Clinical and Radiological Evaluation after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique

이광원,Dong Wook Seo,배경완,Won Sik Choy 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.4

Background: We retrospectively assessed the clinical outcomes and investigated risk factors influencing retear after arthroscopic suture bridge repair technique for rotator cuff tear through clinical assessment and magnetic resonance arthrography (MRA). Methods: Between January 2008 and April 2011, sixty-two cases of full-thickness rotator cuff tear were treated with arthroscopic suture bridge repair technique and follow-up MRA were performed. The mean age was 56.1 years, and mean follow-up period was 27.4 months. Clinical and functional outcomes were assessed using range of motion, Korean shoulder score, Constant score, and UCLA score. Radiological outcome was evaluated with preoperative and follow-up MRA. Potential predictive factors that influenced cuff retear, such as age, gender, geometric patterns of tear, size of cuff tear, acromioplasty, fatty degeneration, atrophy of cuff muscle, retraction of supraspinatus, involved muscles of cuff and osteolysis around the suture anchor were evaluated. Results: Thirty cases (48.4%) revealed retear on MRA. In univariable analysis, retear was significantly more frequent in over 60 years age group (62.5%) than under 60 years age group (39.5%; p = 0.043), and also in medium to large-sized tear than small-sized tear (p = 0.003). There was significant difference in geometric pattern of tear (p = 0.015). In multivariable analysis, only age (p = 0.036) and size of tear (p = 0.030) revealed a significant difference. The mean active range of motion for forward flexion, abduction, external rotation at the side and internal rotation at the side were significantly improved at follow-up (p < 0.05). The mean Korean shoulder score, Constant score, and UCLA score increased significantly at follow-up (p < 0.01). The range of motion, Korean shoulder score, Constant score, and UCLA score did not differ significantly between the groups with retear and intact repairs (p > 0.05). The locations of retear were insertion site in 10 cases (33.3%) and musculotendinous junction in 20 cases (66.7%; p = 0.006). Conclusions: Suture bridge repair technique for rotator cuff tear showed improved clinical results. Cuff integrity after repair did not affect clinical results. Age of over 60 years and size of cuff tear larger than 1 cm were factors influencing rotator cuff retear after arthroscopic suture bridge repair technique.

증상을 동반한 제 2형 부주상골에서 교량형 봉합술을 이용한 변형 Kidner 술식의 단기 치료 결과

김응수,문진선,Kim, Eungsoo,Moon, Jinseon 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.2

Purpose: The purpose of this study was to evaluate the clinical outcome of a modified Kidner procedure using a suture bridge technique in symptomatic type II accessory navicular. Materials and Methods: Between January 2013 and December 2014, a total of 35 cases with symptomatic type II accessory navicular were treated with a modified Kidner procedure using the suture bridge technique. The patients were evaluated preoperatively, 3 months after surgery, and at the latest follow-up (at least six months postoperatively) clinically via the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS), and the self-subjective satisfaction score. Results: The mean AOFAS midfoot score demonstrated significant improvement from a mean of 45.3 preoperatively to a mean of 89.2 at 3 months after surgery. At the latest follow-up, the mean AOFAS midfoot score was 92.6 (p<0.001). The mean VAS also improved significantly, decreasing from 6.7 out of 10 preoperatively to 1.8 at 3 months after surgery. At the latest follow-up, the VAS was 1.2 (p<0.001). The mean time of a single-limb heel raise was 4.6 months postoperatively and the self-subjective satisfaction score was 1.4 out of 4 at the latest follow-up. Conclusion: The short-term surgical results of the modified Kidner procedure with a suture bridge technique for symptomatic type II accessory navicular were good to excellent in terms of pain, functional and clinical assessments. In conclusion, the modified Kidner procedure with the suture bridge technique is a reasonable treatment option for symptomatic type II accessory navicular.

Modified Mason-Allen Suture Bridge Technique: A New Suture Bridge Technique with Improved Tissue Holding by the Modified Mason-Allen Stitch

Bong Gun Lee,조남수,이용걸 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.3

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

변형된 Mac 교량형 봉합술

천상진(Sang Jin Cheon),이효열(Hyo Yeol Lee),안성진(Sung Jin Ahn) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.5

