Articular-sided Partial-thickness Rotator Cuff Tears Research Articles

Transtendon technique versus repair after completion of the tear for articular-sided partial rotator cuff tear: a meta-analysis of comparative studies

BackgroundTranstendon repair and repair after completion of the tear have been widely used to treat partial-thickness rotator cuff tears (PT-RCTs). The present study was aimed to compare the clinical outcomes and tendon integrity following arthroscopic repair of articular PT-RCTs using transtendon repair or repair after completion of the tear.MethodsWe performed a systematic electronic database search on Cochrane Central Register of Controlled Trials, PubMed and Embase to identify articles equating articular-sided PT-RCTs repair. The randomized controlled clinical trials that met our criteria were evaluated for quality of methodology. The results obtained were further analyzed and correlated to present the benefits and drawbacks comparing the two surgical procedures.ResultAccording to our inclusion and exclusion criteria, six articles were included in the present study. A total of 501 patients were analyzed as part of this study. The results indicated that both the surgical treatments provided excellent functional improvements and tendon integrity. However, no significant differences for the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, constant score, range of motion, postoperative adhesive capsulitis, tendon integrity and patient satisfaction were found between the two cohorts (p > 0.05).ConclusionsBoth transtendon technique and repair after completion of the tear for articular-sided partial rotator cuff tear provide improvements in clinical outcome with a low complication rate and a high rate of healing.

MRA improves sensitivity than MRI for the articular-sided partial-thickness rotator cuff tears.

This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT). Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUC). Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65-0.90), 0.96 (95% CI, 0.91-0.98), 68.14 (95% CI, 33.20-139.84) and 0.96 (95% CI, 0.94-0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65-0.87) and 0.97 (95% CI, 0.84-0.99), 47.82 (95% CI, 8.29-275.89) and 0.89 (95% CI, 0.86-0.92), respectively. This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears because of an improvement of sensitivity.

Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up.

Background:The best surgical treatment option for symptomatic moderate- to high-grade articular-sided partial-thickness rotator cuff tears (PTRCTs) is still controversial.Purpose/Hypothesis:The purpose of this study was to evaluate patient-reported and clinical outcomes and tendon integrity after arthroscopic debridement or repair for PTRCTs at a minimum of 2 years postoperatively. We hypothesized that the overall outcomes would be positive, showing pain relief, good shoulder function, and high tendon integrity.Study Design:Cohort study; Level of evidence, 3.Methods:We evaluated 30 patients (16 men, 14 women; mean age, 51 years) who underwent arthroscopic treatment for symptomatic PTRCTs (Ellman grades 2 and 3). Debridement was performed in 15 patients, and arthroscopic tendon repair was performed in the remaining 15 patients. Patients completed the Constant score; American Shoulder and Elbow Surgeons (ASES) shoulder score; Western Ontario Rotator Cuff Index; Simple Shoulder Test; and visual analog scale (VAS) for pain, function, and satisfaction. In addition, patients were examined clinically (range of motion, impingement tests, rotator cuff tests, and tests for the long head of the biceps tendon), and morphologic assessment of rotator cuff integrity was performed using direct magnetic resonance arthrography and was classified according to Sugaya.Results:The mean follow-up period was 55 months. The patient-reported outcome measures showed high patient satisfaction, reduction in persistent pain, and good shoulder function. Linear regression analysis showed that the debridement group had significantly better results on the Constant (bias-corrected and accelerated [BCa] 95% CI, 4.20-26.30), ASES (BCa 95% CI, 5.24-39.26), and VAS (pain: BCa 95% CI, 0.13-3.62; function: BCa 95% CI, 1.04-4.84; satisfaction: BCa 95% CI, 0.14-6.28) scores than did the repair group. At follow-up, there was no significant difference between the groups in clinical testing results. Good supraspinatus tendon integrity was seen in most patients: Sugaya classification grade 1 in 13 patients, grade 2 in 11 patients, and grade 3 in 6 patients.Conclusion:Midterm results after arthroscopic debridement and repair for PTRCTs showed high patient satisfaction, good shoulder function, and high tendon integrity for both procedures. Patients who underwent arthroscopic debridement had higher Constant, ASES, and VAS scores compared with patients who underwent tendon repair.

