Operative Treatment of Calcific Tendinitis of the Shoulder / 대한정형외과학회잡지

PURPOSE: We evaluated the results of surgical treatments for calcific tendinitis of the shoulder according to operative methods. MATERIALS AND METHODS: Retrospective review was done on 32 patients surgically treated for calcific tendinitis from January 1996 through December 2002. Mean age of two groups, open (16 cases) and arthroscopic (16 cases), was 43 years and 46 years, respectively, and mean follow-up after the operation, 9 months and 11 months, respectively. The results of the operation were clinically and radiologically evaluated. The Constant-Murley score was used for the shoulder function. RESULTS: There was no significant difference in pain relief, improvement of range of motion and maintenance of abduction power between the two groups. In both groups, range of rotation was markedly limited and more than 30% of the patients in each group suffered postoperative pain for more than 12 weeks. Preoperatively, the Constant-Murley score was 33 and 32, respectively and at the final follow-up, 80 and 78, respectively. CONCLUSION: Open and arthroscopic surgery for calcific tendinitis of the shoulder were successful and there was no significant difference in the overall results between the two groups.

Involvement of NMDA Receptor and L-type Calcium Channel in the Excitatory Action of Morphine

We studied the excitatory action of morphine on the responses of dorsal horn neuron to iontophoretic application of excitatory amino acid and C-fiber stimulation by using the in vivo electrophysiological technique in the rat. In 137 of the 232 wide dynamic range (WDR) neurons tested, iontophoretic application of morphine enhanced the WDR neuron responses to N-methyl-D-aspartate (NMDA), kainate, and graded electrical stimulation of C-fibers. Morphine did not have any excitatory effects on the responses of low threshold cells. Morphine-induced excitatory effect at low ejection current was naloxone-reversible and reversed to an inhibitory action at high ejection current. NMDA receptor, calcium channel and intracellular Ca2+ antagonists strongly antagonized the morphine-induced excitatory effect. These results suggest that changes in intracellular ionic concentration, especially Ca2+, play an important role in the induction of excitatory effect of morphine in the rat dorsal horn neurons.

Reconstruction of Dislocated Acromioclavicular Joint Augmented with Absorbable Sutures / 대한정형외과학회잡지

PURPOSE: We have studied the result of a modified Weaver-Dunn technique using absorbable sutures and imbrication of deltotrapezial fascia for the treatment of the dislocation of acromioclavicular joints. MATERIALS AND METHODS: Seventeen dislocations treated with the operative technique. Followed-up after at least 18 months postoperatively were retrospectively analyzed using the UCLA rating scale score, radiological films and occurrence of postoperative complications. RESULTS: Overall results were excellent in 7 (41%), good in 8 (47%) and poor in 2 cases (12%) according to UCLA rating system. The effect of age on the outcome was not significant but the result was better for early operations than late operations. Forward elevation loss was found in the group that was older than 39 years. The clavicle was anatomically reduced and maintained in 13 cases (76%). CONCLUSION: Modified Weaver-Dunn technique using absorbable sutures is a good treatment for acromioclavicular dislocations and imbrication of deltotrapezial fascia is important in stabilizing the joint.

Indirect Signs of Magnetic Resonance Imaging of the Knee with Anterior Cruciate Ligament Tears: Comparison between Acute and Chronic ACL Tears / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to assess the differential features of indirect signs at magnetic resonance (MR) imaging in acute and chronic tears of the anterior cruciate ligament. MATERIALS and METHODS: Preoperative MR imagings of 71 patients (71 knees) who were confirmed as complete tear of anterior cruciate ligament (ACL) by arthroscopy were evaluated. On MR imagings of acute (n=47) and chronic (n=24) tear of ACL, and of the control group (n=31) , we reviewed bone bruise, posterior displacement of the lateral meniscus, posterior cruciate ligament (PCL) angle, and PCL line. RESULTS: Bone bruise was observed in 35 cases (74.5%) at acute tear and in 9 (37.5%) at chronic tear, and mean PCL angle was 122 and 106 degrees, respectively. These two signs were significantly different (p<0.05) . The presence of posterior displacement of lateral meniscus was in 26 cases (55.3%) at acute tear and in 12 (50.0%) at chronic tear. Positive PCL line was in 23 (48.9%) and in 16 (66.7%) cases, respectively. CONCLUSION: Bone bruise, posterior displacement of lateral meniscus, PCL angle, and PCL line were helpful indirect signs suggesting an ACL tear in MR imagings. Posterior displacement of lateral meniscus and PCL line were not affected by the time of ACL tear. Bone bruise in acute tear and PCL angle in chronic tear were very frequent.

Influence of the Posterior Slope of the Tibial Component on the Maximal Flexion after Total Knee Arthroplasty

To evaluate the effect of tibial cut with posterior slope in total knee arthroplasty(TKA) surgery on the flexion of the knee, 41 knees(32 patients) with varying degree of the posterior slope were retrospectively reviewed at more than 1 year after operation. Does sloping the tibial cut iurface rnore posteriorly promote increasing of maximal flexion of the knee by elimination of excessive tenaion of the posterior cruciate liga ment The degree of the posterior slope was radiographically measured, awi the change of the degree of the maximal flexion between preoperative and postoperative period was clinimlly measured with a goniometer at the latest follow up more than 1 year after operation. Comparison of the results demonstrated significantly larger degree of rqaximal flexion for the knees that had tibial cut with the degree of the posterior slope, 5 degrees or rnore (p<0.05). We concluded that 5 degrees or more posterior slope in proxirnal tibial cut is one of the important fact()r which could achieve increased flexion of the knee after TKA operation.

Analysis of Bone Mineral Density in the Advanced Osteoporotic Spine with Osteoarthritis / 대한정형외과학회잡지

Measurement of bone mineral density(BMD) of the spine may be affected by the presence of various factors such as osteophytes, osteosclerosis and spinal deformity, particularly in elderly persons. Therefore the accurate evaluation for osteoporosis is difficult in osteoarthritic spine and until now no technique can evaluate true mineral density of the osteoarthritic spine. So we performed this study to evaluate the effect of osteoarthritic changes of the spine on the BMD and various BMD values such as young-adult% and age-matched%. Additionally we evaluated the diagnostic value of the Singhs index in the advanced osteoporotic spine. We reviewed 50 patients with advanced osteoporosis of the spine retrospectively and they were divided into two groups; one consisted of 22 patients with osteoporosis alone and the other consisted of 28 patients with osteoporosis and osteoarthritic change on the spine. The measured mean BMD value in AP plane and that expressed in relation to reference data for young adults(young-adult%) of the patients with arthritic and osteoporotic spine were significantly higher than those of the patients with osteoporosis alone. On the other hand, values expressed in relation to the age and sex matched mean reference data(age-matched%) were not significantly higher in group of patients with osteoporosis and osteoarthritic change, and Singh s index was not diagnostic for the osteoporosis of the spine. But young-adult% were significantly lower than agematched% even in the osteoarthritic group. We concluded that young-adult% is mare useful value for diagnosis of the advanced osteoporosis in the osteoarthritic spine.