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Yusuke IWAHORI, Makoto KATO, Tomoaki OSUGA, Yukihiro KAJITA, Keiji SAT ...
2009 Volume 33 Issue 2 Pages
271-275
Published: 2009
Released on J-STAGE: September 15, 2009
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In 2005 we developed a new type of arthroscopic Bankart repair that provided double anchor footprint fixation of AIGHLC (Modified DAFF technique). The purpose of this study was to evaluate the minimum 1-year follow-up result of this technique. We retrospectively studied 53 shoulders of 52 patients. There were 42 male and 10 female patients. The average age at operation was 22.3 years old (range, 14 to 33). We inserted the medial anchor 4mm under the anterior glenoid edge at the 3.5 o'clock and the lateral anchors on the glenoid at the 4 and 3 o'clock to make a footprint repair of AIGHLC around the anterior glenoid rim. At the 5 and 2 O'clock we used conventional suture anchor technique. We evaluated recurrence, the postoperative range of motion, the preoperative and postoperative JSS instability score, and return to sports. One shoulder of a snowboarder experienced re-subluxation. Postoperatively, the average loss of external rotation was 9.8° with the arm at the side, and 9.0° with the arm in 90° of abduction. The average JSS instability score improved from 47.8 preoperatively to 93.9 postoperatively. 29 patients completely returned to sports, 9 patients returned partially. The short term result of arthroscopic Bankart repair with a modified DAFF technique was satisfing.
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Taishi UEHARA, Kazuhide SUZUKI, Hiroaki TSUTSUI, Kenichi MIHARA, Daisu ...
2009 Volume 33 Issue 2 Pages
277-280
Published: 2009
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The purpose of this study was to compare the clinical results of open Bankart repair (open group) and arthroscopic Bankart repair (arthroscopic group) using Panalok suture anchors for traumatic anterior shoulder instability. We studied retrospectively 66 shoulders in the open group and 86 shoulders in the arthroscopic group. All patients had typical Bankart lesion and underwent open or arthroscopic Bankart repair, and were observed more than 2 years postoperatively. The average age at the time of surgery was 25.4 years old in the open group and 24.9 years old in the arthroscopic group. 41 cases in the open group and 54 cases in the arthroscopic group actively participated in sports activities. The average follow-up was 28.5 months in the open group and 27.2 months in the arthroscopic group. We evaluated the clinical outcome using the JSS shoulder instability score (instability score), Rowe score, recurrence rate and return to sports activities. The instability score and Rowe score were 81.4 and 79.8 in the open group, and 87.5 and 83.8 in the arthroscopic group at the time of final investigation. 9 cases in the open group and 10 cases in the arthroscopic group had experienced re-dislocation. 35 cases (85.4%) in the open group and 49 cases (90.7%) in the arthroscopic group returned to their preoperative sports activities on average 6.8 and 5.9 months postoperatively. The instability score, especially ROM score of the score, and ROM score of Rowe score were significantly higher in the arthroscopic group compared with the open group. Arthroscopic Bankart repair showed similar results to the open Bankart repair.
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Norimasa TAKAHASHI, Hiroyuki SUGAYA, Naoki YAMAGAMI, Yoshihiro HAGIWAR ...
2009 Volume 33 Issue 2 Pages
281-284
Published: 2009
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Generally, open revision surgery is considered as a standard procedure for failed open shoulder stabilization. However, we prefer arthroscopic surgery to open for revision because arthroscopy enables us easy access to the glenohumeral joint even after preceding open surgeries and precise repair of the glenohumeral pathologies. Therefore, we performed arthroscopic revision surgery for all shoulders after failed glenohumeral stabilization regardless of primary methods.
We performed 10 revision arthroscopic stabilizations following failed open surgeries. They were nine males and a female with an average age of 31 years old (range, 17 to 47) at the time of revision surgeries. The primary stabilization methods of these patients included open Bankart repair in 4, Boytchev procedure in 4, modified Bristow procedure in 1 and modified Oudard-Iwahara-Yamamoto procedure in one shoulder. We found a Bankart lesion in all 10 cases. They underwent ordinary arthroscopic Bankart procedure using suture anchors without any difficulties. We performed rotator interval closure as an augmentation in seven cases. Currently, no further failure was observed in 9 of 10 cases. 9 patients were classified as excellent or good using Rowe sore. JOA shoulder score was significantly improved. A 44-year-old-man was reinjured with a medium glenoid fracture during wake-boarding.
Since a Bankart lesion was observed in all cases and 7 patients underwent a recurrent instability within one year without a traumatic event, the pathology for failed open stabilization was believed to be an inadequate technique during primary surgery or problem of the primary procedure itself. We think arthroscopic surgery is a suitable for the revision of failed open stabilization because an approach to the glenohumeral joint is easy despite extra-articular adhesion or scar formation caused by primary open surgery, also, glenohumeral joint structure was well preserved in most shoulders. In conclusion, arthroscopic revision surgery was effective for failed open stabilization.
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Katsumi TAKASE, Yuka SATO, Kengo YAMAMOTO, Masahiro ITO, Masayoshi MIY ...
2009 Volume 33 Issue 2 Pages
285-288
Published: 2009
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The acromioclavicular joint separation was divided into 3 types by Tossy or 6 types by Rockwood. However, the trapezoid and conoid ligament, which were composed of the coracoclavicular ligament, were not estimated in detail in those classifications. In this study, we investigated the sites and degrees of ligament injury in types 1, 2, 3, and 5 acromioclavicular joint separations by magnetic resonance images. There were 13 patients (10 males, 3 females), and their ages ranged from 20 to 58 years old (mean: 35.5 years old). According to Rockwood's criteria, these patients consisted of 1 case in type 1, 5 cases in type 2, 4 cases in type 3, and 3 cases in type 5. MR and enhanced MR images were performed in all cases within 3 days after injury, and evaluated coracoclavicular ligament. Both the trapezoid and conoid ligament were torn in 6 cases out of 7 cases of type 3 and 5. Both ligaments were ruptured at the same site in 4 of 6 cases. However, there were 2 cases that both ligaments ruptured at a different site. On the other hand, the conoid ligament did not recognize clear abnormal findings, but trapezoid ligament was torn in all cases of type 2. From these results, we thought that detailed evaluation of acromioclavicular joint separation could not be made by a used classification.
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Yusuke IWAHORI, Makoto KATO, Tomoaki OSUGA, Yukihiro KAJITA, Keiji SAT ...
2009 Volume 33 Issue 2 Pages
289-292
Published: 2009
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The purpose of this study was to evaluate the minimum 2-year-follow-up result of arthroscopic Bankart repair using suture anchor (ASB) for traumatic anterior glenohumeral instability and made a comparison of the result between the with and without arthroscopic rotator interval closure (ASRIC). We retrospectively studied 105 shoulders of 103 patients. There were 71 male and 32 female patients. The average age at operation was 24.1 years old. 71 shoulders underwent ASB (group S), and 34 shoulders underwent ASB and ASRIC together (groupR). A comparison of the clinical results between with (group S) and without ASRIC (group R) was made. Postoperatively, 6 shoulders (8.5%) in group S and 3 shoulders (8.8%) in group R experienced recurrences. At the time of the final follow-up, the average loss of external rotation was 7.9° in group S and 11.4° in group R with the arm at the side, and 6.3° in group S and 7.8° in group R with the arm in 90° of abduction. The averaged Japanese Shoulder Society shoulder instability score (JSS-IS score) changed from 50.2 before surgery to 94.7 after surgery in group S, from 48.3 before surgery to 93.8 in group R. No significant differences were observed in the recurrence rate, shoulder ROM and JSS-SI score at the time of the final follow- up between group S and R. Rotator interval closure did not affect the result of arthroscopic Bankart repair.