No Difference in Outcome Between Articular-Sided and Bursal-Sided Tears: Comparative Study With Minimum 2-Year Follow-Up of Arthroscopic Repairs in 104 Patients in a Single-Surgeon Series

To evaluate and compare the functional outcomes after arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tears. We conducted a retrospective analysis of patients who had undergone arthroscopic tear completion and subsequent repair of symptomatic partial-thickness rotator cuff tears in a single institution from 2010 to 2015. Range of motion (ROM) (forward flexion and abduction), the pain score as measured on the Numeric Pain Rating Scale, and outcome scores (Constant-Murley score, University of California, Los Angeles shoulder score, and Oxford Shoulder Score) were calculated preoperatively and at 1 year and 2 years postoperatively. The delta difference was calculated for each outcome parameter at the respective follow-up points as the difference from the preoperative baseline score. A total of 104 patients were included. All tears involved the supraspinatus tendon and did not exceed 2 cm. Of the patients, 65 had an articular-sided tear (AST) whereas 39 had a bursal-sided tear (BST). The mean age of the patients was 53.4 years in the AST group and 55.8 years in the BST group. The AST and BST groups did not differ preoperatively in terms of age, sex, and the measured outcome parameters. Postoperatively, the patients in both groups achieved statistically significant improvement in pain relief and functional outcomes at 2 years. No statistically significant difference was observed between the 2 groups in terms of the delta-difference outcomes in ROM in forward flexion (P= .781) or abduction (P= .348), pain score (P= .187), Constant-Murley score (P= .186), University of California, Los Angeles shoulder score (P= .911), and Oxford Shoulder Score (P= .186) at 2 years. Partial-thickness rotator cuff tears treated with arthroscopic tear completion and subsequent repair achieved good outcomes in terms of ROM, functional outcomes, and pain relief at 2 years. There was no difference in outcomes regardless of whether the location of the tear was articular sided or bursal sided. Level III, retrospective comparative study.

Repairing PASTA Lesions Without Violation of the Rotator Cuff

Partial-thickness articular-sided rotator cuff tears are a common cause of shoulder pain in adults. Although partial rotator cuff tears have a high prevalence, there is still controversy over their proper surgical treatment. Different surgical procedures have been suggested when partial tears involve the articular side of the rotator cuff, such as arthroscopic debridement of the tear with or without acromioplasty, tear completion and repair, and transtendinous in situ repair. Although multiple repair techniques have been described, significant clinical data to definitively support one technique over the others are currently lacking. We describe an arthroscopic technique for repair of a partial articular supraspinatus tendon avulsion that avoids the transtendinous insertion of suture anchors to preserve the tendon integrity.

Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study.

The purpose of this prospective study was to compare the clinical and structural findings following the arthroscopic repair of partial-thickness (exceeding 50%) articular-sided rotator cuff tears using either a single-row or a double-row suture bridge fixation. Fifty patients were included in this study. The patients were randomly placed into two groups: 25 underwent the single-row (Group I) and 25 a double-row suture bridge fixation (Group II). The clinical outcomes were assessed using ASES and Constant shoulder scores, both preoperatively and at the end of follow-up. The pain level was evaluated using the visual analogue scale (VAS), preoperatively, at 6months and at the end of follow-up. All patients underwent preoperative MRI to identify the rotator cuff tear, and postoperatively at 12months to evaluate tendon integrity. The average follow-up was 32.5months. The mean ASES scores increased from 35.9 to 96.7 in Group I and from 35.3 to 93.4 in Group II; the mean Constant shoulder scores increased from 55.6 to 97.8 in Group I and from 57.5 to 97.3 in Group II. There were no significant differences between the two groups. The average preoperative pain level decreased from 7.4 to 3 at 6months and to 0.4 at the end of the Group I; and from 7.6 to 3 at 6months and 0.8 in Group II. There was no significant difference between the two groups. At 12months, the MRI assessments showed two retears in Group I (8%) and one retear in Group II (4%). Arthroscopic repair of partial-thickness articular rotator cuff tears that exceed 50% of tendon thickness with a single-row transtendon repair or double-row suture bridge provides functional improvement and pain relief regardless of the repair technique used. There were no differences in clinical results between both techniques. Level II; prospective comparative study.

