BACKGROUND: A novel technique for the repair of tears of the upper subscapularis tendon—intraarticular knotless fixation—has been introduced recently. The purpose of this study was to evaluate the clinical and structural outcomes of arthroscopic intraarticular knotless fixation for the treatment of upper subscapularis tendon tears. METHODS: We retrospectively analyzed the clinical and radiological outcomes of 27 patients who underwent arthroscopic intraarticular knotless fixation for upper subscapularis tendon tears. Finally, a total of 10 patients who could participate in at least a 6 month follow-up of magnetic resonance imaging evaluation and in a least 1-year follow-up on an outpatient basis were enrolled in our study. The mean age at the time of operation was 60.7 years, and the mean duration of follow-up was 14.7 months. Two patients had concomitant tears of the supraspinatus tendon and 8 patients had concomitant tears of the supraspinatus and the infraspinatus tendons. RESULTS: The clinical and radiological outcomes improved after the patients had undertaken arthroscopic intraarticular knotless fixation. The mean visual analogue scale score for pain during motion improved from 6.7 preoperatively to 1.4 at the final follow-up (p<0.001). The mean Constant score improved from 59.3 preoperatively to 79.6 at the final follow-up, and the mean the University of California at Los Angeles score, from 21.7 to 30.2, respectively (p<0.001 and p<0.001). The upper subscapularis tendon tear was healed in every patient except one (90%), for the patient had suffered from a postoperative trauma that resulted in a retear. CONCLUSIONS: We found that arthroscopic intraarticular knotless fixation gives good clinical and structural outcomes for the repair of upper subscapularis tendon tears. Arthroscopic intraarticular knotless fixation provided such a reliable and efficient restoration of the subscapularis tendon footprint that we anticipate it will become a widely-used procedure for upper subscapularis tendon tears.
Arthroscopy ; California ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Outpatients ; Retrospective Studies ; Shoulder ; Tears* ; Tendons* ; Treatment Outcome

BACKGROUND: The purpose of our study was to evaluate the functional and radiologic outcomes of additive augmentation sutures through rotator cuff for proximal humeral fractures stabilized locking plate in elderly patients. METHODS: We enrolled 74 patients over the age of 60 years who received internal fixation using locking plates for proximal humeral fractures. Of these, 50 patients had additive augmentation sutures through rotator cuff. The mean age at the time of surgery was 72.1 years (range, 60-89 years), and the mean follow-up period was 17.5 months (range, 12-62 months). The humeral neck-shaft angle and humeral head height were used as radiological markers to assess the effect of additive augmentation sutures through rotator cuff. We allocated the patients who received additive augmentation sutures into group A and those who did not into group B. RESULTS: At the final follow-up, the mean Korean Showlder Society score and Constant scores were 88.96 +/- 12.1 and 86.6 +/- 11.9, respectively, in group A and 86.21 +/- 11.8 and 85.3 +/- 11.7, respectively, in group B (p=0.368, 0.271). At the final follow-up, the mean loss in humeral neck-shaft angle from the time of immediate postoperative measurement was 1.6degrees in group A and 4.8degrees in group B, whereas the mean loss in humeral head height was 0.82 mm in group A and 0.52 mm in group B (p=0.029, 0.178). CONCLUSIONS: The surgical outcomes of internal fixation using locking plates for proximal humeral fractures were clinically and radiologically good in elderly patients over the age of 60 years without any observable complications. Further, the loss of humeral head shaft angle at the final follow-up from its initial postoperative measurement was significantly smaller in patients who received an additive augmentation suture than in those who did not. Thus, we conclude that augmentation sutures are a beneficial option for elderly patients that clinicians can consider at the time of surgical decision making.
Aged* ; Decision Making ; Follow-Up Studies ; Humans ; Humeral Head ; Rotator Cuff ; Shoulder Fractures* ; Sutures*

BACKGROUND: The purpose of this study was to investigate the difference between two nailing approaches of intramedullary screw fixation, the retrograde nailing versus the anterograde nailing, on the radiological and clinical outcomes in patients with clavicle shaft fractures. METHODS: From April 2002 to August 2014, we enrolled a total of 22 patients with clavicle shaft fractures to participate in this study. Twelve patients received retrograde intramedullary nailing and 10 received anterograde nailing. The average duration of follow-up was 12 months. In all the patients, we took follow-up radiographs of the anteroposterior and the axial views to assess the postoperative radiological outcomes. We measured the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and the range of motion (ROM). RESULTS: Clinically, we did not find a statistically significant difference in the retrograde group and the anterograde group in terms of the duration to bone union, the VAS score the ASES score and the ROMs. Radiologically, we found that the difference in the clavicle shortening of the affected arm and the unaffected arm did not show a statistically significant difference at the immediate postoperative assessment. we found that the difference in the clavicle shortening of the affected arm between the immediate postoperative and the final follow-up value did not show a statistically significant difference. CONCLUSIONS: We found that both the retrograde nailing and the anterograde nailing gave a favorable outcome for clavicle shaft fractures. Although we saw evidence of clavicle shortening after intramedullary screw fixation, this was not a factor that influenced clinical outcome.
Arm ; Clavicle* ; Elbow ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Range of Motion, Articular ; Shoulder

