Cuff Rupture Research Articles

Arthroscopic rotator cuff repair: patients with physically demanding work have significantly worse time to return to work, level of employment, and job loss.

The purpose of this study was to determine the results of arthroscopic rotator cuff repair (ARCR) in terms of return to work (RTW). Inclusion criteria were working patients who underwent ARCR for rotator cuff rupture at the study site between 2008 and 2020 and minimum 12months of follow-up. Patients were stratified based on the physical demand of their work according to the Canadian Classification and Dictionary of Occupations. The primary outcomes were time to RTW, level of employment (LoE), change of tasks, and work loss. Secondary outcomes included the return to sports activities, EQ-VAS, EQ-5D-5L, DASH, and Oxford Shoulder Score. Three-hundred and eighty-three patients were enrolled; at the follow-up evaluation, fifty-three patients (13.8%) lost their job, with a percentage of 34.4% (eleven patients) in the heavy-work category, and five patients (1.3%) chose early retirement. Other twenty-six patients (6.8%) had to lower their level of employment, and twenty patients (5.2%) changing their tasks, with 279 patients (72.9%) returning to their previous work activity. RTW was obtained at a mean time of 4.7 ± 4.6months, ranging from 3.8 ± 3.1months in the sedentary work vs 5.8 ± 2.8months in the very heavy-work category (p = 0.015). The mean EQ-VAS score was 77.3 ± 18 points, the mean Oxford Shoulder Score was 43.4 ± 7.2 points, and the mean DASH score was 9.9 ± 14.5 points; 75.3% returned to their previous level of sport activity. The success of ARCR in terms of RTW is not always complete and varies significantly based on the physical demand of the patient's job. Patients with physically demanding work have a significantly higher time to RTW, reduction of the LoE, and job loss rate, thus affecting the possibility to have a satisfactory return to their previous life. The findings are of clinical relevance since they can help the surgeons to give their patients reliable expectations and to correctly plan the post-operative management. IV.

Comparison of the clinical outcomes of chronic rupture, arthroscopic tenotomy and tenodesis of proximal biceps tendon

Biceps tendon disorders are substantial cause of intense shoulder pain, and thus they require a careful medical attention. We compared the clinical outcomes of chronic rupture, tenotomy and tenodesis of proximal biceps tendon of patients underwent arthroscopic shoulder surgery. We included 98 patients over 50 years-old who underwent arthroscopic surgery for rotator cuff tears and grouped as tenotomy, tenodesis and chronic rupture of biceps tendon. Preoperative and postoperative 24-months follow-up Visual Analog Scale (VAS) score and the University of California–Los Angeles (UCLA) Shoulder Scale scores were compared. Chronic biceps rupture was the most common pathology in massive rotator cuff rupture group (75.9%). As tenotomy, tenodesis and chronic rupture groups were compared in terms of VAS and UCLA score improvements (preoperative and postoperative change); tenotomy showed better outcomes and there was a statistically significant difference between tenotomy and tenodesis groups in terms of improvements in VAS and UCLA scores (p = 0.036, p = 0.010, respectively). No statistically significant difference between chronic rupture and tenodesis in terms of VAS and UCLA scores improvements were observed (p = 1.000, p = 0.250, respectively). Also, tenotomy showed superior VAS score improvement than chronic tendon rupture (p=0.024) however no statistically significant difference was observed in UCLA score improvement between tenotomy and chronic rupture (p = 0.527). According to our study, tenotomy seems to be a more appropriate surgical method than tenodesis in massive and full-thickness rotator cuff tears with severe biceps tendon degeneration, and also it is not necessary to perform tenodesis in cases with chronic biceps rupture.

Wide-awake local anesthesia for open rotator cuff repair: A case report.

Introduction and importanceImproper treatment of rotator cuff tear might result in progression of tear and deterioration of patient function. The rotator cuff tear can be managed conservatively in most cases however surgical treatment is inevitable in persistent patients.Presentation of caseA 45-year-old woman presented to our clinic with shoulder pain and restricted range of motion following a fall from a height three months before the current presentation. Due to the lack of favorable response to conservative treatment and the fact that rotator cuff rupture was traumatic, she became a candidate for rotator cuff repair surgery. Due to financial issues and the patient's refusal of undergoing general anesthesia we considered the WALANT technique. Prior to surgery, we explained the whole procedure to the patient, referring to its pros and cons.Clinical discussionThe WALANT procedure is a relatively recent technique that has become widespread in orthopedic surgery in the past decade. The advantages of the WALANT technique are that it is simple, feasible, and safe and that the analgesic is adequate during the operation and for the first few hours afterward (5). Concerns with this method include patient discomfort and pain during surgery, which can be managed by educating the patient and minute-by-minute explanation during the procedure.ConclusionWe advocate open rotator cuff repair with the WALANT approach as an effective, cost-saving, safe, simple, and quick alternative to general and regional anesthesia for certain patients or with limited anesthetic resources.Level of evidenceV

