Atelocollagen Injections Improve Outcomes in the Nonsurgical Treatment of Grade III Medial Collateral Ligament Injuries.

Background: The purpose of this study was to evaluate the clinical outcomes of atelocollagen injections in isolated grade III medial collateral ligament (MCL) injuries of the knee joint. Methods: A total of 50 participants were included in this retrospective study. Twenty-six patients underwent conservative treatment with a single atelocollagen injection, while the remaining patients underwent only typical conservative treatment. All participants underwent magnetic resonance imaging to identify and grade MCL injury. Valgus stress radiography was performed on both knees at 6 and 12 months after the injury. The visual analog scale (VAS) score was collected at the first visit and at 2 weeks, 6 weeks, 6 months, and 12 months after injury. The International Knee Documentation Committee (IKDC) formula activity level and Lysholm score were evaluated for patient-reported outcomes at the first visit and at 6 and 12 months after injury. The participant's return to the pre-injury activity level ratio was measured by comparing the IKDC formula activity level at 12 months after the injury with that before the injury. Results: The VAS and Lysholm scores improved over time in both groups. The VAS and Lysholm scores were significantly better in the collagen injection group than in the control group. Regarding the activity level, the collagen injection group showed significantly better results at the 6-month follow-up, but there was no significant difference at the 12-month follow-up. The medial gap in the injured knee and the side-to-side difference (SSD) in both groups gradually decreased over time. The SSD in the collagen injection group was significantly smaller than that in the control group. Conclusions: Atelocollagen injections resulted in better clinical and radiologic outcomes along with a higher rate of return to the pre-injury activity level, thereby exhibiting a positive effect in the nonsurgical treatment of grade III MCL injuries.

Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate.

BACKGROUND: Acromioclavicular joint fixation using a hook plate is effective for the treatment of acute acromioclavicular joint dislocation. However, several studies have reported some complications including loss of reduction after surgery for acromioclavicular joint dislocation. This study aimed to identify the risk factors associated with the loss of reduction after acromioclavicular joint dislocation surgery using a hook plate. METHODS: This was a retrospective study that assessed 118 patients with acromioclavicular joint dislocation, who were diagnosed between March 2013 and January 2019 and underwent surgical treatment using the hook plate (reduction loss group: n = 38; maintenance group: n = 80). The mean follow-up period was 29.9 months (range, 24-40 months). We assessed the range of motion, the American Shoulder and Elbow Surgeons score (ASES), visual analog scale score for pain, and a subjective shoulder value. Radiological assessment of coracoid clavicular distance was performed. The risk factors of reduction loss were analyzed using multivariable logistic regression analysis. RESULTS: Age (p = 0.049), sex (female, p = 0.03, odds ratio OR = 4.81), Rockwood type V (p = 0.049, OR = 2.20), and time from injury to surgery > 7 days (p = 0.018, OR = 2.59) were statistically significant factors in the reduction loss group. There were no significant differences in the clinical outcomes for range of motion, ASES, subjective shoulder value, and visual analog scale scores between the two groups. In the radiological results, preoperative coracoid clavicular distance (p = 0.039) and ratio (p = 0.001), and over-reduction (p = 0.023, OR = 0.40) were significantly different between the two groups. The multivariate logistic regression analysis identified the female sex (p = 0.037, OR = 5.88), a time from injury to surgery > 7 days (p = 0.019, OR = 3.36), and the preoperative coracoid clavicular displacement ratio of the injured shoulder (p < 0.001, OR = 1.03) as risk factors associated with reduction loss following surgery using a hook plate for acromioclavicular dislocation. CONCLUSION: A delayed timing of surgery > 7 days, preoperative coracoid clavicular displacement ratio of the injured shoulder, and female sex were identified as risk factors for loss of reduction after surgery using a hook plate for acromioclavicular joint dislocation. LEVEL OF EVIDENCE: Level IV; retrospective comparison; treatment study.

Effects of neuromuscular electrical muscle stimulation on the deltoid for shoulder function restoration after reverse total shoulder arthroplasty in the early recovery period: a prospective randomized study.

