1
|
Yoon JP, Park SJ, Choi YS, Kim DH, Lee HJ, Park EJJ, Chung SW. Current research trends on the effect of diabetes mellitus on rotator cuff tendon healing/tendinopathy. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05350-1. [PMID: 38698293 DOI: 10.1007/s00402-024-05350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
Rotator cuff tendon tears are a leading cause of shoulder pain. They are challenging to treat, and tendon-bone healing has a high failure rate despite successful surgery. Tendons connect the muscles and bones, which make them important for the body's overall mobility and stability. Metabolic diseases, including diabetes or high blood pressure, can affect the healing process after repair of a damaged tendon. With a global incidence of 9.3%, diabetes is considered as a significant risk factor for rotator cuff tendon healing because it causes structural, inflammatory, and vascular changes in the tendon. However, the mechanisms of how diabetes affects tendon healing remain unknown. Several factors have been suggested, including glycation product accumulation, adipokine dysregulation, increased levels of reactive oxygen species, apoptosis, inflammatory cytokines, imbalanced matrix-metalloproteinase-to-tissue-inhibitor ratio, and impaired angiogenesis and differentiation of the tendon sheath. Despite the effects of diabetes on tendon function and healing, few treatments are available to improve recovery in these patients. This review summarizes the current literature on the pathophysiological changes of the tendon in diabetes and hyperlipidemia. Preclinical and clinical evidence regarding the association between diabetes and tendon healing is presented. Moreover, current approaches to improve tendon healing in patients with diabetes are reviewed.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Sung-Jin Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea.
| | - Yoon Seong Choi
- Department of Carbon Hybrid Fiber Science, Kyungpook National University, Daegu, Korea
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Eugene Jae Jin Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, Korea
| |
Collapse
|
2
|
Yoon JP, Park SJ, Kim DH, Lee HJ, Park EJJ, Shim BJ, Chung SH, Kim JS, Chung SW. Tranexamic Acid Can Reduce Early Tendon Adhesions After Rotator Cuff Repair and Is Not Detrimental to Tendon-Bone Healing: A Comparative Animal Model Study. Arthroscopy 2024:S0749-8063(24)00071-9. [PMID: 38311267 DOI: 10.1016/j.arthro.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To determine the effects of topical tranexamic acid (TXA) administration on tendon adhesions, shoulder range of motion (ROM), and tendon healing in an acute rotator cuff repair rat model. METHODS A total of 20 Sprague Dawley rats were used. Tendon adhesion, ROM, and biomechanical and histological analysis of tendon-bone healing was conducted at 3 and 6 weeks after surgery. The rats underwent rotator cuff repair surgery on both shoulders and were administered TXA via subacromial injections. The tendon adhesion was evaluated macroscopically and histologically. Biomechanical tendon healing was measured using a universal testing machine, and histological analysis was quantified by H&E, Masson's trichrome, and picrosirius red staining. RESULTS At 3 weeks after surgery, the adhesion score was significantly lower in the TXA group (2.10 ± 0.32) than in the control group (2.70 ± 0.48) (P = .005), but there was no significant difference between the 2 groups at 6 weeks. Regarding ROM, compared with the control group, the TXA group showed significantly higher external rotation (36.35° ± 4.52° vs 28.42° ± 4.66°, P < .001) and internal rotation (45.35° ± 9.36° vs 38.94° ± 5.23°, P = .013) 3 weeks after surgery. However, at 6 weeks, there were no significant differences in external and internal rotation between the 2 groups. In the biomechanical analysis, no significant differences in gross examination (3 weeks, P = .175, 6 weeks, P = .295), load to failure (3 weeks, P = .117, 6 weeks, P = .295), or ultimate stress (3 weeks, P = .602, 6 weeks, P = .917) were noted between the 2 groups 3 and 6 weeks after surgery. In the histological analysis of tendon healing, no significant differences in the total score (3 weeks, P = .323, 6 weeks, P = .572) were found between the 2 groups 3 and 6 weeks after surgery. CONCLUSIONS Topical TXA administration showed a beneficial effect in reducing tendon adhesions and improving ROM 3 weeks postoperatively and had no effect at 6 weeks. This suggests that additional intervention with TXA may be useful in achieving long-term improvement in shoulder stiffness. Additionally, TXA may increase tissue ground substance accumulation in the late postoperative period but does not adversely affect tendon-bone interface healing. CLINICAL RELEVANCE The use of TXA after rotator cuff repair has no effect on tendon-bone interface healing in clinical practice and can improve shoulder stiffness in the early postoperative period. Additional research on the long-term effects is needed.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sung-Jin Park
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Eugene Jae Jin Park
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Bum-Jin Shim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seung Ho Chung
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jun Sung Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| |
Collapse
|
3
|
Yoon JP, Park SJ, Kim DH, Shim BJ, Chung SW. Current Research on the Influence of Statin Treatment on Rotator Cuff Healing. Clin Orthop Surg 2023; 15:873-879. [PMID: 38045588 PMCID: PMC10689229 DOI: 10.4055/cios23131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 12/05/2023] Open
Abstract
Rotator cuff tears are a condition characterized by damage to the muscles and tendons that connect the scapula and humerus, which are responsible for shoulder rotation and arm lifting. Metabolic factors such as diabetes, thyroid disease, high cholesterol, vitamin D deficiency, obesity, and smoking have been associated with an increased risk of rotator cuff tears. Interestingly, patients with hyperlipidemia, a condition characterized by high levels of cholesterol and other fats in the blood, have been found to have a higher incidence of rotator cuff tears and breakdown of tendon matrix. As a result, statin therapy, which is commonly used to lower cholesterol levels in hyperlipidemia, has been explored as a potential treatment to improve clinical outcomes in rotator cuff tears. However, the results of preclinical and clinical studies on the effects of statins on tendon healing in rotator cuff tears are limited and not well-defined. Moreover, since hyperlipidemia and rotator cuff tears are more prevalent in older individuals, a literature review on the efficacy and safety of statin therapy in this population is needed.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Sung-Jin Park
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Hyun Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Bum-Jin Shim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| |
Collapse
|
4
|
Chung SW, Kim DH, Lee HJ, Hong WK, Chung SH, Yoon JP. Superior capsular reconstruction for irreparable rotator cuff tear: a review of current methods. Clin Shoulder Elb 2023; 26:438-444. [PMID: 37994007 DOI: 10.5397/cise.2023.00514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/30/2023] [Indexed: 11/24/2023] Open
Abstract
Irreparable massive rotator cuff tears can significantly impact daily life; and these types of tears can be difficult to repair completely, especially in younger patients who are more active and have higher functional requirements. Since its introduction by Mihata and the colleagues, superior capsular reconstruction (SCR) has gained popularity in the treatment of irreparable massive rotator cuff tears and has shown promising short-term results. A variety of studies have focused on the clinical and biomechanical outcomes of this procedure. This article reviews the biomechanics, indications for the surgical procedure, graft options, surgical technique, and rehabilitation from SCR.
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Dong-Hyun Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Won Ki Hong
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung Ho Chung
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| |
Collapse
|
5
|
Lee J, Yoon JP, Woo Y, Oh KS, Chung SW. Types and doses of anti-adhesive agents injected into subacromial space do not have an effect on the clinical and anatomical outcomes after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2023; 31:5238-5247. [PMID: 37594502 DOI: 10.1007/s00167-023-07519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Joint stiffness after arthroscopic rotator cuff repair is a major concern for orthopaedic surgeons. Various antiadhesive agents are commonly administered after rotator cuff repair for its prevention. This study aimed to compare the outcomes among patients injected with different types and amounts of anti-adhesive agents after rotator cuff repair. It was hypothesized that the outcomes might differ depending on the use of the anti-adhesive agent and its type and dose. METHODS A total of 267 patients who underwent arthroscopic rotator cuff repair with or without subacromial injection of anti-adhesive agents were enrolled. The first group (group A; 51 patients) were injected with 3 mL of poloxamer/sodium alginate-based anti-adhesive agent. The second group (group B; 93 patients) were injected with 3 mL of sodium hyaluronate-based anti-adhesive agent. The third group (group C; 82 patients) were injected with 1.5 mL of sodium hyaluronate-based anti-adhesive agent. Finally, the last group (group D; 41 patients) who did not use anti-adhesive agents served as the control. The range of motion (ROM) and pain VAS scores were measured preoperatively and at 5 weeks, 3 months, 6 months, and 1 year postoperatively. Functional outcomes were evaluated using American Shoulder and Elbow Surgeons and Constant scores, whereas cuff integrity was assessed via MRI or ultrasonography at least 6 months postoperatively. RESULTS All ROM measurements, pain VAS scores, and functional scores were significantly improved regardless of the use, type, and dose of the anti-adhesive agents. In addition shoulder ROM and rotator cuff healing did not significantly differ among the groups (all n.s.). CONCLUSIONS No significant differences were found in the clinical and anatomical outcomes according to the type and dose of the anti-adhesive agents subacromially injected after rotator cuff repair. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jongwon Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Youngje Woo
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea.
| |
Collapse
|
6
|
Yoon JP, Park SJ, Kim DH, Chung SW. Metformin increases the expression of proinflammatory cytokines and inhibits supraspinatus fatty infiltration. J Orthop Surg Res 2023; 18:674. [PMID: 37700364 PMCID: PMC10496168 DOI: 10.1186/s13018-023-04163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND After a rotator cuff (RC) tendon tear, the supraspinatus (SS) inflammatory response induces fatty infiltration (FI). Metformin has the effect of regulating the initial inflammatory response of atrophic muscles. Therefore, this study aimed to investigate the effect of metformin use on modulating the expression of proinflammatory cytokines and SS FI in an acute RC tear rat model. METHODS This study used 26 male Sprague-Dawley rats. Animals were randomly divided into two groups: The metformin group received metformin for 5 days after cutting the RC tendon, and the control group was administered only with saline after cutting the tendon. Metformin 50 mg/kg was intraperitoneally injected for 5 days. Three rats in each group were sacrificed 5 days after SS tendon rupture surgery, and 10 rats in each group were sacrificed 14 days after surgery. The SS was sampled 5 days after SS tendon tear surgery, and the expression of proinflammatory cytokines was measured by quantitative reverse-transcription polymerase chain reaction (qRT-PCR). On day 14 after sampling, histological analysis of the SS was performed using hematoxylin and eosin, Masson's trichrome, and picrosirius red staining. RESULTS On day 5 of surgery, the expression values of interferon gamma (increased 7.2-fold, P < .01), tumor necrosis factor alpha (increased 13-fold, P < .05), interleukin-1β (increased 4.7-fold, P < .001), and interleukin-6 (increased 4.6-fold, P < .01) increased significantly in the metformin group compared with those in the control group. As a result of Oil Red O staining, SS FI was significantly suppressed in the metformin group compared with that in the control group (metformin group, 305 ± 50.3 µm2, P < .001; control group, 3136 ± 662.8 µm2, P < .001). In addition, the SS volume of the metformin group was not reduced compared with those of the control group, and the morphology and structure of the SS were better preserved. CONCLUSIONS The results of this study revealed that metformin can increase the expression of proinflammatory cytokines and suppress SS fat infiltration in delayed sutures.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung-Jin Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, Korea
| |
Collapse
|
7
|
Lee JG, Seonwoo SM, Lee HK, Lee HJ, Deslivia MF, Lee YM, Yoon JP, Kim JW, Oh CW. Radius palmar plate removal without carpal tunnel release: correlation between plate position and median nerve symptoms. Hand Surg Rehabil 2023; 42:230-235. [PMID: 37084866 DOI: 10.1016/j.hansur.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
We aimed to report the clinical results of volar plate removal without carpal tunnel release in patients with late-onset median neuropathy and to evaluate the relationship between plate position and median nerve symptoms. Part I. Twelve consecutive patients with late-onset median neuropathy treated with volar plate removal without carpal tunnel release were enrolled for analysis. Pre- and post-operative Tinel sign, Phalen and Ten test, subjective rating of tingling sensation, Mayo wrist score and Disabilities of the Arm, Shoulder and Hand (DASH) score were collected. Part II. 232 consecutive patients underwent volar plating for distal radius fracture. The relationships between median nerve symptoms and volar plate prominence on the Soong classification, fracture classification, gender and age were investigated. All cases except one showed complete symptom resolution at final follow-up, with negative Tinel sign and Ten test score of 10/10. Tingling was rated 0 at final follow-up. Mean Mayo wrist and DASH scores improved to 86.7 and 23.1, respectively. The incidence of the median nerve symptoms in our cohort was 5.6%. Even though the odds ratio in Soong grade 2 was 4.0957 (95% CI, 0.93-16.9) compared to the combination of grades 0 and 1, no statistically significant relationship was found between the median nerve symptoms and volar plate prominence (p > 0.05). Plate removal without carpal tunnel release adequately relieved symptoms of late-onset median neuropathy after volar plating in patients with distal radius fracture. Level of Evidence: IV; Therapeutic.
