Dong-Kyo Seo

A Prospective Therapeutic Comparison of Simple Suture Repairs to Massive Cuff Stitch Repairs for Treatment of Small- and Medium-Sized Rotator Cuff Tears

PURPOSE The purpose of this study was to compare the massive cuff stitch (MCS) with the simple stitch in terms of integrity at 2 years after surgery when used to repair small-sized to medium-sized full-thickness rotator cuff tears. METHODS Seventy-one patients underwent arthroscopic repair of full-thickness rotator cuff tears between December 2004 and June 2006. The tear sizes ranged from 0.5 to 1.5 cm. The mean patient age was 53 years (range, 40 to 69 years), and the mean follow-up time was 33 months (range, 24 to 41 months). Group I (n = 35) underwent MCS repair, and group II (n = 36) underwent simple stitch repair. Results were analyzed by use of the Wilcoxon signed rank test and the Mann-Whitney test. Follow-up ultrasound was performed 24 to 41 months after repair. RESULTS All patients showed improvements in the visual analog scale for pain, activities of daily living, and University of California, Los Angeles scores (P < .05), but there were no significant differences in scores between groups (P > .05). The satisfaction rating was similar for group I (4.7) and group II (4.3) (P > .05). The failure (retear) rate was significantly lower in group I (14.3%) than in group II (27.8%) (P < .05). CONCLUSIONS The clinical outcomes between the MCS and simple stitch were not significantly different, but the MCS was superior to the simple stitch in maintaining repair integrity on ultrasound evaluation after arthroscopic repair of small-sized to medium-sized full-thickness rotator cuff tears. LEVEL OF EVIDENCE Level III, prospective therapeutic comparative study.

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.

Measurement of Carpal Alignment Indices Using 3-Dimensional Computed Tomography

PURPOSE This study aimed to establish normal values for wrist carpal alignment measured by 3-dimensional computed tomography (CT) and to show the inter- and intraobserver reliability of this measurement compared with simple radiography. METHODS The study utilized 3-dimensional CT and simple radiography of wrist joints in 30 asymptomatic volunteers. The wrist position was standardized using a custom-designed positioning device. Three independent observers measured carpal alignment parameters including distal radius articular angle, radiolunate angle, radioscaphoid angle, radiocapitate angle, radius-third metacarpal angle, scapholunate angle, lunocapitate angle, and lunate-third metacarpal angle. RESULTS Based on 3-dimensional CT measurement, the mean values of these parameters were: 12.9° ± 1.8° for the distal radius articular angle; 1.2° ± 3.8° for the radiolunate angle; 54.2° ± 5.6° for the radioscaphoid angle; 1.9° ± 2.2° for the radiocapitate angle; -1.0° ± 2.5° for the radius-third metacarpal angle; 52.9° ± 6.9° for the scapholunate angle; 0.7° ± 4.1° for the lunocapitate angle; -2.3° ± 4.6° for the lunate-third metacarpal angle. All parameters showed high inter- and intraobserver reliability in the 2 modalities. CONCLUSIONS The normal values and ranges for carpal alignment angles were evaluated by using 3-dimensional CT. We could obtain high reliability in 3-dimensional CT as well as plain radiograph for the measurement of carpal alignment. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.

Osteochondral lesions of the talus: Few patients require surgery

Background and purpose — The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Patients and methods — This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3–10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results — No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle–hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Interpretation — Nonoperative treatment can be considered a good option for patients with OCL.

Treatment of complex regional pain syndrome using free-flap surgery: a case report

Complex regional pain syndrome is a chronic progressive illness with sensory, autonomic, trophic, and motor abnormalities. Treatment is difficult and controversial. We report the results of free-flap and vein wrapping of the superficial peroneal nerve surgery to treat complex regional pain syndrome.

