Biomedical subjects

Irvin Oh

Publications and source records attributed to Irvin Oh.

14 recordsLinked to original sources

PubMed2006

Arthroscopic all-inside lateral meniscus suture using posterolateral portal.

A new arthroscopic all-inside suture for lateral meniscus posterior horn tear using a single posterolateral portal is described. A lateral meniscus posterior horn peripheral longitudinal tear is often seen with anterior cruciate ligament injury or discoid lateral meniscus tear. Conventional repair methods, such as arthroscopic inside-out, outside-in, or all-inside sutures, can be cumbersome and technically demanding. Our all-inside suture using the posterolateral portal allows thorough visualization of the posterolateral structures, excellent coaptation of torn meniscus, strong knot tightening, and avoidance of inadvertent cartilage injury. The arthroscope is inserted through the anteromedial portal and reaches the posterolateral compartment by a transcondylar approach. A suture hook is introduced into the posterolateral portal without a cannula, penetrates posterior peripheral rim, crosses the tear, and passes through mobile torn fragment. A large amount of No. 0 PDS is passed, so that it curls up inside the joint. After the suture hook is removed, a suture retriever is inserted through the posterolateral portal to pull out 2 ends of the PDS at the same time. The retrieved suture ends are passed through a knot pusher and a 5.5-mm cannula is introduced over the retrieved suture materials for the SMC knot to be tied. A longitudinal tear of lateral meniscus posterior horn is repaired with 2 to 3 sutures.

Adult↗

PubMed2005

Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon.

BACKGROUND: Partial-thickness tear of the subscapularis tendon in the articular surface is common. HYPOTHESIS: Intra-articular repair of a partial articular-surface tear of the subscapularis tendon will provide a successful outcome. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 29 shoulders with an isolated partial articular-surface tear of the subscapularis tendon without another rotator cuff lesion were treated with arthroscopic intra-articular repair using suture anchors. Biceps tenodesis was performed in 16 patients. Outcomes were prospectively evaluated at a mean of 27 months (range, 19-41 months) using 3 objective (University of California at Los Angeles, American Shoulder and Elbow Surgeons Shoulder Index, Simple Shoulder Test) and 2 subjective (pain and function visual analog scales) measurements. RESULTS: There were 21 men and 8 women, with a mean age of 54 years (range, 41-65 years). Tear widths were small (<1 cm) in 16 shoulders and large (>1 cm) in 13 shoulders. Twenty-six shoulders had articular cartilage erosion on the adjacent humeral head. Lesions of the biceps tendon were noted in 25 patients (partial tear in 15 shoulders; subluxation in 13 shoulders). Shoulder pain scores improved after surgery (5.0 +/- 2.7 to 0.3 +/- 0.7, P < .05). According to American Shoulder and Elbow Surgeons Shoulder Index scores, 18 were excellent; 10, good; and 1, fair. Internal rotation strength deficit improved from 32% to 4%. Twenty-six patients returned to more than 90% of previous activity. There were no surgical complications; tear size and biceps tenodesis did not affect outcome (P > .05). CONCLUSION: Arthroscopic intra-articular repair of a partial articular-surface tear of the subscapularis tendon is an effective procedure that spares the intact tendon attachment in the bursal surface. Short-term outcomes were reliable by both objective and subjective measurements.

Adult↗

PubMed2005

Prognostic factors influencing the functional outcome of total hip arthroplasty for hip infection sequelae.

To investigate factors influencing functional prognosis for patients who have undergone total hip arthroplasty for late sequelae of infective arthritis of the hip, we conducted a retrospective analysis of 75 hips. All patients had had pyogenic or tuberculous infection and later underwent total hip arthroplasty. The average follow-up period was 5.8 years (range, 3-9 years). Various clinical and radiographic measures were analyzed with respect to Harris hip scores. Younger age at the time of infection onset, preoperative leg length discrepancy greater than 1 in, fusion, severe femoral hypoplasia, and severe acetabular dysplasia were associated with poorer prognosis. The complication rate, including 1 recurrent infection, was relatively low. Previous infections seemed to predict poorer results mostly because of the consequences of infection for the development of the hip joint, rather than because of infection recurrence.

