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立入 久和, 森原 徹, 祐成 毅, 堀井 基行, 久保 俊一, 黒川 正夫
2012 年 36 巻 3 号 p.
799-801
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Hypothesis: The distance AHD (acromio-humeral distance) in X-rays was used for an index of the rotator cuff tear, but AHI of the rotator cuff tear patient did not always decrease. The purpose of this study was to measure AHD at the time of the shrug against a rotator cuff tear.
Methods: We selected nine people (five men, ten women) who had a diagnosis of shoulder rotator cuff tear by an examination of arthrogram. The AHD of both involved and uninvolved sides were measured and examined in a standing position neutral rotation and shrug position. The statistical official approval set 5% as a level of significance using paired T test.
Results: The mean of AHDs in normal shoulder were 9.31 at neutral and 9.31 at shrug. The mean of AHDs in rotator cuff tear were 9.19 at neutral and 7.76 at shrug.
Discussion: AHD was not shortened by shrug in normal shoulders. AHD was shortened by shrug in medium and large RCT shoulders. This method was simple and useful for screening out the medium-large RCT.
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吉田 雅人, 後藤 英之, 多和田 兼章, 大塚 隆信, 杉本 勝正, 土屋 篤志, 大藪 直子, 武長 徹也
2012 年 36 巻 3 号 p.
803-805
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: In general, it is difficult to insert an anchor at the inferior part of glenoid in arthroscopic Bankart repair. In addition, the anchor at that part has not been sure to be placed within scapula bone. The purpose of this study was to assess a drill hole of a suture anchor to be made for arthroscopic Bankart repair.
Methods: Six consecutive patients, who had recurrent anterior shoulder instability, were included in this study. All the patients underwent surgery with a standardized arthroscopic Bankart technique. Computed tomography (CT) images of the scapula were taken at least one month after surgery. From those data, 3-D scapula models were created by using the software, Mimics and Magics (Materialize, Belgium). Moreover, the distances between the edge of the drill hole of an anchor and the surface of glenoid rim were measured at 3, 6, 9, 12, 15 and 18mm depth from the entering point (0mm) on the 3-D fields.
Results: The mean age at surgery was 25.4 years old (range 17 to 40). A total of 27 drill holes (14 holes at anterosuperior: 0 ∼ 90°, 11 holes at anteroinferior: 90 ∼ 180°, 2 holes at posteroinfrior: 180 ∼ 210°) were investigated on this study. The two holes at posteroinferior position have not been fully surrounded with glenoid bone.
Conclusion: From the above results, the drill hole should be created carefully in the inferior area, especially around the 6 o'clock position.
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後藤 英之, 多和田 兼章, 吉田 雅人, 西森 康浩, 武長 徹也, 大塚 隆信, 杉本 勝正, 大藪 直子, 土屋 篤志
2012 年 36 巻 3 号 p.
807-811
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Accuracy of ultrasound imaging of the rotator cuff in shoulders has been reported as being the same as MRI. The purpose of this study was to compare the integrity of the rotator cuff between the postoperative MRI and ultrasonography (US) for a rotator cuff repair.
Methods: 28 cases of partial to massive rotator cuff tears were treated by arthroscopic rotator cuff repair. The mean age of all cases was 64 years old. Postoperative MRI and US were performed at 3 months and one year after surgery. The rotator cuff integrity was evaluated by means of Sugaya's classification. The irregularity of the surface, effusion of the subacromial bursa, and prominence of the knot were also evaluated.
Results: The post operative findings of MRI were classified as Type I: 7, Type II: 11, Type III: 4, Type IV: 5, Type V: 1 cases at 3 months and Type I: 17, Type II: 5, Type III: 1, Type IV: 2, Type V: 3 cases at one year postoperatively. The findings of US were classified as Type I: 1, Type II: 22, Type III: 3, Type IV: 2, Type V: 0 cases at 3 months and Type I: 9, Type II: 12, Type III: 3, Type IV: 1, Type V: 3 cases at one year postoperatively. Irregularity, effusion of the bursa and prominence of the knot were found in 22, 24, and 22 cases within 3 months and 5, 13, and 4 cases at one year respectively.
Conclusion: In conclusion, the present study shows that the cuff integrity was improved with time detected by both MRI and US. However, it had not become normal according to ultrasonographic examination.
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吉村 英哉, 小松 秀郎, 望月 智之, 二村 昭元, 秋田 恵一, 新井 隆三
2012 年 36 巻 3 号 p.
813-816
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Our previous study revealed that the most proximal portion of the subscapularis tendon supports the long head of biceps (LHB), indicating that repair of this part is important for the stability of LHB. However, several authors previously reported that preoperative MRI scans of the shoulder do not reliably predict subscapularis tendon tears. The purpose of this study was to evaluate the diagnostic value of MRI assessment of subscapularis tendon tears with the results determined by arthroscopic evaluations of the same shoulders.
Methods: Sixty-four patients who received primary arthroscopic rotator cuff repairs participated in this retrospective review. MRI findings of the most proximal portion of the subscapularis tendon were evaluated on the axial and oblique-sagittal images, and were classified into five grades including grade 0, which indicates equal low intensity on T2 weighted image with normal thickness, grade 1: with partial change of intensity, grade 2: insufficient thickness, grade 3: the appearance of partial high intensity, and grade 4: the entire appearance of high intensity around the lesser tuberosity.
Results: Among the 64 patients, 28 (44%) were diagnosed arthroscopically as having a full-thickness subscapularis tendon tear. Twenty-five patients had MRI scans that were preoperatively evaluated as having subscapularis tendon tear. Twenty-three patients (92%) were matched with the arthroscopic results. With preoperative MRI scans, sensitivity was 82%, specificity was 94%, and accuracy was 89%.
Conclusion: Preoperative MRI scans of the shoulder on the axial and oblique sagittal views reliably predict subscapularis tendon tears. Even the smaller, intra-joint tears are more detectable than previously thought.
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福田 昇司, 金丸 明博, 筒井 貴彦, 土井 英之, 大森 貴夫
2012 年 36 巻 3 号 p.
817-820
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Muscle atrophy and fatty degeneration of the rotator cuff muscles has been reported as a negative predictor after rotator cuff repair. However, reliable and reproducible methods of evaluating these pathologic conditions are not established yet. Although the Y-shaped view is widely used for measuring cross-sectional areas (CSA) of the supraspinatus muscle, we have to consider the contribution of retraction of the torn tendon as well as muscle atrophy. The purpose of this study was to clarify the relationship between CSA and tendon retraction or size of the tear.
Methods: This study included ninety-five shoulders which were evaluated for the presence and size of tears arthroscopically. There were 16 shoulders with impingement syndrome, 15 small tears, 32 medium tears, 17 large tears, and 15 massive tears. CSA of supraspinatus muscle was measured on from the Y-shaped view to two more medial slices. The retraction of torn tendon was also measured on the oblique coronal images.
Results: On the Y-shaped view, CSA of supraspinatus decreased in conjunction with the increase in tear size. Significant decrease in CSA was only noted in large and massive tears on more medial slices from the Y-shaped view. A negative correlation was found between tendon retraction and CSA, which was strongest on the Y-shaped view.
Conclusion: To prevent an influence of retraction of supraspinatus tendon, sufficiently medial slices from the musculotendinus junction should be used for evaluation of muscle atrophy.
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森原 徹, 堀井 基行, 岩田 圭生, 立入 久和, 木田 圭重, 古川 龍平, 祐成 毅, 久保 俊一, 黒川 正夫
2012 年 36 巻 3 号 p.
