BACKGROUND: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. METHODS: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. RESULTS: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was 164.6°, external rotation at the side was 61.2°, and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. CONCLUSIONS: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.
Acromioclavicular Joint ; Dislocations ; Follow-Up Studies ; Humans ; Joints ; Ligaments ; Range of Motion, Articular ; Shoulder ; Suture Anchors ; Sutures

BACKGROUND: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. METHODS: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. RESULTS: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was 164.6°, external rotation at the side was 61.2°, and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. CONCLUSIONS The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

BACKGROUND: The currently available reverse shoulder arthroplasty (RSA) designs can be classified into medial glenoid/medial humerus (MGMH), lateral glenoid/medial humerus (LGMH), and medial glenoid/lateral humerus (MGLH) prosthesis designs. The purpose of this study was to radiologically analyze the effect of different RSA designs on humeral position following RSA. METHODS: A total of 50 patients who underwent primary RSA were retrospectively analyzed. Among 50 patients, 33 patients (group A: MGMH) underwent RSA with Aequalis system (Wright, Inc, Bloomington, MN, USA), 6 (group B: LGMH) with Aequalis system using bony increased offset, and 11 (group C: MGLH) with Aequalis Ascend Flex system. The acromiohumeral distance, acromioepiphyseal distance (AED), lateral humeral offset (LHO), LHO from the center of rotation (LHO(COR)), and deltoid length were radiologically measured to quantify the distalization and lateralization of the humerus. RESULTS: The increment in postoperative AED was 19.92 ± 3.93 mm in group A, 24.52 ± 5.25 mm in group B, and 25.97 ± 5.29 mm in group C, respectively (p=0.001). The increment in postoperative LHO was 0.13 ± 6.30 mm, 8.00 ± 12.14 mm, and 7.42 ± 6.88 mm, respectively (p=0.005). The increment in postoperative LHOCOR was 20.76 ± 6.06 mm, 22.04 ± 5.15 mm, and 28.11 ± 4.14 mm, respectively (p=0.002). CONCLUSIONS: The radiologic analysis of the effect of different RSA designs on humeral position following RSA showed significant differences in the increment in postoperative AED, LHO, and LHO(COR) between the 3 groups. Therefore, MGLH design seems to be more effective for humeral distalization and lateralization compared to original Grammont design.
Arthroplasty ; Humans ; Humerus ; Prosthesis Design ; Retrospective Studies ; Shoulder

BACKGROUND: To evaluate the clinical outcome of revision of primary shoulder replacement by using reverse total shoulder arthroplasty (RTSA). METHODS: Seven patients underwent revision RTSA with a mean follow-up of 22.1 months (range, 12 to 54 months). Their mean age at the time of operation was 75.5 years (range, 70 to 80 years). Assessments were performed on the preoperative and postoperative visual analogue scale (VAS) score, muscle strength, range of motion, University of California at Los Angeles (UCLA) score, Constant score, subjective satisfaction and the anteroposterior and axillary views of the glenohumeral joint. The primary operation was hemiarthroplasty in 5 patients, total shoulder replacement in 1 patient, and reverse shoulder arthroplasty in 1 patient. The cause of revision surgery was infection in 2 patients, humeral stem loosening in 2 patients, glenoid arthropathy in 2 patients, and glenoid loosening in 1 patient. The mean duration from primary operation to revision surgery was 52 months (range, 27 to 120 months). RESULTS: The VAS score for pain during motion was improved from 7.3 preoperatively to 2.1 postoperatively (p = 0.03). There were increases in the mean active forward flexion (from 62.1° to 92.8°), abduction (from 70° to 87.1°), external rotation (from 44.2° to 47.4°), and internal rotation (from L5 to L4; p > 0.05) postoperatively. Performance in activities of daily living improved (p > 0.05), except for lifting 10 lb above the shoulder (from 1.2 to 1.1; p = 0.434). Overall, 5 of 7 patients were satisfied with the results of revision surgery. The mean Constant score improved from 44.8 preoperatively to 57.1 postoperatively (p = 0.018). The mean UCLA score improved from 12.8 preoperatively to 22.8 postoperatively (p = 0.027). In the postoperative radiological evaluation, no radiolucency was observed around the base plate or humeral stem. CONCLUSIONS: Pain could be reduced after revision RTSA, but improvements in range of motion and function were difficult to achieve. We think that the patients' satisfaction was relatively high despite the low function score due to the preoperative severe pain and marked limitation of range of motion.
Activities of Daily Living ; Arthroplasty* ; California ; Follow-Up Studies ; Hemiarthroplasty ; Humans ; Lifting ; Muscle Strength ; Range of Motion, Articular ; Shoulder Joint ; 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: Some studies have shown significant functional improvement after rotator cuff (RC) repair in elderly patients. However, few studies have reported the healing potential of RC tears in elderly patients. METHODS: Twenty-five patients aged ≥ 75 years who underwent RC repair were enrolled. The mean age at the time of surgery was 78.3 years (range, 75 to 88 years) while the mean follow-up was 36.3 months (range, 18 to 114 months). We evaluated clinical and structural outcomes after RC repair in the retear and healed groups. RESULTS: Of 25 patients, 16 (64%) had healed RC lesions and 9 (36%) had retorn cuff lesions. The retear rate increased significantly with increasing initial tear size (small to medium, 13%; large, 60%; massive, 80%; p = 0.024) but not with increasing age (p = 0.072). The mean visual analog scale (VAS), University of California Los Angeles (UCLA), and Constant scores significantly improved from 5.2, 15.8, and 49.3 preoperatively to 1.4, 31.1, and 71.9 in the healed group and from 6.0, 14.4, and 39.5 preoperatively to 2.4, 28.3, and 63.6 in the retear group at the final follow-up (p < 0.05, respectively). There were no significant differences in clinical outcomes between the 2 groups at the final follow-up. Retear was significantly correlated with initial tear size (p = 0.001; odds ratio [OR], 2.771; 95% confidence interval [CI], 1.394 to 5.509 for large to massive tears) (p = 0.001; OR, 0.183; 95% CI, 0.048 to 0.692 for small to medium tears). CONCLUSIONS: There were significant improvements in clinical outcomes after RC repair in patients ≥ 75 years. Structural integrity after cuff repair did not affect the final clinical outcome. Even in elderly patients aged ≥ 75 years, healing of repaired RC can be expected in cases of small to medium tears. Although the retear rate was relatively high for large to massive tears, clinical outcomes still showed significant improvement.
Aged ; California ; Follow-Up Studies ; Humans ; Odds Ratio ; Rotator Cuff* ; Shoulder ; Tears ; Treatment Outcome ; Visual Analog Scale