목적: 저자들은 건의 상태가 불량한 회전근 개 파열 환자에서 재파열을 줄이기 위해 변형된 Mac 교량형 봉합술을 고안하였고 임상적 및 영상학적 치료 결과를 분석하여 새로운 봉합법의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 2010년 1월부터 2014년 12월까지 부산대학교병원에서 관절경적 회전근 개 봉합술을 시행한 환자들 중 수술 전 시행한 자기공명영상 검사와 수술 중 관절경 소견을 종합 평가한 결과 건의 상태가 불량하다고 판단되는 경우 변형된 Mac 교량형 봉합술을 시행하였다. 이 중 최소 1년 이상 추시가 가능하였던 환자 52명을 연구대상으로 하였다. 남자 25명, 여자 27명, 평균 연령은 60세였다. 평균 추시 기간은 20개월이었다. 임상적 결과는 술 전 그리고 최종 추시 시 American Shoulder and Elbow Surgeon (ASES) score, University of California, Los Angeles (UCLA) score, Constant shoulder score (CSS), visual analogue scale (VAS), 관절운동 범위를 비교하여 평가하였다. 수술 후 평균 7개월째 자기공명영상 추적관찰을 시행한 42예에서는 Sugaya 분류를 이용하여 구조적 상태를 분석하였다. 결과: 수술 후 시행한 추적 자기공명영상상 치유 정도는 I형은 15명(35.7%), II형은 22명(52.4%), III형은 3명(7.1%), IV형은 2명(4.8%), V형은 없었다. I, II, III형으로 병변의 회복상태로 판단되는 환자는 40명으로 전체의 95.2%에 해당하였다. 재파열(IV, V형)은 2명(4.8%)에서 관찰되었다. 재파열 환자 2명 중 1명은 대파열, 1명은 광범위 파열 환자였다. 최종 추시 시 ASES score는 평균 56.75점에서 83.44점으로, UCLA score는 20.52점에서 29.23점으로, CSS는 64.04점에서 80.90점으로, VAS는 술 전 6.17점에서 술 후 1.62점으로 유의하게 호전되었다(p<0.001). 관절운동 범위는 전방거상 108°에서 158°, 외전 109°에서 160°, 외회전(외전) 27°에서 50°, 내회전(외전) 31°에서 57°로 유의한 회복을 보였다(p<0.001). 결론: 건의 상태가 불량한 회전근 개 파열에서 변형된 Mac 교량형 봉합술은 임상적 및 영상학적 회복 측면에서 기존에 알려진 봉합법들에 대한 유용한 대안이 될 수 있다. Purpose: Base on the concept of the Mac stitch, we designed the modified Mac-suture bridge technique to improve the outcome of arthroscopic repair of rotator cuff tear with poor tissue quality. Moreover, we evaluated both the radiological and clinical outcomes of the surgery to assess the effectiveness of the newly designed technique. Materials and Methods: From January 2010 to December 2014, a total of 52 patients (25 males, 27 females) with rotator cuff tear, with poor tissue quality according to both radiological and intraoperative findings, who underwent arthroscopic rotator cuff repair using the modified Mac-suture bridge technique and followed-up for at least 1 year were included in this study. The mean patient age at the time of surgery was 60 years. The average follow-up period was 20 months. We evaluated the clinical outcomes by checking the range of motion and compared the following, both preoperatively and postoperatively: American Shoulder and Elbow Surgeon (ASES) score, University of California, Los Angeles (UCLA) score, Constant shoulder score (CSS), visual analogue scale (VAS). In addition, we analyzed 42 series of postoperative magnetic resonance imaging by using the Sugaya’s classification for the evaluation of the repair integrity. Results: All clinical scores showed significant improvement (ASES score improved from 56.75 to 83.44, UCLA score from 20.52 to 29.23, CSS from 64.04 to 80.90, and VAS from 6.17 to 1.62; p<0.001). The range of motion was also improved; forward flexion improved from 108° to 158°, abduction from 109° to 160°, external rotation from 27° to 50°, and internal rotation from 31° to 57° (p<0.001). Satisfactory radiologic results were noted on postoperative magnetic resonance imaging, consisting of 15 cases (35.7%) type I, 22 cases (52.4%) type II, 3 cases (7.1%) type III, 2 cases (4.8%) type IV, and no type V, according to the Sugaya’s method. Conclusion: The modified Mac-suture bridge technique provided satisfactory results both radiologically and clinically for the treatment of rotator cuff tear with poor tendon tissue quality. It could possibly be a good alternative to previous techniques of arthroscopic repair.

Revision of a Pull-out Suture Anchor in the Lateral Row During the Suture-bridge Technique

Kyung-Cheon Kim,Kwang-Jin Rhee,Hyun-Dae Shin,Ki-Yong Byun,Jae-Hoon Yang,Dong-Kyu Kim,Bo-Kun Kim 대한견주관절의학회 2009 대한견주관절학회 학술대회논문집 Vol.2009 No.5

Arthroscopic Double-pulley Suture-bridge Technique for Rotator Cuff Repair

Kyung-Cheon Kim,Kwang-Jin Rhee,Hyun-Dae Shin,Ki-Yong Byun,Jae-Hoon Yang,Dong-Kyu Kim,Kyu-Woong Yeon 대한견주관절의학회 2009 대한견주관절학회 학술대회논문집 Vol.2009 No.5