821-823
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: MRI has been used for the evaluation of glenohumeral labrum. Generally, axial, coronal, and sagittal sections in MRI were selected, however in some regions the morphology of labrum were not evaluated. In this study, the radial-sequence MRI method was developed for the evaluation of labrum and its usefulness was investigated.
Methods: Eighteen cases of throwing disorder were studied using axial and radial sequence sections in MRI. T2-weighted and T2 star-weighted images were obtained for the evaluation of the labrum in these cases.
Results: In the conventional method, the morphology of labrum was not detected in 4-5 o'clock directions. In the radial sequence MRI method, labrums in 3-6 o'clock directions were able to be evaluated.
Conclusion: This radial sequence MRI method was considered to be one of the useful methods for the evaluation of labrum.
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中井 大輔, 間瀬 泰克
2012 年 36 巻 3 号 p.
825-828
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Hypothesis: Range of motion and stability assessment in outpatient clinics are not usually true, comparative study with examination under anesthesia (EUA) is crucial for treatment of the shoulder.
Methods: We investigated 188 shoulders from 2008 to 2010, including 59 female and 129 male. The average age was 50.7 ± 17.6 years old. EUA was performed with the patients in the beachchair position. Range of motion was estimated by goniometer and stability was rated as grade from 0 (normal) to 3 (dislocation).
Results: Range of motion of the healthy shoulder and mobility (instability) decreases with aging.
Females have a larger range of motion than males and dominant-side shoulder have a larger range of motion than non-dominant. Patients with anterior instability have a smaller range of internal and external rotation at 90 degrees abduction at outpatient clinic than EUA (14.5 ± 18.8 v/s 34.1 ± 12.8 degrees). Patients with cuff tear have a smaller range of internal rotation at 90 degrees abduction at outpatient clinic than EUA (7.6 ± 12.8 v/s 22.0 ± 17.1 degrees and 84.8 ± 16.3 v/s 98.6 ± 17.3 degrees, respectively).
Discussion: These result suggest that apprehension and pain at particular positions of the arm induce a protective reaction and consequently reduce the range of motion at outpatient clinic. Comparative study with EUA is very crucial for treatment of the shoulder.
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鈴木 朱美, 村 成幸, 米田 稔, 佐原 亘
2012 年 36 巻 3 号 p.
833-835
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We hypothesized that the glenohumeral joint morphology as an intrinsic factor was related to the onset of shoulder instability due to minor injury. The purpose of this study was to clarify the relationship between gender, shoulder laxity and the glenohumeral morphology and the onset of traumatic anterior shoulder instability due to minor injury.
Methods: We examined 125 shoulders of 125 patients (89 males, 36 females) with traumatic anterior shoulder instability who had pre-operative computed tomography. The mean age was 27 years old (14-64). According to the mechanism of the onset of shoulder instability, the patients were divided into 2 groups, traumatic group and minor injury group. The evaluation items of intrinsic factors were gender, laxity and the glenohumeral joint morphology. The maximum transverse diameters of the articular surface of the glenoid and the maximum diameters of the humeral head were measured and the glenoid-head ratio (GH ratio) was calculated on CT in the unaffected shoulder. Gender, laxity and GH ratio were compared between the 2 groups.
Results: The number of females in the minor injury group; 46.7% was significantly more than that in the traumatic group; 12.3%. There was no significant difference between the GH ratio in the traumatic group; 63.9% and that in minor injury group; 62.4%. However, the G-H ratio in females; 61.3% was significantly smaller than that in males; 63.9%.
Conclusion: Being female and having a small GH ratio might be the intrinsic factors of traumatic anterior shoulder instability due to minor injury.
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酒本 佳洋, 田中 康仁, 保利 喜英, 森本 光俊, 橋内 智尚, 桜井 悟良, 二階堂 亮平, 水掫 貴満, 仲川 喜之
2012 年 36 巻 3 号 p.
837-839
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We performed surgical treatment by reconstruction of coraco-clavicular ligament using Fascia lata (F) or Palmaris longus (P) for acromio-clavicular joint dislocation. The purpose was to report long-term results of this method.
Methods: Five cases (F: 1 case and P: 4cases) were examined. We looked at them over 10 years. The average age was 37 years old and all patients were male. We reviewed follow up term, radiographic findings, joint dislocation rate (JDR) by measuring coraco-clavicular distance (compared with the unaffected side) and the post-operative results (JSS AC joint score). In 3 cases, a pair of bone tunnels were made separately in the distal part of the clavicle and centered over the coracoid process. The graft was taken through the hole for reconstruction of coracoclavicular ligament. In 2 cases, a single bone tunnel was centered over the coracoid process.
Results: The mean follow up term was 21 years. On the final radiograph, it showed the calcification of coraco-clavicular ligament in 2 cases, the arthrosis of the acromio-clavicular joint in 2 cases and the osteolysis on clavicle in 1 case. The average JDR was 244% at pre-operation, 106% at post-operation and 120% at the final period. The final JSS AC joint scores were 100 points in all cases.
Discussion: Many operative methods for acromio-clavicular joint dislocation were reported but few long-term results over 10 years after surgery were reported. This method makes anatomical reconstruction of coraco-clavicular ligament without xenobiotic reaction, and gives a stable result for the long term.
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永井 宏和, 菅谷 啓之, 高橋 憲正, 河合 伸昭, 島田 憲明, 田中 基貴, 設楽 仁, 田巻 達也, 小倉 誉大, 森石 丈二
2012 年 36 巻 3 号 p.
841-845
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We have been performing arthroscopically assisted acromioclavicular joint (ACJ) reconstruction using synthetic ligament for acute Rockwood grade III-Ⅴ ACJ separation since 2002. Further, synthetic ligament fixation has been reinforced by additional stapling since 2008. The purpose of this study was to evaluate clinical outcomes of this procedure and compare postoperative X-ray findings between patients with and without stapling.
Methods: Since 2002, 42 patients underwent the index surgery and 38 patients (32 male and 6 female) who were followed for more than 12 months after surgery were investigated in this study. The average age of surgery was 42.4 years old, and the mean follow up period was 18.9 months. The ACJ separation was reduced and stabilized by a synthetic ligament passed around the coracoid process arthroscopically. In addition, reduced clavicle was augmented by the transferred Coracoacromial ligament released from the acromial undersurface. Clinical outcome using JOA and JSS-ACJ scores and postoperative X-ray findings, including ACJ alignment, were assessed at the final follow-up using the following criteria: excellent, no side-to-side difference compared with normal side; good, subluxation with less than 50% width of the acromion; fair, subluxation with less than 100% width of the acromion; poor, dislocation which means that the clavicle displaced beyond the acromion width.
Results: The mean postoperative JOA score significantly improved from 75.4 to 97.4 and the mean JSS-ACJ score was 95.1 postoperatively. Twenty patients demonstrated excellent reduction and 8 patients were estimated as good and 8 as fair on X-rays. Regarding clinical outcomes and X-ray findings, there was no significant difference between patients with stapling and without.
Conclusion: Arthroscopically assisted ACJ reconstruction demonstrated acceptable outcomes in terms of shoulder function and X-ray findings. However, further technological modification can be required in order to achieve more optimal reduction.
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柴田 英哲, 仲摩 憲次郎, 永田 見生, 後藤 昌史, 光井 康博, 樋口 富士男, 白地 功, 福田 啓治, 荻野 美佐
2012 年 36 巻 3 号 p.
847-849
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Hypothesis: We hypothesized that the arthroscopic Bankart repair (ABR) in patients with anterior instability of the shoulder would result in favorable, compared with the previous studies.
