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This study aimed to evaluate the infection control rate of palliative arthroscopic debridement, antibiotics, and implant retention (DAIR) for the high mortality risk or terminal cancer stage patients.From March 2018 to August 2021, 21 patients met the following inclusion criteria: old age of more than 80, diagnosed as a terminal stage of cancer, high risk of mortality and morbidity representing as Charlson comorbidity index (CCI) ≥ 5, low daily activity with disabled extremity, and re-infection after two-stage revision. Each patient underwent arthroscopic DAIR and additional continuous irrigation for 48 hours. The need for subsequent re-arthroscopic DAIR or two-stage revision was determined by the post-operative trends of C-reactive protein (CRP) levels. Infection control was defined as continuing controlled status of infection based on clinical and laboratory results by one or two times of arthroscopic DAIR within initial two months. Treatment failure was defined as more than three times arthroscopic debridement, two-stage revision surgery, or expired due to uncontrolled infection.Arthroscopic DAIR controlled the infection in 19 (90.5%) of the 21 cases. The other knee underwent a total of three times of re-arthroscopic DAIR and the other one underwent two-stage revision. Although five patients expired during the follow-up period due to worsening medical problems or terminal cancer, there were no deaths from uncontrolled infection, sepsis, or surgery-related complications.Arthroscopic debridement with continuous irrigation for the infection TKA with high mortality risk or terminal cancer patients showed a 90.5% infection control rate. For high-risk patients, arthroscopic debridement with continuous irrigation can be an alternative treatment to improve the quality of life during survival.

BACKGROUND Relative to interscalene block, superior trunk block (STB) provides comparable analgesia and a reduced risk of hemidiaphragmatic paralysis. However, the incidence of hemidiaphragmatic paralysis remains high when a standard volume (15 mL) of local anesthetic is used. This study aimed to evaluate the effects of local anesthetic volume of STB on the incidence of phrenic nerve palsy, as well as its analgesic efficacy following arthroscopic shoulder surgery. METHODS Patients scheduled for elective arthroscopic shoulder surgery were randomized to receive ultrasound-guided STB using either 5- or 15-mL 0.5% ropivacaine before general anesthesia. The primary outcome was the incidence of hemidiaphragmatic paralysis at 30 minutes after block. The secondary outcomes were pulmonary function, grade of sensory and motor blockade, pain score, opioid consumption, adverse effects, and satisfaction. RESULTS Relative to standard-volume STB, low-volume STB was associated with a lower incidence of hemidiaphragmatic paralysis after block (14.3 [4.8%-30.3%] vs 65.7 [46.8%-80.9%]; difference 51.4% [95% confidence intervals {CIs}, 29.0%-67.1%]; P < .0001) and at the postanesthesia care unit (9.4% vs 50.0%; difference 40.6 [95% CI, 18.9%-57.7%]; P = .0004). Pulmonary function was also better preserved in the low-volume group than in the standard-volume group. The extent of the sensory and motor blocks was significantly different between the groups. Pain-related outcomes, satisfaction, and any adverse events were not significantly different between the groups. CONCLUSIONS Low-volume STB provided a lower incidence of hemidiaphragmatic paralysis with no significant difference in analgesic efficacy relative to standard-volume STB for arthroscopic shoulder surgery.

Background and Objectives: Intraarticular injection of tranexamic acid (IA-TXA) plus drain-clamping is a preferred method of reducing bleeding after total knee arthroplasty (TKA). However, no consensus has been reached regarding the timing of the clamping. The purpose of this study was to determine the optimum duration of drain-clamping after TKA with IA-TXA. Materials and Methods: We retrospectively reviewed 151 patients that underwent unilateral TKA with IA-TXA plus drain-clamping for 30 min, 2 h, or 3 h. The total drained volume was reviewed as the primary outcome, and hematocrit (Hct) reductions, estimated blood loss (EBL), transfusion rates, and wound complications were reviewed as secondary outcomes. Results: The mean total drained volume, Hct reduction, and EBL were significantly less in the 3 h group than in the 30 min group. Between the 2 h and 3 h groups, there was no statistical difference in the mean total drained volume, Hct reduction, or EBL. The proportion of patients who drained lesser than 300 mL was high in the 3 h group. No significant intergroup difference was observed for transfusion volume, transfusion rate, and wound related complications. Conclusions: In comparison of the IA-TXA plus drain-clamping after TKA, there was no difference in EBL between the 2 h group and the 3 h group, but the amount of drainage volume was small in the 3 h group.

Background Neurologic problems after reverse total shoulder arthroplasty (RTSA) have been reported, but there are a lack of studies regarding which nerve(s) are damaged and the outcomes for the patients who had neurologic complications after RTSA. The purpose of this study was to assess the prevalence and outcomes of neurologic deficit after RTSA and to evaluate the correlation between nonanatomic rearrangement of the shoulder joint and neurologic complications after RTSA. We hypothesized that the neurologic deficit was associated with excessive distalization or lateralization of the humerus after RTSA. Methods RTSA was performed on 182 consecutive shoulders with cuff tear arthropathy. Comparative analysis was performed on 34 shoulders with (group 1) and 148 shoulders without (group 2) neurologic deficit. Results The mean follow-up period in the study was 58.5 months (range: 24-124). The mean age was 71.5 ± 7.7 years in group 1 and 73.1 ± 7.2 years in group 2. Neurologic deficit after RTSA was found in 34 shoulders (19%). The mean postoperative acromiohumeral distance was 34.1 ± 11.0 mm in group 1 and 29.4 ± 7.6 mm in group 2 (P = .015). Significant differences in terms of postoperative distalization of the humerus were seen between group 1 (24.5 ± 9.4 mm) and group 2 (20.5 ± 8.3 mm) (P = .009). The most common forms of neurologic deficit after RTSA were axillary nerve (41.2%) and radial nerve (15%) injuries. Thirty shoulders (88%) had neuropraxia, and 4 shoulders (12%) had axonotmesis. By conservative treatment, all patients with neurologic complications achieved complete recovery without any additional surgery; the mean recovery period was 7.4 months (range: 2-38 months). Conclusion Neurologic deficit occurred in 19% of patients who underwent RTSA, and it was significantly correlated with humeral distalization after surgery. Axillary nerve was mostly involved, and all patients with neurologic deficit achieved complete recovery without any additional surgery.