Inadvertent endotracheal tube cuff rupture during unilateral arytenoid lateralisation for laryngeal paralysis in a dog

AbstractA 12‐year 11‐month‐old, 8.3 kg Jack Russell terrier presented following three episodes of respiratory distress. On initial presentation, conservative management was successful; however, the dog re‐presented 10 weeks later with identical clinical signs. On the second presentation, investigations were unremarkable, so conservative management was continued. On discharge, the dog collapsed, following which, it was referred to the emergency and critical care department, within the same hospital. Examination under a light plane of general anaesthesia revealed left‐sided laryngeal paralysis; therefore surgical management was indicated. During cricoarytenoid laryngoplasty suture placement, a leak was noted in the circle breathing system based on alteration of the capnograph trace, collapse of the ventilator bellows, and noise on inspiration. The pilot balloon of the endotracheal tube had deflated, necessitating re‐intubation with a new endotracheal tube; a urinary catheter was used as a guidewire to facilitate this. The leak was abolished, and the procedure was completed successfully.

Investigation on the Efficiency of the Closed Kinetic Chain and Video-Based Game Exercise Programs in the Rotator Cuff Rupture: A Randomized Trial.

Objective: To examine the effectiveness of video-based game exercises and structured closed kinetic chain exercises in individuals with rotator cuff rupture. Materials and Methods: Forty-five individuals with rotator cuff rupture were included in this study. Individuals were randomly divided into three groups: a conventional exercise group (CEG), a structured closed kinetic chain exercise group (CKCEG), and a video-based game exercise group (VGEG). Interventions were performed twice a week for 6 weeks. Pain severity; pain threshold; disabilities of the arm, shoulder, and hand questionnaire (DASH); rotator cuff quality of life index (RCQOL); range of motion (ROM); and joint position sense and approximation force of all individuals were evaluated pre- and post-treatment. Results: There was a statistically significant difference in all values of the pre- and post-treatment of the groups (P < 0.05). When the differences between the groups were compared, CKCEG and VGEG values were more significant than CEG in all parameters (P < 0.017). Improvements in pain threshold, ROM in shoulder flexion and abduction, DASH score, and all parameters of the RCQOL questionnaire in VGEG were statistically more significant than CKCEG (P < 0.017). Conclusion: Individuals with rotator cuff rupture obtained more improvements in primary and secondary outcomes after closed kinetic chain exercise and video-based game exercise, rather than conventional methods. It was considered that video-based game exercise programs would be used in rotator cuff problems.

Correlation of Physical Examination with Arthroscopic Findings in the Treatment of Rotator Cuff Tear.

Objective To compare clinical data from the physical examination with arthroscopic findings in rotator cuff rupture. Methods A total of 177 patients submitted to arthroscopic treatment of rotator cuff rupture were selected, and arthroscopic findings were compared with physical examination. Results The impingement tests showed high sensitivity for rotator cuff rupture. Among the strength tests, the most sensitive was the Patte test (85.7%), and the one with the highest positive predictive value (PPV) was the Jobe test (95%). The Drop Sign test showed higher specificity and negative predictive value (NPV) (98.7 and 95.9%, respectively). Patients with a history of trauma were 3.5 times more likely to have a positive Lift Off test. Conclusion The impingement tests had high sensitivity for rotator cuff ruptures. The Jobe test showed similar sensitivity among patients who had partial or total supraspinal injury. For complete lesions of the subscapularis, The Lift Off and Belly Press tests showed high sensitivity and specificity.

Tracheal Cuff Rupture During Conventional Total Thyroidectomy: An Unusual Complication

Tracheal Cuff Rupture During Conventional Total Thyroidectomy: An Unusual Complication

Inadvertent endotracheal tube cuff rupture during anterior cervical spine surgery.

Inadvertent endotracheal tube cuff rupture during anterior cervical spine surgery.

