Bong Gun Lee

Results of Arthroscopic Decompression and Tuberoplasty for Irreparable Massive Rotator Cuff Tears

PURPOSE The purpose of this study was to evaluate the clinical and radiologic results of arthroscopic tuberoplasty for symptomatic irreparable massive rotator cuff tears. METHODS This study enrolled 32 patients (32 shoulders) who underwent arthroscopic tuberoplasty for irreparable massive rotator cuff tears and were followed up for at least 24 months. The mean patient age at the time of surgery was 62.4 years (range, 43 to 76 years), and the mean duration of follow-up was 40 months (range, 24 to 63 months). The Constant score and the University of California, Los Angeles score were used for clinical evaluation. The acromiohumeral interval and inferior scapulohumeral line continuity were used for radiologic evaluation. RESULTS Twenty-six shoulders underwent arthroscopic tuberoplasty with concomitant acromioplasty, and 6 shoulders had only arthroscopic tuberoplasty. The Constant score increased from a preoperative mean of 47.6 points to 70.4 points at the last follow-up (P < .001). The University of California, Los Angeles score also improved from a preoperative mean of 15.4 points to 27.1 points at the last follow-up (P < .001), with 3 shoulders (9%) rated as excellent, 23 (72%) as good, and 6 (19%) as poor. The active range of forward flexion improved from 115.9° to 142.7° (P = .024). The final outcomes were not statistically affected by sex, age, preoperative mobility, and existence of a lesion of the long head of the biceps tendon. However, preoperative acromiohumeral interval and inferior scapulohumeral line continuity were statistically correlated with the final results (P < .001 and P = .047, respectively). CONCLUSIONS Arthroscopic tuberoplasty with concomitant acromioplasty, as well as treatment of the biceps tendon when indicated, would be an option for diminishing pain and improving active forward elevation for irreparable massive rotator cuff tears. In particular, satisfactory results during the minimum follow-up period of 24 months can be achieved in the cases with good preservation of the preoperative and postoperative acromiohumeral interval and continuity in the inferior scapulohumeral line, regardless of preoperative mobility.

Modified Mason-Allen Suture Bridge Technique: A New Suture Bridge Technique with Improved Tissue Holding by the Modified Mason-Allen Stitch

We present a new method of suture bridge technique for medial row fixation using a modified Mason-Allen stitch instead of a horizontal mattress. Medial row configuration of the technique is composed of the simple stitch limb and the modified Mason-Allen stitch limb. The limbs are passed through the tendon by a shuttle relay. The simple stitch limb passes the cuff once and the modified Mason-Allen stitch limb passes three times which creates a rip stop that prevents tendon pull-out. In addition, the Mason-Allen suture bridge configuration is basically a knotless technique which has an advantage of reducing a possibility of strangulation of the rotator cuff tendon, impingement or irritation that may be caused by knot.

National Trends in Surgery for Rotator Cuff Disease in Korea

The objective of this study was to investigate the national trends in rotator cuff surgery in Korea and analyze hospital type-specific trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2007 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes, procedure codes, and arthroscopic device code were used to identify patients who underwent surgical treatment for rotator cuff disease. A total of 383,719 cases of rotator cuff surgeries were performed from 2007 to 2015. The mean annual percentage change in the age-adjusted rate of rotator cuff surgery per population of 100,000 persons rapidly increased from 2007 to 2012 (53.3%, P < 0.001), while that between 2012 to 2015 remained steady (2.3%, P = 0.34). The proportion of arthroscopic surgery among all rotator cuff surgeries steadily rose from 89.9% in 2007 to 96.8% in 2015 (P < 0.001). In terms of hospital types, the rate of rotator cuff surgery increased to the greatest degree in hospitals with 30–100 inpatient beds, and isolated acromioplasty procedure accounted for a larger proportion of the rotator cuff surgeries in small hospitals and clinics compared to large hospitals. Overall, our findings indicate that cases of rotator cuff surgery have increased rapidly recently in Korea, of which arthroscopic surgeries account for the greatest proportion. While rotator cuff surgery is a popular procedure that is commonly performed even in small hospitals, there was a difference in the component ratio of the procedure code in accordance with hospital type.