INTRODUCTION: Neuromuscular electrical stimulation (NMES) is a treatment modality that has been used to accelerate the rehabilitation of patients with neurological damage. However, it is unclear whether NMES of the deltoid can lead to the early restoration of shoulder function after reverse total shoulder arthroplasty (RSA). MATERIALS AND METHODS: In this prospective and randomized study, 88 patients who underwent RSA with the same prosthesis design for cuff tear arthropathy or irreparable rotator cuff tear were assessed. The patients were divided into two groups (NMES group and non-NMES group, 44 patients each). For the NMES group, two pads of the NMES device were placed over the middle and posterior deltoid area, and NMES was maintained for 1 month after surgery. Shoulder functional outcomes and deltoid thickness were compared at 3, 6, and 12 months postoperatively. Shoulder functional outcomes were assessed based on the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Constant scores and the range of motion (ROM) and power of the affected shoulder. The thickness of the anterior, middle, and posterior deltoid was measured by ultrasonography. RESULTS: A total of 76 patients (NMES group, 33 patients; non-NMES group, 43 patients) were enrolled in the final analysis. The preoperative demographics and status of the remaining rotator cuff of both groups were not significantly different. At postoperative 3 months, the ROM and power of external rotation of the NMES group were significantly greater than those of the non-NMES group (ROM, 36° ± 14° vs. 29° ± 12°; P = .003; power, 4.8 kg ± 1.8 kg vs. 3.8 kg ± 1.0 kg; P < .002). The ROM of external rotation of the NMES group at postoperative 6 months was also greater than that of the non-NMES group (41° ± 12° vs. 34° ± 11°; P = .013). However, there was no significant difference in the VAS, ASES, and Constant scores at all follow-up points despite gradual improvements until 1 year postoperatively. Serial measurements of the thickness of the anterior, middle, and posterior deltoid of both groups did not show significant differences. CONCLUSIONS: Postoperative NMES of the deltoid after RSA contributed to significantly faster ROM restoration and considerable improvement in the power of external rotation. Therefore, NMES following RSA could lead to the early restoration of external rotation and recovery of deltoid function.

Comparative analysis of superior capsule reconstruction between long head of biceps tendon autograft and human dermis allograft.

BACKGROUND: Although many superior capsule reconstruction (SCR) techniques are currently practiced in clinical settings, guidelines for choosing the appropriate graft material are lacking. Therefore, at most times, the surgeon's personal preference becomes the deciding factor. This study compared 2 fairly recent SCR techniques-SCR with biceps tendon (BT) autograft and SCR with human dermis (HD) allograft-by evaluating clinical and radiologic outcomes to aid the surgeon's decision in choosing the appropriate graft. METHODS: Thirty-one patients underwent SCR using BT autograft (SCR BT), and 22 underwent SCR using HD allograft (SCR HD). SCR BT was selected for patients with a partial BT tear <20%, no severe inflammation signs, and favorable anchor conditions. SCR HD was performed in patients with a BT tear >20%, a superior labrum anterior-posterior (SLAP) lesion, severe inflammation, or subluxation. Range of motion (ROM), strength and shoulder function scoring, plain radiography, and magnetic resonance imaging were evaluated before and after surgery at regular intervals. RESULTS: In the SCR BT group, forward flexion ROM increased from 122° ± 43° to 149° ± 18° at 2 years postoperatively, whereas in the SCR HD group, forward flexion ROM improved from 129° ± 28° to 149° ± 18°. In the SCR BT group, internal rotation (IR) ROM increased from 5 ± 3 to 6 ± 2 at 2 years postoperatively, whereas in the SCR HD group, IR ROM improved from 5 ± 3 to 6 ± 1. Although ROM, strength, visual analog scale score, American Shoulder and Elbow Surgeons score, and Constant score all improved 2 years after surgery, no statistically significant differences were found. Six months after surgery, graft thickness was 3.58 ± 0.384 mm in the SCR BT group and 2.49 ± 0.326 mm in the SCR HD group (P < .001). At 2 years postoperatively, graft thickness was 3.54 ± 0.399 mm in the SCR BT group and 2.49 ± 0.306 mm in the SCR HD group (P < .001). The SCR HD group showed a negative correlation of -0.475 between graft thickness and IR ROM (P = .026). In the SCR BT group, a negative correlation of -0.466 was found between graft thickness and IR ROM (P = .008). A positive correlation of 0.363 was found between IR ROM and the acromiohumeral distance when the results were compared before and 2 years after surgery (P = .045). CONCLUSION: Both SCR using BT autograft and SCR using HD allograft tissue showed favorable results, and no significant difference was noted between the 2 techniques. Given that the 2 techniques show equally favorable results, the surgeon's personal preference in choosing the SCR technique appears to be acceptable. Understanding the costs and patient's characteristics may aid the surgeon in deciding on the graft material.