Association of damage to the coracohumeral ligament with anterosuperior rotator cuff degeneration revealed by anatomical dissection

The coracohumeral ligament (CHL) is an important structure of the biceps pulley which also merges with the rotator cuff. Which role it actually plays in the pathogenesis of rotator cuff degeneration (RCD) and rotator cuff tears (RCT) is still a point of discussion. The hypothesis of this study was, that macroscopic injury to the anterosuperior part of the rotator cuff also includes parts of or the whole CHL. Forty fresh-frozen shoulders were dissected and examined, the morphology of the rotator cuff and the coracohumeral ligament were evaluated and existing lesions documented. 27.5% of the shoulder joints showed an anterosuperior full-thickness RCT. 57.5% of all examined shoulder girdles showed at least a partial rupture of the CHL. A highly significant correlation (p < 0.001, rho = 0.529) between the presence of rotator cuff tears and ruptures of the CHL was found. Cartilage damage within the anterosuperior section of the humeral head was observed in 20% cases. In rotator cuff degeneration and atraumatic rotator cuff tears of the elderly population, the pathomechanism of full-thickness RCT is based on repetitive anterosuperior glenoid impingement. This is especially supported by the identification of a higher frequency of CHL lesions compared to RCT reported in this study. No intact CHL was identified in shoulders with damaged rotator cuff tendons.

Arthroscopic Treatment of Rotator Cuff Rupture in Patients Under 55 years Old versus Patients Older than 65 Years Old.

Objective To evaluate patients submitted to arthroscopic repair of the rotator cuff (RC) comparing the results of muscle, functional strength, and pain obtained in 2 distinct groups: patients < 55 years old (G55) and patients > 65 years old (G65). Methods Data collection was performed with 63 participants (29 < 55 years old and 34 > 65 years old), in 2 moments, analyzing: A) demographic, surgical and RC lesion characteristics; B) functional variables, muscle strength, and pain. Results Higher levels of anterior elevation force, lateral, and medial rotation of the operated shoulder were observed in group G55. However, when the difference between these forces of the operated shoulder and of the contralateral shoulder was evaluated, there was no significant difference between the groups. The other variables of function and pain were similar ( p > 0.05). There was also no difference between the groups in the University of California at Los Angeles Shoulder Rating Scale (UCLA) ( p = 0.56) and Constant-Murley Score ( p = 0.99) scores. Conclusion Arthroscopic repair of the RC in older, active, selected patients may achieve functional improvement and quality of life similar to that performed in younger patients.

Лікування «нещасливої тріади» плечового суглоба

Актуальність. «Нещаслива тріада» плечового суглоба — це тяжка та доволі поширена травма (9–18 % серед усіх вивихів плеча). Під нею розуміють комбінацію вивиху плеча, масивного повношарового розриву ротаторної манжети та ушкодження аксилярного нерва або підключичних відділів плечового сплетення. Мета роботи: на основі аналізу результатів власних досліджень визначити оптимальну тактику обстеження та лікування хворих з «нещасливою тріадою» плечового суглоба. Матеріали та методи. У період з 2000 по 2016 рік у відділенні мікрохірургії та реконструктивної хірургії верхньої кінцівки ДУ «Інститут травматології та ортопедії НАМН України» було проліковано 120 пацієнтів з діагнозом травматичного вивиху плеча. Серед них у 25 (20,8 % від загальної кількості травматичних вивихів) пацієнтів була діагностована «нещаслива тріада» плеча. Усім пацієнтам проводились стандартне клінічне, рентгенологічне дослідження, електронейроміографія (ЕНМГ) та магнітно-резонансна томографія. Результати. Усі пацієнти з даною патологією потребують передопераційного ЕНМГ-дослідження, у випадку збереження провідності за аксилярним нервом більше 30 % на першому етапі лікування рекомендоване відновлення цілісності ротаторної манжети плеча з призначенням консервативного лікування нейропатії. У разі збереження провідності за аксилярним нервом менше 30 % першим етапом лікування варто проводити ревізію та відновлення цілісності аксилярного нерва. Обов’язкова фіксація плеча у вправленому положенні. Висновки. Аналізуючи віддалені результати лікування пацієнтів з «нещасливою тріадою» плечового суглоба, ми виявили залежність між тяжкістю травми та результатами лікування. Так, коли на передопераційній ЕНМГ визначались збереження провідності за аксилярним нервом та позитивна динаміка відновлення, результати лікування через 12 місяців були найкращі. Найгірші результати були у первісно найтяжчих пацієнтів — з підключичним ушко­дженням плечового сплетення.

