Sang-Hoon Lhee

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.

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.

Is Arthroscopic Coracoplasty Necessary in Subcoracoid Impingement Syndrome

PURPOSE The purpose of this study was to analyze the outcomes of arthroscopic coracoplasty in the treatment of subcoracoid impingement syndrome. METHODS We compared 23 shoulders that underwent arthroscopic coracoplasty for the treatment of subcoracoid impingement syndrome with 28 shoulders that did not undergo arthroscopic coracoplasty for the treatment of subcoracoid impingement syndrome, which comprised the control group. All the shoulders had subcoracoid and subacromial impingement syndrome with or without rotator cuff tear. Subcoracoid impingement was defined as a coracohumeral distance of less than 6 mm on the preoperative magnetic resonance image with anterior shoulder pain or tenderness. The 2 groups were further divided into several subgroups according to the size of concomitant rotator cuff tear, and a comparative analysis of functional outcomes after surgery among the subgroups was performed. RESULTS In the 2 groups, the overall functional outcomes improved after surgery. The study group showed a significant increase in internal rotation compared with that in the control group (P = .001) at the last follow-up. The large to massive rotator cuff tear subgroup of the study group showed a significant increase in internal rotation (P = .017). On the other hand, no significant difference was seen in the subgroups with small to medium rotator cuff tears including isolated subscapularis tears. The no rotator cuff tear subgroup of the study group showed a significant increase in internal rotation (P = .046). CONCLUSIONS Arthroscopic coracoplasty for subcoracoid impingement syndrome can provide a satisfactory outcome. In particular, a significant increase in internal rotation of the treated group was achieved after surgery in comparison with the untreated group, especially in the large to massive rotator cuff tear subgroup and in the no rotator cuff tear subgroup. LEVEL OF EVIDENCE Level III, retrospective comparative study.

Perianchor Radiolucency After Knotless Anchor Repair for Shoulder Instability Correlation With Clinical Results of 69 Cases

Background Although there would seem to be a logical relationship between radiolucency around the suture anchor and clinical result in Bankart repair, the correlation has not been demonstrated so far. Hypothesis Knotless suture anchor is a viable alternative for arthroscopic Bankart repair, but postoperative radiologic findings of radiolucency around anchors are correlated with poor clinical results. Study Design Case series; Level of evidence, 4. Methods Sixty-nine consecutive patients with Bankart lesions were treated with arthroscopic reconstruction using knotless metal suture anchors. The mean follow-up was 40 months. Clinical and radiologic analysis was performed retrospectively. A new concept of perianchor radiolucency was introduced and, according to this radiologic finding, patients were divided into 2 subgroups: the perianchor radiolucency group and those who did not reveal perianchor radiolucency. The perianchor radiolucency group was further subdivided by shape and location. “Root type” was defined as a radiolucent halo at the root of the anchor, and perianchor radiolucency without any root halo was named “branch type.” Location of perianchor radiolucency was described as above or below the equator of the glenoid. Results After operation, the mean Rowe score increased to 93.8 from 43.1, and computed tomography arthrogram showed a 97% healing rate. Reoperations were performed due to 1 case of redislocation and 2 cases of anchor arthropathy. All these reoperated cases revealed perianchor radiolucency before reoperation. Other than reoperated cases, 2 patients showed apprehension at final evaluation. The perianchor radiolucency group had a significantly lower Rowe scores than the group that showed no perianchor radiolucency. Some of the patients in the perianchor radiolucency group had peculiar radiologic findings frequently associated with complications. The radiologic findings that consisted of root-type perianchor radiolucency located below the equator of the glenoid was termed the “ominous sign.” Osteophytes of the humeral head together with the ominous sign is considered a warning sign of forthcoming progression of anchor arthropathy, and the authors suggest early surgical intervention with these findings. Conclusion After Bankart repair using knotless suture anchor, the ominous sign might be an important warning sign for possible forthcoming complications including redislocation, anchor arthropathy, and residual instability.

Change in labrum height after arthroscopic Bankart repair: correlation with preoperative tissue quality and clinical outcome

HYPOTHESIS Arthroscopic factors, such as labral and capsular tissue quality or anterior labral periosteal sleeve avulsion (ALPSA) lesion, affect postoperative labral height stability. Labral height stability has a correlation with clinical outcome. METHODS The study included 40 patients who underwent arthroscopic surgery for a Bankart lesion between August 2005 and May 2009. The mean follow-up and patient age were 29.1 ± 10.9 months (range, 15-60 months) and 24.7 ± 8.4 years (range, 12-55 years), respectively. Labral and capsular tissue quality, ALPSA lesions, Hill-Sachs lesions, glenoid erosion, and superior labrum anterior-posterior tears were identified by arthroscopic examination. Stepwise postoperative computed tomography arthrography to estimate the labral height was performed at 3 months and 1 year. RESULTS Correlation of postoperative 1 year Rowe scores with labral height maintenance was statistically significant (P < .01). Correlation of Rowe scores at 1 year postoperatively with labral height at 1 year postoperatively was also statistically significant (P < .01). The mean postoperative labral height at 3 months and at 1 year was 5.13 ± 1.56 mm (range, 2.9-8.8 mm) and 4.69 ± 1.75 mm (range, 1.6-8.5 mm), respectively (P < .01). The decrease in labral height at 1 year after surgery was significant in those patients with ALPSA lesions, Hill-Sachs lesions, and a poor labrum along with a poor capsule (P < .01). CONCLUSIONS The patients with less labral height decrease between 3 months and 1 year or higher labral height at 1 year postoperatively showed higher Rowe scores at 1 year postoperatively. Shoulders with ALPSA lesions, Hill-Sachs lesions, and a poor labrum with poor capsular tissue quality correlated more strongly with postoperative labral height decrease.

Does magnetic resonance imaging appearance of supraspinatus muscle atrophy change after repairing rotator cuff tears

BACKGROUND This study was conducted to determine whether supraspinatus muscle atrophy appearance changes after arthroscopic rotator cuff repair and to quantify the change in appearance on magnetic resonance imaging (MRI), if any, based on age and tendon retraction. METHODS We retrospectively reviewed patients who underwent arthroscopic rotator cuff repair and considered only 209 patients who had both preoperative and immediate postoperative MRI. Patients were grouped by age <60 years and >60 years. They were further subdivided into stage 1 (mild), stage 2 (moderate), and stage 3 (severe), depending on preoperative supraspinatus tendon retraction on the coronal view of MRI according to Patte classification. The postoperative occupancy ratio was compared with the preoperative occupancy ratio within the subgroups, and change in the occupancy ratio was used for comparison between the subgroups. RESULTS There was a significant increase in the occupancy ratio in the mild (P =.001) and moderate-severe (P =.003) subgroup from their preoperative values. In the mild subgroup, the occupancy ratio was significantly greater in the group aged <60 years compared with the group aged >60 years (P =.010). But in the moderate subgroup there was no significant difference between the 2 age groups (P =.710). CONCLUSIONS A significant change in supraspinatus muscle atrophy occurs in every patient, provided the patient has some tendon retraction preoperatively. The amount of change in supraspinatus muscle atrophy after surgery depends on the age to some extent, but tendon retraction is the most important thing that decides how much change in atrophy can occur postoperatively.