Body donation trends in Yonsei University: a statistical analysis of donor records

Body donation trends in Korea have changed significantly over the last 3 decades. Establishing a body donation system will promote donations to universities for academic purposes. Yonsei University College of Medicine started its own body donation system in 1992, including documenting donors' records. However, there has been no reported attempt to analyze the trend of these records, which could provide noteworthy information that can be interpreted for medical advances. This study performed a statistical analysis of the donors' records between 1992 and 2019 to analyze the sociological and anthropological changes. Donor personal information such as sex, age, religion, and place and cause of death were extracted from the Yonsei University College of Medicine database. Our statistical analysis revealed significant correlations between donors' records and the changes in the number of geriatric hospitals, religious beliefs, number of donations, and donor age.ope

Clinical comparison of humeral-lateralization reverse total shoulder arthroplasty between patients with irreparable rotator cuff tear and patients with cuff tear arthropathy

Background: This study aimed to compare the clinical and radiologic outcomes between patients with irreparable cuff tears (ICTs) and those with cuff tear arthropathy (CTA) after reverse total shoulder arthroplasty (RTSA) with a humeral-lateralization prosthesis. Methods: A total of 127 patients with ICTs and CTA who underwent RTSA were enrolled and matched at a 1:2 ratio by propensity score. Preoperative shoulder function was assessed for all patients. Radiologic parameters including the acromion-deltoid tuberosity (ADT) distance, lateral humeral offset, and scapular notching were evaluated. Results: Thirty-four patients in the ICT group and 68 patients in the CTA group were matched for comparison. Preoperatively, mean active forward flexion in the ICT group (89.7° ± 29.4°) was significantly better than that in the CTA group (65.5° ± 24.0°, P < .001). In the CTA group, fatty infiltration of the supraspinatus was worse (3.7 ± 0.5) and the ADT distance was shorter (134.0 ± 12.0 mm) compared with the ICT group preoperatively (3.3 ± 0.8 [P = .008] and 140.7 ± 12.5 mm [P = .001], respectively). There was no significant difference in postoperative functional or radiologic outcomes between the 2 groups. However, gains in active forward flexion (37.9° in ICT group vs. 61.5° in CTA group, P < .01) and abduction (42.1° in ICT group vs. 60.6° in CTA group, P < .01) were significantly greater in the CTA group than in the ICT group. Conclusions: Shoulder function was significantly improved after RTSA regardless of the preoperative diagnosis. Postoperatively, radiologic findings were not significantly different between the 2 groups. Due to the fact that preoperative range of motion and rotator cuff status were better in patients with ICTs, improvements in active forward flexion and abduction were significantly greater in patients with CTA.ope

Treatment of Acute Acromioclavicular Joint Dislocation: Kirschner’s Wire Trans-acromial Fixation versus AO Locking Hook Plate Fixation

Background: The purpose of this study is to compare clinical and radiological outcomes between trans-acromial fixation with Kirschner's wire (K-wire) and AO locking hook plate fixation for acute acromioclavicular (AC) joint dislocation. Methods: This study included 61 patients who underwent either closed reduction and trans-acromial fixation with K-wire (group A, 23 patients) or open reduction and internal fixation with AO locking hook plate (group B, 38 patients). Pain on a visual analogue scale (VAS) score, the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM) were used in the functional evaluation. For radiological evaluation, coracoclavicular distance (CCD) was measured on both clavicular anteroposterior view and compared between groups. Results: At one-year follow-up, no significant differences in VAS pain score, UCLA shoulder score, ASES score, and active ROM were observed between groups, despite five cases (22.7%, 5/23) of complication in group A. The side-to-side difference between normal and affected CCD was 2.4 ± 2.2 mm in group A and 0.2 ± 0.7 mm in group B. This difference showed a statistical significance between groups (p<0.001). Conclusions: For the treatment of acute AC joint dislocation, the K-wire trans-acromial fixation group showed a significantly greater CCD than the AO locking hook plate group. In addition, during the follow-up period, much higher incidence of complication related to implant was observed in the trans-acromial fixation group. Although clinical outcomes between groups were not significantly different, these results should be interpreted carefully.ope