Early Period Results of Patients Undergoing Arthroscopic Repair with a Diagnosis of Full Thickness Rotator Cuff Tear

The aim of this study is to evaluate the early results of patients who were diagnosed with full-thickness rotator cuff tear and underwent arthroscopic repair as a result of physical examination and radiological evaluation.Methods: The study included patients undergoing arthroscopic rotator cuff repair. Biceps tenotomy was performed in accompanying biceps pathologies. Acromioplasty was performed in patients with type 2–3 acromion. Rotator cuff ruptures were repaired with a double row technique using a titanium anchor and a peek anchor. University of California at Los Angeles (UCLA) and Constant scoring were used to evaluate the patients who were called for final follow-up controls. The mean follow-up time was 14.6 months (6-24).Results. Acromioplasty performed on 12 patients (30.7%); While biceps tenotomy was performed on 9 patients (23%); Acromioplasty and biceps tenotomy were performed on 4 (10.2%) patients. Preoperative UCLA score was 11.2, Constant score was 26.9, while postoperative UCLA score was 29.6 and Constant score was 83.2. The results were excellent in 13 (33.3%) patients, good in 16 (41%) patiens, moderate in 9 (23%) patients and poor in 2 (5.1%) patients. There was no significant difference between the groups with and without acromioplasty (p = 0.513). A similar situation was observed in the biceps tenotomy (p = 0.619) and acromioplasty + biceps tenotomy (p = 0.374) groups.Conclusion. Arthroscopic rotator cuff surgery is an effective treatment option with a suitable patient and correct indication. Acromioplasty and / or biceps tenotomy does not affect early results.Keywords: Rotator cuff, arthroscopic repair, acromioplasty.Corresponding author: Alim Can Baymurat, Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey Address: Emniyet Mahallesi, Mevlana Bulvarı No:29Phone: 05455452589E-mail: alimcanbaymuratahoo.comJ Trauma Ortho Kaz 2022; 3 (64): 4-9Recieved: 12-08-2022Accepted: 28-08-2022 This work is licensed under a Creative Commons Attribution 4.0 International License

RETRACTED ARTICLE: Exosome-delivered BMP-2 and polyaspartic acid promotes tendon bone healing in rotator cuff tear via Smad/RUNX2 signaling pathway

Statement of Retraction Lei Han, Hong Liu, Huajun Fu, Yugen Hu, Weili Fang & Junsheng Liu - 2022, Exosome-delivered BMP-2 and polyaspartic acid promotes tendon bone healing in rotator cuff tear via Smad/RUNX2 signaling pathway, Bioengineered 13(1), doi: 10.1080/21655979.2021.2019871 Since publication, significant concerns have been raised about the integrity of the data and reported results in the article. When approached for an explanation, the authors did not provide their original data or any necessary supporting information. As verifying the validity of published work is core to the integrity of the scholarly record, we are therefore retracting the article. All authors listed in this publication have been informed. We have been informed in our decision-making by our editorial policies and the COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

Ultrasound Evaluation of the Rotator Cuff after Osteosynthesis of Humeral Shaft Fractures with Interlocking Intramedullary NailA Prospective Interventional Study

Introduction: Antegrade intramedullary nailing in humeral shaft fracture allows a stable fixation with satisfactory outcomes. However, shoulder impairment remains an important complication of intramedullary nailing. The procedure involving the splitting of supraspinatus tendon to expose humeral head for nail insertion has been attributed for it, even though it is followed by the repair of the tendon. Aim: To evaluate rotator cuff integrity with Ultrasound (USG) in patients who underwent humeral fracture fixation with an intramedullary interlocking nail and to evaluate the clinical outcome of the shoulder joint in patients with and without rupture of the rotator cuff using constant murley and QuickDASH scores. Materials and Methods: This prospective interventional study was conducted in the Department of Orthopaedics of AJ Institute of Medical Sciences, Mangaluru, India, from August 2018 to September 2020 in which 20 adult patients with acute humeral shaft fractures were treated with closed intramedullary nailing in antegrade manner. Patients were followed-up for six months clinically and radiologically. The USG evaluation of rotator cuff was done at six months follow-up, along with clinical evaluation using constant Murley and QuickDASH scores. Association between variables was analysed by using Chi-square test for categorical variables. Unpaired t-test was used to compare the mean of quantitative variables. The level of significance was set at 0.05. Data were entered into Microsoft excel (Windows 7; Version 2007) and analyses were done using the Statistical Package for Social Sciences (SPSS) for Windows software (version 22.0; SPSS Inc, Chicago). Results: At six months follow-up, patients were evaluated by USG showing ruptured supraspinatus tendon in 3 (15%) of the study patients. The results by constant murley score were 76.50±12.61 for the entire series, 77.82±12.75 for patients without rotator cuff rupture, and 69±10.53 for patients with partial rupture of the rotator cuff, with no statistical difference (p=0.275). QuickDASH scores were 9.90±7.69 for the entire series, better in the group without rupture of the rotator cuff (9.41±7.92 versus 12.70±6.84) but without statistically significant difference (p=0.510). Conclusion: The functional outcome of the shoulder joint is satisfactory and is not influenced by the presence or absence of a rotator cuff tear following the procedure.

