Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?

BACKGROUND: Atrophy of rotator cuff muscles has been considered an irreversible phenomenon. The purpose of this study is to evaluate whether atrophy is truly irreversible after rotator cuff repair. METHODS: We measured supraspinatus muscle atrophy of 191 patients with full-thickness rotator cuff tears on preoperative magnetic resonance imaging and postoperative multidetector computed tomography images, taken at least 1 year after operation. The occupation ratio was calculated using Photoshop CS3 software. We compared the change between pre- and postoperative occupation ratios after modifying the preoperative occupation ratio. In addition, possible relationship between various clinical factors and the change of atrophy, and between the change of atrophy and cuff integrity after surgical repair were evaluated. RESULTS: The mean occupation ratio was significantly increased postoperatively from 0.44 +/- 0.17 to 0.52 +/- 0.17 (p < 0.001). Among 191 patients, 81 (42.4%) showed improvement of atrophy (more than a 10% increase in occupation ratio) and 33 (17.3%) worsening (more than a 10% decrease). Various clinical factors such as age tear size, or initial degree of atrophy did not affect the change of atrophy. However, the change of atrophy was related to repair integrity: cuff healing failure rate of 48.5% (16 of 33) in worsened atrophy; and 22.2% (18 of 81) in improved atrophy (p = 0.007). CONCLUSIONS: The supraspinatus muscle atrophy as measured by occupation ratio could be improved postoperatively in case of successful cuff repair.

Recurrent Traumatic Glenohumeral Instability Associated with Glenoid Bone Defect : 3 Case Report

PURPOSE: Capsulolabral reconstruction in a traumatic anterior instability of the glenohumeral joint is successful not only for the prevention of recurrent instability but also for the restoration of function. MATERIALS AND METHODS: However, a capsulolabral procedure alone cannot guarantee a successful result when there is severe bone loss of the glenoid. RESULTS: We report the surgical technique and results of capsulolabral repair and extraarticular bone block with an autogenous iliac crest graft performed on three cases (all male, average age 28 years, minimum follow-up 12 months) with traumatic anterior instability associated with more than 30% glenoid bone loss.

Evaluation of the Hip

The hip is a true ball and socket joint. The hip joint is held in place with ligaments, tendons, and muscles. It is surrounded by a series of bursae which are fluid filled sacs designed to cushion the area. Hip pain may arise from the joint itself, the femur, the pelvic bone, the pelvis, blood vessels and nerves near the hip joint, and even the abdomen. It is important to differentiate true hip pain from other types of pain in the hip region. True hip pain is felt towards the front, in the groin region. It may radiate down the front of the thigh. Physical examination can point to the correct diagnosis. The skilled physician will evaluate range of motion as well as those factors which reproduce the pain. The diagnosis of hip disease usually requires the use of radiologic imaging. The imaging studies include plain films, arthrography, computed tomography (CT) scanning, ultrasound, nuclear imaging, and magnetic resonance imaging (MRI).

MRI Follow-up Study After Arthroscopic Repair of Multiple Rotator Cuff Tendons

PURPOSE: This study investigated the rate of retear and related factors after arthroscopic repair of rotator cuff tears involving more than one tendon. MATERIALS & METHODS: Arthroscopic repair of 22 rotator cuff tears (average size 3.2cm: average age 58 years old) involving the supraspinatus and part or all of the infraspinatus were investigated using MRI on average 10 months after repair. The status of the repaired cuff was investigated using Sugaya's classification, and the change in muscle was evaluated with Goutallier's classification. RESULTS: Retear (Sugaya grade IV, V) was found in 7cases(32%). Tears larger than 3cm had a higher retear rate(67%) than smaller tears(8%). Retear cases had Goutallier grade II or higher muscle changes preoperatively and showed aggravation of muscle atrophy postoperatively. Even without retear, reversal of muscle change was not seen CONCLUSION: Rotator cuff tears not confined to the supraspinatus had a 32% retear rate after arthroscopic repair. The size of the tear was the most crucial factor influencing retear. Retear was frequent in tear over 3cm. Atrophy of the cuff muscle worsened when the repair failed but did not improve even without retear.

