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Takahiko MIKASA, Kazutoshi HAMADA, Yuko ASHIZAWA, Noboru MATSUMURA, Hi ...
2008 Volume 32 Issue 3 Pages
533-536
Published: 2008
Released on J-STAGE: November 21, 2008
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Our modified Phemister procedure (4 in 1 procedure) composed of coracoclavicular ligament repair, Kirschner wire fixation of the acromioclavicular joint, acromioclavicular ligament repair and overlapped suture of deltoid and trapezium muscle in 1 incision. Kirschner wires were removed between 8 and 10 weeks after the surgery. The purpose of this study was to investigate the results of our 4 in 1 procedure for acromioclavicular dislocation. 37 cases with Rockwood classification Types III to V acromioclavicular dislocation had been operated at Saiseikai Kanagawaken Hospital and Shizuoka Red Cross Hospital from 2000 to 2006. The average age at operation was 39.6 years old (17 - 63 years old). The clinical results were evaluated by the Japan Shoulder Society (JSS) score for acromioclavicular dislocation. Using anteroposterior roentgenographic views, rates of acromioclavicular dislocation, coraco-clavicular distances, acromioclavicular osteoarthritis and ossification of the coracoclavicular ligament were evaluated. These factors were examined statistically by using nonparametric tests. The postoperative JSS scores (Type III/Type IV/Type V) were 97.8(93-100)/86.0(82-90)/95.9(82-100)(p>0.05). Acromioclavicular dislocation rates (Type III /Type IV/Type V) after the removal of K-wires were 6.89 % (0-22.2)/28.6% (0-57.1)/32.5%(0-83.3)(p>0.05). Coracoclavicular distances(Type III/Type IV/Type V) after the removal of K-wires were 85.7%(30.0-125)/133%(85.7-180)/141%(57.1-257)(p>0.05). Ossification of coracoclavicular ligament (Type III/Type IV/Type V) were observed 16.7%/50.0%/44.8% (p>0.05). Acromioclavicular osteoarthritis (Type III/Type IV/Type V) were observed 33.3 %/50.0%/34.5% (p>0.05). The clinical results of 4 in 1 procedure were satisfactory. But there is necessity to reconsider the term, the location and the technique of K-wire fixation.
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Shinichiro NAKAMURA, Yasuaki NAKAGAWA, Masahiko KOBAYASHI, Takashi NAK ...
2008 Volume 32 Issue 3 Pages
537-540
Published: 2008
Released on J-STAGE: November 21, 2008
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Various surgical procedures were proposed for recurrent dislocation. Bristow procedure was a nonanatomical repair of anterior structure. However, it had shown a relatively lower rate of post-operative dislocation or subluxation because a bony structure was constructed at anterior glenoid. We assessed two patients who underwent revision surgery after Bristow procedure. The 2 patients were male. One patient was 28 years old at revision surgery and the primary surgery was Bristow-Bankart procedure. He fell while skiing six months after the primary surgery and suffered from subluxation. Eleven months after the primary surgery he underwent revision surgery. The coracoid process was fixed by a screw again and a Bankart repair was added. At 56 months follow-up JSS Shoulder instability score was 90 and subluxation had improved. The other patient was 34 years old at revision surgery and primary surgery was Bristow procedure only. Redislocation occurred 10 months after the primary surgery because of epilepsy. Bony block was broken and he suffered from shoulder pain and recurrent dislocation. Nineteen months after the primary surgery he underwent revision surgery. Iliac bone was fixed at the glenoid and Bankart repair was added. At 36 months follow-up JSS shoulder instability score was 80 and dislocation had not occurred. Bristow procedure had shown a relatively lower rate of post-operative dislocation or subluxation. Once dislocation occurred, screw and/or bone block migration was accompanied and so revision surgery was difficult. We suggested an anterior bony structure was necessary to prevent further anterior dislocation in the revision surgery after a failed Bristow procedure. To reconstruct anterior bony structure led to our successful results. Two patients who underwent revision surgery after Bristow procedure were assessed. No subluxation or dislocation occurred to reconstruct broken anterior bony structure again.
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Masazumi HIRATA, Masao KUROKAWA, Toru MORIHARA, Yoshio IWATA, Hiroaki ...
2008 Volume 32 Issue 3 Pages
541-544
Published: 2008
Released on J-STAGE: November 21, 2008
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We introduced a new arthroscopic Bankart repair technique that provided a double layer footprint fixation by bridging suture using a sliding knot. We investigated four male patients with traumatic anterior shoulder instability. The mean age at operation was 22.5 years old and the mean follow-up period was 7 months. After resurfacing the glenoid rim, the anchor(A) was inserted on the glenoid at the 5 o'clock position. A 2nd anchor with tied suture(B) was placed medially to the glenoid rim at the 4 o'clock position. Both of the end of B suture were passed through the inferior glenohumeral ligament - labral complex with mattress stitches. After making post of suture A and one end of suture B together as post suture, sliding knot was tied( suture-reel technique ). A 3rd anchor(C) was inserted on the glenoid at the 3 o'clock position. Suture C and another end of suture B were tied in the same manner. The shoulders were immobilized in internal rotation for 3 weeks. We evaluated the complications and postoperative JSS shoulder instability score. There was no neurovascular injury and recurrence of dislocation. The mean postopearative JSS-SIS was 97.8. This method is considered to be a secure fixation and a further follow-up is needed.