Latissimus dorsi tendon transposition combined with shoulder joint proximal capsule plasty with peroneal longus tendon autograft in the treatment of patients with massive rotator cuff ruptures and proximal dislocation of the humerus head (clinical case)

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and 40 % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In the treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures.

Arthroplasty for weight-bearing shoulders

IntroductionRepeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population. Materials and methodsThis retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User's Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients’ autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder. ResultsThe 11 patients had a mean age of 64±19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8±3 preoperatively to 4±2 postoperatively (p=0.003). The mean Constant score increased 90% from 22±11 preoperatively to 42±23 postoperatively (p=0.008). The WUSPI score decreased by 73% from 80±30 to 21±15 (p=0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change. DiscussionJoint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion. Level of evidenceIV, retrospective study.

Association between corticosteroid therapy and diagnosis of non-traumatic rotator cuff tear or rupture in patients followed in orthopedic practices in Germany.

The purpose of this case-control study was to examine the association between oral and injected corticosteroids (CS) and subsequent non-traumatic rotator cuff tear or rupture (nt RCT or RCR) in orthopedic practices in Germany. Patients diagnosed with nt RCT or RCR between January 2017 and December 2019 (index date) were included in the study after applying inclusion and exclusion criteria. Controls without nt RCT or RCR were matched using propensity scores based on age, sex, observation time prior to the index date (years), and diseases of the musculoskeletal system and connective tissue. A total of 10,986 patients were included in each group. For both oral and injected CS, we found a significant association with nt RCT or RCR, whereby oral CS had a stronger impact (OR (oral): 1.71 (95% CI: 1.52-1.93) vs. OR (injected): 1.42 (95% CI: 1.28-1.58)). For oral CS, this association was largely unaffected by differences in total doses or latencies between therapy end and index date. Within the group who received injected CS, shorter latencies and total doses of 20 mg or more led to higher odds of nt RCT or RCR. Varying CS had a different impact on rotator cuff tendons. Non-steroidal anti-inflammatory drugs (NSAIDs) were not associated with nt RCT or RCR at all. Oral and injected CS were associated with nt RCT or RCR in patients treated in orthopedic practices in Germany, while analgesics such as NSAIDs were not.

The IBTIS score; a new prognostic score for arthroscopic biceps tenotomies

IntroductionShoulder pain associated with tendinopathy of the long head of biceps (LHB) is common. Surgical treatment with arthroscopic tenotomy of the LHB has been shown to be effective. However, it's efficacy is inconsistent. The objective of this study was to assess the pre-operative clinical and radiological prognostic factors of arthroscopic tenotomy of the long head of biceps, and to establish a predictive score for good responses to treatment; the IBTIS score (Isolated Biceps Tenotomy Index Score). HypothesisPrognostic factors representing a good response to treatment of LHB tendinopathy by arthroscopic tenotomy exist. Materials and methodsWe conducted a retrospective monocentric study including 64 patients who underwent surgery of the LHB by arthroscopic tenotomy (with or without tenodesis) between January 2018 and March 2020. We identified 2 patient groups (good responder group and poor responder group) from a 3-month post-operative clinical assessment, which included a subjective assessment comprising Single Shoulder Value (SSV), Constant score, C-Test, and pain level. Prognostic factors of a good response were then sought from the 2 groups using interviews, clinical examinations and pre-operative imaging. Based on these findings, a predictive score for a good response was established. ResultsAll evaluation criteria demonstrated post-operative improvement: mean SSV (72.2 vs 50.7; p<0.001), relative constant (78.2 vs 64.3; p<0.001), pain level (3.2 vs 7; p<0.001) and C-Test (94.1 vs 85.6; p=0.07). 34 patients (58.6%) were considered good responders, while 24 patients (41.38%) were considered poor responders. There was a trend towards a favourable result for: age>65 years (p=0.01), rotator cuff rupture on preoperative imaging (p=0.01), Cross Arm Test (p=0.02), nocturnal pain (p=0.08), Yergason's test (p=0.16) and Speed's Test (p=0.22). Manual labour appeared to be an unfavourable factor (p=0.07). These factors were incorporated into the 10-point IBTIS score. A score greater than 5 was associated with a favourable result in more than 80% of patients (p<0.001). DiscussionOur score consists of 7 items. We identified 7 pre-operative prognostic factors for a good result after LHB tenotomy. Over 65 years of age was found to be statistically significant in univariate analysis, as was visualization of rotator cuff rupture on pre-operative imaging. The Cross Arm Test was included given its high statistical significance. The Speed's Test and Yergason's Test are ubiquitous in the literature. Nocturnal pain was found in more than 80% of patients. Undertaking manual labour represented an unfavourable prognostic factor after arthroscopic surgery of the LHB. ConclusionThe IBTIS score (Isolated Biceps Tenotomy Index Score) is a pre-operative clinico-radiological score for the surgical treatment of arthroscopic tenotomy of the long head of biceps. Further studies are required to validate its prognostic accuracy. Level of evidenceIII; case-control.

