• Clinics in Shoulder and Elbow
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• v.17 no.3
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• pp.145-150
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• 2014

In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis.

• 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.21 no.4
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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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• v.19 no.2
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• pp.84-89
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• 2016

Background: The purpose of this study was to assess the results of arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Methods: From November 2009 to April 2011, 12 patients underwent arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Patients were followed for an average of 33.9 months. Clinical outcome was evaluated preoperatively and postoperatively using the mean University of California, Los Angeles (UCLA) score and the Korean Shoulder Scoring System (KSS). Magnetic resonance imaging (MRI) was performed postoperatively at an average of 6.5 months. Results: At a mean follow-up of 33.9 months (range, 25 to 42 months), 11 out of 12 patients were satisfied with their procedure. Patients showed significant improvement in their mean modified UCLA score from 15.9 preoperatively to 29.4 postoperatively (p=0.001). The mean KSS score improved from 45.6 preoperatively to 80.5 postoperatively (p=0.002). In MRI studies, 9 out of 12 patients had full incorporation of the graft into the native rotator cuff remnant. To date, there has been no intraoperative or postoperative complication from the graft procedure, such as infection or allograft rejection, in any patient. Conclusions: Arthroscopic bridging repair using a human dermis allograft can be considered as an option in treatment of select cases of massive irreparable rotator cuff tears, resulting in high patient satisfaction.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.71-76
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• 2008

The pathophysiology of rotator cuff tears and the progression of asymptomatic tears to symptomatic tears are yet unclear and much controversy. It is likely to involve a number of factors such as a genetic predisposition, extrinsic impingement from structures surrounding the cuff and intrinsic degeneration from changes within the tendon itself. Degenerative changes in the rotator cuff with aging seem to be related to the anatomic and mechanical environment of the rotator cuff. The histopathologic appearance of rotator cuff tendon rupture specimens demonstrates a consequence of degenerative changes at the site of tendon insertion into bone. It weakens the tensile strength of the tendon. Is the process of degeneration intrinsic or extrinsic in nature? I suggest that degeneration is intrinsic and not caused by extrinsic factors. Even though, rotator cuff tear may be secondary to multiple factors, I believe that primary cause of rotator cuff tears is preexisting degenerative change.

• 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.

• Journal of the Korean Arthroscopy Society
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• v.16 no.1
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• pp.92-97
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• 2012

Purpose: The reparability of rotator cuff tears is very important to establish the indication of the surgical treatment of rotator cuff tears. We reviewed the factors that effect to reparability of rotator cuff tears, and considered about the surgical indication of rotator cuff tears. Materials and Methods: The reparability was considered by the surgical reparability and the postoperative healing potentials of rotator cuff. The natural history of rotator cuff tear gives us the information to make decision about the surgical treatment or the conservative treatment. Results: There are 3 general categories of factors that help predict the healing potential of a rotator cuff tear. These include surgical technique, biology, and environmental issues. Surgeon can control the surgical technique by himself. The control of biology comes from careful operative indications by age, acute trauma history, chronicity, and tear size. And the control of environmental factor can give better outcomes by cessation of smoking and nonsteroidal anti-inflammatory drug (NSAID). Conclusion: A better understanding of the natural history and the reparability of rotator cuff tear will help us to estabilish the indication of surgical treatement of rotoator cuff tears, and lead to satisfactory clinical outcomes.

• Clinics in Shoulder and Elbow
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• v.17 no.1
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• pp.44-47
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• 2014

Typically, massive rotator cuff tears have stiff and retracted tendon with poor muscle quality, in such cases orthopaedic surgeons are confronted with big challenging to restore the cuff to its native footprint. Furthermore, even with some restoration of the footprint, it is related with a high re-tear rate due to less tension free repair and less tendon coverage. In this tough circumstance, the partial repair has yielded satisfactory outcomes at relatively short follow-up by re-creating the transverse force couple of the rotator cuff. Through this partial repair, the massive rotator cuff tear can be converted to the "functional rotator cuff tear" and provide improvement in pain and functional outcomes in patient's shoulder.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 1999.03a
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• pp.104-107
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• 1999

$\cdot$ Although the surgical repair of massive tears of the rotator cuff is demanding procedure, the results are rewarding if technical principles are strictly followed $\cdot$ But structual healing does not parallel to technically successful repair of tears . Alternatives to direct repair might be considered for irrepairable massive tears

• Clinics in Shoulder and Elbow
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• v.21 no.2
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• pp.101-104
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• 2018

Since shoulder have a higher proportion of muscle which would have low electrical resistance, there could be more electrical damage to the rotator cuff muscles. We present a patient with acute rotator cuff tear by sudden uncontrolled jerking contractions caused by an electrical shock. A case of 42-year-old man with acute rotator cuff tear due to electrical injury to the shoulder was presented. Magnetic resonance imaging showed a full thickness tear and an undulating appearance of the peripheral end of the torn supraspinatus and infraspinatus muscle, suggesting an acute complete rupture. By arthroscopic surgery, the torn rotator cuff tendons were repaired with a suture bridge technique. At the final follow-up, the patient had a full, pain-free range of motion and had fully recovered shoulder muscle power.