History Of Rotator Cuff Tears Research Articles

Does surgical intervention alter the natural history of degenerative rotator cuff tears? Comparative analysis from a prospective longitudinal study

The natural history of rotator cuff tears often involves progressive pain development, tear enlargement, and advancing muscle fatty degeneration. Both surgery and conservative management have proven to be effective treatments. Our study purpose was to compare the short to mid-term effects of rotator cuff repair on shoulder function, progression of tear size, and muscle degeneration compared to controls with asymptomatic tears that developed pain and were managed nonoperatively. This comparative study consists of two separate longitudinal study arms. The control group consisted of asymptomatic degenerative cuff tears followed until pain development and then managed nonoperatively with continued surveillance. The surgical group consisted of subjects with degenerative tears that failed nonoperative treatment and underwent surgical intervention with a minimum of 2 years follow-up. Outcomes included VAS pain, ASES, AROM, strength, and ultrasonography. There were 83 controls and 65 surgical shoulders. The surgical group was younger at enrollment (58.9±5.3 yr vs. 61.2±7.8 yr, p=0.04). The median follow-up for control subjects after pain development was 5.1 years (IQR 3.6) and the median postoperative follow-up for the surgical group was 3.0 years (IQR 0.2). Baseline tear widths (median 14 mm, IQR 9 vs. 13 mm, IQR 8; p=0.45) and tear lengths (median 14 mm, IQR 13 vs. median 11 mm, IQR 8; p=0.06) were similar between the surgical group and controls. There were no differences in the baseline prevalence of fatty degeneration of the supraspinatus or infraspinatus muscles between groups (p=0.43 and p=0.58, respectively). At final follow-up, the surgical group demonstrated significantly lower VAS pain (0 [IQR 2] vs. 3.5 [IQR 4], p=0.0002), higher composite ASES (95 [IQR 13] vs. 65.8 [IQR 32], p=0.0002) and ADL scores (29 [IQR 4] vs. 22 [IQR 8], p=0.0002), greater abduction strength (69.6 N [SD 29] vs. 35.9 N [SD 29], p=0.0002), greater active forward elevation (155˚ [SD 8] vs. 142˚ [SD 28], p=0.002), greater active external rotation in abduction (mean 98.5˚, SD 12 vs. mean 78.2˚, SD 20; p=0.0002) compared to controls. Additionally, the prevalence of fatty muscle degeneration was lower in the surgical group for the supraspinatus and infraspinatus (25% vs. 41%, p=0.05; 17% vs. 34%, p=0.03; respectively). This prospective longitudinal study comparing a surgical cohort undergoing rotator cuff repair with a control group treated nonoperatively supports the notion that surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease. Patients in the surgical group demonstrated clinically relevant differences in pain and functional outcomes. Surgical intervention was protective against progressive muscle degeneration compared to nonoperative treatment.

Poster 174: The Role of Familial Predisposition in Imaging-Confirmed Atraumatic Rotator Cuff Tears

Objectives:The etiology of rotator cuff tears is not completely understood. Several studies have identified age, smoking, hypercholesterolemia, diabetes, and hypertension as potential risk factors of rotator cuff tears. Limited data suggests the role of genetic and familial predisposition in the etiology of rotator cuff tears. Our objective was to assess whether there is an increased likelihood of rotator cuff tears in family members of patients with rotator cuff tears versus those without tears. This would provide evidence for whether there is a familial predisposition to rotator cuff tears.Methods:Patients presenting to a shoulder clinic with pain, stiffness, or instability were recruited in this study. Patients that completed a shoulder outcomes questionnaire, were age 18 years or older, and had an available MRI or CT arthrogram of the symptomatic shoulder were included in the study. Any individuals with acute traumatic rotator cuff tears were excluded from analysis. On the questionnaire, patients provided information on demographics, personal medical history, shoulder symptoms, and family history of rotator cuff tears. The diagnosis of rotator cuff tears was based on imaging (MRI or CT arthrogram) confirmation of a structural defect in the rotator cuff. The association between family history of rotator cuff problems and the likelihood of an imaging-confirmed rotator cuff tear diagnosis was evaluated using multivariate logistic regression, adjusting for age, sex, race and ethnicity, smoking, hypertension, diabetes, and depression.Results:In our cohort of 2,337 patients, 52.7% (n=1,231) of patients had an imaging-confirmed atraumatic rotator cuff tear. Among patients with tears, 18.0% (n=221) of patients reported a family history of rotator cuff issues versus 11% (n=123) in patients without tears. A family history of rotator cuff problems was significantly associated with the diagnosis of an imaging-confirmed rotator cuff tear (Odds Ratio=2.27, 95% CI = 1.72, 3.01). Increasing age (Odds Ratio=1.06, 95% CI = 1.05, 1.07) and Hispanic race and ethnicity (Odds Ratio=1.49, 95% CI = 1.06, 2.11 in Hispanic patients versus those of Non-Hispanic White ancestry) were also significantly associated with a rotator cuff tear diagnosis. Sex, smoking, hypertension, diabetes, and depression were not significantly associated with rotator cuff tears.Conclusions:Our study shows that individuals with rotator cuff tears were over two times as likely to have a family member with a rotator cuff tear as compared with patients without tears. These results support previous studies which have suggested a genetic component in the development of tendinopathies1.In a similar study by Assunção et al., individuals with familial history of treatment for rotator cuff tears were 3.3 times as likely to experience a cuff tear2. In another study by Harvie et al, siblings of patients with a full-thickness tear were 2.42 times more likely to experience a tear

