Center for Joint Surgery

Seoul, South Korea

Center for Joint Surgery

Seoul, South Korea
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Shon M.S.,Center for Joint Surgery | Koh K.H.,Inje University | Lim T.K.,Eulji University | Kim W.J.,Center for Joint Surgery | And 2 more authors.
American Journal of Sports Medicine | Year: 2015

Background: Arthroscopic partial repair is a treatment option in irreparable large-to-massive rotator cuff tears without arthritic changes. However, there are indications that arthroscopic partial repair does not yield satisfactory outcomes. Purpose: To report the clinical and radiographic results of arthroscopic partial repairs in patients with irreparable large-to-massive cuff tears. In addition, an analysis was performed regarding preoperative factors that may influence patient outcomes and patient-rated satisfaction over time. Study Design: Case series; Level of evidence, 4. Methods: From 2005 to 2011, a total of 31 patients who underwent arthroscopic partial repair for irreparable large-to-massive cuff tears were retrospectively evaluated. Partial repair was defined as posterior cuff tissue repair with or without subscapularis tendon repair to restore the transverse force couple of the cuff. Pain visual analog scale (PVAS), questionnaire results (American Shoulder and Elbow Surgeons [ASES] and Simple Shoulder Test [SST]), and radiographic changes (acromiohumeral distance and degenerative change) were assessed preoperatively, at first follow-up (roughly 1 year postoperatively), and at final follow-up (>2 years postoperatively). Patients rated their satisfaction level at each postoperative follow-up as well. Preoperative factors that might influence outcomes, such as patient demographics, tear size, and fatty infiltration, were investigated. Results: The preoperative, first follow-up, and final follow-up results for mean PVAS (5.13, 2.13, and 3.16, respectively) and questionnaires (ASES: 41.97, 76.37, and 73.78; SST: 3.61, 6.33, and 6.07, respectively) improved significantly (all P <.05). Radiographic evaluation showed no difference compared with preoperative status. Nevertheless, patient-rated satisfaction at final evaluation was inferior: 16 good responses ("very satisfied" and "satisfied") and 15 poor responses ("rather the same" and "dissatisfied"). Despite initial improvements in both groups (P <.05), patients with poor satisfaction demonstrated statistically significant deterioration in mean PVAS (from 2.07 to 4.67), questionnaire scores (ASES: from 74.56 to 59.80; SST: from 5.11 to 3.81), and acromiohumeral distance (from 7.19 to 5.06 mm) between the first and final follow-up (all P <.05). Patients with good satisfaction showed no significant difference or they improved (P >.05) from the first to the final follow-up. Among preoperative factors, fatty infiltration of the teres minor was identified as the only statistically significant factor affecting patient-rated satisfaction (P =.007). Conclusion: This study showed that arthroscopic partial repair may produce initial improvement in selected outcomes at 2-year follow-up. However, about half of the patients in the study were not satisfied with their outcomes, which had deteriorated over time. Preoperative fatty infiltration of the teres minor was the only factor that correlated with worse final outcomes and poor satisfaction after arthroscopic partial repair. © American Orthopaedic Society for Sports Medicine.


PubMed | Inje University, Sungkyunkwan University, Eulji University, Chungnam National University and Center for Joint Surgery
Type: Journal Article | Journal: The American journal of sports medicine | Year: 2015

