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Background: Even though arthroscopic rotator cuff repair is recognized as a standard treatment option, the risk of postoperative retear is a major concern. Purpose: To evaluate the effect of porcine-derived absorbable patch-type atelocollagen during arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 64 patients with rotator cuff tears diagnosed on magnetic resonance imaging (MRI) were enrolled prospectively from November 2020 to December 2021. Both groups had repairs using the suture bridge technique. For the atelocollagen group, before securing the lateral anchors, we inserted porcine-derived absorbable patch-type atelocollagen between the footprint and the tendon. On postoperative day 2, the patients underwent MRI to confirm containment of the patch-type atelocollagen. At 6 months and 1 year postoperatively, the signal intensity of the repaired tendon was assessed using MRI. Patients were evaluated using the Constant score as the primary outcome, along with the visual analog scale for pain; range of motion; American Shoulder and Elbow Surgeons score; University of California, Los Angeles, score; and Korean Shoulder Score preoperatively and at 2, 3, 6, and 12 months postoperatively. Results: No significant changes in the Constant score as primary outcome, pain or other functional scores, and range of motion were observed between the groups at 1 year postoperatively. The patch-type atelocollagen was confirmed to be contained by the time-zero MRI scan taken 2 days postoperatively. Among the 55 patients included in final analysis, 12 retear cases were recorded (21.8% retear rate). A significantly lower retear rate was found in the atelocollagen group, as 3 cases were observed in this group (10.3%) and 9 cases were observed in the conventional repair group (34.6%) (P =.048). Conclusion: The Constant score was not different between the groups. The retear rate after rotator cuff repair was significantly lower in the group that received porcine-derived absorbable patch-type atelocollagen compared with in the conventional group. Registration: KCT0005184 (Clinical Research Information Service [CRIS]; https://cris.nih.go.kr). [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to determine the relationship between oral-mucosal pressure ulcer (PU) stage and mechanical conditions and individual susceptibility in intubated patients. Methods: We collected 80 patient-days data from an intensive care unit of a 700-bed hospital in Korea. We analyzed oral-mucosal PUs, medical records, amount of saliva, and oral mucosal swabs. Bacterial abundance was enumerated by real-time polymerase chain reaction. The χ2 or Fisher's exact test, t-test or Mann-Whitney U test, and Spearman's rho correlation analysis were performed. Results: The incidence of overall oral-mucosal PUs was 31.3%, and in the maxillary and mandibular sites were 16.3% and 26.3%, respectively. There were significant correlations between the maxillary site PU stage and restraint use (r =.43, p <.001), albumin level (r = −.22, p =.046), and relative abundance of P. aeruginosa (r =.45, p <.001) and S. aureus (r = −.24, p =.033). In the mandibular sites, there were significant correlations between PU stage and restraint use (r =.30, p =.008), level of consciousness (r =.31, p =.005), and relative abundance of P. aeruginosa (r =.25, p =.028) and S. pneumoniae (r =.22, p =.046). Conclusions: Frequent monitoring and repositioning the mechanical pressure on the oral-mucosa could be an effective preventive strategy against the development and advancement of oral-mucosal PUs. Additionally, monitoring the oral microorganisms can prevent advanced stage oral-mucosal PUs in intubated patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of Morning Walk®–assisted gait training for patients with stroke. Design: Prospective randomized controlled trial. Setting: Three hospital rehabilitation departments (two tertiary and one secondary). Patients: We enrolled 58 patients with hemiparesis following a first-time stroke within the preceding year and with Functional Ambulation Category scores ⩾2. Intervention: The patients were randomly assigned to one of two treatment groups: 30 minutes of training with Morning Walk®, a lower limb rehabilitation robot, plus 1 hour of conventional physiotherapy (Morning Walk® group; n = 28); or 1.5 hour of conventional physiotherapy (control group; n = 30). All received treatment five times per week for three weeks. Main outcome measurements: The primary outcomes were walking ability, assessed using the Functional Ambulation Category scale, and lower limb function, assessed using the Motricity Index-Lower. Secondary outcomes included the 10 Meter Walk Test, Modified Barthel Index, Rivermead Mobility Index, and Berg Balance Scale scores. Results: A total of 10 patients were lost to follow-up, leaving a cohort of 48 for the final analyses. After training, all outcome measures significantly improved in both groups. In Motricity Index-Lower of the affected limb, the Morning Walk® group (∆mean ± SD; 19.68 ± 14.06) showed greater improvement (p = .034) than the control group (∆mean ± SD; 11.70 ± 10.65). And Berg Balance Scale scores improved more (p = .047) in the Morning Walk® group (∆mean ± SD; 14.36 ± 9.01) than the control group (∆mean ± SD; 9.65 ± 8.14). Conclusion: Compared with conventional physiotherapy alone, our results suggest that voluntary strength and balance of stroke patients with hemiparesis might be improved with Morning Walk®–assisted gait training combined with conventional physiotherapy. [ABSTRACT FROM AUTHOR]