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Shin-ichi YAMADA, Minoru YONEDA
2009 Volume 33 Issue 2 Pages
293-297
Published: 2009
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The purpose of this study was to evaluate the clinical results of arthroscopic repair of each structure in the rotator interval lesions. 15 patients (12 male, 3 female) with rotator interval lesions were included in this study. In Group A, 9 patients were treated arthroscopically by rotator interval closure. Group B was consisted of 6 patients treated by arthroscopic repair of each structure in the rotator interval lesions: 2 repairs of superior glenohumeral ligament, 2 repairs of middle glenohumeral ligament and 2 of both. The clinical outcomes were assessed by means of JOA shoulder scoring system. The average JOA score was improved from 83.3 points to 97.5 points in Group A and from 74.0 points to 98.8 points in Group B. Postoperative results were not significantly different between 2 groups. 5 patients had limitation of external rotation at the side over 10 degrees, 3 in Group A and 2 in Group B. In 8 patients who participated in sports activity at the competitive level before being affected by rotator interval lesion, 7 could return to sports participation. In Group A, 2 had got to the same level as before injury and 2 had not. In Group B, 3 all could get a complete return. This study showed excellent clinical results of arthroscopic rotator interval repair equal to those of rotator interval closure for the patients with reparable structures in rotator interval lesions.
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Toru MORIHARA, Akiko OGURA, Yoshio IWATA, Yoshikazu KIDA, Toshikazu KU ...
2009 Volume 33 Issue 2 Pages
299-303
Published: 2009
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Traumatic instability of shoulder often resulted from Bankart lesion after anterior shoulder dislocation. We showed the 4 cases of anterior inferior shoulder instability arm at the side. The 4 cases of this study (2 women, 2 men) were included. They did not feel apprehension of the shoulder at the 90 abduction external rotation. In the analysis of needle EMG, there was no paralysis of the deltoid muscle. The conservative therapy including inner muscle training, scapulo-thoracic muscles did not have any effect on the improvement of their symptoms. We performed an arthroscopic surgery in these cases. There were no injuries of rotator cuff and biceps tendon. MGHL were partially torn in the 1st er, and AIGHL was intact and the tension was normal in the 2nd er. In 2 of 4 cases the rotator interval was wide. In 3 of 4 cases MGHL was repaired on the glenoid rim by the suture anchors. After surgery, 1 of 4 (in the case of simple RI closure) remained the inferior instability of the shoulder. In this study after simple RI closure the inferior instability remained. In 3 of 4 cases, MGHL repair had the more effect on the stability of the inferior arm at the side. MGHL repair is one of the effective methods for the antero-inferior instability arm at the side.
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Hiroaki KIJIMA, Hiroshi MINAGAWA, Tatsuru TOMIOKA, Yoichi SHIMADA
2009 Volume 33 Issue 2 Pages
305-307
Published: 2009
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A lot of treatment methods for shoulder dislocation and their evidences have been reported. It is the patients that finally choose the treatment, based on those evidences. For sports players, not only re-dislocation rate but also the period until return to sports is the important factor in selecting the treatment. The purpose of this study was to clarify the actual condition of shoulder dislocation in the high school rugby football player, and to investigate which methods of treatment they expected. One-hundred sixty-one high school rugby football players were studied. First, we informed them about re-dislocation rate and the period until they return to sport in the respective treatment method. Next, we did a questionary survey. The shown treatment methods were doing nothing, fixation at internal rotation, fixation at external rotation, arthroscopic surgery, and the use of braces. The ratio of the player having experienced shoulder dislocation was 8%, and among them the ratio of the player who experienced more than twice dislocation was 46%. The answers to the question which method was chosen if you dislocate your shoulder just before the season was doing nothing: 7.5%, internal rotation fixation: 0%, external rotation fixation: 29.8%, operation: 26.7%, and brace: 31.7%. We showed the possibility that repetitive dislocation patient cannot perform sports enough, however there were many players who select the use of a brace that enable the early sports return but have comparatively high re-dislocation rates.
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Nariyuki MURA, Yasuo GOTO, Yoshiyuki MOMONOI, Isao TAKEI, Daisaku TSUR ...
2009 Volume 33 Issue 2 Pages
309-312
Published: 2009
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There are some patients who have traumatic anterior shoulder instability due to minor injuries like overhead activities. The purpose of this study was to clarify characteristic features of traumatic anterior shoulder instability due to minor injuries. According to the mechanism of injury in initial dislocation, 83 shoulders that underwent the stabilizing surgery for traumatic anterior shoulder instability were divided into 2 groups. Traumatic group included patients who suffered from a fall or a direct injury. Minor injury group included patients who suffered from another injury like overhead activity. General joint laxity, range of motion and laxity under anesthesia, and intraarticular findings were compared between the 2 groups. The morphology of superior and middle glenohumeral ligaments, Bankart lesion, Hill-Sachs lesion, and partial articular surface tendon avulsion lesion were observed in arthroscopy. Minor injury group consisted of 19 shoulders with 8 males, 11 females and the mean age of 22.5 years old. Traumatic group consisted of 64 shoulders with 52 males, 7 females and the mean age of 24.3 years old. The females in minor injury group was significantly more than that in traumatic group. There was no difference in general joint laxity and intraarticular findings between the 2 groups. The range of external rotation in injured side in minor injury group was significantly more than that in traumatic group. Inferior laxity in both sides in minor injury group was more than that in traumatic group. In conclusion, traumatic anterior shoulder instability due to minor injuries might occur in females and those with inferior laxity of the shoulder.
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Hideki SATO, Saori YAMAGUCHI
2009 Volume 33 Issue 2 Pages
313-316
Published: 2009
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The purpose of this study was to evaluate MR arthrograms, recovery of shoulder muscle strength, and clinical results after immobilization in external rotation after initial traumatic shoulder dislocation and subluxation. Subjects were 6 patients who suffered initial traumatic shoulder dislocation or subluxation, and wore an external rotation immobilizer for 3 weeks from 2 days on the average after the onset. Then, active range of motion exercises restricted to 10 degrees external rotation and 90 degrees flexion and abduction was continued until 6 weeks after the onset. Return to sports was permitted at 4 months. MR arthrograms and muscle strength including flexion, abduction, and both external and internal rotation, were examined at 3 months after the onset. Recurrent dislocation or subluxation was evaluated for clinical results. 2 patients showed normal, and 4 patients showed labral detachment with displacement of Hirose's classification in MR arthrograms. The muscle strength showed no side-to-side differences in flexion, abduction and internal rotation. 1/2 of the cases had recurrence 1 year after the onset. All of them showed labral detachment in MR arthrograms. Return to sports at 4 months after the onset could be reasonable based on the results of recovery of muscle strength in this study. However, an obvious Bankart lesion in MR arthrogram 3 months after the onset might indicate a risk of recurrence. Further study for the protocol of conservative treatment using an external rotation immobilizer should be considered.
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Hiroshi IWASO
2009 Volume 33 Issue 2 Pages
317-319
Published: 2009
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Arthroscopic Bankart repair requires a certain level of technical proficiency. Takeda evaluated the learning curve regarding arthroscopic Bankart repair, and reported that experience of about 100 cases is necessary to produce certain results. We evaluated the learning curve of arthroscopic Bankart repair, while giving consideration to the degree of surgical difficulty. The subjects consisted of 119 patients who underwent arthroscopic Bankart repair by the same surgeon between 2003 and 2008. The evaluated items were the operating time, number of used anchors, extent of the Bankart lesion. The operating time varied from 55 to 210 minutes and did not decrease with an increase in treated cases. The number of anchors/Bankart lesion was mostly 1 or less in the first 60 cases but 1 or more in most subsequent cases. The operating time/anchor was 9-70 minutes, being 30 minutes or more in the first 50 cases and 20 minutes or less in most subsequent cases. We expected that the total operating time would be reduced with the mastering of the technique. However, the insertion of more anchors may become possible with the learning of the technique even when the extent of the Bankart lesion is the same. Therefore, the operating time/anchor was evaluated, and the following criteria for proficiency were suggested: 1) surgery in 50 cases or more, 2) an operating time of less than 20 minutes/anchor suture. 3) more than 1 anchor /Bankart region "1 hour".
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Yoshinori TAKUBO, Toru MORIHARA, Haruhiko NAKAGAWA, Motoyuki HORII, To ...