Arthroscopic Footprint Reconstruction of Bursal-side Delaminated Rotator Cuff Tears using the Suture-bridge Technique

Kyung-Cheon Kim,Kwang-Jin Rhee,Hyun-Dae Shin,Ki-Yong Byun,Jae-Hoon Yang,Dong-Kyu Kim,Pil-Sung Kim 대한견주관절의학회 2009 대한견주관절학회 학술대회논문집 Vol.2009 No.5

관절경적 교량형 봉합 술식을 통한 회전근 개 전층 파열의 치료결과

서재성(Jae-Sung Seo),박성혁(Sung-Hyuk Park),김원호(Won-Ho Kim) 대한견주관절의학회 2010 대한견주관절학회지 Vol.13 No.2

목적: 회전근 개 전층 중파열, 대파열 환자에 대하여 관절경적 교량형 봉합 술식을 시행한 후 임상 결과를 분석 보고하고자 하였다. 대상 및 방법: 2007년 11월부터 2008년 10월까지 회전근 개 전층 중파열, 대파열을 관절경적 교량형 봉합 술식으로 치료받은 90예를 대상으로 하였고, 평균 추시 기간은 15개월 (12~23개월)이었다. 파열의 크기는 중파열이 43예, 대파열이 47예였다. 술 전 및 최종 추시 시 KSS, ASES, UCLA, Visual Analogue Scale (VAS)를 이용한 기능평가를 시행하였다. 결과: 휴식 및 운동 시 평균 VAS 점수는 각각 수술 전 2.56, 6.94에서 최종 추시 시 0.96, 1.70으로 현저한 감소를 보였다. UCLA 점수는 수술 전 평균 17.08점에서 최종 추시 시 31.17점으로 향상되었으며, 최우수가 31예 (34%), 양호가 49예 (54%), 불량이 10예 (12%)였다. 최종 추시 시 60세 이하인 경우 31.47점, 61세 이상인 경우 30.69점이었으며 (p=0.344), 중파열인 경우 31.23점, 대파열인 경우 31.11점이었고 (p=0.924), 비외상군이 31.10점, 외상군이 31.23점이었다 (p=0.929). 결론: 회전근 개 전층 중파열, 대파열 환자에서 관절경적 교량형 봉합 술식을 시행하여 동통의 감소 및 견관절 기능 향상의 우수한 결과를 얻을 수 있어 믿을만한 수술적 방법 중 하나라고 생각한다. 수술 당시 연령, 외상력 유무는 치료 결과에 큰 영향을 주지 않았다. Purpose: To determine clinical results for arthroscopic repair of a full-thickness rotator cuff tear using a suture bridge technique. Materials and Methods: Between November, 2007 and October, 2008, we evaluated 90 cases of arthroscopic middle, large rotator tear cuff repair. The mean follow-up period was 15 months (range, 12-23 months). Forty-three cases had medium-sized tears; 47 cases had large-sized tears. At the preoperative stage and again at last follow-up, functional results were assessed by the KSS, ASES, UCLA and the PVAS (Pain visual analogue score). Results: Pain score improved from 2.56 preoperatively to 0.96 at final follow-up; movement scores improved from 6.94 to 1.70. At. final follow-up, the average UCLA score improved from 17.08 to 31.17 with 31 excellent (34%), 49 good (54%) and 10 poor results (12%). The final UCLA score was 31.47 in the group less than 60 years of age and 30.69 in the group over 61 years of age (p=0.344). The UCLA score was 31.23 in those with medium-sized tears and 31.11 in those with large-sized tears (p=0.924). The UCLA score was 31.10 in non-trauma patients and 31.23 in trauma patients (p=0.929). Conclusion: Arthroscopic repair of a full-thickness rotator cuff tear using a suture bridge technique can produce excellent clinical results. These outcomes are not affected by age or trauma history.

회전근 개 파열에 대한 관절경적 교량형 봉합술의 결과

천상진(Sang-Jin Cheon),허준오(Joon-Oh Hur),서정탁(Jeung-Tak Suh),유총일(Chong-Il Yoo) 대한견주관절의학회 2009 대한견주관절학회지 Vol.12 No.2