Primary Repair in Tears Affecting Two or More Rotator Cuff Tendons

PURPOSE: The current study assessed the factors affecting outcomes of primary repair procedures in tears of multiple rotator cuff tendons. MATERIALS AND METHODS: Among the cases of rotator cuff tears involving two or more tendons receiving operations between 1997 and 2003, The clinical results of 19 cases with more than 2 years follow-up were evaluated by the UCLA score. We evaluated the correlation of trauma, active motion, acromiohumeral distance, tear size, and surface area with the UCLA score using Pearson's linear correlation coefficient (PLCC). RESULTS: UCLA scores increased significantly in all cases, from 9 to 26.1 on average. However, the results were good in 53%, and poor in 47% according to Ellman's criteria. Trauma, active elevation, acromiohumeral distance, and tear size did not correlate with the UCLA score, but the tear surface area was inversely correlated with the score (PLCC=- 0.696). Cases with degeneration of the infraspinatus muscle above Goutallier grade III on MRI showed worse results than cases with less degeneration. CONCLUSION: The clinical results of primary repair of rotator cuff tears involving multiple tendons were satisfactory in 53% of patients. Large tear surface area and severe degeneration of the infraspinatus were poor prognostic factors.

A Comparison of Fibular Head Tunnel and Tibial Tunnel in the Reconstruction of a Posterolateral Instability of the Knee / 대한정형외과학회잡지

PURPOSE: This study compared the surgical results of various posterolateral corner sling methods performed through either the fibula head tunnel or tibia tunnel in patients with chronic PLRI (PosteroLateral Rotatory Instability). MATERIALS AND METHODS: Between January 1999 and October 2003, 20 and 19 patients who had undergone surgery for PCL (posterior cruciate ligament) tensioning and an ALB (anterolateral bundle) reconstruction through the fibula head tunnel or tibia tunnel, respectively and were followed up more than 1 year were enrolled in this study. RESULTS: The fibular head tunnel was found to be superior compared with the tibia tunnel method in terms of the operation time (36.5+/-7.5 versus 68.4+/-12.8) (p<0.0001), rotational stability (p= 0.0018) and IKDC objective score (p<0.0001). In the fibula head tunnel group, 85% of patients had an equal to normal or tighter than normal rotational stability in the tibial tunnel group with 63% having an equal to normal or tighter than normal side at the last evaluation. In the IKDC objective score, 85% of patients in the fibula head tunnel group had a rating B or higher at the last evaluation compared with 79% in the tibial tunnel group (p<0.0001). However there were no significant differences in anteroposterior stability and OAK score. CONCLUSION: The modified posterolateral corner sling through the fibula head tunnel produces better results in terms of a posterolateral rotational stability of grade II chronic PLRL in a combined PCL injury than that using the tibia tunnel method.

Bankart Procedure through Lateral Capsulotomy in Traumatic Anterior Instability of the Shoulder / 대한정형외과학회잡지

PURPOSE: To determine the outcome of the Bankart procedure through lateral capsulotomy approach by objective and subjective evalua-tion in traumatic anterior instability of the shoulder. MATERIALS AND METHODS: Thirty-seven patients with traumatic anterior instability, who underwent the Bankart procedure through lateral capsulotomy, were investigated with an average follow-up of 23 months. Every effort was made to maximize the range of motion by repairing the Bankart lesion and closing the capsulotomy to allow as much external rotation as feasible. In 18 cases, superior capsular shift (13) or Neer 's capsular shift (5) were combined to deal with capsular redundancy. Outcome was assessed using range of motion, Pennsylvania Shoulder Function Score, pain, residual symptom and satisfaction. RESULTS: Recurrence of instability was not encountered. Function score increased significantly and all patients were satisfied with the results. However, 8 patients (22%) complained of feeling apprehensive about sports activities. CONCLUSION: The Bankart procedure through lateral capsulotomy appears to minimize unwanted external rotation limitations and enable capsular redundancy to be dealt with adequately.

Retensioning and Augmentation of Posterior Cruciate Ligament

No Abstract Available.

