Clinical and Radiological Evaluation after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique

BACKGROUND: We retrospectively assessed the clinical outcomes and investigated risk factors influencing retear after arthroscopic suture bridge repair technique for rotator cuff tear through clinical assessment and magnetic resonance arthrography (MRA). METHODS: Between January 2008 and April 2011, sixty-two cases of full-thickness rotator cuff tear were treated with arthroscopic suture bridge repair technique and follow-up MRA were performed. The mean age was 56.1 years, and mean follow-up period was 27.4 months. Clinical and functional outcomes were assessed using range of motion, Korean shoulder score, Constant score, and UCLA score. Radiological outcome was evaluated with preoperative and follow-up MRA. Potential predictive factors that influenced cuff retear, such as age, gender, geometric patterns of tear, size of cuff tear, acromioplasty, fatty degeneration, atrophy of cuff muscle, retraction of supraspinatus, involved muscles of cuff and osteolysis around the suture anchor were evaluated. RESULTS: Thirty cases (48.4%) revealed retear on MRA. In univariable analysis, retear was significantly more frequent in over 60 years age group (62.5%) than under 60 years age group (39.5%; p = 0.043), and also in medium to large-sized tear than small-sized tear (p = 0.003). There was significant difference in geometric pattern of tear (p = 0.015). In multivariable analysis, only age (p = 0.036) and size of tear (p = 0.030) revealed a significant difference. The mean active range of motion for forward flexion, abduction, external rotation at the side and internal rotation at the side were significantly improved at follow-up (p 0.05). The locations of retear were insertion site in 10 cases (33.3%) and musculotendinous junction in 20 cases (66.7%; p = 0.006). CONCLUSIONS: Suture bridge repair technique for rotator cuff tear showed improved clinical results. Cuff integrity after repair did not affect clinical results. Age of over 60 years and size of cuff tear larger than 1 cm were factors influencing rotator cuff retear after arthroscopic suture bridge repair technique.

Change of Pelvic Tilt before and after Gait in Patients with Lumbar Degenerative Kyphosis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to verify the value of radiography and gait analysis to analyze the changes of the pelvic tilt before and after gait in the patients with LDK. Summary of Literature Review: Patients with lumbar degenerative kyphosis show dynamic changes that are closely associated with the motion of pelvis. MATERIALS AND METHODS: We analyzed 18 lumbar degenerative kyphosis patients who didn't have multiple vertebral compressio fractures, a past history of spinal surgery or surgery for degenerative arthritis of the knee or hip, and obesity which causes marker errors on the gait analysis. Pelvic tilt was statistically evaluated by utilizing radiographs and dynamically utilizing the gait analysis. The linear parameters of the gait cycle and the kinematic data were obtained from the gait analysis. RESULTS: The LDK patients'mean walking velocity was 80.7 cm/s, and it was largely decreased to 65% of the normal value. The cause of the decreased walking velocity was a decrease of stride length, and not a decrease of cadence. The mean static pelvic tilt in the gait analysis was -1.3+/-8.0degrees , and there were 8 cases of anterior tilt and 10 cases of posterior tilt. The mean pelvic tilt during gait was 12.5+/-8.2degrees , and there were 17 cases of anterior tilt and 1 case of posterior tilt. It was statistically significant difference (p<0.05) between the mean static pelvic tilt in gait analysis and the mean pelvic tilt during gait and the Pearson's correlation coefficient was -0.88. CONCLUSIONS: Though there was no statistical significance, we observed anterior pelvic rotation after gait on the radiographs. As fatigue of the pelvic extensor muscles increases during gait, anterior pelvis tilt increases with statistical significance on the gait analysis. Therefore, we feel gait analysis is useful for evaluating the dynamic change of the pelvic tilt in patients with LDK.