Osteoarthritis (OA) has generally been introduced as a degenerative disease; however, it has recently been understood as a low-grade chronic inflammatory process that could promote symptoms and accelerate the progression of OA. Current treatment strategies, including corticosteroid injections, have no impact on the OA disease progression. Mesenchymal stem cells (MSCs) based therapy seem to be in the spotlight as a disease-modifying treatment because this strategy provides enlarged anti-inflammatory and chondroprotective effects. Currently, bone marrow, adipose derived, synovium-derived, and Wharton’s jelly-derived MSCs are the most widely used types of MSCs in the cartilage engineering. MSCs exert immunomodulatory, immunosuppressive, antiapoptotic, and chondrogenic effects mainly by paracrine effect. Because MSCs disappear from the tissue quickly after administration, recently, MSCs-derived exosomes received the focus for the next-generation treatment strategy for OA. MSCs-derived exosomes contain a variety of miRNAs. Exosomal miRNAs have a critical role in cartilage regeneration by immunomodulatory function such as promoting chondrocyte proliferation, matrix secretion, and subsiding inflammation. In the future, a personalized exosome can be packaged with ideal miRNA and proteins for chondrogenesis by enriching techniques. In addition, the target specific exosomes could be a gamechanger for OA. However, we should consider the off-target side effects due to multiple gene targets of miRNA.

Background: Intraarticular injection of tranexamic acid (IA-TXA) plus drain-clamping is a preferred method of reducing bleeding after total knee arthroplasty (TKA). However, no consensus had been reached regarding the timing of clamping. The purpose of this study was to determine the optimum duration of drain-clamping after TKA with IA-TXA.Methods: We retrospectively reviewed 151 patients that underwent unilateral TKA with IA-TXA plus drain-clamping for 30 minutes (Group A, 60 patients), 2 hours (Group B, 42 patients), or 3 hours (Group C, 49 patients). Total drained volumes, hematocrit (Hct) reductions, estimated blood losses (EBLs), transfusion rates, and wound complications were reviewed.Results: Mean total drained volume, Hct reduction, EBL, and transfusion rate were significantly less in group C than in groups A or B (p < 0.01). No significant intergroup difference was found for wound-related complications. No surgical site infection or deep vein thrombosis was observed.Conclusion: IA-TXA plus drain-clamping for 3 hours is optimal for reducing blood loss with minimal complications after TKA.

Background With the development of health care–related mobile apps, attempts have been made to implement remote patient-reported outcome measures (PROMs). In order for remote PROMs to be widely used by mobile apps, the results should not be different depending on the location; that is, remote PROM results performed in locations other than hospitals should be able to obtain reliable results equivalent to those performed in hospitals, and this is very important. However, to our knowledge, there are no studies that have assessed the reliability of PROMs using mobile apps according to the location by comparing the results performed remotely from the hospital and performed at the outpatient visits. Objective The purpose of this study was to evaluate the reliability of remote PROMs using mobile apps compared to PROMs performed during outpatient follow-up visits after arthroscopic shoulder surgery. Methods A total of 174 patients who underwent arthroscopic rotator cuff repair completed questionnaires 2 days before visiting the clinic for the 1-, 2-, 3-, 6-, and 12-month follow-ups (test A). The patients completed the questionnaires at the clinic (test B) using the same mobile app and device for the 1-, 2-, 3-, 6-, and 12-month follow-ups. Test-retest comparisons were performed to analyze the differences and reliability of the PROMs according to the period. Results Comparisons of tests A and B showed statistically significant differences at 1, 2, and 3 months (all Ps.05). The intraclass correlation values between the two groups were relatively low at the 1-, 2-, and 3-month follow-ups but were within the reliable range at 6 and 12 months after surgery. The rate of completion of tests A and B using the mobile app was significantly lower in the group older than 70 years than in the other groups for all postoperative periods (P Conclusions PROMs using mobile apps with different locations differed soon after surgery but were reliably similar after 6 months. The remote PROMs using mobile apps could be used reliably for the patient more than 6 months after surgery. However, it is to be expected that the use of mobile app–based questionnaires is not as useful in the group older than 70 years as in other age groups.

Background: For total knee arthroplasty (TKA), implant design and proper coverage are important for achieving patient satisfaction. An asymmetrical anatomic implant (Persona® knee system, Zimmer Biomet, Warsaw, Indiana) enables accurate coverage and minimal bone cutting. This study aimed to analyze the clinical and radiological outcomes of TKA using an asymmetrical anatomic implant over a minimum 3-year follow-up.Methods: The medical records of 94 patients who underwent 132 TKAs using the Persona® knee system, between April 2015 and January 2016 were reviewed. Pre- and post-operative clinical outcomes (assessed using the International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores, and range of motion (ROM) were reviewed. The mechanical hip-knee-ankle (HKA) axis, component overhang and underhang and presence of a radiolucent line (RLL) were evaluated. Liner thickness were also reviewed.Results: At 3-year follow-up, the mean ROM improved from 108.4° to 130.3°. The mean IKDC subjective, WOMAC and global KOOS score significantly improved from 29.2 to 70.3, from 64.2 to 11.5, and from 66.6 to 21.7, respectively (p The mean mechanical HKA axis indicated the correction of the malalignment (from 9.2° varus to 0.3° varus, p3-mm bone-to-implant size mismatch were 6.8% and 8.3% for the femoral and tibial components, respectively. RLL was found in seven cases, but they were small (>2 mm) and did not progress. In 36.3% of the knees, the additional liner thickness (11 or 13mm) was used. No case of implant loosening or early failure related to the implant design occurred. Conclusion: TKA using the Persona® knee system improved all the clinical knee scores and ROM without signs of early failure. This knee system also provides more implant size options than the conventional TKA systems and facilitates ligament balancing.

