Light-emitting diode irradiation induces AKT/mTOR-mediated apoptosis in human pancreatic cancer cells and xenograft mouse model.

The beneficial effects of light-emitting diode (LED) irradiation have been reported in various pathologies, including cancer. However, its effect in pancreatic cancer cells remains unclear. Herein, we demonstrated that blue LED of 460 nm regulated pancreatic cancer cell proliferation and apoptosis by suppressing the expression of apoptosis-related factors, such as mutant p53 and B-cell lymphoma 2 (Bcl-2), and decreasing the expression of RAC-ß serine/threonine kinase 2 (AKT2), the phosphorylation of protein kinase B (AKT), and mammalian target of rapamycin (mTOR). Blue LED irradiation also increased the levels of cleaved poly-(ADP-ribose) polymerase (PARP) and caspase-3 in pancreatic cancer cells, while it suppressed AKT2 expression and inhibited tumor growth in xenograft tumor tissues. In conclusion, blue LED irradiation suppressed pancreatic cancer cell and tumor growth by regulating AKT/mTOR signaling. Our findings indicated that blue LEDs could be used as a nonpharmacological treatment for pancreatic cancer.

Photobiomodulation Using a Low-Level Light-Emitting Diode Improves Cognitive Dysfunction in the 5XFAD Mouse Model of Alzheimer's Disease.

Photobiomodulation using low-level light-emitting diode can be rapidly applied in neurological and physiological disorders safely and noninvasively. Photobiomodulation is effective for chronic diseases because of fewer side effects than drugs. Here we investigated the effects of photobiomodulation using light-emitting diode on amyloid plaques, gliosis, and neuronal loss to prevent and/or recover cognitive impairment, and optimal timing of photobiomodulation initiation for recovering cognitive function in a mouse model of Alzheimer's disease. 5XFAD mice were used as an Alzheimer's disease model. Animals receiving photobiomodulation treatment were divided into two groups: an early group starting photobiomodulation at 2 months of age (5XFAD+Early), and a late group starting photobiomodulation at 6 months of age (5XFAD+Delay). Both groups received photobiomodulation 20 minutes per session three times per week for 14 weeks. The Morris water maze, passive avoidance, and elevated plus maze tests were performed at 10 months of age. Immunohistochemistry and Western blot were performed after behavioral evaluation. The results showed that photobiomodulation treatment at early stages reduced amyloid accumulation, neuronal loss, and microgliosis and alleviated the cognitive dysfunction in 5XFAD mice, possibly by increasing insulin degrading enzyme related to amyloid-beta degradation. Photobiomodulation may be an excellent candidate for advanced preclinical Alzheimer's disease research.

Smartphone-Driven Low-Power Light-Emitting Device.

Low-level light (laser) therapy (LLLT) has been widely researched in the recent past. Existing LLLT studies were performed based on laser. Recently, studies using LED have increased. This study presents a smartphone-driven low-power light-emitting device for use in colour therapy as an alternative medicine. The device consists of a control unit and a colour probe. The device is powered by and communicates with a smartphone using USB On-The-Go (OTG) technology. The control unit controls emitting time and intensity of illumination with the configuration value of a smartphone application. Intensity is controlled by pulse width modulation (PWM) without feedback. A calibration is performed to resolve a drawback of no feedback. To calibrate, intensity is measured in every 10 percent PWM output. PWM value is linearly calibrated to obtain accurate intensity. The device can control the intensity of illumination, and so, it can find application in varied scenarios.

Low-level light emitting diode therapy promotes long-term functional recovery after experimental stroke in mice.