Valgus Ankle Degenerative Arthritis with an Isolated Deltoid Insufficiency and Tibial Varus: A Case Report

ABSTRACT We report a case of valgus ankle degenerative arthritis due to chronic isolated deltoid insufficiency combined with tibial varus that was treated successfully with ankle joint preserving surgery. A 63‐year‐old male complained of right lateral ankle pain with 10 minutes of maximal pain‐free walking time. The assessed American Orthopaedic Foot and Ankle ankle‐hindfoot scale score was 33 points. The ankle joint showed 18° of valgus deformity with 6° of tibia varus. Medial displacement calcaneal osteotomy, supramalleolar open wedge osteotomy, and deltoid ligament imbrication were performed. At the 2‐year follow‐up examination, the ankle joint showed 10° of valgus and the tibial plafond showed flattening. The hindfoot showed 7° of valgus. He could run for 2 hours on the treadmill without pain. The American Orthopaedic Foot and Ankle ankle‐hindfoot scale score was 90 points. In conclusion, valgus ankle degenerative arthritis with isolated deltoid insufficiency and tibial varus could be treated successfully with realignment using a double osteotomy and additional deltoid imbrication. &NA; Level of Clinical Evidence: 4

Diabetic Foot Complications Despite Successful Pancreas Transplantation

Background: It is known that successful pancreas transplantation enables patients with diabetes to maintain a normal glucose level without insulin and reduces diabetes-related complications. However, we have little information about the foot-specific morbidity in patients who have undergone successful pancreas transplantation. The purpose of this study was to investigate the prevalence and predisposing factors for foot complications after successful pancreas transplantation. Methods: This retrospective study included 218 patients (91 males, 127 females) who had undergone pancreas transplantation for diabetes. The mean age was 40.7 (range, 15-76) years. Diabetes type, transplantation type, body mass index, and diabetes duration before transplantation were confirmed. After pancreas transplantation, the occurrence and duration of foot and ankle complications were assessed. Results: Twenty-two patients (10.1%) had diabetic foot complications. Fifteen patients (6.9%) had diabetic foot ulcer and 7 patients (3.2%) had Charcot arthropathy. Three patients had both diabetic foot ulcer and Charcot arthropathy. Three insufficiency fractures (1.4%) were included. Mean time of complications after transplantation was 18.5 (range, 2-77) months. Creatinine level 1 year after surgery was higher in the complication group rather than the noncomplication group (P = .02). Conclusion: Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes. Level of Evidence: Level III, comparative study

Nonweightbearing Radiographs in Patients With a Subtle Lisfranc Injury

Background: A midfoot sprain can be easily missed because of minimal findings on initial radiographs, which are almost universally nonweightbearing. We investigated preoperative nonweightbearing plain radiographic images in patients who were found to have unstable subtle Lisfranc injuries. Methods: We retrospectively reviewed 51 patients who were operated on between February 2004 and March 2015. Abnormal preoperative radiographic findings and intraoperative instability were compared. The relationship was calculated with Fisher’s exact test. Results: Based on intraoperative findings, medial cuneiform (C1)–second metatarsal (M2) instability was observed in 50 cases (98%), which was the most common. Thirty-nine cases (76.4 %) had multiple joint (at least 2) instability. In the preoperative radiologic findings, C1-M2 diastasis was the most common abnormal finding, in 46 cases (90.1%). Specificity and positive predictive value were 1.0 in C1-M2 avulsion, diastasis, and C1–intermediate cuneiform (C2) diastasis. Abnormal findings of C1-C2, C1-M1, and C2-M2 showed a significant relationship with intraoperative instability (P < .05). Conclusion: C1-M2 avulsion and diastasis and C1-C2 diastasis were definite preoperative predictors of instability. In unstable subtle Lisfranc injuries, 90% had at least a minor radiographic abnormality at the C1-M2 joint on nonweightbearing radiographs. However, caution should be exercised to identify instability without radiographic abnormality in the C1-M2 joint. Level of Evidence: Level IV, retrospective case series