Is revision remplissage possible for failed primary remplissage operation?: a case report

A Hill-Sachs lesion is a bony defect of the posterosuperior humeral head occurring with anterior shoulder instability. It has been considered as an important factor associated with recurrence, and the risk of recurrent dislocation is increased in the large or engaged type. 1 The remplissage operation is one of the treatment methods for a pathogenic Hill-Sachs lesion. It attaches the posterosuperior aspect of joint capsule and the infraspinatus tendon to the Hill-Sachs lesion, thereby preventing the lesion from engaging into the anterior glenoid. 7 Although the rate is low, redislocation can occur even after the remplissage operation, and how to treat failed remplissage is not yet clear. In this case report we present a patient who underwent a revision remplissage operation for failed remplissage procedure caused by early exercise and trauma.

Arthroscopic reduction and internal fixation for displaced anterior glenoid rim and greater tuberosity fractures

Concomitant fractures of the greater tuberosity and anterior glenoid rim are rare in cases of traumatic anterior dislocation of the shoulder. In such cases, open reduction and internal fixation for both fractures have been tried. However, the extensive dissection required to visualize fracture fragments may contribute to postoperative shoulder stiffness and morbidity. Recent advancements in arthroscopy suggest that the arthroscopic treatment of these fractures appears to be a feasible and attractive challenge. For anterior glenoid rim fractures, techniques described include arthroscopic screw fixation and the Bankart repair technique with suture anchors [1–3]. Recently, a double bony row technique and a bridge technique were developed to increase the primary stability of arthroscopic fixation [4]. For greater tuberosity fractures, techniques described also include arthroscopic screw fixation and suture anchor fixation [5, 6], and techniques for arthroscopic internal reduction and fixation of greater tuberosity fractures using double-row or suture-bridge techniques have recently been described [7, 8]. We present a rare case of anterior dislocation of the shoulder with displaced anterior glenoid rim and greater tuberosity fractures. Few reports have been issued on the simultaneous treatment of both fractures using arthroscopic techniques. In fact, to our knowledge, this is the first case in which both glenoid and tuberosity fractures were repaired using arthroscopic techniques and cannulated screws. The patient provided consent for his case to be submitted for publication.

Intraarticular osteochondroma of shoulder: a case report

Osteochondroma is a cartilage-capped osseous protrusion that arises from the surface of a bone. Osteochondroma occurs mostly in the metaphysis of long tubular bones such as the femur, tibia, and humerus. Osteochondroma is rare in the diaphysis and in the epiphysis. There was only one case in which a patient had a limited range of motion in the shoulder joint due to an intraarticular osteochondroma of the proximal humerus. We present a rare case of intraarticular osteochondroma involving the proximal humerus with pathologic findings and imaging features on computed tomography and magnetic resonance imaging.

Is immediate reconstruction after mastectomy in breast cancer patients beneficial to shoulder function

To compare shoulder morbidity between patients who received transverse rectus abdominis myocutaneous (TRAM) flaps after mastectomy (MX + TRAM) and patients who underwent mastectomy only (MX).

The medial synovial fold of the posterior cruciate ligament: cadaveric investigation together with magnetic resonance imaging and histology.

Objective The purposes of our study were to analyze magnetic resonance imaging (MRI) and cadaveric findings concerning the medial synovial fold of the posterior cruciate ligament (PCL) and to classify the types of fold according to anatomic location. Methods Two musculoskeletal radiologists reviewed MR images of 17 cadaveric knees to classify the types of medial fold of the PCL by consensus. The MRI types were divided into 3 groups. In type A, there was no definitive medial fold; and in type B, inferior-short type, there was a small protrusion of the medial border. Type C, inferior-long type, had a long enough fold to exceed the imaginary line, which is connecting between the medial tibial condyle and posterolateral aspect of the medial femoral condyle. Correlations were sought between the findings derived from the MRI studies and cadaveric dissections. Histologic analyses of the medial fold were also performed. Results On MRI, the most common type of medial fold was type B (76.4%), followed by type C (11.8%) and type A (11.8%). In the cadaveric investigation, the medial folds of both types B and C were found to project into the medial femorotibial joint. Moreover, there was also a protruding medial fold at the superior aspect of the PCL in the A. Histologic examination of the medial folds revealed collagenous tissue surrounded by synovial cells. Conclusions Medial folds of the PCL are normal synovial structures that can be seen by MRI and in cadaveric studies in a large proportion of the population.