Comparison of In Vivo Three-Dimensional Glenohumeral Positions and Scapular Kinematics between Young and Older Male Groups.

BACKGROUND: Many researchers have questioned whether shoulder kinematics such as the glenohumeral position and scapular kinematics would be different in different age groups. However, studies comparing shoulder kinematics between different age groups have been rare. The aim of this study was to analyze and compare the three-dimensional (3D) glenohumeral position, scapular kinematics, and scapulohumeral rhythm (SHR) during scapular plane arm abduction between a normal young male group and a normal older male group. METHODS: Twenty normal men (10 young and 10 older) were enrolled in this controlled laboratory study. Fluoroscopic images were obtained using a single plane X-ray system. Bilateral computed tomography scans were taken to create a 3D model. A 3D-2D registration technique was used to determine the 3D position and orientation of the bones of the shoulder. RESULTS: During scapular plane arm abduction, there were significant differences in scapular kinematics between the groups. The older male group showed more upward rotation, posterior tilt, and external rotation than the young male group. On the other hand, the glenohumeral position such as superior inferior translation, anterior posterior translation, and external rotation of the humeral head did not show significant difference between the groups. The mean value of SHR for the overall arm elevation range from start to maximum elevation angle for the older group and young group was 2.298 ± 0.964 and 2.622 ± 0.931, respectively, showing a significant difference between the two groups (p = 0.035). CONCLUSIONS: Scapular kinematics and SHR were significantly different between the older male group and the young male group. Our study could provide reference values of shoulder kinematics for older men aged 55-65 years.

Early restoration of shoulder function in patients with the Grammont prosthesis compared to lateralized humeral design in reverse shoulder arthroplasty.

BACKGROUND: This study aimed to compare the clinical outcomes and radiographic parameters of patients after reverse shoulder arthroplasty (RSA) between the Grammont prosthesis and lateralized humeral design prosthesis. METHODS: A total of 114 patients who underwent RSA with a lateralized humeral design (group L; 71 shoulders) and medialized humeral design (group M; 43 shoulders) prosthesis for cuff tear arthropathy or irreparable rotator cuff tear were enrolled. Clinical outcomes including visual analog scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores and range of motion (ROM) were serially followed up at postoperative 3, 6, 12, and 24 months. Radiographic parameters were measured to evaluate preoperative and postoperative status. RESULTS: Both prostheses demonstrated similar clinical outcomes and shoulder function preoperatively and at postoperative 2 years (P >.05). However, patients in group M had significantly better postoperative active forward flexion (postoperative 3 months, 115° ± 12° vs. 101° ± 14°; P <.001; 6 months, 125° ± 13° vs. 118° ± 13°; P <.013) and abduction (3 months, 105° ± 12° vs. 98° ± 12°; P = .002); VAS (3 months, 3.1 ± 1.2 vs. 3.7 ± 1.4; P = .031; 6 months, 2.3 ± 1.1 vs. 2.8 ± 1.3; P = .038); ASES (3 months, 64.2 ± 7.0 vs. 60.4 ± 9.2; P = .022; 6 months, 70.6 ± 6.0 vs. 66.6 ± 8.1; P = .007); and Constant scores (6 months, 59.6 ± 6.9 vs. 55.7 ± 9.3; P = .020). Group L showed a significantly lower rate of scapular notching than group M (15.5% vs. 41.8%; P < .001). The position of the proximal humerus in group L was more lateralized and less distalized than in group M after RSA. CONCLUSIONS: RSA with both the Grammont and lateralized humeral design prostheses provided similar shoulder ROM restoration and functional improvements at a minimum of 2 years. However, patients with a humeral lateralized prosthesis showed slower recovery of shoulder function and ROM up to postoperative 6 months despite a lower incidence of scapular notching.

Incidence and risk factors of acromial fracture following reverse total shoulder arthroplasty.