We aimed to investigate the effects of low-level light emitting diode therapy (LED-T) on the long-term functional outcomes after cerebral ischemia, and the optimal timing of LED-T initiation for achieving suitable functional recovery. Focal cerebral ischemia was induced in mice via photothrombosis. These mice were assigned to a sham-operated (control), ischemic (vehicle), or LED-T group [initiation immediately (acute), 4 days (subacute) or 10 days (delayed) after ischemia, followed by once-daily treatment for 7 days]. Behavioral outcomes were assessed 21 and 28 days post-ischemia, and histopathological analysis was performed 28 days post-ischemia. The acute and subacute LED-T groups showed a significant improvement in motor function up to 28 days post-ischemia, although no brain atrophy recovery was noted. We observed proliferating cells (BrdU+ ) in the ischemic brain, and significant increases in BrdU+ /GFAP+ , BrdU+ /DCX+ , BrdU+ /NeuN+ , and CD31+ cells in the subacute LED-T group. However, the BrdU+ /Iba-1+ cell count was reduced in the subacute LED-T group. Furthermore, the brain-derived neurotrophic factor (BDNF) was significantly upregulated in the subacute LED-T group. We concluded that LED-T administered during the subacute stage had a positive impact on the long-term functional outcome, probably via neuron and astrocyte proliferation, blood vessel reconstruction, and increased BDNF expression. Picture: The rotarod test for motor coordination showed that acute and subacute LED-T improves long-term functional recovery after cerebral ischemia.

Pretreatment with light-emitting diode therapy reduces ischemic brain injury in mice through endothelial nitric oxide synthase-dependent mechanisms.

Photostimulation with low-level light emitting diode therapy (LED-T) modulates neurological and psychological functions. The purpose of this study was to evaluate the effects of LED-T pretreatment on the mouse brain after ischemia/reperfusion and to investigate the underlying mechanisms. Ischemia/reperfusion brain injury was induced by middle cerebral artery occlusion. The mice received LED-T twice a day for 2 days prior to cerebral ischemia. After reperfusion, the LED-T group showed significantly smaller infarct and edema volumes, fewer behavioral deficits compared to injured mice that did not receive LED-T and significantly higher cerebral blood flow compared to the vehicle group. We observed lower levels of endothelial nitric oxide synthase (eNOS) phosphorylation in the injured mouse brains, but significantly higher eNOS phosphorylation in LED-T-pretreated mice. The enhanced phospho-eNOS was inhibited by LY294002, indicating that the effects of LED-T on the ischemic brain could be attributed to the upregulation of eNOS phosphorylation through the phosphoinositide 3-kinase (PI3K)/Akt pathway. Moreover, no reductions in infarct or edema volume were observed in LED-T-pretreated eNOS-deficient (eNOS-/-) mice. Collectively, we found that pretreatment with LED-T reduced the amount of ischemia-induced brain damage. Importantly, we revealed that these effects were mediated by the stimulation of eNOS phosphorylation via the PI3K/Akt pathway.

Low-level light emitting diode (LED) therapy suppresses inflammasome-mediated brain damage in experimental ischemic stroke.

Use of photostimulation including low-level light emitting diode (LED) therapy has broadened greatly in recent years because it is compact, portable, and easy to use. Here, the effects of photostimulation by LED (610 nm) therapy on ischemic brain damage was investigated in mice in which treatment started after a stroke in a clinically relevant setting. The mice underwent LED therapy (20 min) twice a day for 3 days, commencing at 4 hours post-ischemia. LED therapy group generated a significantly smaller infarct size and improvements in neurological function based on neurologic test score. LED therapy profoundly reduced neuroinflammatory responses including neutrophil infiltration and microglia activation in the ischemic cortex. LED therapy also decreased cell death and attenuated the NLRP3 inflammasome, in accordance with down-regulation of pro-inflammatory cytokines IL-1ß and IL-18 in the ischemic brain. Moreover, the mice with post-ischemic LED therapy showed suppressed TLR-2 levels, MAPK signaling and NF-kB activation. These findings suggest that by suppressing the inflammasome, LED therapy can attenuate neuroinflammatory responses and tissue damage following ischemic stroke. Therapeutic interventions targeting the inflammasome via photostimulation with LED may be a novel approach to ameliorate brain injury following ischemic stroke. Effect of post-ischemic low-level light emitting diode therapy (LED-T) on infarct reduction was mediated by inflammasome suppression.

Endoscopic Olecranon Bursal Resection for Olecranon Bursitis: A Comparative Study for Septic and Aseptic Olecranon Bursitis.

