Jin-Young Park

Comparison of the Clinical Outcomes of Single- and Double-row Repairs in Rotator Cuff Tears

Background Although research has demonstrated the superiority of double-row rotator cuff repair over single-row methods from a biological and mechanical point of view, few studies have compared clinical outcome of the 2 methods, and no articles have been published describing the superiority of double-row methods in clinical aspects. Hypothesis Arthroscopic double-row repair of a rotator cuff tear has superior clinical outcome to single-row repair. Study Design Cohort study; Level of evidence, 2. Methods The study included 78 patients operated on for full-thickness rotator cuff tears between May 2002 and May 2004. A single-row fixation method was used in the first consecutive 40 patients, and a double-row fixation method was used in the next consecutive 38 patients. The mean age at surgery was 56 years. At 2 years after surgery, final evaluation was done with American Shoulder and Elbow Surgeons and Constant scoring systems and the Shoulder Strength Index. The Shoulder Strength Index is a new evaluation method to estimate relative shoulder strength compared with the unaffected shoulder. Results At final follow-up, the average American Shoulder and Elbow Surgeons scores were 91.6 in the single-row group and 93.0 in the double-row group. The Constant score was 76.7 in the single-row group and 80.0 in the double-row group. Functional outcome was improved in both groups after surgery, but there was no significant difference between the 2 groups. When the patients were further divided by size of tear, there was still no difference between the repair techniques in the patients with small to medium (<3 cm) tears. However, in patients with large to massive tears (>3 cm), the American Shoulder and Elbow Surgeons and Constant scores and Shoulder Strength Index were all significantly better in the group that had double-row repair. Conclusion Small to medium rotator cuff tears should be repaired with the single-row method, and large to massive tears should be repaired with the double-row method.

Interleukin‐22 promotes osteoclastogenesis in rheumatoid arthritis through induction of RANKL in human synovial fibroblasts

OBJECTIVE To examine the regulatory role of interleukin-22 (IL-22) in the expression of RANKL and induction of osteoclastogenesis in rheumatoid arthritis (RA). METHODS Concentrations of IL-22 and RANKL in the serum and synovial fluid of RA patients were measured using enzyme-linked immunosorbent assay. RA synovial fibroblasts were treated with recombinant human IL-22 (rhIL-22), and the expression of RANKL messenger RNA (mRNA) and protein was measured using real-time polymerase chain reaction, Western blotting, and intracellular immunostaining. Human monocytes were cocultured with IL-22-prestimulated RA synovial fibroblasts and macrophage colony-stimulating factor, and osteoclastogenesis was assessed by counting the multinucleated cells (those staining positive for tartrate-resistant acid phosphatase). RESULTS The IL-22 concentration in the synovial fluid was higher in RA patients than in patients with osteoarthritis (OA). The serum IL-22 concentration was also higher in RA patients than in OA patients and healthy volunteers, and this correlated with serum titers of rheumatoid factor and anti-cyclic citrullinated peptide antibodies. In RA synovial fibroblasts treated with rhIL-22, the expression of RANKL mRNA and protein was increased in a dose-dependent manner. IL-22-induced RANKL expression was down-regulated significantly by the inhibition of p38 MAPK/NF-κB or JAK-2/STAT-3 signaling. In human monocytes cocultured with IL-22-prestimulated RA synovial fibroblasts in the absence of exogenous RANKL, the monocytes differentiated into osteoclasts, but this osteoclastogenesis decreased after p38 MAPK/NF-κB or JAK-2/STAT-3 signaling was inhibited. CONCLUSION These results show that IL-22 up-regulates RANKL expression in RA synovial fibroblasts and induces osteoclastogenesis. These effects are mediated by the p38 MAPK/NF-κB and JAK-2/STAT-3 signaling pathways.