Arthroscopic partial repair is a treatment option in irreparable large-to-massive rotator cuff tears without arthritic changes. However, there are indications that arthroscopic partial repair does not yield satisfactory outcomes.To report the clinical and radiographic results of arthroscopic partial repairs in patients with irreparable large-to-massive cuff tears. In addition, an analysis was performed regarding preoperative factors that may influence patient outcomes and patient-rated satisfaction over time.Case series; Level of evidence, 4.From 2005 to 2011, a total of 31 patients who underwent arthroscopic partial repair for irreparable large-to-massive cuff tears were retrospectively evaluated. Partial repair was defined as posterior cuff tissue repair with or without subscapularis tendon repair to restore the transverse force couple of the cuff. Pain visual analog scale (PVAS), questionnaire results (American Shoulder and Elbow Surgeons [ASES] and Simple Shoulder Test [SST]), and radiographic changes (acromiohumeral distance and degenerative change) were assessed preoperatively, at first follow-up (roughly 1 year postoperatively), and at final follow-up (>2 years postoperatively). Patients rated their satisfaction level at each postoperative follow-up as well. Preoperative factors that might influence outcomes, such as patient demographics, tear size, and fatty infiltration, were investigated.The preoperative, first follow-up, and final follow-up results for mean PVAS (5.13, 2.13, and 3.16, respectively) and questionnaires (ASES: 41.97, 76.37, and 73.78; SST: 3.61, 6.33, and 6.07, respectively) improved significantly (all P < .05). Radiographic evaluation showed no difference compared with preoperative status. Nevertheless, patient-rated satisfaction at final evaluation was inferior: 16 good responses (very satisfied and satisfied) and 15 poor responses (rather the same and dissatisfied). Despite initial improvements in both groups (P < .05), patients with poor satisfaction demonstrated statistically significant deterioration in mean PVAS (from 2.07 to 4.67), questionnaire scores (ASES: from 74.56 to 59.80; SST: from 5.11 to 3.81), and acromiohumeral distance (from 7.19 to 5.06 mm) between the first and final follow-up (all P < .05). Patients with good satisfaction showed no significant difference or they improved (P > .05) from the first to the final follow-up. Among preoperative factors, fatty infiltration of the teres minor was identified as the only statistically significant factor affecting patient-rated satisfaction (P = .007).This study showed that arthroscopic partial repair may produce initial improvement in selected outcomes at 2-year follow-up. However, about half of the patients in the study were not satisfied with their outcomes, which had deteriorated over time. Preoperative fatty infiltration of the teres minor was the only factor that correlated with worse final outcomes and poor satisfaction after arthroscopic partial repair.


Tinius M.,Center for Joint Surgery | Hepp P.,University of Leipzig | Becker R.,City Hospital
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2012

Purpose: Patients presenting anterior cruciate ligament (ACL) deficiency and isolated osteoarthritis of the medial compartment are treated either with biplanar osteotomy or with total knee arthroplasty (TKA). However, these patients between the forties and fifties are often very active in daily life and feel limited due to their knee. In order to follow the idea of preserving as much as possible from the joint, the concept of unicondylar joint replacement in conjunction with ACL reconstruction has been followed. There seems to be a limited experience with this concept. The purpose of the follow-up study was to evaluate the midterm clinical and functional outcome. Methods: Twenty-seven patients were followed up for 53 months. The mean age of the 11 men and 16 women was 44 years. All patients were treated by combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Results: The Knee Society Score improved significantly from 77.1 ± 11.6 points to 166.0 ± 12.1 points (P ≤ 0.01). No revision surgery was required and no radiolucent lines were observed on the radiographs at the time of follow-up. The anterior translation showed less than 5 mm in 24 patients and 5 mm in the remaining 3 patients. Conclusions: The midterm clinical data have shown that combined surgery of UKA and anterior cruciate ligament reconstruction has revealed promising results. The restored knee stability seems to prevent the failure of UKA. However, long-term follow-up studies are required in these patients who received partial joint replacement fairly early in their life. Level of evidence: IV. © 2011 Springer-Verlag.


Shon M.S.,Center for Joint Surgery | Jung S.-W.,Sungkyunkwan University | Kim J.W.,Center for Joint Surgery | Yoo J.C.,Sungkyunkwan University
Journal of Shoulder and Elbow Surgery | Year: 2015

Background: The purpose of this study was to report the outcomes of all-intra-articular arthroscopic decompression and labral repair in patients with symptomatic paralabral cysts. Methods: From 2005 to 2011, 20 consecutive cases of symptomatic paralabral cysts were included in this study. All surgical procedures were conducted with intra-articular arthroscopic decompression by use of a probe through the site of labral tear for cyst evacuation and suture anchor repair for the associated posterosuperior labrum. Clinical scores and magnetic resonance imaging (MRI) were obtained preoperatively and at follow-up. MRI was used to evaluate the size and segmentation of the cyst and the presence of the labral tear. Results: MRI revealed paralabral cysts in association with labral tears in all cases. Cysts were extended in the spinoglenoid notch with a mean size of 2.5×2.6×2.2cm on MRI. Cysts were nonsegmented in 5 cases (25%) and had multiple segments in 15 cases (75%). Mean follow-up was 42.8±21.22months. The mean visual analog scale score for pain, the American Shoulder and Elbow Surgeons score, and the Simple Shoulder Test score significantly improved at the last follow-up (. P<.001, P<.001, and P=.001, respectively). The postoperative MRI study performed at a mean of 6 months for 18 of 20 cases (90%) revealed complete cyst removal. The satisfaction level with surgery was good to excellent in 18 patients, fair in 1 patient, and poor in 1 patient. No complication was related to the surgical procedure. Conclusion: Arthroscopic all-intra-articular decompression and labral repair of paralabral cyst can be a simple and effective treatment, regardless of segmentation or size. It also resulted in complete removal of the cyst at a mean of 6 months postoperatively as revealed by MRI. An additional subacromial procedure might not be necessary for complete decompression. © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.