Background: Patients with partial-thickness rotator cuff tears (PTRCTs) can be treated nonoperatively and/or undergo operative treatment, but the ideal time for surgical intervention is unclear. Purpose: To compare the results of immediate arthroscopic rotator cuff repair with repair after 6 months of nonoperative care of PTRCTs involving more than 50% of the tendon thickness. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: The authors prospectively randomized and analyzed 78 consecutive patients diagnosed with either isolated bursal-side or articular-side PTRCTs (supraspinatus only). Group 1 (n = 44) received immediate rotator cuff repair. Group 2 (n = 34) received delayed rotator cuff repair after 6 months of nonoperative treatment. The American Shoulder and Elbow Surgeons (ASES) Score, Constant score, visual analog scale (VAS) for pain, and range of motion at initial visit; months 3, 6, and 12 postoperatively; and the last visit after 24 months were used for the evaluation. Cuff integrity was assessed with magnetic resonance imaging at 12 months postoperatively. Results: There were no significant differences in age, sex (18/26 vs 13/21, male/female), symptom duration, composition of PTRCTs, or clinical outcomes between groups 1 and 2 (P > .05). In group 2, 10 patients voluntarily dropped out from the study due to improvement of symptoms during the 6 months of preoperative nonoperative treatment. The mean follow-up period in groups 1 and 2 was 31.9 ± 1.5 months and 37.0 ± 2.2 months, respectively. At the end of the study, both groups showed significant improvements in terms of functional scores and pain VAS scores compared with the initial period. There were no significant differences between the 2 groups, except for lower pain VAS score and higher ASES Score in group 2 at 6 months postoperatively. At 12 months postoperatively, 1 patient from group 1 and 2 patients from group 2 experienced a retear. Conclusion: Both immediate surgical repair and delayed repair after nonsurgical care for PTRCTs were effective in improving clinical outcomes, and there was a very low incidence of retears in both groups. However, at 6 months postoperatively, superior functional outcomes were observed in the delayed repair group compared with the immediate repair group. A trial period of preoperative nonsurgical care is reasonable, and immediate surgical repair is not crucial for the treatment of PTRCT. [ABSTRACT FROM AUTHOR]

Background: Although image analysis has shown that the outside-in (OI) technique is associated with different femoral tunnel geometry than the transportal (TP) technique in anatomic anterior cruciate ligament (ACL) reconstruction, it is not known whether clinical results differ between the 2 techniques. Purpose: To compare clinical results, second-look arthroscopic findings, and magnetic resonance imaging (MRI) findings between the TP and OI techniques in anatomic double-bundle (DB) ACL reconstruction. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: From November 2010 to March 2013, 128 patients were enrolled in this study and were randomly assigned to either the TP group (64 patients) or the OI group (64 patients), and DB ACL reconstructions were performed. At the minimum 2-year follow-up (34.9 ± 10.9 months), 111 patients (86.7%) were evaluated with multiple clinical scores and stability tests (KT-2000 arthrometer, Lachman test, and pivot-shift test). Ninety-three knees were evaluated for graft continuity, graft tension, and synovialization by use of second-look arthroscopy. Seventy-eight knees were evaluated on MRI for graft continuity, femoral graft tunnel healing, and graft signal/noise quotient (SNQ). The primary outcome was KT-2000 arthrometer results. Results were compared between the TP and OI groups. Results: No significant differences were found between the 2 groups in terms of KT-2000 arthrometer results, which was the primary outcome, and other clinical results, with the exception of the postoperative functional test of International Knee Documentation Committee (IKDC) objective score. The ratio of grade A and B on the postoperative functional test of IKDC objective score was significantly larger for the OI group (51/58) than the TP group (36/53) (P = .005). The second-look arthroscopic findings were not significantly different between the 2 groups in either bundle (P > .05). In addition, MRI findings did not differ significantly between the 2 groups (P > .05). Conclusion: With the exception of the functional test of IKDC objective score, we found that clinical results, second-look arthroscopic findings, and MRI findings did not differ significantly between the OI and TP techniques for anatomic ACL reconstruction, although femoral tunnel geometries differed significantly between the 2 techniques. [ABSTRACT FROM AUTHOR]