BACKGROUND: Open excision of the olecranon bursa has been performed traditionally. However, surgical complications such as wound healing problems and recurrence may occur after the surgery. The purpose of this study was to report on the clinical outcomes of endoscopic olecranon bursal resection performed in both septic and aseptic olecranon bursitis. METHODS: We retrospectively reviewed 30 patients who underwent endoscopic olecranon bursal resection from June 2007 to January 2012. There were 20 males and 10 females. The ages ranged from 22 to 80 years, with an average age of 57.4 years and the average follow-up was 21.1 months (6-61.5 months). There were 15 cases in the septic group. The treatment outcome was measured according to the following; the rate of recurrence, range of motion, complications associated with surgery, VAS and QuickDASH. RESULTS: There were no complications such as postoperative infection or neurovascular injuries. In the septic group, the VAS and QuickDASH scores were significantly improved from 5.6 to 0.1 and from 28 to 1.3, respectively. In the aseptic group, the VAS and QuickDASH scores were improved from 0.6 to 0.1 and from 25.7 to 0.5, respectively. In all cases, there were no recurrences and no limitations of joint motion until the final follow-up. CONCLUSIONS: We were able to obtain excellent outcomes without recurrence by performing endoscopic olecranon bursal resection in both septic and aseptic olecranon bursitis.

Pre-conditioning with transcranial low-level light therapy reduces neuroinflammation and protects blood-brain barrier after focal cerebral ischemia in mice.

PURPOSE: Transcranial low-level light therapy (LLLT) has gained interest as a non-invasive, inexpensive and safe method of modulating neurological and psychological functions in recent years. This study was designed to examine the preventive effects of LLLT via visible light source against cerebral ischemia at the behavioral, structural and neurochemical levels. METHODS: The mice received LLLT twice a day for 2 days prior to photothrombotic cortical ischemia. RESULTS: LLLT significantly reduced infarct size and edema and improved neurological and motor function 24 h after ischemic injury. In addition, LLLT markedly inhibited Iba-1- and GFAP-positive cells, which was accompanied by a reduction in the expression of inflammatory mediators and inhibition of MAPK activation and NF-κB translocation in the ischemic cortex. Concomitantly, LLLT significantly attenuated leukocyte accumulation and infiltration into the infarct perifocal region. LLLT also prevented BBB disruption after ischemic events, as indicated by a reduction of Evans blue leakage and water content. These findings were corroborated by immunofluorescence staining of the tight junction-related proteins in the ischemic cortex in response to LLLT. CONCLUSIONS: Non-invasive intervention of LLLT in ischemic brain injury may provide a significant functional benefit with an underlying mechanism possibly being suppression of neuroinflammation and reduction of BBB disruption.

Randomized controlled trial of the efficacy and safety of self-adhesive low-level light therapy in women with primary dysmenorrhea.

OBJECTIVE: To evaluate the efficacy and safety of low-level light therapy in women with primary dysmenorrhea. METHOD: A multicenter prospective, randomized, double-blind, placebo-controlled clinical trial including patients 18-35 years of age with primary dysmenorrhea was undertaken at two university hospitals in South Korea between October 2011 and September 2012. Patients were randomized using a computer-generated sequence to receive low-level light therapy using the Color DNA-WSF device or to receive placebo treatment with a dummy device. The severity of menstrual pain, assessed using a visual analog scale, was the primary outcome and was evaluated at baseline and during every menstrual cycle for 3 months following treatment. Patients who received more than one application of treatment (with a Color DNA-WSF or placebo device) were included in analyses. Patients and investigators were masked to the treatment assignments. RESULTS: Overall, 44 patients were assigned to each group. At the final study visit, the reduction in scores using a visual analog scale was significantly greater in patients who received low-level light therapy (n=41; 4.34±2.22) than among those in the control group (n=38; 1.79±1.73; P<0.001 when adjusted for age) No serious adverse events occurred. CONCLUSION: Low-level light therapy could be an effective, safe treatment modality for women with primary dysmenorrhea. Clinical Trials.gov: NCT02026206.

Partial pedicle subtraction osteotomy as an alternative option for spinal sagittal deformity correction.