Methods: Ninety-five patients with anterior instability were candidates for this study: 74 males and 21 females. Those who had concomitant rotator cuff tears were excluded from this study. The average follow-up period was 47months (range: 12-110 mos). The average age of the patients at the time of surgery was 26.9 years old (range: 14-72) and the average age at the initial dislocation/subluxation was 20.5 years old (range: 12-60). Thirty-one patients had experienced the dislocation/ subluxation less than 5 times before the operation, 20 patients between 5 and 10 times, and 44patients more than 10 times. Either PanaLok or PanaLok Loop anchor (Mitek) was used during operation (3-5 anchors/ patient). The shoulder was immobilized in a brace for 3 weeks after the surgery. Passive elevation of the shoulder was commenced at 3 weeks after surgery, and active motion of the shoulder was allowed at postoperative 6 weeks. Japanese Shoulder Society Shoulder Instability Score (JSS-SSI) were measured preoperatively and postoperatively. Wilcoxon rank test was used as statistical analysis. P value less than 0.05 was considered significant.
Results: The average points of JSS-SIS were improved from 63.3 points preoperatively (range: 39-87) to 96.1 points preoperatively (range: 93-100) postoperatively. Postoperative re-dislocation was noted in 5 patients (5.2%).
Conclusion: Our ABR managed to produce good results in patients with anterior instability of the shoulder.
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田中 基貴, 菅谷 啓之, 高橋 憲正, 河合 伸昭, 島田 憲明, 永井 宏和, 田巻 達也, 設楽 仁, 小倉 誉大, 森石 丈二
2012 年 36 巻 3 号 p.
851-855
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Hypothesis: The purpose of this study was to investigate the clinical outcomes of arthroscopic stabilization for recurrent anterior glenohumeral instability in dominant arm of overhead athletes.
Methods: Subjects consisted of 34 patients who underwent arthroscopic stabilization for recurrent anterior shoulder instability. There were 15 tennis, 7 badminton, and 12 volleyball players, including 13 males and 21 females with an average age of 30.8 years old. All subjects were followed for 20 months on average after surgery. Arthroscopic Bankart repair was performed using 4 suture anchors in order to provide approximate tension to the inferior glenohumeral ligament. In addition, rotator interval closure was performed in patients with significant bone loss or excessive laxity. The causes of first time dislocation, details of surgery and clinical outcomes were reviewed retrospectively.
Results: The most frequent cause of the first time dislocation was the smash in tennis and badminton players and the diving in volleyball players. All patients underwent arthroscopic Bankart repair and rotatorinterval closure was performed in 20 patients (59%). SLAP lesions were repaired in 9 and debrided without repair in 6 patients. Postoperative side to side differences in external rotation range was 11.3 degree with the arm at side and 1.6 degree with the arm in abduction. All patients returned to their sports successfully without recurrence. The average periods for return to tennis, badminton, and volleyball were 11.6, 10.7, and 12.6 months, respectively.
Conclusion: Arthroscopic stabilization for recurrent anterior glenohumeral instability in the dominant arm of overhead athletes yielded excellent outcomes.
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佐原 亘, 山田 真一, 米田 稔, 阿部 真行
2012 年 36 巻 3 号 p.
857-859
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The arm position of abduction and external rotation (ABER) is widely used to evaluate the function of the inferior glenohumeral ligament-labral complex (IGHL-LC). The purpose of this study is to compare between pre- and postoperative conditions of IGHL-LC by ABER MRI.
Methods: We utilized the pre- and post-operative ABER MRI in the patients with anterior shoulder instability (23 shoulders of 22 patients, 20 males and 2 females). The attachment of IGHL-LC was classified into 3 categories: Type A; the attachment of IGHL-LC was mainly on the glenoid face, Type B; more than half of its attachment was on the glenoid neck, Type C; its attachment was on the glenoid neck only. The inclination of the IGHL-LC against the glenoid neck and the antero-posterior translation of humeral head against the glenoid were measured and compared between pre- and post-operative conditions.
Results: The inclination of IGHL-LC decreased significantly from 16.5 +/- 10.5 degrees before the surgery to 7.1 +/- 5.4 degrees after the surgery. The humeral head center was shifted from +2.1 +/- 13.4% before the surgery to -6.7 +/- 7.7% after the surgery (the positive values mean anterior translation). 13, 4 and 3 shoulders were classified into type A, B and C of the postoperative attachment of IGHL-LC, respectively. 3 shoulders were unable to be classified. The humeral head center of type C was located more anteriorly than those of other types.
Conclusion: The IGHL-LC ran sharply from the glenoid face and the humeral head was translated more posteriorly after the surgery in ABER views of MRI.
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山上 直樹
2012 年 36 巻 3 号 p.
861-864
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The purpose of this study is to reveal the minimum 1-year follow up outcome after arthroscopic stabilization for recurrent traumatic anterior instability using IGHL tensioning method.
Methods: Arthroscopic stabilization was performed under the following principles: adequate IGHL tensioning using suture anchors loaded with high strength sutures, which is accomplished by mobilization of labroligamentous complex from 2:00 to 7:30 associated with cartilage resection with 2 to 5mm width at the edge of the glenoid surface from 3:00 to 7:30; repair of associated pathology including capsular and labrum lesions. Between Apr. 2009 and Oct. 2010 we performed index surgery for 59 patients. 5 patients were interviewed by telephone and the rest, 54 patients, were examined at our office.
Results: The average Rowe, UCLA, JSS S-I scores improved significantly from 14.6, 24.4, 51.8 to 97.3, 34.5, 95.2 respectively. Fifty patients (84.7%) had returned to their sports at the preinjury level, six (10.2%) had returned to their sports with minimal restriction, and two had quit his sport for some specific other reason rather than the shoulder. One patient (1.7%) experienced a subluxation. Of the six patients, who could not return to their sports at preinjury level, four had slight ROM limitation of external rotation and two had slight loss of power.
Conclusion: Arthroscopic stabilization with emphasis on IGHL tensioning worked very well. In order to completely return to preinjury level, intensive physical therapy is necessary.
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永井 宏和, 菅谷 啓之, 高橋 憲正, 河合 伸昭, 島田 憲明, 田中 基貴, 設楽 仁, 田巻 達也, 小倉 誉大, 森石 丈二
2012 年 36 巻 3 号 p.
865-869
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The purpose of this study was to evaluate the cause of the injury and outcomes after arthroscopic stabilization in collision athletes.
Methods: Subjects consisted of 103 shoulders in 95 patients, including 24 American football and 71 rugby players, who underwent arthroscopic stabilization between January, 2004 and August, 2010. All patients were males and the average age at surgery was 21.6 years old. Arthroscopic capsulolabral reconstruction was performed using suture anchors. In shoulders with the bony Bankart lesion, bone fragment was incorporated into the Bankart repair. Arthroscopic bone grafting with capsulolabral reconstruction was performed if patients had significant bone loss. In addition, rotator interval was closed with the arm at side in maximum external rotation. The cause of the injury, surgical findings, ROM, recurrence rate, and level of return to sports were assessed in this case study.
Results: A majority of patients suffered shoulder dislocation by collision sports, and almost half of them suffered this during tackles. Surgical findings demonstrated 70 bony Bankart lesions, 33 SLAP lesions, 18 capsular tears and 3 HAGL lesions. Postoperative Rowe score improved significantly from 30.2 to 91.8. Ninety-three of 103 cases were followed for more than 12 months. Seventy-eight of 93 cases (83.9%) returned to their collision sports. Fifteen of 93 cases (16.1%) were not able to return to their collision sports due to social reasons in 12 and prolonged apprehensive sensation in 2 cases. Seven patients out of 103 (6.8%) experienced re-dislocation during their collision sports.
