A Comparison of the Short-term Results between the PCL Sacrificing Medial Pivot Knee and Nexgen(R) LPS Total Knee Arthroplasty

PURPOSE: We wanted to compare the clinical and radiological results after performing total knee arthroplasty (TKA) with the PCL sacrificing (PS) Medial Pivot Knee (MPK) and the Nexgen(R) LPS. MATERIALS AND METHODS: Seventy knees in 48 patients after TKA with the PS ADVANCE(R) MPK (group I) and 67 knees in 45 patients with the Nexgen(R) LPS (group II) were retrospectively evaluated. All the patients were followed up for more than 2 years. The evaluations included the preoperative and postoperative range of motion (ROM), the Knee Society (KS) scores, the tibiofemoral angle and the postoperative complications. RESULTS: For group I, the ROM increased from a mean flexion contracture of 6.3degrees and further flexion of 116.4degrees to 1.9degrees and 120.5degrees, respectively, and for group II, from 12.6degrees and 117.6degrees to 0.9degrees and 123.0degrees, respectively. For group I, the KS knee and function scores increased from 46 and 37 to 87 and 83, respectively, and for group II, from 50 and 48 to 87 and 83, respectively. For group I, the tibiofemoral angle changed from varus 4.0degrees to valgus 5.5degrees, respectively, and for group II, from varus 4.1degrees to valgus 5.3degrees, respectively. The complications were 2 knees (2.8%) with periprosthetic patellar fractures and 1 knee (1.4%) with a tibial component failure in group I, and 1 knee (1.5%) with early femoral component failure and 1 knee with arthrofibrosis (1.5%) in group II. CONCLUSION: The minimum 2-year follow-up results of PS MPK TKA were comparable to those of Nexgen(R) LPS TKA. However, we think that the MPK system has the advantage of more bony preservation at the femoral intercondylar notch area.

Biomechanical Comparison of the Modified ML (Mattress Locking) Suture and the Modified MA (Mason-Allen) Suture in Rotator Cuff Repairs / 대한정형외과학회잡지

PURPOSE: In arthroscopic rotator cuff repairs, there is generally a weak link in the tendon suture interface, and arthroscopic rotator cuff repairs can have higher retear rates than open repairs. The purpose of this study was to compare the strength of modified ML (Mattress Locking) suture vs. the modified MA (Mason-Allen) suture when the suture is anchored into bone. MATERIALS AND METHODS: Paired human supraspinatus tendons were harvested and split in half, producing four tendons per one cadaver, for a total of 24 specimens. Two suture configurations (ML, MA) were randomized and checked for each set of tendons. Specimens were cyclically loaded under force control between 5 and 30 N at 0.25 Hz for fifty cycles. Each specimen was loaded to failure under displacement control at 1 mm/sec. Cyclic elongation, peak to peak displacement, stiffness, ultimate tensile load, and mode of failure were checked. RESULTS: No significant difference was found between the two suture configuration with respect to peak to peak displacement, cyclic elongation, and stiffness. With regard to ultimate failure load, there were no statistically significant differences between the modified ML suture and the modified MA suture (223.18N, 220.82N). The most common mode of failure between both sutures was suture pullout. CONCLUSION: The modified ML suture and the modified MA suture have similar biomechanical properties. The modified ML suture may be a simple and clever method and similar biomechanical alternative to the modified Mason-Allen suture in arthroscopic rotator cuff repair.

Arthroscopic Stabilization Using Remplissage Technique in Recurrent Shoulder Instability with Large Hill-Sachs Lesion / 대한스포츠의학회지

The glenohumeral bone deficiency plays an important role in the failure of arthroscopic shoulder stabilization procedures. Recently, several authors have described more novel approaches to treat the engaging Hill-Sachs lesion. Presented the 'Remplissage' technique that consists of an arthroscopic posterior capsulodesis and infraspinatus tenodesis to fill the Hill-Sachs lesion in addition to an arthroscopic Bankart repair. We report an arthroscopic technique in recurrent shoulder instability with large Hill-Sachs lesion with posterior capsulodesis and infraspinatus tenodesis.

Arthroscopic Stabilization Using Remplissage Technique In Recurrent Shoulder Instability with Large Hill-Sachs Lesion: Minimum Six Months Follow-Up Results

PURPOSE: To evaluate shoulder stability, clinical, and functional results more than 6 months after utilizing the 'Remplissage' technique, consisting of an arthroscopic posterior capsulodesis and infraspinatus tenodesis, to fill Hill-Sachs lesions. MATERIALS AND METHODS: Seven patients were followed-up more than 6 months after the 'Remplissage' procedures performed in our hospital from August 2008 to August 2009. The mean age of the patients was 28.6 years and the mean follow-up time was 10 months. Evaluations included ROM, ASES score, KSSI score, ROWE score, and postoperative MRI. RESULTS: In a functional evaluation of the patients with an average postoperative time of 10 months, the ASES score improved from 51.4 preoperatively to 76.8 postoperatively, the KSSI score improved from 46.5 preoperatively to 76 postoperatively, and the ROWE score improved from 43.5 preoperatively to 76.3 postoperatively. After an average postoperative time of 10 months, the range of motion was nearly normal (>170 degrees in further flexion, and >45 degrees in external rotation). CONCLUSION: In recurrent shoulder instabilities with large Hill-Sachs lesions, the 'Remplissage' technique resulted in good outcomes in terms of shoulder stability, clinical, and functional results after postoperative times of more than 6 months.