Treatment of acute high-grade acromioclavicular joint dislocation

Acromioclavicular (AC) joint dislocations account for about 9% of shoulder injuries. Among them, acute high-grade injury following high-energy trauma accounts for a large proportion of patients requiring surgical treatment. However, there is no gold standard procedure for operative treatment of acute high-grade AC joint injury, and several different procedures have been used for this purpose in clinical practice. This review article summarizes the most recent and relevant surgical options for acute high-grade AC joint dislocation patients and the outcomes of each treatment type.ope

Follistatin Mitigates Myofibroblast Differentiation and Collagen Synthesis of Fibroblasts from Scar Tissue around Injured Flexor Tendons

PURPOSE: The aim of this study was to investigate the effect of FST gene on the inhibition of fibrosis in fibroblastic cells from scar tissue around repaired zone II flexor tendons. MATERIALS AND METHODS: Immunohistochemistry was conducted on fibroblast cells transfected with adenovirus-LacZ (Ad-LacZ) as a marker gene (control), or with adenovirus-FST (Ad-FST) as a therapeutic gene. Fibroblast cultures without adenoviral exposure served as controls. RESULTS: Fibroblastic cells transfected with Ad-FST demonstrated significant decrease in collagen type I, MMP-1, MMP2, and α-SMA mRNA expressions compared to those transfected with Ad-LacZ. In addition, fibroblastic cells transfected with Ad-FST exhibited significant decrease in MMP-1, TIMP-1, fibronectin, PAI-1, TRPV4, α-SMA, desmin, and PAX7 protein expressions. CONCLUSION: Based on these findings, we conclude that FST may be a novel therapeutic strategy for preventing scar adhesions around repaired tendons by inhibiting fibroblasts from differentiating into myofibroblasts, in addition to producing type I collagen and regulating extracellular matrix turnover via the downregulation of MMP-1 and TIMP-1. FST may also decrease contracture of the scar by inhibiting Ca2+-dependent cell contraction.ope

Clinical Outcomes for Isolated Subscapularis Tears With Advanced Fatty Infiltration: Nonoperative Treatment Versus Arthroscopic Single-Row Repair

Background: No study has investigated the treatment outcomes of isolated subscapularis tears with advanced fatty infiltration and tear progression to the supraspinatus tendon. Purpose: To assess the natural progression of isolated subscapularis tears with advanced fatty infiltration and compare clinical outcomes between nonoperative and operative treatment. Study design: Cohort study; Level of evidence, 3. Methods: This study included 52 patients who received either operative (group A) or nonoperative (group B) treatment at our institution for isolated subscapularis full-thickness tears with grade 3 or 4 advanced fatty infiltration. All study patients had a minimum 2-year follow-up. The following 4 functional measures were used: visual analog scale for pain, Subjective Shoulder Value, American Shoulder and Elbow Surgeons score, and University of California Los Angeles score. The modified belly-press test was used to assess subscapularis muscle strength. In group A, structural integrity was evaluated using magnetic resonance imaging at 6 months after surgery. In addition, ultrasonographic evaluation was performed on both groups during the follow-up period to assess tear progression into the supraspinatus tendon. Results: At initial presentation, all functional assessment scores were significantly worse in group A versus group B (P ≤ .05 for all 4 scores). When we compared the mean change in scores before treatment versus after treatment, the group A patients were found to have significantly greater improvement than group B patients (P < .001 for all 4 scores); however, no significant difference was seen in final outcome scores between the groups. Although a high retear rate of 78.6% (22/28) was identified in group A, both groups showed no further tear progression to the supraspinatus tendon at the final ultrasonographic evaluation. Conclusion: For isolated subscapularis tears with advanced fatty infiltration, clinical improvement was seen with both nonoperative and operative treatment. Although the operatively treated group started with lower baseline scores, there were no significant differences in outcomes at final follow-up. Considering the high retear rate even after repair, surgical treatment of these lesions may not be warranted. Early detection and prompt repair of subscapularis tears, before the lesion becomes advanced with grade 3 or 4 fatty infiltration, are important for better outcomes.ope

