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Park J.-Y.,Konkuk University | Siti H.T.,Institute of Orthopaedics and Traumatology | Keum J.-S.,Konkuk University | Moon S.-G.,Konkuk University | Oh K.-S.,Konkuk University
Clinical Orthopaedics and Related Research | Year: 2010

Biomechanical studies suggest a suture bridge technique enhances rotator cuff tendon footprint contact area, holding strength, and mean contact pressure. Based on these studies, we asked whether (1) the suture bridge technique would provide a high rate of cuff integrity after surgery, (2) the status of the repaired cuff would change with time, (3) preoperative factors could predict postoperative cuff integrity, and (4) patients with retears had less favorable pain, functional scores, range of motion (ROM), and muscle strength compared with those with intact repairs. We prospectively followed 78 patients with arthroscopic repairs in whom we used the suture bridge technique. The integrity of the rotator cuff repair was determined using ultrasonographic evaluation at 4.5 and 12 months after surgery. Ultrasonography revealed intact cuffs in 91% at 4.5 months postoperatively, all of which were maintained at the 12-month followup. Failure rates were 17.6% (three of 17) for massive tears, 11.1% (two of 18) for large tears, 6.3% (two of 32) for medium tears, and no failures for small tears. Preoperative fatty degeneration of the supraspinatus muscle was a strong predictor of cuff integrity. We found no correlation between the integrity and clinical outcomes except for a temporary decrease of abduction strength at 6 months. Arthroscopic repair using suture bridge technique can achieve a low retear rate in shoulders treated for rotator cuff tears, but the occurrence of retear did not influence the outcome. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2009 The Association of Bone and Joint Surgeons®. Source

Jung Y.-B.,Hyundae General Hospital | Jung H.-J.,Chung - Ang University | Siti H.-T.,Institute of Orthopaedics and Traumatology | Lee Y.S.,Gachon University | And 3 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2011

Purpose: To evaluate the stability and functional outcomes of anterior cruciate ligament (ACL) reconstruction by tensioning of the ACL remnant using pullout sutures compared with a remnant preservation technique only. Methods: The data of 33 patients who underwent ACL reconstruction by a remnant tensioning technique (tensioning group) were reviewed retrospectively and compared with the data of 43 patients who underwent ACL reconstruction with remnant preservation without tensioning (preservation-only group) from September 2004 to April 2008 with a minimum follow-up of 2 years. The stability and function were assessed from the side-to-side difference with a KT-1000 arthrometer (MEDmetric, San Diego, CA) and Telos device (Austin & Associates, Fallston, MD), as well as International Knee Documentation Committee and Orthopadische Arbeitsgruppe Knie scores. Results: There were no significant differences between the groups with respect to the subjective and objective International Knee Documentation Committee scores (P =.808 and P =.152, respectively) and Orthopadische Arbeitsgruppe Knie score (P =.702) at the last follow-up. No significant differences in mechanical stability were observed with the KT-1000 arthrometer and stress radiographs between the groups (P =.650 and P =.791, respectively). The remnant tensioning group took a longer surgical time than the preservation-only group (156.4 minutes v 134.5 minutes, P =.117). Conclusions: The ACL remnant tensioning procedure did not improve the final results of an ACL reconstruction in terms of the clinical function and stability compared with an ACL reconstruction using the preservation-only technique. © 2011 Arthroscopy Association of North America. Source

Kim S.H.,Chung - Ang University | Jung Y.B.,Joint Center | Song M.K.,Chung - Ang University | Lee S.H.,Kyung Hee University | And 4 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013

Purpose: The purpose of this study was to evaluate the stability and functional outcomes of anterior cruciate ligament (ACL) reconstruction by tensioning of the ACL remnant using pull-out sutures compared with ACL double-bundle reconstruction. Methods: Forty-four patients were included in single-bundle reconstruction with remnant tensioning group (Group 1), and 56 patients were included in the double-bundle reconstruction group (Group 2). The remnant tissue was tensioned to the direction of posterolateral bundle, which unrelated to the type of remnant bundle. Objective knee stability was evaluated by anterior stress radiography, KT-1000 and lateral pivot shift tests. The Tegner activity scale, International Knee Documentation Committee and OrthopädischeArbeitsgruppeKnie scoring systems were used for clinical evaluation. Results: No statistically significant intergroup differences were observed in mechanical stability and clinical results (n.s). However, surgical time of remnant tensioning group is shorter than double-bundle reconstruction group (P = 0.005). Conclusion: Remnant tensioning suture with single-bundle reconstruction could be used with positive results as good as double-bundle technique if a good ACL remnant was found bridging the femur and tibia, rather than debride or damage to the remnant tissue during operation. Level of evidence: Retrospective, comparative cohort study, Level IV. © 2013 Springer-Verlag Berlin Heidelberg. Source

Park J.-Y.,Konkuk University | Siti H.-T.,Institute of Orthopaedics and Traumatology | O K.-S.,Konkuk University | Chung K.-T.,Dankook University | And 2 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2010

Purpose: Our aim was to verify the association of fullness over the skin distal to anterior acromion termed " ballooning" in relation to accuracy of subacromial injection and determine its accuracy in terms of sensitivity, specificity, and predictive value. We hypothesized that a positive ballooning was a sign of an accurately placed injection into the subacromial bursa. Methods: Data of 136 shoulders with impingement, which received subacromial steroid injections, were evaluated for presence of ballooning signs, pain, motion, and muscle strength. Injections were performed via anterolateral approach, followed by radiographs to locate the contrast. Data were compared between pre- and post-injections as well as between accurate and inaccurate groups to evaluate the correlations between targeting accuracy and immediate outcomes. Results: Ballooning signs were positive in 104 shoulders (76.5%), of which majority were inaccurate (58.7%). The accuracy rate was 49.3% with sensitivity of 64.2%, specificity 11.6% and positive as well as negative predictive values of 41.3% and 25% consecutively. Dispersal rate to the surrounding structures was 86.6% with majority infiltrated the deltoid (29.4%). Significant improvement was noted between pre- and post-injections in all parameters except muscle strength, indicating equal pain relief regardless of locations. Conclusion: The ballooning sign is not a reliable indicator for or against subacromial injection. Blind subacromial injections are frequently inaccurate using the anterolateral approach. Nevertheless, immediate improvement of pain, motion, and muscle strength can be expected regardless of location. © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Source

Xia B.,Shaoxing Hospital of Traditional Chinese Medicine | Xia B.,Zhejiang Chinese Medical University | Di Chen,Zhejiang Chinese Medical University | Di Chen,Rush University Medical Center | And 8 more authors.
Calcified Tissue International | Year: 2014

Osteoarthritis (OA), the most prevalent chronic joint disease, increases in prevalence with age, and affects majority of individuals over the age of 65 and is a leading musculoskeletal cause of impaired mobility in the elderly. Because the precise molecular mechanisms which are involved in the degradation of cartilage matrix and development of OA are poorly understood and there are currently no effective interventions to decelerate the progression of OA or retard the irreversible degradation of cartilage except for total joint replacement surgery. In this paper, the important molecular mechanisms related to OA pathogenesis will be summarized and new insights into potential molecular targets for the prevention and treatment of OA will be provided. © 2014, Springer Science+Business Media New York. Source

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