The role of familial predisposition in imaging-confirmed atraumatic rotator cuff tears.

The etiology of atraumatic rotator cuff tears is not completely understood. Limited data suggest the role of genetic and familial predisposition in the etiology of rotator cuff tears. The purpose of this study was to assess whether there is an increased likelihood of rotator cuff tears in family members of patients with rotator cuff tears vs. those without tears. This would provide evidence for whether there is an association between familial predisposition and rotator cuff tearing. Patients presenting to a shoulder clinic were recruited in this study. They provided information on personal medical history, shoulder symptoms, and family history of rotator cuff tears. The diagnosis of rotator cuff tears was based on imaging (magnetic resonance imaging or computed tomography arthrogram) confirmation of a structural defect in the rotator cuff. The association between family history of rotator cuff problems and the likelihood of an imaging-confirmed rotator cuff tear diagnosis was evaluated using multivariate logistic regression, adjusting for age, sex, race/ethnicity, cigarette smoking, hypertension, diabetes, and depression. In our cohort of 2335 patients, 52.6% (n = 1229) of patients had a rotator cuff tear. Among patients with tears, 17.9% (n = 220) of patients reported a family history of rotator cuff issues vs. 11.1% (n = 123) in patients without tears. A family history of rotator cuff problems was significantly associated with the diagnosis of an imaging-confirmed rotator cuff tear (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.71, 2.95). Other confounding variables such as increasing age (OR 1.06, 95% CI 1.05, 1.07) and Hispanic race/ethnicity as compared to non-Hispanic white race/ethnicity (OR 1.48, 95% CI 1.07, 2.05) were significantly associated with rotator cuff tears. Sex, smoking, hypertension, diabetes, and depression were not significantly associated with rotator cuff tearing. Our study shows that individuals with rotator cuff tears were more than 2 times as likely to have a family member with a tear as compared to patients without tears. Increasing age and patients who identified as being of Hispanic ancestry were also significantly associated with higher odds of rotator cuff tears.

Association between functional outcome scores and MRI-based structural integrity after rotator cuff repair: a prospective cohort study.

Natural history of rotator cuff tears is poorly understood. Repair of rotator cuff tears has shown to improve functional outcomes in full-thickness tears. However, high re-tear rates have been reported in literature, which does not correlate with poorer outcomes. Primary aim of this study was to explore association between functional outcome scores and structural integrity of rotator cuff, using magnetic resonance imaging (MRI)-based grading. Patients with MRI-proven full-thickness rotator cuff tears, undergoing mini-open rotator cuff repair, were assessed for shoulder abduction strength and functional outcome scores before the surgery and 2 years after the procedure. Association between functional outcome scores and MRI grading for rotator cuff healing (Sugaya grading) was analyzed. A total of 38 patients (18 females and 20 males), with a mean age of 50.6 years (SD: 10.9), were included in the study. Mean duration of symptoms was 6.05 months (SD: 4.2). On postoperative MRI, healing of the cuff was categorized as Sugaya grade 1 in 12 patients, grade 2 in 20 patients and grade 3 in 6 patients. Higher Sugaya grades (T: 13.48, p: 0.001) and grades of fatty degeneration (T: 14.05, p: 0.001) were found to be associated with longer duration of symptoms. Improvement in shoulder abduction strength correlated negatively with the duration of symptoms (r: -0.39, p: 0.01). There was a significant improvement in functional outcome scores after the surgery. There was no association between postoperative structural integrity of the repaired tendon (Sugaya grading) and functional outcome scores. Early repair of rotator cuff results in better functional outcomes and shoulder strength. The findings from this study suggest there is a dissociation between MRI-based grades of healing of repaired rotator cuff and function of the shoulder. Level II, Prospective cohort study.

