Arthroscopic Transglenoid Suture Technique ( Rhee's method ): Cadaveric Studies on Relationship between Pinning site and Neurovascular Structures / 대한정형외과학회잡지

Arthroscopic treatment of shoulder instability involves two techniques mainly, transglenoid suture technique and anterior anchoring system. However, anterior anchoring system has some disadvantages such as limited indication, high cost, technical difficulty and incapability to suture or reconstruct for all types of Bankart lesion. Disadvantages of transglenoid suture techniques are indirect suture tie, bump effect and possibility of the suprascapular nerve injury. The authors use modified transglenoid suture technique (Rhees method) for shoulder instability involving Bankart lesion, type II SLAP lesion and capsular laxity. The purpose of this study is to accurately describe the relationship between the major neurovascular structures and the pinning sites used in transglenoid suture technique (Rhees method). Placement of two or three arthroscopic Beath pinning sites was simulated in four fresh cadaveric shoulder specimens by placing Steinman pins into the glenoid rim under open field. The specimens were then dissected and the relationship of the pinning sites to the suprascapular nerve and suprascapular artery were recorded. In Bankart lesion repair, safe zone of pinning sites were 2 and 5 oclock in two portals in right shoulder, safe zone of pinning sites were 7 and 10 oclock in two portals in left shoulder. Safe direction of pinning was as possible as inferomedial side in scapula. In type II SLAP repair, safe zone of pinning sites were 2 oclock and just above 2 oclock of glenoid in right shoulder and 10 oclock and just above 10 oclock of glenoid in left shoulder. Safe direction of pinning was pararell to glenoid cavity and slightly superior in horizontal plane. From this study, these sites and directions appeared to be safe. Proper pinning depends on careful attention to the topographical anatomy about the shoulder.

Rhee's method / 대한정형외과학회잡지

This is a retrospective review of 11patients of type II SLAP lesion which were found during arthroscopic treatment of 26 patients diagnosed SLAP lesion, clinically and radiologically, hetween March l989 and June 1996. Follow-up time was averaged 26 months (range, l2 months to 72 months) and average age was 30 years old. All patients were treated arthroscopically for SLAP lesion. In type II 2 cases were repaired hy biodegradable tacks (Suretac(R)), 9 cases were repaired by transglenoid and transscapular tcchnique that included dehridement of the frayed lahrum and ahrasion of the superior glenoid neck, followed hy the placement of multiple suture on the torn capsular-labrum complex and lahrum-biccps tendon complex using suture hook, heath pin and # 0 PDS (Rhee's method). Among 9 cases with transglenoid and transscapular suture technique in type II SLAP lesion, the result were quantitated with Rowe ratin scale, 4 cases were exellent, 3 cases were good and 2 cases were fair. Our modification technique, using transglenoidal two bone hole technique and tying on scapular spine can ohtain as compatible fixation as other techniques which include metal staple, bioderadahle tacks (Suretac(R)) and anterior anchoring system such as mini-Revo. Our technique also has reasonable recurrence rate with few complication. The advantage of our modified technique is able to do superior capsular advancement, capsular plication and capsular shift which procedures are very difficult in other techniques. We propose arthroscopic transglenoid and transscapular suture technique (Rhee's method) for type II SLAP lesion as one of new method of suture for type II SLAP lesion.

Arthroscopic Treatment of SLAP Lesion / 대한정형외과학회잡지

This is retrospective study of the 18 patients of SLAP lesion which were found during arthroscopic treatment of 92 patients. The patients were diagnosed as recurrent shoulder dislocation (50 patients), shoulder impingement syndrome (36 patients) and SLAP lesion (four patients), clinically and radiologically, between March 1989 and June 1995. SLAP lesion were found in eleven patients with recurrent shoulder dislocation, three patients with impingement syndromes. Solitary SLAP lesions were found in four patients. Mean follow-up time was 36 months (range, 12 to 72 months) and average age of patients were 26 years old. Type I SLAP lesion by Snyder's classification were eight cases, type II were seven cases, type III were two cases and type IV was one case. Arthroscopic debridement of frayed or degenerated labrum and biceps tendon anchor were per formed in ten cases of type I and III. In type II and IV, six cases were repaired by arthroscopic placement of multiple suture, two cases were repaired by biodegradable tack (Suretac). The result were quantitated with Rowe rating scale. Eleven cases were exellent, four cases were good, and three cases were fair with Rowe rating scale. Our study revealed that these lesions were not uncommon in instability or impingement of shoulder. Type II SLAP lesion was frequently associated with anterior shoulder instability.

The Role of Intraoperative Frozen Section as a Guide to Sepsis in Hip Arthroplasty for Teatment of painful Hip Disease / 대한정형외과학회잡지

We performed a retrospective analysis of twenty-four consecutive hip arthroplasties (Total Hip Arthroplasty 18, Bipolar Arthroplasty 1, Cup revision 5) during which intraoperative frozen sections were analyzed to identify the occult active infection. We also reviewed the data such as laboratory findings (ESR, CRP), intraoperative culture, hip joint sonographic evaluation and permanent histologic section. Among the twenty-four patients those who received hip arthroplasties, 10 cases received revisional hip arthroplasties due to painful hip prosthesis loosening, 9 cases with infected hip prosthesis, 3 cases with infection after open reduction and internal fixation due to hip fracture and 2 cases with septic hip sequelae. Intraoperative frozen section had been obtained during staged revisional hip arthroplasties to determine the presence of active infection. We considered positive for infection if it shows more than 10 PML/HPF (Polymorphonuclear leukocyte /high power field) in at least 5 distinct microscopic fields from intraoperative tissue frozen section and postponed implantation of prosthesis. If it shows less than 5 PML/HPF, we performed revisional hip prosthesis implantation. We decided the implantation based on patient's condition, laboratory findings and intraoperative tissue conditions if it shows between 5 and 10 PML/HPF from intraoperative frozen section. At last follow up, 20 of 21 patients who had a revisional hip arthroplasties as below 10 PML/HPF from intraoperative frozen section remained free of infection (Specificity; 95%). We concluded that analysis of the intraoperative frozen sections is a reliable predictor as a guide to sepsis for the successful hip joint arthroplasties.

Dislocation after Hip Arthroplasty: Analysis of the Cause Factors / 대한정형외과학회잡지

We reviewed 174 total hip arthroplasty (25 were revision procedure) and 65 bipolar hemiarthroplasty procedure followed by more than 6 months at Chungnam National University Hospital from July, 1992 to March, 1995. These were performed on 189 male and 50 female patients. We have followed up average 45.8 months and obtained following results; The dislocation rate is 3.76% (9 of 239 cases) and the dislocation rate of revision arthroplasties (16%: 4 of 25 cases) is higher than those of primary hip arthroplasties (2.6%: 5 of 214 cases). Among Nine dislocations, 8 cases (89%) were between fifth and seventh decade and all cases are men. All dislocations occured within 5 weeks postoperatively. Because 6 of 9 cases were due to poor compliance, the patient's cooperation during postoperative recovery is essential to prevent postoperative dislocation. The capsulectomy, surgical approach, or immobilization of patients after operation are unrelated to dislocaton. For the prosthetic factors, 7 cases dislocated posteriorly is appeared that the plane of the cup was between 3 and 9 degrees of anteversion, and also less than the normal range. Stable outcome without surgical operation was achieved in 7 of 9 dislocation. Among 2 patients who had recurrent dislocation after optimum conservative treatment, one had infected arthroplasty and the other had a impinged anterior thick capsule formation around the head. We concluded that the predisposing factors for dislocation after hip arthroplasty is multifactorial.