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Nobuyuki NAKAMURA, Yoichi ITO, Yoshihiro NAKAO, Tomoya MANAKA, Yoshifu ...
2008 Volume 32 Issue 3 Pages
545-547
Published: 2008
Released on J-STAGE: November 21, 2008
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It was reported on for utility the use of various suture anchors with arthroscopic Bankart repair. It was useful in MRI with abduction and external rotation (ABER-MRI) evaluation of the Bankart lesions. The aim of this study was to evaluate arthroscopic Bankart repaired condition after ABER-MRI with metal or absorbable anchors and to examine the utility for this more than 6 months later. We evaluated with ABER-MRI 21 shoulders treated by an arthroscopic Bankart repair with a knotless or absorbable anchor(14 men and 7 women). The average age at operation was 26.2 years old (17-46 years old). The follow-up after an arthroscopic Bankart repair was 6 months. The used anchors were 10 metal and 11 absorbable. The evaluation items were compared according to (1) each anchors of image evaluation possibility with ABER-MRI. (2) evaluation with ABER-MRI and normal position MRI. (3) 3 group classified by ABER - MRI examined the correlation with the clinical results. We evaluated 18 of 21 shoulders with ABER-MRI, and to be 7 of 10 metal anchors(70%), 11 of 11 absorbable anchors (100%). In 7 of 18 shoulders that we were able to evaluate with ABER-MRI, the normal position MRI was impossible to evaluate. In repaired condition evaluated by ABER - MRI in 18 shoulders, type I had 14 shoulders (77.8%), type II had 3 shoulders (16.7%), type III had 1 shoulder. The good shoulder results were all type I, and the re-subluxation and the underachivement shoulders were type II, III. MRI evaluation possibility is more useful for an absorbable anchor than a metal anchor in postoperative evaluation. In the good results condition with ABER-MRI, the clinical results are good.
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Ryuzo ARAI, Jyoji MORIISHI, Hiroyuki SUGAYA, Tomoyuki MOCHIZUKI, Kumik ...
2008 Volume 32 Issue 3 Pages
549-552
Published: 2008
Released on J-STAGE: November 21, 2008
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The long head of the biceps tendon (LHB) tends to dislocate anteromedially due to its change of direction beyond the most proximal portion of the intertubercular groove. The purpose of this study was to clarify the comprehensive stabilization system of the LHB by investigating the most proximal insertion of the subscapularis tendon (SSC), the superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL). 20 embalmed shoulder girdles were used in an anatomical study, and in order to clarify the structural continuity, 5 anterosuperior parts of the glenohumeral joint were histologically observed. Anatomically, the most proximal portion of the SSC tendon inserted on the superior surface of the lesser tuberosity and extended a thin tendinous slip to the fovea capitis of the humerus. The SGHL was like an anterior-inferior spiral sling supporting the LHB and attached to the tendinous slip. Histologically, the CHL and internal wall of the anterosuperior glenohumeral joint were involved in the identical loose connective tissue. The SGHL was discriminated from it due to density of tissue fibers at the lateral part but the difference between them was unclear in the medial part. The SGHL was considered to be a fold extended from the medial part of anterosuperior loose connective tissue and formed a spiral half sling along the LHB. The most lateral part of the loose connective tissue wound around the SGHL to form a membranous structure to support the LHB, which attached to the thin tendinous slip of the SSC. These results suggested that the full thickness and articular side SSC tear might lead to loss of the LHB support because of disruption of both the semitubular structure which consisted of the most proximal insertion of the SSC and the tendinous slip and the membranous structure of the loose connective tissue including the SGHL and CHL.
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Noriyuki ISHIGE, Shigehito KURODA, Kimiko MARUTA, Motohiko MIKASA
2008 Volume 32 Issue 3 Pages
553-556
Published: 2008
Released on J-STAGE: November 21, 2008
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Neer classification is popular. However, there are some cases that can not be classified by it. We reviewed a detail of fracture types by using Codman classification, and clarified the fracture types that could not be classified and groped about for a better classification method. We classified 668 cases of Database by Neer and Codman classifications. In case of Neer classification, we defined a fracture as follows: a greater tubercle displaced beyond the top of the humeral head, a lesser tubercle clearly displaced from the humeral head or shaft, surgical neck displaced over 1/3 width of the shaft. On the other hand, the valgus impacted type of Jacob classification was added to this classification. There were 19 cases of valgus impacted type. And there were 23 cases that could not be classified by Neer classification in 668 cases. That number was smaller than our previous report. Those 23 cases looked like Types three, 6, 14, 15and 16 of Codman classification and humeral head fracture. Types 6 and 14 were less displaced and treated conservatively. Types 3, 15 and 16 had anatomical neck fractures and were mainly treated operatively. These 3 types seemed to need some review of the methods of treatment. We conclude that it is useful to change definitions of fractures and add a valgus impaction type, head fracture, 3, 15 and 16 types of Codman classification to the original Neer classification.