Partial-Thickness Rotator Cuff Tear by Itself Does Not Cause Shoulder Pain or Muscle Weakness in Baseball Players

Background: Partial-thickness rotator cuff tears are common shoulder injuries in baseball players. For some tears, the symptoms can be relieved through physical therapy or debridement without rotator cuff repair. Purpose: To assess whether partial-thickness rotator cuff tear by itself causes shoulder pain and muscle weakness in baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We studied 87 university baseball players (age, 19.5 ± 0.8 years; baseball career, 11.5 ± 1.6 years). All data were obtained during a full-participation annual medical check in 1 team. Rotator cuff tendons were examined ultrasonographically and allocated to 4 groups: (1) no tear, (2) supraspinatus tendon tear, (3) infraspinatus tendon tear, and (4) both supraspinatus and infraspinatus tendon tears. Current shoulder pain and shoulder muscle strength (dominant/nondominant) in abduction, external rotation, and internal rotation were compared by using chi-square and t tests. All players could play baseball with or without shoulder pain in this study. Results: Of the 87 players, 41 (47%) had articular-sided partial-thickness rotator cuff tears diagnosed on ultrasonography; the remaining 46 athletes were tear-free. Of the 41 affected patients, 19 had tears in the supraspinatus, 13 in the infraspinatus, and 9 in both the supraspinatus and infraspinatus tendons. Tear depth (mean ± SD) was 4.6 ± 2.3 mm in the supraspinatus and 6.2 ± 3.6 mm in the infraspinatus. Neither the rate of shoulder pain nor muscle strength differed significantly among the 4 groups (P = .96 and P = .15-.70, respectively). Conclusion: Articular-sided partial-thickness rotator cuff tear—by itself—did not cause shoulder pain and muscle weakness in university baseball players. Most so-called articular-sided partial-thickness rotator cuff tears may not be pathologic tendon tears.

Partial-thickness Rotator Cuff Tear Itself Did Not Cause Shoulder Pain Or Muscle Weakness In Baseball Players

Objectives:Rotator cuff tears are common shoulder injuries in baseball players. In some severe tears (i.e. through more than 50% of the cuff’s thickness), conservative treatment does not work well, and surgical treatment is sometimes chosen in an effort to ensure return to play. In contrast, some partial thickness rotator cuff tears do not cause shoulder symptoms, even during throwing motion. The objective of this study was to assess whether partial thickness rotator cuff tears cause shoulder pain and muscle weakness in baseball players.Methods:We studied 87 university baseball players (age: 19.5±0.8 years; baseball career: 11.5±1.6 years). Rotator cuff tendons were ultrasonographically examined (Fig 1), then divided into 4 groups; (1) no tear, (2) supraspinatus tendon tear, (3) infraspinatus tendon tear, (4) both supraspinatus and infraspinatus tendons tear. Current shoulder pain and shoulder muscle strength (Dominant/Non-dominant) in abduction, external rotation, and internal rotation were compared using Chi square test and t-test.Results:Forty-one (47%) players were diagnosed with articular-sided partial-thickness rotator cuff tears using ultrasonography. Nineteen tears were in the supraspinatus, 13 in the infraspinatus, and 9 in both the supraspinatus and the infraspinatus. Tear depth was 4.6±2.3 mm in the supraspinatus and 6.2±3.6 mm in the infraspinatus. There was no significant difference in rate of shoulder pain (p=0.96) and muscle strength among four groups (p=0.15 - 0.70).Conclusion:In this study, articular-sided partial-thickness rotator cuff tears did not cause shoulder pain and muscle weakness in university baseball players. Most of articular-sided partial-thickness rotator cuff tears are tears of the superior capsule but not the rotator cuff tendons, because the superior capsule is attached in the articular half of the greater tuberosity. Therefore, most so-called articular-sided partial-thickness rotator cuff tears may not be pathological tendon tear.

