Chronic Full-thickness Rotator Cuff Tears Research Articles

The responsiveness and validity of the Rotator Cuff Quality of Life (RC-QOL) index in a 2-year follow-up study.

BackgroundThe Rotator Cuff Quality of Life (RC-QOL) index was developed to evaluate quality of life in patients with rotator cuff disease. This study provides additional psychometric testing in accordance with the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines.MethodsThis was a 2-year follow-up study on 66 patients (mean age, 59 ± 10 years) originally presenting with chronic full-thickness rotator cuff tears to a tertiary care center. The methodology involved testing internal consistency, content validity, and criterion validity. Responsiveness was evaluated using 3 strategies: 1) standardized response mean of the raw change scores; 2) Guyatt’s Responsiveness Index; and 3) Global Rating Scales of improvement correlated to a quality of life measure.ResultsContent validity was confirmed with a Cronbach α of 0.92 (95% confidence interval, 0.92-0.95) and absence of floor and ceiling effects. Criterion validity was confirmed using the Western Ontario Rotator Cuff Index as a reference standard (r = 0.87, P < .001). The effect size of distribution-based methods of determining responsiveness was large (0.99-1.09) compared to that of mixed- and anchor-based methods (0.47-0.89). All responsiveness calculations met minimum requirements for acceptable thresholds.ConclusionThe RC-QOL is a valid and responsive measure of health-related quality of life in patients with chronic rotator cuff pathology. The results of this study added to the methodologic quality assessment of the RC-QOL, completing 7 of 10 Consensus-Based Standards for the Selection of Health Measurement Instruments criteria.

A 3-Dimensional Bioprinted Scaffold With Human Umbilical Cord Blood–Mesenchymal Stem Cells Improves Regeneration of Chronic Full-Thickness Rotator Cuff Tear in a Rabbit Model

Background: Chronic full-thickness rotator cuff tears (FTRCTs) represent a major clinical concern because they show highly compromised healing capacity. Purpose: To evaluate the efficacy of using a 3-dimensional (3D) bioprinted scaffold with human umbilical cord blood (hUCB)–mesenchymal stem cells (MSCs) for regeneration of chronic FTRCTs in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 32 rabbits were randomly assigned to 4 treatment groups (n = 8 per group) at 6 weeks after a 5-mm FTRCT was created on the supraspinatus tendon. Group 1 (G1-SAL) was transplanted with normal saline. Group 2 (G2-MSC) was transplanted with hUCB-MSCs (0.2 mL, 1 × 106) into FTRCTs. Group 3 (G3-3D) was transplanted with a 3D bioprinted construct without MSCs, and group 4 (G4-3D+MSC) was transplanted with a 3D bioprinted construct containing hUCB-MSCs (0.2 mL, 1 × 106 cells) into FTRCTs. All 32 rabbits were euthanized at 4 weeks after treatment. Examination of gross morphologic changes and histologic results was performed on all rabbits after sacrifice. Motion analysis was also performed before and after treatment. Results: In G4-3D+MSC, newly regenerated collagen type 1 fibers, walking distance, fast walking time, and mean walking speed were greater than those in G2-MSC based on histochemical and motion analyses. In addition, when compared with G3-3D, G4-3D+MSC showed more prominent regenerated tendon fibers and better parameters of motion analysis. However, there was no significant difference in gross tear size among G2-MSC, G3-3D, and G4-3D+MSC, although these groups showed significant decreases in tear size as compared with the control group (G1-SAL). Conclusion: Findings of this study show that a tissue engineering strategy based on a 3D bioprinted scaffold filled with hUCB-MSCs can improve the microenvironment for regenerative processes of FTRCT without any surgical repair. Clinical Relevance: In the case of rotator cuff tear, the cell loss of the external MSCs can be increased by exposure to synovial fluid. Therefore, a 3D bioprinted scaffold in combination with MSCs without surgical repair may be effective in increasing cell retention in FTRCT.