Collapse
Affiliation(s)
- Jin-Gyu Lee
- School of Medicine, Kyungpook National University, Daegu, Korea
| | | | - Hyun-Ki Lee
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun-Joo Lee
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
| | | | - Yu-Mi Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Joon-Woo Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Chang-Wug Oh
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| |
Collapse
|
8
|
Lee SH, Lee J, Oh KS, Yoon JP, Seo A, Jeong Y, Chung SW. Automated 3-dimensional MRI segmentation for the posterosuperior rotator cuff tear lesion using deep learning algorithm. PLoS One 2023; 18:e0284111. [PMID: 37200275 DOI: 10.1371/journal.pone.0284111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/23/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Rotator cuff tear (RCT) is a challenging and common musculoskeletal disease. Magnetic resonance imaging (MRI) is a commonly used diagnostic modality for RCT, but the interpretation of the results is tedious and has some reliability issues. In this study, we aimed to evaluate the accuracy and efficacy of the 3-dimensional (3D) MRI segmentation for RCT using a deep learning algorithm. METHODS A 3D U-Net convolutional neural network (CNN) was developed to detect, segment, and visualize RCT lesions in 3D, using MRI data from 303 patients with RCTs. The RCT lesions were labeled by two shoulder specialists in the entire MR image using in-house developed software. The MRI-based 3D U-Net CNN was trained after the augmentation of a training dataset and tested using randomly selected test data (training: validation: test data ratio was 6:2:2). The segmented RCT lesion was visualized in a three-dimensional reconstructed image, and the performance of the 3D U-Net CNN was evaluated using the Dice coefficient, sensitivity, specificity, precision, F1-score, and Youden index. RESULTS A deep learning algorithm using a 3D U-Net CNN successfully detected, segmented, and visualized the area of RCT in 3D. The model's performance reached a 94.3% of Dice coefficient score, 97.1% of sensitivity, 95.0% of specificity, 84.9% of precision, 90.5% of F1-score, and Youden index of 91.8%. CONCLUSION The proposed model for 3D segmentation of RCT lesions using MRI data showed overall high accuracy and successful 3D visualization. Further studies are necessary to determine the feasibility of its clinical application and whether its use could improve care and outcomes.
Collapse
Affiliation(s)
- Su Hyun Lee
- Department of Orthopaedic Surgery, Seoul Red Cross Hospital, Seoul, Korea
| | - JiHwan Lee
- Department of Orthopedic Surgery, Myongji Hospital, Goyang-si, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University College of Medicine, Daegu, Korea
| | - Anna Seo
- SEEANN Solution, Yeonsu-gu, Incheon, Korea
| | | | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Yoon JP, Kim DH, Min SG, Kim HM, Choi JH, Lee HJ, Park KH, Kim SS, Chung SW, Yoon SH. Effects of a graphene oxide-alginate sheet scaffold on rotator cuff tendon healing in a rat model. J Orthop Surg (Hong Kong) 2022; 30:10225536221125950. [PMID: 36121787 DOI: 10.1177/10225536221125950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Natural polymer scaffolds used to promote rotator cuff healing have limitations in terms of their mechanical and biochemical properties. This animal study aimed to investigate the effects of combined graphene oxide (GO) and alginate scaffold and the toxicity of GO on rotator cuff healing in a rat model. METHODS First, the mechanical properties of a GO/alginate scaffold and a pure alginate scaffold were compared. The in vitro cytotoxicity of and proliferation of human tenocytes with the GO/alginate scaffold were evaluated by CCK-8 assay. For the in vivo experiment, 20 male rats were randomly divided into two groups (n = 10 each), and supraspinatus repair was performed: group 1 underwent supraspinatus repair alone, and group 2 underwent supraspinatus repair with the GO/alginate scaffold. Biomechanical and histological analyses were performed to evaluate the quality of tendon-to-bone healing 8 weeks after rotator cuff repair. RESULTS The GO/alginate scaffold exhibited an increased maximum load (p = .001) and tensile strength (p = .001). In the cytotoxicity test, the cell survival rate with the GO/alginate scaffold was 102.08%. The proliferation rate of human tenocytes was no significant difference between the GO/alginate and alginate groups for 1, 3, 5, and 7 days. Biomechanically, group 2 exhibited a significantly greater ultimate failure load (p < .001), ultimate stress (p < .001), and stiffness (p < .001) than group 1. The histological analysis revealed that the tendon-to-bone interface in group 2 showed more collagen fibers bridging, tendon-to-bone integration, longitudinally oriented collagen fibers, and fibrocartilage formation than in group 1. CONCLUSION A small amount of GO added to alginate improved the mechanical properties of the scaffold without evidence of cytotoxicity. At 8 weeks after rotator cuff repair, the GO/alginate scaffold improved tendon-to-bone healing without causing any signs of toxicity in a rat model.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, 34986Kyungpook National University, Daegu, Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, 34986Kyungpook National University, Daegu, Korea
| | - Seung Gi Min
- Department of Orthopaedic Surgery, School of Medicine, 34986Kyungpook National University, Daegu, Korea
| | - Hun-Min Kim
- 65672Korea Dyeing & Finishing Technology Institute, Daegu, Korea
| | - Jin-Hyun Choi
- Department of Bio-Fibers and Materials Science, 34986Kyungpook National University, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, 34986Kyungpook National University, Daegu, Korea
| | - Kyeong Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, 34986Kyungpook National University, Daegu, Korea
| | - Seong Soo Kim
- Department of Orthopaedic Surgery, School of Medicine, 34986Kyungpook National University, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, 34986Konkuk University, Seoul, Korea
| | - Sung Hyuk Yoon
- Department of Orthopaedic Surgery, School of Medicine, 34986Kyungpook National University, Daegu, Korea
| |
Collapse
|
10
|
Yoon JP, Min SG, Choi J, Lee HJ, Park KH, Yoon SH, Kim SS, Chung SW, Kim H, Kim DH. Increased interleukin-6 and TP53 levels in rotator cuff tendon repair patients with hypercholesterolemia. Clin Shoulder Elb 2022; 25:296-303. [DOI: 10.5397/cise.2022.00976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background: A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. Methods: Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. Results: Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05).Conclusions: We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.
Collapse
|
11
|
Yoon JP, Jung YS, Kim DH. Local myofascitis of the deltoid muscle after administration of the AstraZeneca (AZD1222) COVID-19 vaccine: two cases, infectious and inflammatory. JSES Rev Rep Tech 2022; 2:376-379. [PMID: 35571584 PMCID: PMC9085349 DOI: 10.1016/j.xrrt.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Soo Jung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
12
|
Yoon JP. Subscapularis tendon tear involving the first facet. Clin Shoulder Elb 2022; 25:91-92. [PMID: 35698779 PMCID: PMC9185112 DOI: 10.5397/cise.2022.01032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
|
13
|
Kim DH, Min SG, Kim HM, Kang HR, Choi JH, Lee HJ, Kim KR, Chung SW, Yoon JP. Comparison of the Characteristics of Rotator Cuff Tissue in a Diabetic Rat Model. Orthopedics 2022; 45:e154-e161. [PMID: 35112964 DOI: 10.3928/01477447-20220128-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study evaluated the biomechanical and histologic characteristics of the rotator cuff tendon and muscle tissue with rat models with diabetes mellitus (DM) (group 1) and 30 male rats without DM (group 2). We conducted a time zero study without any additional procedures or external variables at 9 weeks after induction of the diabetic rat model. Thereafter, quantitative evaluation of advanced glycation end products (AGEs) was accomplished via enzyme-linked immunosorbent assay and immunohistochemistry (IHC). Fatty infiltration was investigated with Oil Red O staining, and the peroxisome proliferator activated receptor-gamma (PPAR-gamma) value was studied with IHC. Grossly, the supraspinatus tendons of the group 1 rats were more friable and discolored (yellowish) than those of group 2. In the biomechanical analysis, group 1 rats showed significantly inferior ultimate failure load (P=.001) and ultimate stress (P=.02). Group 1 was significantly inferior to group 2 in terms of total histologic scoring (P<.001). Mean AGE levels were significantly higher in group 1 (P<.001), as determined by IHC. In evaluating fatty infiltration, the degree of Oil Red O staining was significantly higher in group 1 (P<.001), but there was no significant difference in PPAR-gamma value between the 2 groups (P=.14). The intact rotator cuffs of rats with DM were associated with inferior biomechanics in association with AGE accumulation and increased fatty infiltration, as confirmed by histologic examination The hyperglycemic state caused by DM is associated with rotator cuff tendon degeneration. [Orthopedics. 2022;45(3):e154-e161.].