BACKGROUND: The occurrence and related predictors of acromial fracture following reverse total shoulder arthroplasty (RTSA) have not been fully elucidated. The aim of this study was to determine the incidence and risk factors of acromial fractures after RTSA. METHODS: We conducted a multicenter, retrospective case-control study of 787 cases (29 in acromial fracture group and 758 in control group) that underwent RTSA performed by 6 surgeons. The mean duration of follow-up after RTSA was 31.6 ± 21.8 months (range, 12-136 months). Demographic variables (age, sex, arm dominance, body mass index, working status, bone mineral density [BMD]), clinical variables (preoperative diagnosis, previous operation, implant design, preoperative clinical scores, screw size in glenoid fixation, postoperative rehabilitation), and radiographic variables (acromial thickness, critical shoulder angle, deltoid length, humeral offset to lateral acromion) were investigated. To determine risk correlation, univariate analysis and multivariate logistic regression analysis with calculated odds ratios (ORs) were performed. RESULTS: Postoperative acromial fractures occurred in 29 of the 787 shoulders with RTSA (3.7%). Acromial fractures were detected at a mean of 10.0 months (range, 1-66 months) postoperatively. Univariate analysis revealed that the occurrence of an acromial fracture was significantly associated with a previous operation (38% [11 of 29] vs. 21% [156 of 758], P = .025) and BMD (-2.33 vs. -1.74, P = .013). Multivariate logistic regression analysis found that the occurrence of a postoperative acromial fracture was significantly associated with a previous operation (P = .034; OR, 2.91; 95% confidence interval, 1.08-7.84) and deltoid length (P = .004; OR, 1.04; 95% confidence interval, 1.01-1.07). CONCLUSION: Acromial fracture following RTSA is not an uncommon complication, with an overall incidence of 3.7%. A previous operation, increased deltoid length, and low BMD were risk factors of acromial fracture following RTSA.

Epidemiologic Study of Shoulder Injuries in the PyeongChang 2018 Winter Olympic Games.

BACKGROUND: The purpose of this study is to describe and analyze the shoulder injuries in elite athletes during the 2018 Winter Olympics in Pyeongchang. METHODS: To collect the data of all Olympic athletes who visited venue medical centers, polyclinics, and Olympic-designated hospitals for shoulder injuries during the Olympic Games (February 9 through 25, 2018), we reviewed Olympic electronic medical records and patient information obtained from Olympic medical service teams about athletes who complained of shoulder pain. RESULTS: During the Olympics, a total of 14 athletes visited clinics for shoulder-related symptoms. Five athletes were injured in games and nine were injured in training. The injury was due to overuse in four patients. Ten patients had trauma-related symptoms: one after being hit by an opponent and the other nine after a collision with the ground or an object. There were no patients who complained of symptoms related to pre-existing shoulder conditions. The most common cause of shoulder pain was snow-boarding (one big air and three slopestyle). The most common diagnosis was contusion (n = 6), followed by rotator cuff injuries (n = 3), superior labrum from anterior to posterior lesion (n = 1), sprain (n = 1), acromioclavicular-coracoclavicular injury (n = 1), dislocation (n = 1), and fracture (n = 1). CONCLUSIONS: To the best of our knowledge, this study is the first epidemiologic study of shoulder injury conducted during a huge sports event involving a variety of competitions for elite athletes. If the risk factors of shoulder injury can be established by continuing research in the future, it will be helpful to prevent injury and to prepare safety measures for athletes.

A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study.

BACKGROUND: We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique. METHODS: We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph. RESULTS: The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation. CONCLUSIONS: The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

Comparison of the Clinical Outcomes of Open Surgery Versus Arthroscopic Surgery for Chronic Refractory Lateral Epicondylitis of the Elbow.

Numerous surgical options have been introduced for the treatment of chronic refractory lateral epicondylitis of the elbow, but it remains unclear which option is superior. The clinical outcomes of an open surgery group and an arthroscopic surgery group were evaluated, and the results of the 2 procedures were compared. From among patients with lateral epicondylitis refractory to 6 months of conservative treatment, 68 patients satisfying study criteria were recruited. Open surgery was performed in 34 cases (group 1), and arthroscopic surgery was performed in 34 cases (group 2). Compared with preoperatively, the 2 groups had significantly improved values for grip strength, range of motion, and Disabilities of the Arm, Shoulder and Hand score at 12 months postoperatively. Group 1 had significantly greater improvements in grip strength and visual analog scale pain score compared with group 2 (P=.048 vs P=.006). Group 2 had significantly greater (P=.045) improvement in pronation compared with group 1. Group 2 returned to work sooner than group 1. On the questionnaire regarding satisfaction with surgery 24 months postoperatively, 4 patients (12%) in group 2 reported dissatisfaction compared with no patients in group 1. Open surgery and arthroscopic surgery both yielded good clinical results. Nonetheless, for patients requiring muscle strength or having severe pain at work, open surgery would be more effective. [Orthopedics. 2018; 41(4):237-247.].

