Full-thickness Rotator Cuff Tears Research Articles

Identification of rare genetic variants for rotator cuff tearing and repair in high-risk pedigrees

BackgroundCommon genetic variants with small effect sizes have been associated with rotator cuff tearing although very few rare, highly penetrant variants have been identified. The purpose of this pilot study was to identify dominant coding variants that segregated with affected individuals in pedigrees at high risk for rotator cuff tears. We hypothesize that rare variants contribute to symptomatic rotator cuff tears and that they can be identified in related cases with a full-thickness tear requiring surgical management. MethodsWe used the Utah Population Database (UPDB) to identify pedigrees that exhibited a significant excess of individuals who had undergone surgical repair of a full thickness rotator cuff tear. We analyzed whole exome sequence analysis to identify rare coding variants in 9 independent affected cousin pairs (first or second cousins) who had undergone arthroscopic surgery for repair of a full thickness rotator cuff tear (mean age at diagnosis 68 years). Validation of association of the candidate variants with risk for rotator cuff tearing was accomplished utilizing data from the UK Biobank and a separate cohort of unrelated cases of full thickness rotator cuff tears. ResultsA total of 82 rare (minor allele frequency <0.005) coding variants were identified as shared in at least one cousin pair affected with full thickness rotator cuff tearing belonging to a high-risk pedigree, which included variants in RUNX1, ADAM12, TGFBR2, APBB1, PDLIM7, LTBP1, MAP3K4 and MAP3K1. Analysis of 39 of these variants with data available in the UK Biobank (3,899 cases with rotator cuff injury and 11,697 matched controls; mean case age 59.9 years) identified a significant association with the APBB1 gene (OR=2.37, p=0.007, uncorrected). The PDLIM7 allele was found to be in significant excess in rotator cuff tear cases in a separate cohort of Utah patients with full thickness rotator cuff tears (10 carriers out of 458 independent, unrelated patients; minor allele frequency of 0.022) compared to a minor allele frequency of 0.0058 for the European (non-Finnish) control population rate (749 carriers out of 128612 tested) (chi square test: 19.3 (p<0.001). DiscussionThe analysis of closely related individuals with confirmed full thickness rotator cuff tears from high-risk pedigrees has identified 82 rare, shared candidate genetic predisposition coding variants. Association of the PDLIM7 allele with risk for tear was confirmed in an independent cohort of rotator cuff tears. Further analysis of the variant alleles is required for confirmation of these genes in rotator cuff tearing.

Arthroscopic Surgery Combined With Platelet-Rich Plasma Does Not Significantly Improve Pain, Function, Complications, and Retear Rate Compared With Arthroscopic Surgery Alone for Full-Thickness Rotator Cuff Tears: A Systematic Review and Meta-analysis

PurposeTo evaluate the effectiveness and safety of arthroscopic surgery combined with platelet-rich plasma (PRP) compared to arthroscopic surgery alone in the treatment of patients with full-thickness rotator cuff tears (RCT). MethodsThe Cochrane Library, PubMed, Embase, Scopus, EBSCO, Web of Science, CNKI, and Wanfang Database were systematically searched from inception to November 2023. Subject words combined with free words were used to collect randomized controlled trials focusing on arthroscopic surgery combined with platelet-rich plasma (PRP) in the treatment of full-thickness RCT. The assessment of evidence quality employed the Cochrane Collaboration risk of bias tool, and data analysis was performed using RevMan 5.3 software. ResultsA total of 9 studies with 537 patients were included. The meta-analysis revealed that compared to the arthroscopic surgery alone group, the summary result of UCLA scores in the arthroscopic combined with PRP group was [MD = 1.08, 95% CI 0.19∼1.97, P = 0.02], subgroup analysis of surgical suture method VAS Single-row [MD = -1.00, 95% CI -1.50∼-0.50, P<0.0001], VAS Double-row [MD = -0.10, 95%CI -0.17∼-0.02, P=0.02], CMS Single-row [MD = 3.49, 95%CI 0.32∼ 6.66, P=0.03], the difference was statistically significant, and the differences in VAS, CMS, qDASH, complications and retear rate were not statistically significant. ConclusionsPatients undergoing arthroscopic repair combined with PRP treatment showed no difference in pain, function, complications, and retear rate compared to those treated with arthroscopic surgery alone.