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Teruaki IZAKI, Yozo SHIBATA, Masatoshi NAITO
2008 Volume 32 Issue 3 Pages
557-560
Published: 2008
Released on J-STAGE: November 21, 2008
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We studied 76 patients (43 males, 33 females) who required surgical intervention for proximal humerus fractures at Fukuoka University between 1994 and 2005. The medical records and plain radiographs were reviewed. The mean age was 54.2 years old. The mean follow-up period was 54 months (range 15-92 months). Each fracture was classified according to the Neer classification. The Japanese Orthopaedic Association's (JOA) shoulder score was used to assess the functional outcome. Our strategy for displaced proximal humerus fractures was fundamentally plate osteosynthesis. Other osteosynthesis procedures included 4 retrograde K-wire fixations and 3 interlocking intramedurally nails for 2-part surgical neck fracture, 6 tension band wiring and/or screwing for 2-part greater tuberosity fracture. In 3- and 4-part fracture/ fracture dislocation for the more than 60 years old, we chose a humeral head replacement. Union occurred in all cases except 1 which required a humeral head replacement. The majority of patients were satisfied with the postoperative functional results. 17 complications during the follow-up period included 10 contractures, 2 axillary nerve palsy, 2 complex regional pain syndrome, 1 K-wire backout, 1 varus deformity of the humeral head and 1 non-union.
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Noboru MATSUMURA, Masaaki TAKAHASHI, Takahiko MIKASA
2008 Volume 32 Issue 3 Pages
561-564
Published: 2008
Released on J-STAGE: November 21, 2008
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The purpose of this study was to evaluate the clinical results of our surgical treatment for proximal humeral fractures. During the period between April 2003 and March 2007, we performed intramedullary fixation with tension band wiring as the surgical treatment of proximal humeral fractures for the elderly. We followed up 31 cases (3 males and 28 females) for more than 6 months after surgery in the population older than 70 years old. The average age of the patients was 78.8 (range, 70 to 90 years old). 21 cases were classified into 2-part fracture, 5 into 3-part fracture, 4 into 4-part fracture, and the last 1 was unclassifiable by Neer's classification. Clinical results were evaluated retrospectively at the time of 6 months after surgery. We observed bone union in all the cases. The mean postoperative JOA score was 80.5 (range, 60 to 96). No cases had an evidence of avascular necrosis of the humeral head. However, we observed loosening of the fixation in 2 cases and protrusion of the intramedullary Kirschner wires followed by subacromial impingement in 6 cases. Satisfactory outcomes were achieved with our surgical procedure and we regarded this method as useful for proximal humeral fractures for the elderly. However some contrivances are needed to avoid complications after surgery in particular cases.
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Koutaro SHINMURA, Katsumi TAKASE, Kengo YAMAMOTO
2008 Volume 32 Issue 3 Pages
565-568
Published: 2008
Released on J-STAGE: November 21, 2008
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For proximal humeral fractures with osteoporosis, we performed internal fixation with an antegrade straight interlocking nail (Targon PH), and had good results via rigid stabilization. The purpose of the present study was to evaluate the therapeutic results and to examine the peculiarity and the surgical technique of this implant. Twenty four patients were treated with this implant. Six months after the surgery, they had flexion of 153 degree, external rotation of 63 degree, and internal rotation of Th11, on average. The mean JOA score was 95.2 points. The Targon PH nail had straight shape and four interlocking screws, each was placed at a different level of the humeral head. Thus, early physiotherapy is allowed even in osteopotic patients via rigid stabilization. We believe that it is important to reduce the displacement exactly, to decide the suitable entry point, and to repair the rotator cuff certainly.
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Kiyoshi SAKAI
2008 Volume 32 Issue 3 Pages
569-571
Published: 2008
Released on J-STAGE: November 21, 2008
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We reported on the clinical efficacy and technical importance of intramedullary nailing for surgical neck fracture of the humerus. From January, 2001 to December, 2006, we surgically treated 56 cases of proximal humeral fracture. 29 of those 56 cases (28 surgical neck fractures and 1 three part fracture of the proximal humerus) were intramedullary nailing using Polarus humeral nails. We retrospectively investigated the fracture type, coexistence of rotator cuff tear, post operative radiograph, pain, and range of motion using the Japanese Orthopaedic Association shoulder score. Post operative varus inverted displacement happened in 4 of the 28 cases (surgical neck fracture), and these cases preoperatively showed varus inverted displacement with the short neck (the fracture line was less than 2 cm below the top of the greater tuberosity). This correction of lost cases showed a delayed union and less abduction range of motion. Cut out of the nail from the humeral head was found in 1 case rescued by endoprosthesis. Except for those 5 cases, fractures healed with good clinical results in each case. Coexistence of rotator cuff tear showed no significant clinical difference compared with normal cuff patients in this series. Intramedullary nailing for surgical neck fracture can generally provide good clinical results. But in case of varus inverted displacement with the short neck, we should consider all kinds of technical invention for the prophylaxis of re-inversion, overcorrection (valgus inversion) fixation assisted by tension band wiring (transtendinous valgus retraction), and osteoporosis patient needs more careful postoperative management not to cause catastrophic state such as cut out of the humeral head.