PubMed | Sungkyunkwan University and Center for Joint Surgery
Type: Journal Article | Journal: Journal of shoulder and elbow surgery | Year: 2014

The purpose of this study was to report the outcomes of all-intra-articular arthroscopic decompression and labral repair in patients with symptomatic paralabral cysts.From 2005 to 2011, 20 consecutive cases of symptomatic paralabral cysts were included in this study. All surgical procedures were conducted with intra-articular arthroscopic decompression by use of a probe through the site of labral tear for cyst evacuation and suture anchor repair for the associated posterosuperior labrum. Clinical scores and magnetic resonance imaging (MRI) were obtained preoperatively and at follow-up. MRI was used to evaluate the size and segmentation of the cyst and the presence of the labral tear.MRI revealed paralabral cysts in association with labral tears in all cases. Cysts were extended in the spinoglenoid notch with a mean size of 2.52.62.2cm on MRI. Cysts were nonsegmented in 5 cases (25%) and had multiple segments in 15 cases (75%). Mean follow-up was 42.821.22months. The mean visual analog scale score for pain, the American Shoulder and Elbow Surgeons score, and the Simple Shoulder Test score significantly improved at the last follow-up (P<.001, P<.001, and P=.001, respectively). The postoperative MRI study performed at a mean of 6 months for 18 of 20 cases (90%) revealed complete cyst removal. The satisfaction level with surgery was good to excellent in 18 patients, fair in 1 patient, and poor in 1 patient. No complication was related to the surgical procedure.Arthroscopic all-intra-articular decompression and labral repair of paralabral cyst can be a simple and effective treatment, regardless of segmentation or size. It also resulted in complete removal of the cyst at a mean of 6 months postoperatively as revealed by MRI. An additional subacromial procedure might not be necessary for complete decompression.


PubMed | Seoul National University and Center for Joint Surgery
Type: Journal Article | Journal: Knee surgery & related research | Year: 2016

Correlations between maximum flexion and functional outcomes in total knee arthroplasty (TKA) patients are reportedly weak. We investigated whether there are differences between passive maximum flexion in nonweight bearing and other types of maximum flexion and whether the type of maximum flexion correlates with functional outcomes.A total of 210 patients (359 knees) underwent preoperative evaluation and postoperative follow-up evaluations (6, 12, and 24 months) for the assessment of clinical outcomes including maximum knee flexion. Maximum flexion was measured under five conditions: passive nonweight bearing, passive weight bearing, active nonweight bearing, and active weight bearing with or without arm support. Data were analyzed for relationships between passive maximum flexion in nonweight bearing by Pearson correlation analyses, and a variance comparison between measurement techniques via paired t test.We observed substantial differences between passive maximum flexion in nonweight bearing and the other four maximum flexion types. At all time points, passive maximum flexion in nonweight bearing correlated poorly with active maximum flexion in weight bearing with or without arm support. Active maximum flexion in weight bearing better correlated with functional outcomes than the other maximum flexion types.Our study suggests active maximum flexion in weight bearing should be reported together with passive maximum flexion in nonweight bearing in research on the knee motion arc after TKA.


