Arthroscopic Findings of Isolated Meniscal Tears in Soldiers Younger Than 30 Years of Age / 대한스포츠의학회지

Meniscal tears are a common source of knee pain in military personnel. We aimed to investigate the arthroscopic findings of isolated meniscal tears in soldiers younger than 30 years of age. Between May 2011 and April 2014, a total of 36 soldiers with 37 knees who underwent arthroscopic surgeries for isolated meniscal tears were included in this study. All patients were male soldiers and average age was 22 years (range, 19 to 30 years). Thirty patients (83%) were identified as having trauma in sports activity or military training, but no definite trauma was documented in six patients. We analyzed whether medial or lateral meniscus, the location and type of tear according to the arthroscopic findings. The incidence of meniscal tears was nearly same for both knees (right 18 and left 19). Twenty-six of 37 tears (70%) were found in the lateral meniscus and 11 (30%) in the medial meniscus. Twenty-five tears (68%) were located in mid body and traumatic vertical type tears (65%) were more common than degenerative horizontal type tears (35%). Although our study based on relatively small cohort, isolated meniscal tears in young soldiers were usually resulted from trauma such as sports or ranger training and commonly located in lateral meniscus. Regarding the type of tear, traumatic vertical type was more common than degenerative horizontal type.

Rapidly Progressive Osteonecrosis of the Humeral Head after Arthroscopic Bankart and Rotator Cuff Repair in a 66-Year Old Woman: A Case Report

Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery.

Gravity Valgus Stress Ultrasonographic Assessment of Ulnar Collateral Ligament Injury among Baseball Players / 대한스포츠의학회지

The purpose of this study is to evaluate the gravity valgus stress ultrasonographic findings of ulnar collateral ligament (UCL) injury among baseball players. Twenty-eight (age, 16-30; mean, 19.5 years) UCL injured players, diagnosed by magnetic resonance imaging (MRI), were examined by bilateral elbow ultrasonography. On MRI findings, partial and complete tears were 17 and 11 players, respectively. Ultrasonographic examinations were performed in 90 degree elbow flexion with gravity valgus stress, and abnormalities around UCL and ulnohumeral distance were compared with contralateral uninjured elbow. 22 of 28 (79%) players had sonographic abnormalities in injured elbow such as thickening, wavy contour of the UCL (32%), hypoechoic foci in the ligament (43%), osteophyte on trochlear or ulnar articular margin (36%), joint effusion (29%) and ossicles in or around the UCL (68%) that were the most common finding in both partial and complete tears. In all players, the ulnohumeral distance was significantly wider on the injured side than it was on the uninjured side (4.0+/-1.5 mm and 2.5+/-0.43 mm, respectively; p=0.015). Significant increased average ulnohumeral distance in injured elbow was observed with complete UCL tears compared with partial tears (5.4+/-0.9 mm and 3.1+/-0.8 mm, respectively; p=0.021) and the mean difference between injured and uninjured elbow was more significant in complete tears than partial tears (2.8+/-1.2 mm and 0.7+/-0.6 mm, respectively; p=0.012). Gravity valgus stress ultrasonography is rapid noninvasive diagnostic tool and can provide clinicians valuable information regarding the condition of the UCL and medial elbow laxity in partial and complete UCL tear players.

Scapulothoracic Bursitis in a Amateur Baseball Pitcher / 대한스포츠의학회지

Scapulothoracic bursitis refers to inflammation of the bursae secondary to trauma or overuse owing to sports activities or work. It usually causes persistent pain and scapulothoracic crepitus by irritation of bursa but can be presented as painless mass around chest wall. We report a case of scapulothoracic bursitis in a baseball pitcher presenting as rapidly growing chest wall mass confused with a soft tissue tumor. Computed tomography and magnetic resonance imaging revealed as a well-demarcated cystic mass situated between the scapula and chest wall. Incisional drainage resulted in complete resolution of the mass within a couple of weeks. Scapulothoracic bursitis may be presented as painless huge mass in overhead sports athlete and one of the differential diagnoses of soft tissue tumor of the chest wall.

Rapidly Progressive Osteonecrosis of the Humeral Head after Arthroscopic Bankart and Rotator Cuff Repair in a 66-Year Old Woman: A Case Report

Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery.

Evaluation of the Kinetic Chain in Little League Elbow / 대한스포츠의학회지

This study is to evaluate the abnormalities in the kinetic chain in the players with little league elbow during the medical screening of middle school baseball teams. Ninety-three players were examined with elbow ultrasonography in the field. Using kinetic chain evaluation test, 27 players sonogrphically diagnosed of little league elbow in dominant arm were compared with 25 players who were normal as control. Scapular-spine distance, horizontal flexion test, combined abduction test, and glenohumeral internal rotation deficit were used for evaluating kinetic chain in the upper extremities, while tightness of quadriceps and hamstring muscles, internal rotation of stance leg, and external rotation of stride leg were used for lower extremities. Also, the single leg stance test and finger-floor distance were used for core stability and flexibility. Twenty-five of 27 players (93%) having little league elbow showed kinetic chain abnormalities of either upper or lower extremities or trunk. This rate was significantly higher for the players having the little leaguer's elbow than control (28%) (p=0.017). Each specific tests for evaluating kinetic chain were also more prevalent in little league elbow group than control, and the abnormalities in the upper extremity were more common than those in lower extremity (p=0.026). Combined abduction test (23/27) and limitation of internal rotation of stance leg (16/27) were the most prevalent abnormalities in upper and lower extremity test, respectively. Our findings showed that there are many abnormalities in kinetic chain in players having the little league elbow and it may be associated with pathogenesis of little league elbow.