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Taizo KONISHIIKE
2008 Volume 32 Issue 3 Pages
573-575
Published: 2008
Released on J-STAGE: November 21, 2008
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We had used needle wires to fix greater and lesser tuberosity fragments and humeral prosthesis. The purpose of this report was to evaluate the cable wire system for shoulder hemiarthroplasty. We performed hemiarthroplasty on 13 patients from1999 to 2006. Three cases were males and 10 were females. The average age was 63 years old. We compared the 2 groups; Group A: simple needle wire from 1999 to 2003, Group B: cable wire system (the compounded needle wire with compression device) from 2004 to 2006. Group A was composed of 6 cases and Group B was 7 cases. We evaluated the results by the Japan Orthopeadic Association's (JOA) score. The average postoperative JOA score was 69.2 points in Group A and 86.2 in GroupB. The cable wire system was considered to be effective to fix greater and the lesser tuberosities.
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Kazuhiko KIKUGAWA, Nobuyoshi OKUHIRA
2008 Volume 32 Issue 3 Pages
577-580
Published: 2008
Released on J-STAGE: November 21, 2008
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We assessed the clinical outcome of arthroscopic decompression and G-T plasty for impingement syndrome after fracture of the humeral greater tuberosity. 5 cases of impingement syndrome after fracture of the humeral greater tuberosity were treated since 2003. The cases were 3 male and 2 female, with an averaged age of 47 years old. The mean follow up period was 14 months. The duration from trauma to surgery ranged from 8 to 25 months. 3 shoulders were fracture of the humeral greater tuberosity alone and two shoulders were 3 part fractures. Preoperatively, impingement tests (Neer,Hawkins,Ellman) were positive in all cases. All cases were treated by arthroscopic subacromial decompression and 2 shoulders were associated with removal of exostosis of the great tuberosity. The clinical evaluation was performed using the JOA score, impingement sign and range of motion. The average postoperative JOA score increased from 62 points to 87 points significantly. The clinical results were excellent in 2 cases, good in 2, fair in 1. The average score of pain improved from 15.1 points to 26.8 points. Postoperatively, impingement tests (Neer,Hawkins, Ellman) were negative in all cases. Arthroscopic decompression and G-T plasty for impingement syndrome after fracture of the humeral greater tuberosity can provide good pain relief and improve the functional results.
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Yasuhiro MITSUI, Kenjiro NAKAMA, Tetsu YAMADA, Kensei NAGATA, Masafumi ...
2008 Volume 32 Issue 3 Pages
593-595
Published: 2008
Released on J-STAGE: November 21, 2008
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Hyaluronan (HA) improves postoperative recovery after flexor tendon surgery, preventing postoperative adhesion. However, its influence on the rotator cuff tendon after cuff repair has not yet been clarified in detail. HA is likely to modulate cell proliferation and mRNA expression of procollagens α 1 (I) and α 1 (III) in tendon fibroblasts derived from rotator cuff diseases. The study's subjects were 10 patients with rotator cuff disease, with an average age of 62 years old (range 44 to 72 years old). Various concentrations of HA (1.0 ∼ 5.0 mg/ml) were added to monolayer-cultured tendon fibroblasts derived from these patients. CD44 expression on the tendon fibroblasts were evaluated by confocal microscopy using fluorescein-conjugated HA and anti-human CD44 antibody (OS/37). Cell proliferation was evaluated by recording changes in cell number. The levels of expression of procollagen α 1 (I) andα 1 (III) mRNA were measured by real-time reverse transcripts polymerase chain reaction. Immunofluorescence cytochemistry detected constitutive binding of CD44 expression on the tendon fibroblasts derived from rotator cuff disease. Treatment with various concentrations of HA significantly inhibited cell proliferation and decreased the expression level of procollagen α 1 (III) mRNA, but not that of procollagen α 1 (I) mRNA, in the tendon fibroblasts. HA modulated cell proliferation and the expression level of procollagen α 1 (III) mRNA, but not that of procollagen α 1 (I), in tendon fibroblasts derived from rotator cuff disease. Postoperative use of exogenous HA may allow the healing of a repaired rotator cuff tendon with minimal adhesion.
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Hisakazu TACHIIRI, Toru MORIHARA, Yoshio IWATA, Yoshikazu KIDA, Toshik ...
2008 Volume 32 Issue 3 Pages
597-600
Published: 2008
Released on J-STAGE: November 21, 2008
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The purpose of this study was to examine the behavior of the host and graft cells in early remodeling process after tendon implantation to the defect using a green fluorescent protein (GFP) transgenic rat. Sprague Dawley (SD) rats and GFP rats were used in this study. Tendinous defect were made close to the supraspinatus tendon insertion. In group A, Achilles tendons of SD rats were transplanted into the defect of GFP rats. In group B, frozen Achilles tendons of SD rats were transplanted into the defect of GFP rats. At Zero, 3 and 7 days after surgery, sections stained with hematoxylin and eosin were assessed histologically, and localization of GFP positive cells were also evaluated. Frozen Achilles tendons of GFP rats were also assessed. No cells were observed in the frozen Achilles tendons. The graft was surrounded by inflammatory cells at 3days. Signal positive host cells were observed in the peripheral margins in group A at 3 days. There were no GFP cells in the graft substance. At 7 days, acellular areas remained in the core part of the graft in group B. GFP cells in group B were less infiltrated into graft than in group A. Replacement of graft cells by host cells occurred in the early remodeling process after tendon implantation for the defect of rotator cuff. GFP host cell infiltrated the graft in a frozen Achilles tendon later than that in a live Achilles tendon. It is considered that the live graft cells were important for the repair and the remodeling of the graft.