Effects of arthroscopic rotator cuff repair on isokinetic muscle function 6 months following surgery: influence of tear type, tear size, and tendon retraction

BackgroundRotator cuff tears are a common musculoskeletal condition which can lead to functional limitations and impairments in quality of life. The purpose of the present study was to investigate the effects of arthroscopic repair surgery on isokinetic muscle function before and 6-months after surgery. Additionally, the mediating effects of tear type, tear size and tendon retraction were examined. MethodsData from n = 67 patients (56 ± 9 years) with full-thickness rotator cuff tears were analyzed. Before and 6-months after surgery, isokinetic muscle function in external/internal rotation and abduction/adduction movements was assessed. Further, tear size, tear type (Collin classification) and tendon retraction (Patte classification) were analyzed using magnetic resonance imaging (MRI). ResultsAfter statistical analysis, a significant increase in limb symmetry index (LSI) of external (p < 0.001), internal rotation (p < 0.01), abduction (p < 0.001) and adduction (p < 0.001) were observed from pre- to post-surgery. The results revealed that tear size and tendon tear type significantly mediated the functional outcome, with no significant effect of tendon retraction. ConclusionThe present findings point towards the notion that the functional outcome following rotator cuff repair was significantly dependent on tear type and tear size but not tendon retraction. Patients with larger sized tears presented pronounced deficits following 6-months indicating that rehabilitation times need to be adjusted accordingly.

Magnetic resonance imaging for relationship between the severity of perianchor fluid collection and rotator cuff integrity after arthroscopic double-row suture-bridge rotator cuff repair

PurposeThe primary purpose of this study was to assess perianchor fluid collection (PFC) severity of medial anchor and rotator cuff integrity association after arthroscopic double-row suture-bridge rotator cuff repair (RCR) and the secondary purpose was to identify the demographic and radiologic risk factors for high-grade PFC. HypothesisRe-tear rate would be significant higher in patients with high-grade PFC. MethodsWe retrospectively reviewed patients with arthroscopic double-row suture-bridge RCR for full-thickness rotator cuff tear (RCT) at our institution between February 2012 and May 2018. Based on the PFC severity, they were divided into the no-fluid (no fluid collection), low-grade (minimal or local fluid collection around the anchor), and high-grade (fluid collection beyond the entire length of the anchor) groups. Magnetic resonance imaging was performed 6 months postoperatively for assessing PFC severity and repaired rotator cuff integrity association, besides evaluating correlation between severity and various demographic and radiologic factors, including work level (low/medium/high) and RCT size. ResultsThis study included 312 patients, 181 (58%) in the no fluid group, 82 (26.3%) in the low-grade PFC group, and 49 (15.7%) in the high-grade PFC group. Re-tear occurred in 73 (23.4%) patients and was more frequent in the high-grade group (26/49 [53.1%]) than in the no-fluid (27/181 [14.9%]; p<0.001) and low-grade (20/82 [24.4%]; p=0.001) groups, without statistically significant differences between the latter two (p=0.082). Among the demographic factors, work level (low/medium/high) differed significantly between the no-fluid (22.1%/58.0%/19.9%), low-grade (25.7%/46.3%/28.0%), and high-grade (26.5%/34.7%/38.8%) groups (p=0.026). Among the radiologic factors, the mediolateral tear size differed significantly between the three groups (no-fluid group: 1.7±0.8cm, low-grade group: 1.8±0.6cm, high-grade group: 2.2±1.0cm; p=0.003). Multivariate regression analysis showed that mediolateral tear size (odds ratio: 1.821; 95% confidence interval: 1.258–2.636; p=0.001) was an independent risk factor for high-grade PFC. ConclusionsAfter arthroscopic double-row suture-bridge RCR, the highest re-tear rate was observed in patients with high-grade PFC, while there was no significant difference in rates between no-fluid and low-grade PFC groups. As PFC severity increased, the risk of re-tear increased. In particular, larger mediolateral tear size was associated with high-grade PFC. Level of evidenceIII; case-control study.