Sohn H.-S.,Center for Joint Surgery | Kim W.J.,Center for Joint Surgery | Shon M.S.,Center for Joint Surgery
Injury | Year: 2015

Background Current literatures describe good clinical outcomes of acute displaced fracture of clavicle treated with minimally invasive plate osteosynthesis (MIPO). But, there are little comparative data of the outcomes between open plating and MIPO techniques. We compared the outcomes of open plating and MIPO for treatment of acute displaced clavicular shaft fractures. Materials and methods The author performed a retrospective review on a consecutive series of patients with clavicular shaft fracture who underwent open plating or MIPO. Fourteen patients were treated with open plating with interfragmentary screw fixation, and 19 were treated with the MIPO technique without exposing a fracture site itself. A superior plating method was applied to both groups. Patient demographics, clinical outcomes using Constant score and University of California Los Angeles (UCLA) shoulder score, operation time, union rate, complications, and radiographic evaluation were evaluated. Results There were no statistically significant differences in the demographic data, including patient's variables (age, gender, involved side, smoking, alcohol, and diabetic status) and fracture characteristics (trauma mechanism, distribution of fracture type, presence of polytrauma, and time from trauma to surgery) between the two groups. Mean operation time was 87.5 min in open plating and 77.2 min in MIPO (p = 0.129). The mean time to union was 15.7 weeks in patients who underwent open plating and 16.8 weeks in patients who underwent MIPO (p = 0.427). Although there was no significant difference, nonunion developed 1 case in MIPO while none was in open plating. Four patients in open plating had skin numbness (none in MIPO, p = 0.024). There was no significant difference in the Constant score and UCLA score of the two surgical methods. Conclusion This study showed that both open plating with interfragmentary screw fixation (Open plating) and minimally invasive plate osteosynthesis (MIPO) are equally effective and safe treatment methods for acute displaced clavicle shaft fracture. © 2015 Elsevier Ltd. All rights reserved.


PubMed | Center for Joint Surgery
Type: Evaluation Studies | Journal: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA | Year: 2012

Patients presenting anterior cruciate ligament (ACL) deficiency and isolated osteoarthritis of the medial compartment are treated either with biplanar osteotomy or with total knee arthroplasty (TKA). However, these patients between the forties and fifties are often very active in daily life and feel limited due to their knee. In order to follow the idea of preserving as much as possible from the joint, the concept of unicondylar joint replacement in conjunction with ACL reconstruction has been followed. There seems to be a limited experience with this concept. The purpose of the follow-up study was to evaluate the midterm clinical and functional outcome.Twenty-seven patients were followed up for 53months. The mean age of the 11 men and 16 women was 44years. All patients were treated by combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction.The Knee Society Score improved significantly from 77.111.6 points to 166.012.1 points (P0.01). No revision surgery was required and no radiolucent lines were observed on the radiographs at the time of follow-up. The anterior translation showed less than 5mm in 24 patients and 5mm in the remaining 3 patients.The midterm clinical data have shown that combined surgery of UKA and anterior cruciate ligament reconstruction has revealed promising results. The restored knee stability seems to prevent the failure of UKA. However, long-term follow-up studies are required in these patients who received partial joint replacement fairly early in their life.IV.


PubMed | Center for Joint Surgery
Type: Comparative Study | Journal: Injury | Year: 2015

Current literatures describe good clinical outcomes of acute displaced fracture of clavicle treated with minimally invasive plate osteosynthesis (MIPO). But, there are little comparative data of the outcomes between open plating and MIPO techniques. We compared the outcomes of open plating and MIPO for treatment of acute displaced clavicular shaft fractures.The author performed a retrospective review on a consecutive series of patients with clavicular shaft fracture who underwent open plating or MIPO. Fourteen patients were treated with open plating with interfragmentary screw fixation, and 19 were treated with the MIPO technique without exposing a fracture site itself. A superior plating method was applied to both groups. Patient demographics, clinical outcomes using Constant score and University of California Los Angeles (UCLA) shoulder score, operation time, union rate, complications, and radiographic evaluation were evaluated.There were no statistically significant differences in the demographic data, including patients variables (age, gender, involved side, smoking, alcohol, and diabetic status) and fracture characteristics (trauma mechanism, distribution of fracture type, presence of polytrauma, and time from trauma to surgery) between the two groups. Mean operation time was 87.5 min in open plating and 77.2 min in MIPO (p=0.129). The mean time to union was 15.7 weeks in patients who underwent open plating and 16.8 weeks in patients who underwent MIPO (p=0.427). Although there was no significant difference, nonunion developed 1 case in MIPO while none was in open plating. Four patients in open plating had skin numbness (none in MIPO, p=0.024). There was no significant difference in the Constant score and UCLA score of the two surgical methods.This study showed that both open plating with interfragmentary screw fixation (Open plating) and minimally invasive plate osteosynthesis (MIPO) are equally effective and safe treatment methods for acute displaced clavicle shaft fracture.

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