Pathoanatomy of Shoulder Instability in Collegiate Female Athletes

Background: Shoulder instability has been well described in young men; however, few studies have specifically evaluated the pathoanatomy and unique spectrum of injuries in women with shoulder instability. Purpose: To describe the pathoanatomy of operative shoulder instability in a collegiate female cohort. Study Design: Case series; Level of evidence, 4. Methods: The authors performed a retrospective analysis of a consecutive series of female students at a National Collegiate Athletic Association Division I military service academy treated operatively for shoulder instability by a single surgeon between September 2008 and September 2014. Preoperative data collected included patient age, sport, mechanism of injury, number and frequency of dislocations, direction of instability, and co-occurring surgical abnormalities at the time of arthroscopy. Outcome variables included recurrent instability after surgery and need for revision. Results: Thirty-six female student athletes with an average age of 20 years (range, 18-22 years) were included. The majority of instability events were traumatic in nature (69%), and 61% of the total events were subluxations. Rugby was the most common sport for experiencing instability (7 patients), followed by obstacle course training (6 patients). Thirty-two patients (89%) reported multiple instability events, averaging 4 per shoulder. The primary direction of instability was anterior in 26, combined anterior and posterior in 7, and 3 met criteria for multidirectional instability. At the time of surgery, 26 patients (72%) had a Bankart tear, 9 (25%) had a posterior labral tear, and 5 (14%) had superior labrum anterior to posterior tears. Nine patients (25%) were found to have humeral avulsion of the glenohumeral ligament (HAGL) lesions, 7 (19%) had partial-thickness articular-sided rotator cuff tears, and only 1 patient (3%) had evidence of true attritional glenoid bone loss. Hill-Sachs lesions were found in 16 patients (44%). Recurrent instability occurred in 9 patients (25%) following arthroscopic stabilization, and revision surgery was performed in 6 (17%). Conclusion: Shoulder instability in female athletes presents commonly as multiple subluxation events. While soft tissue Bankart lesions were found in numbers equal to those in previous studies include both sexes, bony Bankart lesions were less common in women. Finally, the presence of combined anterior and posterior labral tears and HAGLs in women was more common than previously reported.

Short-term Outcomes of Arthroscopic Debridement and Selected Acromioplasty of Bursal- vs Articular-Sided Partial-Thickness Rotator Cuff Tears of Less Than 50.

Background:While it is believed that good results can be achieved by arthroscopic debridement of partial-thickness tears (PTTs) of <50% tendon thickness, few studies have directly compared the treatment of articular- versus bursal-sided PTTs of <50%.Purpose:To compare the postoperative outcomes of patients with articular- versus bursal-sided PTTs of <50% tendon thickness that were treated with arthroscopic debridement and selective acromioplasty (for type II or III acromions).Study Design:Cohort study; Level of evidence, 3.Methods:An analysis was performed with data from 76 consecutive patients diagnosed with a PTT <50% tendon width (Ellman grade II) who had undergone arthroscopic debridement and selective acromioplasty (for type II or III acromions). Outcome measures included the short version of the Western Ontario Rotator Cuff index, the American Shoulder and Elbow Surgeons score, and the relative Constant-Murley score, as well as strength of the affected shoulder. A statistical paired t test (preoperative vs 2 years postoperative) and an independent t test were utilized to compare outcomes between patients with bursal- and articular-sided tears.Results:Between 2001 and 2010, there were 40 (53%) articular- and 36 (47%) bursal-sided tears treated with debridement and selective acromioplasty. The mean patient age was 55 years (range, 36-77 years) for the bursal group and 56 years (range, 33-81 years) for the articular group. The mean follow-up was 24 months (range, 22-26 months). Both groups showed significant improvement in the short version of the Western Ontario Rotator Cuff index, American Shoulder and Elbow Surgeons score, and relative Constant-Murley score 2 years after surgery (P < .0001) as well as in strength (P < .0001 for bursal tears, P = .006 for articular tears). There was no statistically significant difference between groups in any of the postoperative outcome measures at 2 years.Conclusion:The results of this study demonstrate that good outcomes can be achieved with arthroscopic debridement and selective acromioplasty among patients with articular- or bursal-sided PTT of <50% tendon thickness. No difference was observed between groups at 2-year follow-up.

