Abstract: Purpose: Our purpose was to assess the short-term results of arthroscopic bridging repair of massive, irreparable rotator cuff tears by use of a Permacol. Materials and Methods: Between October 2010 and April 2011, 6 patients with massive, irreparable rotator cuff tears were treated with arthroscopic bridging repair using a Permacol. All were evaluated preoperatively and postoperatively by use of the Korean Shoulder Scoring System (KSS). Magnetic resonance imaging was performed postoperatively at mean 4.2 months (range, 2 to 10 months) after operation. Results: At a mean follow-up of 7 months (range, 4 to 12 months), the mean KSS increased significantly from preoperatively mean 53.0 to postoperatively mean 72.3 (p=0.046). Statistically insignificant improvements were seen in pain (p=0.066) and range of motion (p=0.336). As documented on magnetic resonance imaging, there were two patients with full incorporation of the graft into the native tissue, 1 partial retear, and 3 complete retear. There were no complications such as adverse inflammatory or septic joint in these patients. Conclusion: Although Permacol, porcine dermal xenograft may be effective in other areas of the body for tendon healing, its use in bridging repair of massive, irreparable rotator cuff tears seems to have to be chosen prudently and warrants further evaluation.

Abstract: Purpose: The purpose of this study was to evaluate the clinical result of arthroscopic debridement with treatment of associated intra-articular lesions in lateral epicondylitis patients who did not response to conservative treatment. Method: Between March 2005 and January 2010, 43 patients who were diagnosed with lateral epicondylitis and did not response to conservative treatment over 6 months were selected. The mean age of the patients was 51 years (39~68 years) and the mean follow up period was 36.7 months (18~72 months). Among the 43 patients, 15 were male and 28 were female. They were evaluated by visual analog scale (VAS) and Mayo Elbow Performance Score (MEPS). Results: Intra-articular synovitis was found in 11 cases (26%) and intra-articular loose body was observed in 2 cases. The average VAS score was 7(±0.7) preoperatively and decreased to 1(±1.0) at last follow up. MEPS was 45(±10.2) preoperatively and increased to 93(±10.0). At last follow up, 41 of the 43 patients showed satisfaction (MEPS <75) and 2 showed dissatisfaction (MEPS 75). Conclusion: There was a better outcome at 18 months follow up after arthroscopic debridement with treatment of associated intra-articular lesion in lateral epicondylitis patients who had not responsed to conservative treatment.

Abstract: Purpose: To analyze clinical results of arthroscopic trans-tendon repair in a partial articular-side rotator cuff tear. Materials and Methods: Of 31 patients presenting with partial intra-articular rotator cuff tears between April 2006 and January 2010, we selected 24 who had received arthroscopic trans-tendon repair. The average age of patients was 55 (27~75) and the average follow-up period was 37 months (19~64). There were 10 men and 14 women and all had at least a 6 mm tear categorized as Ellman grade 3. Change in range of motion, VAS, ASES, Constant score, and ultrasonographic findings were evaluated postoperatively. Results: The average forward elevation range prior to surgery was 150.2 (±6.67) and it improved to 170 (±5.32) by the last follow-up (p<0.001). The average VAS score prior to surgery was 7.38 (±1.38) and it decreased to 3 (±1.38) (p<0.001). The Constant score before surgery was 49.25 (±5.65) and it increased to 73.81 (±5.64) by the last follow-up (p<0.001). The ASES score before surgery was 39.59 (±12.27) and it increased to 80.56 (±11.36) (p<0.001). At the last follow-up, 21 of the 24 patients were satisfied with the result. However, 3 patients were unhappy and had mild pain. On ultrasonography, 22 patients (91.66%) showed improvement without re-rupture, while the other 2 patients (8.34%) showed an with improved symptoms. Conclusion: In a partial rotator cuff tear in an articular-side lesion, the arthroscopic transtendon suture method shows excellent clinical and ultrasonographic results for at least eighteen months.