Histological and biochemical changes in a rat rotator cuff tear model with or without the subacromial bursa

The subacromial bursa (SAB) plays an important role in the tendon healing process. Based on previous reports, co-culture of the rotator cuff (RC) and SAB have been shown to increase the tendon-related gene expressions, inflammatory cytokines, and tensile strength. However, the nature of the specific biochemical alterations during the inflammatory and repair phases of tendon healing with or without the SAB remain unknown. Using a full-thickness RC tear rat model, we determined how the presence or absence of the SAB alters the histological characteristics and gene expressions. After 3 and 6 weeks, tissues were collected for histological and real-time quantitative polymerase chain reaction (RT-qPCR) evaluations. Results showed greater cell density at 3 weeks, neovascularization and tendon thickening at 6 weeks with SAB preservation. Immunostaining revealed significant increases in type 3 collagen (COL3) expression at 6 weeks with SAB preservation. The RT-qPCR results showed that SAB preservation induced significant increases in the expression of scleraxis, matrix metalloproteinase-13 (MMP-13), interleukin-1β (IL-1β), and inducible nitric oxide synthase (iNOS) at 3 weeks and significant increases in COL3, IL-10, and arginase-1 (Arg-1) at 6 weeks. An RC tear undergoes more appropriate inflammatory and repair phases during the tendon healing process when the SAB is retained.

Arthroscopic rotator cuff repair in active patients younger than 45 Years: a prospective analysis with a mean 5-year follow-up

PurposeTo report clinical and activity specific outcomes after arthroscopic RCR(ARCR) for full-thickness supraspinatus tears in active individuals younger than or equal to 45 years of age. The pre hoc hypothesis was that patients in this age group would demonstrate significant improvements in clinical outcomes following ARCR along with a significant improvement of athletic abilities. MethodsPatients were included in this study if they were (1)active individuals between 18 and 45 years of age at the time of surgery, (2)had a full-thickness rotator cuff tear(RCT) of the supraspinatus tendon with or without anterior or posterior extension and (3)underwent ARCR. Pre- and postoperative patient-reported outcomes scores including the American Shoulder and Elbow Surgeons(ASES) score, Disabilities of Arm, Shoulder and Hand(Quick-DASH), Single Assessment Numeric Evaluation(SANE), Short Form-12 Physical Component Summary(SF-12PCS) were prospectively collected and postoperative patient satisfaction(scale of 1-10) was recorded at a minimum of 2 years postoperatively. Attainment of the minimal clinically important difference(MCID) and patient acceptable symptom state(PASS) for the ASES was calculated. Athletic activity specific outcomes and return to activity(RTA) were investigated prospectively via a custom-made comprehensive questionnaire. ResultsBetween 11/2005 and 6/2020, of 1149 RCRs performed by the senior author, 54 patients (mean age 40.9 years,13 female; follow-up 69.7 ± 35.2 months in a range of 24.6 – 179.6 months) were included into the outcomes analysis. Of those, 4 patients(7.4%) had progressed to revision rotator cuff repair. At a follow-up of 5.8 years, outcome scores had significantly improved compared to preoperative baselines (ASES55.6±13.8to90.1+15.8;p<.001;QuickDASH38.9±18.4to 11.9±17.1;p<.001, SANE60.7±22.7to79.3±27.6;p=.001, SF-12PCS41.6±8.3to51.9±9.0;p<=.001). 93.6% of the patients reached the MCID and 72.6% reached the PASS. Median satisfaction was 9.5/10. 86% of the patients returned to sports, while 67% of the patients returned to a similar level compared to preoperatively. All sport specific metrics such as shoulder strength and endurance(p<.001), intensity(p<.001), and impairments from pain affecting speed(p=0.002), endurance(p=.002) and competition(p<.001) significantly improved postoperatively. ConclusionARCR of full-thickness RCT in active individuals aged 45 or younger results in a clinically relevant improvement of outcomes, function and quality of life at a minimum of 2 years and mean 5.8-year follow-up with a low rate of revision. While 86% of patients were able to RTA and sport specific outcome metrics significantly and substantially improved compared to preoperatively, a return to preinjury levels was not reliably achieved in all patients, with particular limitations observed in overhead active individuals. The data support the hypothesis that patients in this age group demonstrate significant improvements in clinical outcomes following ARCR along with significant improvements in athletic abilities.

Dermal Allograft Augmentation for Large and Massive Rotator Cuff Tears and Revisions: A Case Series.