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Noriaki NAKAMICHI, Noboru MATSUMURA, Shohei SHIONO, Atsushi TANJI, Tak ...
2008 Volume 32 Issue 3 Pages
601-604
Published: 2008
Released on J-STAGE: November 21, 2008
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The contact area and contact pressure at the tendon-bone area interface after the rotator cuff repair have not been investigated. To compare the contact area and contact pressure of different types of suture anchors for a rotator cuff tear repair. 2 types of absorbable suture anchors, Panalok loop rc PL Group, Bioknotless rc BK Group were inserted into the urethane made blocks. Anchors were inserted perpendicular to the block surface. The contact area and contact pressure were recorded. The contact area of the BK group was 56% greater than that of the PL group. The contact pressure of the BK group was 72% greater than that of the PL group. The Bioknotless rc anchor may provide a better healing than the Panalok loop rc anchor.
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Takehiko NAMURA, Toru MORIHARA, Yoshinori TAKUBO, Masazumi HIRATA, Yos ...
2008 Volume 32 Issue 3 Pages
605-608
Published: 2008
Released on J-STAGE: November 21, 2008
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The aim of this study was to clarify the relationship between superior migration of the humeral head and torn tendon on massive rotator cuff tear. We studied 23 shoulders in 17 patients of massive rotator cuff tear seen from April 2004 to March 2007 in our hospital. There were 15 men and 2 women, their mean age was 70.5 years old (range, 56-81 years old), right-side 16 shoulders and left-side 7 shoulders. We evaluated the superior migration of the humeral head by X-rays on the supine and standing position, and torn tendon size by MRI. We evaluated whether rupture of the long head of the biceps tendon (LHB) led to the superior migration of the humeral head. On X-rays, superior migration of the humeral head were recognized in 7 shoulders in both the supine and standing positions, 13 shoulders were so only in the supine position. Three shoulders were recognized neither in the supine nor standing position. On MRI, all 7 shoulders showed superior migration in the standing position recognized complete tears in supraspinatus, infraspinatus and subscapularis tendon, and 19 of 20 shoulders in the supine position recognized rupture of the LHB tendon. In massive rotator cuff tear, the superior migration in the supine position will take place if the LHB tendon is ruptured, and thus further the superior migration in the standing position will take place if the infraspinatus and subscapularis are torn completely, because the depressor for the humeral head is lost.
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Daisuke MAKIUCHI, Kazuhide SUZUKI, Kenichi MIHARA, Takayuki MATSUHISA, ...
2008 Volume 32 Issue 3 Pages
609-612
Published: 2008
Released on J-STAGE: November 21, 2008
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The aim of this study was to investigate the clinical outcome of conservative treatment for full-thickness rotator cuff tears (FTRCTs), and to analyze factors that influence the clinical outcome. We selected 19 patients who were diagnosed as having FTRCTs by MRI or MR arthrography and were treated conservatively, and were followed-up for more than two years. There were 7 males and 12 females with an average age of 66.4 years old. All patients were evaluated with the use of the JOA score, and we investigated the transition of each score. The mean JOA score improved from 58.3 at the initial examination to 85.4 at the last examination. The mean range of external rotation improved from 46.32° at the time of initial examination to 59.21° at the last examination. The mean range of active flexion improved from 86.05° at the time of initial examination to 152.11° at the last examination. The function score and ROM score revealed good improvement in all patients. The pain score also revealed good improvement in the excellent group, but in the poor group, the pain score revealed few improvements between the initial and the last follow-up examination. Our clinical results of conservative treatments for the patients with FTRCTs were almost satisfactory. For the improvement of the function and ROM, conservative treatments were effective. However, the conservative treatment was insufficient for the patients who reported few improvements of pain in the early stage of treatments.
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Akira TAKAHASHI, Risa MATSUMOTO, Tomoyuki SAITO
2008 Volume 32 Issue 3 Pages
613-617
Published: 2008
Released on J-STAGE: November 21, 2008
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Clinical effects of subacromial injections of triamcinolone for 53 shoulders with rotator cuff tears were investigated and compared with the x-ray findings, the amount of subacromial effusions and the cuff tear size. The x-ray findings were classified into five groups:group A, superiorly migrated humeral head and narrowed joint space in 4 shoulders ; B, only superior migration in 8 ; C, only narrowed joint space in 2 ; D, no changes in 20;E, only subacromial spurs more than 5 mm in 19. The cuff tear size was examined by operative findings or MRIs and the amount of subacromial effusions was classified by MRIs into 4 groups : none,small,medium and large. The effects of steroids was classified by the motion and night pain into 5 grades ; pronounced effect, improvement, slight improvement, relapse and no change. The effects after a 1st injection and at follow-up, JOA pain scores and the final outcomes were investigated. The JOA pain score at follow-up showed 15.0±5.4 points significantly higher than 8.2±3.1 points before injections. The ratio of shoulders which showed a pronounced effect or improvement ( good effects ) at follow-up was 49%.The shoulders with small tears showed good effects after injections of steroids compared with those with large tears. The JOA pain score at follow-up in groups A and C with a narrowed joint space was lower than that of other groups and all shoulders in group A showed a relapse. The shoulders with large amounts of subacromial effusions showed good effects after their 1st injection compared with those with small effusions. The evaluation and expectancy of the effects of subacromial injections of steroids for rotator cuff tears using x-ray findings and MRI is useful in the choice of a therapy.