Background: High tibial osteotomy (HTO) produces valgus limb alignment, and this change can affect lower limb length. Purpose: To compare the change in lower limb length and the discrepancy compared with the contralateral limb after unilateral lateral closing wedge HTO (CWHTO) and medial opening wedge HTO (OWHTO). Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In this study, 30 knees undergoing unilateral CWHTO and 30 knees undergoing unilateral OWHTO for medial compartmental osteoarthritis were analyzed with 1-year follow-up. The tibial length, lower limb length, and lower limb length discrepancy were measured preoperatively and 1 year postoperatively. The patients’ subjective sensation of, and discomfort due to, the lower limb length discrepancy were recorded 1 year postoperatively. Univariate and multivariate linear regression analyses were conducted to identify predictors related to the change in lower limb length. Results: The mean lengths of the tibia and lower limb increased significantly after OWHTO (5.2 ± 3.7 and 7.6 ± 2.1 mm, respectively; P < .001). The mean tibial length decreased significantly after CWHTO (−6.0 ± 2.1 mm; P < .001); however, the mean lower limb length change was not significant (−0.8 ± 2.5 mm; P = .073). The mean lower limb length discrepancy increased significantly after OWHTO (−0.5 ± 0.7 to 7.2 ± 2.1 mm; P < .001) but not after CWHTO (−0.7 ± 0.6 to −1.0 ± 2.5 mm; P = .539). A significantly greater proportion of patients in the OWHTO group were aware of (70% vs 20%, respectively; P = .002), and uncomfortable because of (37% vs 7%, respectively; P = .010), the lower limb length discrepancy compared with those in the CWHTO group. The strongest predictor of a change in lower limb length was the wedge length in the OWHTO group and the preoperative hip-knee-ankle angle in the CWHTO group. Conclusion: The lower limb length change and discrepancy were significant after unilateral OWHTO, whereas they were negligible after unilateral CWHTO. CWHTO was more beneficial in cases of unilateral HTO to minimize the discrepancy of lower limb length rather than OWHTO, particularly in knees requiring a large correction. Registration: Clinical Trials Registry Platform (protocol number KCT00001684). [ABSTRACT FROM AUTHOR]

The article presents a study on graft extrusion in sagittal and coronal planes after medial and lateral meniscus allograft transplantation (MAT). Topics covered include anterior cartilage meniscus distance (ACMD), posterior cartilage meniscus distance (PCMD) horns, and magnetic resonance imaging (MRI) after MAT.

The article presents a study which investigates the primary caregivers' attitudes toward hospice/palliative care (HPC) utilization in South Korea. Topics discussed include the management of terminal cancer patients, the availability of health-care resources, and the importance of promoting awareness of prognosis and improved communication between doctors and families for facilitating the use of HPC.

The article focuses on multivariate and univariate analysis performed on 108 patients to determine the scope of arthographic treatments for massive rotator cuff injuries. The study found that although healing in most patients failed post operative findings showed that functionality of the shoulder was retained. Computed tomography arthogrpahy and ultrasonography images were used as evaluation tools.

The article discusses a study aimed to identify whether intra-articular injections with a high-dose corticosteroid reduces pain in patients with adhesive capsulitis, better than a low dose or a placebo. The efficacy of corticosteroid injections in intra-articular injections for adhesive capsulitis was assessed. The results revealed no major differences between the high- and low-dose corticosteroid groups, and confirmed the use of a low dose in the initial stage.