BACKGROUND With the development of health care–related mobile apps, attempts have been made to implement remote patient-reported outcome measures (PROMs). In order for remote PROMs to be widely used by mobile apps, the results should not be different depending on the location; that is, remote PROM results performed in locations other than hospitals should be able to obtain reliable results equivalent to those performed in hospitals, and this is very important. However, to our knowledge, there are no studies that have assessed the reliability of PROMs using mobile apps according to the location by comparing the results performed remotely from the hospital and performed at the outpatient visits. OBJECTIVE The purpose of this study was to evaluate the reliability of remote PROMs using mobile apps compared to PROMs performed during outpatient follow-up visits after arthroscopic shoulder surgery. METHODS A total of 174 patients who underwent arthroscopic rotator cuff repair completed questionnaires 2 days before visiting the clinic for the 1-, 2-, 3-, 6-, and 12-month follow-ups (test A). The patients completed the questionnaires at the clinic (test B) using the same mobile app and device for the 1-, 2-, 3-, 6-, and 12-month follow-ups. Test-retest comparisons were performed to analyze the differences and reliability of the PROMs according to the period. RESULTS Comparisons of tests A and B showed statistically significant differences at 1, 2, and 3 months (all PsPs>.05). The intraclass correlation values between the two groups were relatively low at the 1-, 2-, and 3-month follow-ups but were within the reliable range at 6 and 12 months after surgery. The rate of completion of tests A and B using the mobile app was significantly lower in the group older than 70 years than in the other groups for all postoperative periods (P CONCLUSIONS PROMs using mobile apps with different locations differed soon after surgery but were reliably similar after 6 months. The remote PROMs using mobile apps could be used reliably for the patient more than 6 months after surgery. However, it is to be expected that the use of mobile app–based questionnaires is not as useful in the group older than 70 years as in other age groups.

Objectives: Acute kidney injury (AKI) is a rare but serious complication after hip fractures. The aim of this study was to evaluate the incidence and the risk factors of postoperative AKI after hip fractures. Methods: From January 2011 to December 2016, 550 patients who underwent surgery of hip fractures at our institution were retrospectively reviewed. AKI was defined and classified by AKI Network (AKIN) Classification/Staging System. The incidence, mortality, and risk factors of postoperative AKI were investigated. Receiver operating characteristic curve analysis was conducted to evaluate the ability of markers in predicting AKI. Results: The incidence of postoperative AKI was 4.4% (25 cases). The mean onset of postoperative AKI was 8.0 ± 5.3 days and recovered after 7.0 ± 4.2 days after the occurrence of AKI. Of 25 patients with AKI, 6 patients (24.0%) died within 1 year after surgery. The independent risk factors for postoperative AKI are the estimated blood loss (EBL) (odds ratio (OR) 1.64; 95% confidence interval (CI) 1.33–2.58; p < 0.01) and postoperative level of albumin (OR 1.77; 95% CI 1.52–2.74; p < 0.01). The cutoff value of the serum albumin was Conclusion: Postoperative AKI after hip fractures had low incidences (4.4%) but high mortality (24.0%). The postoperative AKI was correlated with blood loss and low postoperative albumin levels.

Background Although reverse total shoulder arthroplasty (RTSA) has been shown to reduce pain and to improve function in most patients, some still suffer from functional limitations. This study aimed to investigate the incidence of poor motion recovery after RTSA and to identify factors that may cause poor outcomes. Methods Seventy-six patients who underwent primary RTSA with a reverse-type Aequalis prosthesis (Tornier, Montbonnot, France) were allocated to a satisfactory or unsatisfactory group on the basis of their postoperative active anterior elevation. The average age of the patients was 69 ± 8 years (range, 42-82 years); average follow-up period was 34 ± 12 months (range, 24-93 months). Results Fifty-eight patients had a satisfactory outcome (satisfactory group) and 18 had an unsatisfactory outcome (unsatisfactory group). Twenty-seven patients (46.6%) in the satisfactory group and 10 (55.6%) in the unsatisfactory group had preoperative pseudoparalysis ( P = .504). Pre-existing medical comorbidities, such as thyroid disease, hypertension, diabetes, and smoking, showed no significant differences. Anterior deltoid muscle belly volume also did not significantly differ between the satisfactory and unsatisfactory groups. However, mean postoperative lateral humeral offset (LHO) was −2 ± 6 mm in the satisfactory group and 3 ± 5 mm in the unsatisfactory group ( P = .001). Conclusion Satisfactory improvement of active anterior elevation was achieved in three-quarters of patients who underwent RTSA using a prosthesis designed to be medialized. Of the factors we investigated, only postoperative LHO was found to be a significant risk factor for poor postoperative active anterior elevation. Therefore, surgeons should attempt to avoid increasing postoperative LHO when performing RTSA using an implant designed to be medialized.

Background: Many studies have identified risk factors that cause retear after rotator cuff repair. However, it is still questionable whether retears can be predicted preoperatively. Purpose: To determine the risk factors related to retear after arthroscopic rotator cuff repair and to evaluate whether it is possible to predict the occurrence of retear preoperatively. Study Design: Case-control study; Level of evidence, 3. Methods: This study enrolled 112 patients who underwent arthroscopic rotator cuff repair with single-row technique for a large-sized tear, defined as a tear with a mediolateral length of 3 to 5 cm. All patients underwent routine magnetic resonance imaging (MRI) at 9 months postoperatively to assess tendon integrity. The sample included 61 patients (54.5%) in the healed group and 51 (45.5%) in the retear group. Results: In multivariate analysis, the independent predictors of retears were supraspinatus muscle atrophy ( P < .001) and fatty infiltration of the infraspinatus ( P = .027), which could be preoperatively measured by MRI. A significant difference was found between the two groups in sex, the acromiohumeral interval, tendon tension, and preoperative or intraoperative mediolateral tear length and musculotendinous junction position in univariate analysis. However, these variables were not independent predictors in multivariate analysis. The cutoff values of occupation ratio of supraspinatus and fatty infiltration of the infraspinatus were 43% and grade 2, respectively. The occupation ratio of supraspinatus Conclusion: In patients with large rotator cuff tears, it was possible to predict the retear before rotator cuff repair regardless of intraoperative factors. The retear could be predicted most effectively when the occupation ratio of supraspinatus was

