Yong Girl Rhee

Bridging the Gap in Immobile Massive Rotator Cuff Tears Augmentation Using the Tenotomized Biceps

Background Numerous operative techniques have been described for the treatment of massive rotator cuff tears with severe retraction where anatomical repair is impossible. Purpose To evaluate the outcome of massive rotator cuff tears repaired using the biceps interposition technique. Study Design Case series; Level of evidence, 4. Methods Between April 2000 and April 2004, 31 shoulders with irreparable massive rotator cuff tears and associated degenerative lesions of the biceps tendon were included for analysis. Open procedures were performed in 15 cases (open group), while 16 patients underwent arthroscopic procedures (arthroscopic group). The mean follow-up period was 32 months (range, 24-67 months). Results The overall University of California at Los Angeles score at the last follow-up was 31.1 points (range, 21-35). The clinical outcome was excellent in 15 (48.4%) and good in 13 (41.9%) cases. Three patients (9.7%) had poor outcome. There was 1 case of reoperation in the open group for a retear. The mean preoperative Constant score, which was 44.6 points (range, 8-70) in the open group and 51.8 points (range, 24-70) in the arthroscopic group, improved to 80.7 points (range, 37-88) in the former and 83.5 points (range, 57-96) in the latter. The University of California at Los Angeles score improved from preoperative means of 11.3 points (range, 6-16) and 13.6 points (range, 6-19) to 29.5 points (range, 9-33) and 32.6 points (range, 21-35), respectively. However, the differences between the scores in both the categories were not statistically significant (P = .412 and .198, respectively). According to the postoperative repair integrity analyzed with use of magnetic resonance imaging in 14 of 16 cases with arthroscopic augmentation, 9 (64.3%) presented complete healing. Conclusion The biceps tendon interposition technique for massive rotator cuff tears offers a possible improvement in the clinical outcomes and is comparable to that of conventional repair. As well, the augmentation technique using the tenotomized biceps as potential graft for rotator cuff tears is particularly useful in bridging the gap in immobile massive rotator cuff tears with posterior defects and retraction.

Patient-Controlled Analgesia after Arthroscopic Rotator Cuff Repair: Subacromial Catheter Versus Intravenous Injection

Background No study has compared pain control results between patient-controlled subacromial infusion and intravenous injection after arthroscopic shoulder surgery. Hypothesis Subacromial infusion of analgesics are more effective in pain alleviation than intravenous injection. Study Design Randomized controlled clinical trial; Level of evidence, 2. Methods The authors prospectively analyzed 40 cases of arthroscopic rotator cuff repair that received patient-controlled anal-gesia. They divided the 40 cases into 2 groups: subacromial infusion group with 0.5% bupivacaine (group 1, 20 cases) and intravenous injection group with fentanyl and ketorolac tromethamine (group 2, 20 cases). The visual analog scale was used to record the patients level of pain every 12 hours until postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. Results The mean preoperative visual analog scale score during motions was 6.8 in group 1 and 5.8 in group 2. The immediate postoperative visual analog scale score was 7.6 and 7.4, respectively, for each group. At postoperative time periods, most of the scores of subacromial infusion at rest and during motions were lower than those of intravenous injection, but significant differences were not found between groups 1 and 2. Conclusion Patient-controlled analgesia after arthroscopic rotator cuff repair showed that both subacromial infusion of bupiva-caine and intravenous injection of fentanyl and ketorolac tromethamine were equally effective and clinically equivalent pain control methods.

Functional Outcome of Arthroscopic Repair With Concomitant Manipulation in Rotator Cuff Tears With Stiff Shoulder

Background Little has been reported on treatment of rotator cuff tears with shoulder stiffness. Hypothesis Rotator cuff tears with shoulder stiffness will show worse clinical results than will tears without stiffness. Those with stiffness are expected to take longer time in pain reduction and recovery of range of motion. Study Design Case control study; Level of evidence, 3. Methods Among patients who underwent arthroscopic rotator cuff repairs, 15 cases with preoperative shoulder stiffness (group A) and 30 without shoulder stiffness (group B) were enrolled in this study. Preoperative mean forward flexion was 118.3° in group A and 163.4° in group B, whereas external rotation at the side was 34.6° and 55.0°, respectively. The mean follow-up period of group A was 29.8 months (range, 19.5-73.9 months) and 32.4 months (range, 16–0.6 months) in group B. Results The mean visual analog scale during motion at the last follow-up was 0.75 in group A and 0.76 in group B (P = .942). The mean University of California at Los Angeles score was, respectively, 33.1 and 33.2 points (P = .561). Forward flexion was 166.7° in group A and 170.2° in group B, whereas external rotation at the side was 48.8° and 53.4°, respectively (P = .157 and .384, respectively). However, the 2 groups showed a significant difference in forward flexion until 1 year postoperatively as group A recovered more slowly (P = .021). Both groups showed significant differences in external rotation at the side, internal rotation to the back, and cross-body adduction until 6 weeks postoperatively (P = .009, P < .001, and P = .026, respectively). Conclusion Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of the presence of shoulder stiffness. Patients with full-thickness rotator cuff tears and stiffness of the shoulder can be treated with a single surgery and concomitant manipulation with overall good results. Although final outcomes were as good as those in patients without stiffness, the return of range of motion took longer in those patients undergoing manipulation for stiffness of the shoulder.