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: 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

Many studies have investigated relationships between APOE genotype and bone mineral density (BMD). However, the results of these studies have been inconsistent. Few studies have been carried out in Asian populations. We studied the relationship of the APOE gene polymorphism and BMD in two large population-based studies. The datasets included the Dong-gu Study (3575 men and 5335 women) and the Namwon Study (2310 men, 3512 women). Lumbar spine and femoral neck BMD were measured by dual-energy X-ray absorptiometry. APOE genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The APOE genotypes were classified into APOE E2 (E2/E2 and E2/E3), APOE E3 (E3/E3), and APOE E4 (E3/E4 and E4/E4). The genotype distribution of the study population was in Hardy-Weinberg equilibrium. There were no significant differences among APOE genotype groups in lumbar and femoral neck BMD in either cohort. Our data do not support the hypothesis that the APOE genotype is associated with BMD.
Absorptiometry, Photon ; Apolipoproteins E ; Asian Continental Ancestry Group ; Bone Density ; Cohort Studies ; Dataset ; Female ; Femur Neck ; Genotype ; Humans ; Jeollabuk-do ; Male ; Polymorphism, Genetic ; Spine

Low levels of vitamin D have been associated with increased cardiovascular disease risk. However, few studies have evaluated the association between vitamin D status and peripheral arterial disease (PAD). We therefore aimed to investigate whether low 25-hydroxyvitamin D (25(OH)D) levels were associated with increased risk of PAD in the Korean population. This cross-sectional study was conducted among 8,960 subjects aged 50 years or older without known myocardial infarction or stroke. PAD was defined by an ankle brachial blood pressure index <0.9. Multivariate logistic regression was used to evaluate the association between serum 25(OH)D levels and risk of PAD. Of the 8,960 subjects, 3.0% had PAD and the age and sex adjusted prevalence of PAD decreased with the increasing 25(OH)D quartile. After adjusting for potential confounders and parathyroid hormones, serum 25(OH)D levels were associated with a significantly decreased risk of PAD (OR for one SD increase, 0.98; 95% CI, 0.95-1.0, P for trend=0.040). Compared with the first 25(OH)D quartile, the odds of PAD were 0.86 (95% CI, 0.62-1.21), 0.67 (95% CI, 0.46-0.97), and 0.71 (95% CI, 0.49-1.04) for the second, third, and fourth quartiles, respectively. In this cross-sectional study, we found that low serum 25(OH)D levels were associated with an increased risk of PAD, independent of traditional cardiovascular risk factors and parathyroid hormone. Our findings suggest that low vitamin D levels may contribute to PAD in the Korean population.
Ankle ; Atherosclerosis ; Blood Pressure ; Cardiovascular Diseases ; Cross-Sectional Studies ; Logistic Models ; Myocardial Infarction ; Parathyroid Hormone ; Peripheral Arterial Disease ; Prevalence ; Risk Factors ; Stroke ; Vitamin D ; Vitamins