2009 Volume 33 Issue 2 Pages
321-323
Published: 2009
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We reported previously anchor hole enlargement after arthroscopic Bankart repair using bioabsorbable suture anchors. Subsequently, we have used a modified anchor. The changes of frequency by modifying the shape of anchor were investigated. 20 patients(18 males, 2 females) who underwent arthroscopic Bankart repair using Panalok suture anchors for anterior shoulder instability were examined(PA group). After October 2005, we have used Panalok loop anchors for arthroscopic Bankart repair. 34 patients (27 males, 7 females) using Panalok loop anchors were examined (LO group). Anchor hole enlargement was defined as high signal areas of anchor hole more than 1 slice on T2
* weighted MR images after 3 months postoperatively. The numbers of enlarged anchor holes were compared between the 2 groups. The clinical results of the 2 groups were evaluated. In PA group, 62 anchors were used for surgery (mean; 3.1 anchors /patient). 3 cases of anchor hole enlargement were identified, and 5 anchor holes out of 62 (8.1%) showed enlargement. 2 of the 3 patients had instability at 3 months after surgery, but all of the patients had no instability at final follow-up (mean; 14 months). In LO group, 131 anchors were used for surgery (mean; 3.9 anchors /patient). Only 1 case of anchor hole enlargement was recognized, and 1 anchor hole out of 131 (0.76%) demonstrated enlargement. The rate of anchor hole enlargement of LO grope was fewer than PA. The patient had no instability over all periods of observation, and excellent clinical results at final follow-up (24 months). There is no difference of clinical results between PA and LO group. A secure fixation of capsulo-labrum complex on arthroscopic Bankart repair could prevent anchor hole enlargement.
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Teruaki IZAKI, Yozo SHIBATA, Takeshi TERATANI, Jun TANAKA, Masatoshi N ...
2009 Volume 33 Issue 2 Pages
325-327
Published: 2009
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The purpose of this study was to evaluate the clinical results of patients with recurrent anterior shoulder dislocations aged 50 years old and more at the time of surgery. From January 1992, 27 consecutive patients were included in the study with a mean follow-up of 30.5 months, ranging from 7 to 89.3 months. The age range was 50 to 79 years old with an average of 63.0 years old. 20 patients were women and 7 were men. The most common finding was a Bankart lesion associated with complete cuff tears with an average age of 68.3 years old (17 patients). 8 patients had Bankart lesions alone with an average age of 52.9 years old. 2 patients had complete cuff tear alone with an average of 58.5 years. The Japanese Orthopaedic Association shoulder scores improved, from a mean score of 56.1 points preoperatively to 86.1 points postoperatively. The Japanese Shoulder Society Shoulder Instability Scores improved, from a mean score of 30.8 points preoperatively to 79.3 points postoperatively. Recurrent anterior shoulder dislocation in elderly patients is more common than is generally believed. Operation is needed to repair torn cuff or to stabilize the shoulder. Patients with a Bankart lesion associated with complete cuff tears will require both procedures.
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Noboru MATSUMURA, Shouhei SHIONO, Noriaki NAKAMICHI, Hiroyasu IKEGAMI, ...
2009 Volume 33 Issue 2 Pages
329-332
Published: 2009
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The purpose of this study was to evaluate the clinical results of our surgical treatment for chronic acromioclavicular dislocation. During the period between July, 1993 and July, 2003, we used Dacron grafts for the reconstruction of coracoclavicular ligaments to treat chronic acromioclavicular dislocations. We could follow-up on 7 cases (male4, female3) for more than 3 years after the operations. The average age of the patients at the time of surgical treatment was 43.9 (22-67). We evaluated the findings of their X-ray films retrospectively. And we had followed-up on 5 cases by the time of this research. Clinical results of these cases were evaluated by JSS acromioclavicular joint score. The average preoperative distance of coracoclavicular interval was 14.4mm (9-20mm), and the average ratio between the value of affected side and that of the healthy side was 216.3% (187.5-228.6%). At the time of final follow-up, the distance decreased to 6.8mm (4-12mm) and the ratio improved to 103.5% (80.0-133.3%). The bone tunnels of the clavicle tended to be larger, however, it stopped in a year after the surgeries. The mean JSS acromioclavicular joint score was 83.0 (80-90). We had 1 case of clavicular fracture along with the bone tunnels of the clavicle after the surgery as a complication. Satisfactory outcomes were achieved by our surgical treatment. However we had 1 case of clavicular fracture. We have to pay attention to a patient's age at the time of operation when using Dacron grafts as the reconstruction of coracoclavicular ligaments.
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Tetsuya TAKENAGA, Katsumasa SUGIMOTO
2009 Volume 33 Issue 2 Pages
333-335
Published: 2009
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The purpose of this study was to evaluate the short term results of arthroscopic Bankart repair, using 1 anchor-2 sutures technique, for traumatic anterior glenohumeral instability. We studied 48 patients 51 shoulders who underwent this procedure. There were 38 male and 10 female patients. The average age at operation was 24.6 years old (range, 13 to 64). The mean interval from the time of operation to the final follow-up evaluation was 35 months (range, 20 to 62). Postoperatively, 5 patients experienced re-dislocation, and 3 patients underwent an open Bristow and Bankart procedure. The average loss of external rotation was 13.5° (range, 0 to 80). The present study suggests that arthroscopic Bankart repair using 1 anchor-2 sutures technique may provide a satisfactory outcome.
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Katsumi TAKASE, Yuka SATO, Kotaro SHINMURA, Kengo YAMAMOTO
2009 Volume 33 Issue 2 Pages
337-340
Published: 2009
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For patients with traumatic anterior shoulder instability, we have been performing arthroscopic Bankart procedures using suture anchors. Here, we reported the therapeutic results of the patients with some intraarticular lesions except for Bankart lesion compared to that on the patients with only Bankart lesion. The subjects were 27 patients. Their mean age at the time of surgery was 31.8 years old. Almost all cases engaged in sports activities. On preoperative radiographic findings, Bankart lesions were observed in all patients. During arthroscopic procedure, intraarticular lesions, except for Bankart lesion, consisted of SLAP lesion in 20 cases, rupture of the capsule in 5 cases, and joint mice in 5 cases. The mean follow-up period was 2 years and 3 months and the therapeutic results were evaluated according to the JOA score and JSS shoulder instability score. Meanwhile, the therapeutic results of the patients with only Bankart lesion were evaluated as a comparison group. Of 27 patients, no patient developed subluxation or dislocation after surgery. The final therapeutic results were evaluated as 95.1 points in JOA score and 90.8 points in JSS shoulder instability score. The comparison group was evaluated as 97.2 points in JOA score and 96.1 points in JSS shoulder instability score. In the postoperative range of motion, external rotation was restricted by about 12.3 degrees on average, compared to the non-affected side. However, the restriction in the comparison group was 5.4 degrees compared to the non-affected side. There was no difference in shoulder instability between the subjects and the comparison group, postoperatively. However, the postoperative external rotation was restricted higher in the subjects compared to the comparison group.
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Yoshiyuki MOMONOI, Mikio HARADA, Nariyuki MURA, Toshihiko OGINO
2009 Volume 33 Issue 2 Pages
341-343
Published: 2009
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There were some patients who had humeral head perforations after operation for proximal humeral fracture using an All-in-One Nail. The purpose of this study was to investigate the rate of perforation, the cause of perforation and the influence of perforation on the postoperative outcome. We evaluated the clinical result of 12 patients who underwent internal fixation with All-in-One Nails for proximal humeral fracture. 1. Number of humeral head perforations after surgery, 2. number of perforations during operating, 3.redisplacement after surgery, 4. the starting day of exercises after surgery, 5. active ROM at the latest examination (flexion, abduction) were examined. 3 cases had perforation after surgery. 2 cases of perforated group had perforation during surgery. Redisplacement after surgery was seen equally in both groups. The starting day of exercises tended to be earlier in perforated group. The mean ROM tended to be larger in not perforated group. Some advantages of the All-in-One Nail were described, such as low invasive, maintains alignment to the distress cases and it could start exercises at an early period. On the other hand, from our study, the risk factors of humeral head perforation was clarified as perforation during surgery and starting exercises at an early period after surgery. All-in-One Nail gives support to fracture that cannot keep the reposition during conservative treatment, but does not have enough stability immediately after operation among the other implants.
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Takahiko MIKASA, Takeshi MORIOKA, Kazutoshi HAMADA, Yuko ASHIZAWA, Kao ...