Introduction Arthroscopic advancements have notably improved rotator cuff repair, yet the healing of tendons and retear risks still pose significant challenges, especially with massive and large tears. These larger tears have shown a quadruple increase in retear rate when the tear size grows from 1-3 cm. The prevalent cause of failure, particularly in tears with fatty degeneration, is suture tearing.As such, techniques that enhance tendon healing are pivotal due to their correlation with improved functional outcomes. Dermal allograft augmentation (DAA) is one method that has demonstrated improvements in rotator cuff repair biomechanics, as well as the promotion of vascularization and neotendon formation. This study evaluates the efficacy of DAA in the postoperative healing of large and massive rotator cuff tears, assessed through patient-reported outcomes and functional range of motion. Methods This retrospective study reviewed a single surgeon's database, selecting patients who underwent arthroscopic surgery for full-thickness rotator cuff tears measuring at least 3 cm, or those with maximum stage II fatty infiltration of the supraspinatus or infraspinatus muscle on MRI. We used three validated patient-reported outcome (PRO) measures, American Shoulder and Elbow Surgeon Score (ASES), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST), alongside a range of motion metrics, external rotation (ER), and forward flexion (FF). These were recorded pre-operatively and, at minimum, one year post-operatively, with a standard student t-test employed for comparative analysis. Results Out of 18 total patients, the average age was 61 years, and 83% were male. The cause of injury was mostly traumatic in nature (n=11), with the remainder being chronic (n=7). All three PROs (n=11) demonstrated a statistically significant increase in score including ASES (p=0.003), SANE (p=0.004), and SST (p=0.039). External rotation also significantly improved pre- to post-operative function (46 vs 58, p=0.049).Three patients (17%) suffered from a retear within three months of their rotator cuff repair. Two patients (11%) required a reverse shoulder arthroplasty within a year. Conclusion Our study demonstrated that DAA in rotator cuff repair yielded notable functional and clinical advancements, with a moderately low retear rate as confirmed by ultrasound. These outcomes suggest that DAA is a promising intervention for large and historically difficult rotator cuff tears, offering significant implications for future treatment protocols.

O142: Current clinical applications and limitations of graft augmentation in rotator cuff repair: a systematic review

Abstract Background Rotator cuff tears (RCTs) are a leading source of chronic and acute shoulder pain globally, with causes spanning from tendon degeneration to traumatic injury. Especially prevalent in the aging population, RCTs have a significant retear rate despite surgical intervention, and recent years have seen an increase in the use of grafts in surgery to address many of the clinical issues previously encountered in tendon-healing. Objectives To compare the effectiveness of various grafts in graft-augmentation surgery for full-thickness rotator cuff tears, assessed with functional and clinical outcomes. Selection criteria Adult patients with MRI-diagnosed full-thickness RCT and subsequently underwent graft-augmentation surgery; followed-up &amp;gt;1year, with assessment for retear and quantitative clinical outcomes. Results 32 primary studies, mean follow-up of 2 years and total of 1052 patients were included. The effectiveness of graft-augmentation was assessed using retear rate, ASES, Constant, UCLA and VAS. Graft-augmentation significantly improves all functional and clinical scores (p&amp;lt;0.05), and decreases retear rate to an average of 18.5% &amp;gt;1year post-surgery (p&amp;lt;0.0001), with no significant difference in effectiveness between the 4 different types of grafts. (p&amp;gt;0.05). No significant difference in outcomes was found in graft-augmentation between different tear sizes. Conclusions Graft augmentation for RCTs shows significant improvements in clinical and functional outcomes, and significantly lowers retear rate compared to conservative treatment or surgery without graft augmentation. The choice of graft has been shown to be of less importance than the clinical decision to use surgical-intervention with graft-augmentation, which applies to full-thickness tears of all sizes; both primary and revision tears.