Arthroscopic Management of Septic Arthritis of the Shoulder Joint

BACKGROUND Nineteen patients with septic arthritis of the glenohumeral joint were treated with a combination of arthroscopic irrigation and débridement and systemic antibiotics according to bacterial sensitivity. We retrospectively reviewed the series to determine the efficacy and safety of this treatment. METHODS There were seventeen men and two women, with a mean age of fifty-nine years. Underlying medical disease was present in thirteen patients, with six of them having diabetes. The average duration of symptoms prior to the arthroscopic lavage was three weeks. Fifteen patients had had local injections into the shoulder joint. The arthroscopic staging of the infection was based on the modified criteria of Gächter. The functional outcome was evaluated with use of the UCLA scoring system. RESULTS As determined at arthroscopy, one infection was classified as stage I; seven, as stage II; nine, as stage III; and two, as stage IV. Staphylococcus was the most common organism identified. The infection was eradicated completely with a single arthroscopic procedure in fourteen patients. The mean UCLA score at the time of the last follow-up was 26 points, with a mean score of 23.7 points for the eleven patients with a rotator cuff tear and 29 points for the eight with an intact rotator cuff. Patients who had had symptoms for no more than two weeks prior to the arthroscopic lavage had better results than those who had had symptoms for longer than two weeks. CONCLUSIONS Arthroscopic débridement for the treatment of septic arthritis of the shoulder is safe and efficient, particularly in the early stages of the disease. Underlying medical diseases such as diabetes, prior injections, or a preexisting rotator cuff tear were seen in a high proportion of these patients.

Is shoulder pain for three months or longer correlated with depression, anxiety, and sleep disturbance?

BACKGROUND Recent studies have found a high prevalence of depression, anxiety, and sleep disturbance in patients with chronic musculoskeletal pain. We conducted a study to determine whether shoulder pain for 3 months or longer is correlated with depression, anxiety, and sleep disturbance. MATERIALS AND METHODS We prospectively evaluated 130 patients who had had shoulder pain for 3 months or longer (group I) and 60 healthy controls (group II). We obtained visual analog scale (VAS) pain score, and scores for the American Shoulder and Elbow Surgeons (ASES), Korean Shoulder Scale (KSS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI). RESULTS The mean VAS pain score, ASES score, and KSS score in group I were 6.2, 46.6, and 51.5, respectively. In that group, 22.3% had depression, 19.2% had anxiety, and 81.5% had sleep disturbance. The prevalences were higher in group I than in group II. There were no differences in depression, anxiety, or sleep disturbance by age, sex, type of disease, or duration of symptoms in group I. VAS pain scores positively correlated with PSQI scores (P = .01). ASES and KSS scores negatively correlated with HADS depression and anxiety subscale and PSQI scores (P < .001). Shoulder pain for 3 months or longer was the strongest predictor of sleep disturbance (P < .001). CONCLUSIONS Our study demonstrated high prevalence and close relationships of depression, anxiety, and sleep disturbance in patients with shoulder pain for 3 months or longer. These results may indicate importance of the psychologic approach as well as adequate pain control.

Antegrade humeral nailing through the rotator cuff interval: a new entry portal.

The conventional approach for antegrade intramedullary nailing (AIN) of humerus fractures is associated with persistent pain and compromised shoulder function. Damage to the critical hypovascular zone of the rotator cuff near its insertion on the humerus and/or irritation of the subacromial space by prominent hardware are the factors believed to be responsible for poor shoulder function after AIN of the humerus. This study describes a new entry portal through the rotator interval that minimizes iatrogenic damage to the rotator cuff at its insertion. This approach offers a solution for the disappointing postoperative shoulder function and pain scores associated with conventional antegrade nailing techniques. This study consisted of 33 patients with 34 humeral fractures followed for an average of 34 months. The overall satisfaction rate was more than 90%, according to the ASES (American Shoulder and Elbow Society) score. The mean Constant Score was 84 (SD, 14; range, 17 to 98), and primary bone union was achieved in 32 of the 34 cases.