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Keiko HORIGOME
2008 Volume 32 Issue 3 Pages
619-622
Published: 2008
Released on J-STAGE: November 21, 2008
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The present study was designed to evaluate the efficacy of our arthroscopic repairing procedure for bursal side partial-thickness rotator cuff tear where only the torn cuff was debrided and sutured without converting to a full- thickness tear to the humeral head with single-row anchor(s). Because the articular footprint of bursal side partial-thickness rotator cuff tear was intact. We compared the clinical results with those of arthroscopic single-row repair for full-thickness rotator cuff. Partial-thickness tear types of Ellman's type B2 and B3 were indicative of this procedure. These patients (partial tear group: PTG) and those with full-thickness tear treated with single-row fixation (full-thickness tear group: FTG) were followed up for more than 12 months postoperatively, and analyzed. There were 15 patients (16 shoulders) in PTG, and 16 patients (17 shoulders) in FTG. The average age was 57.7 years old in PTG and 62.1 years old in FTG. At operation time, the Japanese Orthopaedic Association score (JOA score), strength of shoulder abduction and external rotation were measured and compared between these two groups at 6 and 12 months postoperatively. We also evaluated the postoperative MRIs. The average operation time was 154 minutes in PTG and 162 minutes in FTG. The average JOA score improved from 71.3 to 90.3 at 6 months and 97.4 at 12 months in PTG, while it did from 66.5 to 89.2 and 95.1 in FTG. The average strength of shoulder abduction and external rotation increased from 4.5kg to 4.8kg and 6.3kg and from 5.6kg to 7.6kg and 9.2kg, respectively, in PTG. They increased from 2.8kg to and 4.8kg and 6.3kg and from 4.2kg to 7.1kg and 8.3kg, respectively, in FTG. There were no statistical differences between the groups. Postoperative MRIs did not show any re-torn cuff in both either groups. This technique is relatively simple, and fairly applicable to PTG.
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Tomoya MANAKA, Yoichi ITO, Yoshihiro NAKAO, Yoshifumi NAKA, Nobuyuki N ...
2008 Volume 32 Issue 3 Pages
623-626
Published: 2008
Released on J-STAGE: November 21, 2008
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Arthroscopic rotator cuff repair was developed with advances in arthroscopic techniques and it was used successfully to treat rotator cuff tears. However, there was little known about postoperative accurate second look evaluation for arthroscopic rotator cuff repair. The aim of this study was to evaluate the current arthroscopic rotator cuff repair technique by second look arthroscopy in the cases of good clinical results.We evaluated 11 patients (8 males and 3 females), who had undergone arthroscopic rotator cuff repair for full-thickness rotator cuff tears. The average age of the time of the surgery was 61.5 years old(49-70 years old). The second look evaluation was composed of 6 different items: hypertrophy of intra-articular synovial tissue, articular side integrity at the repaired rotator cuff, hypertrophy of intra-bursal synovial tissue, bursal side integrity at the repaired rotator cuff, bursal tissue adhesion and appearance of coraco-acromial arch.Full-thickness tear was observed in 2 cases and partial-thickness tear was observed in 5 cases. Complete rotator cuff repair was seen only in 4 cases. 4 cases of hypertrophy of intra-articular synovial tissue, 4 cases of hypertrophy of intra-bursal synovial tissue, 7 cases of bursal tissue adhesion and 10 cases of newly formed coraco-acromial ligaments were recognized. Bursal tissue adhesion and remained rotator cuff tear might be one of the problems of current arthroscopic rotator cuff repair technique.
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Kimikazu SAKAGUCHI, Yoichi ITO, Yoshifumi NAKA, Yoshihiro NAKAO, Tomoy ...
2008 Volume 32 Issue 3 Pages
627-630
Published: 2008
Released on J-STAGE: November 21, 2008
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Delamination was one of the horizontal tears combined with articular side tears and bursal side tears observed in full-thickness rotator cuff tears. Double row rotator cuff repair was a current surgical technique for rotator cuff tears with delamination. The aim of this study was to evaluate the usefulness of double row repair technique for delamination by MRI. We retrospectively evaluated 18 patients in which we performed arthroscopic double row repair for delamination. Postoperative MRI was performed at 8.6 months on average. MRI findings were classified according to the modified Sugaya's classification (Type1, sufficient thickness with homogenously low intensity; type2, sufficient thickness with partial high intensity; type3a, articular side re-tear; type3b, bursal side re-tear; type4, presence of a minor discontinuity; type5, presence of a major discontinuity). Postoperative MRIs revealed 6 type1 (33.3%), 3 type2 (16.7%), 6 type3a (33.3%), 0 type3b (0%), 0 type4 (0%) and 3 type5 (16.7%). All type3 cases were articular side re-tears (type3a). Articular side re-tear was seen in 9 cases (50%) and bursal side re-tear was seen in 3 cases (16.7%). Significant differences between articular side re-tear and bursal side re-tear were observed.Bursal side tear was well repaired, though articular side re-tear was seen in 50% after a double row repair for delamination.
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Toshiro ITSUBO, Shigeharu UCHIYAMA, Hiroyuki KATO, Yukihiko HATA, Koui ...