Acetabulum↗

PubMed2005

Loss of chondrolabral containment of the glenohumeral joint in atraumatic posteroinferior multidirectional instability.

BACKGROUND: Although the cause of posteroinferior instability of the shoulder has not been fully defined, glenoid version can be more completely measured when chondrolabral structures are included because conformity and containment of the glenohumeral joint are integral functions of both the articular cartilage and the labrum. The purpose of this study was to use magnetic resonance imaging-arthrography to evaluate the chondrolabral containment of the glenohumeral joint in patients with atraumatic posteroinferior multidirectional instability of the shoulder. METHODS: We evaluated four measurements (osseous and chondrolabral glenoid version, labral height, and glenoid depth) on T2-weighted axial magnetic resonance-arthrography images of thirty-three shoulders with atraumatic posteroinferior multidirectional instability. Shoulders with a documented labral tear were excluded. The measurements were compared with those of thirty-three age-matched controls without glenohumeral pathology. The angles of version of the osseous and chondrolabral portions of the glenoid were measured in three consecutive planes (superior 25%, middle 50%, and inferior 75% in relation to the superior lip of the glenoid) perpendicular to the long axis of the glenoid. RESULTS: The shoulders with posteroinferior instability had greater retroversion of both the osseous and the chondrolabral portion of the glenoid in the middle and inferior planes. The chondrolabral portion of the glenoid had more retroversion than the osseous portion in the inferior plane. The height of the posterior portion of the labrum was decreased in the inferior plane in the shoulders with instability. Glenoid depth in the middle and inferior planes was significantly shallower in the shoulders with instability. CONCLUSIONS: Loss of containment in the chondrolabral portion of the glenoid in the middle and inferior planes is a consistent finding in shoulders with atraumatic posteroinferior multidirectional instability and is associated with loss of posterior labral height. It is unclear whether the retroversion of the posteroinferior aspect of the labrum is a cause or a consequence of atraumatic posteroinferior multidirectional instability, but this factor should be considered during surgical repair.

Adult↗

PubMed2004

Modified inside-out technique for meniscal repair.

A modified technique of the inside-out suture for arthroscopic repair of meniscus is described. Although the conventional inside-out technique is a fine modality of a meniscal repair, it is difficult to perform vertical suture and to attain good coaptation and strong fixation. We introduce a modified inside-out suture, which uses a suture hook, a zone-specific cannula, and a specially designed looped needle for an efficient meniscal repair. The modified inside-out suture technique provides vertically oriented suture, excellent tissue coaptation, and firm fixation. We recommend this technique as an excellent method for repairing a tear in most parts of the meniscus, especially the posteromedial corner.

Arthroscopy↗

PubMed2004

Arthroscopic partial meniscectomy of a medial meniscus bucket-handle tear using the posteromedial portal.

Arthroscopic resection of irreparable bucket-handle tears of the medial meniscus is a commonly performed procedure. Adequate visualization of the posterior horn of the medial meniscus can be a challenging task with the conventional use of the anterior portal. An attempt to resect the posterior horn in a blind fashion may result in iatrogenic damage of the articular cartilage in the posterior compartment, over-resection of a remnant meniscus, or an insufficient resection of the torn fragment. We describe the use of the posteromedial portal for an accurate visualization and resection of the posterior attachment of a bucket-handle tear for arthroscopic partial meniscectomy, as well as detection of other injuries that may be involved in the posteromedial compartment, while avoiding injury to other intra-articular structures during the arthroscopic procedure. We found that the use of the posteromedial portal is a safe and efficient method in removing a bucket-handle tear of the medial meniscus in one piece.

Arthroscopy↗

PubMed2004

Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder.

