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.

Intrapelvic Granulomatous Mass Causing Ipsilateral Lower Leg Swelling following Total Hip Arthroplasty: A Case Report / 대한정형외과학회잡지

The usual causes of unilateral lower extremity swelling after total hip arthroplasty include deep vein thrombosis, chronic venous insufficiency and less frequently an infection or a neoplasm. Unilateral deep vein thrombosis or swelling of the lower extremity due to an intrapelvic granulomatous mass after total hip arthroplasty is quite unusual. We report a rare case of a patient with an intrapelvic granulomatous mass causing deep vein thrombosis and unilateral lower leg swelling after total hip arthroplasty with a review of the relevant literature.

Relationship between Osteoarthritis and Leptin Concentrations in Synovial Fluid / 대한정형외과연구학회지

PURPOSE: Leptin may play an important role in the pathophysiology of osteoarthritis. This study investigated whether leptin concentration in synovial fluid is related to the radiographic severity of osteoarthritis. MATERIALS AND METHODS: Synovial fluids were obtained from 29 osteoarthritis patients who underwent knee surgery and 10 who had no abnormality on articular cartilage during arthoscopic examination. The progression of osteoarthritis was classified by Kellgren Lawrence grading scale. The concentrations of leptin was measured with commercial enzyme-linked immnosorbent assay kits. RESULTS: A significant increase in synovial fluid concentrations was observed in osteoarthritis patients (6.7+/-4.1 ng/ml) compared to the control (2.4+/-1.3 ng/ml). Leptin levels were increased with advancing osteoarthritis stage, resulting in the highest level in stage IV patients(10.7+/-4.9 ng/ml; range 4.7-15.8) compared to that of stage I patients (4.0+/-2.0 ng/ml; range 1.2-7.3). In osteoarthritis patients, age showed a significant correlation with leptin concentrations. CONCLUSION: This study shows that synovial fluid leptin concentrations were closely related to the radiographic severity of osteoarthritis, and suggests that the age of patient may influence synovial fluid leptin concentrations during osteoarthritis progression.

Treatment in the ACL Partial Tear Using Radiofrequency Electrothermal Shrinkage

PURPOSE: To evaluate the effectiveness and results of the treatment with the radiofrequency electrothermal shrinkage in the patients with symptomatic knee instability caused by anterior cruciate ligament (ACL) partial tears. MATERIALS AND METHODS: Eleven patients with pains or instability of the knee caused by ACL partial tears were treated with the radiofrequency electrothermal shrinkage and followed for an average 19 months (range, 15 to 24 months). Inclusive criteria for this study included 1+ or negative in pivot-shift test, a side-to-side arthrometric difference less than 5 mm and structural integrity of the ACL more than 75% by arthroscopic inspection. Preoperative physical examination, Lysholm knee score and Tegner activity score were compared with postoperative ones. RESULTS: Preoperative Lachman test was positive in all cases and preoperative pivot-shift test was in 7 cases. Preoperative Telos stress radiographs revealed a mean side-to-side difference of 3.6 mm (2~5 mm). A mean preoperative Lysholm and Tegner score were 68.4 (44~90) and 3.1 (1~4) respectively. The other 4 patients had 1+ instability in Lachman test and two of the 4 patients also had 1+ finding in pivot-shift test. A mean postoperative Lysholm and Tegner score were 89.1 (75~99) and 6.3 (4~7) respectively. And a mean postoperative Telos stress radiographs was 4.0 mm (2~7 mm). CONCLUSION: The treatment using radiofrequency shrinkage for symptomatic ACL partial tears is helpful to relieve the symptoms, especially pain and recover functional activity. And it is important to have narrow indication and strict POP care to achieve good results.

Arthroscopic Reconstruction of the Posterior Cruciate Ligament : Comparison of Tibial Inlay and Tibial Tunnel Techniques / 대한정형외과학회잡지

PURPOSE: To compare the results of posterior cruciate ligament reconstructions by tibial inlay and tibial tunnel techniques. MATERIALS AND METHODS: Despite of conservative treatment, all patients (31 cases) had pain and grade 2 or more posterior instability. Posterior drawer test and posterior drawer stress radiography were performed. Clinically, Lysholm knee score and Tegner activity score were evaluated. RESULTS: In the tibial tunnel group, posterior drawer test demonstrated grade 1 instability in 7 cases, grade 2 in 4 cases, and grade 3 in 1 case at the last follow-up. In the tibial inlay group, there was grade 1 instability in 14 cases and grade 2 in 5 cases. On posterior drawer stress radiography, the mean side-to-side difference in measurement of the tibial tunnel group improved from 12.4 mm preoperatively to 4.0 mm at follow-up, and that of the tibial inlay group improved from 11.8 mm to 2.9 mm. Lysholm knee score and Tegner activity score improved to 86.8 points and 5.83 points, respectively, in the tibial tunnel group, and to 88.2 points and 5.84 points, in the tibial inlay group. CONCLUSION: PCL reconstruction with the tibial inlay technique tends to maintain better posterior stability, but there is no statistically significant difference between the two techniques. Further study may be required.

An Inguinal Mass associated with Polyethylene Wear Debris after a Total Hip Arthroplasty: A Case Report / 대한정형외과학회잡지

Ostelolysis and implant loosening by wear particles after a total hip arthroplasty is a well-documented phenomenon. Howerver, the occurrence of a soft tissue mass around the hip joint after a total hip arthroplasty is rare. We experienced a case of an inguinal mass associated with polyethylene wear particles. An excision of the mass and revision arthroplasty for a polyethylene liner and metal head were performed successfully via a separate incision. We describe this rare case with a review of the relevant literature.