Do Articular-Sided Partial-Thickness Rotator Cuff Tears After a First-Time Traumatic Anterior Shoulder Dislocation in Young Athletes Influence the Outcome of Surgical Stabilization?

Background:Because of the high risk for redislocations after a first-time traumatic anterior shoulder dislocation with conservative treatment, recent publications have recommended early arthroscopic intervention, especially for young athletes. Concomitant rotator cuff tendon damage may occur when the shoulder dislocates; however, its presence and influence on clinical results have not been well described in this patient category.Hypothesis:In opposition to current opinion, a substantial number of articular-sided partial-thickness rotator cuff tears (APTRCTs) would be found at surgery after a first-time traumatic anterior shoulder dislocation in young athletes. However, the impact of these injuries on 2-year postoperative results would be negligible.Study Design:Cohort study; Level of evidence, 3.Methods:Sixteen male patients (mean age, 21 years [range, 16-25 years]) with a first-time traumatic anterior shoulder dislocation without bony Bankart lesions were included in this study. The indications for surgical treatment were age less than 25 years and being active in collision or contact sports at a competitive level. Arthroscopic surgery was performed at a mean 7.8 days (range, 2-14 days) after injury. Rowe and American Shoulder and Elbow Surgeons (ASES) scores as well as range of motion were evaluated at a minimum 2 years after an arthroscopic Bankart procedure, and a comparison of the clinical results between patients with and without APTRCTs was conducted.Results:An anterior-inferior capsulolabral injury was found in all patients. There were no bony Bankart lesions. An APTRCT was found in 9 of the 16 patients. At 2 years after surgical treatment, there were no significant differences between the patients with and without APTRCTs in terms of the Rowe score (90.0 and 87.1, respectively; P = .69) and ASES score (94.6 and 90.4, respectively; P = .67).Conclusion:APTRCTs were found in the superior part of the shoulder joint after a first-time traumatic anterior shoulder dislocation in a majority of young male athletes treated with surgical stabilization. There were no significant differences found between patients with and without APTRCTs in terms of the Rowe and ASES scores at 2 years after surgical treatment.

Arthroscopic knotless single-row repair preserving full footprint versus tear completion repair for partial articular-sided rotator cuff tear.

The comparison of clinical outcomes of arthroscopic footprint-preserving knotless single-row repair with the tear completion repair technique for articular-sided partial-thickness rotator cuff tears (PTRCTs) remains unclear. A total of 68 patients diagnosed with articular-sided PTRCTs who underwent rotator cuff repair between December 2014 and June 2015 were included. Of the 68 patients, 30 received footprint-preserving knotless single-row repair (group 1) and 38 received the tear completion repair technique (group 2). Preoperative and postoperative assessments were compared. Both groups had significantly improved American Shoulder and Elbow Surgeons (ASES) scores (group 1: 48.2 preoperatively to 81.9 postoperatively, p < 0.001; group 2: 47.1 preoperatively to 84.9 postoperatively, p < 0.001) and visual analog scale (VAS) pain score (group 1: 6.0 preoperatively to 0.93 postoperatively, p < 0.001; group 2: 6.1 preoperatively to 1.1 postoperatively, p < 0.001), showing that the two procedures significantly improved postoperative shoulder function. No significant differences were shown in ASES score or VAS pain score between the two groups ( p > 0.05). The mean operation time was significantly shorter in group 1 with an average of 48.1 min than in group 2 with an average of 60.4 min ( p < 0.001). Footprint-preserving knotless single-row repair obtains similar clinical results compared to tear completion repair in the treatment of articular-sided PTRCTs. Footprint-preserving knotless single-row repair may be a convenient choice for the treatment of articular-sided PTRCTs. Randomized controlled studies are needed to investigate whether the footprint-preserving knotless single-row repair yields better long-term outcomes through the protection of the bursal cuff and restoration of the healthy footprint.