BACKGROUND: The jerk test has been used as a diagnostic test of the posteroinferior instability of the shoulder. Pain may or may not be associated with posterior clunking during the jerk test. PURPOSE: To evaluate the presence or absence of pain with the jerk test as a predictor of the success of nonoperative treatment for posteroinferior instability of the shoulder and to identify the pathologic lesion responsible for the pain in the jerk test. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Eighty-one patients (89 shoulders) who had posteroinferior instability with a positive posterior clunk in their shoulders during the jerk test were nonoperatively treated. The patients were divided into 2 groups with respect to the presence of pain in the jerk test: the painless jerk group (54 shoulders) and the painful jerk group (35 shoulders). Response to the nonoperative treatment was evaluated after at least a 6-month rehabilitation program. Patients who did not respond to the rehabilitation underwent arthroscopic examination to identify any pathologic lesions. RESULTS: The painful jerk group had a higher failure rate with nonoperative treatment (P < .001). In the painless jerk group, 50 shoulders (93%) responded to the rehabilitation program after a mean of 4 months. Four shoulders (7%) were unresponsive to the rehabilitation. In the painful jerk group, 5 shoulders (16%) were successful with the rehabilitation, whereas the other 30 shoulders (84%) failed. All 34 shoulders that were unresponsive to the rehabilitation had a variable degree of posteroinferior labral lesions. CONCLUSIONS: The jerk test is a hallmark for predicting the prognosis of nonoperative treatment for posteroinferior instability. Shoulders with symptomatic posteroinferior instability and a painful jerk test have posteroinferior labral lesions.

Adolescent↗

PubMed2003

Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis at 2 to 6 years' follow-up.

PURPOSE: The purpose of this study was to compare the outcomes of arthroscopic repair of medium and large rotator cuff tears with the outcomes for mini-open repair of similar tears in which arthroscopic repair was technically unsuccessful. TYPE OF STUDY: Retrospective case series. METHODS: We evaluated 76 patients who were treated for full-thickness rotator cuff tears either by all-arthroscopic (42 patients) or mini-open salvage of technically unsuccessful arthroscopic repair (34 patients). Patients who had acromioclavicular arthritis, subscapularis tear, or instability were excluded. There were 39 men and 37 women, with a mean age of 56 years (range, 42 to 75 years). At a mean follow-up of 39 months (range, 24 to 64 months), the results of both groups were compared using the University of California Los Angeles and American Shoulder and Elbow Surgeons shoulder rating scales. RESULTS: Shoulder scores improved in all ratings in both groups (P <.05). Overall, 66 patients showed excellent or good and 10 patients showed fair or poor scores by the University of California Los Angeles scale. Seventy-two patients satisfactorily returned to previous activity, and 4 showed unsatisfactory returns. The range of motion, strength, and patient satisfaction were improved postoperatively. No differences were seen in shoulder scores, pain, and activity return between the arthroscopic and mini-open salvage groups (P >.05). However, patients with larger tears showed lower shoulder scores and less predictable recovery of strength and function (P <.05). Postoperative pain was not different with respect to the size of the tear (P =.251). CONCLUSIONS: Arthroscopic repair of medium and large full-thickness rotator cuff tears had an equal outcome to technically unsuccessful arthroscopic repairs, which were salvaged by conversion to a mini-open repair technique. Surgical outcome depended on the size of the tear, rather than the method of repair.

Adult↗

PubMed2003

Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal.

We describe an arthroscopic technique for the reconstruction of the posterior cruciate ligament (PCL), while preserving the remnant bundle of the original PCL and meniscofemoral ligament, using the posterior trans-septal portal. The posterior trans-septal portal provides an excellent visualization of the PCL tibial attachment and an easy access to the tibial tunnel without injuring any neurovascular structure. The remnant bundle of the original PCL and meniscofemoral ligament, which significantly contributes to the posterior stability of the knee joint, are preserved to be healed with a graft and subsequently form an integrated structure. We report a new arthroscopic technique for an effective reconstruction of the PCL, using the posterior trans-septal portal.

Achilles Tendon↗

PubMed2003

Comparison of hydroxyapatite- and porous-coated stems in total hip replacement.

24 patients underwent bilateral hip replacement, using the SROM modular system (Depuy Johnson & Johnson, MA, USA) with the porous-coated sleeve in one hip and an HA-coated sleeve in the other. 20 patients were followed for at least 4 years with clinical and radiographic evaluations. We found no difference between the two sides as regards the time of disappearance of thigh pain and hip scores. Radiographs showed a buttress sign in 18 HA-coated and 15 porous coated stems. There were no differences in the serial bone-remodeling pattern around the proximal sleeve and measurement of wear volume between the two groups. In the short- to medium-term, our findings support the view that the hydroxyapatite-coated femoral stem has no advantages over those with porous coating.

