The Natural History of High-Grade Partial Thickness Rotator Cuff Tears: The Conversion Rate to Full Thickness Tears and Affecting Factors

Background@#Information regarding the progression of high-grade partial thickness rotator cuff tears (PTRCTs) is scarce. We aimed to assess the clinical outcome and the conversion rate to full thickness tears in patients with high-grade PTRCTs who underwent nonoperative treatment and to determine the factors associated with tear progression. @*Methods@#A total of 52 patients with high-grade PTRCTs, which were detected by magnetic resonance imaging or ultrasonography (USG), were treated conservatively between 2010 and 2017. They were followed up with USG at 6- to 12-month intervals for a mean of 34 months (range, 12–105 months). The average patient age was 57 years (range, 34–70 years), and 34 patients were women. Age, sex, body mass index, arm dominance, symptom duration, subscapularis tendon involvement, tear location, and trauma history were compared between patients with and without conversion to full thickness tears. @*Results@#A substantial percentage of high-grade PTRCTs progressed to full thickness tears (16/52, 30.8%). According to KaplanMeier analysis, the full thickness conversion rate was 30.8% at 3 years and 64% at 4 years. The full thickness conversion rate was higher in patients with subscapularis tendon involvement (p = 0.012). @*Conclusions@#A considerably large proportion of high-grade PTRCTs progressed to full thickness tears. Therefore, regular monitoring of tear progression should be considered after conservative treatment of high-grade PTRCTs, particularly in patients with subscapularis tendon involvement.

Factors Associated with the Effect of Conservative Treatment in Surgically Indicated Single-Level Lumbar Spinal Stenosis Patient

OBJECTIVES@#To report analytic results about association factors related to effect of conservative treatment in surgically indicated single level lumbar spinal stenosis patient.SUMMARY OF LITERATURE REVIEW: There have been various reports about clinical outcomes and relative factors after surgical treatment of spinal stenosis. However, there are few reports about factors related to effect of conservative treatment in surgically indicated lumbar spinal stenosis patient.@*MATERIALS AND METHODS@#We based on 40 patients who had visited our hospital from May 2010 to April 2016 who were traceable for at least three years. We analysed 20 patients who improved symptom and who didn't improved symptom then investigated association factors related to effect of conservative treatment. Clinical assessment was conducted using questionnaire and spinal canal's area and muscle amount were measured in the MRI.@*RESULTS@#Average of the spinal canal of not-improved group is 91.29(±34.26) mm², improved group is 130.70 (±32.18) mm² and impoved group is wider (p=0.001). Muscle mass of improved group is 91.47(±9.43) cm², not-improved group is 79.26 (±14.35) cm², and improved group is wider (p=0.003). Repetitive strain and traffic accident were related in not-improved group (p=0.028). However, practiced stretching continuously were related to symptom improvement (p=0.022).@*CONCLUSIONS@#Association factors related to effect of conservative treatment are cases of wide spinal canal, wide muscle amount, repetitive sprain, traffic accident and stretching. A small muscle amount can be considered as a key factor related to surgical conversion.

Factors Associated with the Effect of Conservative Treatment in Surgically Indicated Single-Level Lumbar Spinal Stenosis Patient / 대한척추외과학회지

STUDY DESIGN: Retrospective study of date collected prospectively.OBJECTIVES: To report analytic results about association factors related to effect of conservative treatment in surgically indicated single level lumbar spinal stenosis patient.SUMMARY OF LITERATURE REVIEW: There have been various reports about clinical outcomes and relative factors after surgical treatment of spinal stenosis. However, there are few reports about factors related to effect of conservative treatment in surgically indicated lumbar spinal stenosis patient.MATERIALS AND METHODS: We based on 40 patients who had visited our hospital from May 2010 to April 2016 who were traceable for at least three years. We analysed 20 patients who improved symptom and who didn't improved symptom then investigated association factors related to effect of conservative treatment. Clinical assessment was conducted using questionnaire and spinal canal's area and muscle amount were measured in the MRI.RESULTS: Average of the spinal canal of not-improved group is 91.29(±34.26) mm², improved group is 130.70 (±32.18) mm² and impoved group is wider (p=0.001). Muscle mass of improved group is 91.47(±9.43) cm², not-improved group is 79.26 (±14.35) cm², and improved group is wider (p=0.003). Repetitive strain and traffic accident were related in not-improved group (p=0.028). However, practiced stretching continuously were related to symptom improvement (p=0.022).CONCLUSIONS: Association factors related to effect of conservative treatment are cases of wide spinal canal, wide muscle amount, repetitive sprain, traffic accident and stretching. A small muscle amount can be considered as a key factor related to surgical conversion.

Effect of Sarcopenia on Postoperative Mortality in Osteoporotic Hip Fracture Patients

BACKGROUND: Few studies have investigated the effects of sarcopenia on postoperative outcomes including mortality rates following surgery for osteoporotic hip fractures. The purpose of the present study was to determine the prevalence of sarcopenia and the relationship between sarcopenia and 1- and 5-year mortality rates in a consecutive series of patients with osteoporotic hip fractures. METHODS: Among patients who underwent hip surgery for osteoporotic hip fractures, this study included 91 patients subjected to abdominal computed tomography within 1 year of hip surgery. We defined sarcopenia using sex-specific cut-off points for the skeletal muscle index at the level of the third lumbar vertebra. All patients were divided into 2 groups according to the presence or absence of sarcopenia and the 1- and 5-year mortality rates were compared. To confirm factors affecting mortality in addition to sarcopenia, we examined patient age, sex, American Society of Anesthesiologists grade, location of fracture, type of surgery, and bone mineral density. RESULTS: The 1- and 5-year mortality rates were 20.9% and 67.2%, respectively. Among the 45 patients with sarcopenia, the 1- and 5-year mortality rates were 22.2% and 82.7%, respectively. Of the 46 patients without sarcopenia, the 1- and 5-year mortality rates were 19.6% and 52.7%, respectively. Results of the Kaplan-Meier analysis showed that sarcopenia did not affect the 1-year mortality rate (P=0.793), but had a significant effect on the 5-year mortality rate (P=0.028). Both perioperative sarcopenia (P=0.018) and osteoporosis (P=0.000) affected the 5-year mortality rate. CONCLUSIONS: Sarcopenia increases the risk of 5-year mortality in patients with osteoporotic hip fractures.