To introduce an arthroscopically assisted coracoclavicular (CC) fixation technique using a cortical fixation button device and to evaluate the clinical and radiologic outcomes in patients with acute acromioclavicular (AC) dislocation who were treated with the technique.Twenty-one consecutive patients with grade III and V acute AC dislocation who underwent arthroscopically assisted CC ligament reconstruction using a cortical fixation button device were prospectively enrolled. Our fixation technique involved using a cortical fixation button device consisting of 1 coracoid button and 2 clavicular buttons connected with 2 suture tapes to reconstruct the conoid and trapezoid ligaments, respectively. Clinical outcomes were evaluated and CC distance and horizontal displacement of the AC joint were measured.The mean follow-up period was 27.2 months (range, 24-32 months). The average CC distance of the injured shoulder was 17.2 ± 5.2 mm preoperatively, which represented an increase of 103% ± 42% compared with the uninjured shoulder. The CC distance was significantly reduced to 8.5 ± 1.5 mm after surgery (P.001). At the final follow-up, the CC distance was maintained in 20 patients (95%) without loss of reduction. No significant radiologic difference was found in horizontal displacement of the AC joint immediately after the operation and at the final follow-up (P = .422). The average American Shoulder and Elbow Surgeons and Constant scores were 95.7 ± 3.6 and 95.4 ± 3.4, respectively. There were 3 complications, including 1 reduction loss, 1 coracoid process fracture, and 1 CC interval ossification.Satisfactory clinical and radiologic outcomes were obtained simultaneously by arthroscopically assisted CC reconstruction using cortical fixation buttons. This reconstruction technique provided sufficient stability of the AC joint by using 2 clavicular holes to reconstruct the conoid and trapezoid ligaments separately. Therefore, arthroscopically assisted CC ligament reconstruction using a cortical fixation button device for management of acute AC dislocation is considered a viable treatment option for restoring stability to the AC joint.Level IV, therapeutic case series.

Background There have been numerous reports of clinical outcomes associated with tendon healing after repair that suggest a nonhealed tendon has a negative effect on postoperative clinical outcomes. However, to our knowledge, there has been no report on the relationship between tear size progression of nonhealed tendons and clinical outcomes.

Background: Generally, a glenoid bone loss greater than 20% to 25% is considered critical for poor surgical outcomes after a soft tissue repair. However, recent studies have suggested that the critical value should be lower. Purpose: To determine the critical value of anterior glenoid bone loss that led to surgical failure in patients with anterior shoulder instability. Study Design: Case-control study; Level of evidence, 3. Methods: The study included 169 patients with anterior glenoid erosion. The percentage of glenoid erosion was calculated as the ratio of the glenoid loss width and the glenoid width to the diameter of the outer-fitting circle based on the inferior portion of the glenoid contour. The critical value of the glenoid bone loss was analyzed by means of receiver operating characteristic (ROC) curve analysis. Patients were divided into 2 groups based on the amount of glenoid bone loss: group A (less than the critical value) and group B (more than the critical value). Patients evaluated their shoulder function as a percentage of their preinjury level using the Single Assessment Numeric Evaluation (SANE) score, and postoperative clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score and Rowe score. Surgical failure was defined as the need for revision surgery or the presence of subjective symptoms of instability. Results: The optimal critical value of glenoid bone loss was 17.3% (area under the curve = 0.82; 95% confidence interval, 0.73-0.91; P < .001; sensitivity 75%; specificity 86.6%). Group A and B contained 134 and 35 patients, respectively. Shoulder functional scores were significantly lower in group B than in group A ( P < .001). Five patients (3.7%) in group A and 15 (42.9%) in group B had surgical failure ( P < .001). The SANE score was significantly lower in group B (83.8 ± 12.1) than in group A (92.9 ± 4.7, P = .001). Conclusion: An anterior glenoid bone loss of 17.3% or more with respect to the longest anteroposterior glenoid width should be considered as the critical amount of bone loss that may result in recurrent glenohumeral instability after arthroscopic Bankart repair.

Purpose: The purpose of this study was to evaluate the mid-term outcomes of anatomic anterior cruciate ligament (ACL) reconstruction using two anteromedial (AM) portals by comparing with short-term follow-up results. Materials and Methods: Fifty patients who were treated by ACL reconstruction using a two AM portal technique were evaluated retrospectively. The follow-up period was at least 5 years. The mean follow-up period was 68.5±13.9 months. The mid-term clinical outcomes were compared with short-term (≥12 months) results. For the assessment of knee stability, anterior tibial translation was evaluated using the Lachman test and the KT- 2000. Rotational stability was evaluated using pivot shift test. For clinical assessment, the Lysholm and International Knee Documentation Committee scores were used. Results: The average anterior translation was 2.1±1.4 mm at the short-term follow-up and 2.8±1.8 mm at the mid-term follow-up. Stability and midterm clinical outcomes were not significantly improved compared to the short-term follow-up results. At the mid-term follow-up, anteroposterior (AP) instability assessed by the KT-2000 was slightly increased, but still acceptable. On the other clinical physical evaluation, there was no statistically significant difference. Conclusions: The short-term and mid-term outcomes of ACL reconstruction using the two AM portal technique were not significantly different except for AP stability although the value was less than 3 mm at both follow-ups. Therefore, this operative technique could be considered a satisfactory alternative for ACL reconstruction.

Background Although interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery, one major drawback of interscalene brachial plexus block is ipsilateral phrenic nerve palsy. Several diaphragm-sparing nerve blocks have been suggested. We prospectively evaluated the effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for postoperative analgesia following arthroscopic shoulder surgery.Methods Nineteen patients scheduled for arthroscopic shoulder surgery received combined ultrasound-guided suprascapular nerve and costoclavicular brachial plexus block. Pain scores, use of supplemental analgesia, incidence of phrenic nerve palsy, block-related outcomes, patient satisfaction, and adverse effects were assessed.Results The block was successful in 17 patients (89.5%). Postoperative pain control was effective during the first 24 h after surgery. Phrenic nerve palsy did not occur (0%, 95% confidential interval 0 – 17%). There were no severe adverse events. Patients reported a high degree of satisfaction.Conclusion Combined suprascapular nerve and costoclavicular brachial plexus block provided effective postoperative analgesia for arthroscopic shoulder surgery without causing phrenic nerve palsy.

Background There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. Methods We retrospectively reviewed 57 patients who underwent arthroscopic or open debridement for acute shoulder infection between 2001 and 2015. Arthroscopic debridement was performed in 27 patients, and open debridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2, n = 21, erosions seen in MRI but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). Results The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/10) and 15.4% (2/13) in group 1; 75% (9/12) and 11.1% (1/9) in group 2; and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell, erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P Conclusions When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic debridement was above 75%. Therefore, if preoperative MRI showed erosions, open debridement is more likely to be appropriate than arthroscopic debridement.