STUDY DESIGN: A retrospective study. OBJECTIVE: To describe the technique of a partial pedicle subtraction osteotomy (PPSO) and to report on the clinical and radiological outcomes. SUMMARY OF BACKGROUND DATA: Numerous corrective osteotomy techniques have been reported. Until now, there has been no reported method that can achieve a correction angle between those of the Smith-Petersen osteotomy and pedicle subtraction osteotomy as a posterior closing osteotomy that can be safely performed on the thoracic spine. METHODS: A total of 38 patients aged between 31 and 72 years, who underwent PPSO for spinal sagittal deformity correction were enrolled in this study. The mean postoperative follow-up period was 30.1 months (range, 24-36 mo). The assessments included the Oswestry Disability Index scores, immediate postoperative and 2-year postoperative correction angles, correction loss, pseudoarthrosis, and complications. RESULTS: There were 6 patients who underwent PPSO alone and 32 patients who underwent PPSO combined with at least one other surgical procedure (PSO in 16 patients, anterior lumbar interbody fusion in 12 patients, and Smith-Petersen osteotomy in 4 patients). The level of the osteotomy was T10 in 6 patients, T11 in 15 patients, T12 in 10 patients, 1 in 4 patients, L2 in 2 patients, and L3 in 1 patient. There were significant improvements in the overall Oswestry Disability Index scores (P = 0.001). The mean postoperative correction angle immediately after the PPSO was 18.8° (range, 12.4°-26.1°) and the mean postoperative correction angle at 2 years was 18.4° (range, 11.9°-25.7°). There was no significant loss of correction found during the 2-year follow-up. There was also no pseudoarthrosis or neurological complications. CONCLUSION: PPSO had resulted in intermediate correction rates between those of Smith-Petersen osteotomy and PSO. PPSO is considered to be a safe and reliable procedure for patients with spinal sagittal deformities even at the thoracic spine level. LEVEL OF EVIDENCE: 4.

Body mass index as a predictor of advanced colorectal neoplasia.

BACKGROUND: Colorectal cancer (CRC) is the third frequent cancer in Korea. There are several risk factors including male sex, older age, smoking and family history of colon cancer. Recently, obesity is thought to be a risk factor for CRC and advanced colon polyps. Therefore, we designed a cross-sectional study to determine the association between BMI and advanced colorectal neoplasia. METHODS: A total of 256 patients with advanced colorectal neoplasia who were diagnosed using colonoscopy between May, 2004 and December, 2011 were included in this study. Advanced colorectal neoplasia was defined large (≥1 cm) adenoma or adenocarcinoma. We compared these patients to a control group consisting of 217 subjects with normal colonoscopic findings recruited during the same period. RESULTS: Of the 256 patients, there were 132 (51.6%) men, and the mean age was 56.4±12.3 years. The rate of males, alcohol drinker and current smokers was significantly higher in the advanced colorectal neoplasia compared to control group. In the subgroup analysis, the mean age and body mass index (BMI, kg/m(2)) of advanced colorectal neoplasia were higher than control group in the female subjects. However, there were no significant differences between two groups in the male subjects. Multiple logistic regression analysis identified overweight (BMI 23.0-24.9 kg/m(2), odds ratios [OR]=2.022) and obesity (BMI≥25 kg/m(2), OR=2.383) as independent risk factors for advanced colorectal neoplasia. CONCLUSIONS: We suggest that BMI should be considered as an independent risk factor for advanced colorectal neoplasia, and people with high BMI should be recommended to undergo colonocoscopy screening earlier than scheduled.

Risk factors of atrophic gastritis and intestinal metaplasia in first-degree relatives of gastric cancer patients compared with age-sex matched controls.

BACKGROUND: To identify whether first-degree relatives (FDRs) of gastric cancer (GC) patients have increased risk for atrophic gastritis (AG) and intestinal metaplasia (IM) in relation to other risk factors of GC. METHODS: The study cohort consisted of 224 pairs of age-sex matched controls and FDRs. AG and IM in the gastric mucosa were scored histologically using the updated Sydney classification. Risk of having AG and IM was studied by comparing FDRs to controls. Impacts of age, H. pylori infection, smoking, dietary and socioeconomic factors on the presence of AG and IM were studied. RESULTS: In multivariate regression analysis, FDRs had adjusted OR of 2.69 (95% CI 1.06-6.80, P=0.037) for antral IM in male population. Adjusted OR for antral AG and IM were 9.28 (95% CI 4.73-18.18, P<0.001) and 7.81 (95% CI 3.72-16.40, P<0.001) for the H. pylori infected subjects in total population. Getting old by 5 years increased the ORs of having AG and IM by approximately 1.25 fold (P<0.001). Spicy food increased the OR of antral IM by 2.28 fold (95% CI 1.36-3.84, P=0.002). CONCLUSIONS: Family history of GC was an independent risk factor for antral IM in male in our study, which could be one reason for the increase of gastric cancer in the family member of gastric cancer. It could be an evidence for the necessity of frequent endoscopy in the presence of family history of GC compared to general population in male.