Ultrasonic shear wave elastography predicts the quality of the residual tendon before the rotator cuff repair

Background and purposeEffective evaluation of rotator cuff tear residual tendon quality is the key to surgical repair. However, until now, the evaluation of rotator cuff tissue by ultrasonic shear wave elasticity (SWE) has been controversial. This prospective study analyzed the association between preoperative SWE and arthroscopic residual tendon quality scores.MethodsThe shear wave velocity (SWV) of the deltoid muscle, the supraspinatus tendon, and the supraspinatus muscle were measured in full-thickness rotator cuff tear patients. Tendon quality was scored according to tear size, tendon margin, tendon thickness, and footprint coverage during arthroscopy. The arthroscopic scores were used as the gold standard, and the SWV ratio of tendon and muscle (supraspinatus tendon/deltoid and supraspinatus muscle/deltoid) were calculated and correlated with the arthroscopic scores.ResultEighty-nine patients (129 shoulders) were enrolled, including 89 operation shoulders and 40 control shoulders. In the group of operation shoulders, both the SWV ratios of tendon (SWV-RT) and the SWV ratio of muscle (SWV-RM) were negatively correlated with arthroscopic scores (The correlation coefficient (R) ranged from -0.722 to -0.884 and -0.569 to -0.689). The SWV-RT and SWV-RM of the operation shoulders were significantly lower than that of the control shoulders (p < 0.05).ConclusionSWE could be used to predict the quality of the residual tendon before the rotator cuff repair. SWV of the supraspinatus tendon and muscle was a useful parameter to predict the quality of the residual tendon.Critical relevance statementMeasuring the shear wave velocity of the supraspinatus tendon and muscle with SWE is useful for predicting the quality of the residual tendon which is one of the key factors for a successful rotator cuff repair.Key points• Evaluating the quality of the residual tendon is important before surgery.• Elasticity measurements were negatively correlated with the arthroscopic score.• SWE is useful for predicting the quality of the residual tendon.Graphical

Role of Critical Shoulder Angle in Degenerative Type Rotator Cuff Tears: A Turkish Cohort Study.

BACKGROUND This retrospective study investigated the association between the critical shoulder angle (CSA) and the development of full-thickness rotator cuff tears (FTRCTs) in the Turkish population. The CSA is an imaging parameter that quantifies the relationship between the inclination of the glenoid and the lateral extension of the acromion in the coronal plane. The CSA is an anatomical measurement, and higher CSA values have been associated with an increased incidence of FTRCTs. However, there is a lack of data on CSA regarding the Turkish population. MATERIAL AND METHODS In this study, CSA measurements were recorded in 2 groups: 50 patients with FTRCT who had arthroscopic repair (group 1) and 50 age- and sex-matched individuals with no FTRCT detected by magnetic resonance imaging (group 2). Sex, age, affected side, dominant side, and smoking status were recorded for each patient. The CSA measurements of the affected sides were performed on true anterior-posterior view radiographs. RESULTS The results showed a statistically significant difference between the mean CSA values of group 1 (37.48°) and group 2 (33.53°), P<0.001. CSA values of 36 and above had a sensitivity of 73.58%, specificity of 74.47%, positive predictive value of 75%, and negative predictive value of 74.47% for detecting FTRCT. CONCLUSIONS CSA measurement on radiographs is a useful diagnostic tool in the Turkish population, and an above-average CSA value is associated with a significantly increased incidence of degenerative-type FTRCT.

Critical Shoulder Angle in Patients With Cuff Tears.

The pathogenesis of rotator cuff tears (RCTs) is multifactorial. Critical shoulder angle (CSA), which represents the lateral extension of the acromion over the cuff, has been proposed as an extrinsic risk factor. The aim of the present systematic review and meta-analysis was to analyze the available literature regarding the correlation between RCT and CSA. A review was carried out in accordance with the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" guidelines on July 17, 2023, using the following databases: PubMed, Ovid, and Cochrane Reviews. The following keywords were used: "critical shoulder angle," "rotator cuff tears," and "rotator cuff lesions." The methodological quality of the studies was assessed with the MINORS SCORE. Twenty-eight studies were included. The average CSA among the 2110 patients with full-thickness RCT was 36.7 degrees, whereas the same value among the 2972 controls was 33.1 degrees. The average CSA in the 348 patients with partial-thickness RCT was 34.6 degrees, whereas it was 38.1 degrees in the 132 patients with massive RCT. The average MINORS score was 15.6. CSA values were significantly higher in patients with RCT compared with the asymptomatic population. In addition, it appears that CSA values increase with the severity of rotator cuff involvement.

