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Chris Hyunchul Jo,Mee Soo Chang 대한견주관절의학회 2015 대한견주관절학회지 Vol.18 No.2
Background: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. Methods: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. Results: Mean total degeneration scores in the NE group (13.3 ± 3.21), the FE group (12.5 ± 2.30), and in the MTJ group (10.8 ± 3.10) were significantly higher than those in the normal control group (5.0 ± 2.87; all p<0.001). Mean total degeneration score in the NE group was significantly higher than that in the MTJ group (p=0.012), but was not from that of the FE group. Mean total degeneration score in the FE group was not significantly different from that of the MTJ group. Conclusions: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair.
Jo, Chris Hyunchul,Lee, Seung Yeon,Yoon, Kang Sup,Shin, Sue AMERICAN JOURNAL OF SPORTS MEDICINE 2017 AMERICAN JOURNAL OF SPORTS MEDICINE - Vol.45 No.5
<P>Conclusion: This study shows that the addition of PRP does not interfere with the anti-inflammatory effects of a corticosteroid on IL-1 beta-treated tenocytes from degenerative rotator cuff tears but that it does avoid the deleterious side effects of a corticosteroid.</P>
Multiple Channeling Improves the Structural Integrity of Rotator Cuff Repair
Jo, Chris Hyunchul,Shin, Ji Sun,Park, In Woong,Kim, Hyang,Lee, Seung Yeon SAGE Publications 2013 AMERICAN JOURNAL OF SPORTS MEDICINE - Vol.41 No.11
<P><B>Background:</B></P><P>Multiple channeling is a straightforward additional procedure for rotator cuff repair that creates multiple channels in the greater tuberosity, through which bone marrow of the proximal humerus communicates with the repair site.</P><P><B>Purpose:</B></P><P>To investigate the effect of multiple channeling on clinical and structural outcomes of arthroscopic rotator cuff repair.</P><P><B>Study Design:</B></P><P>Cohort study; Level of evidence, 3.</P><P><B>Methods:</B></P><P>A total of 124 patients with a full-thickness rotator cuff tear were included in the study. Fifty-seven patients underwent arthroscopic rotator cuff repair with multiple channeling (the multiple channeling group) and 67 without it (the conventional group). Analysis of surface markers was performed to characterize the cells recruited by multiple channeling using flow cytometry. Clinical outcomes were evaluated preoperatively and at a minimum of 2 years after surgery (average, 36.79 ± 13.69 months) with respect to pain, range of motion, muscle strength, overall satisfaction, and commonly used functional scores. At a minimum of 9 months after surgery, structural integrity was assessed by magnetic resonance imaging or computed tomography arthrography.</P><P><B>Results:</B></P><P>Mesenchymal stem cells (MSCs) positive for CD73, CD90, and CD105 and negative for CD45 could be isolated and cultured from bone marrow mononuclear cells of the proximal humerus. Clinical outcomes, including pain, range of motion, strength, overall satisfaction, and functional scores, showed no statistical difference between the 2 groups (all <I>P</I> > .05). The retear rate of the multiple channeling group (22.2%) was significantly lower than that of the conventional group (45.2%) (<I>P</I> = .023).</P><P><B>Conclusion:</B></P><P>The findings of the study showed that multiple channeling significantly decreased the retear rate after arthroscopic rotator cuff repair, probably via the recruitment of endogenous MSCs from the proximal humerus. Although the results did not show significant differences in the clinical outcomes between the 2 groups, better clinical outcomes might be anticipated in the multiple channeling group via improved structural integrity in a long-term follow-up.</P>
Arthroscopic supraspinatus advancement for retracted rotator cuff tears: a technical note
Chris Hyunchul Jo,Pei Wei Wang 대한견주관절의학회 2022 대한견주관절의학회지 Vol.25 No.4
Irreparable rotator cuffs with retracted torn ends remain a significant challenge for most shoulder surgeons. Since repairs are preferable to reconstruction or replacement whenever possible, studies for anatomical reductions with minimal tension and secure fixation are important. In this study, the authors introduce an arthroscopic supraspinatus advancement (ASSA) procedure for retracted rotator cuff tears that could not be adequately reduced to the original footprint. Using modified long, narrow, curved Cobb elevators, procedures can be performed through lateral portals without any additional skin incision. Following meticulous stepwise three-compartment elevation procedures based on the supraspinatus insertion anatomy, the supraspinatus muscle could be safely elevated from the fossa and sufficiently advanced laterally. The authors suggest that ASSA could be a useful procedure for management of challenging retracted rotator cuff tears by maximizing lateral excursions that could convert irreparable tears to reparable tears in select patients.
Jo, Chris Hyunchul,Shin, Ji Sun,Shin, Won Hyoung,Lee, Seung Yeon,Yoon, Kang Sup,Shin, Sue SAGE Publications 2015 AMERICAN JOURNAL OF SPORTS MEDICINE - Vol.43 No.9
<P><B>Background:</B></P><P>Two main questions about the use of platelet-rich plasma (PRP) for regeneration purposes are its effect on the speed of healing and the quality of healing. Despite recent numerous studies, evidence is still lacking in this area, especially in a representative patient population with medium to large rotator cuff tears.</P><P><B>Purpose:</B></P><P>To assess the efficacy of PRP augmentation on the speed and quality of healing in patients undergoing arthroscopic repair for medium to large rotator cuff tears.</P><P><B>Study Design:</B></P><P>Randomized controlled trial; Level of evidence, 1.</P><P><B>Methods:</B></P><P>A total of 74 patients scheduled for arthroscopic repair of medium to large rotator cuff tears were randomly assigned to undergo either PRP-augmented repair (PRP group) or conventional repair (conventional group). In the PRP group, 3 PRP gels (3 × 3 mL) were applied to each patient between the torn end and the greater tuberosity. The primary outcome was the Constant score at 3 months after surgery. Secondary outcome measures included the visual analog scale (VAS) for pain, range of motion (ROM), muscle strength, overall satisfaction and function, functional scores, retear rate, and change in the cross-sectional area (CSA) of the supraspinatus muscle.</P><P><B>Results:</B></P><P>There was no difference between the 2 groups in the Constant score at 3 months (<I>P</I> > .05). The 2 groups had similar results on the VAS for pain, ROM, muscle strength, overall satisfaction and function, and other functional scores (all <I>P</I> > .05) except for the VAS for worst pain (<I>P</I> = .043). The retear rate of the PRP group (3.0%) was significantly lower than that of the conventional group (20.0%) (<I>P</I> = .032). The change in 1-year postoperative and immediately postoperative CSAs was significantly different between the 2 groups: –36.76 ± 45.31 mm<SUP>2</SUP> in the PRP group versus −67.47 ± 47.26 mm<SUP>2</SUP> in the conventional group (<I>P</I> = .014).</P><P><B>Conclusion:</B></P><P>Compared with repairs without PRP augmentation, the current PRP preparation and application methods for medium to large rotator cuff repairs significantly improved the quality, as evidenced by a decreased retear rate and increased CSA of the supraspinatus, but not the speed of healing. However, further studies may be needed to investigate the effects of PRP on the speed of healing without risking the quality.</P>