2009 Volume 33 Issue 2 Pages
345-347
Published: 2009
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The purpose of this study was to investigate the surgical outcome for distal end fracture of the clavicle. 70 cases had been operated on at Saiseikai Kanagawaken Hospital, Shizuoka City Shimizu Hospital and Shizuoka Red Cross Hospital from 2001 to 2007. These cases were classified according to Craig classification and Takubo's classification type VI. There were 2 cases in type IIa, 46 cases in type IIb, 15 cases in type V, and 7 cases in type VI. The average age at operation was 40.7 years old (19 - 80 years old). The operations contained 52 cases of ACJ plate, 10 cases of tension-band wiring, and 8 cases of Scorpion plate. The mean follow-up period was 9.9 months (5.6 - 19.3 months). The bone union period, stability of acromioclavicular joint, and the displacement rate at fracture site were evaluated on X-ray at final follow-up. The postoperative clinical results were evaluated by the Japan Orthopaedic Association (JOA) shoulder score. In 4 cases (1 case of type IIb and 3 cases of type V), non-union developed. The postoperative JOA scores were 96.2(82 - 100). There were no significant differences in JOA scores among fracture types (p=0.36) and among the operative procedures (p=0.077). The bone union periods did not show significant difference among the operative procedures (p=0.97). Displacement rate at fracture site displayed significantly higher in tension band wiring and Scopion plate group than in ACJ plate group (p=0002). The frequency of acromion-clavicular joint subluxation displayed significantly higher in tension-band wiring and Scopion plate group than in ACJ plate group (p=002). The cases operated on using procedures which did not stabilize the acromionclavicular joint developed acromioclavicular dislocation or displacement at fracture site more frequently. It could be important to stabilize the acromionclavicular joint for a while after operation in order to get a stable acromioclavicular joint.
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Hiroyasu IKEGAMI, Kiyohisa OGAWA, Shuuzo KOBAYASHI, Noriaki NAKAMICHI, ...
2009 Volume 33 Issue 2 Pages
349-352
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We reported that the sliding method was very useful for nonunion case of acromion fracture and an os acromiale. It is often happens that, in fracture of the acromion, the distal fragment is dragged by the deltoid muscle and dislocated downward, which makes it nonunion. Also an os acromiale that is unfused acromial epiphysis can become a cause of subacromial impingement syndrome and in some cases, the open reduction internal fixation fails to unite fragments. We treated by sliding method such cases and observed good results. The targets were 8 cases we treated by sliding method during the period between 2002 and 2007 (5 cases of the fracture of acromion, 3 cases of the os acromiale: 5 males, 3 females). The average age at the time of the operation was 29 years old (16 to 42), with 6 right shoulders and 2 left shoulders. We studied the place of unfused area, complications, the relationship between the A-C joint and unfused area, the rate of bone union, and the results of the surgery. We got bone unions in all cases. There was no nonunion case after sliding method. The sliding method was originally developed by Albee. This technique is very useful to get bone unions for a non-union case of acromion fracture and an os acromiale without iliac bone transplantation.
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Daisaku TSURUTA, Nariyuki MURA, Toshihiko OGINO, Yasuo GOTO, Junya SAS ...
2009 Volume 33 Issue 2 Pages
353-356
Published: 2009
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The purpose of this study was to clarify the results of the postoperative outcome in 4-part fracture of the proximal humerus with dislocation. We operated between 1995 and 2006, and could follow-up 5 shoulders in different cases with 4-part fracture-dislocation of the proximal humerus, Neer Group VI. 2 were males, and 3 were females. The average time from injury to operation was 19 days. The mean age at the time of the operation was 62 years old. Open reduction and internal fixation (ORIF) was done for 1 case, and hemiarthroplasty was done for 4 cases. The average follow-up period was 66 months. We evaluated postoperative results with JOA score. 1 case treated with ORIF had 75 points, and 4 cases treated with hemiarthroplasty, had an average of 61 points JOA score, at the time of the last follow-up. Brachial plexus palsy had occurred in a case operated on 74 days, after injury. After the operation this palsy had recovered. The case after ORIF was complicated by avascular necrosis. In the cases after hemiarthroplasty, absorption of the tuberosity had occurred in 1 case. The JOA score ranged from 45 to 75 points, and postoperative outcome in 4-part fracture of the proximal humerus with dislocation is unsatisfactory.
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Akiyoshi HANDA, Yoshiyasu UCHIYAMA, Eiji SHINPUKU, Hiroko OMI, Joji MO ...
2009 Volume 33 Issue 2 Pages
357-360
Published: 2009
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The purpose of this study was to evaluate the long term results of humeral head replacement (hemiarthroplasty) of the shoulder in young patients (<30 years of age).
In this study, we investigated 5 shoulders of 5 patients (all males) for the hemiarthroplasty (Kirschner modular type II-C and Neer II) of the shoulder. The average age was 23.8 years old(range, 17-30 years old), and the average follow-up was 137.2 months (range, 121-167 months). Fractures were 2-part (anatomical neck fracture) in 2 patients, 3-part (humeral head necrosis after fracture) in 1, and 4-part in 2. Functional evaluation was done by use of the JOA score. The follow-up radiographs were compared with the postoperative radiographs, and all were scrutinized with regard to prosthetic loosening, superior migration and ectopic bone formation.
There were no complications in all patients. The average JOA score was 85.2 points (range, 62-100 points). 2 patients (desorption of greater tuberosity and humeral head necrosis) had poor clinical outcomes for limitation of ROM. No cases of prosthetic loosening and superior migration of the prosthesis were found in all patients. Cemented hemiarthroplasty of the shoulder is a viable treatment option for younger, active patients. Implant loosening and osteoarthritis of the glenoid do not appear to be concerns in the long term despite the high activity levels of all patients.
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Tetsutaro FUKUHARA, Teruhisa MIHATA, Kenji YASUI, Takeshi KAWAKAMI, Ch ...
2009 Volume 33 Issue 2 Pages
361-364
Published: 2009
Released on J-STAGE: September 15, 2009
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The transosseous-equivalent technique (suture-bridge technique) is widely used in rotator cuff repair. However, there have been no biomechanical reports that have assessed the effect of the bridging suture on glenohumeral abduction. The objective of this study was to investigate the effect of bridging suture on glenohumeral abduction. Double-row repair (DR) and double-row repair with the bridging suture (compression double-row repair, CDR) were performed on 32 fresh frozen porcine shoulders. For compression double row repair, a suture limb from each of 2 medial anchors was bridged over the tendon after double row repair, and fixed laterally with 2 sutures of lateral anchor. Each repair was tested for tensile strength at 0° and 40° of simulated glenohumeral abduction to measure the yield load, tensile load, and linear stiffness at a deformation rate of 1 mm/s. At 0° of glenohumeral abduction, the yield and ultimate loads were significantly greater for CDR than for DR (yield load: DR, 44.1 ± 4.2 N; CDR, 137.5 ± 13.6 N and failure load: DR, 69.2 ± 13.7 N; CDR, 153.8 ± 20.5 N). While the yield and ultimate loads after DR at 40 ° of glenohumeral abduction were increased compared to the loads at 0° of glenohumeral abduction, those after CDR at 40° of glenohumeral abduction were significantly decreased compared to the loads at 0° of glenohumeral abduction. There were no significant differences concerning about stiffness between DR and CDR at both 0° and 40°. Bridging sutures increases the tensile strength of repaired tendon at low glenohumeral abduction angle. Increased glenohumeral abduction decreases the effect of the bridging suture on tensile strength after a rotator cuff repair.
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Daisuke NAKAI, Eiichi SUZUKI, Takashi ITO
2009 Volume 33 Issue 2 Pages
365-368
Published: 2009
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The purpose of this study was to report which preoperative factors could influence on the postoperative results of arthroscopic rotator cuff repair (ARCR). A consecutive series of 52 patients with rotator cuff tears underwent ARCR and were evaluated by the scoring system of the Japanese Orthopaedic Association (JOA) pre- and post-operatively. The 52 shoulders were classified into 2 (high and low score) groups by preoperative JOA pain, or function, or ROM subscore. The 2 groups were compared by each postoperative JOA total score at 3, 6, 9 and 12 months and retear rate at 6 months. Retear rate was estimated by MRI, using Sugaya's classification. The postoperative JOA score in the low function score group was less than the high score group at 3, 6 and 12 months, and had higher retear rate (33 % vs 12 %, p < 0.05). The JOA score in the low ROM group was less than the high score group at 6 and 9 months postoperatively, but had no significant difference in retear rate. There was no difference in both JOA score and retear rate between high and low pain score groups. There were higher correlation (r
2 = 0.488) between preoperative function and ROM subscore because the ROM score in JOA was evaluated in active motion. So, we propose preoperative evaluation of rotator cuff tears with classification into 4 groups using a combination of JOA pain and function subscores which we regarded as independent. The group 1 (low pain and low function scores) had a lower postoperative JOA score and higher retear rate than other groups. In conclusion, preoperative JOA function subscore could influence on the postoperative clinical results of ARCR, especially when there were lower scores in both function and pain subscores.