Skin adhesive low-level light therapy for dysmenorrhoea: a randomized, double-blind, placebo-controlled, pilot trial.

PURPOSE: The cause of dysmenorrhoea is an abnormal function of smooth muscles in the uterus due to long-term deficient blood supply into smooth muscle tissue. The purpose of this study was to evaluate the effectiveness of skin adhesive low-level light therapy (LLLT) in participants with dysmenorrhoea. METHODS: Thirty-one women were included in this randomized, double-blind, placebo-controlled, pilot trial. Twenty-one women were treated with active LLLT and ten women were treated with placebo one. The therapy was performed in a laboratory room for 20 min a day over a period of 5 days prior to the expected onset of menstruation. The outcome was measured using a visual analog scale (VAS) for each participant's dysmenorrhoeal pain severity. VAS of each subject was measured every month for 6 months. RESULTS: In the active LLLT group, 16 women reported successful results during their first menstrual cycle just after active LLLT and 5 women had successful results from the second menstrual cycle after active LLLT. The pain reduction rate was 83 % in the active LLLT group, whereas there was only a slight and temporary reduction in pain in the placebo LLLT group. Changes of VAS within 6 months of LLLT showed statistical significance (p = 0.001) over placebo control. CONCLUSIONS: Our study suggests that skin adhesive LLLT on acupuncture points might be an effective, simple and safe non-pharmacological treatment for dysmenorrhoea.

Does it need to perform anterior column support after Smith-Petersen osteotomy for ankylosing spondylitis?

PURPOSE: The aim of this study was to determine whether anterior column support is required in Smith-Petersen osteotomy procedure with correction angles of more than 10°, while examining the subsequent healing patterns in relation to the disrupted area. METHODS: An analysis was done on 26 segments of 19 patients who showed a correction angle of more than 10° in the anterior opening after SPO. There were 17 male and two female patients with a mean age of 40 years (24-56 years). The mean follow-up period was 6.5 years (2-9.1 years). The patients were classified according to the site of the anterior opening, as the disc level, the lower end-plate of the upper body (upper body), or the upper end-plate of the lower body (lower body). The healing patterns of anterior opening and the radiological correction angles were evaluated relative to the opening site. RESULTS: In all cases, bony fusion was confirmed at a mean period of 5.6 months (3-6.7 months) after surgery and the anterior opening gap was healed in 18 segments (69.2%). For patients that developed an opening in the upper body, all of the gaps were healed. The gaps in the lower body opening group were healed in 85.7% of the cases, and for the opening at the disc level, the gaps were healed only in 12.5% of the cases. The least amount of correction was obtained when anterior opening occurred in disc level. CONCLUSIONS: In our study of subjects presenting with anterior opening angles from 10° to 32°, we obtained successful fusion without the need for additional anterior interbody fusion. Improved gap healing and increased correction angles were obtained when the opening was present in the upper or lower body endplates compared to those at the disc space level.

Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion: a prospective, randomized study.

STUDY DESIGN: A prospective, randomized study. OBJECTIVE: To analyze the effect of local retropharyngeal steroid to reduce prevertebral soft tissue swelling (PSTS) after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: There have been several reports on intravenous corticosteroid to prevent airway complication without a consensus; however, there have been no reports to date that have discussed the use of local steroids to reduce PSTS. METHODS: Fifty cases that underwent ACDF involving 1 or 2 segments were enrolled. The mean follow-up period was 22 months. Of the 25 cases randomly selected as the steroid group, a mixture of triamcinolone and morcellized collagen sponge was applied to the retropharyngeal space before wound closure. For the control group, the other 25 cases received the operation without steroid. We measured the PSTS ratio to vertebral body from C3 to 7 and PSTS index (PSTSI; mean of PSTS ratio at C3, 4, and 5) on cervical spine. Simple lateral radiographs were taken preoperatively, immediately after operation, and at postoperative 2 days, 4 days, 2 weeks, and the last follow-up. The changes in odynophagia, radiological union, Neck Disability Index were analyzed. RESULTS: The PSTS ratio of the steroid group was significantly lower on C3 and C4 immediately after operation, on C3, 4, 5 and C6 at postoperative 2 days, on C3, 4, and 5 at 4 days. The differences of PSTSI (the steroid: control group) maintained at 58.2: 74.3% (P = 0.004) immediately after operation, 57.9: 84.1% (P = 0.000) at 2 days, 56.3: 82.9% (P = 0.000) at 4 days, and 44.9: 51.4% (P = 0.037) at 2 weeks. The mean Visual Analogue Scale for odynophagia was significantly lower in the steroid group until postoperative 2 weeks. The last follow-up showed no significant difference in the radiological and clinical outcome. CONCLUSION: Using the retropharyngeal local steroid, we significantly reduced PSTS and odynophagia following ACDF without additional complication. This method may be considered a simple and effective method to decrease PSTS following anterior cervical spine surgery.