Which additional augmented fixation procedure decreases surgical failure after proximal humeral fracture with medial comminution: fibular allograft or inferomedial screws?

BACKGROUND: The purpose of this study was to compare clinical and radiologic results between treatment with locking plate fixation and fibular allograft augmentation (FA) and treatment with locking plate fixation and additional inferomedial screws (IMSs) in 3- or 4-part proximal humeral fractures with medial comminution in geriatric patients. METHODS: We enrolled 164 patients with 3- or 4-part proximal humeral fractures with medial comminution who were treated with locking plates. The patients were divided into 2 groups according to additional augmented fixation procedures. The IMS group was composed of patients treated with additional IMSs (80 patients), whereas the FA group was treated with an additional fibular allograft (84 patients). On the basis of fracture classification, the IMS group was subdivided into those with 3-part fractures (52 patients) and those with 4-part fractures (28 patients) and the FA group was subdivided into those with 3-part fractures (55 patients) and those with 4-part fractures (29 patients). Clinical and radiographic results were compared and analyzed. RESULTS: In patients with 3-part fractures, no differences in clinical outcomes were found regardless of additional procedures. However, the FA group showed superior clinical outcomes in patients with 4-part fractures (P = .038 for Constant score and P = .045 for visual analog scale score). The postoperative neck-shaft angle was maintained in the FA group compared with the IMS group with both fracture types at the last follow-up (P = .048 for IMS vs FA with 3-part fractures and P = .023 for IMS vs FA with 4-part fractures). The number of complications was significantly higher in the IMS group (5.5%) than in the FA group (1.2%) (P = .001). CONCLUSION: An FA technique is considered a primary additional procedure for medial support in patients with 4-part proximal humeral fractures involving medial metaphyseal comminution when treated with locking plate fixation.

Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes?

BACKGROUND: The purpose of this study was to investigate whether healed tuberosities yield better rotational range of motion (ROM) and functional outcomes compared with unhealed tuberosities after reverse shoulder arthroplasty in elderly patients with comminuted proximal humerus fractures. METHODS: This study included 38 patients who underwent reverse arthroplasty because of 4-part proximal humerus fractures; 14 patients had healed tuberosities (group A) and 24 patients had unhealed tuberosities (group B). Functional assessments included visual analog scale pain score, American Shoulder and Elbow Surgeons score, Constant score, and active ROM. RESULTS: There were no significant differences in the patients' demographics between the 2 groups. At final follow-up, no significant differences were found between groups in visual analog scale score (group A, 1.4; group B, 1.6; P = .647), American Shoulder and Elbow Surgeons score (74.3 and 70.7; P = .231), and Constant score (67.9 and 63.9; P = .228) and ROM with forward flexion and internal rotation. However, in external rotation, there was a significant difference between groups (29° and 10° in external rotation with the elbow at the side [P < .001]; 25° and 7° in external rotation with shoulder abduction [P < .001]). CONCLUSION: After reverse shoulder arthroplasty for 4-part proximal humerus fracture, tuberosities were healed in an anatomic position in 37% of patients. However, there were no significant differences in functional outcomes and ROM between the 2 groups, with the exception of external rotation, which was better in the healed tuberosity group. Therefore, tuberosity healing is not a prerequisite for satisfactory outcomes after reverse shoulder arthroplasty for 4-part proximal humerus fractures in elderly patients.

Relationship between the extent of labral lesions and the frequency of glenohumeral dislocation in shoulder instability.

