• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.176-180
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• 2006

Purpose: Although surgical arthroscopic repair of rotator cuff has become much more common as surgeons have developed proficient techniques, it is still technically difficult. The purpose of this study was to evaluate the clinical results and the usefulness of mini-open repair in large and massive size tears. Materials & Methods: From January 2000 to December 2004, sixteen patients were treated with mini-open repair. There were 10 male and 6 female patients with the average age of 62.5 years. The size of tear was massive in 4 cases and large in 12 cases. All tears were repaired with metal anchor sutures. The mean duration of follow-up period was 23 months. Postoperative results were evaluated based on American Shoulder and Elbow Society scoring system. Results: Five patients showed excellent results, five good, and two fair in large tears while one patient showed excellent result, one good, and two fair in massive tears. Poor outcome was not seen during the follow-up period. There was no significant relationship between the patient's age and the size of tear, and postoperative results. However, the relationship between the duration of symptomatic period in preoperation and postoperative results showed significant correlation. Conclusion: Mini-open repair combined with the preservation of deltoid and early rehabilitation is clinically useful in large and massive size rotator cuff tear patients treatment.

• Investigative Magnetic Resonance Imaging
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• v.22 no.4
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• pp.229-239
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• 2018

Purpose: To assess the diagnostic performance in detecting rotator cuff tears at 3T of non-arthrographic shoulder magnetic resonance imaging (MRI) using 3D isotropic turbo spin-echo (TSE-SPACE) sequence as compared with 2D sequences. Materials and Methods: Seventy-four patients who were arthroscopically confirmed to have underwent non-arthrographic shoulder MRI with 2D sequences and TSE-SPACE were included. Three independent readers retrospectively scored supraspinatus and infraspinatus tendon (SST-IST) and subscapularis tendon (SCT) tears on 2D sequences and TSE-SPACE. Results: The mean sensitivity, specificity, and accuracy of the three readers were 95%, 100%, and 95% on TSE-SPACE and 99%, 93%, and 98% on 2D sequences for detecting SST-IST tears, respectively, whereas those were 87%, 49%, and 68% on TSESPACE and 88%, 66%, and 77% on 2D sequences for detecting SCT tears, respectively. There was no statistical difference between the two sequences, except for in the specificity of one reader for detecting SCT tears. The mean AUCs of the three readers on TSE-SPACE and 2D sequences were 0.96 and 0.98 for detecting SST-IST tears, respectively, which were not significantly different, while those were 0.71 and 0.82 for detecting SCT tears, respectively, which were significantly different (P < 0.05). Conclusion: TSE-SPACE may have accuracy and reliability comparable to conventional 2D sequences for SST-IST tears at non-arthrographic 3T shoulder MRI, whereas TSE-SPACE was less reliable than conventional 2D sequences for detecting SCT tears.

• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.296-303
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• 2022

Background: A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. Methods: Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, Western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. Results: Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05). Conclusions: We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.223-229
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• 2010

Purpose: The purpose of this study was to determine the correlation between the radiographic and clinical findings of massive rotator cuff tears. Materials and Methods: Forty-five diagnosed cases (35 patients) of massive rotator cuff tears were investigated in this study. Grade of arthritis in the massive rotator cuff tears was classified based on plain radiographs using the method of Hamada et al.. And we clinically evaluated cases using the UCLA scoring system. Results: No statistically significant correlation ($r_s$=0.220, p=0.151) was found between arthritis grades in massive rotator cuff tears and clinical features. Dominant arm involvement appeared to be related to a higher rate of surgical treatment and a lower UCLA score. Conclusion: In massive rotator cuff tear patients, radiographic findings of arthritis may not always correspond to clinical features relevant in daily life. Therefore, we suggest that treatment strategies should be carefully considered when considering treatment modalities.

• Clinics in Shoulder and Elbow
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• v.18 no.1
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• pp.47-51
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• 2015

Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.

• Clinics in Shoulder and Elbow
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• v.19 no.1
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• pp.51-58
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• 2016

The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.