Arthroscopy Assisted Percutaneous Reduction and Screw Fixation of a Displaced Intra-articular Glenoid Fracture: A Case Report

PURPOSE: The authors used arthroscopy-assisted percutaneous reduction and cannulated screw fixation rather? than conventional arthrotomy for displaced glenoid fracture. MATERIALS AND METHODS: We used arthroscopy assisted reduction and screw fixation for a 66 year old man who had a clavicle fracture, a displaced glenoid fracture and a scapula fracture. RESULTS: At 9 months postoperatively, the patient had recovered full range of motion and was not inconvenienced by the surgery. Removal of the implant was done 12 months post-operatively under general anesthesia. CONCLUSION: The advantages of arthroscopy-assisted percutaneous screw fixation are less pain and less bleeding, shorter hospital stay and earlier rehabilitation. Arthroscopic percutaneous screw fixation for a displaced glenoid fracture seems to be a good alternative treatment method.

Arthroscopic Reconstruction in Anterior Shoulder Instability : Prospective Comparison of Anteroinferior Plication Versus Inferior Plication

PURPOSE: We wanted to evaluate the effectiveness of inferior capsular plication for treating the anterior instability of the shoulder by comparing the prospective outcomes and the incidence of complications of the group (group1) that underwent arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of inferior glenohumeral ligament and the group (group2) that underwent inferior capsular plication that was augmentated by the same method. MATERIALS AND METHODS: From March 2005 to August 2007, we compared group 1 (42 cases) that underwent arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of the inferior glenohumeral ligament and group 2 (33 cases) that underwent augmentated inferior capsular plication for recurrent anterior instability of the shoulder. The mean age was 22.5 years (range: 17~31 years) in group I, and 21.8 years (range: 16~30 years) in group II. The mean follow up was 23.5 months (range: 12~45 months in group I, and 20.1 months (range: 12~49 months) in group II. We checked the Rowe score and ROM preoperatively and at postoperative 6 months, 1 year and at the last follow up and we compared the incidence of complications. RESULTS: The Rowe score increased from a preoperative mean of 20.6 to the last follow up mean of 86.8 after surgery in group I, and the Rowe score increased from a preoperative mean of 20.5 to the last follow up mean of 94.1 after surgery in group II. For the anterior instability of the shoulder, arthroscopic reconstruction had a good outcome in all of the cases, but group II had better outcomes and less complications than did group I (p<0.05). CONCLUSION: We thought that arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of the inferior glenohumeral ligament with inferior capsular plication can lower the complication rate and show better outcomes.

All Arthroscopic Repairs with Massive Cuff Stitch in Medium-sized Full Thickness Rotator Cuff Tears / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the usefulness of arthroscopic repair using the modified Mason-Allen Massive Cuff Stitch for medium sized full thickness rotator cuff tear. We verified the clinical results and evaluated the repair integrity after short term follow up. MATERIALS AND METHODS: Twenty-three cases of arthroscopically repaired full thickness tear of the rotator cuff of an estimated medium size were evaluated between December 2004 to May 2005. The average patient age was 54 years old (range: 43-69 years old), and the mean follow-up was 14 months (range: 12-17 months). We analyzed the results by paired t-test. The follow up MRIs were checked in 11 cases. RESULTS: The VAS pain score was improved from a preoperative average of 7.0 to a postoperative average of 0.9, the ADL was improved from 11.1 to 26.0 and the UCLA score was improved from 13.6 to 32.5 (all p<0.05). 91.3% showed an excellent or good result at the final follow-up. The satisfied rate was 95.7% (22 cases). There was re-rupture of the repaired rotator cuff in one out of 11 cases (9.1%). CONCLUSION: Arthroscopic repairs using a modified Mason-Allen Massive Cuff Stitch for full thickness rotator cuff tear of an estimated medium size showed good clinical outcomes.

The Usefulness of all Arthroscopic Repair with Biceps Incorporation in Massive Sized Fullthickness Rotator Cuff Tears

Purpose: The purpose of this paper is to clinically evaluate the usefulness of all arthroscopic repair with biceps incorporation in massive sized full thickness rotator cuff tears. Materials and Methods: This is a prospective comparative outcome study evaluating a series of all arthroscopic rotator cuff repairs with biceps incorporation on massive (range: 5~6 cm sized) from March 2003 to May 2006. Group I was twenty two cases of arthroscopically repaired with biceps incorporation, twenty cases of group II without biceps incorporation were analyzed. The average age of the patients was 58 years (range, 41~74 years), and mean follow-up was 24 months (range, 12~36 months). Results were statistically compared by Mann-Whitney test. Results: Average VAS for pain, ADL, UCLA score were not significantly different between group I and group II (P>0.05 for each). Forward elevation strength was 4.3 in group I, 3.5 in group II (P<0.05). On postoperative follow up ultrasound, retear was 10 cases in the middle of 19 cases at group I, 15 cases in the middle of 17 cases at group II (P<0.05). Conclusion: This study reveals that all arthroscopic repairs with biceps incorporation in massive sized full thickness rotator cuff tears is an effective surgical method and reduced retear and enhanced strength.