Collapse
|
14
|
Song HE, Oh KS, Yoon JP, Lee DR, Baek S, Chung SW. Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression. Knee Surg Sports Traumatol Arthrosc 2021; 29:3961-3970. [PMID: 34312711 DOI: 10.1007/s00167-021-06681-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre- and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors. METHODS Thirty-five patients (mean age, 62.5 ± 8.4 years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre-existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference < - 5°; type 2 SD, internal rotation angle difference > 5°; and type 3 SD, upward rotation angle difference > 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups. RESULTS Twenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p < 0.05). No healing failure occurred in the improved SD group (p = 0.037). CONCLUSION The prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Han Eui Song
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, College of Medicine, Kyungpook University, Daegu, Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Samuel Baek
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University, School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea.
| |
Collapse
|
15
|
Yoon JP, Kim HM, Choi JH, Kang HR, Kim DH, Choi YS, Kim KR, Kim JY, Baek S, Chung SW. Effect of a Porous Suture Containing Transforming Growth Factor Beta 1 on Healing After Rotator Cuff Repair in a Rat Model. Am J Sports Med 2021; 49:3050-3058. [PMID: 34288794 DOI: 10.1177/03635465211028547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The healing failure rate after rotator cuff repair is considerably high. PURPOSE To evaluate the effect of a porous suture containing transforming growth factor beta 1 (TGF-β1) on the sustained release of TGF-β1 and rotator cuff healing in a rat model. STUDY DESIGN Controlled laboratory study. METHODS A porous suture was developed, and its tensile strength was measured. TGF-β1 was delivered using the porous suture, and a TGF-β1 release test and human fibroblast proliferation assay were performed. For the animal experiment, 30 rats were randomly allocated into 3 groups (n = 10 each). A bilateral supraspinatus tendon tear was made in all the rats, and repair was performed. Group 1 received repair only; group 2, repair and a single injection of TGF-β1; and group 3, repair using the porous suture containing TGF-β1. Eight weeks after repair, biomechanical and histological analyses were performed. RESULTS The porous suture was successfully developed with mechanical properties compatible with the conventional suture, and the sustained release of TGF-β1 from the porous suture was confirmed. In addition, the cell proliferation assay confirmed the biological safety of the porous suture. In the animal experiment, group 3 biomechanically exhibited the largest cross-sectional area and the highest ultimate failure load and ultimate stress (all P < .05). Histological examination revealed that group 3 showed significantly better collagen fiber density and tendon-to-bone maturation than did groups 1 and 2 (all P < .05). CONCLUSION The porous suture containing TGF-β1 could sustainedly and safely release TGF-β1, and its use during rotator cuff repair could improve rotator cuff healing, as assessed on the basis of the biomechanical and histological changes in the rat model in this study. Considering the effectiveness, safety, and convenience of the porous suture without extra effort in surgery, the findings of the present study will have a far-reaching effect on the treatment of rotator cuff tears. CLINICAL RELEVANCE The porous suture containing TGF-β1 might improve healing after rotator cuff repair.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hun-Min Kim
- Functional Materials R&D Group, Korea Dyeing and Finishing Technology Institute, Daegu, Republic of Korea
| | - Jin-Hyun Choi
- Department of Bio-fibers and Materials Science, College of Agriculture and Life Science, Kyungpook National University, Daegu, Republic of Korea
| | - Hae Rim Kang
- Department of Bio-fibers and Materials Science, College of Agriculture and Life Science, Kyungpook National University, Daegu, Republic of Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Young Seo Choi
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kyung-Rock Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ja-Yeon Kim
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Samuel Baek
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| |
Collapse
|
16
|
Abstract
Irreparable massive rotator cuff tears cause pain, loss of function, and a decrease in range of motion, which cause serious disturbances in daily life. Young patients, in particular, are active and have relatively high functional requirements, and their surgical options are limited. Superior capsular reconstruction (SCR) was first proposed for irreparable massive rotator cuff tears, good clinical results have been reported in short-term follow up. Since then, SCR has been used increasingly worldwide for irreparable massive rotator cuff tears, and various studies have been published on clinical outcomes, biomechanical outcomes, surgical techniques, and graft types. This article reviews the optimal graft and surgical options for improving clinical outcomes in SCR.
Collapse
Affiliation(s)
- Dong Hyun Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Soo Jung
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyung-Rock Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
17
|
Kim DH, Min SG, Lee HS, Lee HJ, Park KH, Chung SW, Dehdashtian A, Yoon JP. Clinical outcome of rotator cuff repair in patients with mild to moderate glenohumeral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2021; 29:998-1005. [PMID: 33095332 DOI: 10.1007/s00167-020-06307-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 09/28/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE Osteoarthritis (OA) in the glenohumeral joint is a concomitant lesion with rotator cuff tear that commonly occurs in older patients. The authors aimed to evaluate the effect of associated OA on the treatment outcome of rotator cuff repair. METHODS A total of three hundred and forty-eight patients who underwent full-thickness arthroscopic rotator cuff repair were retrospectively reviewed, and the data were prospectively collected. The severity of OA was evaluated using the Samilson and Prieto method preoperatively and the Outerbridge classification intraoperatively. The patients were divided into the small-to-medium group and large-to-massive group according to rotator cuff tear size and were evaluated for presence or absence of OA. The postoperative clinical outcomes were assessed using the visual analog scale for pain, simple shoulder test (SST), University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons (ASES) scoring systems at baseline and at final follow-up. RESULTS Forty-five patients were diagnosed with glenohumeral OA (12.9%). Overall, no significant differences were observed in demographic and baseline data between the two groups according to the presence or absence of OA. The clinical symptoms of both groups significantly improved at the final follow-up. At the final follow-up, no significant differences were found in the VAS for pain, SST, UCLA, Constant, and ASES scores between the two groups. In the large-to-massive tear group, patients with OA had significantly inferior clinical results compared with those without OA. CONCLUSION The clinical outcome scores improved after rotator cuff repair regardless of the presence of concomitant OA. However, glenohumeral OA should be considered as a potential negative prognostic factor in patients with large-to-massive rotator cuff tears. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung Gi Min
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ho Seok Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyeong Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea
| | - Amir Dehdashtian
- Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea.
| |
Collapse
|
18
|
Shim E, Kim JY, Yoon JP, Ki SY, Lho T, Kim Y, Chung SW. Automated rotator cuff tear classification using 3D convolutional neural network. Sci Rep 2020; 10:15632. [PMID: 32973192 PMCID: PMC7518447 DOI: 10.1038/s41598-020-72357-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/24/2020] [Indexed: 11/20/2022] Open
Abstract
Rotator cuff tear (RCT) is one of the most common shoulder injuries. When diagnosing RCT, skilled orthopedists visually interpret magnetic resonance imaging (MRI) scan data. For automated and accurate diagnosis of RCT, we propose a full 3D convolutional neural network (CNN) based method using deep learning. This 3D CNN automatically diagnoses the presence or absence of an RCT, classifies the tear size, and provides 3D visualization of the tear location. To train the 3D CNN, the Voxception-ResNet (VRN) structure was used. This architecture uses 3D convolution filters, so it is advantageous in extracting information from 3D data compared with 2D-based CNNs or traditional diagnosis methods. MRI data from 2,124 patients were used to train and test the VRN-based 3D CNN. The network is trained to classify RCT into five classes (None, Partial, Small, Medium, Large-to-Massive). A 3D class activation map (CAM) was visualized by volume rendering to show the localization and size information of RCT in 3D. A comparative experiment was performed for the proposed method and clinical experts by using randomly selected 200 test set data, which had been separated from training set. The VRN-based 3D CNN outperformed orthopedists specialized in shoulder and general orthopedists in binary accuracy (92.5% vs. 76.4% and 68.2%), top-1 accuracy (69.0% vs. 45.8% and 30.5%), top-1±1 accuracy (87.5% vs. 79.8% and 71.0%), sensitivity (0.92 vs. 0.89 and 0.93), and specificity (0.86 vs. 0.61 and 0.26). The generated 3D CAM provided effective information regarding the 3D location and size of the tear. Given these results, the proposed method demonstrates the feasibility of artificial intelligence that can assist in clinical RCT diagnosis.
Collapse
Affiliation(s)
- Eungjune Shim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, 02792, Korea
| | - Joon Yub Kim
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon, 14555, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
| | - Se-Young Ki
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, Seoul, 143-729, Korea
| | - Taewoo Lho
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, Seoul, 143-729, Korea
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, 02792, Korea.
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, Seoul, 143-729, Korea.
| |
Collapse
|
19
|
Chung SW, Kim JY, Yoon JP, Suh DW, Yeo WJ, Lee YS. Atrogin1-induced loss of aquaporin 4 in myocytes leads to skeletal muscle atrophy. Sci Rep 2020; 10:14189. [PMID: 32843684 PMCID: PMC7447774 DOI: 10.1038/s41598-020-71167-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/10/2020] [Indexed: 12/25/2022] Open
Abstract
The water channel aquaporin 4 (AQP4) regulates the flux of water across the cell membrane, maintaining cellular homeostasis. Since AQP4 is enriched in the sarcolemma of skeletal muscle, a functional defect in AQP4 may cause skeletal muscle dysfunction. To investigate a novel mechanism underlying skeletal muscle atrophy, we examined AQP4 expression and its regulation in muscle using the rotator cuff tear (RCT) model. Human and mouse AQP4 expression was significantly decreased in atrophied muscle resulting from RCT. The size and the number of myotubes were reduced following AQP4 knockdown. Atrogin 1-mediated ubiquitination of AQP4 was verified with an ubiquitination assay after immunoprecipitation of AQP4 with an anti-AQP4 antibody. In this study, we identified high mobility group box 1 (HMGB1) as a potent upstream regulator of atrogin 1 expression. Atrogin 1 expression was increased by recombinant mouse HMGB1 protein, and the HMGB1-induced atrogin 1 expression was mediated via NF-κB signaling. Our study suggests that loss of AQP4 appears to be involved in myocyte shrinkage after RCT, and its degradation is mediated by atrogin 1-dependent ubiquitination. HMGB1, in its function as a signaling molecule upstream of the ubiquitin ligase atrogin 1, was found to be a novel regulator of muscle atrophy.
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopedic Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ja-Yeon Kim
- Department of Orthopedic Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong Won Suh
- Joint Center, Barunsesang Hospital, #75-5, Yatap-ro, Seongnam-si, Gyeonggi-do, 13497, Republic of Korea
| | - Woo Jin Yeo
- Joint Center, Barunsesang Hospital, #75-5, Yatap-ro, Seongnam-si, Gyeonggi-do, 13497, Republic of Korea
| | - Yong-Soo Lee
- Department of Orthopedic Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea. .,Joint Center, Barunsesang Hospital, #75-5, Yatap-ro, Seongnam-si, Gyeonggi-do, 13497, Republic of Korea.
| |
Collapse
|
20
|
Min SG, Kim DH, Lee HS, Lee HJ, Park KH, Yoon JP. Concomitant Coracoid Process Fracture with Bony Bankart Lesion Treated with the Latarjet Procedure. Clin Shoulder Elb 2020; 23:31-36. [PMID: 33330231 PMCID: PMC7714321 DOI: 10.5397/cise.2019.00423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 11/25/2022] Open
Abstract
Bony lesions of the glenoid and Hill-Sachs lesions are the most common injuries after a first-time traumatic shoulder dislocation. However, fracture of the coracoid process after traumatic shoulder dislocation is rare. A single, open surgical procedure could be performed by a Latarjet procedure using a fractured fragment of the coracoid process. If a fracture of the coracoid process is associated with a traumatic anterior shoulder dislocation, the Latarjet procedure may be the most appropriate surgical option.