Conclusion: In collision athletes, several pathological lesions were observed in addition to Bankart lesion. Arthroscopic stabilization for collision athletes yielded satisfactory outcomes in terms of sports return and performance level. To prevent re-dislocation, athletic rehabilitation and skill-up training of tackling are necessary in addition to the appropriate IGHL tensioning during surgery.
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河合 伸昭, 菅谷 啓之, 高橋 憲正, 永井 宏和, 田中 基貴, 田巻 達也, 小倉 誉大, 森石 丈二, 設楽 仁, 島田 憲明
2012 年 36 巻 3 号 p.
871-875
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The purpose of this study was to report the clinical outcomes of arthroscopic stabilization for recurrent anterior glenohumeral instability in basketball players.
Methods: Subjects consisted of 39 basketball players who underwent arthroscopic stabilization for recurrent anterior glenohumeral instability from 2004 to 2010. There included 18 males and 21 females with an average age of 21.7 (14-34) years old. All patients underwent arthroscopic Bankart repair using suture anchor technique, which included 16 bony Bankart repairs, one capsular repair and one HAGL repair. In addition, arthroscopic iliac bone grafting with capsulolabral reconstruction was performed in 5 patients and Hill-Sachs remplissage in one patient. Rotator interval closure was performed in all except 2 patients. The causes of first time dislocation and clinical outcomes were evaluated retrospectively.
Results: Sixty-nine percent of the first time dislocations occurred during basketball play. The cause of the injury was during contact play such as competition for loose or rebound balls, mostly as well as during non-contact play: shoot blocks; pass cuts; over-handed passes. Postoperative Rowe score was significantly improved from 27 to 98, as well as JSS-SIS being improved from 50.4 to 91. 26 in patients who we could check by questionnaire had returned to basketball. However, 2 patients (5.2%) suffered re-injury during Basketball play and one patient underwent revision surgery.
Conclusion: Arthroscopic stabilization for recurrent anterior glenohumeral instability in basketball players yielded successful outcomes. The ratio of dislocation during contact play was almost equal to that during non-contact play.
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小林 篤, 林田 賢治, 田中 誠人
2012 年 36 巻 3 号 p.
877-880
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We evaluated the anterior shoulder translation at 90 degree abduction in the scapula plane at various external and internal rotations.
Methods: Forty patients with recurrent anterior shoulder instability were enrolled in this study. They all underwent operative treatment and had Bankart lesion as the main pathology of recurrent anterior dislocation. The mean age at surgery was 28 years old (13-73 years old). Under general anesthesia at supine position, the examiner kept the shoulder at 90° abduction, drew the humeral head (HH) anterior, and assessed the shift of HH to glenoid from maximum external rotation to maximum internal rotation at every 10 degree interval.
Results: There was no case of HH movement over the glenoid rim and it never reduced spontaneously (grade 3), 6 cases where HH moved over the rim but reduced spontaneously (grade 2), 21 HH run on the rim (grade 1), and 11 cases where HH slightly moved in the healthy shoulder. In the disease shoulders, 7 shoulders were grade 3, 26 shoulders were grade 2, and 5 shoulders were grade 1. Twenty-seven healthy shoulders with grade 1 and 2 showed translation over grade 1 in the middle range of rotation and no translation at maximum external and internal rotation. Comparing the healthy to the disease side in the same laxity grade, there was no significant differences in grade 1 and 2 in Mann-Whitney U test.
Conclusion: The anterior translation was one of the important factors to make laxity symptomatic in anterior shoulder instability, however, the other factors such as pain or catching sensation may be related to being symptomatic or not.
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落合 信靖, 見目 智紀, 山崎 博範, 菅谷 啓之, 高橋 憲正, 河合 伸明, 森石 丈二
2012 年 36 巻 3 号 p.
897-900
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: There were no reports using electrophy siological evaluation of the rotator cuff tear.
Methods: The purpose of this study was to evaluate the correlation between the tear size and fatty degeneration of rotator cuff muscle in MRI, and the amplitude of the nerve conduction study. One hundred and eighty nine patients with a mean age of 62.7 years who had no rotator cuff tear on the other side using ultrasound study and had no previous shoulder surgery or neurological disease were enrolled in this study. Tear sizes were shown as followed; bursal side tear; 24 cases, small size; 31 cases, medium size; 48 cases, large size; 61 cases and massive tear; 25 cases. Electro-stimulation at Erb's point was used to evaluate the amplitude of the supraspinatus and infraspinatus and the ratio of the normal side to the operative side of the amplitude were used. Fatty degeneration was evaluated using the Goutallier's classification.
Results: As the tear size became larger, the amplitude of the supraspinatus and infraspinatus became significantly lower (p<0.05). Moreover, the fatty degeneration of the supraspinatus and infraspinatus negatively correlated with the amplitude of these muscles.
Conclusion: This study showed that the larger the tear sizes become, the lower the amplitude of the supraspinatus and the infraspinatus. Moreover, the more severe the fatty degeneration becomes, the lower the amplitude of the supraspinatus and the infraspinatus. These data suggested that a nerve conduction study would be helpful to evaluate the pre-operative condition of the supraspinatus and infraspinatus muscles.
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村 成幸, 原田 幹生, 鶴田 大作, 田中 靖久, 荻野 利彦
2012 年 36 巻 3 号 p.
901-903
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We need to diagnose the rotator cuff tears and shoulder adhesive capsulitis at the first examination. The purpose of this study was to clarify the difference of physical findings between rotator cuff tears and shoulder adhesive capsulitis.
Methods: 247 patients were examined and diagnosed as having rotator cuff tears or shoulder adhesive capsulitis on MRI. The rotator cuff tears group consisted of 157 patients with 88 males and 69 females. The adhesive capsulitis group consisted 90 patients with 50 males and 40 females. Muscle atrophy, tenderness on palpation, delle on the greater tuberosity, shoulder active ROM (flexion, extension, abduction, external rotation and internal rotation), terminal pain, limitation of passive shoulder motion, shoulder strength, impingement sign, belly press test, and lift off test were examined and compared between the two groups.
Results: The average age of the rotator cuff tear group was 68 years and that of the adhesive capsulitis group was 59 years. The incidence of several findings showed the statistical differences between the two groups. The strength of abduction at 45 degrees, the strength of abduction at 90 degrees, the strength of external rotation, painful arc sign, delle on the greater tuberosity, atrophy of infraspinatus and the tenderness on palpation of the greater tuberosity were high in the Odds ratio. Shoulder ROM in adhesive capsulitis was statistically less than that in rotator cuff tears.
Conclusion: The weakness of shoulder abduction and external rotation would suggest rotator cuff tear. Especially, the loss of 45 degrees abduction strength was the physical finding for rotator cuff tear that had the highest accuracy. In addition, normal shoulder strength and the limitation of shoulder ROM would suggest adhesive capsulitis.
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戸野塚 久紘, 菅谷 啓之, 高橋 憲正, 河合 伸昭, 舟﨑 裕記, 丸毛 啓史
2012 年 36 巻 3 号 p.
905-908
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Hypothesis: Preoperative pain control before arthroscopic rotator cuff repair is important.
Methods: Subjects consisted 268 shoulders in 256 patients, including 147 males and 109 females with an average age of 62 (range, 28-88), who underwent primary arthroscopic rotator cuff repair and were followed for a minimum 2 years. All patients were divided into two groups: group A, those who required steroid injection for preoperative pain control, and group B, those who did not require steroid injection. In addition, group A was divided into two subgroups: group A+, whose night pain persisted even after several steroid injections, and group A-, whose night pain disappeared before surgery. Mann-Whitney U test was used for statistical analysis.
