Woong Kyo Jeong

Sonographically Guided Tendon Sheath Injections Are More Accurate Than Blind Injections Implications for Trigger Finger Treatment

Trigger finger is frequently treated with tendon sheath injections. This cadaveric study evaluated the accuracy and safety of blind and sonographically guided tendon sheath injections. To our knowledge, a study that precisely mapped the locations of material injected into the tendon sheath has not been reported previously.

Repair of osteochondral defects with a construct of mesenchymal stem cells and a polydioxanone/poly(vinyl alcohol) scaffold

The purpose of the present study was to test the potential of an MSC (mesenchymal stem cell)/PDO/PVA [polydioxanone/poly(vinyl alcohol)] hybrid scaffold construct to repair cartilage defects. For the in vitro study, MSCs were isolated from human bone marrow and cultured in PDO/PVA scaffolds for 4 weeks. Gross and microscopic examinations were performed, as well as RT‐PCR (reverse‐transcription PCR) analyses for cartilage‐specific genes. For the in vivo study, MSCs isolated from rabbits were cultured in the PDO/PVA scaffolds and tissue‐engineered into neocartilage, then implanted into the osteochondral defect on the distal femur of the same rabbits. Gross and histological evaluations were performed at 8 weeks after the implantation. The results of the in vitro study demonstrated that the physical stability of the cell‐cultured hybrid scaffold was maintained until 4 weeks after initial placement. Scanning electronmicroscopy indicated the infiltration of the cells into, and appropriate interactions with, the scaffolds. RT‐PCR showed an expression of cartilage‐specific genes similar to that seen with pellet‐cultured MSCs. From the in vivo study, the defect area of the experimental group showed smooth consistent glistening white tissue resembling articular cartilage, whereas the control group showed a red irregular tissue with surface depression. The regenerated cartilage of the experimental group showed metachromasia on both Safranin‐O and dense staining for type II collagen, whereas the control group showed little metachromatic staining and less intense staining for type II collagen. A histological score of the quality of cartilage formation indicated that the MSC/PDO/PVA hybrid scaffold successfully produced neocartilage in vitro and enhanced the repair of the osteochondral defect in vivo. Further in vivo studies will be necessary to elucidate further the value of PDO/PVA as a scaffold material for cartilage regeneration.

Correlation between magnetic resonance imaging and clinical impairment in patients with adhesive capsulitis

ObjectiveTo determine the relationship between clinical impairment and MRI findings in patients with adhesive capsulitis.Materials and methodsContrast-enhanced MRI of 97 patients with a clinical diagnosis of adhesive capsulitis (AC) were retrospectively reviewed. Specific MRI criteria, including thickness and gadolinium enhancement of the joint capsule in the axillary recess and subcoracoid fat obliteration in the rotator interval, were correlated with limited range of motion (ROM) and pain. Other variables considered in this study were rotator cuff pathology, arm dominance, diabetes mellitus, age, and gender. Statistical analysis was performed using logistic and linear regression analysis.ResultsThickening of the joint capsule in the axillary recess correlated with limited external rotation (p < 0.01), gender (p < 0.01) and arm dominance (p < 0.05). Gadolinium enhancement of the joint capsule in the axillary recess correlated with pain intensity (p < 0.05). Subcoracoid fat obliteration in the rotator interval was not correlated with limited ROM or pain.ConclusionsMRI can be a useful technique to assess several clinical impairment measures in patients with adhesive capsulitis. Thickening and gadolinium enhancement of the joint capsule in the axillary recess on MRI are associated with limited ROM and pain.

Arthroscopic excision of osteoid osteomas of the hip in children

The atypical presentation of intra-articular osteoid osteoma in the hip joint frequently results in delayed diagnosis compared with the diagnosis of extra-articular osteoid osteoma. We present 2 cases of hip joint osteoid osteoma in children treated by hip arthroscopy. Intra-articular osteoid osteoma was suspected when computed tomography (CT) findings were reviewed. Of the various surgical options including wide-open or CT-guided minimally invasive techniques, arthroscopic excision was selected for our patients to avoid damage to the adjacent growth plate (the triradiate cartilage) and to treat concomitant synovitis. Under arthroscopic visualization, biopsy specimens were obtained first, and the lesions were excised. In both cases, postoperative CT showed complete excision and histologic examination confirmed the diagnosis. Both patients enjoyed excellent clinical outcomes. We conclude that the arthroscopic excision of the hip joint osteoid osteoma in children is effective because it causes minimal damage to normal bone or the adjacent growth plate, and because synovectomy for concomitant synovitis may be performed. Hip arthroscopy also yields a biopsy specimen adequate for pathologic examination.