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Norio ISHIGAKI, Yukihiko HATA, Koichi NAKAMURA, Narumichi MURAKAMI, Hi ...
2009 Volume 33 Issue 2 Pages
369-372
Published: 2009
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Postoperative results for the rotator cuff tear are good, but some cases with pain remain. A prior report described that factors of persistent postoperative pain in rotator cuff tear were "tear size" and "postoperative range of motion (ROM) limitation in the direction of extension and CTD", but we were unable to refer to the cause of the latter. This study is intended to investigate the findings of cases with postoperative ROM limitation, and to determine a cause for limitation of the direction of extension and CTD. From among 391 rotator cuff tear patients for whom more than 1 year postoperative had passed, we extracted 2 groups (Excellent 50 shoulders, Poor 50 shoulders) according to results of each direction of extension and CTD during the 1st postoperative year. We investigated each group. We evaluated patients' medical histories, tear forms, and preoperative clinical examination results. Regarding the 2 groups for extension, significantly more cases of preoperative limitation of extension and subscapular tendon rupture occurred in the Poor group. Of the 2 groups regarding CTD, there were significantly more cases with a preoperative limitation of CTD, large tear size, and a subscapular muscle tendon rupture in the Poor group. From these results, we inferred that the cause of "limitation of extension and CTD during the 1st postoperative year" was presence of preoperative limitations of extension and CTD or subscapular tendon rupture.
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Tomoya MANAKA, Yoichi ITO, Yoshihiro NAKAO, Yoshifumi NAKA, Kuniaki TU ...
2009 Volume 33 Issue 2 Pages
373-376
Published: 2009
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Arthroscopic rotator cuff repair (ARCR) is one of the most common surgical procedures performed in the shoulder. It is useful to predict post operative functional recovery period for accurate evaluation of surgical effect. However, there was little known about the postoperative functional recovery period after ARCR. The aim of this study was to evaluate functional recovery period post ARCR and elucidate preoperative affecting factors. We retrospectively evaluated 201 patients (126 male and 75 female), who had undergone ARCR. The average age at the surgery was 61.4 years old (33-83 years old). Patients were evaluated by using the Japanese Orthopaedic Association (JOA) shoulder scoring system. A well functioned shoulder was determined when the score was more than 25 points in pain, more than 8 points in function, more than 8 points in ADL and more than 25 points in ROM by JOA scoring system. A well recovery period was the required time to the well functioned shoulder conditon. The well recovery periods were divided into 3 groups: group A (63 cases) was less than 3 months, group B (81 cases) was between 3 and 6 months, group C (57 cases) was more than 6 months. We statistically evaluated relations among the following items: age, sex, stiffness, rotator cuff tear morphology and rotator cuff tear size in each group of the well recovery periods. There was a significant difference among age, stiffness, rotator cuff tear size and the well recovery periods. An early recovery was expected when they were young people, no stiffness and smaller size rotator cuff tear. There was no significant difference among sex, rotator cuff tear morphology and the well recovery periods. Age, stiffness and rotator cuff tear size are the main affecting factors for functional recovery periods.
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Toshiaki HIROSE, Kenji OKAMURA, Shigekazu UENO, Kenji TATEDA, Shota YO ...
2009 Volume 33 Issue 2 Pages
377-380
Published: 2009
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The purpose of this study was to evaluate the postoperative MRI images in early time after arthroscopic rotator cuff repair. We retrospectively studied 51 patients (52 shoulders) who had received arthroscopic rotator cuff repair and performed MRI within 2 weeks after surgery. The patients were 24 males and 28 females. The mean age at operation was 63 years old (range, 36-85). For quantitative assessment, the area of supraspinatus muscle and the fossa supraspinata were measured at the most lateral image on which the scapular spine is in contact with the rest of the scapula in a single sequence of oblique sagittal T2-weighted MRI. Standardized cross-sectional areas of supraspinatus muscle were calculated by dividing muscle areas by the area of the fossa supraspinatus. We evaluated fatty infiltration in supraspinatus muscle by the classification system of Goutallier et al. and cuff integrity after surgery by the classification system of Sugaya et al. Standardized areas of supraspinatus muscle were significantly increased in tear size more than 21mm, postoperatively. Longitudinal diameters were significantly increased in tear size more than 16mm, postoperatively. There were type 1: 45 shoulders, type 2: 6 shoulders, type 3: 1 shoulder in cuff integrity after surgery. The larger tear size increase standardized areas postoperatively, it was suggested that cuff muscle was pulled out laterally by repairing cuff tear. It means that we should not compare preoperative MRI with postoperative MRIs when evaluating muscle atrophy.
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Masafumi GOTOH, Kenjiro NAKAMA, Fujio HIGUCHI, Yasuhiro MITSUI, Isao S ...
2009 Volume 33 Issue 2 Pages
381-384
Published: 2009
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A Mason-Allen technique is feasible with open/mini-open cuff repair. Pierre
et al. have developed an arthroscopic cruciate suture technique with a suture anchor, which is similar to the modified Mason-Allen technique. Their biomechanical study has demonstrated that the cruciate technique with a suture anchor has a higher load to failure than the modified Mason-Allen technique. With combination of the suture anchor and transosseous suture technique, we have developed a new method the Open Cruciate Suture (OCS) repair technique. In this study, the functional and structural outcome of the OCS technique was compared with those of open transosseous simple suture (OTSS) technique as conventional fixation method. From April 2005 to June 2007, 62 patients underwent open cuff repair: 32 with OCS and 30 with OTSS repair techniques. ROM, muscle strength, VAS, and JOA score were examined pre- and post-operatively. Postoperative cuff integrity was evaluated at postoperative 1 year, by MRI using Sugaya`s classification. Of 62 patients, 47 patients with more than 1 year follow-up were candidates for this study: 25 with OCS repair and 22 with OTSS repair. As well as the preoperative patient's profile, there was no significance between the 2 groups in postoperative functional outcome including ROM, muscle strength, VAS, and JOA scores. Postoperative MRI revealed. significantly less re-tear rate in OCS repair (8.3%
vs 37.5%). Both techniques were comparable in terms of functional outcome, although the OCS repair technique produced superior structural outcome with significantly less re-tear rate.
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Hideki ASATO, Hitoshi TERUYA, Fuminori KANAYA
2009 Volume 33 Issue 2 Pages
385-388
Published: 2009
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The purpose of this study was to compare the functional outcome and the structural outcome evaluated with postoperative MRI T2 finding based on Sugaya's classification in a suture bridge (B) fixation, a single-row (S) fixation and a dual-row (D) fixation for arthroscopic rotator cuff repair using suture anchors. We studied 21 B fixation, 21 S fixation and 42 D fixation shoulders. In B, S and D fixation, the average age at operation was 58, 61 and 63 years old, the mean interval from the time of the operation to the final follow-up evaluation was 9, 16 and 16 months respectively. The size of rotator cuff tear was 2 small, 12 medium, 4 large, 3 massive in B and 11 small, 7 medium, 3 massive in S and 3 small, 17 medium, 15 large, 7 massive in D. The average postoperative JOA score in B, S and D fixation was 94.7, 98.3 and 95.6 respectively, which improved significantly compared with the pre-operation JOA score in all groups. Postoperative MRIs were 10 type I, 5 type II, 3 type III, 2 type IV, 1 type V in B and 15 type I, 4 type II, 2 type V in S and 16 type I, 10 type II, 11 type III, 5 type IV in D. The clinical outcomes of these groups treated with arthroscopic rotator cuff repair were favorable. A suture bridge fixation is easier than a dual-row fixation, because it can reduce the number of threads in an operation.
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Takeshi KOKUBU, Issei NAGURA, Narikazu TOYOKAWA, Atsuyuki INUI, Ryosuk ...