2008 Volume 32 Issue 3 Pages
631-634
Published: 2008
Released on J-STAGE: November 21, 2008
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We reported that the high signal intensity on a portion of rotator cuff insertion seen on MRI after rotator cuff repair was not re-tear last year. At this time, we reported on whether a low signal intensity change showed recovery of the rotator cuff itself. We investigated 71 shoulders of 70 cases showing high intensity signal changes of the rotator cuff on MRI 6 months after rotator cuff repair. We classified the patients into two groups; the 1st consisted of 37 patients (“A” group) with low signal intensity changes of the rotator cuff, and the 2nd group consisted of 34 patients (“B” group) with no low signal intensity changes. For the clinical evaluation, we examined the patients' JOA score, UCLA score, range of motion (ROM) of the shoulder, and MMT. For the configuration evaluation, we estimated the muscle belly thickness of the SSP, ISP, and deltoid muscles, and the fatty degeneration of the SSP muscle using Nakagaki's classification. We compared and reviewed each item at 6 months and 1 year postoperatively. Based on the clinical evaluation, the UCLA and JOA scores were more significantly improved at 1 year postoperative time than at 6 months (p<0.01). Based on the configuration evaluation, recovery of the thickness of the ISP muscle belly and fatty degeneration were statistically significant in the A group (p<0.01, p<0.01, respectively), but the B group did not show significant recovery. Based on these results, we believed that low signal intensity changes show recovery of the rotator cuff itself.
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Koumei MATSUURA, Eiichi ISHITANI
2008 Volume 32 Issue 3 Pages
635-638
Published: 2008
Released on J-STAGE: November 21, 2008
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We evaluated the characteristics in MRIs of the re-tear cases after ARCR and the changes of a postoperative rotator cuff at a later period. We examined 40 cases (average age 65.8 years old) on whom we performed ARCR from May 2003 to April 2007 and who had had MRIs preoperative and at 6, 12 months post operation. We classified them in two groups, the re-tear group after operation and the non re-tear group, and evaluated thepreoperative tear shape, atrophy of rotator cuff muscle belly, fat degeneration using MRIs. The fat degeneration was evaluated by Goutllier's classification. In addition, we investigated tbe postoperative changes at a later period. We diagnosed re-tear in 6 shoulders (15%) out of 40 shoulders in MRIs at a postoperative 6 months. The tear size had a tendency of enlargement. The age of either group did not have a significant difference. Preoperative rotator cuff tear size of the re-tear group was larger than of the non re-tear group in transverse and longitudinal diameters, significantly (P < 0.01). The small tendency had the cross section product of rotator cuff belly of muscle in re-tear group, but there was not the statistical significance difference. As a risk factor of a re-tear, it was thought that a preoperative rotator cuff tear being big, fatty degeneration of rotator cuff belly of muscle were strong. We conclude that the risk factors of rotator cuff re-tear are preoperative large tear, fat degeneration of the muscle belly.
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Tomoya MATSUHASHI, Naomi OIZUMI, Shintaro YAMANE, Akio MINAMI, Naoki S ...
2008 Volume 32 Issue 3 Pages
639-643
Published: 2008
Released on J-STAGE: November 21, 2008
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Treatment for irreparable rotator cuff tears remained controversial. Latissimus dorsi transfer had been proposed for the treatment of irreparable tears by Gerber et al. in 1988. Our aim of this study was to investigate outcomes of the latissimus dorsi transfer for irreparable rotator cuff tears. From 1992 to 2004, 7 shoulders in 7 cases which were performed on a latissimus dorsi transfer for irreparable rotator cuff tears were evaluated clinically and radiographically. The averaged follow-up period was 78.9 months (range 36-169 months). The study group included seven men, with an average age of 63 years old at the time of surgery. The outcome assessment included the JOA scores, range of motion of active flexion and external rotation, internal rotation. Osteoarthritis and upper migration of the humeral head were also evaluated on standardized radiographs. The averaged JOA score improved from 41.4 preoperatively to 81.1 at the time of follow-up. Flexion increased from 63.3° to 140.8°. External rotation was increased. 4 had significant progress of the osteoarthritic change and the upper migration of the humeral head. Femoralization of greater tuberosity was appeared in 4 shoulders. All 7 patients were satisfied with their shoulder condition. The disabling pain in most patients was diminished after surgery, however, the osteoarthritic change progressed in 57.1%. Further long-term follow-up should be necessary.
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Norio ISHIGAKI, Yukihiko HATA, Koichi NAKAMURA, Narumichi MURAKAMI, Hi ...
2008 Volume 32 Issue 3 Pages
645-647
Published: 2008
Released on J-STAGE: November 21, 2008
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When we chose a therapy for rotator cuff tear, there was no definite basis , but presence and degree of a pain tended to become a large element of the judgment. The aim of this study was to investigate it about the factor influencing the difference of pain, and to prove that characteristic of pain with rotator cuff tear. A consecutive series of 328 shoulders in 328 patients with rotator cuff tear underwent operative treatment were concerned since July 1997 to December 2006. These patients were divided with three groups ; Group A, consisted of 135 shoulders which had a night pain (Japanese Orthopaedic Association score (JOA score) of pain<10), Group B, consisted of 60 shoulders which pain was produced in daily living activities (JOA score of pain=15), Group C, consisted of 133 shoulders which produced pain only in working or no pain (JOA score of pain>20). All patients had erevations of their age, sexuality, the affected side, a contraction period, history of trauma, tear size and range of motion. Age, sexuality, the affected side, contraction period, history of trauma, tear size did not recognize a significant difference between 3 groups. In the range of motion, group A, B were limited in comparison with group C in flexion and C7 thumb distance (CTD) significantly, and group A was limited in comparison with group B, C in extension significantly.
