Hyun Seok Song

Arthroscopic reduction and fixation with suture-bridge technique for displaced or comminuted greater tuberosity fractures.

The arthroscopic suture-bridge technique (transosseous equivalent technique) was initially described for increasing the footprint size during arthroscopic rotator cuff repair. We describe a method in which the same principles are used to fix a displaced or comminuted greater tuberosity fracture. The technique involves reducing the displaced fragment with two medially placed, trans-tendinous anchors and compressing the greater tuberosity using the sutures from these medial anchors in two laterally placed anchors. The two medial anchors are inserted through the junction of the cuff and fragment. The anchor driver can be used as a joystick to reduce the fragment into position. One suture limb of each anchor is passed back through the tendon 5 mm from the original anchor insertion point in the tendon. With the scope in the subacromial space, the sutures from the medial anchors are tied in a mattress configuration. The four suture ends are passed distally over the greater tuberosity and incorporated into two PushLock anchors (4.5 mm; Arthrex, Naples, FL) using the suture-bridge technique. The postoperative rehabilitation protocol is similar to that for rotator cuff repairs.

Early clinical results of reverse total shoulder arthroplasty in the Korean population

BACKGROUNDnWe evaluated the short-term clinical outcomes and compared the components sizes of reverse total shoulder arthroplasty (RTSA) in Korean Population.nnnMATERIALS AND METHODSnWe performed an RTSA on 42 patients between December 2007 to February 2010. The mean age at surgery was 72.5xa0±xa05.6 (10 men, 32 women) and average follow-up period was 24 months. Twenty-two cuff tears arthropathy, 15 irreparable massive rotator cuff tears with pseudoparalysis, 5 proximal humeral fractures, and 2 infection cases were included. We evaluated clinical outcomes and also the intra- and postoperative complications to determine if any of the complications were unique to the use of a RTSA in a Korean population. In the anatomic study, 92 uninjured shoulders of 92 patients were used for measuring the inferior glenoid size, and we compared the components sizes of RTSA with those of the normal population.nnnRESULTSnThe ASES (American Shoulder and Elbow), UCLA, and KS (Knee Society) scores significantly improved from preoperative 35 (0-63), 12 (5-27), and 39 (3-81) to postoperative 68 (37-95), 24 (16-35), and 68 (34-88), respectively (Pxa0<xa0.05). Postoperative complications were seen in 20% and scapular notching 35%. Three patients required further surgery for shoulder dislocation, periprosthetic fracture, and stem loosening. In the anatomic study, mean radius of the inferior glenoid was 17.1xa0±xa02.1 mm in male and 15.4xa0±xa01.6 mm in female.nnnCONCLUSIONnThe short-term clinical results of an RTSA in Korean population are excellent despite high complication rate. However, the size of the glenoid is sometimes smaller than the baseplate (29 mm diameter) in female patients. More adequate size of the glenoid component should be considered.

Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears

PURPOSEnTo compare the clinical outcomes of arthroscopic in situ repair with the tear completion repair technique for partial-thickness rotator cuff tears (PT-RCTs).nnnMETHODSnWe prospectively enrolled 100 cases with articular-sided and bursal-sided PT-RCTs exceeding 50% of tendon thickness and allocated them randomly. An in situ repair was performed in group 1 (nxa0= 50). Completion of the remaining cuff tissue and repair were performed in group 2 (nxa0= 50). The medial row was knotted as transosseous repair (suture-bridge technique) in all cases. American Shoulder Elbow Society (ASES) score, Constant shoulder (CS) score, Simple shoulder (SS) score, and Korean shoulder (KS) score, and visual analog scale (VAS) for pain and range of motion were assessed at 3, 6, and 12 months and at the last visit. Repaired tendon integrity was determined at 6 to 12 months by magnetic resonance imaging.nnnRESULTSnEight cases were lost to follow-up. Ultimately, 92 cases were analyzed. The average follow-up was 19.1 months (range, 12 to 42 months). Significant improvements in the VAS for pain and functional outcomes were observed in both groups postoperatively (Pxa0=xa0.001 for VAS; P < .001 for ASES score; P < .001 for CS score; Pxa0= .001 for SS score; P<.001 for KS score). No significant difference in the clinical results was observed at any time between the groups. No difference of retear rate on articular-sided PT-RCT was observed between the groups (Pxa0= .34). Retears on the bursal-sided PT-RCT were more frequent in group 2 (Pxa0= .02).nnnCONCLUSIONSnArthroscopic repair of PT-RCT exceeding 50% of the thickness provided functional improvements and pain relief regardless of the repair technique. The retear rate for bursal-sided PT-RCT was higher in group 2, although the retear rate for the articular-sided PT-RCT was not different.nnnLEVEL OF EVIDENCEnLevel II, prospective comparative study.