Peri-anchor cyst formation after arthroscopic bankart repair: comparison between biocomposite suture anchor and all-suture anchor

Background The purpose of this study is to investigate clinical outcomes and radiological findings of cyst formation in the glenoid around suture anchors after arthroscopic Bankart repair with either biocomposite suture anchor or all-suture anchor in traumatic anterior shoulder instability. We hypothesized that there would be no significant difference in clinical and radiological outcomes between the two suture materials. Methods This retrospective study reviewed 162 patients (69 in group A, biocomposite anchor; 93 in group B, all-suture anchor) who underwent arthroscopic Bankart repair of traumatic recurrent anterior shoulder instability with less than 20% glenoid defect on preoperative en-face view three-dimensional computed tomography. Patient assignment was not randomized. Results At final follow-up, the mean subjective shoulder value, Rowe score, and University of California, Los Angeles shoulder score improved significantly in both groups. However, there were no significant differences in functional shoulder scores and recurrence rate (6%, 4/69 in group A; 5%, 5/93 in group B) between the two groups. On follow-up magnetic resonance arthrography/computed tomography arthrography, the incidence of peri-anchor cyst formation was 5.7% (4/69) in group A and 3.2% (3/93) in group B, which was not a significant difference. Conclusions Considering the low incidence of peri-anchor cyst formation in the glenoid after Bankart repair with one of two anchor systems and the lack of association with recurrence instability, biocomposite and all-suture anchors in Bankart repair yield satisfactory outcomes with no significant difference.ope

Arthroscopic Treatment of Septic Arthritis of the Shoulder: Decision-Making for Reoperation

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Treatment of Open Proximal Humerus Fracture by Gunshot.

PURPOSE: To consider the proper managment of proximal humerus fracture on gunshot wounds. MATERIALS AND METHODS: A 28-year-old male patient, who sustained a gunshot injury on the left arm 5 days ago, was admitted through the emergency department. Although he underwent an emergency surgery (bullet fragment removal and debridement), there remained bullet fragments around the proximal humerus fracture site. The wound seemed to be infected and a partial dehiscence occurred. No neurologic deficit was noted. Immediate exploration and debridement were performed, and an external fixator was applied to restore the anatomical alignment and manage the wounds. Intravenous antibiotics were administered. On the 9th postoperative day, wound debridement was done again, and cement beads mixed with antibiotics were inserted. After two weeks, the external fixator was removed, and the pin sites were closed after debridement. One week later, the open reduction and internal fixation with locking compression plate and screws were done. RESULTS: At 3 months after the internal fixation, the bone union was obtained with satisfactory alignment of the humerus. CONCLUSION: The severity of the soft tissue injury influences the fracture management plan. Further, the risk on lead toxicity should be considered.ope

Arthroscopic Partial Repair of Massive Contracted Rotator Cuff Tears

Typically, massive rotator cuff tears have stiff and retracted tendon with poor muscle quality, in such cases orthopaedic surgeons are confronted with big challenging to restore the cuff to its native footprint. Furthermore, even with some restoration of the footprint, it is related with a high re-tear rate due to less tension free repair and less tendon coverage. In this tough circumstance, the partial repair has yielded satisfactory outcomes at relatively short follow-up by re-creating the transverse force couple of the rotator cuff. Through this partial repair, the massive rotator cuff tear can be converted to the "functional rotator cuff tear" and provide improvement in pain and functional outcomes in patient's shoulder.ope