Partial-thickness tears involving the rotator cable lead to abnormal glenohumeral kinematics

The objective of this study was to determine the biomechanical function of the rotator cable when a partial-thickness (>50%) tear is present. We compared intact specimens with partial tears of the anterior cable followed by partial anterior and posterior tears in regard to glenohumeral kinematics and translation. The hypothesis was that partial-thickness tears will lead to abnormal glenohumeral biomechanics, including glenohumeral translation and path of glenohumeral articulation. Five fresh frozen cadaveric shoulders with intact labrum, rotator cuff, and humerus were tested using a custom shoulder testing system in the scapular plane. Glenohumeral translation was measured after applying an anterior load of 30 N at different angles of external rotation. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at 30°, 60°, 90°, and 120° of external rotation. With an anterior force of 30 N, there was a significant increase in anterior and total translation at 30° of external rotation after the anterior cable was cut (P < .05). When the tear was extended to the posterior cable, there was a significant increase in anterior, inferior, and total translation at 30° and 120° of external rotation (P < .05). With respect to the path of glenohumeral articulation , the humeral head apex was shifted superiorly at 90° and 120° of external rotation after the posterior cable was cut (P < .05). Partial-thickness articular-sided rotator cuff tears with a thickness >50% involving the rotator cable increased glenohumeral translation and changed kinematics in our cadaveric biomechanical model.

Ultrasound and Functional Assessment of Transtendinous Repairs of Partial-Thickness Articular-Sided Rotator Cuff Tears.

Background:Partial-thickness articular-sided rotator cuff tears are a frequent source of shoulder pain. Despite conservative measures, some patients continue to be symptomatic and require surgical management. However, there is some controversy as to which surgical approach results in the best outcomes for grade 3 tears.Hypothesis/Purpose:The purpose of this study was to evaluate repair integrity and the clinical results of patients treated with transtendinous repair of high-grade partial-thickness articular-sided rotator cuff tears. Our hypothesis was that transtendinous repairs would result in reliable healing and acceptable functional outcomes.Study Design:Case series; Level of evidence, 4.Methods:Twenty patients with a minimum follow-up of 2 years were included in the study. All patients underwent arthroscopic repair of high-grade partial-thickness rotator cuff tears utilizing a transtendinous technique by a single surgeon. At latest follow-up, the repair integrity was evaluated using ultrasound imaging, and functional scores were calculated.Results:Ultrasound evaluation demonstrated that 18 of 20 patients had complete healing with a normal-appearing rotator cuff. Two patients had a minor residual partial tear. Sixteen of 20 patients had no pain on visual analog scale. Four patients complained of mild intermittent residual pain. All patients were rated as “excellent” by both the University of California at Los Angeles Shoulder Score and the Simple Shoulder Test.Conclusion:The transtendon technique for the repair of articular-sided high-grade partial rotator cuff tears results in reliable tendon healing and excellent functional outcomes.

Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique.

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 6months 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<0.001). No patients had rotator cuff retears on 6-month MRI. No complications related to surgical procedures had occurred. The devised technique of arthroscopic transtendon repair provided satisfactory functional outcomes without postoperative discomforts. This technique minimizes over-tightening of the articular layer and reduces tension mismatches between the articular and bursal layers, which are considered as important factors for improvement of postoperative shoulder motion.