• Clinics in Shoulder and Elbow
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• v.23 no.2
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• pp.86-93
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• 2020

Background: Several systematic reviews have reported on the conservative treatment of full-thickness rotator cuff tears; however, clinical results of this treatment still remain determined. Methods: PubMed, Cochrane Library, PEDro, and CINAHL databases were systematically searched for randomized clinical trials and observational studies. Two independent researchers reviewed a total of 2,981 articles, 28 of which met the criteria for inclusion in the study. Clinical outcome measures included Constant score, visual analog scale score for pain, range of motion, and short-form 36 questionnaires. The meta-analysis used a linear mixed model weighted with the variance of the estimate. Results: The meta-analysis showed a significant improvement after surgery. Pain score is 26.2 mm (1 month) to 26.4 mm (3 months), and 24.8 mm (12 months) (P<0.05); active abduction: 153.2° (2 months), 159.0° (6 months), 168.1° (12 months) (P<0.05); Constant score: 67.8 points (2 months) to 77.2 points (12 months) (P<0.05); short-form 36 questionnaires "vitality" section: 57.0 points (6 months) to 70.0 points (12 months) (P<0.05). Conclusions: Our data confirmed the effectiveness of conservative treatment in patients with full-thickness rotator cuff tears 12 months post-intervention. The results suggest that conservative treatment for patients with full-thickness rotator cuff tears should be the first line of treatment before considering surgery.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.122-122
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• 2008

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.73-82
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• 2006

Purpose: The purpose of the present study was to evaluate the diagnostic efficacy of CT arthrography (CTA) in the assessment of various shoulder pathologies, compared with MR arthrography (MRA) and MRI with arthroscopic correlation. Materials and Methods: CTA in 84 patients, MRA in 70 patients, and MRI in 27 patients were obtained. A radiologist interpreted each image for 5 pathologies: Bankart, SLAP, Hill-Sachs lesion, full-thickness, and partial-thickness rotator cuff tear. Detailed arthroscopic reports were compared with CTA, MRA, and MRI. The sensitivity, specificity, predictive values, and accuracy were calculated. The agreement between each diagnostic modality and arthroscopy was calculated. Diagnostic efficacy was assessed by the areas under the receiver operating characteristic (ROC) curves. Results: The diagnostic values of all three imaging groups were comparable to each other for Bankart, SLAP, Hills-Sachs, and full-thickness cuff tear lesions, but those of CTA were lower than MRI and MRA for partial-thickness cuff tears. The areas under the ROC curves for CTA, MRA, and MRI were not significantly different for all pathologies, except for partial-thickness cuff tears. Conclusion: CTA was equally competent to MRA or MRI in demonstrating Bankart, Hill-Sachs lesions, SLAP, and full thickness rotator cuff tears but not as efficient in diagnosing partial thickness rotator cuff tears.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.96-103
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• 2008

Purpose: This study investigated the rate of retear and related factors after arthroscopic repair of rotator cuff tears involving more than one tendon. Materials & Methods: Arthroscopic repair of 22 rotator cuff tears (average size 3.2cm: average age 58 years old) involving the supraspinatus and part or all of the infraspinatus were investigated using MRI on average 10 months after repair. The status of the repaired cuff was investigated using Sugaya's classification, and the change in muscle was evaluated with Goutallier's classification. Results: Retear (Sugaya grade IV, V) was found in 7cases(32%). Tears larger than 3cm had a higher retear rate(67%) than smaller tears(8%). Retear cases had Goutallier grade II or higher muscle changes preoperatively and showed aggravation of muscle atrophy postoperatively. Even without retear, reversal of muscle change was not seen Conclusion: Rotator cuff tears not confined to the supraspinatus had a 32% retear rate after arthroscopic repair. The size of the tear was the most crucial factor influencing retear. Retear was frequent in tear over 3cm. Atrophy of the cuff muscle worsened when the repair failed but did not improve even without retear.