Clinical and Radiological Results after Arthroscopic Superior Capsular Reconstruction in Patients with Massive Irreparable Rotator Cuff Tears

BACKGROUND: Massive, irreparable rotator cuff tears (RCTs) are a challenging clinical problem in young patients. In recent years, arthroscopic superior capsular reconstruction (ASCR) is a popular treatment in the massive, irreparable RCTs. However, studies reporting clinical results of ASCR are rare in the literature. METHODS: Between 2013 and 2015, six patients underwent ASCR. One patient treated with dermal allograft, while five patients with autogenous fascia lata graft. Demographic data, as well as preoperative and last follow-up clinical data including pain, range of motion (ROM), strength, American Shoulder and Elbow Surgeons system, the Constant system, the University of California at Los Angeles system, the Simple Shoulder Test, and the Shoulder Pain and Disability Index system were obtained. Acromiohumeral distances and Hamada classification were measured on standard anteroposterior x-ray. RESULTS: All patients were men, and the average age was 59.5 ± 4.18 years (range, 53–65 years).The minimum follow-up was 18 months with a mean follow-up was 27.33 ± 7.58 months (range, 18–36). All patients had postoperative improvement in pain scores and functional scores. The ROM and strength did not improve after surgery. The Hamada score progressed of radiographic stage in 2 patients. In the case of dermal allograft, there was graft failure 6 weeks after ASCR. CONCLUSIONS: Our results support the ASCR as a viable treatment for surgical salvage in massive, irreparable RCTs. This treatment option may provide patients with decreased pain and increased function. And studying our case of dermal allograft failure provides opportunities to decrease graft failure in ASCR using dermal allograft.

Comparative Analysis of Platelet-rich Plasma Effect on Tenocytes from Normal Human Rotator Cuff Tendon and Human Rotator Cuff Tendon with Degenerative Tears

BACKGROUND: Platelet-rich plasma (PRP) stimulates cell proliferation and enhances matrix gene expression and synthesis. However, there have been no comparative study of the PRP effect on the normal and degenerative tenocytes. The purpose of this study was to compare the effect of PRP on tenocytes from normal and degenerative tendon. METHODS: Tendon tissues were obtained from patients undergoing arthroscopic repair (n=9) and from healthy donors (n=3). Tenocytes were cultured with 10% (vol/vol) platelet-poor plasma, PRP activated with calcium, and PRP activated with calcium and thrombin. The total cell number was assessed at days 7 and 14. The expressions of type I and III collagen, decorin, tenascin-C, and scleraxis were evaluated by quantitative real-time reverse transcriptase polymerase chain reaction. The total collagen and glycosaminoglycan (GAG) synthesis was evaluated at days 7 and 14. RESULTS: No differences were observed between the groups at day 7, but cell proliferation was remarkably increased in tenocytes from the degenerative tendon at day 14. In both tenocyte groups, the gene expressions of type I and III collagen were up-regulated. GAG synthesis was greater in the normal tendon, whereas the expressions of decorin and tenascin-C were increased in tenocytes from the degenerative tendon. Tenocytes from the degenerative tendon had higher fold-change of GAG synthesis and a lower collagen III/I ratio than normal tenocytes. CONCLUSIONS: PRP promoted the cell proliferation and enhanced the synthesis of tendon matrix in both groups. PRP has a greater positive effect on cell proliferation, matrix gene expression and synthesis in tenocytes from degenerative tendon.

Platelet-Rich Plasma Injection / 대한정형외과학회잡지

Platelet-rich plasma (PRP) supplies numerous growth factors from concentrated platelets required to promote the healing process of injured or degenerated tissue. PRP is already a popular option to treat a variety of musculoskeletal injuries and diseases, even though the precise mechanism of action is not completely understood. Varying outcomes, from favorable to poor, after PRP injection may arise from interstudy differences with respect to 4Ds (Drug [PRP], Delivery [application method], Donor [patients], and Disease [stage of rotator cuff disease]). In addition, there is no standard treatment regimen (injection location, number, interval, volume). Therefore, precise outcome measures as well as long-term follow-up are required to accurately evaluate the efficacy.

Changes in Bone Mineral Density of Both Proximal Femurs after Total Knee Arthroplasty

BACKGROUND: This study investigated the effects of total knee arthroplasty (TKA) on bone mineral density (BMD) of the proximal femur in patients who underwent the procedure. METHODS: Forty-eight patients scheduled to undergo unilateral TKA because of primary knee osteoarthritis were included in this study, which was conducted at a medical center between October 2006 and October 2009. In these 48 patients, 96 hips were evaluated. Measurement of BMD was performed preoperatively and one month, three months, six months, and one year after unilateral TKA. Repeated measured analysis of variance and paired t-tests for comparison of two repeated samples were used to compare differences between time points (preoperation, one, three, six, and 12 months) and between the operative and nonoperative sides. RESULTS: Preoperatively, BMD of the femoral neck, trochanter, and total hip on the operative side were lower than on the nonoperative side; however, there was no statistical difference. BMD of both femoral neck areas was significantly lower than preoperative BMD at one month and three months after TKA. BMD of both trochanter areas was significantly lower than preoperative BMD at one month and three months after TKA. BMD of both total hips was significantly lower than preoperative BMD at three months after TKA. However, no statistical differences of changes in BMD were observed between the operative and nonoperative sides at each measurement time. CONCLUSIONS: According to our results, TKA was found to affect both proximal femurs during the acute period. However, TKA did not affect a change in BMD of the proximal femur during one year postoperative.