Which is the best repair of articular-sided rotator cuff tears: a meta-analysis.

BackgroundTear conversion followed by repair and trans-tendon techniques have been widely used for partial-thickness rotator cuff tears. Both of them showed favorable results with regard to the management of articular-sided partial-thickness rotator cuff tears (PTRCTs) of more than 50 % thickness. However, controversy continues with the best management. This study aims to compare the clinical outcomes between the two techniques.MethodsThe PubMed, Embase, and Cochrane library databases were searched for relevant studies published before October 1, 2014. Studies that clearly reported a comparison between the two procedures were selected. The American Shoulder and Elbow Surgeons scale (ASES) and the re-tear rate were evaluated. Statistical analysis was performed using the special meta-analysis software called “Comprehensive Meta Analysis”.ResultsFinal meta-analysis after the full-text review included four studies about tear conversion followed by repair and seven studies about trans-tendon technique. The trans-tendon technique showed no significant difference with the tear conversion followed by repair technique with regard to the ASES scale (P = 0.69). But the re-tear rate (P < 0.05) was markedly lower in the trans-tendon technique group than the tear conversion and repair technique group.ConclusionIn conclusion, the meta-analysis suggests that the trans-tendon technique is better than the tear conversion followed by repair technique with regard to the management of articular-sided PTRCTs of more than 50 % thickness in the re-tear rate aspect.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-015-0224-6) contains supplementary material, which is available to authorized users.

Biomechanical Analysis of Articular-Sided Partial-Thickness Rotator Cuff Tear and Repair

Background: Articular-sided partial-thickness rotator cuff tears are common injuries in throwing athletes. The superior shoulder capsule beneath the supraspinatus and infraspinatus tendons works as a stabilizer of the glenohumeral joint. Purpose: To assess the effect of articular-sided partial-thickness rotator cuff tear and repair on shoulder biomechanics. The hypothesis was that shoulder laxity might be changed because of superior capsular plication in transtendon repair of articular-sided partial-thickness rotator cuff tears. Study Design: Controlled laboratory study. Methods: Nine fresh-frozen cadaveric shoulders were tested by using a custom shoulder-testing system at the simulated late-cocking phase and acceleration phase of throwing motion. Maximum glenohumeral external rotation angle, anterior translation, position of the humeral head apex with respect to the glenoid, internal impingement area, and glenohumeral and subacromial contact pressures were measured. Each specimen underwent 3 stages of testing: stage 1, with the intact shoulder; stage 2, after creation of articular-sided partial-thickness tears of the supraspinatus and infraspinatus tendons; and stage 3, after transtendon repair of the torn tendons by using 2 suture anchors. Results: Articular-sided partial-thickness tears did not significantly change any of the shoulder biomechanical measurements. In the simulated late-cocking phase, transtendon rotator cuff repair resulted in decreased maximum external rotation angle by 4.2° (P = .03), posterior shift of the humeral head (1.1-mm shift; P = .02), decreased glenohumeral contact pressure by 1.7 MPa (56%; P = .004), and decreased internal impingement area by 26.4 mm2 (65%; P < .001) compared with values in the torn shoulder. In the acceleration phase, the humeral head shifted inferiorly (1.2-mm shift; P = .03 vs torn shoulder), and glenohumeral anterior translation (1.5-mm decrease; P = .03 vs torn shoulder) and subacromial contact pressure (32% decrease; P = .004 vs intact shoulder) decreased significantly after transtendon repair. Conclusion: Transtendon repair of articular-sided partial-thickness supraspinatus and infraspinatus tears decreased glenohumeral and subacromial contact pressures at time zero; these changes might lead to reduced secondary subacromial and internal impingements and consequently progression to full-thickness rotator cuff tear. However, repair of the tendons decreased anterior translation and external rotation and changed the positional relationship between the humeral head and the glenoid. Clinical Relevance: Careful attention should be paid to shoulder laxity and range of motion when transtendon repair is chosen to treat articular-sided partial-thickness rotator cuff tears, specifically in throwing athletes.