Biological repair of cartilage lesions remains a significant clinical challenge. A wide variety of methods involving mesenchymal stem cells (MSCs) have been introduced. Because of the limitation of the results, most of the treatment methods have not yet been approved by the Food and Drug Administration (FDA). However, bone marrow aspirate concentrate (BMAC) and human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) implantation were approved by Korea FDA. The aim of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes after two different types of MSCs implantation in knee osteoarthritis. Fifty-two patients (52 knees) who underwent cartilage repair surgery using the BMAC (25 knees) and hUCB-MSCs (27 knees) were retrospectively evaluated for 2 years after surgery. Clinical outcomes were evaluated according to the score of visual analogue scale (VAS), the International Knee Documentation Committee (IKDC) subjective, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Cartilage repair was assessed according to the modified Magnetic Resonance Observation of Cartilage Repair Tissue (M-MOCART) score and the International Cartilage Repair Society (ICRS) cartilage repair scoring system. At 2-year follow-up, clinical outcomes including VAS, IKDC, and KOOS significantly improved ( P < 0.05) in both groups; however, there were no differences between two groups. There was no significant difference in M-MOCART [1-year ( P = 0.261), 2-year ( P = 0.351)] and ICRS repair score ( P = 0.655) between two groups. Both groups showed satisfactory clinical and MRI outcomes. Implantation of MSCs from BMAC or hUCB-MSCs is safe and effective for repairing cartilage lesion. However, large cases and a well-controlled prospective design with long-term follow-up studies are needed.

Background Actinomycosis is a rare, chronic granulomatous disease caused by Gram-positive anaerobic bacteria that colonize the oral cavity. Cervicofacial actinomycosis is the most frequent clinical presentation of actinomycosis, but hematogenous osteomyelitis at distant sites can occur in rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Here we described a new case of distal femur osteomyelitis caused by Actinomyces in an adult patient who was immunocompetent and had no predisposing factors. Case presentation A woman aged 52 years with no history of trauma presented with severe pain, swelling, and increased local heat in the proximal area of the right knee 3 weeks after she first noticed discomfort. Magnetic resonance imaging showed persistent osteomyelitis of the distal metaphysis and diaphysis of the femur with a multifocal intraosseous abscess pocket. An incision and drainage of the abscess were conducted. The tissue culture, fungus culture, acid fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was successfully treated with intravenous penicillin G for 8 weeks followed by oral amoxicillin-clavulanate for 6 weeks with repeated surgical debridement and drainage. After a 5-year follow up, the patient had no signs of recurring infection or complications and she had full range of movement in the affected knee. Conclusions Although rare, actinomycotic osteomyelitis can occur in healthy people. Furthermore, actinomycotic osteomyelitis is easily misdiagnosed as tuberculosis in areas with a high prevalence of tuberculosis. To detect and identify the bacteria accurately, pathologic examination should be performed as well as culture tests, because the probability for culture confirmation of actinomycosis is quite low. The initial treatment is vital to a successful outcome without ostectomy or amputation.

Background: The optimal procedure for anterior shoulder instability with a borderline (15%-20%) bone defect on the anterior rim of the glenoid is still controversial. Purpose: To compare the clinical outcome and recurrence rate between the arthroscopic Bankart repair and Latarjet procedure among patients with recurrent anterior shoulder instability and a borderline glenoid bone defect. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively reviewed cases of arthroscopic Bankart repair and the Latarjet procedure for recurrent anterior shoulder instability with a borderline (15%-20%) glenoid bone defect. Enrollment comprised 149 patients (Bankart group, n = 118; Latarjet group, n = 31). The mean follow-up and age at operation were 28.9 ± 7.3 months (range, 24-73 months) and 26 ± 5 years (range, 16-46 years), respectively. Results: Rowe and UCLA (University of California, Los Angeles) shoulder scores significantly improved from 42.0 ± 14.3 and 22.9 ± 3.2 preoperatively to 90.9 ± 15.4 and 32.5 ± 3.3 postoperatively in the Bankart group ( P < .001) and from 41.0 ± 17.9 and 22.3 ± 3.4 to 91.1 ± 16.1 and 32.3 ± 3.4 in the Latarjet group ( P < .001), respectively. There were no significant between-group differences in Rowe ( P = .920) or UCLA ( P = .715) scores at the final follow-up. Mean postoperative loss of motion during forward flexion, external rotation in abduction, and internal rotation to the posterior was 3.0° ± 6.2°, 11.6° ± 10.2°, and 0.6 spinal segment in the Bankart group and 3.7° ± 9.8°, 10.3° ± 12.8°, and 0.9 spinal segment in the Latarjet group, respectively. These differences were not significant. However, the loss of external rotation at the side was significantly greater in the Bankart group (13.3° ± 12.9°) than in the Latarjet group (7.3° ± 18.1°, P = .034). The overall recurrence rate was significantly higher in the Bankart group (22.9%) than in the Latarjet group (6.5%), ( P = .040). Conclusion: The Latarjet procedure and arthroscopic Bankart repair both provided satisfactory clinical outcome scores and pain relief for anterior shoulder instability with a borderline glenoid bone defect. However, the Latarjet procedure resulted in significantly lower recurrences and less external rotation limitation than the arthroscopic Bankart repair. Therefore, the Latarjet procedure could be a more reliable surgical option in anterior recurrent instability with a borderline glenoid bone defect.