2009 Volume 33 Issue 2 Pages
389-392
Published: 2009
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Preoperative stiffness has been one of the poor prognostic factors for rotator cuff repair. The purpose of this study was to evaluate the clinical outcome of arthroscopic rotator cuff repair (ARCR) associated with stiffness of the shoulder joint. 27 patients who underwent ARCR were evaluated at 6 months postoperatively. 11 patients who underwent preoperative manipulation or arthroscopic capsular release under general anesthesia were defined as stiffness group, and the others were considered non-stiffness group. The JOA score and range of motion were assessed. Total JOA score increased significantly in both stiffness group and non-stiffness group. The average total JOA score increased from 60.8 to 87.0 in stiffness group and from 70.6 to 89.6 in non-stiffness group. The average of flexion in stiffness group was 143.6° at 6 months postoperatively, and that in non-stiffness group was 160.3°. There was no significant difference between the 2 groups at 6 months postoperatively. The range of flexion was also increased in both groups, however the stiffness group includes few poor resulting patients. The clinical results of ARCR were satisfactory even if there was preoperative stiffness of the shoulder.
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Akira TAKAHASHI, Takayuki KAMIISHI, Risa MATSUMOTO, Hideto EGUCHI, Tom ...
2009 Volume 33 Issue 2 Pages
393-396
Published: 2009
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Among 85 patients with 87 cuff tears older than 50 years old treated by the open repair using McLaughlin's methods, 11 shoulders had a preoperative disability of the shoulder elevation with an active elevation less than 90 degrees after a xylocaine test and a passive elevation more than 90 degrees. Clinical findings and postoperative results of these 11 shoulders were investigated. Patients' mean age at the operation was 65 years old and the mean follow-up period was 15 months. The preoperative active elevation averaged 44 degrees and 5 shoulders had a superior migration of the humeral head less than 5mm of the acromiohumeral interval (AHI). Mechanisms of onset, the location and the size of cuff tears, degenerations of a bicipital long head, JOA score, the postoperative active elevation and retear rate were investigated. The relationship among postoperative JOA scores with age, the presence of the superior migration and tear size were evaluated. The mechanism of onset was trauma in 5, continued degenerative tears in 3 and trauma added to pre-existed degenerative tears in 3 shoulders. All 11 rotator cuff tears were involved at more than 2 tendons containing both supraspinatus and infraspinatus. The size of tears was 30 ∼ 50mm in 6 and more than 50mm in 5 shoulders. Bicipital long heads showed ruptures in 2 and dislocations in 2. The mean total JOA scores increased from 46.7 preoperatively to 83.5 postoperatively(p<0.01). Active elevation more than 90 degrees was obtained in 9 shoulders(82%) and the retear rate was 36%. Good results were obtained by the open repairs with McLaughlin's methods, but the JOA scores were significantly lower in cases with an age of over 65 years old, tear size over 50mm and a superior migration less than 5mm of AHI.
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Shintaro YAMANE, Naoki SUENAGA, Hiroshi YAMAGUCHI, Naomi OIZUMI, Tadan ...
2009 Volume 33 Issue 2 Pages
397-399
Published: 2009
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The purpose of this study was to investigate the clinical results after long head of biceps (LHB) graft for irreparable rotator cuff tears. When it was impossible to repair the torn rotator cuff after extensive release and mobilization, the LHB tendon graft was performed. After tenodesis of LHB, tenotomized LHB tendon was interposed into the defect for bridging between the rotator cuff and bone. We investigated 15 consecutive patients (mean age: 68.9 years old) who were followed up for more than 1 year postoperatively. All patients were evaluated preoperatively and post operatively using Japanese Orthopaedic Association scoring system (JOA score). In addition, integrities of repaired rotator cuff were evaluated using MRIs. The average time from surgery to the final follow-up was 18 months (range, 12 to 36 months). The mean preoperative JOA score, which was 56.7 points (range, 35 to 75), improved to 88.4 points (range, 74 to 100) at the last follow-up. According to the post operative repair integrity analyzed with use of MRIs, 3 cases presented re-tear of tendon. The long head of biceps tendon graft for irreparable massive rotator cuff tears offered a possible improvement in the clinical outcomes.
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Koichi NAKAMURA, Yukihiko HATA, Norio ISHIGAKI, Narumichi MURAKAMI, Hi ...
2009 Volume 33 Issue 2 Pages
401-405
Published: 2009
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We assessed the clinical results and findings of joint-sided partial thickness tear (PTT) of rotator cuff treated by conservative treatment to clarify the criteria of indication for conservative PTT treatment. We studied 84 patients, of 47.6 years old mean age, who had been diagnosed with joint sided PTT and treated using a conservative treatment. Their mean UCLA score at the initial visit was 22.5 points. It was 30.1 after 6 months' conservative treatment. We defined the top 25 cases of UCLA score after 6 months' conservative treatment as the "Good group" and the bottom 25 cases as the "Poor group". Inter-group differences were tested for statistical significance according to medical history, clinical findings (range of motion: ROM, muscle strength, UCLA score), and tear length, the location and size of PTT before treatment. No significant differences were found between the groups in either medical history or muscle strength at the initial visit. External rotation in the 2nd position at the initial visit in the Good group were higher than that in the Poor group (
P<005). The total score, pain and function item of the UCLA score at the initial visit for the Good were higher than for the Poor (
P<0.05). The length of tear in the Poor group was longer than in the Good group (
P<0.05). Significantly more cases with a PTT of supraspinatus tendon occurred in the Poor group (
P<0.05). Box plot graph indicated that if maximal tear length rate was larger than 0.2, total score of UCLA score was lower than 24 points, which 75% of Poor group was contained. It is considered that a good result for joint-sided PTT is expected from conservative treatment if these criteria are not met.
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Noriyuki ISHIGE, Shigehito KURODA, Kimiko MARUTA, Motohiko MIKASA
2009 Volume 33 Issue 2 Pages
407-409
Published: 2009
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We reported the clinical results of arthroscopic rotator cuff repair without anchors for partial-thickness rotator cuff tears. 36 cases (bursal-side tears: 25 cases, joint-side tears: 11 cases, men: 16 cases, women: 20 cases, the averaged age: 59.4 years old, the average follow-up period: 9.9 months) were evaluated. For bursal-side tears, we restored the deep layers of the cuffs and refreshed the foot prints sufficiently and repaired torn superficial layers. For articular-side tears, we cut the superficial layers of cuffs transversely and repaired them with the torn deep layers. All patients began active-exercise from 4 weeks after operation. The average of the total score of JOA was improved significantly from 70.3 preoperative to 92.5 postoperative. Because we did not use any anchors in this technique, we could suture like as the double row method for the narrow foot print of the partial-thickness rotator cuff tears. In other words, it was possible for partial-thickness rotator cuff tears to be fixed firmly by mattress suture and bridging suture like as the treatment of the full-thickness rotator cuff tears. Therefore, we think that this technique is useful for the treatment of partial-thickness rotator cuff tears.
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Koji IWASAKI, Tadanao FUNAKOSHI, Naomi OIZUMI, Tomoya MATSUHASHI, Akio ...
2009 Volume 33 Issue 2 Pages
411-414
Published: 2009
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The aim of the present study was to evaluate the medium term clinical outcome and cuff integrity examined with MRI after the operative treatment with open acromioplasty for pacial-thickness rotator cuff tear (PTRCT). 21 patients were included in this study. Types of PTRCT were articular-side tears (AST) in 3 patients (Ellman's grade Ia only), bursal-side tears (BST) in 16 patients (Ellman 's grade Ib : 8 patients, grade IIb : 4 patients, grade IIIb : 4 patients) and intratendenous tear (IT) in 2 patients. By a single shoulder surgeon, 11 patients (Ellman's grade Ia and Ib) underwent debridement, 6 patients (Ellman grade IIb & IT) underwent rotator cuff side to side suture, and 4 patients (Ellman's grade IIIb) underwent rotator cuff repair with suture anchor. All patients underwent open acromioplasty. We evaluated clinical outcome according to the Japanese Orthopaedic Association (JOA) score, Constant score and DASH, and examined the rotator cuff integrity according to Sugaya's postoperative MRI classification. The average follow-up term in this study was 7.5 years (range 6.0 to 9.1). The average JOA score, Constant score and DASH were 94.7 points (range 75.5 to 100), 84.2 points (range 64 to 98) and 5.6 points (range 0 to 25), respectively. Retear (Sugaya's classification type IV & V) was observed in 2 patients. Sugaya's classification type III and IV were observed in Ellman's grade II and III. In this study, the clinical outcome of treatment of PTRCT was as good as the results of previous studies. MRI showed that postoperative PTRCTs maintained good cuff integrity at mid-term follow-up. Degree and location of cuff tear might be associated with postoperative cuff integrity.