PURPOSE: This study aimed to evaluate the relationship between the extent of the labral lesion and the frequency of glenohumeral dislocation in patients with shoulder instability. METHODS: Ninety-three patients, who underwent surgical treatment at our clinic for chronic anterior shoulder dislocation, were selected and divided into 3 groups (group I: only Bankart lesion; group II: Bankart and SLAP lesions; group III: circumferential-labral lesion). The pre-operative frequency of dislocation, intraoperative findings, operation time, post-operative clinical score, and range of motion 2 years after surgery were analysed and compared among the 3 groups. RESULTS: The time interval from the initial dislocation to operation was significantly shorter in group III than in groups I and II (P = 0.034 and P = 0.046, respectively). The median number of preoperative dislocations was also significantly less in group III than in groups I and II (P = 0.025 and P = 0.044, respectively). In all groups, the clinical scores (Constant, Rowe, and visual analogue scale) improved significantly post-operatively, and there were no significant differences in the scores between the different groups. All patients returned to work, and most patients returned to their preoperative sports activity levels. CONCLUSION: The extent of the labral lesion is not always related to the number of dislocations; therefore, treatment should not be based on this. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Ganglion cyst of the spinoglenoid notch: comparison between SLAP repair alone and SLAP repair with cyst decompression.

BACKGROUND: Some authors have described the ganglion cyst of the spinoglenoidal notch as related to repetitive overhead activities and labral tear caused by trauma, while others have explained lesions of the capsulolabral complex and ganglion cysts to have separate pathologies. The purpose of this study is to compare clinical and radiological outcomes between 2 groups: 1 with superior labrum anterior and posterior (SLAP) repair only and the other with SLAP repair and cyst decompression prospectively. MATERIALS AND METHODS: From August 2000 to March 2007, 28 patients matching the inclusion criteria were selected for the study. They were divided into 2 groups: 1 who received SLAP repair and the other with concomitant SLAP repair and cyst decompression. A visual analogue scale (VAS) and Rowe and Constant scores were used to make evaluation. Preoperative magnetic resonance images (MRIs) of 2 patient groups were compared with 2 follow-up MRIs taken 3 months after the operation and at final follow-up. RESULTS: Mean VAS and Constant and Rowe scores in groups I and II improved significantly from mean preoperative score compared to last follow-up score; however, there was no statistically significant difference between the 2 groups (P > .05). Preoperative MRI and arthroscopy revealed type II SLAP lesions and a type V lesion, respectively, as accompanying lesions in 24 cases. CONCLUSION: The hypothesis stating 1-way valve mechanism of SLAP lesion as an initial cause of ganglion cysts has been proved indirectly in this study. Furthermore, direct decompression of the cyst does not lead to different results.

Clinical results of technique for double bundle anterior cruciate ligament reconstruction using hybrid femoral fixation and Retroscrew.

BACKGROUND: Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome. METHODS: Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. RESULTS: Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up. CONCLUSIONS: Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes.

Arthroscopic repair for combined Bankart and superior labral anterior posterior lesions: a comparative study between primary and recurrent anterior dislocation in the shoulder.

PURPOSE: The purpose of this study was to compare clinical outcomes between a primary dislocation group (group P) and a recurrent dislocation group (group R) with combined lesion of Bankart and type II SLAP lesions (type V SLAP lesion) and to evaluate incidence of type V SLAP lesion. In addition, the authors evaluated clinical outcomes of these patients by dividing two groups according to the sequence for Bankart and SLAP lesion suture. METHODS: From May 2000 to May 2005, 310 patients who gave informed consent, underwent the diagnostic arthroscopy and magnetic resonance arthrography (MRA). One hundred and ten patients met the following criteria: (1) post-traumatic primary or recurrent anterior shoulder instability, (2) a normal contralateral shoulder, (3) a type V SLAP lesion, and (4) minimum follow-up of two years. Group P included 42 patients, and group R, 68 patients. Among all patients, 58 patients who had Bankart lesions sutured first were included in group B, and 52 who had their SLAP lesions sutured beforehand, group S. Visual analogue scale, range of motion, Rowe and Constant score were used to compare results between group P and group R, also group B and group S. RESULTS: The incidence rates of type V SLAP lesion were 42.8% in group P and 32.0% in group R. The overall treatment results in our study were good. Even if the difference between the two groups was statistically insignificant, group P showed greater recovery of range of motion than group R in external rotation. No significant difference was found between the two different operative methods according to suture sequence. CONCLUSION: The incidence rates of type V SLAP lesion were 42.8% in the primary dislocation group and 32.0% in the recurrent dislocation group. The overall treatment results in our study were good. Although there was no statistical significance in surgical time between the two groups, when both SLAP and Bankart lesions are present, the Bankart lesion must be sutured first to reduce surgical time.