There have been numerous reports of clinical outcomes associated with tendon healing after repair that suggest a nonhealed tendon has a negative effect on postoperative clinical outcomes. However, to our knowledge, there has been no report on the relationship between tear size progression of nonhealed tendons and clinical outcomes.(1) Do patients with healed arthroscopic rotator cuff repairs have better outcomes, less pain, and more strength than patients whose repair did not heal? (2) In patients with nonhealed rotator cuff tendons, does tear size progression (increase or decrease) affect outcomes, pain, and strength? (3) Is there continued improvement beyond 6 months in outcomes, pain, and strength; and how do the improvements differ based on whether the tear size has increased or decreased?Between May 2008 and December 2012, 647 patients underwent arthroscopic rotator cuff repair for full-thickness tears at our institution. Of those, 442 patients (68%) had all MRI and clinical information available to permit inclusion in this retrospective study at a minimum of 2 years followup (mean, 33 ± 4 months; range, 24-43 months). Healing of the repaired tendon and tear size progression were assessed using MRI at 6 months postoperatively. Eighty-two of 442 tears (19%) were not healed. Of the nonhealed tears, 45 (55%) had a decrease and 37 (45%) had an increase in tear size. Shoulder function outcomes using the American Shoulder and Elbow Surgeon (ASES) and Constant scores and pain severity using VAS scores were evaluated preoperatively, at 6 months postoperatively, and at the latest followup. Isometric muscle strength was measured at 6 months postoperatively and at the latest followup.Compared with patients with nonhealed tendons after arthroscopic rotator cuff repair, patients with healed repairs had improved ASES scores (healed, 93 ± 5; nonhealed, 89 ± 8; mean difference, 4; 95% CI, 3-5; p0.001), better Constant scores (healed, 91 ± 5; nonhealed, 85 ± 8; mean difference, 6; 95% CI, 4-7; p0.001), and greater strength ([flexion: healed, 96% ± 7%; nonhealed, 85% ± 12%; mean difference, 11%; 95% CI, 9%-13%; p0.001]; [external rotation: healed, 92% ± 8%; nonhealed, 80% ± 12%; mean difference, 11%; 95% CI, 9%-14%; p0.001]; [internal rotation: healed, 97% ± 8%; nonhealed, 92% ± 8%; mean difference, 5%; 95% CI, 3%-7%; p0.001]); however there was no difference in pain level based on VAS scores (healed, 0.9 ± 0.8; nonhealed, 1.0 ± 0.8; mean difference, 0.2; 95% CI, 0.0-0.4; p = 0.226). Compared with patients with increased tear size, patients with decreased tear size had better ASES scores (decreased, 91 ± 6; increased, 8 6 ± 8; p = 0.001), improved Constant scores (decreased, 88 ± 6; increased, 82 ± 9; p = 0.003), greater flexion strength (decreased, 91% ± 9%; increased, 78% ± 11%; p0.001), and greater external rotation strength (decreased, 86% ± 10%; increased, 73% ± 11%; p0.001). However, the difference does not seem to meet a minimal clinically important difference. Patients with increased tear size differed from those with decreased tear size with respect to flexion and external rotation strength where the former had no improvement. There was no improvement in flexion (6 months, 78% ± 11%; latest followup, 78% ± 11%; p = 0.806) and external rotation strength (6 months, 74% ± 12%; latest followup, 73% ± 11%; p = 0.149).Patients who had healed tendons after arthroscopic rotator cuff repair had better shoulder function than patients who had nonhealed tendons. Among patients with nonhealed rotator cuff tendons after surgery, those with decreased tear size, observed on their 6-month postoperative MRI, compared with their initial tear size, showed better shoulder function and muscle strength than those with increased tear size beyond 6 months. Although results are statistically different, they seem insufficient to achieve clinically important differences.Level III, therapeutic study.

The purpose of this study was to identify the tear pattern that could be anatomically repaired by preserving the remaining tendon on footprint and evaluate clinical outcomes of patients who underwent remaining tendon preserving cuff repair. Of 523 patients with full-thickness rotator cuff tears who underwent arthroscopic repair, 41 (7.8%) patients had repairable rotator cuff tear while preserving the remaining tendon. Among them, 31 patients were followed-up for more than 2 years, including 26 patients with posterior L-shaped tear and 5 patients with transtendinous tear patterns. Clinical outcomes were evaluated using ASES and Constant score, SANE score for patient satisfaction, and VAS for pain. MRI was taken for tendon integrity 6 months postoperatively. Of the 31 patients, 11 (35.5%) had previous injury history before rotator cuff tear, including 7 (26.9%) of the 26 patients with posterior L-shaped tear and 4 (80%) of the 5 patients with transtendinous tear. The average size of preoperative cuff tear was 17.8 ± 6.8 mm in anterior-to-posterior direction and 15.2 ± 5.1 mm in medial-to-lateral direction. ASES and Constant score, SANE score, and VAS for pain were significantly (p

Background Rotator cuff tear and glenohumeral osteoarthritis are 2 common diseases, but there are few studies about their clinical correlation. The purpose of this study was to evaluate the influence of mild glenohumeral osteoarthritis on the clinical outcome after large to massive rotator cuff repair. Methods This study included 146 patients who underwent rotator cuff repair for large to massive tears and were available for follow-up at a minimum of 2 years. Of the patients, 74 had mild glenohumeral osteoarthritis (group A) and 72 did not have glenohumeral osteoarthritis (group B). Results The mean visual analog scale score during motion, mean University of California at Los Angeles score, and mean Constant score were 1.8, 30.2, and 87.4, respectively, in group A and 2.0, 30.8, and 89.2, respectively, in group B at final follow-up. The retear rates were 31.1% (23 of 74 patients) in group A and 25.0% (18 of 72 patients) in group B. The osteoarthritis progression rates were 12.1% (9 of 74) in group A and 13.8% (10 of 72) in group B. However, in group A, the osteoarthritis progression rates were 26.1% (6 of 23) for retear cases and 5.9% (3 of 51) for healed cases. There was a significant difference in the progression rates between retear and healed cases in group A (odds ratio, 5.65; P = .022). Conclusions There were no significant differences in clinical outcomes between patients with and without glenohumeral osteoarthritis before surgery and during final follow-up. The progression of osteoarthritis in large to massive rotator cuff tears is relatively low. However, it is significantly higher in patients with retears in whom osteoarthritis is present.

Background: The repair of anterior L-shaped tears is usually difficult because of the lack of anterior rotator cuff tendon to cover the footprint. The biceps tendon is usually exposed from the retracted anterolateral corner of the torn tendon and can be easily used to augment rotator cuff repair. Hypothesis/Purpose: This study compared the clinical outcomes of the biceps augmentation technique with those of partial tendon repair for the arthroscopic treatment of large anterior L-shaped rotator cuff tears to evaluate the role of additional biceps augmentation in tendon healing. We hypothesized that the biceps augmentation technique would lead to a lower rotator cuff tendon retear rate and provide satisfactory functional outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 64 patients with anterior L-shaped rotator cuff tears who underwent arthroscopic repair. Patients were divided into 2 groups: group A (31 patients) underwent repair of an anterior L-shaped tear combined with biceps augmentation, and group B (33 patients) had a partially repaired tendon whose footprint was exposed after repair without undue tension on the retracted tendon. Clinical evaluations were performed using the American Shoulder and Elbow Surgeons (ASES) score, Constant score, muscle strength, visual analog scale for pain, and patient satisfaction. Magnetic resonance imaging (MRI) was performed for tendon integrity at 6 months postoperatively. Results: The mean period of follow-up was 29.1 ± 3.5 months (range, 24-40 months). The mean ASES and Constant scores significantly improved from 52.8 ± 10.6 and 43.2 ± 9.9 preoperatively to 88.2 ± 6.9 and 86.8 ± 6.2 at final follow-up in group A ( P < .001) and from 53.0 ± 11.8 and 44.3 ± 11.3 preoperatively to 87.4 ± 7.2 and 87.9 ± 7.3 at final follow-up in group B ( P < .001). Overall muscle strength (given as % of the other side’s strength) significantly increased from preoperatively to final follow-up in group A (forward flexion [FF]: 62.0 ± 8.2 to 89.0 ± 8.6; external rotation [ER]: 57.5 ± 9.9 to 86.8 ± 9.3; internal rotation [IR]: 68.1 ± 10.8 to 88.1 ± 8.4; P < .001) and group B (FF: 59.9 ± 9.6 to 87.7 ± 9.0; ER: 58.6 ± 9.3 to 86.2 ± 7.5; IR: 70.0 ± 9.3 to 87.0 ± 8.4; P < .001). Twenty-one patients (67.7%) in group A and 20 patients (60.6%) in group B showed a healed rotator cuff tendon on postoperative MRI. The retear rate between the 2 groups showed no significant difference ( P = .552). Regarding clinical outcomes, both groups had no significant difference in the ASES score ( P = .901), Constant score ( P = .742), and muscle strength. Conclusion: There was no significant difference in the clinical outcomes and retear rate of anterior L-shaped tears between biceps augmentation and partial tendon repair. Additional biceps augmentation proved to have no enhancement in tendon healing. A precise method such as only partial tendon repair for reducing the footprint exposure without undue tension may be considered as one of the treatment options for large anterior L-shaped rotator cuff tears.