Results: There were 151 patients in group A, including 70 A+ and 81 A-, and 117 patients in group B. Average JOA total, pain, function, and ROM score were 92.8, 26.3, 19.7, 26.5 in group A+, 97.9, 29.3, 19.9, 28.7 in group A-, and 97.7, 29.3, 20.0, 28.4 in group B, respectively. In addition, 27.1% of group A+ also demonstrated postoperative night pain. However, only 8.6% of group A- demonstrated postoperative night pain. Furthermore, postoperative ROM scores of group A- at 6, 9, 12, and 24 months after surgery were respectively significantly better than those of group A+.
Conclusion: Preoperative pain control is important in arthroscopic rotator cuff repair and the presence of preoperative night and rest pain adversely affects postoperative functional outcomes.
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荻野 修平, 黒田 重史, 石毛 徳之, 村田 亮, 丸田 喜美子, 三笠 元彦
2012 年 36 巻 3 号 p.
909-912
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We reported good clinical results of an original anchorless arthroscopic rotator cuff repair (arthroscopic transosseous suture repair of the rotator cuff: ATOS). Meanwhile we pointed out axillary nerve (AN) injury because of a blind maneuver when making an entry hole for the Kirshcner wires (K wire).
Methods: 41 shoulders were included in the study from October 2010 to March 2011. 19 male and 24 female patients (mean age 65 years old) were evaluated. Three bursal side tear, 19 small tears, 16 medium tears, four large tears, and a massive tear were involved. When four weeks passed after a surgery, the activity of the deltoid muscle was measured by an electromyogram and the value of the integral of the waveform was obtained. Moreover, we measured distances, (A) between the acromion and the entry hole of the K wire, and (B) between the great tuberosity (GT) and the entry hole of the K wire by using MR images.
Results: Deltoid muscle activity was found in all shoulders. The distance of (A) was42mm, and (B) was 20.1mm.
Discussion: This result showed that ATOS never develop axillary nerve injuries. Gardner reported that the axillary nerve was 6.3cm from the acromion. In this study, it was demonstrated that the entry hole of the K wire of ATOS was set far from the AN, so any maneuver of ATOS would never develop an AN injury. Moreover, to reduce the possibility of AN injury, we made the tip of this aiming guide dull.
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乾 淳幸, 国分 毅, 坂田 亮介, 美舩 泰, 無藤 智之, 藤岡 宏幸
2012 年 36 巻 3 号 p.
913-916
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Surgical treatment for massive rotator cuff tear is still challenging. We created a novel poly (D-L-lactide-co-glycolide) (PLG) scaffold using the electrospinning method and evaluated its application in a rabbit rotator cuff defect model.
Methods: Thirty-six Japanese white rabbits were used in this study. Defects of the infraspinatus tendon were created and the PLG scaffolds were implanted. Histological analyses were performed 4, 8, and 16 weeks after the operation, and mechanical evaluations were also performed at 4, 8, and 16 weeks after the operation.
Results: Scaffold fibers remained without dissolution and spindle shaped cells were observed inside the scaffold at 4 weeks postoperatively. At 8 weeks, the PLG scaffold had dissolved and bone formation was observed at the scaffold-bone interface. At 16 weeks, the scaffold-bone interface matured and expression of type II collagen was observed. The ultimate failure load of the treatment group was 28.1 (12.0) N, 71.7 (12.0) N, and 75.3 (18.7) N at 4, 8, and 16 weeks postoperatively, respectively. There was no statistical difference between the normal infraspinatus tendon at 8 and 16 weeks postoperatively.
Conclusion: This novel, cell-free PLG scaffold demonstrated functional rotator cuff regeneration with sufficient mechanical properties in a rabbit rotator cuff defect model.
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中川 滋人, 水野 直子
2012 年 36 巻 3 号 p.
917-920
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The purposes of this study were to investigate the healing condition of rotator cuff after arthroscopic rotator cuff repair of partial rotator cuff tears by second-look arthroscopy, and to compare two repair techniques.
Methods: Among 32 shoulders with partial rotator cuff tear repaired arthroscopically, 18 shoulders underwent second-look arthroscopy. According to their repair techniques, they were divided into 2 groups; 7 shoulders repaired by trans-tendon repair as P group, and 11 shoulders repaired after the formation of complete tear as C group. While in P group the average age was 20 years old, all of them were athletes, and there were 3 with throwing injury, and 4 with anterior instability, in C group the average age was 51 years old, and there were 3 with throwing injury, 4 with traumatic tear, and 4 with non-traumatic tear. Second-look arthroscopy was done at a minimum of 3 months after initial surgery.
Results: While there was complete healing in 3, incomplete healing in 3 and insufficient healing in 1 in P group, there was complete healing in 10 and incomplete healing in 1 in C group. Incomplete healing in P group was seen in 2 throwing shoulders and one dislocated shoulder of throwing shoulder, and insufficient healing was seen in throwing shoulder. Incomplete healing in C group was seen in a shoulder with non-traumatic tear. Almost all of them showed remarkable adhesion at the subacromial bursa and rotator interval.
Conclusion: In conclusion, by second-look arthroscopy, the healing condition of rotator cuff after trans-tendon repair was not so good, especially in throwing shoulders. As postoperative contracture was often seen, postoperative rehabilitation should be reconsidered.
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尾崎 律郎, 永澤 雷太
2012 年 36 巻 3 号 p.
921-924
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The reported rate of failure after arthroscopic rotator cuff repair (ARCR) is variable. We evaluate functional outcome and repair integrity of large and massive rotator cuff tears (RCT) that underwent primary ARCR.
Methods: We retrospectively followed 146 shoulders on which we performed primary ARCR between June 2006 and March 2011. Average follow up period was 31 months (6-65). We performed ARCR using double row technique, bridging sutures technique and single row technique. We immobilized the shoulder for 8 weeks after operation with a sling immobilizer with an abduction pillow. The abduction angle was 60 degrees for 6 weeks and 30 degrees for another 2 weeks. Exercise of active range of motion was prohibited for 6 weeks. The repair integrity was assessed by Sugaya's MRI classification and clinical results were assessed by JOA score.
Results: Re-tear rate was 14.4% (21 shoulders). The change of average total JOA score was from 59.2 ± 10.8 points preoperatively to 91.7 ± 6.4 points postoperatively (Sugaya's type I ∼ III, p<0.01), from 55.6 ± 12.6 points to 89.2 ± 4.5 points (Sugaya's type IV, p<0.01), from 55.3 ± 16.7 points to 57.7 ± 2.5 points (Sugaya's type V, p= 0.82).
Discussion: In this study, the clinical results of ARCR for large and massive RCT were mostly satisfactory. Adequate tendon mobilization procedures, strong sutures and careful rehabilitation resulted in superior tendon healing compared with previous study.
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太田 悟
2012 年 36 巻 3 号 p.
925-928
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The purpose of this study was to evaluate the postoperative results between mattles suture only (A method) and suture bridging addition group (B method) to the transtendon suture anchor technique to articular surface tears of the rotator cuff.
Methods: We used this Transtendon Suture Anchor Technique to articular surface tears of about 50% of the tendon's thickness and the cases of delamination observed with GH arthroscopy. The A method was carried out on 13 men and two women. The B method was carried out on 7 men and 8 women.
Results: The JOA score has significantly improved both in the A method, after the operation (an average of 95.0) from before the operation (an average of 72.5) and the B method after the operation (an average of 95.5) from before the operation (an average of 66.3) (P<0.01). In the A method and the B method, we did not observe a significant difference in postoperative pain, function, and ROM. The A method on the VAS score (0-4) 2nd day after the operation was 2.7, on the other hand, the B method was 1.6, and a significant difference was seen (P<0.01).
Discussion: Postoperative short-term results of the transtendon suture anchor technique to PASTA lesions were mostly satisfactory. As for the suture bridging addition group B, decrease of postoperative pain was seen. We would also like to examine the repair state next.