Reconstruction of the Posterior Cruciate Ligament by the Modified Tibial Inlay Method / 대한정형외과학회잡지

PURPOSE: To introduce the modified tibial inlay technique and evaluate the clinical results of 44 patients who underwent PCL reconstruction by this method and were followed-up for more than 2 years. MATERIALS AND METHODS: The clinical results were assessed using the Orthopadishe Arbeitsgruppe Knie (OAK) and International Knee Documentation Committee (IKDC) knee scoring systems. The integrities of the reconstructed PCLs were assessed using posterior stress radiographs and the manual maximum displacement test using a KT-1000 (TM) arthrometer. RESULTS: The average 65.8+/-9.4 OAK score, 10.8+/-4.6 mm displacement by stress radiographs and 9.4+/-4.1 mm displacement by KT-1000 (TM) arthrometer, were improved to an average 87.5+/-7.8, 3.4+/-0.4 mm, 2.7+/-0.9 mm, respectively, at the last follow-up. By the IKDC and OAK scoring systems, 35 cases (79%) and 40 cases (90%), respectively, showed satisfactory clinical outcome. A second arthroscopic examination was performed in 20 of 44 cases. No case showed rupture of the grafted tendon. However, 3 cases showed recurrence of posterior instability, which requried a retightening at the tibial bone block site. CONCLUSION: The modified tibial inlay technique may improve the quality of outcome of arthroscopic PCL reconstruction, because this technique can avoid grafted tendon abrasion at the posterior orifice, and this preserve the remnant PCL bundle, and it allows the retightening of loose grafted tendon to be performed easily.

Geometric Measurement of Bony Structure of Kness in Korean and The Study of Tibial Plateau Coverage in Total Knee Arthroplasty / 대한정형외과연구학회지

No Abstract Available.

Clinical Comparison of Posterior Cruciate Retained and Sacrificed in Mobile Bearing Total Knee Arthroplasty

PURPOSE: To evaluate the effect of posterior cruciate ligament retaining on clinical results in tota] knee arthroplasty. MATERIALS AND METHODS: Ninety-nine cases(80 patienis) of osteoarthritis were evaluated average 39 months(range 25-98 months) after total knee arthroplasty with LCS. the cases was divided into posterior cruciate retained group I(54 knees) and sacrificed group Il(45 knees). RESULTS: There was no statistically significant difference in H.S.S. knee score(I:87.4+/-6.3, II:86.1+/-5.7), range of motion(l:113.7 degrees +/- 19.8 degrees, II:111.9degrees +/-10.9 degrees), stability and roent- genographic findings, however, the functional score of the H.S.S. score was higher in group I(l: l8.2+/-5.6, II:15.3+/-4.5. p<0.05) and 6 patients with preoperative range of motion below 50 were in group II. 4 patients of 5 bilateral paired patients who ascended and descended stairs with one leg at a time prefer PCL retained side subjectively. CONCLUSION: We found no significant difference between group I and II in clinical results, however, might be that subjective symptom is excellent in group I and PCL sacrificed design seems to be effective in severely deformed knees and too tight PCL tension.

The surgical treatment of tibial avulsion fracture of the posterior cruciate ligament: Results between fixation methods and usefulness of arthroscopic exam / 대한정형외과학회잡지

PURPOSE: To introduce the results of surgical methods in tibial avulsion fracture of the posterior cruciate ligament (PCL) and arthroscopic exam as useful therapeutic one. MATERIALS AND METHODS: 32 cases with tibial avulsion fracture of the PCL were received surgical treatment and followed up at least 12 months. Clinical results were evaluated with IKDC score and posterior laxity test with Telos device. The posterior approach was performed in 31 cases (19 screw fixation, 12 pullout suture) and arthrosco-pic reduction and fixation in one. Since 1995, arthroscopic exam was performed on the beginning of operation in all cases and combined injury was treated simultaneously. RESULTS: The IKDC scores were A (normal) in 8, B (nearly normal) in 21, C (abnormal) in 2, D (severe abnormal) in 1 and two of C and D showed posterior instability. 7 of 17cases from 1995 had a combined injury and all revealed above B. The result of compar-ison of screw fixation and pullout suture technique showed no difference between them. CONCLUSION: The results were favorable regardless of surgical methods and arthroscopy was useful in diagnosis and treatment of combined injury.