Collapse
Affiliation(s)
- Seung Gi Min
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Seok Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyeong Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
21
|
Yoon JP, Chung SW, Jung JW, Lee YS, Kim KI, Park GY, Kim HM, Choi JH. Is a Local Administration of Parathyroid Hormone Effective to Tendon-to-Bone Healing in a Rat Rotator Cuff Repair Model? J Orthop Res 2020; 38:82-91. [PMID: 31441073 DOI: 10.1002/jor.24452] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/02/2019] [Indexed: 02/04/2023]
Abstract
To evaluate the effect of local parathyroid hormone (PTH) administration on rotator cuff tendon-to-bone healing in a rat model compared with systemic PTH injection and untreated controls. PTH-alginate scaffold was prepared and sustained release of PTH was confirmed. Bilateral supraspinatus tendon repairs were performed in 39 rats (group 1, supraspinatus repair only; group 2, supraspinatus repair with systemic PTH injection; group 3, supraspinatus repair with local PTH administration via an absorbable scaffold; n = 13 each). Biomechanical (cross-sectional area, mode of failure, load to failure, and ultimate stress: right side) and histological analyses (hematoxylin and eosin stain, Masson's Trichrome stain Picrosirius red stain, Immunohistochemistry for BMP2, PTH1R, ColI, and ColIII: Left side) were performed to evaluate tendon-to-bone healing quality at 8 weeks after repair, and blood test (osteocalcin and procollagen type I N-terminal pro-peptide [PINP] levels) was performed in all rats. There was no intergroup difference in the healing failure rate (p = 0.910) or failure mode (p = 0.585). Biomechanically, subjects in groups 2 and 3 exhibited significantly larger cross-sectional areas and higher ultimate failure loads and ultimate stress than those in group 1 (all p < 0.05); however, no differences were noted between groups 2 and 3 (all p > 0.05). Histologically, groups 2 and 3 exhibited more organized tendon-to-bone interface structures with higher density, parallel orientation, and collagen fiber continuity than group 1 (all p < 0.05 except collagen fiber continuity in group 1 vs. 2); however, no differences in histological parameters between groups 2 and 3 (all p > 0.05). The protein levels of bone morphogenic protein 2, PTH 1 receptor, and collagen I and III and the serum level of PINP were increased in groups 2 and 3 versus group 1 (all p < 0.05) without showing differences between groups 2 and 3 (all p > 0.05). Local PTH administration using an absorbable scaffold improved the biomechanical and histological outcomes of rotator cuff tendon-to-bone healing comparable with systemic PTH injection at 8 weeks after repair in a rat model. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:82-91, 2020.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, College of Medicine, Kyung Pook National University, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Jae Wook Jung
- Department of Orthopaedic Surgery, College of Medicine, Kyung Pook National University, Daegu, Korea
| | - Yong-Soo Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Kwang-Il Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Ga Young Park
- Department of Bio-Fibers and Materials Science, College of Agriculture and Life Science, School of Medicine, KyungPook National University, Daegu, Korea
| | - Hun-Min Kim
- Department of Bio-Fibers and Materials Science, College of Agriculture and Life Science, School of Medicine, KyungPook National University, Daegu, Korea
| | - Jin-Hyun Choi
- Department of Bio-Fibers and Materials Science, College of Agriculture and Life Science, School of Medicine, KyungPook National University, Daegu, Korea
| |
Collapse
|
22
|
Oh JH, Yoon JP, Kim DH, Chung SW, Kim JY, Lee HJ, Il S, Park KH, Lee H. Does strength deficit correlate with shoulder function in patients with rotator cuff tears? Characteristics of massive tears. J Shoulder Elbow Surg 2019; 28:1861-1868. [PMID: 31279717 DOI: 10.1016/j.jse.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/02/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The correlation between shoulder strength deficits and function in rotator cuff tears remains uncertain. This study aimed to determine the correlation between shoulder strength deficits and shoulder function evaluated by various clinical scoring systems. METHODS A total of 262 patients (mean age, 59.67 years [standard deviation, 8.06 years]) who underwent full-thickness rotator cuff repair were included. Patients in group I (n = 188) had small to large rotator cuff tears, whereas those in group II (n = 74) had massive rotator cuff tears. Demographic factors, isokinetic test results, and shoulder function evaluated using various scoring systems were obtained. Correlation differences according to severity of the rotator cuff tear were evaluated. RESULTS We found weak correlations between shoulder strength deficits (peak torque and total work) and clinical outcomes in patients with rotator cuff tears (r = -0.288). For patients in group I (nonmassive tears), we found a weaker correlation (r = -0.242) according to the tear pattern. However, shoulder strength deficits in group II patients (massive tears) were strongly correlated with American Shoulder and Elbow Surgeons (r = -0.598), Constant (r = -0.582), and Short Form 36 (r = -0.511) scores, especially regarding internal rotator strength deficits. CONCLUSIONS Shoulder strength deficits measured via isokinetic testing and shoulder function were weakly correlated in patients with rotator cuff tears. However, shoulder strength deficits in patients with massive tears considerably worsened shoulder function and systemic disability, but not regional disability. In particular, internal rotator strength deficits were strongly correlated with poor shoulder function.
Collapse
Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Joon Yub Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang-Si, Republic of Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seo Il
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kyeong Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hoseok Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| |
Collapse
|
23
|
Chung SW, Oh KS, Ki SY, Kim J, Yoon JP, Kim JY. Factors associated with needle breakage of antegrade suture passer and effect of intratendinous remnant needle tip on clinical outcomes after arthroscopic rotator cuff repair. Acta Orthop Traumatol Turc 2019; 53:106-114. [PMID: 30655093 PMCID: PMC6510669 DOI: 10.1016/j.aott.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 01/08/2023]
Abstract
Objective The aim of this study was to evaluate factors associated with the needle breakage of antegrade suture passer and the effect of intratendinous remnant needle tip on clinical outcomes after rotator cuff repair. Methods We retrospectively reviewed 283 patients (138 men and 145 women; mean age: 59.7 ± 9.3 years) who underwent arthroscopic repair for full-thickness rotator cuff tear. We evaluated the characteristics of 16 patients in whose needle tip had been broken and embedded and remained in the rotator cuff (remnant needle group) and compared them with the remaining 267 patients (control group). Afterwards, another 64 patients were selected from control group (1:4 matching) after propensity score matching (PSM). The groups were compared anatomically with MRI or ultrasonography and functionally (serial pain VAS and ROM; ASES, Constant, UCLA and SST scores) at a minimum follow-up of 1 year. Results The remnant needle group showed preoperative thicker tendon (6.72 mm vs 5.33 mm, p = 0.047), higher tendinosis (mean grade, 1.88 vs. 1.43, p = 0.029), and more frequent delaminated tears (p = 0.035) compared with control group. When we compare the clinical outcomes after PSM, the initial pain VAS of the remnant needle tip group was higher up to 3 months (pain VAS: 4.13 ± 2.07 vs 2.48 ± 1.61 (p = 0.032) at 5 weeks and 3.79 ± 2.12 vs 2.25 ± 1.76 (p = 0.044) at 3 months), however the difference disappeared after 6 months postoperatively. In final evaluation, there was no significant differences in every outcome parameters (all p > 0.05). Conclusion Breakage of the needle of the antegrade suture passer occurred more frequently in the thicker tendon, higher tendinosis, and delaminated tears. The retained broken needle tip was associated with higher pain scores during the early postoperative period, but revealed no difference in final outcomes by using PSM. Level of Evidence Level III, Therapeutic Study
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, South Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, South Korea
| | - Se-Young Ki
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, South Korea
| | - Jayoun Kim
- Research Coordinating Center, Konkuk University Medical Center, Seoul, South Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University, College of Medicine, Daegu, South Korea
| | - Joon Yub Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang-si, South Korea.
| |
Collapse
|
24
|
Yoon JP, Kim DH, Jung JW, Lee CH, Min S, Lee HJ, Kim HJ. Patient-specific Guides Using 3-dimensional Reconstruction Provide Accuracy and Reproducibility in Reverse Total Shoulder Arthroplasty. Clin Shoulder Elb 2019; 22:16-23. [PMID: 33330189 PMCID: PMC7713874 DOI: 10.5397/cise.2019.22.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/10/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to evaluate whether the use of our novel patient-specific guide (PSG) with 3-dimensional reconstruction in reverse total shoulder arthroplasty (RTSA) would allow accurate and reliable implantation of the glenoid and humeral components. Methods 20 fresh-frozen cadaveric shoulders were used. The PSG group (n=10) and conventional group (n=10) was evaluated the accuracy and reproducibility of implant positioning between before and after surgery on the computed tomography image. Results The superoinferior and anteroposterior offset in the glenoid component were 0.42 ± 0.07, 0.50 ± 0.08 in the conventional group and 0.45 ± 0.03, 0.46 ± 0.02 in the PSG group. The inclination and version angles were -1.93° ± 4.31°, 2.27° ± 5.91° and 0.46° ± 0.02°, 3.38° ± 2.79°. The standard deviation showed a smaller difference in the PSG group. The anteroposterior and lateromedial humeral canal center offset in the humeral component were 0.45 ± 0.12, 0.48 ± 0.15 in the conventional group and 0.46 ± 0.59 (p=0.794), 0.46 ± 0.06 (p=0.702) in the PSG group. The PSG showed significantly better humeral stem alignment. Conclusions The use of PSGs with 3-dimensional reconstruction reduces variabilities in glenoid and humerus component positions and prevents extreme positioning errors in RTSA.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jae Wook Jung
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Chang-Hwa Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seunggi Min
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| |
Collapse
|
25
|
Kim DH, Min S, Lee HJ, Kim HJ, Lee H, Yoon JP. Synchronization of Synovial Chondromatosis and Mycobacterium intracellurae Infection in Olecranon Bursitis: A Case Report. Clin Shoulder Elb 2019; 22:46-49. [PMID: 33330194 PMCID: PMC7713878 DOI: 10.5397/cise.2019.22.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022] Open
Abstract
A 73-year-old woman presented with a recurrent cystic mass around her left olecranon. She had a history of 8 steroid injections due to elbow pain beginning 3 years ago and twice had undergone aspiration of olecranon bursitis that developed two months prior to presentation. She had been taking medications for hypertension and diabetes with no pertinent past history. On magnetic resonance imaging (MRI), there were multiple nodules in the olecranon bursa, which were isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Our initial diagnosis was synovial chondromatosis. On bursoscopy, masses of gray-white colored nodules were observed in the bursa. Finally, synovial chondromatosis and non-tuberculous mycobacterial infection were concurrently diagnosed. In conclusion, uncalcified synovial chondromatosis and rice bodies can have similar visual and MRI characteristics; therefore, we suggest that clinicians should be aware of the possibility of other infections in cases of this type.
Collapse
Affiliation(s)
- Dong Hyun Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seunggi Min
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hoseok Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
26
|
Kim DH, Min SG, Yoon JP, Park GY, Choi JH, Jung JW, Lee HJ, Kim HJ, Chung SW, Kim JY. Mechanical Augmentation With Absorbable Alginate Sheet Enhances Healing of the Rotator Cuff. Orthopedics 2019; 42:e104-e110. [PMID: 30540880 DOI: 10.3928/01477447-20181206-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/08/2018] [Indexed: 02/03/2023]
Abstract
For anatomical restoration of a repaired rotator cuff, mechanical augmentation of the repaired structure is essential. Using histological and biomechanical evaluation in a rat model, the authors sought to determine the efficacy of an absorbable alginate sheet at the supraspinatus tendon-to-bone repair site for healing of the rotator cuff tear. Forty adult (12 weeks old) male Sprague- Dawley wild-type rats were used in this study. The animals were randomly separated into 2 groups: group 1, conventional supraspinatus repair with acute repair; or group 2, supraspinatus repair with absorbable alginate sheet. Biomechanical and histological analyses were performed at 6 and 12 weeks after index rotator cuff surgery. Compared with group 1, group 2 exhibited a significantly greater mean ultimate failure load (group 1, 23.70±3.87 N; group 2, 61.44±43.67 N; P=.023) and mean ultimate stress (group 1, 2.83±0.50 MPa; group 2, 7.36±2.87 MPa; P=.020). However, 6-week outcomes were not significantly different. On histological scoring, compared with group 1, group 2 exhibited a significantly greater mean 6-week score (group 1, 4.10±1.72 points; group 2, 7.80±1.47 points; P<.001) and mean 12-week score (group 1, 3.50±1.00 points; group 2, 5.25±2.62 points; P=.020). Mechanical augmentation with absorbable alginate may improve tendon healing after surgical repair of the rotator cuff. [Orthopedics. 2019; 42(1):e104-e110.].