목적: 회전근 개 건 전층 파열 시 관절경적 교량형 봉합술 시행 후 단기 추시 관찰을 통해 이 술식의 임상적 결과에 대해 알아보고자 하였다. 대상 및 방법: 회전근 개 건 전층 파열로 관절경적 교량형 봉합술을 시행 받고 조기 재활을 시행한 29명 (남자:17명, 여자:12명)의 환자를 대상으로 시행하였다. 평균 나이는 56.4세 (34~73세)였으며 추시 관찰 기간은 평균 13개월 (12~15개월)이었다. 임상적 및 기능적 평가로 The University of California at Los Angeles (UCLA) score, The Korean Shoulder Scoring system (KSS) 및 Visual Analogue Scale (VAS) score를 이용하였다. 15예에서 최종 추시시 자기 공명 영상을 촬영하여 Sugaya 분류를 통해 회전근 개의 구조적 상태를 분석하였다. 결과: 수술 후의 UCLA score는 수술 전과 수술 후 각각 16.4에서 31.6으로 측정되어 유의할만한 호전을 보였고 (p< 0.05), KSS는 수술 후 6개월에 88이었고, 최종 추시 시 92로 측정되었다. VAS score는 수술 전 8.6에서 수술 후 3개월에 2.1로, 수술 후 6개월에는 1.4로 나타났다. 28예 (96.5%)에서 수술 후 관절 운동 범위가 증가되었다. 추시 시 자기 공명 영상을 촬영한 15예에서 Sugaya 분류에 의해 I형이 6예, II형이 7예, III형이 1예, V형이 1예이었다. 결론: 회전근 개 건 전층 파열에 대한 관절경적 교량형 봉합술을 이용한 회전근 개 봉합술은 임상적으로 96.5%에서 양호 이상의 만족할 만한 결과를 보였으므로 믿을 만한 수술적 방법 중 하나라고 생각한다. Purpose: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. Materials and Methods: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. Results: Postoperative UCLA scores improved from16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. Conclusion: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.

교량형 봉합술을 이용한 관절경적 회전근개 건 봉합술 후 회전근개 건 복원 생태

천상진(Sang Jin Cheon),허준오(Joon Oh Hur),서정탁(Jeung Tak Suh),유총일(Chong Il Yoo) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.1

목적: 회전근개 건 전층 파열에서 관절경적 교량형 봉합술 후 복원된 회전근개 건의 회복 상태에 대해 알아보고자 하였다. 대상 및 방법: 회전근개 건 전층 파열로 관절경적 교량형 봉합술을 시행받고 수술 후 복원 정도를 평가하기 위해 평균 9개월에 자기 공명 영상을 얻을 수 있었던 42명(남자: 14명, 여자: 28명)의 환자를 대상으로 하였다. 평균 나이는 57세(44-75세)였으며 추시 관찰 기간은 평균 14개월(12-16개월)이었다. 추시 시 촬영한 자기공명 영상을 통해 Sugaya 분류에 따라 복원된 회전근개 건의 구조적 상태를 분석하였다. The University of California at Los Angeles(UCLA) score, The Korean Shoulder Scoring System (KSS) 및 Visual Analogue Scale (VAS)을 이용하여 임상적 및 기능적 평가를 시행하였다. 결과: 추시 시 자기 공명 영상을 촬영한 42예에서 Sugaya분류 Ⅰ형이 10예, Ⅱ형이 28예, Ⅲ형이 2예, Ⅳ형이 1예 및 Ⅴ형이 1예로 관찰되었다. 대파열 이하의 파열크기를 보인 39예 중 수술 후 Sugaya 분류상 Ⅰ형이 9예, Ⅱ형이 27예로 대파열 이하에서 92.3%의 정상 복원율을 보았다. 광범위 파열에서는 3예 중 1예에서 Ⅴ형의 재파열이 발생하여 재파열률은 33.3%였으며 전체 재파열률은 4.8%이었다. 또한 3단계 이하의 지방변성도를 보인 41예에서 수술 후 92.7%의 정상 복원율을 보였다. Sugaya 분류 Ⅴ형인 재파열 1예를 제외한 41예에서 UCLA score는 수술 전 17.2에서 수술 후 31.4로, KSS score는 58.2에서 90.8로 향상되어 유의할만한 호전을 보였으며(p<0.05) 각 형들에 따른 임상적인 차이 없이 모두 만족할 만한 임상적 결과를 보였다. 결론: 회전근개 건 전층 파열에 대한 관절경적 교량형 봉합술을 이용한 회전근개 봉합술은 90.4%에서 구조적으로 정상 복원된 결과를 보였고, 임상적으로 향상된 결과를 보여 회전근개 건 전층 파열 시 사용할 수 있는 믿을 만한 수술 방법 중 하나라고 생각한다. Purpose: We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears. Materials and Methods: Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Significance was set at p values < 0.05 Results: In the 42 cases with follow up MRI, the cuff integrity was graded as type Ⅰ in 10 cases, type Ⅱ in 28, type Ⅲ in 2, type Ⅳ in 1 and type Ⅴ in 1 case. Out of the 39 cases having a medium to large tear, the type Ⅰ and Ⅱ cuff integrity was 92.3% and two patients had type Ⅲ cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear. the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity. Conclusion: The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.