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田久保 興徳, 森原 徹, 堀井 基行, 久保 俊一, 橋口 淳一, 黒川 正夫
2012 年 36 巻 3 号 p.
929-932
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The clinical results of the ARCR (Arthroscopic Rotator Cuff Repair) for amateur golfers with rotator cuff tears are unclear.
Methods: We examined 10 shoulders of 10 patients(9 males and 1 female, 57 ∼ 74 years old, average; 65 years old, average handicap; 17 (10 ∼ 33))who underwent ARCR for rotator cuff tears. Over one year after operation, clinical results were evaluated. The mean follow-up period was 20 months. The MRI, JOA score, Japan shoulder society - shoulder sports score (JSS-SSS) and golf performance were investigated.
Results: On the MRI at one year after surgery, there were 5 shoulders of type I, 3 shoulders of type II and 2 shoulders of type III with Sugaya's classification. The mean JOA score was improved from 68.1 preoperatively to 93.7 postoperatively. The mean JSS-SSS was improved from 47.9 to 92.2 respectively. All patients returned to golf rounds at 3.5 ∼ 12 months after surgery (mean 7.4 months). The total driving distance was 101% and the mean golf score was +0.1 points compared with before surgery.
Conclusion: The clinical results of ARCR for amateur golfers were good, all patients could return to golf play with similar performance to before surgery.
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松本 一伸, 伊藤 陽一, 間中 智哉, 市川 耕一, 中村 信之, 中村 博亮
2012 年 36 巻 3 号 p.
933-936
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Shoulder joint stiffness commonly occurs in patients with rotator cuff tears. Rotator cuff tear morphology can be classified into articular side partial-thickess tears, bursal side partial-thickess tears and full-thickness tears. However, the relationship between rotator cuff tear morphology and shoulder joint stiffness is not well known. The aim of this study was to evaluate the correlation between rotator cuff tear patterns and shoulder joint stiffness.
Methods: We retrospectively evaluated 903 arthroscopically treated shoulders (506 male, 397 female), in which rotator cuff tears morphology were correctly recorded. Patients below 40 years of age and accompanied shoulder dislocation histories were excluded in this study. Concerning rotator cuff tear morphology, articular side partial-thickness tears were classified as group A, bursal side partial-thickness tears were classified as group B and full-thickness complete tears were classified as group C. Shoulder joint stiffness was diagnosed in the patients with less than 120 degrees in maximum rotational angles: total external and internal rotation angles at 90 degrees of abduction under general anesthesia. The ratio of shoulder joint stiffness in the three groups was statistically evaluated.
Results: The ratio of shoulder joint stiffness was 29.5% (70/237) in group A, 17.0% (24/141) in group B and 6.3% (33/525) in group C. Shoulder joint stiffness was observed more frequently in partial-thickness tears than in full-thickness tears. Articular side partial-thickness tears have the highest correlation between shoulder joint stiffness.
Conclusion: Our results showed that there is significant correlation between rotator cuff tear morphology and shoulder joint stiffness.
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南村 武彦, 玉井 幹人, 竹内 裕介, 水城 安尋, 榎本 光宏
2012 年 36 巻 3 号 p.
937-940
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Acromial spur is often recognized on plain X-rays in patients with rotator cuff tears. It is unclear if spur formations on the undersurface of acromion are primary changes causing rotator cuff tear or if the tear itself induces spur formation. The objective of this study was to evaluate the relationship between acromial spur formation on rotator cuff and age, the size of torn tendons, occupation, the duration of the symptom, trauma.
Methods: The subjects comprised of 269 shoulders who underwent arthroscopic rotator cuff repair between January 2008 and June 2010. There were 135 men and 134 women, 177 right and 92 left shoulders, their mean age was 62.7 years old, the mean duration of the symptom was 6.1months. We defined acromial spur as the protrusion from the inclination of the inferior arch, and we measured the distance from the anteroinferior edge of the acromion to the tip of the spur on scapular Y view.
Results: The incidence of acromial spur increased with groups older than 50 years old, but in groups older than 60 years old there was not tendency of the spur size to increase. The incidence of spurs in the group of patients who engaged in the primary sector of industry increased more than that of other sectors, and the spur size was larger.
Discussion: Acromial spur formation was related to the age and the activity of daily life and occupation. Therefore, it suggests that acromial spur formation may be related to the mechanical stress of the coracoacromial arch.
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喜馬 崇至, 森原 徹, 祐成 毅, 古川 龍平, 小椋 明子, 久保 俊一, 黒川 正夫
2012 年 36 巻 3 号 p.
941-944
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The purpose of this study was to evaluate how modified Debeyre-Patte procedure for massive rotator cuff tear affected superior humeral migration.
Methods: 18 shoulders in 17 patients who underwent modified Debeyre-Patte procedure for massive rotator cuff tear were examined in this study. The mean age at the time of operation was 65.9 years old, and the mean follow-up period was 11.3 months. We evaluated the superior humeral migration by anteroposterior radiographs in standing position and in external rotation, with the distance between the lower glenoid rim and the inferior border of the articular surface of the humeral head. Then we examined postoperative rotator cuff tendons by magnetic resonance images, and evaluated them with Sugaya's classification and investigated the relationship between the condition of postoperative rotator cuff tendon and superior humeral migration.
Results: The degree of humeral migration improved from +9.9% to +2.0% (p<0.05). The degree of superior humeral migration correlated with Sugaya's classification (p<0.01).
Conclusion: The Modified Debeyre-Patte procedure improved superior humeral migration when the condition of postoperative rotator cuff tendon was good.
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岩下 哲, 橋口 宏, 星川 直哉, 高井 信朗
2012 年 36 巻 3 号 p.
945-948
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Shoulder surgery is often associated with severe postoperative pain. Purpose of this study was to evaluate the efficacy of pain reduction by using interscalene brachial plexus blocks with continuous versus single-shot for ARCR.
Methods: 32 shoulders which had undergone ARCR were the subjects of this study. They were assigned randomly into 3 groups, 11 cases were administered continuous interscalene brachial plexus block (0.25 ropivacaine, 4ml/hr) for 2 days postoperatively (Continuous Group “C”), 10 cases were administered single interscalene brachial plexus block with 10ml of 0.75% ropivacaine preoperatively (Single-Shot Group “SS”), and 11 cases without on interscalene brachial plexus block (Control Group “L”). The amount of diclofenac sodium applied, pentazocine injection used, and VAS were weighted as evaluation items between the groups. For VAS, measurement was applied soon after the operation, 1 and 6hours, 1, 2, 3, 7 and 14 days postoperatively. ANOVA was used for statistical examination, and the significance level being considered as under 5%.
Results: No significant difference in diclofenac sodium amounts applied, or pentazocine used was seen between the groups. For VAS, the significance was lower in SS and C than in L at 1 and 6 hours postoperatively (L:57mm, 58mm, 48m, SS:2.0mm, 2.0mm, 14mm, C:3.6mm, 9.1mm, 8.2mm). VAS had lower significance 1 day postoperatively in C (C 18mm, L 46mm, SS 54mm). No complications such as pneumothorax were found.
Conclusion: Both single-shot and continuous interscalene brachial plexus block for pain relief on the operation day were effective. The continuous interscalene brachial plexus block allows for continuous pain relief, and may reduce protective muscle contraction on shoulder muscles caused by postoperative pain.
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呉屋 五十八, 山口 浩, 金谷 文則, 末永 直樹
2012 年 36 巻 3 号 p.