Muscle Strength After Anterior Shoulder Stabilization Arthroscopic Versus Open Bankart Repair

Background A number of reports have been made on the muscle strength at the last follow-up after arthroscopic or open Bankart repairs. Few have analyzed the change over time in muscle strength and compared the changes between different operative methods. Hypothesis Muscle strength recovers faster after arthroscopic Bankart repair than after open Bankart repair, and the final muscle strength is not different between the 2 procedures. Study Design Cohort study; Level of evidence, 2. Methods Sixty patients with anterior shoulder instability and an isolated Bankart lesion were enrolled for this study. Thirty patients underwent open Bankart repair (open group), and 30 patients went through arthroscopic Bankart repair (arthroscopic group). Results The open group demonstrated markedly weaker muscle strength during forward elevation than did the arthroscopic group up to 3 months after surgery, but the difference narrowed to about 5% at 6 months (P = .074). At 6 months after surgery, the muscle strength of the open group measured 85.8% ± 11.5% in forward elevation, 89.5% ± 10.3% in external rotation, and 89.3% ± 13.3% in internal rotation. The corresponding figures of the arthroscopic group were 90.6% ± 8.6%, 92.1% ± 9.1%, and 92.1% ± 11.7%. As for external and internal rotations, the open group demonstrated markedly weaker muscle strength 6 weeks after surgery, but the differences were reduced to about 6% and 4%, respectively, at 3 months (P = .092 and .163, respectively). There was no statistically significant difference in final muscle strength 12 months after the operation between the 2 groups (P = .503, .468, and .659, respectively). Conclusion Muscle strength recovered faster with an arthroscopic procedure than with an open procedure during the early postoperative periods, and strength was restored to the level of the unaffected side at 6 months postoperatively. In the group with open Bankart repairs, the muscle strength during forward elevation recovered slower than did external and internal rotation muscle strengths.

Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: A case report

A soft-tissue ganglion is a mucous cyst commonly observed on clinical examination. In the shoulder joint, it is most frequently around the spinoglenoid notch, with the accompanying pain and muscle atrophy resulting from suprascapular nerve compression. An intraosseous ganglion, however, is not common and is limited to the hip, knee, and ankle. In particular, an intraosseous ganglion of the glenoid is extremely rare, and no study to date has reported on an intraosseous glenoid ganglion leading to suprascapular nerve entrapment syndrome.

Clinical Outcome of Shoulder Replacement in Non-Traumatic Arthritis -A Comparison of Hemiarthroplasty and Total Shoulder Arthroplasty-

Purpose: To compare the clinical outcomes and complications of hemiarthroplasty (HHR) and total shoulder arthroplasty (TSR) in non-traumatic arthritis patients. Materials and Methods: Thirty-two patients (34 shoulders) underwent shoulder arthroplasty for nontraumatic shoulder arthropathy. There were sixteen patients with rheumatoid arthritis, nine with osteoarthritis, four with avascular necrosis and etc. HHR was performed in eleven shoulders and TSR in twentythree shoulders. Results: In HHR, the pain score decreased from preoperatively 7.09 to 0.91 postoperatively. The mean forward elevation was and the mean external rotation at the side and abduction were and , respectively. The mean ASES score was 82.4. In TSR, the pain score decreased from 7.04 preoperatively to 1.17 postoperatively. The mean forward elevation, external rotation at the side and abduction were , , and , respectively. The mean ASES score was 81.2. In rheumatoid arthritis, the mean ASES score of the HHR and TSR were 77.8 and 78.1, respectively. In osteoarthritis, the mean ASES score was 84.7 and 90.8, respectively. During the follow up, glenoid erosion was observed in three HHR cases, and glenoid loosening in two TSR case.