Search

Backgroud The goal of this study was to evaluate the clinical and radiological outcomes of arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon and to identify prognostic factors affecting rotator cuff healing in patients with irreparable large to massive posterosuperior rotator cuff tears. Methods Between July 2012 and March 2016, 42 patients with irreparable large to massive posterosuperior rotator cuff tears underwent an arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon. All patients had a minimum of 2-year follow-up (mean, 35.4 ± 7.3 months). Clinical evaluation was performed using the visual analog scale, the University of California, Los Angeles shoulder rating scale, Constant score, and active range of motion. Radiological evaluation was performed using magnetic resonance imaging and simple radiography. Results Clinical outcomes at the final follow-up improved significantly compared with the preoperative values (all p < 0.001). The failure rate was 23.8% (10/42); however, clinical outcomes significantly improved regardless of cuff healing (all p < 0.001). The mean acromiohumeral distance was 6.5 ± 1.7 mm (range, 3.2–9.7 mm) before surgery and 6.3 ± 1.6 mm (range, 2.8–9.5 mm) at the final follow-up. Preoperative acromiohumeral distance was associated with failure of cuff healing in the univariate analysis (p = 0.043) and multivariate analysis (p = 0.048). A receiver operating characteristic curve was used to determine the predictive cutoff value for the smallest preoperative acromiohumeral distance for successful healing, which was calculated as 5.3 mm. Conclusions Despite healing failure, arthroscopic partial repair with medialization can be a possible treatment option for irreparable large to massive posterosuperior rotator cuff tears because of the improvement in clinical outcome. The shorter preoperative acromiohumeral distance was the single most important factor negatively affecting cuff healing, and the likelihood of success of healing might be improved if a repair is performed when the preoperative acromiohumeral distance is < 5.3 mm.

We presented a surgical technique including a suture bridge technique with relatively small incision for the reduction and fixation of posterior ligament avulsion fractures. A suture anchor was used to hold the avulsed fragment and a knotless anchor was used to continuously compress the bony fragment into the fracture site, thereby maintaining reduction during healing.

Without traumatic history, spontaneous hemarthrosis of the knee is a relatively rare condition, and there is no report of the diagnosis and treatments in Korea. In this case, magnetic resonance imaging and arthroscopic findings showed hemarthrosis and a lateral meniscus tear. Hemarthrosis of the patient remained after meniscus resection and coagulation; we then, found rupture of the lateral geniculate artery by computed tomography-angiography. We report on a case of successful treatment of spontaneous hemarthrosis with therapeutic embolization with a thorough review of the relevant literatures.

Because the integrity of repaired rotator cuff is closely related to the functional results of patients,1,2,3) its accurate determination can have important implications for the management of postoperative shoulder pain. There are several methods to evaluate rotator cuff integrity before and after repair including ultrasonography,4,5,6,7,8,9) multidetector computed tomographic arthrography (CTA),1,10) magnetic resonance imaging (MRI),1,2,11,12,13) magnetic resonance arthrography (MRA),14) and second look arthroscopy.5) Of them, ultrasonography is recognized as a simple and relatively accurate method for the detection of rotator cuff integrity. However, it is difficult to identify the integrity of the rotator cuff after a surgery with ultrasonography because bone and soft tissue ultrasonographic landmarks around the tendon become distorted or absent and tendons are hyperechoic which leads to further difficulties in the diagnosis of recurrent rotator cuff tears.4,9,15) Furthermore, it may not be possible to accurately identify the integrity of the rotator cuff with ultrasonography if the ends of torn rotator cuffs are not retracted or a gap in the tear is not filled with synovial fluid.16) We thought the sonography could be combined with arthrography (arthrosonography) to overcome those disadvantages. This technique was reported in previous studies.16,17,18) However, to our knowledge, there has been no report on comparing the results between conventional ultrasonography and arthrosonography in assessing the repaired cuff integrity. Therefore, the present study was designed to compare the repaired cuff integrity measured by two methods. The hypothesis of the present study was that arthrosonography would provide a higher accuracy in detecting the integrity of the repaired rotator cuff than conventional ultrasonography.

o, respectively, and the anterior covering of the acromion was measured to be 0.55±0.13 and 0.51±0.14, respectively. In a comparison with the control group of subjects, the lateral extension of the acrominon of the rotator cuff tear group of patients was larger and the lateral acromial angle was smaller; these findings were statistically significant (p＜0.001). In addition, the correlation coefficients of the lateral extension of the acromion to the lateral acromial angle in the rotator cuff tear group of patients and in the control group of subjects was −0.44 and −0.46, respectively; a statistically significant correlation was seeen (p＜0.001). Conclusion: The results suggest that the measurement of the lateral extension of the acromion and the lateral acromial angle determines the shape of the acromion, and thus it may represent a useful marker to confirm the interrelationship of a rotator cuff tear.

Purpose: To analyze the findings of midcarpal and radiocarpal arthroscopic examinations in the diagnosis of wrist trauma and pathology focusing on interosseous ligament laxity. Materials and Methods: Forty-one midcarpal arthroscopic examinations were performed in conjunction with radiocarpal arthroscopic examinations. Thirty-one wrists with distal radius fracture and ten wrists with triangular fibrocartilage complex tear were included. Scapholunate and lunotriquetral ligament laxity was graded by using the Geissler classification and radiocarpal and midcarpal arthroscopic findings were compared. Results: For scapholunate findings midcarpal arthroscopy confirmed radiocarpal findings in 14 cases and provided a diagnosis in 6 cases. For lunotriquetral findings midcarpal arthroscopy confirmed radiocarpal findings in 13 cases and provided a diagnosis in 6 cases. Conclusion: Midcarpal arthroscopy added more statistically significant information to the results of radiocarpal examination than wrist arthroscopy performed without a midcarpal examination.