Background Bleeding control is critical after total knee arthroplasty (TKA). The purpose of this study was to evaluate the optimal time to release the clamped drain after TKA. Methods We performed unilateral TKA in 120 patients using three methods of drainage. Group A (N = 40) had a 3-hour clamp applied, and group B (N = 40) had a 4-hour clamp applied. Group C (N = 40) underwent conventional negative drainage. We evaluated the drainage volume, as well as the hemodynamic markers, transfusion volume, visual analog scale (VAS) scores, and range of motion (ROM). Results The drained blood volume in groups A and B was significantly less than that in group C. No significant difference was found between groups A and B. The level of hemoglobin in group A was significantly higher than that in group C at 2 days after surgery. The ROM of groups A and C was larger than that of group B at 5 days after surgery. Furthermore, the VAS scores of groups A and C were significantly lower than those of group B at both 2 and 5 days after surgery. Conclusions The temporary drain clamping method after TKA significantly reduced the volume of bleeding and blood transfusion. The 3-h clamping method reduced the drained volume as effectively as the 4-hour clamping method and resulted in less acute phase pain and more rapid recovery of ROM than the 4-hour clamping method. In conclusion, we recommend 3-h clamping after TKA as the optimal release time to reduce blood loss and acute phase pain.

Background Recently, minimally invasive plate osteosynthesis (MIPO) has been widely used for the treatment of proximal humeral fractures. However, there is concern about whether the MIPO in comminuted proximal humeral fractures is also comparable to open plating. The purpose of this study was to compare the clinical and radiographic outcomes of open plating and MIPO for acute displaced proximal humeral fractures. Materials and methods In this prospective, randomized controlled study, 107 patients who had an acute proximal humeral fracture were randomized to either the open plating or MIPO techniques. Forty-five patients treated with open plating and 45 with the MIPO technique who were followed up at least 1 year were evaluated. Shoulder functional assessment, operating time, several radiographic parameters, and complications were evaluated at final follow-up. Results The mean follow-up period was 15.0 months in the open plating and 14.3 months in the MIPO technique. There were no statistically significant differences in functional assessment scores and radiographic parameters between the two groups. High complications rates were found in 4-part fracture in both surgical methods The average operation time in the MIPO group were significantly lower compared to the open plating group ( p Conclusion This study showed MIPO in proximal humerus fractures had similar clinical and radiographic outcomes compared to the open plating. However, the MIPO technique in proximal humerus fracture provided significantly shorter operation time than the open plating.

Background The authors analyzed clinical and radiological 6-year follow-up results after total knee arthroplasty (TKA) with NexGen LPS-flex® and implant survivorship. Methods The medical records of 80 patients that underwent 122 TKAs using NexGen LPS-flex® from February 2005 to November 2008 and followed up for at least 6 years were reviewed. The Internal Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores and preoperative and postoperative ranges of motion (ROMs) were recorded. Radiological assessments were performed by simple radiography preoperatively, immediately postoperatively, and at the final follow-up. Results At the last follow-up visits, average ROM improved from 115.0° (80°–135°) to 131.76° (80°–150°), average IKDC subjective score from 30.54 (13–48) to 53.53 (31–80), average WOMAC score from 59.81 (35–90) to 15.98 (1–47), and average KOOS score from 75.33 (38–115) to 115.0 (52–174). The clinical results of 66 knees that had >130° of postoperative flexion and 56 knees that had 130° and in 6 knees in those with a flexion angle of 130° or 0.05). Conclusions TKA with NexGen LPS-flex® showed satisfactory clinical improvements, including high flexion, and no early loosening was found at 6-year follow-up visits.

The purpose of this study was to introduce a novel arthroscopic transtendon anatomic repair technique that spares the intact bursal-sided tendon in articular-sided partial-thickness rotator cuff tears (PTRCT) and to present shoulder functional outcomes in patients with symptomatic articular-sided PCRCT that involves more than 50 % of its thickness after arthroscopic repair using a novel technique. Eighteen patients with symptomatic articular-sided PCRCT involving more than 50 % of the tendon’s thickness underwent arthroscopic repair using a devised technique. The devised technique restores only the torn articular portion of the rotator cuff at the anatomical footprint using a suture anchor, and preserves the integrity of the corresponding bursal-sided tendon by tying knots at the most lateral bursal side on the subacromial space. Clinical and functional outcome using ASES and Constant scores were evaluated. The structural integrity of the rotator cuff was evaluated by MRI at 6 months postoperatively. Pain relief and shoulder functional outcomes were encouraging during the recovery phase after operation. ASES (preoperative 54.0 ± 10.3 to postoperative 92.6 ± 8.0), Constant score (61.2 ± 8.5–88.0 ± 5.3), VAS for pain (4.9 ± 2.6–0.6 ± 0.7) improved significantly after arthroscopic transtendon anatomic repair (p