The Effect of Tendon Delamination on Rotator Cuff Healing

Background: While patient age, tear size, and muscle fatty infiltration are factors known to affect the rate of tendon healing after rotator cuff repair, the effect of tendon delamination is less known. Purpose: To assess the effect of tendon delamination on rotator cuff healing after arthroscopic single-row (SR) repair. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients (N = 117) with chronic full-thickness rotator cuff tears underwent arthroscopic SR repair with the tension-band cuff repair. The mean ± SD age at the time of surgery was 60 ± 8 years. There were 25 small, 63 medium, and 29 large tears. Tendon delamination was assessed intraoperatively under arthroscopy with the arthroscope placed in the lateral portal. Patients were divided into 2 groups: those with nondelaminated (n = 80) and delaminated (n = 37) cuff tears. The 2 groups were comparable for age, sex, body mass index, preoperative pain, strength, and a Constant-Murley score. Repair integrity was evaluated with sonography (mean, 24 months after surgery; range, 6-62 months) and classified into 3 categories: type A, indicating complete, homogeneous, and thick coverage of the footprint; type B, partial coverage with a thin tendon; and type C, no coverage of the footprint. Results: The prevalence of tendon delamination observed under arthroscopy was 32% (37 of 117), which increased with tear size and retraction: from 15% in small tears to 32% in medium tears and 45% in large tears (P = .028). Postoperatively, 83 patients had complete coverage of footprint (type A = 71%) and the cuff was considered healed, whereas 26 had partial coverage or a thin tendon (type B = 22%) and 8 had no coverage (type C = 7%). Overall, the rate of complete healing was 78% in nondelaminated cuff tears and 57% in the case of tendon delamination (P = .029). In large retracted tears, the healing rate dropped from 81% in the absence of delamination to 39% when the tendons were delaminated (P = .027). Conclusion: Tendon delamination increases with tear size and retraction. Patients with chronic delaminated and retracted rotator cuff tears (stage 2 or 3) are at risk of failure after SR cuff repair, whereas patients with small delaminated rotator cuff tears (stage 1) involving only the supraspinatus can be treated with an SR cuff repair with a high chance of tendon healing. These results suggest that SR cuff repair may be insufficient to treat delaminated chronic cuff tears. To improve the anatomic outcomes of rotator cuff repairs, surgeons should consider treating delaminated tears with a double-row or double-layer repair.

Validation of a tool to assess patient satisfaction, waiting times, healthcare utilization, and cost.

Patients' experience of the quality of care received throughout their continuum of care can be used to direct quality improvement efforts in areas where they are most needed. This study aims to establish validity and reliability of the Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ) - a tool that collects patients' experience that quantifies aspect of care used to make judgments about quality from the perspective of the Alberta Quality Matrix for Health (AQMH). The AQMH is a framework that can be used to assess and compare the quality of care in different healthcare settings. The AQMH provides a common language, understanding, and approach to assessing quality. The HAPSQ is one tool that is able to assess quality of care according to five of six AQMH's dimensions. This was a prospective methodologic study. Between March and October 2015, a convenience sample of patients presenting with chronic full-thickness rotator cuff tears was recruited prospectively from the University of Calgary Sport Medicine Centre in Calgary, Alberta, Canada. Reliability of the HAPSQ was assessed using test-retest reliability [interclass correlation coefficient (ICC)>0.70]. Validity was assessed through content validity (patient interviews, floor and ceiling effects), criterion validity (percent agreement >70%), and construct validity (hypothesis testing). Reliability testing was completed on 70 patients; validity testing occurred on 96 patients. The mean duration of symptoms was three years (SD: 5.0, range: 0.1-29). Only out-of-pocket utilization possessed an ICC<0.70. Patients reported that items were relevant and appropriate to measuring quality of care. No floor or ceiling effects were present. Criterion validity was reached for all items assessed. A priori hypotheses were confirmed. The HAPSQ represents an inexpensive, reliable, and valid approach toward collecting clinical information across a patient's continuum of care.

Arthroscopic repair of full-thickness rotator cuff tears

Background Rotator cuff tears are among the most common conditions affecting the shoulder. Despite their ubiquity, there is substantial debate concerning their management. Arthroscopic repair methods have been developed, with the promise of more rapid patient recovery. Purpose The aim of this study was to describe the surgical technique and to evaluate the clinical results of arthroscopic repair of different-sized full-thickness rotator cuff tears using bone suture anchors. Patients and methods The study was conducted in the Department of Orthopaedic Surgery, El-Hadara Orthopaedic and in Traumatology University Hospital, Alexandria University (Egypt) from 2008 to 2010. Eighty shoulders in 80 patients, 38 men and 42 women, with symptomatic chronic full-thickness rotator cuff tears were included in the study. Arthroscopic cuff repair (using bone suture anchors) with subacromial decompression was applied to all patients. The age of the patients varied from 37 to 78 years with a mean of 61.15 years. There were 38 men (47.5%) and 42 women (52.5%). The patients were prospectively followed up clinically for a mean of 30 months (range: 20-37 months). The clinical assessment was performed with the modified University of California at Los Angeles score (55 points). Results The modified University of California at Los Angeles score improved significantly from a mean of 24.85 points preoperatively (range: 16-38 points) to a mean of 43.83 points postoperatively (range: 16-55 points) (P Conclusion Arthroscopic repair of full-thickness rotator cuff tears using bone anchors offered good results, provided a stable construct that can allow early rehabilitation without failure, and enabled tendon-bone healing. Arthroscopic rotator cuff repair was successful for large and small tears. Moreover, the earlier the operative intervention, the better was the outcome.