Results of terrible triads in the elbow: the advantage of primary restoration of medial structure

BackgroundThe purpose of this study was to report the clinical and radiological outcomes and surgical strategy for terrible triad injury of the elbow. We hypothesized that the outcomes of this type of injury would be satisfactory if the medial structure was routinely restored at the same time as the repair of the lateral structure.MethodsWe retrospectively reviewed the results of this treatment performed in 13 elbows with terrible triads. Our surgical protocol included fixation or replacement of the radial head and repair of the ruptured lateral ulnar collateral ligament through the lateral traumatic window. In all cases, simultaneous fixation of the coronoid and repair of the common flexor muscle were performed through the medial traumatic window. In eight patients with medial collateral ligament injury, the ligament was always repaired. The follow-up period ranged from 18 to 41 months (mean, 25 months).ResultsThe flexion-extension arc of the elbow averaged 128° and forearm rotation averaged 134.6°. The mean Mayo elbow performance score was 95 points (range, 85 to 100), which corresponded to ten excellent results, and three good results. Concentric stability was restored to all cases. As postoperative complications, one patient had ulnar nerve neuropathy.ConclusionsThe present operative procedures restoring all damaged lateral and medial structures through the lateral and the medial windows provided satisfactory clinical and radiological outcomes and are recommended for patients with terrible triad injury.

Ultrasound Elastography of Lateral Epicondylosis: Clinical Feasibility of Quantitative Elastographic Measurements

OBJECTIVE The objective of our study was to investigate the clinical feasibility of ultrasound elastography for assessing patients with lateral epicondylosis and to establish an objective and quantitative method of elastographic measurement in the affected tendon. SUBJECTS AND METHODS A total of 97 symptomatic and 89 asymptomatic common extensor tendons from both elbows of 79 consecutive patients with lateral epicondylosis and 14 healthy participants were prospectively examined by gray-scale sonography, color Doppler sonography, and compression-based elastography. Real-time color-coded elastography was performed and quantified with two regions of interest: the adjacent subcutis (S1) for a reference area and the common extensor tendon (S2) for the target area. The mean strain ratio (S1/S2) was used for quantitative comparisons. The difference in the mean strain ratio between symptomatic and asymptomatic tendons was assessed with conditional regression analysis. RESULTS In symptomatic elbows, 87 of 97 tendons (89.7%) showed intratendinous hypoechogenicity, 86 of 97 (88.7%) showed swelling, and 70 of 97 tendons (72.2%) showed intratendinous hyperemia. Color-coded elastography revealed a soft area on 73 of 97 tendons (75.3%). The mean strain ratio was 1.45 (SD, 0.45) for symptomatic tendons and 2.07 (SD, 0.70) for asymptomatic tendons. The mean strain ratio of the symptomatic tendons was significantly lower than that of asymptomatic tendons (p < 0.001), indicating that the symptomatic tendons were softer. CONCLUSION Our results revealed that patients with lateral epicondylosis had significantly lower strain ratios in their common extensor tendon origins. Ultrasound elastography using quantitative strain ratio measurements could be a promising supplementary method to evaluate tendon abnormalities in lateral epicondylosis.

What Is the Critical Value of Glenoid Bone Loss at Which Soft Tissue Bankart Repair Does Not Restore Glenohumeral Translation, Restricts Range of Motion, and Leads to Abnormal Humeral Head Position?:

Background: A general consensus has been formed that glenoid bone loss greater than 20% to 25% is the critical amount at which bony augmentation procedures are needed; however, recent clinical results suggest that the critical levels must be reconsidered to lower values. Purpose: This study aimed to find the critical value of anterior glenoid bone loss when a soft tissue repair is not adequate to restore anterior-inferior glenohumeral translation, rotational range of motion, or humeral head position using a biomechanical anterior shoulder instability model. Study Design: Controlled laboratory study. Methods: Eight cadaveric shoulders were tested with a customized shoulder testing system. Range of motion, translation, and humeral head position were measured at 60° of glenohumeral abduction in the scapular plane under a total of 40-N rotator cuff muscle loading in the following 11 conditions: intact; soft tissue Bankart lesion and repair; Bankart lesion with 10%, 15%, 20%, and 25% glenoid bone defects based on the largest anteroposterior width of the glenoid; and soft tissue Bankart repair for each respective glenoid defect. Serial osteotomies for each percentage of bone loss were made parallel to the long axis of the glenoid. Results: There was significantly decreased external rotation (121.2° ± 2.8° to 113.5° ± 3.3°; P = .004), increased anteroinferior translation with an externally applied load (3.0 ± 1.2 mm to 7.5 ± 1.1 mm at 20 N; P = .008), and increased posterior (0.2 ± 0.6 mm to 2.7 ± 0.8 mm; P = .049) and inferior shift (2.9 ± 0.7 mm to 6.6 ± 1.1 mm; P = .018) of the humeral head apex in the position of maximum external rotation after soft tissue Bankart repair of a 15% glenoid defect compared with the repair of a Bankart lesion without a glenoid defect, respectively. Conclusion: Glenoid defects of 15% or more of the largest anteroposterior glenoid width should be considered the critical bone loss amount at which soft tissue repair cannot restore glenohumeral translation, restricts rotational range of motion, and leads to abnormal humeral head position. Clinical Relevance: The critical level of anterior glenoid bone loss at which bony restorations should be considered is closer to 15% of the largest anteroposterior width of glenoid for defects perpendicular to the superoinferior glenoid axis, which is lower than the commonly accepted threshold of 20% to 25%.