949-951
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Hypothesis: Although a number of surgical procedures have been developed for rotator cuff tears, retear rates for large and massive rotator cuff tears have been higher than for patients with small tears. We adopted surface-holding repair, which was characterized by the footprint being advanced medially to avoid the strong tension in repaired tendon. The objective of this study was to evaluate clinical results and repair integrity of this procedure.
Methods: 18 shoulders with large and massive rotator cuff tears were repaired using this technique. There were 12 males and 6 females, and the average age was 68.9 years old, and the average follow-up period was 15.7 months. All patients were evaluated clinically, and were examined using the JOA score. In the A-P radiograph, upward migration of humeral head was compared pre- and postoperatively. Repair integrity was evaluated using Sugaya's classification.
Results: The average JOA score improved from 57.5 preoperatively to 88.8 at the time of final follow up. Upward migration progressed in 5.6% and improved in 38.9%. Postoperative MRI scans revealed 7 shoulders with Sugaya's classification type1, 4 shoulders with type2, 6 shoulders with type3, 1 shoulder with type4, and none with type5.
Discussion: Satisfactory clinical results were obtained with the surface-holding repair for massive rotator cuff tears. Although upward migration had progressed postoperatively in some shoulders, the incidence rates were no higher than those associated with other procedures. Therefore, this technique is anticipated to be recognized as an effective surgical method for rotator cuff injuries.
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野中 伸介, 廣瀬 聰明, 木村 重治, 上野 栄和, 吉本 正太, 道家 孝幸, 杉 憲, 山下 敏彦, 岡村 健司
2012 年 36 巻 3 号 p.
953-956
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Morphologic changes and instability in the long head of biceps (LHB) have been considered as one possible cause of damage of rotator interval structures. However, there have seldom been studies about the relationship between lesions of LHB and the morphology of biceps groove (BG). The purpose of this study was to classify the morphology of BG in rotator cuff tears by 3DCT and to evaluate LHB changes in form with arthroscopy.
Methods: We retrospectively studied 59 cases who had arthroscopic rotator cuff repair performed. The average age at operation was 66.2 years old. We evaluated the morphology of BG by preoperative 3DCT. And then, we assessed the relationship of the morphology of BG and the tear size, LHB changes.
Results: We classified the morphology of BG into 5 types. Type 1 (no change): 33 shoulders, Type 2 (lateral wall spur): 9 shoulders, Type 3 (medial wall spur): 3 shoulders, Type4 (lateral and medial wall spur): 7 shoulders, Type5 (lateral and medial wall spur): 7 shoulders. The tear size was significantly smaller in Type1 and larger in Type5. Rotator cuff tears involving the subscapularis tendon in type5 were significantly more than in type1. Complete tear of LHB in type4 was significantly more than in type1. Instability of LHB in type5 was significantly more than in type1.
Conclusion: There was a relationship between lesions of LHB and the morphology of BG. Complete tears of LHB were frequently found in type4, and instability of LHB in type5.
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米川 晋, 菊川 和彦, 奥平 信義
2012 年 36 巻 3 号 p.
957-959
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Arthroscopic rotator cuff repair has been prevalent and allows us to obtain excellent clinical results. However, in elder patients there are some complaints. The purpose of this study is to compare the clinical result of arthroscopic rotator cuff repair in the elderly with younger patients.
Methods: We retrospective studied 21 patients (26shoulders). The patients were 11males and 15 females. The mean age at operation was 82.2 years old(80 ∼ 88years). The mean postoperative follow-up period was 20.5 months(12 ∼ 51months). 1 shoulder had a small tear, 7 shoulders had medium tears, 11 shoulders had massive tears, and 7shoulders were global rotator cuff tears.18 shoulders were treated by primary repair(3shoulders single row methods, 15shoulders double row methods). 5 shoulders treated by facia lata graft, and 3shoulers with partial repair. The clinical results were evaluated according to the Japanese Orthopedic Association score (JOA score) and re-tears were evaluated using MRI.
Results: The average JOA score was changed from 47.3 to 78.1. In post operative MRI re-tear were shown in 11 shoulders. There is no interrelation between the trauma and the clinical result.
Conclusion: The clinical result of ARCR for the elderly persons was almost satisfactory, but it must be careful of indications.
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大前 博路
2012 年 36 巻 3 号 p.
961-964
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The double-row suture technique and the suture-bridge technique have been used for rotator cuff repair to decrease the re-rupture. However, as far as suturing only the degenerated tendon end itself for the repair goes, the risk of re-rupture remains. The augmentation suture technique is a new procedure, connecting the intact medial tendon to the lateral greater tuberosity, which might protect the initial repaired site. The purpose of this study was to evaluate the postoperative results of the augmentation suture technique.
Methods: The thirteen patients with medium to large rotator cuff tears had cuff repair with the augmentation suture technique. At six months after the operation, the clinical outcome and the cuff integrity were evaluated.
Results: At six months after the operation, the clinical outcome scores were improved significantly (63.2 to 94.6 points; the Japanese Orthopaedic Association score, p<0.01 Paired t-test). In twelve cases (92%), the repaired cuff had good integrity on magnetic resonance images (Type-I and II of the Sugaya's classification). Re-rupture (Type-IV) was detected in one case (8%).
Discussion: The augmentation suture, connecting the medial intact tendon to the lateral greater tuberosity, will protect the initial cuff repair, and might be useful for the repair of a rotator cuff tear with a degenerated cuff end.
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祐成 毅, 森原 徹, 小椋 明子, 立入 久和, 堀井 基行, 久保 俊一, 平田 正純, 黒川 正夫
2012 年 36 巻 3 号 p.
965-968
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: It is important to demonstrate how we can advance the tip of torn rotator cuff in the decision of the operative procedure. The purpose of this study is to investigate the advanced length of the tip of torn rotator cuff after modified Debeyre-Patte procedure by magnetic resonance imaging (MRI).
Methods: We investigated 10 shoulders (6 rights, 4 lefts) of 10 patients after modified Debeyre-Patte procedure between 2008 and 2010. The mean contraction period, the mean age at operation, and the mean follow-up period were 5.6 months, 65.5 years old, and 20.6 months, respectively. We measured the advanced length of the tip of torn rotator cuff on the MRI in the preoperative and postoperative periods. The subacromial bursa portion of the largest rotator cuff tear on oblique coronal plane at superior facet and middle facet were identified. We discussed the relationship between fatty degeneration and the advanced length of the tip of torn rotator cuff. The preoperative fatty degeneration was judged by Goutallier's classification.
Results: The mean advanced length of the tip of torn rotator cuff was 40.0mm on average (21.7mm to 58.3mm) at superior facet and 44.6mm on average (26.5mm to 58.5mm) at middle facet. The advanced length wasn't related to be the amount of fatty degeneration.
Conclusion: These clinical results are good, and the advanced length of the tip of torn rotator cuff is considered to be one of the useful indicators of the decision of the operative procedure.
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杉原 隆之
2012 年 36 巻 3 号 p.
969-971
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We investigated the clinical outcome of arthroscopic rotator cuff repair using bioabsorbable suture anchors.
Methods: Arthroscopic rotator cuff repair using bioabsorbable suture anchors was performed on nineteen shoulders from 2004 to 2011. There were 14 males and 5 females with an average age of 60.7 years old. There were 14 right sides and 5 left. They were followed up for 12 months to 40 months (average 14.6 months). The pre and post-operative results were evaluated according to the shoulder evaluation sheet of the Japanese Orthopaedic Association (JOA score).
Results: The average preoperative JOA score was 65.4 points and the average postoperative JOA score was 98.2 points. The average postoperative JOA score improved compared with the preoperative JOA score significantly. The average preoperative JOA pain score was 9.5 points and the average postoperative JOA pain score was 29.5 points. The average preoperative JOA function score was 14.3 points and the average postoperative JOA function score was 19.7 points. The average preoperative JOA ROM score was 22.9 points and the average postoperative JOA ROM score was 29.7 points. Each average postoperative JOA score improved compared with the preoperative JOA score significantly.
