Clinical outcomes of bending versus non-bending of the plate hook in acromioclavicular joint dislocation

We aimed to assess the effect of plate hook bending in treatment of acromioclavicular (AC) dislocation by analyzing clinical and radiological results according to the angle of the plate hook (APH). Methods: This was a retrospective, observational, case-control study including 76 patients with acute AC joint dislocation that were divided into two groups according to treatment with bent or unbent plate hook. The visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) shoulder score, and range of motion (ROM) were evaluated as clinical outcomes. Comparative coracoclavicular distance (CCD) was measured to evaluate radiological outcomes. Results: While the VAS and ASES of the bending group at 4 months after surgery were significantly higher (p=0.021 and p=0.019), the VAS and ASES of the bending group at other periods and ROM of the bending group showed no significant difference. The initial CCD decreased from 183.2%±25.4% to 114.3%±18.9% at the final follow-up in the bending group and decreased from 188.2%±34.4% to 119.1%±16.7% in the non-bending group, with no statistical difference (p=0.613). The changes between the initial and post-metal removal CCD were 60.2%±11.2% and 57.3%±10.4%, respectively, with no statistical difference (p=0.241). The non-bending group showed greater subacromial osteolysis (odds ratio, 3.87). Pearson’s coefficients for the correlation between APH and VAS at 4 months after surgery and for that between APH and ASES at 4 months after surgery were 0.74 and –0.63 (p=0.027 and p=0.032), respectively. Conclusions: The APH was associated with improved postoperative pain and clinical outcomes before implant removal and with reduced complications; therefore, plate hook bending is more useful clinically during plate implantation.

Arthroscopic Treatment of a Type II Superior Labrum Anterior to Posterior (SLAP) Lesion Combined with a Bankart Lesion: Comparative Study between Debridement and Repair of Type II SLAP Lesion by the Status of Lesion

BACKGROUND: The purpose of this study is to evaluate results of superior labrum anterior to posterior (SLAP) repairs and debridement of type II SLAP lesions combined with Bankart lesions. METHODS: Between 2010 and 2014, total 58 patients with anterior shoulder instability due to a Bankart lesion combined with a type II SLAP lesion were enrolled. Patients were divided into two groups: group C consisted of 30 patients, each with a communicated Bankart and type II SLAP lesion and group NC consisted of 28 patients, each with a non-communicated Bankart and type II SLAP lesion. Bankart repairs were performed for all patients. SLAP lesions were repaired in group C and debrided in group NC. Clinical results were analysed to compare groups C and NC by using the visual analogue scale pain score, American Shoulder and Elbow Surgeons score, Constant scores, Rowe score for instability and range of motion assessments. RESULTS: The clinical scores were improved in both groups at final follow-up. Also, there were no differences between two groups. No significant difference was found in terms of the range of motion measured at the last follow-up. The number of suture anchors used was significantly higher in group C than in group NC (5.6 vs. 3.8; p=0.021). CONCLUSIONS: In this study, it is considered that Bankart repair and SLAP debridement could be a treatment option in patients with a non-communicated type II SLAP lesion combined with a Bankart lesion (study design: IV, therapeutic study, case series).

Is There a Clinically Important Superior Labrum Anterior to Posterior (SLAP) Lesion? / 대한정형외과학회잡지

Superior labrum anterior to posterior (SLAP) lesion is a tear of the superior labrum, which starts posteriorly and extends anteriorly to include the anchor of the biceps tendon to the superior labrum. Symptoms of SLAP tear may include pain or instability. Recently, with the development of arthroscopy, the diagnosis and treatment of SLAP lesion have been made a lot. However, the diagnosis of clinically relevant SLAP tears remains challenging because of the lack of specific examination findings and the frequency of concomitant shoulder lesion. And there is still controversy regarding the treatment. Accordingly, proper treatment is important through accurate evaluation of whether or not it is a clinically important SLAP lesion.

Change in Neural Tube Size for a Lumbar Spinal Stenosis Patient on Axial Loading Magnetic Resonance Imaging / 대한정형외과학회잡지

PURPOSE: A conventional magnetic resonance imaging (MRI) was conducted in supine position, showing a slight different from that conducted in upright position. Therefore, we simulated the upright position by applying the axial load on a lumbar spinal stenosis patient and measured the change of neural tube size in axial load and standardized the data. MATERIALS AND METHODS: We compared the axial loading MRI obtained from spinal stenosis patients who visited Wonkwang University Hospital outpatient clinic between October 2010 and May 2011 showing radiologic and physical symptoms. RESULTS: Neural tube sizes by conventional MRI were as follows: 195.57 mm² and 203.20 mm² on average between the left and right sides in L3/4; 194.64 mm² and 211.43 mm² on average in L4/5; and 199.38 mm² and 203.04 mm² on average in L5/S1. Neural tube sizes by axial loading MRI were as follows: 166.43 mm² and 174.27 mm² on average between the left and right sides in L3/4; 154.81 mm² and 158.67 mm² on average in L4/5; and 148.48 mm² and 157.19 mm² on average in L5/S1. Changes of neural tube sizes in L3/4, L4/5, and L5/S1 had a significant correlation (p<0.05). CONCLUSION: The axial loading device was an excellent tool in simulating the upright position for spinal stenosis patients, and the change of neural tube sizes reproduced for the upright position was statistically significant. This is thought to be meaningful for clinical applicability.