Evaluation of Associated Carpal Bone Fractures in Distal Radial Fractures

BACKGROUND: The purpose of this study was to investigate the frequency and distribution of associated carpal bone fractures (CBFs) in distal radial fractures (DRFs). METHODS: Three hundred and thirteen patients who underwent surgical treatment for DRFs between March 2007 and January 2010 were reviewed retrospectively. In this study, 223 patients who had preoperative computed tomography (CT) were included. We investigated the frequency and distribution of associated CBFs on CT scans. The relationship between the frequency of associated CBFs and patient factors such as age, gender, body mass index, and the mechanism of injury was assessed. RESULTS: CBFs were complicated in 46 of 223 DRFs (20.9%). The distribution of CBFs was 23 cases in the triquetrum, 16 in the lunate, 12 in the scaphoid, five in the hamate, and four in the pisiform. Among the 46 cases, a fracture of one carpal bone occurred in 36 cases, two in seven cases, three in two cases, and four in one case. In 10 of the 46 cases, associated CBFs occurred in more than two carpal bones. No significant differences were observed for age, sex, body mass index, or the mechanism of injury between patients with DRFs and CBFs and those without CBFs. CONCLUSIONS: Because CBFs that mainly occur in the proximal carpal row are complicated in DRFs at a relatively high frequency, assessment of carpal bones using CT scans is beneficial.

Prevalence of PPNG in Seoul , Korea ( 1987 ) / 대한피부과학회지

The prevalence of PPNG among pretreatment isolates at a VD Clinic in Seoul has been studied and reported annually since 1981. In 1987, 649 strains of N. gonorrhoeae were isolated, among which 339(52.2%) were PPNGs. The prevalence of PPNG in Seoul is still increasing.

Treatment of Uncomplicated Male Gonococcal Urethritis: Kanamycin vs . Gentamicin / 대한피부과학회지

Between December 18, 1985 and May 31, 1986 at the VD Clinic, Choong-ku Public Health Center, in Seoul, 274 male patients with uncomplicated gonococcal infection, including 124 penicillinase producing Neisseria gonorrhoeae(PPNG) infection, were entered into the study. They were divided randomly into the group A and the group B. In the group A, treated with kanamycin 2g, im regimen, 126 of 137 patients were followed and 86 patients(68.3%) were cured. In the group B, treated with gentamicin 240mg, im regimen, 125 of 137 patients were followed and 78 patients(62.4%) were cured. The cure rates in PPNG urethritis were 63.9%(39/61) in the group A and 50.9%(29/57) in the group B. The cure rates in non PPNG urethritis were 72.3%(47/65) in the group A and 72.1% (49/68) in the group B. No significant difference was observed in cure rates between two groups. It is suggested that. both kanamycin 2g, im regimen and gentamicin 240mg, im regimen is not suitable for a first line treatment for uncomplicated gonococcal urethritis.

Treatment of Uncomplicated Male Gonococcal Urethritis with Norfloxacin / 대한피부과학회지

From November 18 to December 31, 1986, seventy-five male patients with unconplicated gonococcal urethritis at the Venereal Disease Clinic of Choong-ku Public Health Center in Seoul were allocated randomly into one of two treatment regimens, and seventy patients were followed. All thirty-five patients including PPNG infections, treated with single oral dose of norfloxacin 600mg, were recovered(100%). One of thirty-five patients treated with a single oral dose of norfloxacin 800mg, failed. This failed case was one of eighteen nonPPNG infections (failure rate of 5.6%). Susceptibility test with disks containing norfloxacin 10ug showed the inhibition zone greater than 30mm. It is suggested that a single oral dose of 600mg or 800mg norfloxacin has good effect in the treatment of gonococcal urethritis with minimal side effects. Because of high prevalence of PPNG, it can be recommended as the first line treatment for gonorrhoea in Korea.

Lichen planus specific antigen and antibodies: in a patient with generalized lichen planus

A 43-year-old man with generalized lichen planus demonstrated serum antibodies against autologous lesional skin. Indirect immunofluorescence using serum and papular lesional skin revealed a lichen planus specific antigen found only in the granular layer. The specific tissue antigen was not detected in normal skin from this patient, in normal skin from patients with skin disorders other than lichen planus or in skin from normal control persons. When titers of the serum antibodies against lichen planus antigen were examined before and after a successful therapy a positive correlation of the titer could be found in this patient.