The development and validation of an appraisal method for rotator cuff disorders: The Korean Shoulder Scoring System

HYPOTHESIS The purpose of this study was to develop and validate a disease-specific appraisal method for patients with rotator cuff disorders. The Korean Shoulder Scoring System (KSS) includes 5 domains totalling 100 points: function, 30 points; pain, 20; satisfaction, 10; range of motion, 20; and muscle power, consisting of strength, 10; and endurance, 10. METHOD The KSS was used to evaluate clinical outcomes of 430 patients with rotator cuff disorder for a period of 6 months postoperatively. RESULT The KSS had an acceptable level of internal consistency (alpha = 0.840). The KSS scores also correlated strongly with the Constant scores (r = 0.802), but less so with the American Shoulder and Elbow Surgeons scores (r = 0.602) and the University of California Los Angeles shoulder scores (r = 0.573). A large effect size (r = 1.234) and a standardized response mean (r = 1.317) for KSS were evident at 6 months postoperatively. CONCLUSION The KSS is a useful measurement tool that combines subjective and objective evaluations for shoulder function related to rotator cuff disorders.

Clinical and Radiological Outcomes of Type 2 Superior Labral Anterior Posterior Repairs in Elite Overhead Athletes

Background: Although there are multiple reports on surgical outcomes of type 2 superior labral anterior posterior (SLAP) repairs, a literature review noted a paucity of data on clinical and radiological outcomes in elite overhead athletes. Purpose: To determine midterm clinical outcomes of type 2 SLAP repairs in elite overhead athletes and whether labral integrity provides consistent return to play. Study Design: Case series; Level of evidence, 4. Methods: Medical records were retrospectively reviewed of 24 elite overhead athletes who underwent arthroscopic type 2 SLAP repairs. There were 18 men and 6 women, and their mean age was 22.7 years (range, 19-30 years); the majority of them (16/24) were baseball players. Four outcome measures were used: visual analog scale (VAS) for pain and satisfaction, American Shoulder and Elbow Surgeons (ASES) score, subjective feeling of recovery, and return to play. Multidetector computed tomographic arthrography was performed to evaluate labral integrity after surgery. Results: At a mean follow-up of 45.8 months (range, 24-68 months), overall pain and function improved significantly. The VAS for pain was 5.7 preoperatively and 2.0 postoperatively (P < .01), and VAS for satisfaction was 8.6. The ASES score was 55.8 preoperatively and 87.1 postoperatively (P < .01). The overall mean value of subjective feeling of recovery was approximately 76%. Twelve of 24 athletes (50%) returned to play after the operation. Although there was a trend toward higher return rate in the other overhead athletes (75%) compared with the baseball players (38%), this trend did not reach statistical significance (P = .097). Labral retear with clinical significance was noted in 2 athletes who failed to return to play. Osteolysis was observed in 2 athletes, 1 of whom had a retear. A statistical relation between the integrity of the repair and return to play was not found (P > .05). Conclusion: Arthroscopic SLAP repairs show favorable clinical and radiological outcomes; however, the study findings raise a concern that return to play may still be problematic in elite baseball players. This study also indicates that labral healing does not ensure consistent return to play in elite overhead athletes.

The effect of physical characteristics and field position on the shoulder and elbow injuries of 490 baseball players: confirmation of diagnosis by magnetic resonance imaging.