Biceps Rerouting Regardless of a Biceps-Labral Lesion During Rotator Cuff Repair Results in Lower Retear Rates and Comparable Clinical Outcomes to Subpectoral Biceps Tenodesis

PurposeTo evaluate the radiographic and clinical outcomes when rerouting a pathologic biceps during arthroscopic rotator cuff repair, by comparing it with concomitant subpectoral biceps tenodesis. MethodsThis retrospective, historical cohort study was conducted with patients who underwent an arthroscopic repair of a full-thickness rotator cuff tear, with intraoperative confirmation of biceps pathology including partial tears, subluxation, pulley lesions, or type II superior labrum anterior to posterior (SLAP) lesions. Until May 2018, such patients were treated with concomitant subpectoral tenodesis (group SPBT). Afterward, biceps rerouting was done regardless of biceps pathology (group BR) without biceps or SLAP repair. Radiographic parameters, including fatty degeneration, acromiohumeral distance, Sugaya classification, and retears, were evaluated using preoperative and one-year postoperative MRI. Clinical evaluation with a minimum two-year follow-up included pain visual analogue scale, American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant-Murley scores. Whether individual patients exceeded these scores' minimal clinically important difference was also determined. ResultsA total of 64 patients (group SPBT, 32; group BR, 32) were included in the final analysis. The duration of clinical follow-up was 36.2 ± 9.3 months in group SPBT and 29.4 ± 6.9 months in the BR group (P=0.002). Compared to group SPBT, group BR demonstrated a significantly lower retear rate (SPBT vs. BR: 34.4% vs. 12.5%, P=0.039). In the BR group, 8/32 (25%) patients demonstrated a postoperative LHBT tear. The four cuff retears in group BR only took place within these patients. Other postoperative radiographic and clinical outcomes were comparable between the groups. Within each group, significant postoperative improvements were demonstrated (P<0.05 for all clinical scores). ConclusionEven in the presence of a pathologic LHBT and/or a type II SLAP lesion, augmenting the rotator cuff repair with BR significantly reduced retear rates while achieving clinical scores comparable to SPBT in a minimum two-year follow-up.

Retracted: Effect of Arthroscopic Acromioplasty Combined with Rotator Cuff Repair in the Treatment of Aged Patients with Full-Thickness Rotator Cuff Tear and Rotator Cuff Injury.

[This retracts the article DOI: 10.1155/2022/4475087.].

Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon

Background: Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors—including age, sex, and tear severity—have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. Purpose: To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. Results: From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. Conclusion: Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.

Analysis of the risk factors of shoulder pseudoparalysis in patients with full­thickness rotator cuff tears

Background. Rotator cuff tears occur in approximately one in five people in the general population. The unpredictability of the dynamics of tears gives rise to studies of the patterns of their progression. It is known that massive rotator cuff tears form over a long period of time, as a result of which normal biomechanics are disrupted and cuff tear arthropathy develops. The loss of active elevation of the upper limb, developing due to a violation of the normal biomechanics of the shoulder joint, is called “shoulder pseudoparalysis”. There are a small number of studies devoted to risk factors for the occurrence of this condition, and they are completely absent in the domestic literature. These facts dictate the need to conduct research aimed at identifying risk factors for the development of shoulder pseudoparalysis, especially in our country. The aim isto evaluate, using our own clinical material, risk factors for the development of functional disorders in the shoulder joint in the form of shoulder pseudoparalysis in patients with full-thickness rotator cuff tears. Material and methods. A retrospective study was conducted of 254 patients who underwent surgery for full-thickness rotator cuff tears between January 2018 and August 2021. The analysis was based on data from medical histories, clinical, functional and instrumental studies. Results. 34.3% of patients had functional impairment in the form of shoulder pseudoparalysis; risk factors were: massive damage to the rotator cuff (p&lt;0.001), irreparable ruptures (p&lt;0.001), involvement of the subscapularis tendon (p&lt;0.001), involvement of attachment points of “rotator cable” (p&lt;0.001). More severe injuries to the subscapularis tendon aggravate the manifestations of shoulder pseudoparalysis (p&lt;0.001). Involvement of a greater number of attachment points of the “rotator cable” aggravates the manifestations of shoulder pseudoparalysis (p&lt;0.001) Conclusion. The data obtained demonstrate that massive irreparable tears of the rotator cuff of the shoulder joint with severe damage to the subscapularis tendon are the most dangerous from the point of view of disruption of normal biomechanics and, as a consequence, the development of shoulder pseudoparalysis

Functional and Radiological Out Comes of Patients With Full-Thickness Rotator Cuff Tears Repaired By arthroscopic Knotted-Suture Bridge Double Row Method