Purpose: The purpose of this study was to assess the relationships between the pattern of fractures and associated intra-articular soft tissue injuries. Materials and Methods: We performed a study of 31 patients treated for distal radius fracture. Radiographic evaluation included ulnar styloid process fracture, dorsal anglulation and ulnar variance. We observed TFCC injuries, scapholunate and lunotriquetral ligament injuries by arthroscopy. Results: The incidence of TFCC radial rim tear and lunotriquetral ligament injuries were significantly higher in die punch fractures with lunate facet involvement than in fractures without lunate facet involvement (p0.05). Conclusion: The TFCC radial rim and the lunotriquetral ligament may be injured by axial compression loading of the ulnar head on the triquetrum. TFCC radial rim tear and lunotriquetral ligament injuries must be kept in mind in die punch fractures with lunate facet involvement.

Purpose: To analyze functional and radiological results and early motion after the stable fixation of fractures of the distal radius by using two small fragment plates. Materials and Methods: Thirty cases were analyzed clinically and radiographically. Internal fixation was achieved using two 2.7 mm stainless steel small fragment plates on the radial and intermediate columns angled 60 apart in all cases. For functional evaluation, Green and O'Brien scores were analyzed. For radiological evaluation, volar tilting angle, radial inclination, and ulnar variance were analyzed. Arthroscopy was performed in all cases concomitantly. Results: Functional results were excellent or good in 24 patients (80%) according to the modified system of Green and O'Brien. Radiological analysis showed that volar tilting angle, radial inclination or ulnar variance during the immediate postoperative to bony union period had no significant difference. Complications occurred in two wrists, namely reflex sympathetic dystrophy (1) and delayed union (1) needing an additional palmar plate and a bone graft. No case experienced implant failure or extensor tendinitis. Conclusion: Two 2.7 mm small fragment plates fixations provided good stability, and allowed early function. We report a series of 30 fractures treated by this method of internal fixation with satisfactory results.

Purpose : This study sought to perform proximal tibia opening wedge osteotomy on osteoarthritis patients, assess the treatment effect, and identify factors affecting clinical results. Materials and Methods : Nineteen patients (19 cases) who had opening wedge osteotomy at our hospital from November 1987 to May 1998, and were followed up on for at least 2 years were enrolled in the study. The follow-up period ranged from 2 years to 10 years and 4 months averaging 5.3 years. We analyzed those factors that affected the results of operation, such as age, weight, joint space narrowing and corrective angle. Results : Preoperative mean varus angle was 6.8 degrees and postoperative mean valgus angle 6.8 degrees. Mean valgus angle was 6.3 degrees at the final follow-up. Clinical assessment of the patients following the final follow-up showed: excellent in 8 cases, good in 8 cases, and fair in 2 cases. In addition, the remaining one case, assessed as poor, received total knee arthroplasty. The postoperative knee score was 86.310.6 in the lower age group, and 82.48.8 in the higher age group (p>0.05). The postoperative knee score was 89.25.2 in the non-obesity group, and 78.011.0 in the obesity group (p5.0 in the stage I group and 70.09.9 in stage II group (p10.8, 82.6 8.0 and 91.05.3, for those with postoperative valgus angles of below 5 degrees, 6 to 7 degrees, and over 8 degrees, respectively (p

Purpose : To evaluate the changes at the postoperative site of anterior cruciate ligament (ACL) reconstruction, in which bioabsorbable screws were used for fixation, by magnetic resonance imaging (MRI) and to evaluate the efficacy and safety of (Linvatec, Largo, FL). Materials and Methods : This prospective study was initiated in May 1997 upon 38 patients receiving . All patients with arthroscopically assisted primary reconstruction of ACL involving fixation with Bioscrews were examined 3, 6, 12 and 24 months after operation by Lysholm score, KT-2000 arthrometer and MRI. MR Images were interpreted by musculoskeletal radiologists. Results : There were no complications related to loss of fixation. The Lysholm scores and the KT-2000 arthrometer measurement at final follow-up were 95.6 and 1.8 mm respectively. Even after two years there was evidence of screw material in all cases. MRIs taken at 3 months showed fluid collections inside the tibial tunnel (n=3) and the anterior aspect of the tibial tunnel (n=1), Though these fluid collections disappeared gradually. Varying amounts of edma were observed around the tunnels. We divided the bone edema into the ring (n=5) and diffuse types (n=16), which disappeared gradually. Conclusion : The was found to be a safe and effective alternative for fixation in ACL reconstruction, but requires the long term follow-up to confirm its safety.

Purpose : The purpose of this study was to evaluate arthroscopically the morphological changes of the transplanted human allogenic meniscus including MRI changes at follow up. Materials and Methods : From Feb. 1996 to Dec. 1997, among seventeen patients that received allogenic meniscal transplantation, fourteen patients underwent arthroscopic evaluation (7 medial and 7 lateral) at follow-up (from 26 to 48 months post transplantation, average 34 months). To fix the transplanted meniscus, we used a bone-plug method in ten, it key-hole method in three, and the bone-bridge method in one patient. MRI of the five volunteer knees were taken 6 months and 1 year after the operation. In three patients, biopsy samples were taken from the peripheral and central portion of the grafted meniscus. Results : The second-look arthroscopy after allogenic meniscal transplantation revealed that grafts were viable and well incorporated with surrounding capsular tissue. In all cases, the substance of the meniscus was probed and seemed normal. There was no evidence of shrinkage except in one case. Conclusion : Second-look arthroscopy revealed excellent incorporation of the allograft with firm attachment throughout. Although early clinical results seem to be promising, further studies are necessary to properly assess whether meniscal transplants will prevent degenerative changes, and enhance knee joint stability.