Comparison of early fixation and delayed reconstruction after displacement in previously nondisplaced acromion fractures.

Scapular fractures account for approximately 1% of all fractures, and 8% to 10% are acromion fractures. We compared the results of early and delayed treatment for nondisplaced and type III acromion fractures, respectively, to investigate an early treatment method for nondisplaced acromion fractures. Patients treated between March 1999 and March 2006 with 2-year follow-up were selected for the study. The early fixation group comprised 16 patients, and the delayed reconstruction group comprised 18 patients. Moreover, the delayed reconstruction group was further divided into 2 additional groups: delayed group B and delayed group N. Delayed group B comprised 7 cases receiving bone graft, and delayed group N comprised 11 cases not receiving bone graft. Mean Constant scores were significantly greater for the early fixation group (92+/-6.6; range, 64-98) than for both delayed groups N (86+/-7.8; range, 54-96) and B (81+/-9.4; range, 58-92) (P=.042 and .024, respectively). Mean pain score was 14+/-4.8 (range, 5-15) in the early fixation group, 12+/-7.4 (range, 5-15) in delayed group N, and 9+/-8.8 (range, 5-15) in delayed group B (P=.052 and .018, respectively). Mean daily activity score was also significantly greater in the early fixation group (19+/-6.4; range, 16-20) than in both delayed group N (14+/-6.2; range, 10-18) and delayed group B (10+/-4.4; range, 8-18) (P=.048 and .021, respectively). The P values for Constant, pain, and daily activity scores between delayed groups N and B were .048, .038, and .052, respectively. In cases of young patients with type IC acromion fractures at the time of injury, a high activity level, and the early need for crutches or a walker, early surgical treatment should be considered.

Prevalence comparison of accompanying lesions between primary and recurrent anterior dislocation in the shoulder.

BACKGROUND: Many authors have reported the presence of intra-articular lesions after primary dislocation of the shoulder joint. However, few studies have focused on their prevalence or the differences in accompanying lesions between primary and recurrent dislocations of the shoulder joint. PURPOSE: This study was undertaken to investigate and analyze accompanying lesions, including types of anteroinferior labrum injuries, using diagnostic arthroscopy and magnetic resonance arthrography (MRA) in 144 patients with traumatic anterior dislocation of the shoulder joint. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: There were 33 patients with 33 dislocations in the primary dislocation group and 111 patients with 111 dislocations in the recurrent dislocation group. Preoperative magnetic resonance arthrography and diagnostic arthroscopy were performed on all patients. RESULTS: In the primary dislocation group, 8 Bankart lesions, 9 free anterior labrum periosteal sleeve avulsion (ALPSA) lesions, 4 bony Bankart lesions, and 1 adhesive ALPSA lesion were observed. In the recurrent dislocation group, 68 Bankart lesions, 11 free ALPSA lesions, 13 bony Bankart lesions, 16 adhesive ALPSA lesions, and 1 glenoid articular rim disruption lesion were found. There were 22 (66.6%) and 109 (98.1%) patients with lesions in the anteroinferior labrum in the primary and recurrent groups, respectively. There was a statistically significant difference between the 2 groups (P = .002). Also, there was a significant difference between the 2 groups in the prevalence of the Hill-Sachs lesion and inverted pear-shaped glenoid lesion (P = .008/P = .047). Inverted pear-shaped glenoids were observed in 15 patients in the recurrent group. In 139 of 144 patients, surgical findings of accompanying lesions coincided with magnetic resonance arthrography findings (96.5%). CONCLUSION: Various forms of anteroinferior labral lesions were seen in patients with traumatic anterior dislocation of shoulder. The recurrent dislocation group showed a significantly higher prevalence of anteroinferior labral lesions and bony lesions in comparison with the primary group. In our study, magnetic resonance arthrography was an accurate method to assess accompanying lesions in first-time and recurrent anterior dislocation of the shoulder, suggesting that this may be a useful tool for determining a treatment method.

The spectrum of lesions and clinical results of arthroscopic stabilization of acute anterior shoulder instability.

PURPOSE: The purpose of this study is to investigate and analyze accompanying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time. MATERIALS AND METHODS: The study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy. RESULTS: There was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture. CONCLUSION: Under MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remarkably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families.