Functional and Radiological Out Comes of Patients With Full-Thickness Rotator Cuff Tears Repaired By arthroscopic Knotted-Suture Bridge Double Row Method

Outcomes of initial nonoperative treatment of traumatic full-thickness rotator cuff tears

IntroductionNon-surgical management of chronic, degenerative rotator cuff tears (RCT) can be an effective treatment strategy, but there is limited evidence to support conservative treatment for acute, traumatic RCTs. The objective of this study is to assess clinical outcomes and predictors of treatment success for patients with traumatic RCTs who elected for initial non-operative treatment. MethodsPatients from a single institution were retrospectively identified using diagnostic codes for traumatic RCT followed by confirmed initial treatment with at least 2 months of physical therapy. Exclusion criteria included surgery within 2 months of injury and greater than grade I fatty infiltration on MRI. At minimum 2-year follow-up, patients were contacted by phone to collect interval surgical history and standardized patient reported outcomes. All those who had surgical treatment and those with satisfaction ratings of “moderately dissatisfied” and “very dissatisfied” were considered to have failed physical therapy. ResultsFollow-up outcomes were obtained in forty of 49 patients (82%) with an average follow-up time of 4.2 years. Nine RCTs (22%) were small (< 1cm), 22 (54%) were medium (>1 and < 3cm), and 9 (22%) were large (> 3 cm and < 5cm). Grade I fatty infiltration was seen on 25% (n=10) of MRIs. Eighteen patients (45%) underwent rotator cuff repair following an average 6 months (R: 3-12) of nonoperative treatment. In total, 23 of 40 patients (58%) were determined to have failed nonoperative treatment. Patients with multiple tendons torn were more likely to fail conservative management (p=0.014). Tear size and retraction were not significantly different between patents who had surgery and those who did not. Patients who underwent surgical management had 83% satisfaction rate at final follow-up compared to 55% satisfaction for patients who had no surgery (p=0.054). There was no statistical difference in the ASES (American Shoulder and Elbow Surgeons score) and VAS (Visual Analog Scale) between these groups. While patients who had surgery had a higher mean SANE (Single Alpha Numeric Evaluation) (86.3 vs. 75.1; p=0.041), this difference was below the previously established minimally clinically important difference. ConclusionNon-operative treatment remains a viable option for certain patients with traumatic RCTs; however, the results of our study demonstrate a considerable early failure rate. This study further supports historical literature demonstrating reliably successful outcomes with surgical treatment of acute, traumatic RCTs. Level of EvidenceLevel IV; Case Series; Treatment Study

Effect of Patient Characteristics on the Minimal Clinically Important Difference and Patient Acceptable Symptom State Thresholds After Arthroscopic Bankart Repair

Background: There is scarce literature on clinically significant values after arthroscopic Bankart repair (ABR). Purpose: To determine the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) thresholds at 1 year for the Rowe and Athletic Shoulder Outcome Scoring System (ASOSS) scores after ABR and to determine the effect of patient characteristics on these metrics after ABR. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of patients undergoing ABR from a single institution between January 2017 and January 2020 was performed. Patients with at least 1 episode of instability and a minimum follow-up of 12 months were included. The exclusion criteria were as follows: bony defects of >20% on the anteroinferior portion of the glenoid based on a preoperative computed tomography scan; engaging Hill-Sachs lesions at 90° of abduction and 90° of external rotation based on an arthroscopic examination; previous surgery on the same shoulder; multidirectional instability or concomitant repair of full-thickness rotator cuff tears; superior labral anterior to posterior lesions; posterior labral tears; or humeral avulsion of the glenohumeral ligament lesions. Patient-reported outcome measures were collected both preoperatively and 1-year postoperatively. Delta was defined as the change between preoperative and 1-year postoperative scores. Distribution-based (one-half the standard deviation of the difference between pre- and postoperative outcome scores) and anchored-based approaches (response to a satisfaction question at 1 year) were used to estimate the MCID and the PASS, respectively. The optimal cutoff point, where sensitivity and specificity were maximized, and the percentage of patients achieving those thresholds were also calculated. Results: Overall, 190 patients were included. The distribution-based MCID for the Rowe and ASOSS scores were calculated to be 8.2 and 8.7, respectively. The rate of patients who achieved MCID thresholds was 96% for the Rowe and 96% for ASOSS scores. The PASS threshold for the Rowe and ASOSS scores were ≥80 and ≥90, respectively. The rate of patients who achieved PASS scores after ABR were 86% and 83%, respectively. The MCID and PASS values showed great variability based on sex (men: 8.5 and ≥85 for Rowe / 8.9 and ≥90 for ASOSS, respectively, vs women: 6.7 and ≥73 for Rowe / 8.1 and ≥75 for ASOSS), age (≥21: 8.4 and ≥80 / 9.2 and ≥90 vs <21: 7.8 and ≥75 / 7.7 and ≥85), sports participation (sports: 8.8 and ≥85 / 9.5 and ≥90 vs no sports: 8.1 and ≥75 / 8.6 and ≥80), and type of athlete (competitive: 8.4 and ≥85 / 8.9 and ≥87 vs recreational: 7.5 and ≥73 / 8.1 and ≥68). Conclusion: This study identified the MCID and PASS thresholds for the Rowe and ASOSS scores at 1 year after ABR. However, these values showed great variability when accounting for different patient characteristics such as sex, age, sports participation, and type of athlete, highlighting the importance of considering individual patient-specific characteristics for optimal treatment decision-making and ensuring treatment success tailored to each patient’s unique needs and expectations.

