Purpose: The bone defects that are associated with shoulder anterior instability may be the causes of failure of arthroscopic surgery. For the treatment of traumatic shoulder instability, we tried to determine the arthroscopic techniques that can be used for the bone defect of the glenoid and the humeral head. The purpose of this study is to assess the surgical techniques for the arthroscopic reconstruction of the shoulder with anterior instability and bone defects. Materials and Methods: We analyzed the articles that have been recently published on anterior shoulder instability and we assessed the arthroscopic surgical techniques. We compared the articles and the methods of arthroscopic surgical techniques for treating bone defects of the anteroinferior glenoid and the posterolateral humeral head, which were considered as the causes of recurrence of shoulder instability. Results: There are the anteroinferior bone defects of the glenoid and Hill-Sachs lesions in the bone defects that appear in patients with anterior shoulder instability. These bone defects are currently the causes of failure of arthroscopic surgery. Conclusion: Open shoulder surgery may be the treatment of the choice for a shoulder with instability and significant bone defects of the glenoid and the humeral head. But efforts are being made to overcome the weaknesses of open surgery by the use of arthroscopy.
PURPOSE: To compare the clinical and radiological result of arthroscopic Mattress Locking suture repair to that of a Simple suture repair with small and medium-sized rotator cuff tears.MATERIALS AND METHODS: Among 92 patients who were followed up after arthroscopic repair in patients with small and medium-sized rotator cuff tear from April 2007 to October 2010, 27 patients who took Arthroscopic Mattress Locking suture were set as group I and 65 patients who took Simple suture were set as Group II. The average age of patients were 58 years old and average follow-up period was 30 months. For analysis, VAS, ASES and KSS were used to analyze the range of joint movement and pain. And, for the image result, MRI performed after operation were evaluated.RESULTS: The average VAS, KSS, UCLA score and ASES prior to surgery improved in the last follow-up (p<0.001), while was no difference in two groups (p>0.001). In MRI follow-up examination, the 2 cases (7.41%) of group 1 showed increased rupture lesions with improved symptoms. And the 12 cases (18.47%) of group 2 showed increased rupture lesions with improved symptoms. Retears in the group I were significant less than the group II (p<0.001).CONCLUSION: Comparing patients with small and medium-sized rotator cuff tear who took arthroscopic mattress locking suture repair to those who took simple suture repair after over one year follow up period, the clinical result showed no significant difference between two groups. However, Mattress Locking suture repair showed excellent radiological result compared to simple suture repair when comparing rerupture.
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. Keywords: Bispectral index; MAP; rSO2; Shoulder surgery; Sitting position.
Background: The aim of this study was to investigate the demographic and clinical characteristics of patients with primary frozen shoulder in a Korean population. Methods: A total of 1,373 patients whose shoulders were diagnosed with primary frozen shoulder across 11 resident-training hospitals were reviewed retrospectively. Various demographic characteristics and clinical characteristics according to gender and presence of diabetes were evaluated. Results: The average age of patients was 55.4 years. Gender proportion was 58.3% females and 41.7% males. The frozen shoulder involved the non-dominant arm in 60.7% of patients and the bilateral arms in 17.6% of patients. The average duration of symptoms was 8.9 months, and 51.3% of patients had experienced nocturnal pain. Comorbidities associated with frozen shoulder in our sample of patients included diabetes (18.7%), cardiovascular diseases (17.7%), thyroid diseases (5.4%), and cerebrovascular diseases (3.6%). The diabetic group was correlated with the following demographic and clinical characteristics: old age, involvement of the dominant arm, nocturnal pain, long duration of symptoms, and no history of trauma. Further, we found that, in males, having a frozen shoulder was significantly correlated with a history of trauma; in females, having a frozen shoulder was significantly correlated with having thyroid diseases. Conclusions: These demographic data of primary frozen shoulder in the Korean population were consistent with those of previously reported epidemiologic studies. Primary frozen shoulder with diabetes was correlated with old age, bilateral involvement, long duration of symptoms, and nocturnal pain.
It was reported that atorvastatin co-administered with clopidogrel for 8 months did not affect the anti-platelet potency of clopidogrel in Korean patients with acute coronary syndrome, but not in patients with stable angina. We investigated whether co-administration of statins with clopidogrel affected the anti-platelet efficacy of clopidogrel in Korean patients with stable angina.This was a randomized, open-label and two-period crossover design study conducted at two centers. Two hundreds thirty three patients with stable angina scheduled for coronary stenting were randomized into two groups. In Group A, 119 patients first received atorvastatin (10 mg) followed by fluvastatin (80 mg) for 12 weeks per treatment. In Group B, 114 patients received the same treatments in reverse order.Baseline adenosine diphosphate (ADP, 10 µmol/L)-induced platelet aggregation was 54.4±9.1% in Group A and 53.8±9.0% in Group B (p=0.44), and significant differences were noted after each treatment period (p<0.001). Inhibition of platelet aggregation was similar between Group A and Group B at 24 hours following clopidogrel loading (29.2±11.0% vs. 30.4±12.7%; p=0.42). The two treatment least square means of 12-week ADP (10 mol/L)-induced platelet aggregation [29.50±0.79 {standard error (SE)}% on the atorvastatin treatment group vs. 28.16±0.70 (SE)% in the fluvastatin treatment group] in a 2×2 cross-over study were not significantly different (p=0.204).Statin and clopidogrel co-administration for 12 weeks is not associated with attenuated anti-platelet activity of clopidogrel in Korean patients with stable angina after coronary stenting, in support of the findings of similar studies conducted in Caucasian populations.