In vivo analysis of acromioclavicular joint motion after hook plate fixation using three-dimensional computed tomography

BACKGROUNDnThe clavicle hook plate can be used to treat acromioclavicular and coracoclavicular ligament injury or distal clavicular fracture with comminution. However, the hook plate can induce subacromial impingement, resulting in discomfort from the hardware.nnnMETHODSnOur inclusion criteria were (1) men and women aged older than 20 years and (2) the presence of comminuted distal clavicular fractures (Neer type IIB) fixed with a hook plate (Synthes, Oberdorf, Switzerland). Three-dimensional computed tomography was obtained before removal of the hook plate. Seven patients were enrolled prospectively. The mean age was 42 years (range, 24-60 years). Zero degree images and abduction images were obtained. The sagittal cut surface was obtained 5 mm medial from the distal clavicle. The equator of the cut surface of the clavicle was compared with the full abduction model to analyze rotation. The center of the cut surface of the clavicle was compared with the full abduction model to analyze translation.nnnRESULTSnThe average difference in rotation of the distal clavicle between both shoulders was 16° (range, 3°-22°; P = .001). The mean difference in anterior translation of the distal clavicle was 2.2 mm (range, -0.7 to 5.6 mm; P = .030).nnnCONCLUSIONnHook plate fixation at the acromioclavicular joint causes decreased internal rotation and increased anterior translation of the distal clavicle with respect to the medial acromion, indicating that the scapula relative to the thorax has decreased posterior tilting and increased external rotation in shoulders fixed using a hook plate.

Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old

IntroductionWe retrospectively analyzed the clinical results of treatment of impacted or undisplaced femoral neck fractures (Garden types 1 and 2) by osteosynthesis in elderly patientsxa0>70-year old.Materials and methodsWe retrospectively reviewed the radiological results of 52 patients who were followed up for at least 6xa0months from April 2002 to December 2008. The average age of the patients was 77.6xa0years (range 70–97xa0years), and 38 patients were females. The mean follow-up period was 11.7xa0months (range 6–19xa0months). Thirteen cases were Garden type 1 fractures, and 39 were Garden type 2 fractures. We assessed the relationships between the occurrence of complications and age, sex, Garden stage, bone mineral density (BMD), history of contralateral hip fracture, and any additional hip injury.ResultsMajor complications occurred in 18 cases (34.6xa0%), including nonunion (8 cases), osteonecrosis (6 cases), stress fracture of the subtrochanter (2 cases), excessive pull-out of a screw (1 case), and deep infection (1 case). The development of complications was associated with Garden stage 2, BMD, and additional hip injury. However, other factors were not associated with complications. Reoperations were performed in 16 cases (30.1xa0%), and 2 of the patients died during follow-up.ConclusionA relatively high rate of complications or reoperations developed after treatment of Garden 2 femoral neck fractures in senile patientsxa0>70xa0years of age with osteoporosis. Although internal fixation has been recommended in the literature for undisplaced femoral neck fractures, primary arthroplasty may be a better option for treatment of Garden type 2 fractures in elderly patients.

Repair of a radial tear in the posterior horn of the lateral meniscus

BACKGROUNDnThere have been no studies evaluating the clinical results after repair of a radial tear in the posterior horn of the lateral meniscus (PHLM) using the FasT-Fix system. This study was undertaken to evaluate the clinical outcomes after repair of a radial tear in the PHLM using the FasT-Fix system in conjunction with anterior cruciate ligament (ACL) reconstruction.nnnMETHODSnBetween September 2008 and August 2011, 15 radial tears in the PHLM identified during 132 consecutive ACL reconstructions were repaired using the FasT-Fix meniscal repair system. We classified the radial tears into three types according to the tear patterns: simple radial tear, complex radial tear, and radial tear involving the popliteal hiatus. Postoperative evaluation was performed using the Lysholm knee score and Tegner activity level. Second-look arthroscopy was performed in all cases.nnnRESULTSnThe mean follow-up period was 24 months. None of the patients had a history of recurrent effusion, joint line tenderness or a positive McMurray test. The meniscal repair was considered to have a 100% clinical success rate. At the final follow-up, the Lysholm knee score and Tegner activity level were significantly improved compared to the preoperative values. On the second-look arthroscopy, repair of radial tears in the PHLM in conjunction with ACL reconstruction using the FasT-Fix device resulted in complete or partial healing in 86.6% of cases.nnnCONCLUSIONnClinical results after meniscal repair of a radial tear in the PHLM by using the FasT-Fix system were satisfactory.nnnLEVEL OF EVIDENCEnCase series, Level IV.