Objective:To evaluate the distribution of shoulder and elbow injuries confirmed by magnetic resonance imaging in throwing athletes. Study Design:Descriptive epidemiological study. Setting:Tertiary institution. Participants:Five hundred fifty-four baseball players referred to our institute for shoulder and elbow rehabilitation. Interventions:All injured players except those with fractures underwent magnetic resonance imagings, which were read by a radiologist, and players were diagnosed by orthopedic surgeons based on the clinical and imaging findings. Main Outcome Measures:Analysis of baseball-related injuries was performed according to the physical characteristics of each athlete and his positions on the team. Results:Junior high school players sustained a higher proportion of osteochondritis dissecans compared with high school and collegiate players. High school and collegiate players were more likely to have ulnar collateral ligament (UCL) injuries or superior labrum anterior-posterior (SLAP) lesions than junior high school players. Pitchers and outfielders were more likely to have UCL injuries than the infielders. In the junior high school group, the players with UCL injuries were taller and heavier than the players in the control group. In the high school group with UCL injuries or SLAP lesions, the players were both taller and heavier than the players in the control group. Conclusions:These data support the conclusion that there is a significant difference in the distribution of injuries according to the players age and position. For the age-matched comparison, taller and heavier players are more likely to be affected by UCL injury or SLAP lesion.

Follow-up Computed Tomography Arthrographic Evaluation of Bony Bankart Lesions After Arthroscopic Repair

PURPOSE The follow-up results of bony union after an arthroscopic bony Bankart repair have not been reported. We studied follow-up computed tomography (CT) arthrograms to evaluate radiographic healing of bony Bankart fragments. METHODS Among 41 patients who underwent arthroscopy for a bony Bankart lesion between July 2006 and May 2009, 31 cases in 30 patients who had undergone sequential follow-up CT arthrography preoperatively, at 3 months postoperatively, and at 1 year postoperatively were enrolled. Radiologic patterns of fracture healing were classified into bony healing and fibrous healing. The mean age was 23.4 years, and the mean follow-up was 30.5 months. The mean interval from the first trauma to surgery was 32.5 months, and the mean preoperative dislocation number was 12.1. RESULTS The mean preoperative glenoid defect was 14.1%. The fracture healing patterns included 26 bony and 5 fibrous unions. There was a significant positive relation between the total dislocation number and the preoperative glenoid defect (P = .003). The proportion of the mean fragment dimension to a circle drawn through the outer cortex of the inferior glenoid was 8.4% preoperatively, 6.6% at 3 months postoperatively, and 6.2% at 1 year postoperatively. The fragment size decreased from that measured preoperatively to the size measured 3 months after surgery (P < .05). However, the fragment size was maintained between 3 months and 1 year postoperatively (P > .05). The mean Rowe score at 1 year postoperatively was 97.2. CONCLUSIONS Follow-up CT arthrographic evaluation showed that small bony Bankart fragments survived without resorption until 1 year postoperatively, even with fibrous union, and that reattached bone fragment fixation to the anatomic position with the labrum could survive. LEVEL OF EVIDENCE Level IV, therapeutic case series.

How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography--a new diagnostic modality.

BACKGROUND Aberrations in scapular motion are believed to be associated with the presence of shoulder or elbow pathologies. There are many methods to evaluate scapular kinematics, but they have certain limitations. Nevertheless, it is believed that appropriate rehabilitation for each type of scapular dyskinesis is important. METHODS Eighty-nine athletes were videotaped and seven blinded observers categorized scapular dyskinesis into 4 types, which was followed by 3-dimensional (3D) wing computer tomography (CT). Four blinded examiners evaluated 5 angles [upward rotation (UR), internal rotation (IR), anterior tilting (AT), superior translation (ST), and protraction (PRO)] on the 3D wing CT. Inter-rater reliability (IRR) was calculated for both the methods. CT scan measurements were compared with the 4 observational types to establish the validity. RESULTS The IRR with observational assessment of scapular dyskinesis into 4 types was good, 0.780. The 3D wing CT analysis had a very high IRR, 0.972. There was a statistically significant correlation between observational assessment and 3D wing CT analysis. The UR angle, ST angle in type 3 scapular dyskinesis, and AT angle in type 1 scapular dyskinesis were increased as compared with those in the other types of scapular dyskinesis. All these measurements were made in the resting position of the scapula. CONCLUSION The 3D wing CT analysis allows precise quantification of a position associated with scapular dyskinesis. Therefore, 3D wing CT can be considered as an alternative method for assessing scapular dyskinesis.