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Mitsuru NAGOSHI, Hiroyuki HASHIZUME, Takahiko HIROOKA, Yasuro OZE
2009 Volume 33 Issue 2 Pages
415-418
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Though rotator interval lesion(RIL) is known as one of the causes of throwing shoulder, the way of thinking about its diagnosis and treatment has not been made clear. We treated throwing shoulder patients complicated RIL by conservative(CT) and surgical treatment(ST). The clinical observation before treatment, clinical results and the arthroscopic findings were investigated, and examined about the indication of surgical treatment and the pathogenesis. 38 throwing shoulder patients (36 men, 2 women, average age 23.2) in which pooling of contrast media at RI area was seen in arthrography were investigated. The details of the players were softball players:3, rubber baseball players:12 and hard baseball players:23. 20 patients were treated by conservative treatment (CT) and 18 were treated by surgical treatment (ST). CT included NSAIDs, joint injection, rehabilitation and joint distension. RIL was repaired by the anterior approach. Debridement of the labrum(10), repair of the anterior labrum(3), SLAP(2), rotator cuff repair(2) were arthroscopically done before RI repair. The ability of throwing, the area of pain at apprehension position(APP), supra-spinatus test were compared between CT and ST groups. Clinical results were evaluated according to JSS sports score. The average follow-up period was 31 months. In ST group, before treatment throwing performance was inferior to CT group, pain in APP was often seen at both anterior and posterior in ST group. JSS improved from 72.6 to 94.4 points in CT and 59.6 to 91.3 points in ST. SGHL injury, MGHL injury, antero-superior labrum injury, and ISP injury were often seen in arthroscopy. The RIL in a throwing shoulder should be carefully diagnosed. Surgical treatment was needed for the patients who lost their throwing ability and the repair of RI was effective for recovery of the throwing performance.
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Atsushi YAMAMOTO, Kenji TAKAGISHI, Toshihisa OSAWA, Hitoshi SHITARA, K ...
2009 Volume 33 Issue 2 Pages
419-422
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The purpose of this study was to investigate clinical characteristics of rotator cuff tear with or without pain at night, and to evaluate the clinical results of rotator cuff repair in those patients. 62 shoulders of 61 cases who underwent rotator cuff repair from June 2005 to June 2007 (male; 38 shoulders, female; 24 shoulders, mean age; 60.2 years old) were divided into 2 groups according to pain at night. Group A included patients with pain at night defined by more than 30 mm in visual analog pin scale (VAS), and group B included patients without pain at night defined by under 30 mm in VAS. Between the 2 groups, we statistically analyzed the pre-operative clinical conditions and results of rotator cuff repair. Group A was comprised of 38 shoulders (male: 23 shoulders, female: 15 shoulders, mean age: 62.0 years old), and group B was comprised of 24 shoulders (male: 25 shoulders, female: 9 shoulders, mean age: 57.2 years old). In terms of pre-operative clinical conditions, age, affected period, gender, dominant arm, history of trauma, active flexion and abduction, strength in abduction and external rotation, impingement sign were not significantly different in the 2 groups, but group A showed less active external rotation and internal rotation, and had more partial-thickness tear and less massive tear. In terms of post-operative evaluation items, VAS, active flexion and abduction, JOA total score were not significantly different in the 2 groups, but recovery in active external rotation and internal rotation were delayed in group A. Patients with rotator cuff tear have various kinds of symptoms, so it is necessary to select the most appropriate treatment depending on each of their clinical conditions. Further investigations are necessary to examine renewed treatment strategy focused on the difference of symptoms.
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Teruhisa MIHATA, Chisato WATANABE, Mitsuo KINOSHITA, Tomoyuki TSUJIMUR ...
2009 Volume 33 Issue 2 Pages
423-426
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We developed a new rotator cuff repair method, namely compression double-row repair, which was combined the double-row repair with suture-bridge method. The purpose of this study was to compare the functional and structural outcomes after arthroscopic rotator cuff repair between compression double-row, double-row, and single-row method. A consecutive series of 96 shoulders in 94 patients with full-thickness rotator cuff tears was evaluated using the rating scale of the Japanese Orthopaedic Association (JOA) scores at an average of 11.3 months (range, 6 to 36 months) after arthroscopic rotator cuff repair. Fifty shoulders were repaired using the compression double-row technique, 16 shoulders using double-row technique, and 30 shoulders using the single-row technique. Postoperative cuff integrity was determined by Sugaya's classification of magnetic resonance imaging. Retear rate after arthroscopic rotator cuff repair was 8.0% of compression double-row, 18.8%of double-row, and 10.0% of single-row technique. Only in large and massive rotator cuff tears, retear rate was 12.5% of compression double-row, 33.3%of double-row, and 28.6% of single-row technique. Postoperative JOA score in patients with retear was significantly lower than that in patients without retaer. Compression double-row method, which had a low rate of postoperative retear, is effective option for arthroscopic rotator cuff repair because postoperative functional outcome in patients with retaer is inferior to that without retear.
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Yu MOCHIZUKI, Yoshihiko NAGATA, Mitsuo OCHI
2009 Volume 33 Issue 2 Pages
427-430
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The purpose of this study was to evaluate the outcomes of operative results for rotator cuff tears by single row procedure(SR), dual row procedure(DR) and transosseous procedure(TO) arthroscopically. The subjects were 75 cases, males 50 cases, and females 25 cases, with an average age of 55.5 years old. We performed the SR procedure for 30 cases, DR procedure for 30 cases and TO procedure for 15 cases. The outcomes were assessed on the basis of the Japanese Orthopaedic Association (JOA) shoulder score and postoperative MRI findings according to Spielmann classification. The average JOA score of SR group increased from 59.8 points to 90.8 points, DR group increased from 57.5 points to 89.5 points and TO group increased from 56.4 points to 90.5 points. There was no significant difference in preoperative and postoperative JOA scores in each group. Regarding postoperative MRI findings, the increase of higher intensity area caused the lower JOA scores. Each arthroscopic operative procedure provided preferable results. The arthroscopic transosseous with bone trough suture procedure provided anatomical attachment of the tendon-bone junction at the greater tuberosity because of pulling the stump of rotator cuff into the trough at the greater tuberosity.
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Toru MORIHARA, Yoshio IWATA, Yoshinori TAKUBO, Haruhiko NAKAGAWA, Hisa ...
2009 Volume 33 Issue 2 Pages
431-433
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Arthroscopic shoulder surgery has been widely used for arthroscopic rotator cuff repair. We developed and introduced the suture-reel technique through sliding knot for the footprint fixation of arthroscopic rotator cuff repair last year. In this study short clinical results were evaluated. We clinically performed this procedure on 20 shoulders in 20 patients with medium(15 cases) or large(5 cases) rotator cuff tear in our hospital. There were 20 men and 2 women, the mean age was 68 years old. We evaluated the troubles during the surgery and the short term clinical results using JOA scores and MRI. The repaired cuff was evaluated by MRI using the grading system previously described by Sugaya. In all 22 cases there was no trouble with suture tangles and suture breakage during the surgery. 6 months after this procedure, Type I were 10, type II: 4, type III: 2, were in the case of medium tear, type I were 2 type II: 2, type III: 1, and type IV: 1 were in the large tear by MRI. This suture-reel technique enables the bridging suture to be slid and fixed freely and adequately. This technique may be one of the useful options for the suture-bridge employed for the repair of rotator.
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Yoshihiko NAGATA, Yu MOCHIZUKI, Mitsuo OCHI
2009 Volume 33 Issue 2 Pages
435-438
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We reported that a poly-glycolic acid (PGA) sheet is effective to the regeneration of insertion and tendon of rotator cuff in vivo. We have surgically treated 32 patients with irreparable rotator cuff tear by grafting patch with a PGA sheet. We reported the clinical results of surgical treatment of irreparable rotator cuff with a PGA sheet. This study group included 26 patients who had undergone rotator cuff repair with a patch more than 1 year previously. 13 of 26 patients were surgically treated by patch graft made of fascia combined with PGA sheet (PGA group). Another 13 patients were surgically treated by patch graft made of fascia only (Fascia group). Japanese Orthopaedic Association (JOA) score was used to evaluate clinical results at 1 year after the operation. The pre-operative total JOA scores were 57.1 points in PGA group, and 52.4 points in Fascia group. The post-operative total JOA scores were 87.3 points in PGA group, 87.2 points in Fascia group. The post-operative clinical scores of both groups were acceptable, and were not significantly different. Intensities of most grafted patches were type1 of Spielmann's classification on MRI. The thickness of grafted patch with PGA sheets was preserved. In blood examination at 4 days after operation, the transient C-reactive protein (CRP) elevation was appeared. However, CRP had almost normalized with time about 3 weeks after surgery. There were no remarkable complications such as hydrarthrosis and destruction of bone in both groups from clinical findings and MRI findings. Patch graft using PGA was determined to be effective and safe in our study.