Collapse
|
27
|
Chung SW, Lee YS, Kim JY, Lee JH, Ki SY, Oh KS, Yoon JP, Kim JY. Changes in Perianchor Cyst Formation Over Time After Rotator Cuff Repair: Influential Factors and Outcomes. Am J Sports Med 2019; 47:165-172. [PMID: 30485118 DOI: 10.1177/0363546518810517] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a lack of knowledge about the changes in perianchor cysts over time and the factors related to perianchor cysts. PURPOSE To evaluate the changes in perianchor cyst formation and anchor absorption over time after arthroscopic rotator cuff repair with a biocomposite suture anchor and to evaluate the factors affecting perianchor cyst persistence and their relationship with patient outcomes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Forty consecutive patients (mean age, 61.10 ± 5.79 years) who underwent arthroscopic repair for medium- to large-sized rotator cuff tears using a single type of biocomposite (poly-L-lactic acid/polyglycolic acid-beta tricalcium phosphate) medial-row anchor were prospectively enrolled. Postoperative magnetic resonance imaging (MRI) at 2 different time points (6 and 18 months) was performed, and perianchor cyst formation, anchor absorption, and healing failures were evaluated using postoperative MRI. Demographic and clinical data were collected, and functional outcomes at a minimum of 18 months after surgery were assessed. RESULTS Perianchor cysts were observed in 24 patients (60.0% total; grade 1: 35.0%; grade 2: 10.0%; grade 3: 7.5%; grade 4: 7.5%) at 6 months, and 7 patients (18.4% total; grade 1: 7.9%; grade 2: 5.3%; grade 3: 2.6%; grade 4: 2.6%) had a persistent perianchor cyst at 18 months after surgery. No anchors were absorbed at 6 months, but 73.7% of patients revealed complete or near-full absorption at 18 months. Patients with persistent perianchor cysts showed a significantly larger tear size in the anteroposterior dimension ( P = .002) and greater retraction ( P < .001). There were no differences in healing failures and functional outcomes between patients with and without persisting perianchor cysts (all P > .05). No differences were found in perianchor cyst formation and anchor absorption between anchors inserted in the greater tuberosity and the lesser tuberosity (all P > .05). CONCLUSION The incidence and severity of perianchor cysts decreased with time, and most biocomposite suture anchors were absorbed at 18 months after surgery. Persisting perianchor cysts correlated with a larger tear size in the anteroposterior dimension and greater retraction.
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong-Soo Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ja-Yeon Kim
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung-Ho Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Se-Young Ki
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University, College of Medicine, Daegu, Republic of Korea
| | - Joon Yub Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University, College of Medicine, Goyang, Republic of Korea
| |
Collapse
|
28
|
Cho CH, Kim BS, Rhyou IH, Park SG, Choi S, Yoon JP, Choi CH, Dan J. Posteromedial Elbow Dislocations without Relevant Osseous Lesions: Clinical Characteristics, Soft-Tissue Injury Patterns, Treatments, and Outcomes. J Bone Joint Surg Am 2018; 100:2066-2072. [PMID: 30516630 DOI: 10.2106/jbjs.18.00051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although simple posterolateral or posterior elbow dislocations are relatively common and usually stable after closed reduction, simple posteromedial dislocations are extremely rare and poorly characterized. We investigated the clinical characteristics, soft-tissue injury patterns, treatments, and outcomes of a series of posteromedial elbow dislocations without relevant osseous lesions. METHODS We retrospectively reviewed 20 cases of simple posteromedial elbow dislocations without relevant osseous lesions that were treated at 7 fellowship training hospitals during a 10-year period. Soft-tissue injury patterns in 15 cases were investigated with use of magnetic resonance imaging. Clinical outcomes were evaluated after an average of 56.1 months (range, 24 to 93 months) with use of the Mayo Elbow Performance Score (MEPS) and the Quick-DASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]) score. Complications were also evaluated. RESULTS On magnetic resonance imaging, significant tears of the lateral collateral ligament complex and common extensor group were observed in all cases. Seventeen cases (85%) required surgical treatment for acute instability. Fourteen cases underwent only lateral complex repair and 3 underwent repair of both the medial and lateral complexes. At the time of the latest follow-up, the mean MEPS and Quick-DASH scores were 85.8 ± 15.0 and 10.5 ± 16.3, respectively. Seventeen patients (85%) had a satisfactory clinical outcome. Complications following treatment included 4 patients with heterotopic ossification; 2 of these patients also experienced posttraumatic elbow stiffness, which was treated with arthrolysis at 8 and 18 months after the initial operation. CONCLUSIONS Posteromedial elbow dislocations without relevant osseous lesions are associated with a more severe soft-tissue injury, especially to the lateral complex, resulting in a high rate of surgical treatment. With careful post-reduction evaluation, either operative or nonoperative treatment provided satisfactory clinical outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | - In Hyeok Rhyou
- Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, Semyeong Christianity Hospital, Pohang, South Korea
| | - Sam-Guk Park
- Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, South Korea
| | - Sung Choi
- Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, South Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Chang-Hyuk Choi
- Department of Orthopedic Surgery, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Jinmyoung Dan
- Department of Orthopedic Surgery, Gumi CHA University Hospital, Gumi, South Korea
| |
Collapse
|
29
|
Abstract
BACKGROUND No study to date has directly evaluated rotator cuff repair results among smokers. PURPOSE To evaluate whether smoking affects healing after arthroscopic rotator cuff repair through propensity score matching (PSM). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Among 249 patients who underwent arthroscopic repair of full-thickness rotator cuff tears, 34 current heavy smokers were selected with a smoking history >20 pack-years (mean ± SD pack-years, 33.91 ± 12.13). Characteristics between current heavy smokers and nonsmokers were compared. According to the PSM technique, 34 nonsmokers were selected after 1:1 matching for age, fatty infiltration, and tear size-the main prognostic factors of outcomes after rotator cuff repair. Each patient's outcome evaluation was completed anatomically at a minimum of 6 months (magnetic resonance imaging or ultrasonography) and functionally at a minimum of 1 year (pain visual analog scale, range of motion, American Shoulder and Elbow Surgeons, Constant, University of California, Los Angeles, and Simple Shoulder Test scores), and every outcome was analyzed in the matched smoker and nonsmoker groups. RESULTS Current heavy smokers had a higher incidence of male sex ( P < .001), heavy manual work ( P = .025), high bone density ( P = .036), and poor tendinosis grade ( P = .028). After adjustment for the confounding variables by PSM, the matched smoker group showed a significantly higher healing failure rate than the matched nonsmoker group (29.4% vs 5.9%, P = .023). However, we failed to detect significant differences in the functional outcomes between the matched groups ( P > .05). CONCLUSION Smoking affected healing failure after arthroscopic rotator cuff repair. Attention should be paid to smokers, especially current heavy smokers, in cases of rotator cuff repair surgery.
Collapse
Affiliation(s)
- Jung Ho Park
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jayoun Kim
- Research Coordinating Center, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University, College of Medicine, Daegu, Republic of Korea
| | - Joon Yub Kim
- Department of Orthopaedic Surgery, Myungji Hospital, Goyang, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Republic of Korea
| |
Collapse
|
30
|
Kim JY, Yoo BC, Yoon JP, Kang SJ, Chung SW. A Comparison of Clinical and Radiological Outcomes of Minimally Invasive and Conventional Plate Osteosynthesis for Midshaft Clavicle Fractures. Orthopedics 2018; 41:e649-e654. [PMID: 30011053 DOI: 10.3928/01477447-20180711-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/03/2018] [Indexed: 02/03/2023]
Abstract
Thirty patients with displaced midshaft clavicle fractures were prospectively enrolled in this study. Fifteen were randomly assigned to the minimally invasive plate osteosynthesis group and 15 to the conventional plate osteosynthesis group. Constant score, visual analog scale satisfaction score, operative time, scar length, and complications, including hypoesthesia, were evaluated at least 1 year postoperatively to determine functional outcomes and time to bone union as a radiological outcome. Factors related to bone union, including the gap interval between fracture fragments and the number of fracture fragments, were also evaluated. The Constant score and the visual analog scale satisfaction score were higher in the minimally invasive plate osteosynthesis group than in the conventional plate osteosynthesis group; however, there was no significant difference between the groups in these scores or in the time to bone union (all P>.05). Hypoesthesia was the only complication, and its incidence was not different between the groups (P=.249). However, operative time (52.33±13.87 vs 110.33±25.39 minutes, P<.001) and scar length (64.95±3.19 vs 99.39±15.98 mm, P<.001) were significantly shorter in the minimally invasive plate osteosynthesis group than in the conventional plate osteosynthesis group, respectively. In the minimally invasive plate osteosynthesis group, time to bone union was significantly correlated with the gap interval (P=.004) and the number of fracture fragments (P=.002). Minimally invasive plate osteosynthesis showed some superiority over conventional plate fixation for midshaft clavicle fractures, having a shorter operative time and scar length. The time to bone union was influenced by the reduction status and the number of fracture fragments in the minimally invasive plate osteosynthesis group. [Orthopedics. 2018; 41(5):e649-e654.].
Collapse
|
31
|
Chung SW, Han SS, Lee JW, Oh KS, Kim NR, Yoon JP, Kim JY, Moon SH, Kwon J, Lee HJ, Noh YM, Kim Y. Automated detection and classification of the proximal humerus fracture by using deep learning algorithm. Acta Orthop 2018; 89:468-473. [PMID: 29577791 PMCID: PMC6066766 DOI: 10.1080/17453674.2018.1453714] [Citation(s) in RCA: 204] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - We aimed to evaluate the ability of artificial intelligence (a deep learning algorithm) to detect and classify proximal humerus fractures using plain anteroposterior shoulder radiographs. Patients and methods - 1,891 images (1 image per person) of normal shoulders (n = 515) and 4 proximal humerus fracture types (greater tuberosity, 346; surgical neck, 514; 3-part, 269; 4-part, 247) classified by 3 specialists were evaluated. We trained a deep convolutional neural network (CNN) after augmentation of a training dataset. The ability of the CNN, as measured by top-1 accuracy, area under receiver operating characteristics curve (AUC), sensitivity/specificity, and Youden index, in comparison with humans (28 general physicians, 11 general orthopedists, and 19 orthopedists specialized in the shoulder) to detect and classify proximal humerus fractures was evaluated. Results - The CNN showed a high performance of 96% top-1 accuracy, 1.00 AUC, 0.99/0.97 sensitivity/specificity, and 0.97 Youden index for distinguishing normal shoulders from proximal humerus fractures. In addition, the CNN showed promising results with 65-86% top-1 accuracy, 0.90-0.98 AUC, 0.88/0.83-0.97/0.94 sensitivity/specificity, and 0.71-0.90 Youden index for classifying fracture type. When compared with the human groups, the CNN showed superior performance to that of general physicians and orthopedists, similar performance to orthopedists specialized in the shoulder, and the superior performance of the CNN was more marked in complex 3- and 4-part fractures. Interpretation - The use of artificial intelligence can accurately detect and classify proximal humerus fractures on plain shoulder AP radiographs. Further studies are necessary to determine the feasibility of applying artificial intelligence in the clinic and whether its use could improve care and outcomes compared with current orthopedic assessments.