Assessment of function in patients with rotator cuff tears: Functional test versus self-reported questionnaire.

Purpose:The rotator cuff tears (RCT) are a well-known cause of shoulder pain and loss of upper extremity function. The purpose of this study was to evaluate the upper extremity function using two different methods in patients with RCT and to determine the parameters that influence the upper extremity function.Materials and Methods:A sample of 38 patients (27-76 years; 10 men and 28 women) who were diagnosed with a chronic full-thickness RCT, confirmed by magnetic resonance imaging (MRI), was studied. Upper extremity function was determined using Western Ontario Rotator Cuff Index (WORC) and 9 Hole Peg Test (9PEG). Other assessments included active range of motion (ROM), muscle strength, shoulder pain, and scapular dyskinesis.Results:There was a weak association between WORC scores and 9PEG. A statistically significant, negative relationship was found between 9PEG and ROM in supination, as well as muscle strength of shoulder extensors, adductors, internal and external rotators.Conclusions:In addition to the weak association between WORC and 9PEG, the difference between the parameters related to each method suggests that they should not be used interchangeably to determine the upper extremity function. We recommend the utilization of 9PEG instead of WORC in assessing the upper extremity function in the setting of loss of muscle strength.Level of Evidence:Level IV, Therapeutic study.

Simultaneous repair of chronic full-thickness rotator cuff tears during fixation of proximal humerus fractures and clinical results

We investigated the incidence of chronic rotator cuff tears encountered during fixation of proximal humerus fractures with locking plate-screw systems, and evaluated the functional results of simultaneous surgical repair of these injuries. A total of 111 patients underwent surgical treatment for proximal humerus fractures. Of these, nine patients (8 females, 1 male; mean age 73 years; range 56 to 84 years) who had concomitant chronic full-thickness rotator cuff tears were included in the study. According to the AO classification, the fractures were type 11A1 (12C1 also present) in one patient, 11A2 (12C2 also present) in one patient, 11B1 in two patients, 11B2 in three patients, and 11C2 in two patients. None of the patients underwent preoperative magnetic resonance imaging. Fracture fixation was made with the PHILOS plate in five patients, and with the S3 Proximal Humerus Plate in four patients. All full-thickness rotator cuff tears were detected during the operation. Following open reduction and internal fixation after a deltoid splitting incision, rotator cuff tears were repaired by primary suture in two patients, and with a suture anchor in seven patients. All the patients used a padded shoulder-arm sling for six weeks and received a standard rehabilitation program. All the patients were evaluated radiographically and functionally using the Constant-Murley shoulder score at postoperative 6 weeks, 6 months, and 12 months. The mean follow-up period was 17.3 months (range 8 to 30 months). The incidence of full-thickness rotator cuff tears was 8.1%. All the patients had supraspinatus tears, which were accompanied by infraspinatus tears in three patients. The sizes of the tears were classified as large (between 3-5 cm) in three patients, intermediate (between 1-3 cm) in five patients, and small (<1 cm) in one patient. One patient had L-shaped, two patients had U-shaped, and six patients had C-shaped tears. None of the patients had healing problems or avascular necrosis. The mean Constant-Murley shoulder score was 85.4 (range 67 to 100). All the patients were satisfied with the results of surgical treatment. The integrity of the rotator cuff must be checked after reduction and fixation of proximal humerus fractures and, when present, the tears should be repaired simultaneously either primarily or with suture anchors. Simultaneous repair of rotator cuff tears does not negatively affect functional outcomes.

Repair of full-thickness rotator cuff tears is recommended regardless of tear size and age: A retrospective study of 218 patients

Conservative therapy has been recommended for the treatment of a chronic cuff lesion with relatively good results. However, recent reports about operative treatment of cuff lesions have yielded more favorable results. Although the current literature seems to favor early treatment, there is an ongoing debate about the timing of the operation. During a 16-year period, 415 chronic full-thickness rotator cuff tears were operated on at our institution. The indication for operative treatment was persistent, severe or moderate pain at rest and impairment of shoulder function after initial conservative treatment. At follow-up, the symptoms were assessed by an interview, and all patients were clinically examined. Pain, function, range of active forward flexion, active abduction, strength (manual muscle testing), and patient satisfaction were recorded, and the results were evaluated by the University of California, Los Angeles shoulder rating scale. On the basis of our results, we recommend operative treatment of the rotator cuff for all cases in which the tear is full thickness, regardless of tear size, if patients have any symptoms, especially pain.

Cuff Tear Arthropathy

Visotsky, Jeffrey L. MD; Basamania, Carl MD; Seebauer, Ludwig MD; Rockwood, Charles A. MD; Jensen, Kirk L. MD Author Information