodegradable suture anchors in the surgical repair of rotator cuff tears has increased. Because of the radiolucency of these anchors, radiography is not appropriate for early detection of anchor failure. Ultrasonography is an advantageous modality in visualizing biodegradable, radiolucent anchors on a real-time basis without risk of radiation exposure. We report on two cases of displacement of a biodegradable suture anchor diagnosed on ultrasonography during the postoperative follow- up, which has not been previously reported. Because this displacement could be missed in the postoperative follow up ultrasonography, we describe the ultrasonographic features of the displaced biodegradable anchors. Surgeons and radiologists should pay special attention to the possibility of displacement of the suture anchor in patients who underwent rotator cuff repairs using suture anchors.

• Clinics in Shoulder and Elbow
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• 제21권4호
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• pp.207-212
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• 2018

Background: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears. Methods: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS). Results: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be $15.46{\pm}3.60mm$ and $14.17{\pm}3.16mm$ (p=0.013), and muscle atrophy of SS (occupation ratio) was $60.54{\pm}13.15$ and $56.55{\pm}12.88$ (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups. Conclusions: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.

• Clinics in Shoulder and Elbow
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• 제9권2호
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• pp.222-226
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• 2006

Full-thickness rotator cuff tears are relatively uncommon in the young adults. One of the pathogenesis of such tear is thought to be closely related to the specific trauma event. Favorable outcome is expected in young patient rotator cuff tears when it is diagnosed early following prompt surgical repair. However, early detection is sometimes difficult when the acute rotator cuff tear is combined with other injuries especially around the shoulder joints such as ipsilateral humerus fractures. Authors report an uncommon case of acute traumatic rotator cuff tear accompanied by the midhumerus shaft fracture in young adult.

• 대한물리의학회지
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• 제9권4호
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• pp.485-492
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• 2014

PURPOSE: This study aimed to examine the pain, range of motion (ROM), upper extremity task performance, and functional levels of patients after rotator cuff repair according to the timing of a closed chain exercise thereby presenting basic data for an effective rehabilitation program. METHODS: The intervention was applied three times per week, one hour per day, for four weeks to 40 participants, 78 of whom had undergone rotator cuff repair. The participants were divided into four groups and assigned to usual general physical therapy and an open chain exercise. Group I consisted of the open chain exercise only. The closed chain exercise was applied to group II after the 4 times, group III after the 7 times, group IV after the 10 times. Measurement were used ROM, visual analogue scale (VAS), box and block test (BBT), and shoulder pain and disability index (SPADI). A one-way analysis of variance was conducted to test differences. RESULTS: There were significant differences in the internal/external rotation between group I and group II. The VAS significantly differed between group II and group I, group III, and group IV. The BBT results of group II and group I were significantly different compared to those of group IV. The SPADI significantly differed between group II and group I and between group II and group IV. CONCLUSION: The closed chain exercise was effective for patients following rotator cuff repair from the second week after active exercise was prescribed, verifying its applicability in rehabilitation programs.

• 대한관절경학회지
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• 제13권1호
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• pp.72-76
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• 2009

당뇨환자로서 관절경적 회전근 개 봉합술을 시행 후 견관절의 화농성 관절염으로 진단된 2예에 대해 관절경적 치료 및 추가적인 개방성 치료를 시행하였다. 관절경적 회전근 개 봉합술 후 감염은 평균 18일 뒤에 발생하였으며, 증상 발현으로부터 수술까지의 평균 기간은 65일이었다. 또한 기능 평가는 KSS, ASES, UCLA, Constant 점수를 이용하였다. 관절경적 변연 절제술과 추가적인 시술 후 평균 22.5일의 항생제 치료로 4개월에 염증이 치료되었으며 최종 결과는 KSS점수가 82점, UCLA점수가 33점, ASES점수가 91점, Constant점수가 71점이었다. 관절경적 회전근 개 봉합술 후 발생한 화농성 견 관절염은 관절경적 치료 및 추가적인 시술로 치료되었고, 관절 운동 범위 및 기능적 결과와 통증 및 만족도는 많이 개선되었다.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.57-63
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• 2014

Background: To compare the effect of different starting periods of rehabilitative exercise (early or delayed passive exercise) on the rate of retear and other clinical outcomes after the arthroscopic repair of the rotator cuff. Methods: In total, 103 patients who underwent arthroscopic repair of the rotator cuff were included in the study. Determined at 2 weeks post-operation, patients who were incapable of passive forward elevation greater than $90^{\circ}$ were allotted to the early exercise group (group I: 79 patients; 42 males, 37 females), whilst those capable were allotted to the delayed exercise group (group II: 24 patients; 14 males, 10 females). The group I started passive exercise, i.e. stretching, within 2 weeks of operation, whilst group II started within 6 weeks. The results were compared on average 15.8 months (11-49 months) post-operation using the passive range of motion, the Visual Analog Scale (VAS) pain score, and the University of California at Los Angeles (UCLA) and Constant scores. Stiffness was defined as passive forward elevation or external rotation of less than $30^{\circ}C$ compared to the contralateral side. Follow-up magnetic resonance imaging (MRI) was carried out on average 1 year post-operation and the rate of retear was compared with Sugaya's criteria. Results: There were no differences between the two groups in gender, age, smoking, presence of diabetes, arm dominance, period of tear unattended, pre-operative range of motion, shape and size of tear, degree of tendon retraction, and tendon quality. There were no significant differences in clinical outcomes. Whilst stiffness was more frequent in group II (p-value 0.03), retear was more frequent in group I (p-value 0.028) according to the MRI follow-up. Conclusions: During rehabilitation after the arthroscopic repair of the rotator cuff, the delay of passive exercise seems to decrease the rate of retear but increase the risk of stiffness.

• Clinics in Shoulder and Elbow
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• 제24권3호
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• pp.135-140
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• 2021

Background: We hypothesized in this study that the characteristics of retear cases vary according to surgeon volume and that surgical outcomes differ between primary and revision arthroscopic rotator cuff repair (revisional ARCR). Methods: Surgeons performing more than 12 rotator cuff repairs (RCRs) per year were defined as high-volume surgeons, and those performing fewer than 12 RCRs were considered low-volume surgeons. Of the 47 patients who underwent revisional ARCR at our clinic enrolled in this study, 21 cases were treated by high-volume surgeons and 26 cases by low-volume surgeons. In all cases, the interval between primary surgery and revisional ARCR, degree of "acromial scuffing," number of anchors, RCR technique, retear pattern, fatty infiltration, retear size, operating time, and clinical outcome were recorded. Results: During primary surgery, significantly more lateral anchors (p=0.004) were used, and the rate of use of the double-row repair technique was significantly higher (p<0.001) in the high- versus low-volume surgeon group. Moreover, the "cut-through pattern" was observed significantly more frequently among the cases treated by high- versus low-volume surgeons (p=0.008). The clinical outcomes after revisional ARCR were not different between the two groups. Conclusions: Double-row repair during primary surgery and the cut-through pattern during revisional ARCR were more frequent in the high- versus low-volume surgeon groups. However, no differences in retear site or size, fatty infiltration grade, or outcomes were observed between the groups.