Simultaneous double dislocation of the interphalangeal joint in a finger

Isolated traumatic dislocation of the distal and proximal interphalangeal joints of the fingers is a common occurrence. However, simultaneous dislocation of both interphalangeal joints in a single finger appears to be a rare event. We report five cases of simultaneous dislocation of both interphalangeal joints in a single finger with a review of the literature.

Clinical outcome of arthroscopic SLAP repair: conventional vertical knot versus knotless horizontal mattress sutures

PurposeArthroscopic repair of type II superior labrum anterior to posterior (SLAP) tears yields variable results. In this study, the clinical outcomes of arthroscopic knotless horizontal mattress repair were compared to those of conventional vertical knot repair.MethodsForty-six patients treated arthroscopically for isolated SLAP lesions were assessed. Forty-one of those patients underwent follow-up evaluations for a minimum of 2xa0years: 21 received vertical knot (group 1), while 20 received horizontal mattress (group 2). In group 1, an anchor was inserted at the superior glenoid. After relaying the sutures, knotting over the labral tissue was performed. In group 2, two strands were passed through the labrum and fixed into the glenoid with a bioabsorbable knotless anchor. Functional scores were evaluated preoperatively and at the final follow-up assessment. A visual analogue scale (VAS) for pain and range of motion (ROM) were assessed preoperatively, 2xa0months postoperatively and at the last follow-up visit.ResultsThere were no significant differences in functional scores between groups (n.s.). However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2 at the last follow-up visit. At 2xa0months postoperatively, the VAS for pain and ROM of internal rotation at abduction were better in group 2.ConclusionAt the final assessment, there were no significant differences in functional scores between the two groups. However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2.Level of evidenceCase–control study, Level III.

Symptomatic residual instability with grade II acromioclavicular injury

PurposeOur objective was to evaluate the effectiveness of arthroscopic distal clavicle resection in cases presenting with pain and subtle instability after neglected grade II acromioclavicular (AC) joint dislocation.MethodsFrom February 1998 to May 2006, 17 patients with symptomatic AC instability following chronic grade II AC joint injury were studied. Sixteen patients were male and one female, with a mean age of 48xa0years. An all-arthroscopic procedure comprising disk removal and distal clavicle resection was performed in all cases. All patients were reviewed clinically, preoperatively and at final follow-up (mean 38xa0months) using the pain score on a visual analog scale and the Constant score. Strength was measured using an Isobex digital strength analyzer. Patient’s personal satisfaction after the procedure was documented as excellent, good or poor. Postoperative AC joint radiographs were routinely obtained in all patients to measure the amount of clavicle resection.ResultsTwo patients underwent additional reconstructive surgery for disabling pain and dysfunction even after the arthroscopic resection procedure. The remaining 15 patients were analyzed. The pain scores improved significantly (pxa0=xa00.03). The mean pain score was 5.8 (range 5–9) before treatment and 1.6 (range 0–3) at follow-up. The Constant scores had improved significantly at the final follow-up (pxa0=xa00.001). The median Constant score increased from 46 (range 36–69) preoperatively to 71 (range 48–84) postoperatively. Strength had improved at the last follow-up. Eleven patients were satisfied and six were not satisfied with this procedure at the final follow-up.ConclusionsArthroscopic distal clavicle resection statistically improved the pain score, Constant score and strength for grade II AC injury with subtle distal clavicle instability. However, six patients (33.5xa0%) were not satisfied subjectively. This procedure seemed to be a reasonable initial treatment option with lower morbidity.

All-arthroscopic biceps tenodesis by knotless winding suture.

Biceps tenodesis techniques can use a large-caliber interference screw, a suture anchor, or a knotless anchor. This report describes a tenodesis technique that is easy to perform and does not require any knotting. Before penetration of the tendon with the tip, a No. 2 nonabsorbable braided suture is passed through the lumen of the hook-like instrument. The use of only 1 hooking maneuver through the tendon can allow the winding of the whole tendon. The eyelet of a knotless anchor (Bio-PushLock; Arthrex, Naples, FL) with 2 ends of the suture is inserted into the bone hole at the bicipital groove.