A Comparative Study About The Natural Course Of Idiopathic Frozen Shoulder And The Effectiveness Of Conservative Treatment / 대한정형외과학회잡지

PURPOSE: The aim of this study was to investigate about the natural course of idiopathic frozen shoulder and the efficacy of conservative treatment. MATERIALS AND METHODS: Twenty-five cases of unilateral frozen shoulder (study group) treated conservatively by intra-articular steroid injection and staged passive stretching were prospectively followed for average 9.1 months, the outcome was assessed in terms of motion range and the function score derived from patients' self-evaluation, and timing of improvement was searched. Compared with study group, 20 patients (control group) , who were diagnosed as idiopathic frozen shoulder but didn't undertake specific treatment, were checked at average 40 months. RESULTS: Eighteen cases (72%) of the study group had residual symptom, which was mild in most cases. Range of motion less than 80% of normal side was noted in 2 cases. Intra-articular steroid injection was effective for pain relief in 75%. In the control group, one case showed decreased motion and 2 case had mild pain. Comparing with the control group, the study group was improved significantly & statistically faster. CONCLUSION: It is construed that the long term result of idiopathic frozen shoulder is excellent and the combined effect of steroid injection and stretching shortens the duration of disease. Operative treatment for idiopathic frozen shoulder, if indicated, needs to be decided after long term follow-up.

Diagnosis and Management of Shoulder Disorders

No abstract available.

Retension of Chronic Posterior Cruciate Ligament Injury: Two Cases Reports

PCL reconstruction in chronic PCL injury has been still controversy. Retension technique of chronic laxed PCL injury at tibial attachment site is introduced as a new method of treatment. Tibial attachment area of laxed PCL is detached with bone block and pulled downward. Retensed PCL is fixed at the distal area of original tibial attachment site of PCL. This technique is relatively simple and original propriocep-tion of PCL fiber can be preserved. Also it is not necessary to consider tunnel placement and isometirc point. We report two cases of chronic laxed PCL injury who were treated by retension technique.

Arthroscopic Meniscal Repair

Between December 1994 and December 1996, 42 patients underwent arthroscopic meniscal repair in our institute. Among them, 31 patients with a follow up more than one year were reviewed. Mean age was 24.4 years(range, 18-52 years) and mean interval between onset of symptom and opera- tion was 12.3 months(range, 3 days-6 years). The associated injuries were tibial plateau fracture(6 cases), anterior cruciate ligament injury(4 cases) and posterior cruciate ligament injury(2 cases). The type of tear were longitudinal in 28 cases(90%) and combined in 3 cases(10%). Most of the meniscal tear were encountered in posterior hom(12 cases, 39%) and middle portion(11 cases, 35%). Out side to in technique was used in anterior horn tears and inside to out technique in middle or posterior hom tears. In tibial plateau fractures, arthroscopic assisted reduction was performed with autogenous bone graft. Ligament reconstructions were performed in the cases of associated cruciate ligament injury. According to Ikeuchis grading system, the result was satisfactory(excellent or good) in 23 cases(74%), fair in 6 cases(19%) and poor in 2 cases(6%). But in the cases of isolated meniscal injury, the result was satisfactory in 95%. The result of arthroscopic repair in the meniscal tears associated with other intra-articular injuries seems to be worse than that of the isolated injuries.