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Hiroaki KIJIMA, Hiroshi MINAGAWA, Tatsuru TOMIOKA, Yoichi SHIMADA
2009 Volume 33 Issue 2 Pages
439-441
Published: 2009
Released on J-STAGE: September 15, 2009
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In 1986, Bigliani et al. classified acromial shape: type I (flat) 18.6%, type II (curved) 42%, type III (hooked) 38.6%, and found 66% type III acromions among cadavers with rotator cuff tears. The majority of studies have confirmed this correlation. The relation between age and acromial types have been also investigated, however the acromial types in children was not investigated in most reports. Thus, the classification is performed after the developments have finished and ossifications have been completed. Therefore, there is no report about the cartilaginous acromions as the mold of ossification in live shoulders. The purpose of this study was to clarify the morphology of cartilaginous acromions. Seventy-eight persons (156 shoulders, 8-12 years old) were studied. Because the acromions consist of cartilage, the undersurface of acromion can be depicted when the probe of ultrasound machine (Xario, Toshiba, Japan) attached parallel to the lateral edge of acromions. We classified these cartilaginous acromions into Bigliani classification by using the quantitative classification method (Getz et al., Radiology, 1996). The distribution of acromial types was as follows: type I (flat) 22%, type II (curved) 78%, type III (hooked) 0%. We did not find Type IV (convex) acromion which Gagey reported (Surg Radiol Anat, 1993). There were little Type III acromions in the cartilaginous stage. Type III acromion may be formed by the traction of coracoacromial ligament, because there are many reports that the older have more Type III acromion and that enthesophytes are more common in type III acromions.
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Mitsuru NAGOSHI, Hiroyuki HASHIZUME, Takahiko HIROOKA, Takuo ISHIHAMA, ...
2009 Volume 33 Issue 2 Pages
443-446
Published: 2009
Released on J-STAGE: September 15, 2009
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We repaired partial thickness rotator cuff tears after converting to complete tear under arthroscopy. We presented about the clinical results of this method. 28 patients (males 19, females 9, mean age 52.6years old) were operated on. Clinical symptoms of all patients had not improved by conservative therapy of over 3 months. There were 6 bursal side, 5 intra-tendinous, 17 joint side tears. 13 cases were induced by trauma, 5 cases were by sports and 10 cases had no clear trauma. All patients were repaired arthroscopically using single or dual raw fixation technique after making complete tears and retention of the cuff. Clinical results were evaluated according to the Japanese Orthopaedic Association score ( JOA score). The mean follow-up period was 17.2 months. The JOA scores improved from 52.6 points to 94.2 points at the final follow-up. In all cases physical signs indicating dysfunction of rotator cuff disappeared. Even in partial thickness rotator cuff tear cases, the tendon that lost its function should be repaired. We think the advantage point of this method is to be able to strain the loosened cuff tendon and that is the most important point in the repair of cuff tear. We got excellent clinical results by repair after converting to complete tear for partial thickness rotator cuff tears. This method seemed be effective to get retention of the cuff tendon and tendon healing.
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Yu MOCHIZUKI, Yoshihiko NAGATA, Mitsuo OCHI
2009 Volume 33 Issue 2 Pages
447-450
Published: 2009
Released on J-STAGE: September 15, 2009
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The purpose of this study was to evaluate the outcomes of operative results for partial-thickness rotator cuff tears (PTRCT). The subjects were 52 cases, male 42 cases, and female 10 cases, with an average age of 53.1 years old. Types of partial-thickness rotator cuff tears were bursal-sided tears (BST) in 21 cases, articular-sided tears (AST) in 21 cases and intratendinous tears (ITT) in 10 cases. We selected the operative procedure based on the types of injury and Ellman's classification regarding depth of the tears, from arthroscopic subacromial decompression, debridement and arthroscopic rotator cuff repair. The outcomes were assessed on the basis of the Japanese Orthopaedic Association (JOA) shoulder score and postoperative MRI findings according to Spielmann's classification. The average JOA score increased from 62.6 points to 88.9 points. There was no significant difference in postoperative JOA scores on the types of PTRCT. Regarding postoperative MRI findings, the increase of higher intensity area caused the lower JOA scores. We reported that the repair for PTRCT has not always been satisfactory and unsolved therapeutic problems remained. We developed the MRI procedure using a shoulder array coil, and clarified that the healing process of the PTRCT has not promoted spontaneously. Our operative results were preferable, however, we had better pursue the procedure of increasing the healing capacity of injured rotator cuff tendons.
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Daisuke MAKIUCHI, Kazuhide SUZUKI, Kenichi MIHARA, Naoya NISHINAKA, Ta ...
2009 Volume 33 Issue 2 Pages
451-454
Published: 2009
Released on J-STAGE: September 15, 2009
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The objective of this study was to investigate the clinical outcome of conservative treatment for partial-thickness rotator cuff tears (PTRCTs) and to compare them with that for full-thickness rotator cuff tears (FTRCTs), and to analyze factors that influence the clinical outcome. We selected 25 patients who were diagnosed as having PTRCTs and were treated conservatively. There were 14 males and 11 females with an average age of 55.8 years old. All patients were evaluated using JOA score and were classified into 2 groups and 4 sub-groups; Satisfactory group (excellent; ≥90 points, good; 80 to 89 points) with over 80 points and Unsatisfactory group (fair; 70 to 79 points, poor; ≤69 points) with below 79 points. Age, sex, duration of symptoms before the 1st consultation, traumatic history, night pain, and dominant versus non-dominant side were compared among the groups. The mean JOA score improved from 69.2 points at the initial consultation to 83.7 points at the final follow-up. Eventually, there were 7 excellent (28%), 13 good (52%), 1 fair (4%), and 4 poor results (16%). 20 patients (80%) were assessed as excellent or good. In the several factors, there was no statistical difference among the groups. The patients with PTRCTs had poor clinical results compared with the patients with FTRCTs. Despite the conservative treatment, clinical symptoms deteriorated in the 2 patients with PTRCTs. Our clinical results of conservative treatments for the patients with PTRCTs were almost satisfactory. But our results might suggest that conservative treatment was not so effective for PTRCTs compared with FTRCTs.
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Hiroshi HASHIGUCHI, Hiromoto ITO
2009 Volume 33 Issue 2 Pages
455-458
Published: 2009
Released on J-STAGE: September 15, 2009
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The purpose of this study was to analyze clinical outcomes and postoperative MRI findings with combined arthroscopic rotator cuff repair (ARCR) and capsular release (CR) for partial-thickness rotator cuff tear (PTRCT) with shoulder stiffness. The subjects were 76 patients with PTRCT whose average age was 55.9 years old (range, 30-72). Types of PTRCT were bursal-sided tear (BST) in 49 patients and articular-sided tear (AST) in 27 patients. 24 patients with severe shoulder stiffness with an average age of 54.4 years old, including BST in 15 and AST in 9, underwent ARCR and CR. 52 patients with mild stiffness or without stiffness with an average age of 56.6 years old, including BST in 34 and AST in 18, underwent ARCR without CR. Clinical outcomes were assessed on the basis of the JOA score, and postoperative improvement of the shoulder motion was compared between the 2 groups. The average JOA score in the 24 patients underwent ARCR and CR improved from 57.3 points preoperatively to 93.6 points postoperatively, and that in the 52 patients underwent ARCR without CR improved from 71.7 points preoperatively to 95.2 points postoperatively. There was no significant difference between the 2 groups in the postoperative JOA scores and the shoulder motion at the final follow-up. Regarding postoperative MRI findings, all of the patients in the 2 groups obtained sufficient thickness and no retear of the repaired cuff. This study suggested that combined ARCR and CR for PTRCT is a secure and reliable procedure to predict clinical and structural outcomes satisfactorily. Therefore, this procedure can be considered as a 1st-line therapy as well as nonsurgical treatments for PTRCT with severe symptoms and shoulder stiffness.
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