Abstract: Purpose: To retrospectively analyze the clinical results of the cubital tunnel syndrome after ulnar nerve transmuscular anterior transposition according to the severity of the disease. Materials and Methods: From January 2003 to December 2008, the 94 cases that underwent ulnar nerve anterior transposition using modified Mackinnon method after diagnosed as cubital tunnel syndrome were enrolled for this study. The severity of each cases was classified using McGowan classification before surgery, and were divided into grade I of 35 cases (group 1), grade II of 37 cases (group 2), and grade III of 22 cases (group 3). Results: All groups showed significant degree of pain improvement, and which was more statistically significant in group 1 and 2 compared to group 3. All groups showed significant degree of sensory function improvement. The degree showed no difference between group 1 and 2, and 2 and 3, however, group 1 showed higher degree of improvement compared to group 3. All groups showed significant degree of motor function improvement, and which showed no difference between group 1 and 2, and compared to group 3, group 1 and 2 showed significant improvement of disease severity (p<0.05). In evaluation using Akahori classification after surgery, 28 cases in group 1 (80%), 27 cases in group 2 (73%), and 13 cases in group 3 (59%) showed results of “good” or “excellent”. In the whole group, the age and Akahori classification after surgery showed significant negative correlation (p<0.05, r=-0.512). Conclusion: In the retrospective analysis regarding the cubital tunnel syndrome using modified Mackinnon method, postoperative pain, sensory, and motor function was improved compared to which before surgery, however, the degree of improvement decreased as the disease was more severe. Especially, as the age is older, the degree of improvement more decreases.

Abstract: Purpose: We present an atypical case of calcific tendinitis of the shoulder with intraosseous loculation. Materials and Methods: A 59 year-old female complained of acute exacerbation of chronic left shoulder pain and restricted range of motion. Simple radiographs showed a subacromial calcific deposit and magnetic resonance imaging revealed cortical erosion with intraosseous extension of calcific material mimicking infection or tumor. She was managed with arthroscopic excision of the calcific deposit, curettage of the intraosseous lesion and subsequent rotator cuff repair with a suture anchor. Results: Her acute pain promptly subsided. Her rehabilitation was uneventful and she gained full range of motion. Radiographs five months after the operation showed no recurrence of calcific material. Conclusion: Calcific tendinitis of the shoulder can present with a variety of images involving the adjacent bone. The correct recognition of this disorder may avoid unnecessary investigation and treatment.

Abstract: Purpose: To report the usefulness of dynamic ultrasonography in subluxation of the long head of the biceps tendon, which is difficult to detect with static imaging such as plain radiography, static sonography, MRI and in a subtle physical examination. Materials and Methods: Two male patients suffered from subluxation of the long head of the biceps. This difficult diagnosis? was managed by surgery (biceps soft tissue tenodesis) with the aid of dynamic ultrasonography. At final follow up, we evaluated patients’ symptoms and functional outcomes using KSS, UCLA and ASES scores. Results: We diagnosed and treated subluxation of the long head of the biceps easily using dynamic ultrasonography. At the final follow up, both patients’ symptoms and functional outcomes were improved. There were no significant complications. Conclusion: Dynamic ultrasonography is a useful method in the difficult and subtle diagnosis of subluxation of the long head of the biceps .

Abstract: Purpose: To investigate the relationship between the size of a rotator cuff tear and the grade of fatty degeneration of the supraspinatus and infraspinatus muscles. Materials and Methods: From a database of 541 patients who underwent a shoulder MRI between September 2004 and September 2010, we enrolled 148 patients that had a full-thickness rotator cuff tear. The anteroposterior diameter of the tear was measured in sagittal views on an MRI. The patients were divided into 6 groups reflecting the anteroposterior diameter: group 1 (a width of <10 mm), group 2 (10 mm≤ width<15 mm), group 3 (15 mm≤width<20 mm), group 4 (20 mm≤width<25 mm), group 5 (25 mm≤ width<30 mm) and group 6 (a width<30 mm). Fatty degeneration was rated according to Goutallier et al. Results: Fatty degeneration in the supraspinatus and infraspinatus muscles increased with the severity of the rotator cuff tear. The supraspinatus fatty degeneration increased prominently as the tear size increased from 15~19 mm to 20~24 mm and from 25~29 mm to over 30 mm. The infraspinatus fatty degeneration increased prominently as the tear size increased from 25~29 mm to over 30 mm. Seventeen patients had tear widths under 10 mm and 8 patients among them had fatty degeneration of the infraspinatus. Conclusion: Fatty degeneration in supraspinatus and infraspinatus muscles increases prominently at specific tear sizes. The presence of tears under 10 mm with infraspinatus fatty degeneration indicates that the infraspinatus tendon may have an anatomical or functional effect even in small tears.