Risk Factors for Newly Developed Osteoporotic Vertebral Compression Fractures Following Treatment for Osteoporotic Vertebral Compression Fractures

BACKGROUND CONTEXT It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established. PURPOSE The purpose of this study was to investigate the risk factors for newly developed OVCFs after treatment by vertebroplasty (VP), kyphoplasty (KP), or conservative treatment. STUDY DESIGN/SETTING A retrospective comparative study. PATIENT SAMPLE One hundred thirty-two patients who had radiographic follow-up data for one year or longer among 356 patients who were diagnosed with OVCF and underwent VP, KP or conservative treatment between March 2007 and February 2016. OUTCOME MEASURES All records were examined for age, sex, body mass index (BMI), rheumatoid arthritis and other medical comorbidities, osteoporosis medication, bone mineral density (BMD), history of vertebral and nonvertebral fractures, treatment methods used, level of fractures, and presence of multiple fracture sites. METHODS Patients were divided into those who manifested new OVCF (Group A) and those who did not (Group B). For the risk factor analysis, students t-tests and chi-square tests were used in univariate analysis. Multivariate logistic regression analysis was carried out on variables with a p<.1 in the univariate analysis. RESULTS Newly developed OVCFs occurred in 46 of the 132 patients (34.8%). Newly developed OVCF increased significantly with factors such as average age (p=.047), low BMD T-score of the lumbar spine (p=.04) and of the femoral neck (p=.046), advanced age (>70 years) (p=.011), treatment by cement augmentation (p=.047) and low compliance with osteoporosis medication (p=.029). In multivariate regression analysis, BMD T-score of the lumbar spine (p=.009) and treatment by cement augmentation (p=.044) showed significant correlations with the occurrence of new OVCFs with a predictability of 71.4%. CONCLUSION Osteoporotic vertebral compression fracture patients with low BMD T-score of the lumbar spine and those who have been treated by cement augmentation have an increased risk of new OVCFs after treatment and, therefore, require especially careful observation and attention.

The Diagnostic Reproducibility of Tomosynthesis for the Correlation between Acromiohumeral Distance and Rotator Cuff Size or Type

Objective To correlate the acromiohumeral distance (AHD) using tomosynthesis and rotator cuff (RC) pathology and various anatomical indices and to assess the diagnostic reproducibility of tomosynthesis for the evaluation of subacromial impingement. Materials and Methods A retrospective review of 63 patients with clinically suspected subacromial impingement was conducted. Two musculoskeletal radiologists independently measured the following quantitative data: the AHD on plain radiographs and the AHD at three compartments (anterior, middle, and posterior) using tomosynthesis, computed tomography (CT) arthrography, or magnetic resonance (MR) arthrography. To investigate the association between the AHD and RC pathology and various anatomical indices, we reviewed the arthroscopic operation record as the referenced standard. Results The size of rotator cuff tear (RCT) in full-thickness tears displayed a significant inverse correlation with the middle and the posterior tomosynthetic AHDs (p < 0.05). The results of an ANOVA revealed that the middle tomosynthetic AHD retained a significant association with the type of RCT (p = 0.042), and the posterior tomosynthetic AHD retained significance for the size of RCT in a full-thickness tear (p = 0.024). The inter-modality correlation exhibited significant agreement especially among the plain radiography, tomosynthesis, and CT or MR arthrography (p < 0.05). The intraobserver and interobserver correlation coefficients (ICCs) displayed excellent agreement (ICC = 0.896–0.983). The humeral head diameter and glenoid height were significantly correlated with patient height and weight. Conclusion Acromiohumeral distance measurement using tomosynthesis is reproducible compared with other modalities.