Outcomes Related to Closed Interlocking Intramedullary Nailing for Segmental Tibia Fracture

PURPOSE: To evaluate the outcomes of twenty-six cases of segmental tibia fracture that were treated by closed interlocking intramedullary nailing. MATERIAL AND METHODS: All cases were followed up for at least 1 year (average 14.3 months). Clinical results were evaluated by Klemm & Borner's scale. We analyzed the average range of the motion of the ankle and knee joint, atrophy of quadriceps muscle and angular deformity at the last follow up. We evaluated complications (new fracture of the tibia, infection, compartment syndrome, nonunion, delayed union, angular deformity and pain of ankle and knee joint). RESULTS: Results were excellent in 4 cases (15.4%), good in 18 cases (69.2%), fair in 3 cases (11.5%), and poor in 1 case (3.9%). Union was obtained in 25 cases (96.1%) over an average period of 23.3 weeks. Nine cases showed intra-operative or post-operative complications: new fracture of the proximal tibia on the posteromedial side (2 cases), local infection at an entry point (2 cases), compartment syndrome (1 case), deep infection (1 case), and delayed union (3 cases). At the last follow up, angular deformity was found in 4 cases (mean of all deformities, 6 degrees): 3 cases at the proximal fracture site (2 cases of valgus deformity: 5 and 8 degrees and 1 case of varus deformity: 7 degrees) and the other case in the distal fracture site (valgus 5 degrees). Average postoperative range of motion of the knee joint was 123.7 degrees (80~135 degrees). Knee pain or limited motion occurred in 4 cases. The average range of the motion of the ankle joint was 68.1 degrees (60~70 degrees). Limited motion occurred in 4 cases (average, 10 degrees) but no case showed ankle pain. CONCLUSION: Closed interlocking intramedullary nailing for segmental tibia fracture often results in complications. To minimize these complications, comprehensive evaluation of the fracture, and careful surgical treatment are required.

An Enlarged Iliopsoas Bursa Associated with Osteonecrosis of the Femoral Head: A Case Report / 대한정형외과학회잡지

An enlarged iliopsoas bursa caused by hip joint disease, such as osteoarthritis, rheumatoid arthritis, synovial chondromatosis, pigmented villonodular synovitis and septic arthritis, but rarely due to osteonecrosis of the femoral head have been documented. We experienced a rare case of an enlarged iliopsoas bursa associated with osteonecrosis of the femoral head, and drained the iliopsoas bursa through an anterior capsule during total hip arthroplasty, using a posterior approach. We describe this rare case, with a review of the literature.

Prognostic factors of adult osteochondritis dissecans in the knee

PURPOSE: To analyze factors related to prognoses of adult osteochondritis dissecans. MATERIALS AND METHODS: 19 cases of osteochondritis dissecans(16 patients) were studied for 9 years(19901998) and mean follow-up was 3 years 5 months(2 years-5 years 6 months). To evaluate factors possibly related to prognoses, age at the onset of symptom and location, size, and degrees of progres-sion of the lesion were compared with final results. RESULTS: Clinical symptoms were improved in all cases, and evaluation with the Huston rating scale for osteochondritis dissecans revealed 2 excellent result, 9 good, 6 fair, 1 poor, and 1 failure. The results for the patients who initially developed symptoms before epiphyseal closure were better than for the patients who developed symptoms after epiphyseal closure, Lesions of non-weight-bearing area showed better results than lesions of weight bearing area. There were no relations between final results and lesions size. The lower stage of pathologic deterioration of the lesion had the better results. CONCLUSION: After arthroscopic treatment for osteochondritis dissecans, clinical results were improved in all cases, but radiologic results showed various results from complete healing to joint space narrowing. Radiologic finding determined final results. Age at the onset of symptoms and location and degrees of progression of the lesion have direct relationship with final results, but because this study for prognosis factor is short term result, long term follow up will be needed.

Complications after Hip Fracture in Children / 대한정형외과학회잡지

PURPOSE: To analyze complications and their effects on prognoses of children hip fractures. MATERIALS AND METHODS: 26 childhood hip fractures (6 type I, 7 type II, 10 type III, 3 type IV) were studied for 11 years (1986-1997) . We analyzed factors possibly related to complications and their effects on prognoses, especially avascular necrosis (AVN) of the femoral head. RESULTS: Of 26 patients, there were 7 AVN (27%) , 2 nonunions (8%) , 3 coxa vara (12%) , 9 premature epiphyseal closures (35%) , and 2 infections (8%) . Of 7 patients with AVN, 3 patients had type I fracture and 4 patients had type II fracture. No AVN developed in type III and IV fractures. Of 2 patients who had type I fracture with dislocation, all patients had AVN (100%) . Four of 14 patients who had displacement of the fracture site and one in 10 patients who had non-displacement fracture developed AVN. In our study of the incidence of AVN according to surgical reduction time after injury, 3 (60%) of 5 patients who were treated by surgical reduction within 6 hours and 4 (19%) out of 21 patients who were treated by surgical reduction after 6 hours developed AVN. CONCLUSION: In childhood hip fracture, surgical reduction time after trauma (10 years) were found to be an effective treatment of AVN. AVN concomitant with pyogenic infection had the worst prognosis.