Conclusion: The clinical results of arthroscopic rotator cuff repair using bioabsorbable suture anchors were mostly good.
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小椋 明子, 森原 徹, 祐成 毅, 喜馬 崇至, 堀井 基行, 久保 俊一, 平田 正純, 黒川 正夫
2012 年 36 巻 3 号 p.
973-976
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: One of the complications of rotator cuff tears is abnormality or injury of the long head of biceps tendon (LHB). The purpose of this study was to investigate the condition of LHB in massive rotator cuff tears after modified Debeyre-Patte procedure.
Methods: The study included 19 patients (20 shoulders) after modified Debeyre-Patte procedure from 2008 to 2010, 12 males and 7 females with an average age of 66.1(56-71) years old. The mean follow-up period was 14.8 (3-36) months.
The conditions of LHB were examined at preoperative stage of rotator cuff tears and postoperative stage at a proximal muscular slice in the axial plane on magnetic resonance imaging (MRI). We investigated arthroscopic findings of the shape and condition of LHB at operative period.
Results: At the pre-operative / post-operative stage, normal were 6/11 shoulders, dislocation were 6/0, sublaxation were 5/1, absence were 4/5, effusion at groove were 10/5 respectively. We confirmed 4 normal LHB, 12 abnormal LHB with hypertrophy or depressed and/or partial rupture, and 4 completely ruptured LHB. We performed 1 tendon fixation, 1 trimming, and 1 cutting. The complete ruptures of LHB were found in 4 of the 10 shoulders with subscapularis tear.
Conclusion: The dislocation of LHB improved in the post operative period.
We concluded that the improvement of LHB condition after the repair of massive rotator cuff tear resulted from normal LHB sliding by the reduction of dislocation and improvement of superior migration of the humeral head.
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松浦 恒明, 進 訓央, 原口 和史, 大江 健二郎, 朝倉 透
2012 年 36 巻 3 号 p.
977-981
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We investigated the re-tear rate of rotator cuff tears after ARCR, especially massive and large rotator cuff tears. 150 shoulders that had undergone ARCR were investigated regarding the preoperative tear size, repair methods, and re-tear rate.
Methods: From October, 2007 to December, 2010, in old Wakamatsu Municipal Hospital, 150 shoulders that had undergone ARCR (125 shoulders using dual row (DR) method, 25 shoulders using bridging suture (BS) method) were investigated regarding the preoperative tear size, re-tear rate 6 months after operation, and operative findings for the re-tear group and non-re-tear group of BS group, back out of lateral anchor and problems of suture technique.
Results: The re-tear rate 6 months after operation was 31% in large and massive tears in DR group and was 36.4% in BS group. Incomplete back out of lateral anchor was found in 5 out of 11 cases of massive tears.
Conclusion: We discussed how we should do the bridging suture technique.
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五藤 和樹, 二宮 裕樹, 信原 克哉
2012 年 36 巻 3 号 p.
983-986
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: The purpose of this study was to examine images and clinical evaluation global rotator cuff tears in the long-term postoperatively.
Methods: 10 shoulders (9 males and 1 female) examined this year were evaluated.The average follow-up period was 14.8 years (range: 12-21), and mean age at the time of examination was 72.5 years old (range: 62-92). Superior migration of the humeral head and osteoarthritis changes were examined with X-P. Cuff integrity and fatty infiltration were examined with MRI. Clinical results were evaluated with JOA score and UCLA score.
Results: AHI(acromio-humeral interval) was an average of 3.7mm (range:0-9.2) and decreased in all cases. Superior migration was observed but osteoarthritis changes had not progressed. In cuff integrity, 7 cases (70%) were Sugaya's Classification types 4+5. Similarly, in fatty infiltration, 7 cases (70%) were Gutallier's Classification grade3+4. 8 shoulders acquired complete Zero Position. Active flexion, abduction, and external rotation angle were an average of 129 degrees (range: 85-150), 104 degrees (range: 70-140), and 19.5 degrees (range -40-60) respectively. The average JOA score was 81(range: 60-87).There were no correlations between postoperative AHI and other values. Preoperative indicators of upward migration of the humeral head, and indicators of cuff integrity were correlated with JOA score.
Conclusion: In the long-term post repair of global rotator cuff tears, superior migrations of the humeral head tended to progress but were not necessarily correlated with clinical outcome. But, less superior migration preoperatively, and better cuff integrity did contribute to a better clinical outcome.
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望月 由, 越智 光夫
2012 年 36 巻 3 号 p.
987-990
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: We reported that poly-glycolic acid (PGA) sheet was effective for the regeneration of the insertion and the proper portion of the rotator cuff tendon experimentally. We clinically used the PGA sheet for the repair of massive rotator cuff injuries and reported the good results.
Methods: The patch graft using PGA sheet was performed on 62 cases. Thirty five cases had the patch graft performed using three layers PGA sheets (3PGA group) and 27 cases had performed using five layers of PGA sheets (5PGA group). 36 cases were male and 26 cases were female. The average age was 61.5 years old. We evaluated the clinical results using JOA score. The MRI findings were evaluated by using Spielmann criteria. The clinical results were analyzed statistically.
Results: The average JOA score improved from 54.9 points to 91.7 points postoperatively in the 3PGA group and from 52.6 points to 75.7 points postoperatively in the 5PGA group. Eleven cases of the 5PGA group showed the severe effusion 2 months after surgery. From the MRI findings, 12 cases(45%) had re-ruptured.
Discussion and Conclusion: We increased the layers of the PGA sheet for the purpose of the repair of the massive rotator cuff repair. However, severe effusion and reinjury occurred. It is better to use three layers of PGA sheet. Also, we are trying to investigate the effective usage of PGA sheet for new materials.
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宮本 崇, 中川 照彦, 佐藤 哲也, 多嶋 佳孝, 松山 嘉彦, 土屋 正光
2012 年 36 巻 3 号 p.
991-993
発行日: 2012年
公開日: 2012/10/25
ジャーナル
認証あり
Background: Subscapularis tendon tears are rare injuries. The purpose of this study was to evaluate clinical outcomes of arthroscopic repair of subscapularis tendon.
Methods: Eight shoulders in 8 patients (4 males, 4 females, 6 right and 2 left shoulders) who underwent arthroscopic repair of subscapularis tendon between April 2005 and March 2011 were reviewed. The average age at the time of operation was 66.1 years old (32-84 years old). Seven tears were traumatic and one was degenerative. Lift-off and belly-press tests were positive in all patients. Full thickness tear of subscapularis tendon was observed by MRI. Isolated tears of the subscapularis tendon were observed in 2 cases, 3 cases combined with a supraspinatus tendon tear, and 3 cases combined with a supraspinatus and an infraspinatus tendon tear. The subscapularis tendon was refixed arthroscopically to the lesser tubercle using an anchor. The average interval from the onset of symptoms to the time of surgery was 6.3 months (3-13 months). The average duration of follow-up was 16.1 months (6-72 months). Clinical outcomes were evaluated with JOA score and MRI classified according to Sugaya's classification.
Results: Postoperative MRI revealed 3 type I, 2 type II, 2 type III, and 1 type V. The average JOA score was improved from 66.1 points (45-83 points) to 82.8 points (69-91 points).
Discussion: JOA score improved for pain after the operation. Improvement of the internal rotation strength indicates that subscapularis tendon function was reformed.
Conclusion: The subscapularis tendon tears treated by arthroscopic repair were improved significantly.
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