Adult↗

PubMed2003

Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up.

BACKGROUND: The purpose of this study was to evaluate prospectively the surgical outcomes of arthroscopic repair of anterior capsulolabral lesions with use of suture anchors in a large series of patients who were followed for two to six years. METHODS: We evaluated the results of arthroscopic Bankart repair with use of suture anchors and nonabsorbable sutures in 167 patients with traumatic recurrent anterior instability of the shoulder. The mean age at the time of the operation was twenty-five years. Preoperatively and at the time of follow-up (at a mean of forty-four months), the patients were assessed with three objective outcome measurement tools (the Rowe score, the University of California at Los Angeles [UCLA] shoulder rating scale, and the American Shoulder and Elbow Surgeons [ASES] score) and two subjective measurement tools (pain and function visual analog scales). The recurrence rate, range of motion, and risk factors for postoperative recurrence were evaluated. RESULTS: All shoulder scores improved after surgery (p < 0.001). According to the Rowe scale, 130 patients (78%) had an excellent score; twenty-nine (17%), a good score; six (4%), a fair score; and two (1%), a poor score. Overall, the rate of postoperative recurrence of instability was 4% (one dislocation, two subluxations, and four positive results on the anterior apprehension test). Postoperative recurrence was related to an osseous defect of >30% of the entire glenoid circumference. In the patients with recurrent postoperative instability, the episodes were less frequent than they had been preoperatively and shoulder function was related to activity level. A revision arthroscopic Bankart repair stabilized three of the four shoulders in which it was performed. One hundred and fifty-two patients (91%) returned to >/=90% of their preinjury activity level. The mean loss of external rotation (and standard deviation) was 2.0 degrees +/- 4.0 degrees. CONCLUSIONS: We found that, in contrast to previous reports on the results of arthroscopic repair, arthroscopic capsulolabral repair with use of suture anchors can provide satisfactory outcomes in terms of recurrence rate, activity, and range of motion.

Activities of Daily Living↗

PubMed2002

A cannula for non-slip knots.

In this article, we introduce a modified cannula that has 1 process and 2 notches. We believe that this will allow a surgeon to complete tying of a non-slip knot without any slippage.

Arthroscopy↗

PubMed2002

A water-infusion system with two reservoirs at different levels.

To provide a continuous supply of fluid during arthroscopic surgery, we suggest an infusion system with 2 reservoirs placed at different heights. The lower bag serves as a water reservoir, which allows more time for the circulating nurse to complete the task of exchanging the emptied water bag.

Arthroscopy↗

PubMedDate not supplied

Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder.

BACKGROUND: Arthroscopic treatment of posteroinferior multidirectional instability of the shoulder is not well documented. PURPOSE: To evaluate pathologic lesions of posteroinferior multidirectional instability and the results of arthroscopic capsulolabroplasty. STUDY DESIGN: Prospective nonrandomized clinical trial. METHODS: Thirty-one patients with posteroinferior multidirectional instability were prospectively evaluated after arthroscopic capsulolabroplasty (mean follow-up, 51 months). Labral lesion and height were measured in the MRI arthrogram and arthroscopic examination. RESULTS: All patients had a labral lesion and variable capsular stretching in the posteroinferior aspect. There were 11 type I labral lesions (incomplete detachment), 12 type II (the Kim's lesion: incomplete and concealed avulsion), 6 type III (chondrolabral erosion), and 2 type IV (flap tear). All patients with type II and III lesions had chondrolabral retroversion, with lost labral height in the MRI arthrogram and arthroscopic examination. Twenty-one patients had an excellent Rowe score, nine had good scores, and one had a fair score. Thirty patients had stable shoulders, and one had recurrent instability. All patients had improved shoulder scores and function and pain scores. CONCLUSIONS: Symptomatic patients with posteroinferior multidirectional instability had posteroinferior labral lesions, including retroversion of the posteroinferior labrum, which were previously unrecognized. Restoration of the labral buttress and capsular tension by arthroscopic capsulolabroplasty successfully stabilized shoulders with posteroinferior multidirectional instability.

Adult↗