Unrepaired rotator cuff tears following acromioplasty

Background: The natural history of rotator cuff tears suggests that not all tears progress and small isolated rotator cuff tears might heal. To date there have been no long-term studies assessing the MRI changes of unrepaired full thickness supraspinatus tears after acromioplasty. Methods: A database of patients from a single surgeon that have had acromioplasty without rotator cuff repair in the last five to 15 years was reviewed. The number of shoulders examined in this study was 17. Patients all completed an Oxford score, Constant score and had an MRI to assess fatty infiltration and atrophy. Results: Mean follow-up time 7.2 years (range, 5–13 years). The patients were divided into three groups depending on the size of the tear at time of surgery: C1 tears (<1 cm) n=5, C2 tears (1–1.9 cm) n=8, C3 tears (2–3 cm) n=4. In the C2 group, MRI evaluation showed there were two patients that had tears that had regressed in size (CI 1.4–36, 4). In the C3 group, MRI evaluation revealed that all (100%) of the rotator cuff tears had significant fatty infiltration and atrophy. There was no statistical difference between groups when assessing Oxford scores (p=0.75) and Constant scores (p=0.69). There was significant association between increase in tear size and fatty infiltration (p=0.028). A possible association was noted between increase in tear size and atrophy (p=0.054). Conclusion: Patients had good long-term clinical outcomes irrespective of tear size. It showed that not all tears progressed to significant fatty change and atrophy. Level of evidence: Level 3

Partial and Full-Thickness RCT: Modern Repair Techniques.

The purpose of this article is to review the recent literature concerning modern repair techniques related to partial- and full-thickness rotator cuff tears. The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears. Significant controversy remains in treatment indications for partial-thickness rotator cuff lesions as well as optimal surgical repair techniques for both partial- and full-thickness tears. Techniques such as margin convergence and reduction of the so-called "comma" tissue have improved the ability to anatomically reduce large and retracted tears. Repair strength and contact pressures are improved with double-row repairs and transosseus-equivalent techniques compared to traditional single-row repairs. Future work is directed towards obtaining reliable radiographic healing and demonstrating clinical superiority and cost-effectiveness of a single technique. Much recent work regarding rotator cuff anatomy and pathology has been reported. Newer techniques improve repair strength. Despite these advances, significant questions remain concerning surgical indications and clinical outcomes.

Development of an Arthroscopic Joint Capsule Injury Model in the Canine Shoulder.

BackgroundThe natural history of rotator cuff tears can be unfavorable as patients develop fatty infiltration and muscle atrophy that is often associated with a loss of muscle strength and shoulder function. To facilitate study of possible biologic mechanisms involved in early degenerative changes to rotator cuff muscle and tendon tissues, the objective of this study was to develop a joint capsule injury model in the canine shoulder using arthroscopy.MethodsArthroscopic surgical methods for performing a posterior joint capsulectomy in the canine shoulder were first defined in cadavers. Subsequently, one canine subject underwent bilateral shoulder joint capsulectomy using arthroscopy, arthroscopic surveillance at 2, 4 and 8 weeks, and gross and histologic examination of the joint at 10 weeks.ResultsThe canine subject was weight-bearing within eight hours after index and follow-up surgeries and had no significant soft tissue swelling of the shoulder girdle or gross lameness. Chronic synovitis and macroscopic and microscopic evidence of pathologic changes to the rotator cuff bony insertions, tendons, myotendinous junctions and muscles were observed.ConclusionsThis study demonstrates feasibility and proof-of-concept for a joint capsule injury model in the canine shoulder. Future work is needed to define the observed pathologic changes and their role in the progression of rotator cuff disease. Ultimately, better understanding of the biologic mechanisms of early progression of rotator cuff disease may lead to clinical interventions to halt or slow this process and avoid the more advanced and often irreversible conditions of large tendon tears with muscle fatty atrophy.