Collapse
Affiliation(s)
| | | | | | | | - Na Ra Kim
- Department of Radiology, Konkuk University School of Medicine, Seoul;
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University College of Medicine, Daegu, Korea;
| | - Joon Yub Kim
- Department of Orthopaedic Surgery, Myungji Hospital, Goyang;
| | - Sung Hoon Moon
- Department of Orthopaedic Surgery, Kangwon National University College of Medicine, Chuncheon, Korea;
| | - Jieun Kwon
- Department of Othopaedic Surgery, National Police Hospital, Seoul;
| | - Hyo-Jin Lee
- Department of Orthopaedic Surgery, Catholic University College of Medicine, Seoul, St Mary’s Hospital, Seoul, Korea;
| | - Young-Min Noh
- Department of Orthopaedic Surgery, Dong-A University College of Medicine, Pusan;
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Korea,Correspondence:
| |
Collapse
|
32
|
Oh JH, Min S, Jung JW, Kim HJ, Kim JY, Chung SW, Kim JY, Yoon JP. Clinical and Radiological Results of Hook Plate Fixation in Acute Acromioclavicular Joint Dislocations and Distal Clavicle Fractures. Clin Shoulder Elb 2018; 21:95-100. [PMID: 33330159 PMCID: PMC7726378 DOI: 10.5397/cise.2018.21.2.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/16/2018] [Accepted: 03/18/2018] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to evaluate the clinical outcomes and complications of hook plate fixation in acromioclavicular (AC) joint dislocations and distal clavicle fractures. Methods We retrospectively reviewed a series of 60 consecutive patients with hook plate fixation for AC joint dislocation (group I) and distal clavicle fracture (group II). Groups I and II had 39 and 21 patients, respectively. Clinical results were evaluated using the pain visual analogue scale (VAS), simple shoulder test, and Constant-Murley scores. In addition, subacromial erosion and stiffness were evaluated as complications. Results At the removal, the pain VAS was 2.69 ± 1.30 and 4.10 ± 2.14 in groups I and II, respectively, which were significantly different (p=0.003). The simple shoulder test score was 9.59 ± 1.60 and 7.81 ± 2.67 in groups I and II, respectively, which were also significantly different (p=0.002). Subacromial erosion was significantly more frequent in group II (14/21 patients, 66.7%) than in group I (15/39 patients, 38.5%) (p=0.037), and stiffness was also higher in group II (17/21 patients, 81.0%) than in group I (22/39 patients, 56.4%), but it was not significant. Conclusions Hook plate fixation showed good clinical and functional results for the treatment of acute unstable AC joint dislocation and distal clavicle fracture. But, in distal clavicle fractures, there are more subacromial erosion and stiffness compare with acute unstable AC joint dislocation.
Collapse
Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seunggi Min
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Jae Wook Jung
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Jae Yoon Kim
- Department of Orthopaedic Surgery, Chung-Ang University School of Medicine, Seoul, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Joon Yub Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| |
Collapse
|
33
|
Yoon JP, Lee CH, Jung JW, Lee HJ, Lee YS, Kim JY, Park GY, Choi JH, Chung SW. Sustained Delivery of Transforming Growth Factor β1 by Use of Absorbable Alginate Scaffold Enhances Rotator Cuff Healing in a Rabbit Model. Am J Sports Med 2018. [PMID: 29543511 DOI: 10.1177/0363546518757759] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The failure rate for healing after rotator cuff repair is relatively high. PURPOSE To establish a system for sustained release of transforming growth factor β1 (TGF-β1) using an alginate scaffold and evaluate the effects of the sustained release of TGF-β1 on rotator cuff healing in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS Before the in vivo animal study, a standard MTS assay was performed to evaluate cell proliferation and metabolic activity on the alginate scaffold. Additionally, an enzyme-linked immunosorbent assay was performed to confirm the capacity of the sustained release of TGF-β1-containing alginate scaffold. Once the in vitro studies were completed, bilateral supraspinatus tendon repairs were performed in 48 rabbits that were allocated to 3 groups (n = 16 each) (group 1, supraspinatus repair only; group 2, supraspinatus repair with TGF-β1 single injection; group 3, supraspinatus repair with TGF-β1 sustained release via an alginate-based delivery system). Biomechanical and histological analyses were performed to evaluate the quality of tendon-to-bone healing at 12 weeks after rotator cuff repair. RESULTS The cell proliferation rate of the alginate scaffold was 122.30% compared with the control (fresh medium) group, which confirmed that the alginate sheet had no cytotoxicity and enhanced cell proliferation. Additionally, the level of TGF-β1 was found to increase with time on the alginate scaffold. Biomechanically, group 3 exhibited a significantly heightened ultimate failure load compared with groups 1 and 2 (group 1, 74.89 ± 29.82 N; group 2, 80.02 ± 34.42 N; group 3, 108.32 ± 32.48 N; P = .011) and more prevalent midsubstance tear compared with group 1 ( P = .028). However, no statistical differences were found in the cross-sectional area of the supraspinatus tendon (group 1, 32.74 ± 9.38; group 2, 33.76 ± 8.89; group 3, 34.80 ± 14.52; P = .882) and ultimate stress (group 1, 2.62 ± 1.13 MPa; group 2, 2.99 ± 1.81 MPa; group 3, 3.62 ± 2.24 MPa; P = .317). Histologically, group 3 exhibited a significantly heightened modified total Bonar score (group 1, 5.00 ± 1.54; group 2, 6.12 ± 1.85; group 3, 7.50 ± 1.31; P = .001). In addition, the tendon-to-bone interface for group 3 demonstrated better collagen orientation, continuity, and organization, and the area of new fibrocartilage formation was more evident in group 3. CONCLUSION At 12 weeks after rotator cuff repair, the authors found improved biomechanical and histological outcomes for sustained release of TGF-β1 using alginate scaffold in a rabbit model. CLINICAL RELEVANCE The alginate-bound growth factor delivery system might improve healing after rotator cuff repair in humans.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Chang-Hwa Lee
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Wook Jung
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Yong-Soo Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ja-Yeon Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ga Young Park
- Department of Bio-fibers and Materials Science, College of Agriculture and Life Science, Kyungpook National University, Daegu, Republic of Korea
| | - Jin Hyun Choi
- Department of Bio-fibers and Materials Science, College of Agriculture and Life Science, Kyungpook National University, Daegu, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
34
|
Chung SW, Oh KS, Kang SJ, Yoon JP, Kim JY. Clinical Outcomes of Arthroscopic Rotator Cuff Repair Using Poly Lactic-co-glycolic Acid Plus β-tricalcium Phosphate Biocomposite Suture Anchors. Clin Shoulder Elb 2018; 21:22-29. [PMID: 33330147 PMCID: PMC7726374 DOI: 10.5397/cise.2018.21.1.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/16/2018] [Accepted: 02/07/2018] [Indexed: 11/30/2022] Open
Abstract
Background This study is performed to evaluate anchor-related outcomes and complications after arthroscopic rotator cuff repair using 30% β-tricalcium phosphate (β-TCP) with 70% poly lactic-co-glycolic acid (PLGA) biocomposite suture anchors. Methods A total of 78 patients (mean age, 61.3 ± 6.9 years) who underwent arthroscopic medium-to-large full-thickness rotator cuff tear repair were enrolled. The technique employed 30% β-TCP with 70% PLGA biocomposite suture anchors at the medial row (38 patients, Healix BRTM anchor [Healix group]; 40 patients, Fixone anchor B [Fixone group]). The radiologic outcomes (including perianchor cyst formation or bone substitution) and anatomical outcomes of the healing failure rate were evaluated using magnetic resonance imaging at least 6 months after surgery, the pain visual analogue scale at 3, 6 months, and final follow-up visit, and American Shoulder and Elbow Surgeons scores at least 1 year postoperatively. Anchor-related complications were also evaluated. Results The perianchor cyst formation incidence was similar for both groups (60.5%, Healix group; 60.0%, Fixone group; p=0.967), although severe perianchor cyst incidence was slightly lower in the Fixone group (15.0%) than in the Healix group (21.1%). There was no occurrence of anchor absorption and bone substitution. No differences were observed in the healing failure rate (13.2%, Healix group; 15.0%, Fixone group; p=0.815) and functional outcome between groups (all p>0.05). Anchor breakage occurred in 5 patients (2 Healix anchors and 3 Fixone anchors); however, there were no major anchor-related complications in either group. Conclusions No differences were observed in the clinical outcomes of the Healix and Fixone groups, neither were there any accompanying major anchor-related complications.
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Jin Kang
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook University College of Medicine, Daegu, Korea
| | - Joon Yub Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| |
Collapse
|
35
|
Yoon JP, Jung JW, Lee CH, Kim YG, Chung SW, Kim JY, Lee HJ, Yoon JW, Lee H. Fatty Degeneration of the Rotator Cuff Reflects Shoulder Strength Deficits in Patients With Rotator Cuff Tears. Orthopedics 2018; 41:e15-e21. [PMID: 29136253 DOI: 10.3928/01477447-20171106-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/19/2017] [Indexed: 02/03/2023]
Abstract
Fatty degeneration is an important clinical factor in patients with rotator cuff tears. Goutallier grade, occupation ratio, and tangent sign help identify fatty degeneration; however, little is known about how closely these measurement techniques correlate with actual muscle strength deficits. The authors evaluated each method's ability to determine the correlation between fatty degeneration and muscle strength deficits. The authors included 203 patients who underwent full-thickness rotator cuff repair (mean age, 61.29±7.92 years). All patients were evaluated with preoperative magnetic resonance imaging to identify fatty degeneration and with an isokinetic test to determine actual shoulder strength. Fatty degeneration was evaluated using Goutallier grade, occupation ratio, and tangent sign. The actual shoulder strength deficit was evaluated by abduction, whereas external and internal rotation were tested using the isokinetic test. More severe fatty degeneration was correlated with lower degrees of abduction, external rotation, and internal rotation. The occupation ratio was more closely correlated with actual muscle strength deficits. However, in patients with massive tears, the correlation between fatty degeneration and muscle strength was less pronounced. Tangent sign (+) findings had a significantly lower strength of external rotation and abduction. The fatty degeneration of the rotator cuff muscle measured by each method was correlated with actual shoulder strength deficits in patients with rotator cuff tears. However, the correlations were less clear in patients with massive rotator cuff tears. Therefore, in cases of massive rotator cuff tears, fatty degeneration was correlated with muscle strength deficits but was not directly proportional to their extent. [Orthopedics. 2018; 41(1):e15-e21.].