BACKGROUND: Management of massive rotator cuff tears can be challenging because of the less satisfactory results and a higher retear rate regardless of the use of open or arthroscopic repair technique. METHODS: We retrospectively analyzed 102 cases of massive rotator cuff tear treated with either open or arthroscopic repair. Open repair was performed in 38 patients; and arthroscopic repair, in 64 patients. The mean age at the time of surgery was 59.7 years in the open group and 57.6 years in the arthroscopic group. RESULTS: The Constant score increased from the preoperative mean of 55.9 to 73.2 at the last follow-up in the open repair group and from 53.8 to 67.6 in the arthroscopic repair group (p<0.001 and <0.001, respectively). The University of California at Los Angeles (UCLA) score increased from a preoperative mean of 17.7 to 30.8 at the last follow-up in the open group and from 17.5 to 28.7 in the arthroscopic group (p<0.001 and <0.001, respectively). No statistically significant difference in the Constant and UCLA scores was observed between the two groups at the last follow-up (p=0.128 and 0.087, respectively). Retear was found in 14 patients (36.8%) in the open group and 39 patients (60.9%) in the arthroscopic group (p=0.024). CONCLUSIONS: Open and arthroscopic repairs of massive rotator cuff tears may provide satisfactory clinical results with no significant difference. However, a significantly lower retear rate was observed for the open repair group compared with the arthroscopic repair group.
Arthroscopy ; California ; Follow-Up Studies ; Humans ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Tears* ; Tendon Injuries

BACKGROUND: Kirschner's wire (K-wire) transfixation and locking hook plate fixation techniques are widely used in the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of this study was to compare the clinical and radiologic outcomes between K-wires transfixation and a locking hook plate fixation technique. METHODS: Seventy-seven patients with acute ACJ dislocation managed with K-wire (56 shoulders) and locking hook plate (21 shoulders) were enrolled for this study. The mean follow-up period was 61 months. RESULTS: At the last follow-up, the shoulder rating scale of the University of California at Los Angeles (UCLA) was higher in patients treated with locking hook plate than with K-wires (33.2 +/- 2.7 vs. 31.3 +/- 3.4, p=0.009). In radiologic assessments, coracoclavicular distance (CCD) (7.9 mm vs. 7.7 mm, p=0.269) and acromioclavicular distance (ACD) (3.0 mm vs. 1.9 mm, p=0.082) were not statistically different from contralateral unaffected shoulder in locking hook plate fixation group, but acromioclavicular interval (ACI) was significant difference. However, there were significant differences in ACI, CCD, and ACD in K-wire fixation group (p<0.001). Eleven complications (20%) occurred in K-wire transfixation group and 2 subacromial erosions on computed tomography scan occurred in locking hook plate fixation group. CONCLUSIONS: ACJ stabilization was achieved in acute ACJ dislocations treated with K-wires or locking hook plates. Locking hook plate can provide higher UCLA shoulder score than K-wire and maintain CCD, and ACD without ligament reconstruction. K-wire transfixation technique resulted in a higher complication rate than locking hook plate.
Acromioclavicular Joint* ; Bone Wires ; California ; Dislocations* ; Follow-Up Studies ; Humans ; Ligaments ; Shoulder