Purpose: The purpose of this study was to analyse the characteristics of acalculous cholecystitis (AC) compared with those of calculous cholecystitis (CC), and also to find the relationship of preoperative radiologic findings to the classification of pathological degree of inflammation of the gallbladder in AC. Methods: Between March 1996 and June 2000 a total of 163 patients undergoing cholecystectomy for cholecystitis were divided into group AC (21 patients) and group CC (142 patients) and retrospectively studied by analyzing clinical data. Results: The incidence of AC among cbolecystitis cases was 12.9%. there was male preponderance in group AC whereas female preponderance in group CC (P
Purpose:The purpose of this study was to evaluate the usefulness and clinical results of arthroscopic double row repair with UU stitches for massive, full-thickness, rotator cuff tears.Materials and Methods: Between January 2007 and July 2009, we consulted on 36 massive tears in which it was possible to repair the middle area of the greater tuberosity by arthroscopy.One group consisted of 11 cases that had a double row repair with UU stitches.A second group consisted of 20 cases that had a single row repair with simple stitches.We compared the 2 groups for pain, Activities of Daily Living, UCLA score, and KSS score.We did this pre operatively, and at 6 months, 1 year and final follow-ups.Statistical analysis included Student's t test and a paired t est.Mean age was 59 (48~70); mean follow-up was 28 (12~43) months Results: VAS scores decreased from 7.5 pre operatively to 1.5 post operatively at the last f/u in the 1 st group (p<0.05).In the 2 nd group, the score decreased from 7.6 in pre op to 1.8 post operatively at the last f/u (p<0.05).There was no significant difference between the two groups (p＞0.05).Mean ADL increased from 11.5 to 25.1 at the last f/u in the 1 st group (p<0.05); in the 2 nd group the ADL score increased from 11.3 to 27.5 (p<0.05).There was no significant difference between the two groups (p＞0.05).The UCLA score increased from 13.9 to 31.6 in the 1 st group (p<0.05),while in the 2 nd group the score increased from 13.8 to 30.1 (p<0.05);there was no significant difference between the two groups (p＞ 0.05).Comparing MRIs at 3 and 6 months post op, there were retears in 3 of 9 cases in the first group, and in 8 of 15 cases in the second group; there was no significant difference between the two groups (p＞0.05).Conclusion: Arthroscopic double row repair with UU stitches for massive, full-thickness rotator cuff tears showed no differences in clinical results.However, it was associated with a significant difference in the incidence of retears.
Abstract Purpose Currently, there is limited information on the clinical outcomes of arthroscopic reduction and double‐row suture bridge fixation for large greater tuberosity fractures of the proximal humerus. This study aimed to evaluate the radiological and clinical outcomes of arthroscopic reduction and double‐row suture bridge fixation for these fractures, hypothesizing that arthroscopic reduction and double‐row suture bridge fixation is a safe, effective and minimally invasive treatment for large greater tuberosity fractures. Methods This retrospective study analysed patients with large greater tuberosity fractures (fracture fragment ≥30 mm in diameter) who underwent arthroscopic reduction and double‐row suture bridge fixation and had a follow‐up period exceeding 2 years. The anatomic reduction was confirmed by assessing the step‐off on radiographs immediately after surgery, and the radiologic union time was recorded. At the final follow‐up, range of motion and functional outcome scores were evaluated. Additionally, any surgery‐related complications were evaluated. Results Fifteen patients with a mean follow‐up of 57.7 ± 23.1 months were included in the study. The mean fracture fragment size was 32.5 ± 2.4 mm, with a mean displacement of 5.1 ± 1.6 mm. Immediately postsurgery, 13 of 15 patients (86.7%) had a fracture step‐off of <3 mm, with an average union time of 3 months. At the final follow‐up, patients demonstrated excellent outcomes, with an average forward flexion of 167 ± 9.7° and external rotation of 70 ± 16.3. Functional outcome scores showed significant improvement compared with preoperative scores ( p < 0.001). No major surgery‐related complications were reported. Conclusions Arthroscopic reduction and double‐row suture bridge fixation for large‐sized greater tuberosity fractures is safe and shows good fracture reduction and excellent clinical outcomes. Therefore, this surgical method can be considered an alternative to open reduction for large greater tuberosity fractures. Level of Evidence Level IV.
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