Ulnar artery pseudoaneurysm after tension band wiring of an olecranon fracture resulting in Volkmann's ischemic contracture: a case report.

Olecranon fracture and its fixation by tension band wiring (TBW) is a common clinical procedure in orthopedic surgery, and although TBW is considered a simple procedure, it is associated with a high complication rate. We report a patient with an ulnar artery pseudoaneurysm that resulted from unintended injury of the ulnar artery by prominent Kirschner (K) wire used for TBW. This led to chronic compartment syndrome and Volkmann’s ischemic contracture (VIC) of the dominant hand and severe disability. To our knowledge, this complication has not been previously reported in the English literature.

Status of the contralateral rotator cuff in patients undergoing rotator cuff repair.

Background: Although the prevalence of rotator cuff tear (RCT) in the general population has been analyzed, little information is available on the status of the opposite-side rotator cuff in patients who have undergone arthroscopic rotator cuff repair. Purpose/Hypothesis: To identify the characteristics of the contralateral shoulder and to identify factors associated with RCT of the contralateral shoulder in patients who underwent surgery for symptomatic RCT. The hypothesis was that the prevalence of RCT in the contralateral shoulder would be higher in patients with increasingly larger cuff tears requiring surgical intervention. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 140 patients with RCT who underwent arthroscopic rotator cuff repair. Opposite-shoulder rotator cuff tendons of all patients were evaluated by ultrasonography. Demographic information and factors related to contralateral RCT were investigated, and risk factors associated with contralateral RCT were assessed. Results: Of the 140 patients who underwent arthroscopic rotator cuff repair, 54 (38.6%) had an RCT of the contralateral shoulder. Of 51 patients with partial-thickness and small-sized full-thickness tears of the operated shoulder, 35 (68.6%) had no tears; 14 (27.5%) had partial-thickness tears; and 2 (3.9%) had small-sized full-thickness tears of the contralateral shoulder. Of 75 patients with medium-sized full-thickness tears, 43 (57.3%) had no tears; 12 (16%) had partial-thickness tears; and 20 (26.7%) had full-thickness tears of the contralateral shoulder. Of 14 patients with large to massive full-thickness tears, 8 (57.1%) had no tears; 1 (7.1%) had a partial-thickness tear; and 5 (35.7%) had full-thickness tears of the contralateral shoulder. The prevalence of RCT of the contralateral shoulder differed significantly among groups classified by tear size (P = .007). The mean American Shoulder and Elbow Surgeons score was significantly lower in the RCT than in the nontear group (55.8 ± 16.9 vs 61.6 ± 13.3; P = .03). Of 29 subjects with symptomatic tears involving the nondominant arm, 17 (58.6%) had contralateral asymptomatic RCT, compared with 37 of 111 (33.3%) subjects with symptomatic tears involving the dominant arm (P = .007). Conclusion: The prevalence of RCT of the contralateral asymptomatic shoulder tends to be higher in patients with more symptomatic RCT on one side, in patients with medium-sized or larger RCT in the operated shoulder, and in patients with symptomatic RCT in the nondominant arm.

Necrotising fasciitis in both calves caused by Aeromonas caviae following aesthetic liposuction

Liposuction is the most widely performed cosmetic procedure in the world, and is considered safe and without serious complications. However, necrotising fasciitis has been documented as a rare complication following abdomen and thigh liposuction. We present a case of necrotising fasciitis in a 22-year-old female who underwent cosmetic liposuction in both calves. The diagnosis of necrotising fasciitis was delayed, leading to multi-organ dysfunction and skin necrosis with consequent massive skin loss. Non-cosmetic physicians are generally unfamiliar with liposuction-induced complications, and may not suspect necrotising fasciitis due to its rarity. However, awareness of its clinical features is critical since early diagnosis and prompt surgical debridement can prevent significant morbidity and even death.