Abstract: 목적: 견관절에 발생한 만성 재발성 다발성 골수염의 진단 및 치료 경험을 보고하고자 한다. 대상 및 방법: 견관절에 발생한 만성 재발성 다발성 골수염을 가진 16세 남자 환자에 대해 관절경하 변연 절제술 및 Naproxen을 이용한 치료를 시행하였다. 결과: 치료 후 16개월 동안 추시상 재발 없이 증상이 소실되었다. 결론: 만성 재발성 다발성 골수염은 비특이적 임상 양상과 드문 발병률 때문에 진단에 어려움이 있는 질환이다. 저자들은 16세 남자 환자에서 견관절에 발생한 만성 재발성 다발성 골수염 1예를 경험 하였기에 문헌 고찰과 함께 보고하는 바이다. 【Purpose: We report a case of chronic recurrent multifocal osteomyelitis of the shoulder. Materials and Methods: A 16 year-old male who had suffered from chronic recurrent multifocal osteomyelitis of the shoulder was diagnosed by clinical features and biopsy and was treated with arthroscopic debridement and Naproxen. Results: Symptoms was subsided without relapse during 16 months follow up. Conclusion: Chronic recurrent multifocal osteomyelitis is rare disease and it can be misdiagnosis because of its rarity and non-specific clinical presentation. This is a report of a case of chronic recurrent multifocal osteomyelitis of the shoulder in 16 years man.】

Abstract: Purpose : Because of increasing high energy traumas such as traffic accidents and industrial injuries, operative treatments in midshaft fractures of clavicles are increased. With analyzing factors that make an effect on postoperative complications, compatibilities of current treatment techniques and fixation devices should be discussed. Materials and Methods: Sixty two patients with fractures on the midshaft of clavicles underwent operative treatment between 2004 and 2009. Many factors such as age, gender, type of fractures, underlying disease, operation time, fixation technique were analyzed for the evaluation of effects on developing postoperative complications. Plain radiography and/or computerized tomography were used. With a minimum 1 year follow-up, postoperative function were assessed by means of a ASES scoring system. Results: 7 postoperative complications were developed. All of these belonged to male and severe fracture pattern. 3 infections, 3 metal failures, and 1 refracture were developed. All of 3 patients with infection were concerned with underlying diseases. Metal failures were developed in 2 of 15 patients with anatomical reconstruction plates fixation and 1 patients with cannulated screw fixation. Refracture were developed in 1 of 46 patients with LC-DCP fixation. Conclusion: Severe comminuted or displaced fractures, long operation time and underlying disease were related with postoperative complications, especially such as infection. For male patients or athletes with high activity, the stronger fixation device than usual fixation device such as the anatomical reconstruction plate is needed, and vigorous activities should be postponed until complete bone union.

Abstract: Purpose: To compare the mid-term clinical results of arthroscopic and open repair for large to massive rotator cuff tear. Materials and Methods: We retrospectively reviewed 48 patients who underwent either arthroscopic or open repair for large to massive rotator cuff tear. 28 patients underwent arthroscopic repair and 20 patients had open repair. The clinical outcome for the 2 groups was evaluated using range of motion, Visual Analogue Scale (VAS) for pain and function, American Shoulder and Elbow Society (ASES) score and Korean Shoulder Scoring System (KSS) score. Results: The range of motion, VAS for pain and function and ASES score was improved significantly in both groups at the final follow-up visit compared with preoperative values. However, there were no significant differences between the two groups statistically (p>0.05). There were no significant differences between the two groups statistically at the final follow-up KSS score (p>0.05) either. Conclusion: We could obtain improved mid-term clinical outcomes in both arthroscopic repair and open repair without any statistically significant differences between the two groups.