Humeral head cysts: association with rotator cuff tears and age

The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. Magnetic resonance (MR) images of 657 patients who underwent shoulder arthroscopy for treatment of rotator cuff disorders were reviewed to localize the cystic changes at anterior (supraspinatus insertion) and posterior (infraspinatus insertion) aspects of greater tuberosity (GT) and lesser tuberosity (subscapularis insertion). Preoperative MR reports as well as cyst size and locations on MR images were correlated with arthroscopic records of rotator cuff pathology (tear type, size, location and tendon involvement) and patient age. The prevalence of cystic changes was 9.1% (60 patients) in the study population. Anterior GT cysts were found in 56% of patients and were strongly associated with full-thickness (p<.001) and articular-sided partial-thickness rotator cuff tears (p=.02). Posterior GT and lesser tuberosity cysts were found in 27 and 17% of patients, respectively, and were not significantly related to rotator cuff tears, although there was an increased trend of posterior cysts in patients with infraspinatus tears (p=.09). A significant relation was found between patient age and the cyst size (p=.01), while none of the cyst localizations were statistically related to age. Anterior GT cysts were more common in this patient group and demonstrated a strong association with rotator cuff disorders regardless of age. Posterior GT and lesser tuberosity cysts were less common and showed no association with rotator cuff pathology or patient age.

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

To compare two groups of patients who underwent two different arthroscopic procedures for repair of articular-sided partial-thickness rotator cuff tears (PTRCTs). This is a comparative prospective study of two methods for repair of partial cuff tears: Thirty-two patients underwent arthroscopic rotator cuff repair with a transtendon technique (group 1); 28 underwent arthroscopic full-thickness conversion and repair of the lesion (group 2). ROM measures, clinical findings, MRI features (tendon healing and re-tear), Constant-Murley and ASES scores were assessed pre- and postoperatively and compared. Patients were also asked about return to sport and level of activity. At the last appointment, patients of both the groups were significantly improved for clinical findings, ROM measures, imaging features, Constant-Murley and ASES scores than at baseline, without any significant inter-group difference. In group 1, 15 of 20 patients (75 %) who practiced recreational sport activities had returned to sport at the same level as before the onset of symptoms, without any discomfort. In group 2, 12 of 18 patients (67 %) had returned to the same level of sport activity they practiced before symptoms. At the last follow up, MRI showed rotator cuff healing in 31 patients of Group 1 and 27 patients of Group 2 (p = 0.83). The two procedures are safe, effective, and comparable.

Histopathology of Residual Tendon in High-Grade Articular-Sided Partial-Thickness Rotator Cuff Tears (PASTA Lesions)

The purpose of this study was to examine the histopathologic features of the residual intact tissue of a partial articular surface tendon avulsion (PASTA) tear. In 30 consecutive patients with PASTA lesions, biopsy specimens of the residual tendon were taken. The mean age was 60.4 years (range, 28 to 78 years). All tears were converted to full-thickness tears and arthroscopically repaired. None of the patients were overhead athletes. Samples were histopathologically examined and graded by use of a modified semiquantitative scale (between 0, normal appearance, and 21, most abnormal appearance). Data were analyzed by multiple regression analysis to estimate the effect of aging, smoking status, duration of pain, and steroid injections. Degenerative changes were evident in 28 of 30 cases (93%). The mean score on the modified semiquantitative grading scale was 10.5 (range, 3 to 16; SD, 2.6). Multiple regression analysis failed to show a statistically significant correlation between the score on the modified semiquantitative grading scale and aging, smoking status, duration of pain, or steroid injections. Over 90% of the macroscopically intact residual tendon tissues of the PASTA lesions showed moderate histopathologic degeneration. Level IV, therapeutic case series.