Background: Little is known about morphologic changes in the remodeling period after human meniscal allograft transplantation (MAT).Hypothesis: The gross structure of meniscal transplants may be altered significantly in width and thickness during early remodeling periods.Study Design: Cohort study; Level of evidence, 3.Methods: Thirty-one patients who underwent MAT (9 medial and 22 lateral menisci) between 2008 and 2009 were prospectively evaluated by serial magnetic resonance imaging scans 2 days, 6 weeks, and 3, 6, and 12 months after surgery. At each time point, the width and thickness of the menisci were measured. The relative degree of shrinkage after 1 year was categorized as minimal (<10%), mild (10%-25%), moderate (25%-50%), or severe (>50%). The Lysholm score and Tegner activity level were used for clinical outcome scales.Results: More apparent changes were observed at mid-body rather than at the posterior horn. Meniscal width at the mid-body decreased to 89% (P < .01), whereas thickness increased to 115% (P < .01) at 12 months. Shrinkage was observed for 3 months after MAT, but there were no significant changes thereafter. The thickness of the meniscal peripheral rim did not change before 3 months but increased afterward, for up to 1 year. Of the 31 patients, 20 (64.5%) had minimal shrinkage, 6 (19.4%) had mild shrinkage, 5 (16.1%) had moderate shrinkage, and none had severe shrinkage over 1 year. In the 5 cases of moderate shrinkage, the reduction occurred progressively for 1 year. However, the relative morphologic changes did not correlate with clinical outcome scales at postoperative 1 and 2 years (P > .05). The preoperative alignment deviation, cartilage status (Outerbridge grade), age, gender, amount of extrusion, and time from previous meniscectomy did not affect the degree of shrinkage.Conclusion: Gross morphologic alterations, as determined by width and thickness, were observed during the first postoperative year. Substantial shrinkage at the mid-body occurred progressively for 1 year in 16.1% of the cases. No association was found between morphologic changes and short-term clinical outcomes. [ABSTRACT FROM PUBLISHER]

Objectives To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women. Methods The study was a randomised single-blind sham-controlled clinical trial. Perimenopausal or postmenopausal women with moderate or severe hot flushes were randomised to receive real or sham acupuncture. Both groups underwent a 4-week run-in period before the treatment. The real acupuncture group received 11 acupuncture treatments for 7 weeks, and the control group underwent sham acupuncture on non-acupuncture points during the same period. Both groups were followed for 8 weeks after the end of treatment period. Changes from baseline in the hot flush scores at week 7, measured by multiplying the hot flush frequency and severity, were the primary outcome. Hot flush frequency, severity and menopause-related symptoms measured with the Menopause Rating Scale Questionnaire were regarded as secondary outcomes. Results 54 participants were randomised into the real acupuncture group (n=27) and the sham acupuncture group (n=27). The mean change in hot flush scores was -6.4±5.2 in the real acupuncture group and -5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment (10.0±8.1 vs 11.7±12.6), respectively (p=0.0810). No serious adverse events were observed during the whole study period. Conclusions Compared to sham acupuncture, acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity. Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes. Whether acupuncture has point-specific effects for hot flushes should be also considered in designing future researches. [ABSTRACT FROM AUTHOR]

Background: Suture bridge repair has been recognized to have superior biomechanical characteristics, as shown in previous biomechanical studies. However, it is not clear whether the tendon heals better in vivo after suture bridge repair.Purpose: To evaluate the clinical results and repair integrity after arthroscopic rotator cuff repair using a suture bridge technique for patients with rotator cuff tears.Study Design: Case series; Level of evidence, 4.Methods: One hundred twenty-three shoulders (120 patients) that underwent arthroscopic suture bridge repair for full-thickness rotator cuff tear were enrolled for this study. The mean duration of follow-up was 25.2 months (range, 16-34 months). The postoperative repair integrity was analyzed with use of magnetic resonance imaging (MRI) in 87 shoulders. According to the retear patterns on postoperative MRI, the cases were divided into type 1 (failure at the original repair site) or 2 (failure around the medial row).Results: At the last follow-up, the University of California at Los Angeles (UCLA) score improved from the preoperative mean of 13.2 points to 29.7 points (P < .001). The rotator cuff was completely healed in 58 (66.7%) of the 87 shoulders, and there was a recurrent tear in 29 shoulders (33.3%). The incidence of retear tended to increase with age older than 60 years at the time of surgery (P = .002). When there was a larger intraoperative tear, the rate of retear was also higher (P = .002). When the severity of preoperative fatty degeneration of the cuff muscles was higher, there was a greater chance of a recurrent tear (P < .001). The retear patterns on postoperative MRI in 29 shoulders with recurrent failures were classified as type 1 in 12 shoulders (41.4%) and type 2 in 17 shoulders (58.6%). The preoperative cuff tear size did not have an influence on retear patterns (P = .236), but the percentage of type 1 retear increased with the severity of fatty degeneration or muscle atrophy (P = .041, .023).Conclusion: Arthroscopic suture bridge repair of full-thickness rotator cuff tears led to a relatively high rate of recurrent defects. However, the mean 25-month follow-up demonstrated excellent pain relief and improvement in the ability to perform the activities of daily living, despite the structural failures. The factors affecting tendon healing were the patient’s age, the size and extent of the tear, and the presence of fatty degeneration in the rotator cuff muscle. The retear in cases with a suture bridge technique tended to be more frequently at the musculotendinous junction. [ABSTRACT FROM PUBLISHER]