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Koumei MATSUURA, Eiichi ISHITANI
2008 Volume 32 Issue 3 Pages
649-652
Published: 2008
Released on J-STAGE: November 21, 2008
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We divided the rotator cuff tear part according to the articular surface of the greater tubercle of the humerus and conducted an investigation into the influence that each gave to each rotator muscle power.
From October 2004 to April 2007, we evaluated 80 patients with rotator cuff tear. We defined the location of cuff tear the facet as zone one ; superior facet, as zone2 ; anterior part of middle facet, as zone3 ; posterior part of the middle facet, and as over zones 1,2,3. We measured both sides of the muscle strength of abduction, external rotation, internal rotation, internal rotation using Microfet. The muscle strength of the unaffected side became significantly big in order of abductor power < external rotation power < adductor power (P <0.001). Each muscle strength test showed that JOBE <40°, ISP <ER2 (P <0.01), BPT <SSC (NS). Regardless of tear size, on the rotator cuff tear side, muscle strength showed that abductor power < external rotation power < adductor power (P <0.001), but did not show significant differences between each muscle strength tests. The muscle strength rate of the affected side for the unaffected side according to a part on greater tubercle of humerus of a rotator cuff tear, was Zone 1, 83%, 83%, 90%, Zone 1,2 , 72.5%, 76%, 87%, Zone 1,2,3, 79%, 75%, 88%, 49% that were bigger than Zone 1,2,3, 39%, 91% in order of abduction, external otation, adduction. In the cases of cuff tear on the superior facet only, not only exterenal rotation power but also external and internal rotation power decreased.
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Yoshihiro NAKAO, Yoichi ITO, Tomoya MANAKA, Yoshifumi NAKA, Hiroyasu T ...
2008 Volume 32 Issue 3 Pages
653-656
Published: 2008
Released on J-STAGE: November 21, 2008
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Arthroscopic rotator cuff repair was developed with advancement in arthroscopic techniques and it was used clinically to treat rotator cuff tears. However, there was little known about postoperative biological healing potential of the rotator cuff tendon. The aim of this study was to evaluate the bone-tendon junction histologically post arthroscopic rotator cuff repair. We evaluated bone-tendon junction histologically with the extracted tissue by needle biopsy at the repaired site of each rotator cuff tear. We used six samples from six patients (five male and one female), who had undergone arthroscopic rotator cuff repair surgeries for full-thickness rotator cuff tears and postoperative good clinical results at a minimum 6 months follow-up. The average age at the time of rotator cuff repair surgery was 55.5 years old (38-65 years old). Each sample was fixed in formalin and embedded in paraffin. Staining was performed with hematoxylin eosin and toluidine blue. Fibrocartilage formation was observed at the repaired site of the bone-tendon junction in four of six samples (67%). However, they were unlike normal enthesis composed of 4 distinct zones. Fibrous connective tissue interposition without any fibrocartilage formation, was recognized in the other 2 samples (33%).Fibrocartilage formation was observed at the repaired site of bone-tendon junction after arthroscopic rotator cuff repair. This indicates that the natural healing potential has remained at the bone-tendon junction of torn rotator cuff tendon.
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Kaoru YAMANAKA, Kazutoshi HAMADA
2008 Volume 32 Issue 3 Pages
657-660
Published: 2008
Released on J-STAGE: November 21, 2008
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37 shoulders (36 patients) more than 40 years old without apparent complete supraspinatus tendon tear were studied by serial MRIs to evaluate the factors affecting the aging and tering the supraspinatus tendons. There are 13 males and 23 females with the averaged age of 62.0 years old. The mean period between the initial and the final MRIs was 14.6 months and disease periods was 6.1 months.
The MR images of supraspinatus, infraspinatus and subscapularlis tendons were assessed by signal intensity in the tendon. Signal intensity of the tendon was classified into six grades. Grade 0: tendon was occupied with low signal intensity area. Grade 1: iso signal intensity area was scattered in the tendon. Grade2: high signal intensity area was scattered in the tendon. Grade3: high signal intensity area was mainly in the bursal side of the tendon. Gade4: high signal intensity area was mainly in the middle of the tendon. Grade 5: high signal intensity area was mainly in the joint side of the tendon. High signal intensity in the bursa (subacromial, subscapularis bursa and bicipital sheeth) and joint (glenohumeral and acromio clavicular) was classified into 3 grades namely Grade 0: none. Grade 1: mild. Grade 2: apparent. Increase of high signal intensity area in the SSP tendon was seen in 16 cases and decrease of high signal intensity area was seen in 15 cases at 2nd MRI. 6 cases remained in the same grade. 2 shoulders progressed to complete cuff tear. High signal intensity in the glenohumeral joint, subacromial bursa and bicipital groove may predispose the supraspinatus tendon to increase of the high signal intensity area.
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