Collapse
|
36
|
Yoon JP, Yoon JP. Dose fatty degeneration of rotator cuff reflect shoulder strength deficit in rotator cuff tear patient ? Asia Pac J Sports Med Arthrosc Rehabil Technol 2017. [DOI: 10.1016/j.asmart.2017.05.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
37
|
|
38
|
Chung SW, Choi BM, Kim JY, Lee YS, Yoon JP, Oh KS, Park KS. Altered Gene and Protein Expressions in Torn Rotator Cuff Tendon Tissues in Diabetic Patients. Arthroscopy 2017; 33:518-526.e1. [PMID: 27789071 DOI: 10.1016/j.arthro.2016.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/16/2016] [Accepted: 08/23/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze and compare the gene and protein expression characteristics in torn rotator cuff tendon tissues between diabetic and nondiabetic patients. METHODS This was a pilot study. Twelve samples of rotator cuff tendon tissue from diabetic patients (mean age, 62.3 ± 9.9 years) and 12 age- and sex-matched nondiabetic tendon tissues (62.3 ± 9.9 years) were acquired from the torn tendon end of medium rotator cuff tears during arthroscopic surgery, after applying the same inclusion and exclusion criteria. Expressions of various genes of interest, including collagens I and III, matrix metalloprotease (MMP)-2, MMP-3, MMP-9, MMP-13, interleukin (IL)-1, IL-6, insulin-like growth factor-1, vascular endothelial growth factor, tenomodulin, tumor necrosis factor-α, and p53, were analyzed with real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, immunohistochemistry and western blot assay were performed for the genes that revealed significantly different expressions in real-time qRT-PCR between groups. RESULTS Gene expression levels of MMP-9, MMP-13, IL-6, and tenomodulin were significantly higher in the diabetic than in the nondiabetic group by real-time qRT-PCR analyses (P = .011, .004, .009, and .010, respectively). The density of cells expressing MMP-9 and IL-6 was significantly increased in the torn tendons of the diabetic patients on immunohistochemical analysis, and the density of MMP-9 and IL-6 protein expressions was significantly higher in the diabetic group on western blot (P = .018 and .044, respectively). CONCLUSIONS Diabetic torn cuff tendon tissues showed MMP-9 and IL-6 overexpressions compared with controls. CLINICAL RELEVANCE The overexpressions of MMP-9 and IL-6 may be one of the explanations for the high healing failure rate after rotator cuff repair in the diabetic patients.
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Bo Mi Choi
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ja Yeon Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong-Soo Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea; Korea University College of Medicine, Seoul, Republic of Korea.
| | - Kyung Sik Park
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
39
|
Yoon JP, Kim DH, Chung SW. Patients' Satisfaction after Reverse Total Shoulder Arthroplasty Is Affected by Preoperative Functional Status. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.3.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
40
|
Yoon JP, Chung SW, Kim JY, Lee BJ, Kim HS, Kim JE, Cho JH. Outcomes of Combined Bone Marrow Stimulation and Patch Augmentation for Massive Rotator Cuff Tears. Am J Sports Med 2016; 44:963-71. [PMID: 26851271 DOI: 10.1177/0363546515625044] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The high failure rate after surgical repair of massive rotator cuff tears is a consistent problem. PURPOSE To evaluate the clinical and radiological outcomes of arthroscopic rotator cuff repair with bone marrow stimulation and patch augmentation in patients with massive rotator cuff tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study included 21 patients who underwent bone marrow stimulation and patch augmentation (group 1) and 54 patients who underwent conventional repair (group 2) for massive rotator cuff tears. Postoperative clinical outcomes were evaluated based on visual analog scale (VAS) for pain, simple shoulder test (SST), University of California, Los Angeles (UCLA), Constant, and American Shoulder and Elbow Surgeons (ASES) scores at baseline, 1 year postoperatively, and final follow-up. Anatomic outcomes were evaluated by using postoperative magnetic resonance imaging at 1 year after surgery. RESULTS No significant differences in demographic characteristics and baseline data were observed between groups 1 and 2. Clinical symptoms were significantly improved at the final follow-up in both groups (P < .001). At the final follow-up, no significant differences were found in VAS pain (P = .676), SST (P = .598), UCLA (P = .100), Constant (P = .469), or ASES (P = .880) scores. However, the retear rate was lower in group 1 (4/21, 19.0%) than in group 2 (25/54, 46.3%) (P = .036), and the medial-row failure rate (type 2 retears) was much lower in group 1 (0/4, 0%) than in group 2 (18/25, 72.0%) (P = .014). CONCLUSION Concomitant bone marrow stimulation and patch augmentation significantly reduced retear and medial-row failure rates in the arthroscopic repair of massive rotator cuff tears.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Orthopaedic Surgery, Chung-Ang University School of Medicine, Seoul, Korea
| | - Byung Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyung-Sub Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ju Eun Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jung Hyun Cho
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
41
|
Yoon JP, Chung SW, Kim JE, Kim HS, Lee HJ, Jeong WJ, Oh KS, Lee DO, Seo A, Kim Y. Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial. J Shoulder Elbow Surg 2016; 25:376-83. [PMID: 26927433 DOI: 10.1016/j.jse.2015.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/28/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this prospective randomized study was to compare the efficacy of 3 injection methods, intra-articular injection, subacromial injection, and hydrodilatation (HD), in the treatment of primary frozen shoulder. METHODS Patients with primary frozen shoulder were randomized to undergo intra-articular injection (n = 29), subacromial injection (n = 29), or HD (n = 28). Evaluations using a visual analog scale for pain, Simple Shoulder Test, Constant score, and passive range of shoulder motion were completed before treatment and 1 month, 3 months, and 6 months after treatment. RESULTS Among the 3 injection methods for primary frozen shoulder, HD resulted in a greater range of motion in forward flexion and external rotation, a lower visual analog scale score for pain after 1 month, and better outcomes for all functional scores after 1 month and 3 months of follow-up. However, there were no significant differences in any clinical outcomes among the 3 groups in the final follow-up at 6 months. CONCLUSIONS Although HD yielded more rapid improvement, the 3 injection methods for primary frozen shoulder resulted in similar clinical improvement in the final follow-up at 6 months.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea.
| | - Ju-Eun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyung Sup Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Won-Ju Jeong
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea
| | - Dong-Oh Lee
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea
| | - Anna Seo
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea
| |
Collapse
|
42
|
Cho CH, Oh JH, Jung GH, Moon GH, Rhyou IH, Yoon JP, Lee HM. The Interrater and Intrarater Agreement of a Modified Neer Classification System and Associated Treatment Choice for Lateral Clavicle Fractures. Am J Sports Med 2015; 43:2431-6. [PMID: 26264768 DOI: 10.1177/0363546515593949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND As there is substantial variation in the classification and diagnosis of lateral clavicle fractures, proper management can be challenging. Although the Neer classification system modified by Craig has been widely used, no study has assessed its validity through inter- and intrarater agreement. PURPOSE To determine the inter- and intrarater agreement of the modified Neer classification system and associated treatment choice for lateral clavicle fractures and to assess whether 3-dimensional computed tomography (3D CT) improves the level of agreement. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Nine experienced shoulder specialists and 9 orthopaedic fellows evaluated 52 patients with lateral clavicle fractures, completing fracture typing according to the modified Neer classification system and selecting a treatment choice for each case. Web-based assessment was performed using plain radiographs only, followed by the addition of 3D CT images 2 weeks later. This procedure was repeated 4 weeks later. Fleiss κ values were calculated to estimate the inter- and intrarater agreement. RESULTS Based on plain radiographs only, the inter- and intrarater agreement of the modified Neer classification system was regarded as fair (κ = 0.344) and moderate (κ = 0.496), respectively; the inter- and intrarater agreement of treatment choice was both regarded as moderate (κ = 0.465 and 0.555, respectively). Based on the plain radiographs and 3D CT images, the inter- and intrarater agreement of the classification system was regarded as fair (κ = 0.317) and moderate (κ = 0.508), respectively; the inter- and intrarater agreement of treatment choice was regarded as moderate (κ = 0.463) and substantial (κ = 0.623), respectively. There were no significant differences in the level of agreement between the plain radiographs only and plain radiographs plus 3D CT images for any κ values (all P > .05). CONCLUSION The level of interrater agreement of the modified Neer classification system for lateral clavicle fractures was fair. Additional 3D CT did not improve the overall level of interrater or intrarater agreement of the modified Neer classification system or associated treatment choice. To eliminate a common source of disagreement among surgeons, a new classification system to focus on unclassifiable fracture types is needed.
Collapse
Affiliation(s)
- Chul-Hyun Cho
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Gu-Hee Jung
- Department of Orthopedic Surgery, Gospel Hospital, Kosin University School of Medicine, Busan, South Korea
| | - Gi-Hyuk Moon
- Department of Orthopedic Surgery, Pohang St Mary's Hospital, Pohang, South Korea
| | - In Hyeok Rhyou
- Upper Extremity and Microsurgery Center, Department of Orthopedic Surgery, Pohang Semyeng Christianity Hospital, Pohang, South Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Ho Min Lee
- Department of Orthopedic Surgery, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, South Korea
| |
Collapse
|
43
|
Yoon JP, Chung SW, Yi JH, Lee BJ, Jeon IH, Jeong WJ, Lee HJ. Prognostic Factors of Arthroscopic Extensor Carpi Radialis Brevis Release for Lateral Epicondylitis. Arthroscopy 2015; 31:1232-7. [PMID: 25828167 DOI: 10.1016/j.arthro.2015.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 01/27/2015] [Accepted: 02/06/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to analyze factors affecting the treatment outcomes and prognoses of arthroscopic debridement for refractory lateral epicondylitis. METHODS We included 45 patients who had undergone arthroscopic extensor carpi radialis brevis release for chronic refractory lateral epicondylitis between October 2008 and December 2012. Demographic data, magnetic resonance imaging studies, and arthroscopic findings were examined and analyzed. RESULTS The mean age of the enrolled patients (23 men and 22 women) was 45.9 ± 7.8 years, and the mean follow-up duration was 26.9 ± 9.0 months. All the patients showed significant clinical improvement on all parameters assessed using the visual analog scale (6.9 preoperatively to 0.9 postoperatively), the Upper Extremity Functional Scale (34.8 to 66.7), and the Mayo Elbow Score (63.5 to 92.3) (P < .05). There were no reports of serious surgical complications. At final follow-up, 37 patients (82.2%) were satisfied with their outcomes whereas 8 patients (17.8%) were dissatisfied. In terms of demographic factors, female sex was significantly different between the 2 groups. On preoperative magnetic resonance imaging, 7 patients in the satisfied group (18.9%) had a definite tendon lesion (grade III defect, ≥6 mm) whereas 6 patients in the dissatisfied group (75%) had a grade III defect (P = .016). CONCLUSIONS Overall, clinical outcome scores showed improvement after arthroscopic extensor carpi radialis brevis release for refractory lateral epicondylitis. However, preoperative tendon status and sex were associated with dissatisfaction and poor postoperative outcomes after the arthroscopic release procedure. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Jae Hyuck Yi
- Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Byoung-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Won-Ju Jeong
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| |
Collapse
|
44
|
Chung SW, Kim JY, Yoon JP, Lyu SH, Rhee SM, Oh SB. Arthroscopic repair of partial-thickness and small full-thickness rotator cuff tears: tendon quality as a prognostic factor for repair integrity. Am J Sports Med 2015; 43:588-96. [PMID: 25535097 DOI: 10.1177/0363546514561004] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The healing failure rate is high for partial-thickness or small full-thickness rotator cuff tears. PURPOSE To retrospectively evaluate and compare outcomes after arthroscopic repair of high-grade partial-thickness and small full-thickness rotator cuff tears and factors affecting rotator cuff healing. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Included in the study were 55 consecutive patients (mean age, 57.9 ± 7.2 years) who underwent arthroscopic repair for high-grade partial-thickness (n = 34) and small full-thickness (n = 21) rotator cuff tears. The study patients also underwent magnetic resonance imaging (MRI) preoperatively and computed tomography arthrography (CTA) at least 6 months postoperatively, and their functional outcomes were evaluated preoperatively and at the last follow-up (>24 months). All partial-thickness tears were repaired after being converted to full-thickness tears; thus, the repair process was almost the same as for small full-thickness tears. The tendinosis of the torn tendon was graded from the MRI images using a 4-point scale, and the reliabilities were assessed. The outcomes between high-grade partial-thickness tears that were converted to small full-thickness tears and initially small full-thickness tears were compared, and factors affecting outcomes were evaluated. RESULTS The inter- and intraobserver reliabilities of the tendinosis grade were good (intraclass correlation coefficient, 0.706 and 0.777, respectively). Failure to heal as determined by CTA was observed in 12 patients with a high-grade partial-thickness tear (35.3%; complete failure in 4 and partial failure in 8) and in 3 patients with a small full-thickness tear (14.3%; complete failure in 1 and partial failure in 2). The patients with high-grade partial-thickness rotator cuff tears showed a higher tendinosis grade than did those with small full-thickness tears (P = .014), and the severity of the tendinosis was related to the failure to heal (P = .037). Tears with a higher tendinosis grade showed a 7.64-times higher failure rate (95% CI, 1.43-36.04) than did those with a lower tendinosis grade (P = .013). All functional outcome scores improved after surgery (all P < .001); however, there was no difference between groups. CONCLUSION The high-grade partial-thickness rotator cuff tears showed more severe tendinosis compared with the small full-thickness tears in this study. Contrary to previous impressions that tear size or fatty infiltration is the factor that most influences healing, tendinosis severity assessed by preoperative MRI was the only factor associated with failure to heal, given the numbers available for analysis, in patients with partial-thickness and small full-thickness rotator cuff tears. Surgeons should pay more attention to tendon quality during repair surgery or rehabilitation in smaller rotator cuff tears, especially in high-grade partial-thickness tears with severe tendinosis.