The Result of Operative Treatment in Fracture of the Proximal Humerus / 대한정형외과학회잡지

PURPOSE: To evaluate the functional outcome after surgical treatment for displaced fractures of proximal humerus and assess the final results according to surgical methods. MATERIALS AND METHODS: Thirty-three cases with follow-up over 12 months were divided into three groups: double tension band wiring (Group I, 14), plate fixation (Group II, 10) and closed reduction with internal/external fixation (Group III, 9). The pain index, the self-assessed functional score and the range of motion were obtained. RESULTS: Anatomical reduction was best obtained in group II and fractures united in 11-16 weeks. The pain index was worst in group III and the functional score of group I (80+/-12.2%) was higher than in the others (II: 69+/-15.7%, III: 55+/- 7.9%). The range of motion was worst in group III. Complications were noted in 9 cases, which occurred mostly in group II and III. CONCLUSIONS: Double tension band wiring in displaced proximal humerus fracture demonstrated that it provides a sufficient fixation for early rehabilitation and union, while minimizing complication

Arthroscopic Posterior Cruciate Ligament Reconstruction with Two Graft Tendons by Combined Femoral Dual Tunnel and Modified Tibial Inlay Method

From July 1997, Authors have reconstructed the posterior cruciate ligament(PCL) deficient knees with two graft tendons; an autogenous bone-patellar tendon-bone (BPTB) and a semitendinosus tendon. At Femoral side, the two graft tendons were fixed through the two tunnels which were made at the site of foot print of PCL. The original site of anterolateral bundle of the PCL was reconstructe(I with the autogenous BPTB and the original site of posteromedial bundle with the semitendinosus tendon. At tibial side, the two graft tendons were fixed by modified inlay technique; the BPTB was fixed with a cancellous screw and the semitendinosus tendon with staples. Seven cases were followed up more than six months and authors evaluated the results with the KT-1000TM arthrometer and the posterior stress radiographs by Telos stress dcvice and compared the resu]t of injured knee with the uninjured side of each patient. The results of manual maximal displacement test with arthrometer were less than 4 mm in six patients and 8 rnm in one patient at last follow up. The average distance of posterior displacement on stress radiographs was 10.3 mm preoperatively and 2.7 mm at final follow up period. Six of the seven patients had a good stability on posterior stress radiographs compared with the uninjured side. One patient had posterior knee insta- bility on stress radiographs due to loosening of the grafted tendon and retightening of the grafted tendon was performed through the posterior approach to the proximal tibia. The original idea of femoral dual tunnel method in PCL reconstructiori is to reconstruct the PCL more anatomically and the modified tibial inlay technique can solve the problern of graft tendon abrasion at the posterior opening of the tibial tunnel in transtibial tunnel method and retightening of the loose grafted tendon is simple than the other methods of PCL reconstruction. Authors expect that this combined femoral dual tun- nel and modified tibial inlay method may improve the quality of the outcome of the arthroscopic PCL reconstruction.

Roentgenographic Study on Shape and Size of the Femoral Head of Normal Korean Adults / 대한정형외과학회잡지

In order to provide the basic data about the hip joint arthroplasty, we measured the femoral head diameter, offset and position in normal 150 males and 150 females using a standardized roentgenographic technique that provided views perpendicular to the plane of the femoral neck in which the focus centered on the lesser trochanter of the femur. We obtained 11.4% of magnification rate by comparing the real size of femoral marker with radiologic size. The result of this study are as following: The mean femoral head diameter was 46.4 ±4.1mm in male and 45.1±3.8mm in female. The mean femoral head offset was 39.2±4.8mm in male and 37.8±4.6mm in female. The mean femoral head position was 48.9±3.2mm in male and 47.6±3.6mm in female.

Arthroscopic Management of Osteoarthritic Knee / 대한정형외과학회잡지

There are many options for the management of osteoarthritis of the knee joint. Recently, arthroscopic surgery has been added to the armamentorium of the treatment modalities in osteoarthritis of the knee which does not respond to conservative treatment. Among 74 arthroscopic pocedures(including partial menisectomy, removal of loose bodies, synovectomy, cartilage drilling and simple lavage) done for osteoarthritis of the knee, 68 patients studied at average 3.1 years after procedure and the results were as follows 1. Seventy-one percent of patients had at least 2.5 years or more relief of pain and symptoms. 2. Fifty-six percent were still good at follow-up of 3.1 years. 3. The best result were obtained after removal of loose bodies and resection of unstable flap tear of a meniscus in association with mild osteoarthritis. 4. The poor result were obtained in patients with severe degenerative changes of both femoral condyle, 5. The results were much better in the normally aligned knee compared with valgus knee.