Sang-Hun Ko

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.

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.

Cerebral oxygenation monitoring of patients during arthroscopic shoulder surgery in the sitting position

Background Cerebral hypotension and desaturation can occur during shoulder surgery in the seated position. We evaluated the correlation of cerebral oxygen saturation (rSO2) using near infra-red spectroscopy (NIRS) and mean arterial pressures (MAP) (at the levels of the brain and heart). Methods Fifty patients, scheduled for the arthroscopic shoulder surgery in the seated position, were enrolled to monitor the rSO2, bispectral Index (BIS), and MAPs at the levels of the brain and heart. The values of each parameter were collected at 5 min after intubation, immediately after placing the patient in the sitting position, 5 min after the patient was seated, immediately after the surgical incision, and every 30 min after incision. Results A correlation between the cerebral rSO2 and the MAP at the level of brain were statistically significant. Cerebral rSO2 and MAP after a change of posture from supine to sitting position were significantly decreased, compared to the baseline value. Conclusions Monitoring cerebral rSO2 and MAP at the level of brain can be helpful to detect the possibility of cerebral deoxygenation earlier.

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.

Post-traumatic Lumbar Epidural Hematoma with Neurology: Report of 1 Case

The purpose of this study was to report a case with post-traumatic spinal epidural hematomas with abnormal neurologic findings, which is uncommon. A 40-year-old man presented at our clinic after a blunt trauma caused by a traffic accident in which he was a pedestrian. After admission, abnormal neurologic symptoms developed including loss of sensation and motor function in his left lower extremity. Magnetic resonance imaging demonstrated a spinal epidural hematoma with 40% canal stenosis at the L5-S1 level. Decompression including hematoma evacuation was done. Symptoms started to be reduced 18 days after operation. He was treated conservatively with medications and all symptoms resolved completely during admission and there were no further neurologic sequelae. Post-traumatic lumbar spinal epidural hematoma with abnormal neurologic findings is an uncommon condition that may present belatedly after trauma with significant neurologic compromise.

Single row rotator cuff repair with modified technique

Rotator cuff tear is a common medical condition. We introduce various suture methods that can be used for arthroscopic rotator cuff repair, review the single row rotator cuff repair method with modified technique, and introduce the Ulsan-University (UU) stich. We compare the UU stitch with the modified Mason-Allen (MA) suture method. The UU stitch configuration is a simple alternative to the modified MA suture configuration for rotator cuff repair.

Minimally Invasive Plate Osteosynthesis Using a Screw Compression Method for Treatment of Humeral Shaft Fractures

Background This study aims to compare the surgical outcomes of open reduction and internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) using a screw compression method in simple humeral shaft fractures. Methods This retrospective study was performed with 50 patients who had surgical interventions for the treatment of simple humeral shaft fractures and had follow-ups of at least 12 months in Ulsan University Hospital between August 2008 and June 2015. Group 1 included 23 patients treated with ORIF and group 2 included 27 patients treated with the MIPO technique using a locking screw plate. The time to clinical/radiographic union, the joint range of motion (ROM), and function were evaluated. Results The average time to clinical/radiographic bone union was shorter in group 2 (12.0 ± 3.7 weeks/14.8 ± 2.0 weeks in group 1 and 9.4 ± 1.3 weeks/12.0 ± 3.3 weeks in group 2; p = 0.022/p = 0.034). Shoulder and elbow joint function evaluated by joint ROM and visual analogue scale (VAS), Korean Shoulder Elbow Society (KSS), American Shoulder and Elbow Surgeons (ASES), and the University of California at Los Angeles (UCLA) scores was excellent in both groups. On the average shoulder ROM at 12 months after the operation, group 1 had forward elevation of 160°, external rotation of 30° in adduction and lumbar vertebra 10 level in internal rotation and group 2 had forward elevation of 170°, external rotation of 35° in adduction and lumbar vertebra 9 level in internal rotation. The mean VAS, KSS, ASES, and UCLA scores were 2.8, 87.0 ± 0.9, 89.4 ± 0.9, and 31.0 ± 1.4, respectively, in group 1 and 1.7, 89.1 ± 2.7, 91.0 ± 1.6, and 32.4 ± 3.2, respectively, in group 2. There were statistically significant intergroup differences in VAS score (p = 0.011). There were significantly less postoperative infections in group 2 (three cases, 10.7% in group 1 and 0 case in group 2; p = 0.041) although all of them were superficial infections and well-treated by an average 4-week course of antibiotics (range, 2 to 6 weeks). Conclusions MIPO using a screw compression method in simple humeral shaft fractures demonstrated superior efficacy to ORIF in terms of the time to clinical/radiographic union, pain score, and postoperative infection rate.