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, Kyung-Pook National University College of Medicine, Daegu, Korea
| | - Seong Hwa Lyu
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Min Rhee
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Se Bong Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
45
|
Yoon JP, Lee BJ, Nam SJ, Chung SW, Jeong WJ, Min WK, Oh JH. Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation. Clin Orthop Surg 2015; 7:97-103. [PMID: 25729525 PMCID: PMC4329540 DOI: 10.4055/cios.2015.7.1.97] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/25/2014] [Indexed: 01/28/2023] Open
Abstract
Background In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. Methods Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. Results The mean VAS scores at the final follow-up were 1.6 ± 1.5 and 1.3 ± 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 ± 9.9 and 89.2 ± 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% ± 50.9% preoperatively to 106.1% ± 10.2% at the final follow-up in group I, and from 239.9% ± 59.2% preoperatively to 133.6% ± 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. Conclusions In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Byoung-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Jin Nam
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Won-Ju Jeong
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Woo-Kie Min
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
46
|
Yoon JP, Chung SW, Kim SH, Oh JH. Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. J Shoulder Elbow Surg 2013; 22:1186-92. [PMID: 23434234 DOI: 10.1016/j.jse.2012.12.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/21/2012] [Accepted: 12/02/2012] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The lift-off, internal rotation lag sign, belly-press, and bear-hug tests are widely used to evaluate the integrity of the subscapularis. We hypothesized that these tests might reflect different types of subscapularis tears and sought to ascertain whether these tests accurately determine the severity of the internal rotation strength deficit and fatty degeneration. METHODS Isokinetic testing and the 4 clinical tests were used preoperatively to evaluate 312 patients who had undergone arthroscopic rotator cuff surgery. Of these, 37 patients had a full-thickness subscapularis tear, 96 had a partial-thickness tear, and 179 had no tear. RESULTS For differentiating any tears from an intact subscapularis, the most sensitive test was the belly-press test (27.8%), and the most specific test was the lift-off test (100%). For differentiating a full-thickness tear from a partial tear, the most sensitive test was the belly-press test (56.8%), and the most specific was the lift-off test (96.9%). A positive lift-off test also most reflected loss of internal rotation strength (mean, 72.2%; 95% confidence interval, 61.9-82.5), followed by the internal rotation lag sign (55.1%; 44.2-66.1) and the belly-press test (45.9%; 36.4-54.4). CONCLUSIONS A positive lift-off test was highly specific for the detection of a full-thickness subscapularis tear and to reflect severe fatty degeneration. The lift-off, internal rotation lag sign, belly-press, and bear-hug tests sequentially predict internal rotation strength deficit and provide discrimination of internal rotation strength impairment.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | | | | | | |
Collapse
|
47
|
Abstract
Lipoma arborescens, a rare benign intra-articular lesion, is characterized by lipomatous proliferation of the synovium in which the subsynovial tissue is replaced by mature adipocytes. Subdeltoid bursa is a rare location for lipoma arborescens, and only a few cases have been reported in the literature. This article reports 2 cases of subdeltoid lipoma arborescens combined with rotator cuff tears, and the possible relationships between subdeltoid lipoma arborescens and rotator cuff tears are discussed. The intra-articular villous proliferations on fat-suppressed T2-weighted magnetic resonance imaging appeared as yellowish-white lipomatous villous proliferations on arthroscopy, and finger-like lipomatous proliferation of the synovium, where the subsynovial connective tissue is replaced by mature adipocytes, on histology. Although further evidence would be necessary, the bony proliferations, in addition to bone-to-bone abrasion and inflammatory processes, may contribute to the relationship between subdeltoid lipoma arborescens and rotator cuff tears. Because this is a rare disease in a rare location, no established treatment guidelines are available for lipoma arborescens in subdeltoid bursa. For the current patients, arthroscopic excision of the lipoma arborescens and concomitant rotator cuff repair were prescribed after more than 6 months of conservative management. All patients had symptom relief and were satisfied with their results. Paying special attention to the radiologic and arthroscopic characteristics of the lipoma arborescens will help physicians and surgeons to achieve a more accurate diagnosis and effective treatment strategy, especially in patients with concomitant rotator cuff tears.
Collapse
|
48
|
Chung SW, Kim SH, Tae SK, Yoon JP, Choi JA, Oh JH. Is the supraspinatus muscle atrophy truly irreversible after surgical repair of rotator cuff tears? Clin Orthop Surg 2013; 5:55-65. [PMID: 23467404 PMCID: PMC3582872 DOI: 10.4055/cios.2013.5.1.55] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/05/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atrophy of rotator cuff muscles has been considered an irreversible phenomenon. The purpose of this study is to evaluate whether atrophy is truly irreversible after rotator cuff repair. METHODS We measured supraspinatus muscle atrophy of 191 patients with full-thickness rotator cuff tears on preoperative magnetic resonance imaging and postoperative multidetector computed tomography images, taken at least 1 year after operation. The occupation ratio was calculated using Photoshop CS3 software. We compared the change between pre- and postoperative occupation ratios after modifying the preoperative occupation ratio. In addition, possible relationship between various clinical factors and the change of atrophy, and between the change of atrophy and cuff integrity after surgical repair were evaluated. RESULTS The mean occupation ratio was significantly increased postoperatively from 0.44 ± 0.17 to 0.52 ± 0.17 (p < 0.001). Among 191 patients, 81 (42.4%) showed improvement of atrophy (more than a 10% increase in occupation ratio) and 33 (17.3%) worsening (more than a 10% decrease). Various clinical factors such as age tear size, or initial degree of atrophy did not affect the change of atrophy. However, the change of atrophy was related to repair integrity: cuff healing failure rate of 48.5% (16 of 33) in worsened atrophy; and 22.2% (18 of 81) in improved atrophy (p = 0.007). CONCLUSIONS The supraspinatus muscle atrophy as measured by occupation ratio could be improved postoperatively in case of successful cuff repair.
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
49
|
Yoon JP, Yoo JH, Chang CB, Kim SJ, Choi JY, Yi JH, Kim TK. Prediction of chronicity of anterior cruciate ligament tear using MRI findings. Clin Orthop Surg 2013; 5:19-25. [PMID: 23467216 PMCID: PMC3582867 DOI: 10.4055/cios.2013.5.1.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/29/2012] [Indexed: 11/06/2022] Open
Abstract
Background The estimation of anterior cruciate ligament (ACL) tear is required in certain cases involving legal and financial administration, such as the worker's compensation and/or insurance. The aim of this study is to propose and evaluate a quantitative evaluation instrument to estimate the chronicity of the ACL tear, based on the four magnetic resonance imaging (MRI) findings. Methods One hundred and fifty one cases of complete ACL tear confirmed by arthroscopy were divided into 4 groups according to the time from ACL injury to MRI acquisition: acute (< 6 weeks), subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (> 1 year). The four MRI findings including ACL morphology, joint effusion, posterior cruciate ligament angle, and bone bruise were analyzed for temporal changes among the 4 groups. Binary logistic regression equations were formulated using the MRI findings to estimate the chronicity of ACL tear in a quantitative manner, and the accuracy of the formulated regression equations was evaluated. Results The four MRI findings showed substantial temporal correlation with the time-limits of ACL injury to be included in the estimation model. Three predictive binary logistic equations estimated the probability of the ACL injury for the three cutoff time-limits of 6 weeks, 3 months, and 1 year with accuracies of 82.1%, 89.4%, and 89.4%, respectively. Conclusions A series of predictive logistic equations were formulated to estimate the chronicity of ACL tear using 4 MRI findings with chronological significance.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
Background To specify what patients want and worry preoperatively is important in orthopedic practice. The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery, and to evaluate the differences in expectations and concerns by age and gender. Methods We prospectively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008. Three questionnaires were completed before surgery: the first one addressing preoperative patient's expectation, the second one focusing on concerns by covering 64 items using a visual analogue scale, and the third one evaluating patient's demographic characteristics. The characteristics of preoperative expectation, concern, and demographic data were evaluated according to gender and age group. Results Female patients had lower level of sports activity (p = 0.007) and lower levels of information (p = 0.028). Gender specific worries are about a caregiver during hospital stay, operating on the working side, fear about ugly scars, postoperative pain, applying makeup or combing hair. The older group responded that they can't be willing to change activities of daily living (p = 0.001), are not living with a spouse (p = 0.002), had previous shoulder operation history (p = 0.008), and had a lower level of information (p = 0.007). They especially worried about medical bills, worried about the physician being too young and inexperienced, postoperative pain, loss of arm function, and hospital food. Conclusions Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery. This can empower patients to formulate realistic expectations and make informed decisions. We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | | | | | | | | | | |
Collapse
|