Anatomic factors associated with degeneration and fraying of the coracoacromial ligament.

The coracoacromial ligament (CAL) is frequently observed to be damaged during arthroscopy and it is unclear how demographic, anatomic, and radiographic factors are related to CAL degeneration in full-thickness rotator cuff tears. A prospective study was conducted of patients at a single institution undergoing shoulder arthroscopy for first-time, full-thickness rotator cuff tears. We evaluated preoperative anteroposterior radiographs to obtain critical shoulder angle, glenoid inclination, acromial index, acromiohumeral distance, lateral acromial angle, and acromial morphology. We documented CAL quality, rotator cuff tear size and pattern during arthroscopy. Multiple logistic regression was used to identify predictive factors for encountering severe CAL fraying during arthroscopy. Shoulders had mild CAL degeneration in 58.1% of cases, whereas severe CAL degeneration was present in 41.9% of shoulders. Patients with severe CAL attrition were significantly older (62.0 years vs. 58.0 years, P=0.042). Shoulders with severe CAL attrition had large rotator cuff tears in 54.1% of cases (P<0.001), and tears involving the infraspinatus (63.2% vs. 29.6%, P=0.003). The severe degeneration group was more likely to have a larger critical shoulder angle measurement on preoperative radiographs than those in the mild attrition group (36.1°±3.6° [range, 30°-45°] vs. 34.1°±3.8° [range, 26°-45°], P=0.037). While the clinical impact of CAL degeneration remains uncertain, increased severity of CAL degeneration is associated with older age, larger rotator cuff tear size, presence of infraspinatus tearing, and increased preoperative critical shoulder angle. Level of evidence: III.

Efficacy of rotator cuff suture and arthroscopic 360° capsular release in patients with rotator cuff tear with limited shoulder movement

BackgroundTo determine the clinical efficacy of rotator cuff suture and arthroscopic 360° capsular release in patients with rotator cuff tendinopathy to improve the Constant-Murley and Visual Analogue Scale (VAS) scores, and shoulder flexion.MethodsFifty-one patients with full-thickness rotator cuff tears and limited shoulder movement who were admitted to our hospital from October 2017 to October 2020 were selected; all patients were treated with arthroscopic rotator cuff suture and 360° capsular release. The Constant-Murley score, VAS score, and shoulder flexion angle were used to evaluate shoulder joint function before and during follow-up. Rotator cuff healing was assessed by MRI with the Sugaya classification.ResultsAfter treatment, the Constant-Murley score (58.98 ± 9.84) was significantly improved compared with pre-treatment (29.33 ± 9.71), the VAS score (1.23 ± 0.87) was significantly lower than pre-treatment (7.54 ± 1.22), and the shoulder flexion angle (142.67 ± 8.59°) was significantly improved compared with pre-treatment (51.50 ± 2.10°); the difference was statistically significant (P < 0.05).ConclusionsArthroscopic rotator cuff suture and simultaneous 360° capsular release have a significant effect on the treatment of rotator cuff tear with limited shoulder movement.