Avulsion Fracture of the Talar Attachment of the Anterior Talofibular Ligament in Pediatric Patient: A Case Report / 대한족부족관절학회지

Inversion injury of the lateral ankle ligaments is very common. Few studies, however, have focused on avulsion fracture of the lateral ankle ligaments. A fracture producing a small fragment usually avulsed from lateral malleolus and may be easily misdiagnosed as a sprain because the fragment is superimposed on the lateral malleolus and goes undetected on early radiographs, especially in skeletally immature patients. We present a case of isolated avulsion fracture of the talar attachment of the anterior talofibular ligament in 13-year-old male patient. Diagnosis was confirmed by computed tomography and avulsed fragment was fixed to original talar footprint with suture anchors. A high level of suspicion must be maintained to obtain an accurate diagnosis of avulsion fracture in inversion ankle injury because of the high incidence in children and to prevent recurrent instability.

Arthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results

BACKGROUND: To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations. METHODS: From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion. RESULTS: VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions. CONCLUSIONS: In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.

Effects of Leptin on Proliferation, Anabolic and Catabolic Metabolism in Chondrocytes / 대한정형외과연구학회지

PURPOSE: Leptin may play an important role in the pathophysiology of osteoarthritis. However, the effect of letpin on the anabolic and catabolic metabolisms in chondrocytes remains unclearly elucidated. Therefore, the purpose of this study was to investigate the effect of leptin on proliferation, anabolic and catabolic metabolism of chondrocyte using ATDC5 chondrogenic cell line. MATERIALS AND METHODS: The effects of leptin on chodnrocyte proliferation, anabolic and catabolic meatabolism were examined in ATDC5 cells treated with leptin at varying concentrations(10, 100, 300, 600 ng/ml) for 24, 48, and 72 hours. The cell proliferation was evaluated by MTT assay. The anabolic and catabolic activities were assayed by RT-PCR for transforming growth factor-beta(TNF-alpha), proteoglycan-4 (PRG4), type- I collagen (type- I Col) and tumor necrosis factor-beta(TNF-alpha), matrix metalloproteinase -2 (MMP-2), respectively. RESULTS: Leptin treatment did not influence cell proliferation of chondrocyte regardless of concentration. TGF-beta expression was increased until 48 hours of leptin treatment compared to controls. Especially, it was significantly increased in leptin of 10 ng/ml and 100 ng/ml (P<0.05). PRG4 expression was not different between letpin treatment and controls. Type-I Col expression was decreased in dose- and time-dependent manner. Leptin of 10ng/ml significantly inhibited MMP-2 and TNF-alpha expressions compared to controls (P<0.05). CONCLUSION: This study shows that leptin at low concentration increases TGF-beta expression, but inhibits the expression of TNF-alpha and MMP-2. Also this study shows that leptin do not affect the cell proliferation of chondrocytes. These results suggest that leptin at low or physiological level contributes to the prevention of cartilage damage by stimulating anabolic activity and inhibiting catabolic activity of chondrocyte rather than chondrocyte regeneration by increasing cell proliferation.

Granuloma Mimics a Clinical Manifestation of Lumbar Spinal Stenosis after Acupuncture: A Case Report / 대한정형외과학회잡지

Recently, the use of acupuncture has been increasing for the management of low back pain and herniated nucleus pulposus. There are many debates on its usefulness and associated complications. Complications such as hemorrhage, infection, direct internal organ or nerve injury and disease transmission have been reported. We report a case of dural sac and nerve root compression caused by chronic inflammatory granuloma. This chronic inflammatory granuloma, which might have been formed by local hemorrhage or low-grade infection after acupuncture is highly suspected to produce the symptoms of spinal stenosis; moreover, after surgical excision of the granuloma the patient's symptoms were eliminated. Hence, we report this case and discuss the possibility of the acupuncture as a cause.

Functional Outcome of the Surgical Correction of Neuromuscular Scoliosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study of functional outcome after surgical correction of neuromuscular scoliosis. OBJECTIVES: To assess functional outcomes and their significances after the surgical correction of neuromuscular scoliosis. SUMMARY OF LITERATURE REVIEW: The surgical correction of neuromuscular scoliosis has been used to stabilize the trunk for balanced sitting, to improve cardiopulmonary function, and the function of the upper extremities. Many authors have reported favorable surgical results, but few studies have been undertaken on functional assessment after surgery. MATERIALS AND METHODS: Eighteen adult patients with neuromuscular scoliosis underwent surgical correction. Functional assessments were performed in terms of impairments, disabilities, and handicaps. The impairments included sitting ability, coronal Cobb's angle, pain after surgery, and cosmesis after surgery. The disabilities included dressing, feeding, toilet/bathing, locomotion, and the use of both hands, and the handicaps included the effort and time to care for patients. Each parameter was checked preoperatively, 6 months after surgery, and at the last follow-up. RESULTS: In terms of impairments, sitting ability, coronal Cobb's angle, pain, and cosmesis were improved by surgery. In terms of disabilities, dressing, toilet/bathing, and locomotion were not improved after surgical correction. However, the feeding and use of both hands were significantly improved. And, in terms of handicaps, both the effort and the time required for care were reduced post-surgically. CONCLUSIONS: We conclude that impairments, handicaps, and the functions of the upper extremities were improved after surgical intervention to stabilize the trunk and spine in cases of neuromuscular scoliosis, but that overall disabilities were unaffected. This latter apparent shortcoming is attributed to the inability of surgery to treat previous systemic disease affecting physical disabilities of lower extremities. However, surgical correction of neuromuscular scoliosis was found to be clinically significant in terms of improving the functions of the trunk and of the upper extremities.