Purpose The purpose of this study was to compare the prevalence of concomitant intra-articular pathologies and clinical manifestations after arthroscopic stabilization between patients with symptomatic anterior instabilities following recurrent shoulder subluxations and dislocations. Methods Among patients who underwent arthroscopic stabilization, 28 patients who experienced shoulder subluxations (subluxation group, 26.7 ± 1.8 years) and 84 who had shoulder dislocations (dislocation group, 25.9 ± 2.2 years) were included. Recurrent shoulder subluxation was defined as instability caused by repeated injuries without a history of frank dislocation or manual reduction maneuver. Common inclusion criteria were positive clinical test of anterior instability and Bankart lesion with less than 25% of glenoid bone loss. The pathoanatomies in radiologic and arthroscopic examinations and postoperative clinical outcomes were compared. Results The number of instability events was significantly fewer in the subluxation group (5.0 ± 1.3) than in the dislocation group (12.1 ± 2.0; P = .01). The pathologic findings in preoperative radiology demonstrated no intergroup differences, except for the prevalence of Hill-Sachs lesions. In the subluxation group, the Hill-Sachs lesions were significantly less commonly detected with computed tomography and magnetic resonance arthrography (28.6%) than in the dislocation group (63.1%, 60.7%; P = .001, P = .003, respectively). There were no significant differences in arthroscopic findings in both groups including superior labral anterior to posterior lesion (subluxation group, 39.3%; dislocation group, 45.2%), anterior labral periosteal sleeve avulsion lesion (21.4%, 29.8%), and bony Bankart lesion (21.4%, 28.6%). Preoperative and postoperative functional outcomes also did not differ between the groups. There was no statistical difference in terms of the rate of revision or postoperative subjective instability. Conclusions Patients who had anterior instability after recurrent shoulder subluxation demonstrated a similar rate of concomitant intra-articular pathologies requiring the same level of management as recurrent shoulder dislocation. Recurrent shoulder subluxation also displayed similar functional outcomes and failure rate after arthroscopic stabilization procedures as recurrent dislocation. Thus, the clinical importance of symptomatic recurrent subluxation should be considered comparable with that of recurrent dislocation. Level of Evidence Level IV, case control study.

In the present prospective study, the functional outcomes of non-operative treatment were evaluated in patients aged between 30 and 45 years presenting SLAP lesion in diagnostic provocative tests and magnetic resonance (MR) arthrography. Forty-six patients with a symptomatic SLAP lesion who participated in recreational level of sports were prospectively enroled. SLAP lesion was diagnosed using combinations of several clinical tests and MR arthrography findings. All patients were treated with intra-articular corticosteroid injections, followed by rotator cuff and periscapular muscle-strengthening exercises. Patients with persistent discomfort after second injection underwent arthroscopic SLAP repair. Functional outcomes were evaluated using ASES and Constant scores, and pain and satisfaction for visual analogue scale (VAS). Pain had significantly improved from 5.2 ± 2.2 to 1.0 ± 1.1 (p

Background The purpose of this study was to compare the clinical results between osteosynthesis and endoprosthesis for femoral neck fractures in asian elderly patients, and to analysis the factors that may affect the failure of osteosynthesis. Methods A retrospective review of 382 hips over 65-year old with femoral neck fracture was done. Within non-displaced fracture group, 81 cases (56.6 %) underwent internal fixation (IF) and with 62 cases (43.3 %) having bipolar hemiarthroplasty (BPHA). As for displaced fracture group, 60 cases (25.1 %) underwent internal fixation (IF) with 179 cases (74.8 %) having BPHA. Average follow-up period for the patients was 36.8 months. Analysis was conducted on complications depending on fracture types and osteoporosis, and clinical evaluation was done on gait capability by using Koval walking ability. Results In non-displaced group, BPHA group showed statistically significant lower percentage of complications compared to IF group, but re-operation rate and the degradations of Koval score were no significant differences. In displaced group, complication, re-operation rate and the degradations of Koval score of BPHA group were statistically better than those of IF group. Association between osteoporosis and non-union is no statistically significant. Conclusions Endoprosthetic replacement could be a primary option for displaced femoral neck fracture in elderly asian patients. The choice of surgical treatment methods of non-displaced fracture in elderly asian patients should be determined carefully considering the age and the presence of osteoporosis.

Purpose:The purpose of this article was to assess the clinical outcome of high tibial osteotomy (HTO) with articular cartilage surgery compared with unicompartmental knee arthroplasty (UKA) in unicompartmental osteoarthritis (OA).Methods:We designed retrospective study and evaluated 47 patients with unicompartmental OA (Kellgren–Laurence [K–L] grade ≥III OA). Two groups of patients underwent either HTO with articular cartilage surgery or UKA by the senior author between January 2010 and April 2013. The minimum follow-up period is 2 years. Clinical outcomes were assessed using Knee Injury and Osteoarthritis Outcome Scores, International Knee Documentation Committee (IKDC), and visual analog scale (VAS) score. And we evaluated the radiologic result of HTO and UKA by measuring mechanical axis at preoperative period and at last follow-up.Results:The IKDC score was significantly better in the UKA group than in the HTO group at 6 months but there was no significant difference in the two groups at 2 years. The VAS score was improved at the final follow-up compared to before surgery in both groups and did not show significant intergroup difference ( p = 0.123). There was no significant difference in the preoperative mechanical axis in the two groups. But their mechanical axis at the final follow-up were significantly different ( p = 0.0001).Conclusion:The clinical outcome was significantly better in the UKA group at 6 months. But in the two groups, there were no significant differences at 12 months and 2-year follow-up, and the mechanical axis correction effect is greater than the UKA group. Based on our research, HTO with articular cartilage surgery can be considered as the treatment of choice for more active and younger patients with unicompartmental OA.

321 통신저자:이 동 주 인천시 중구 신흥동 3가 7-206 인하대학교 의과대학 정형외과학교실 Tel:032-890-3662ᆞFax:032-890-3099 E-mail:TJLEE@inha.ac.kr 본 논문은 2009년 인하대학교의 지원에 의하여 연구되었음. 접수: 2010. 3. 31 심사 (수정): 2010. 5. 18 게재확정: 2010. 6. 10 Address reprint requests to:Tong-Joo Lee, M.D. Department of Orthopaedic Surgery, Inha University School of Medicine, 7-206, Sinheung-dong 3-ga, Jung-gu, Incheon 400-103, Korea Tel:82-32-890-3662ᆞFax:82-32-890-3099 E-mail:TJLEE@inha.ac.kr 수부에서 근위 지간 관절 골두의 부분 골연골 결손에 대한 자가 족지 골두 이식술 증례 보고