An anatomical study of the fetal superior capsule of the glenohumeral joint

IntroductionThe superior part of the glenohumeral joint capsule has an intimate relationship with the tendons of the rotator cuff and the tendon of the long head of the biceps. One of the strategies currently proposed in the event of a massive cuff rupture is to reconstruct this superior capsule. The main objective of this anatomical study was to describe the superior joint capsule of the embryonic glenohumeral joint and its relationship to the tendons of the rotator cuff. HypothesisThe hypothesis was that this structure was an anatomical entity, morphologically identifiable from the embryogenesis of the joint (more pronounced tissue boundaries in the fetus). Material and methodsIn total, 101 continuous fetal anatomical sections (4 fetuses of 336mm), in the frontal plane, made it possible to identify and measure: diameters of the humeral head and glenoid, dimensions of the joint capsule insertion zone at the level of the greater tubercle, as well as the different thicknesses of this insertion zone. The ratios above the head of the biceps and against the superior labrum were also measured. ResultsAt the level of its distal insertion on the greater tuberosity, the thickness of the superior joint capsule varies on average between 0.8mm laterally and 1.2mm next to the tendons of the supraspinatus and infraspinatus; the thickness is 0.9mm next to the middle part of the supraspinatus tendon (the “rotator cable” zone). For its insertion at the level of the glenoid labrum, the superior capsule measures 0.6mm thick on average. The capsule around the tendon of the long head of the biceps is 1.5mm thick on average. DiscussionHere, we confirm the existence of this superior joint capsule, which can potentially be reconstructed. It is inserted on the greater tubercle covering 30 to 60% of its surface with variations in thickness. The joint capsule is fused to the supraspinatus tendon at the rotator cuff insertion area, preventing independent reinsertion of the tendon. Level of evidenceIV; anatomical study.

The effect of row number on clinical and life quality outcomes of patients who underwent arthroscopic rotator cuff repair

Objective: Shoulder pain and disability are mostly seen following rotator cuff rupture. Arthroscopic rotator cuff repair becomes a gold standard treatment for rotator cuff rupture when conservative treatment fails. Comparing functional results, retear rates and reoperation rates of arthroscopic rotator cuff repair in terms of single-row versus double row techniques is our aim in this study. &#x0D; Material and Method: Overall, 174 arthroscopic rotator cuff surgery patients were specified into 2 groups. Group 1 consists of 81 patients underwent single-row repair and group 2 consists of 93 patients consisted of transosseos equivalent technique double row. We evaluated demographic data and American Shoulder and Elbow Surgeons, Constant Murley, Visual analogue scale and 36-item Short Form subscale scores.&#x0D; Results: Mean follow-up time was 14.08±4.77 months. ASES, CM and VAS following ARCR were similar between two groups. Some of SF-36 subscale score improvements after operation are significantly better in group 2; role limitations due to physical health (p = 0.041), energy/fatigue (p = 0.026), emotional well-being (p = 0.017), pain (p = 0.010), general health (p = 0.037). Re-rupture rates were significantly different. In group 1 re-rupture rate was 13.6% and for group 2 it was 1.1% (p = 0.001).&#x0D; Conclusion: Lower re-rupture rates, and improved quality of life outcomes at short-term follow-up can be obtained by arthroscopic double-row repair. We suggest that the double-row technique can be considered for patients who have medium to large rotator cuff tears for lower re-rupture rates and some quality of life outcomes.