Radiographic progression of degenerative lumbar scoliosis after short segment decompression and fusion.

STUDY DESIGN: A retrospective study. PURPOSE: To assess the radiographic progression of degenerative lumbar scoliosis after short segment decompression and fusion without deformity correction. OVERVIEW OF LITERATURE: The aims of surgery in degenerative lumbar scoliosis are the relief of low back and leg pain along with a correction of the deformity. Short segment decompression and fusion can be performed to decrease the level of low back and leg pain provided the patient is not indicated for a deformity correction due to medical problems. In such circumstance, the patients and surgeon should be concerned with whether the scoliotic angle increases postoperatively. METHODS: Forty-seven patients who had undergone short segment decompression and fusion were evaluated. The average follow-up period was more than 3 years. The preoperative scoliotic angle and number of fusion segments was 13.6+/-3.9 degrees and 2.3+/-0.5, respectively. The preoperative, postoperative and last follow-up scoliotic angles were compared and the time of progression of scoliotic angle was determined. RESULTS: The postoperative and last follow-up scoliotic angle was 10.4+/-2.3 degrees and 12.1+/-3.6 degrees , respectively. In eight patients, conversion to long segment fusion was required due to the rapid progression of the scoliotic angle that accelerated from 6 to 9 months after the primary surgery. The postoperative scoliosis aggravated rapidly when the preoperative scoliotic angle was larger and the fusion was extended to the apical vertebra. CONCLUSIONS: The scoliotic angle after short segment decompression and fusion was not deteriorated seriously in degenerative lumbar scoliosis. A larger scoliotic angle and fusion to the apical vertebra are significant risk factors for the acceleration of degenerative lumbar scoliosis.

Osteotomy of the spine to correct the spinal deformity.

There are a number of reports on Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). However, there are few systematic reviews of all three kinds of osteotomies. Literature review and author's experience of SPO, PSO and VCR osteotomy will be described. Various surgical techniques can be applied according to the disease entity and magnitude of the deformity. The most appropriate methods for deformity correction should be chosen and the potential complications should be considered. Before attempting an osteotomy of the spine for a spinal deformity, sufficient surgical experience and a thorough understanding of the anatomy of the spine and adjacent structures are needed. In addition, a well-organized team with the other departments is essential.

Clinical outcome of anterior shoulder instability with capsular midsubstance tear: a comparison of isolated midsubstance tear and midsubstance tear with Bankart lesion.

To analyze the clinical outcomes of patients with a midsubstance capsular tear for anterior shoulder instability, 21 shoulders with a midsubstance tear were reviewed. There were 7 isolated midsubstance tears (group I) and 14 combined midsubstance tears with Bankart lesions (group II). The Rowe score averaged 92.3 points with 6 excellent and 1 good one in group I. Group II scored 86.3 points with 8 excellent, 3 good, 2 fair, and 1 poor (P = .184). The Rowe score averaged 89.8 points for the cases with an arthroscopic procedure and 86.9 points with an open repair (P = .542). At the last follow-up, forward elevation increased by 6 degrees in group I and 8 degrees in group II (P = .432). External rotation decreased by 8 degrees and 16 degrees , respectively (P = .150). The clinical outcomes of anterior instability with a midsubstance tear were good in both groups. The loss of external rotation was greater in the cases with combined midsubstance tears and Bankart lesions than in those with an isolated midsubstance tear.