Chae-Chil Lee

Arthroscopic Single-Row Supraspinatus Tendon Repair With a Modified Mattress Locking Stitch: A Prospective, Randomized Controlled Comparison With a Simple Stitch

PURPOSE Our purpose was to compare the clinical results and failure rates of arthroscopic rotator cuff repair by use of a modified mattress locking stitch (MMLS) repair versus a simple stitch repair. METHODS Between December 2004 and January 2006, 78 cases of arthroscopically repaired full-thickness rotator cuff tears were evaluated prospectively. All tears were between 1.5 and 3 cm in size. The mean age of the patients was 53.4 years (range, 39 to 68 years), and the mean follow-up duration was 31.1 months (range, 24 to 37 months). Thirty-nine individuals underwent arthroscopic repair by use of an MMLS (group I). Thirty-nine individuals underwent arthroscopic repair by use of a simple stitch (group II). Postoperative visual analog scale scores for pain, scores for activities of daily living, and University of California, Los Angeles (UCLA) scores were obtained at a mean of 12 months (range, 6 to 36 months). We compared the results statistically by Mann-Whitney U test. In both groups magnetic resonance imaging scans were obtained at 6 to 36 months after repair. RESULTS Between groups, the visual analog scale scores for pain, scores for activities of daily living, and University of California, Los Angeles scores were not significantly different (P > .05 for all). Of the patients, 92.3% in group I and 89.7% in group II showed excellent or good results at the final follow-up (P > .05). The satisfaction rate was 94.9% (37 cases) in group I and 89.7% (34 cases) in group II (P < .05). Radiographic failure was seen in 6 of 36 cases in group I (16.7%) and 9 of 30 cases in group II (27.4%) (P < .05). CONCLUSIONS Arthroscopic repair of medium-sized (1.5- to 3-cm) full-thickness rotator cuff tears by use of an MMLS improves patient satisfaction rates and radiographic repair integrity in comparison to simple stitch repair. LEVEL OF EVIDENCE Level II, lesser-quality randomized controlled trial.

The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone

Background Recurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit. Methods Engaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging. Results The average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II. Conclusions Compared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions.

Mucoid Degeneration of Both ACL and PCL

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patients magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.

MRI features of calcifying aponeurotic fibroma in the upper arm: a case report and review of the literature

Calcifying aponeurotic fibroma is a rare soft tissue tumor that occurs in the distal extremities of children and adolescents. We report a case of pathologically proven calcifying aponeurotic fibroma in the left upper arm of a 23-year-old female. Radiographs revealed increased soft tissue density with multiple stippled calcifications in the mid-portion of the patient’s left upper arm. Magnetic resonance imaging (MRI) showed a well-defined soft tissue mass with low to intermediate signal intensity on T1-weighted images, heterogeneously low signal intensity on T2-weighted images, and heterogeneous enhancement on fat-suppressed, contrast-enhanced T1-weighted images. Histologically, spindle cell proliferation with scattered calcifications and hyalinization was present. Seven years after surgery, there was no evidence of local recurrence. This is the first report of MRI findings of calcifying aponeurotic fibroma in the upper arm. We also summarize the MRI findings of 16 previously reported cases of calcifying aponeurotic fibroma originating in the upper or lower extremities.