Repair of the rotator cuff tear is a joint-tightening procedure that can worsen joint stiffness. This paradoxical phenomenon complicates treatment of rotator cuff tear with joint stiffness. As a result, there is controversy about how and when to treat joint stiffness. As many treatments have been published, this review discusses the latest findings on treatment of rotator cuff tear with joint stiffness.

Objective: Lateral and medial epicondylitis are relatively common diseases, but they do not improve quickly and are known to reduce patients' quality of life. Much research has been done on Platelet‐Rich Plasma (PRP) as a treatment for lateral epicondylitis, but research on medial epicondylitis is lacking. The purpose of this study is to compare: (i) the pain intensity; and (ii) the functional outcome between the simultaneous treatment of medial and lateral epicondylitis and the treatment of only lateral or medial epicondylitis using PRP.Methods: In this retrospective study, 209 patients treated with PRP on epicondylitis between March 2018 and December 2021 were enrolled. Simultaneous treatment was underwent 68 patients (group I). Seventy patients were treated for lateral epicondylitis (group II). The remaining 71 patients were treated for medial epicondylitis (group III). The visual analogue scale for pain (VAS) and the Mayo elbow performance score (MEPS) were evaluated for clinical outcomes at the initial visit and 6 months after injection.Results: VAS for pain and MEPS showed significant improvement in all three groups compared to before treatment. There was no significant difference between three groups on –ΔVAS (P > 0.05). However, in case of ΔMEPS, group III showed significantly lower compared to groups II and III (P < 0.05). No patients showed worsening of symptoms or complications during the treatment.Conclusion: PRP injection for the patient with elbow medial and lateral epicondylitis can be treated effectively simultaneously in terms of pain. From a functional point of view, the effect of simultaneous treatment may be lessened than in the case of only lateral and medial treatment.

Background and Objectives: The arthroscopic biceps rerouting (BR) technique was introduced as a novel technique for large-to-massive rotator cuff tears (LMRCTs). This method can restore shoulder stability, and its biomechanical effect was verified in a cadaver experiment. Recent reports have shown favorable clinical outcomes. This study aimed to compare the clinical outcomes of partial repair with those of the BR technique in LMRCTs. Materials and Methods: We included 72 patients who had undergone LMRCTs. Arthroscopic partial repair was performed in 31 patients (group I), while repair with the BR technique was performed in 41 patients (group II). Functional and imaging outcomes were evaluated and compared using a visual analog scale for pain, range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Korean Shoulder Score (KSS) before the surgery and at 3, 6, and 12 months after the surgery and at the last follow-up. Tendon integrity was investigated using magnetic resonance in all the patients at 12 months postoperative. Results: The mean follow-up period was 22.11 ± 10.47 months (range, 12–53 months). Forward flexion (p = 0.02) and external rotation at the side (p = 0.04) were significantly higher in group II than in group I on postoperative day (POD) 12 months. For internal rotation, group II showed significant improvement compared to group I on POD 3 months (p = 0.002) and at 6 months postoperative (p = 0.01). On POD 12 months, the ASES (p = 0.047) and KSS (p = 0.048) were better in group II. Significant improvements in pain and clinical scores were observed in both groups at the last follow-up. However, the two groups had no significant differences in pain, clinical scores, or ROM at the last follow-up. Retear of the repaired tendon was observed in nine patients in group I (29.03%) and eight in group II (19.51%, p = 0.35). Conclusions: Partial repair and repair using the BR technique effectively improved clinical and radiologic outcomes. The BR technique revealed early recovery of ROM and better clinical results than partial repair at one year postoperative. This could be a useful method in treating LMRCTs.

Hyung Seok Park, Jun Young Lee, Kang Yeol Ko, Jehong Ryu, Jae Hwan Lim. JKFAS 2020;24:129-34. https://doi.org/10.14193/jkfas.2020.24.4.129

Medial‐end clavicle fractures are rare, and the published literature is limited. Most injuries can be managed nonoperatively with favorable outcomes; however, displaced or comminuted fractures, symptomatic delayed union/nonunion, or fixation failure may require surgery, and operative management is challenging because of the proximity to vital mediastinal structures. We describe a 38‐year‐old man with a left medial‐end clavicle fracture sustained in a fall from approximately 9–10 m. Two prior plate fixation attempts at an outside clinic failed to maintain stable reduction, with persistent pain and fracture‐site prominence. At our facility, computed tomography confirmed an intact sternoclavicular joint but revealed severe comminution at the proximal fracture site with anterosuperior displacement of the distal fragment. We removed the failed hardware and performed revision fixation using a clavicle hook plate, intentionally limiting screw purchase to the distal fragment to reduce mediastinal risk. Postoperatively, teriparatide was administered as an adjunctive therapy because of concern for impaired healing after repeated fixation failure. The implant was removed on 28 October 2024 after radiographic union, and at the final follow‐up on 18 April 2025, union was maintained and pain was minimal (VAS ≤ 1/10); standardized functional outcome scores were not available. This single case suggests that hook plate fixation may be a salvage option when safe medial screw purchase is not feasible; interpretation is limited by the case‐report design and adjunctive pharmacologic therapy.

Background/Objectives: Osteoporosis is caused by excessive osteoclast activation via the receptor activator nuclear factor kappa B ligand (RANKL), which is released from osteoblasts or osteocytes. RANKL regulates osteoclast activity by binding to the receptor activator of nuclear factor kappa B (RANK) in the canonical pathway or leucine-rich repeat-containing G protein-coupled receptor 4 (LGR4) in the non-canonical pathway. In this study, we attempted to develop an intact small-fragment protein based on RANKL by removing the RANK-binding site and transforming the amino acid residues at crucial sites to inhibit osteoclast activity and treat osteoporosis. Methods: We expressed a small-fragment variant of RANKL as a soluble glutathione S-transferase (GST) or 6x histidine (His)-tagged fusion protein using a GST- or His-binding domain tag expression vector system. To generate an intact form of small-fragment RANKL, ribosome-inactivating protein–His-fusion RANKL was purified using HisTrap affinity chromatography and treated with tobacco etch virus nuclear inclusion endopeptidase to remove the His-tag fusion protein. Tartrate-resistant acid phosphatase (TRAP) and bone resorption pit formation assays were performed to analyze the inhibitory effects on osteoclast differentiation and activation. Results: The intact forms of 225RANKL295P and 225RANKL295A showed the strongest inhibitory effects on TRAP activity and bone resorption pit formation. Conclusions: Using an optimal construct design, a large and diverse range of small RANKL fragments could be generated. This suggests that the generation of small-fragment RANKL provides a promising avenue for the advancement of novel therapeutic approaches to osteoporosis.