No abstract available.
Edema* ; Humans ; Hydrops Fetalis* ; Infant, Newborn*

BACKGROUND: The purpose of this study was to evaluate the functional and anatomic results of arthroscopic rotator cuff repair, and to analyze the factors affecting the integrity of arthroscopically repaired rotator cuff tears of the shoulder. METHODS: One hundred sixty-nine consecutive shoulders that underwent arthroscopic rotator cuff repair, had a postoperative MRI evaluation and were followed for at least two years were enrolled in this study. The mean age was 57.6 years (range, 38 to 74 years) and the mean follow-up period was 39 months (range, 24 to 83 months). RESULTS: The rotator cuff was completely healed in 131 (77.5%) out of 169 shoulders and recurrent tears occurred in 38 shoulders (22.5%). At the last follow-up visit, the mean score for pain during motion was 1.53 (range, 0 to 4) in the completely healed group and 1.59 (range, 0 to 4) in the group with recurrent tears (p = 0.092). The average elevation strength was 7.87 kg (range, 4.96 to 11.62 kg) and 5.25 kg (range, 4.15 to 8.13 kg) and the mean University of California at Los Angeles score was 30.96 (range, 26 to 35) and 30.64 (range, 23 to 34), respectively (p < 0.001, p = 0.798). The complete healing rate was 87.8% in the group less than 50 years of age (49 shoulders), 79.4% in the group over 51 years but less than 60 years of age (68 shoulders), and 65.4% in the group over 61 years of age (52 shoulders, p = 0.049); it was 96.7% in the group with small-sized tears (30 shoulders), 87.3% in the group with medium-sized tears (71 shoulders), and 58.8% in the group with large-sized or massive tears (68 shoulders, p = 0.009). All of the rotator cuffs with a global fatty degeneration index of greater than two preoperatively had recurrent tears. CONCLUSIONS: Arthroscopic repair of full-thickness rotator cuff tears led to a relatively high rate of recurrent defects. However, the minimum two-year follow up demonstrated excellent pain relief and improvement in the ability to perform the activities of daily living, despite the structural failures. The factors affecting tendon healing were the patient's age, the size and extent of the tear, and the presence of fatty degeneration in the rotator cuff muscle.
Activities of Daily Living ; Adult ; Aged ; *Arthroscopy ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Strength ; Pain Measurement ; Range of Motion, Articular ; Recurrence ; Rotator Cuff/*injuries/pathology/*surgery ; Shoulder Joint/pathology/physiopathology ; Treatment Outcome

BACKGROUND: We evaluated the current status of diabetes management and the predictors for poor glycemic control in an urban area. METHODS: This study included 1,138 community-dwelling adults (> or =50 years) with diabetes, of which 584 participated in the diabetes care survey. Logistic regression was used to identify the factors predicting poor glycemic control (hemoglobin A1c[HbA1c]> or =7%) in the total sample and to evaluate the relationship between the history of diabetes management checkup and poor glycemic control in the diabetes care survey sample. RESULTS: Of the 1,138 patients, 53.2% had blood pressure less than 130/80 mmHg, 41.7% had fasting glucose between 70 and 130 mg/dL, 48.6% had HbA1c below 7.0%, 60.1% had triglycerides below 150 mg/dL, 41.4% had low density lipoprotein cholesterol below 100 mg/dL, and 59.1% had normoalbuminuria (urine albumin-to-creatinine ratio <30 mg/g creatinine). Of the 584 patients completing the diabetes care survey, 63.9% had one or more lipid tests, 32.0% had one or more HbA1c tests, 43.8% had one or more microalbuminuria tests, and 42.5% had one or more fundoscopic examinations annually. Female gender (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.23-2.36), duration of diabetes (OR, 1.07; 95% CI, 1.06-1.09), and alcohol use (OR, 1.40; 95% CI, 1.06-1.85) were associated with an increased risk for poor glycemic control while age (OR, 0.97; 95% CI, 0.96-0.99) and antihypertensive medication (OR, 0.64; 95% CI, 0.50-0.83) were associated with a decreased risk. CONCLUSIONS: This study shows that glycemic control is likely to be poor in urban areas. We need to develop appropriate community-based strategies to achieve optimal glycemic control and prevent diabetes complications.
Adult ; Blood Pressure ; Cholesterol ; Cholesterol, LDL ; Diabetes Complications ; Diabetes Mellitus ; Fasting ; Female ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Lipoproteins ; Logistic Models ; Triglycerides

Arachnoid cysts are benign developmental cysts that occur between aachnoid layers, which represent approximately 1 percent of all intracranial space-occupying lesions, their most common location being the middle cranial fossa. Current surgical treatment options for intracranial arachnoid cyst are either craniotomy and excision of cyst or shunting of cyst contents extracranially. We treated 10 cases of intracranial arachnoid cyst by excision during last two years. For the best surgical curability, we have, not only removed the cyst wall and adhesive gliotic tissue as possible, but also made the opening to basal cistern for communication. During average 8.4 months follow up, we observed, not specific morbidity and mortality, but good clinical improvement and brain expansion. As above result, if haven't specific problem, the direct surgical removal may be the primary choice for intracranial arachnoid cyst, especially in children with noncommunicating type in sylvian.
Adhesives ; Arachnoid Cysts* ; Brain ; Child ; Cranial Fossa, Middle ; Craniotomy ; Follow-Up Studies ; Humans ; Mortality

We present a new method of suture bridge technique for medial row fixation using a modified Mason-Allen stitch instead of a horizontal mattress. Medial row configuration of the technique is composed of the simple stitch limb and the modified Mason-Allen stitch limb. The limbs are passed through the tendon by a shuttle relay. The simple stitch limb passes the cuff once and the modified Mason-Allen stitch limb passes three times which creates a rip stop that prevents tendon pull-out. In addition, the Mason-Allen suture bridge configuration is basically a knotless technique which has an advantage of reducing a possibility of strangulation of the rotator cuff tendon, impingement or irritation that may be caused by knot.
Arthroscopy/methods ; Humans ; Rotator Cuff/injuries/*surgery ; Suture Anchors ; *Suture Techniques