Tissue regeneration for the traumatic anterior instability with bony defect

10 LONGITUDINAL STUDY FOR ROTATOR CUFF TEARS IN THE GENERAL POPULATION Atsushi Yamamoto, Kenji Takagishi, Hitoshi Shitara, Tsuyoshi Ichinose, Tsuyoshi Sasaki, Noritaka Hamano, Tsutomu Kobayashi, Daisuke Shimoyama, Toshihisa Osawa, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Department of Physical Therapy, Takasaki University of Health and Welfare, Department of Orthopaedic Surgery, Takasaki General Medical Center The purpose of this study was to elucidate the natural history of rotator cuff tears (RCTs) in the general population. We have performed annual medical check-ups since 2006. The subjects of this study consisted of 568 people, with 1,136 shoulders, who were investigated longitudinally more than two times between 2009 and 2015, which comprised 400 men and 736 women, with a mean age of 67.2 years (range; 30-85), and a mean follow-up period of 3.5 years (range; 1-6). We performed ultrasonography to diagnose RCTs. At the beginning of the survey, 957 shoulders were diagnosed as non-tear. As time passed, 45 and 29 of these shoulders progressed to partial-thickness tear (PTT) and full-thickness tear (FTT), respectively. At the same time, 32 shoulders were diagnosed as PTT, and 53.1% of them progressed to FTTas time passed. Additionally, 147 shoulders were diagnosed as FTTat the beginning of the survey, and 33.3% of them enlarged the size of tears by more than 5 mm during the survey. In 147 of FTTs, 43 shoulders were symptomatic tears and 104 shoulders were asymptomatic tears. The development of symptoms in both symptomatic and asymptomatic tears was associated with the enlargement of the size of tear. In conclusion, RCTs might become asymptomatic if the size of tear the remains the same, while they seem to be symptomatic when a new tear or enlargement of the size of the existing tear occurs.

The natural history of rotator cuff tears: a systematic review.

To analyse the current scientific evidence regarding the natural history of the clinical and anatomical progression of rotator cuff tears. A broad systematic review of the literature (PubMed database through January 2014) which was guided, conducted and reported according to PRISMA criteria. This article focuses on the rotator cuff tears. Articles had to meet an inclusion criteria. The methodological quality of each study was individually assessed using a recently developed general assessment tool AMQPP (assessing the methodological quality of published papers). Seven articles dealing with rotator cuff tears were included, one of them was a high-quality study. Three papers assessed the natural history and the natural course of rotator cuff rupture directly. The other studies indirectly assessed the natural history with reports on non-operative and operative therapy trends. All of these articles had been published in four different top medical journals according to 2013 ranking. We found no articles which clearly referred to the role of regression to the mean of rotator cuff tears. The development of symptoms and anatomical deterioration are often directly correlated. Spontaneous recovery to normal levels of function has been successfully achieved, and standardised non-operative treatment programmes are an effective alternative to surgery for many patients. Follow-up is necessary to avoid irreparable stage. However, surgery is still favoured by young active people and highly professional persons who need to get fit in a short period of time. Further research is still necessary. The AMQPP score system is simple and reliable. It works as a quick quality-checking tool which helps researchers to identify the key points in each paper and reach a decision regarding the eligibility of the paper more easily.

Natural history of rotator cuff tears monitored by magnetic resonance imaging

Natural history of rotator cuff tears monitored by magnetic resonance imaging

Role of serum fibrinogen levels in patients with rotator cuff tears.

Although rotator cuff (RC) tendinopathy is a frequent pathology of the shoulder, the real understanding of its aetiopathogenesis is still unclear. Several studies showed that RC tendinopathy is more frequent in patients with hyperglycemia, diabetes, obesity, or metabolic syndrome. This paper aims to evaluate the serum concentration of fibrinogen in patients with RC tears. Metabolic disorders have been related to high concentration of serum fibrinogen and the activity of fibrinogen has been proven to be crucial in the development of microvascular damage. Thus, it may produce progression of RC degeneration by reducing the vascular supply of tendons. We report the results of a cross-sectional frequency-matched case-control study comparing the serum concentration of fibrinogen of patients with RC tears with that of a control group of patients without history of RC tears who underwent arthroscopic meniscectomy. We choose to enrol in the control group patients with pathology of the lower limb with a likely mechanic, not metabolic, cause, different from tendon pathology. We found no statistically significant differences in serum concentration of fibrinogen when comparing patients with RC tears and patients who underwent arthroscopic meniscectomy (P = 0.5). Further studies are necessary to clarify the role of fibrinogen in RC disease.

Natural History of Rotator Cuff Tears Monitored by Magnetic Resonance Imaging

Natural History of Rotator Cuff Tears Monitored by Magnetic Resonance Imaging

Risk of Tear Progression in Nonoperatively Treated Small Full-Thickness Rotator Cuff Tears

Rotator cuff disorders are the most common cause of disability related to the shoulder. Despite a large amount of literature on the outcomes of surgical repair of rotator cuff tears, the indications for surgery still remain controversial and are not standardized. Dunn et al. reported on the variation in surgeons’ perceptions about the indications for the treatment of rotator cuff tears1. One of the most important reasons for the lack of consistent indications is the paucity of quality information on the natural history of rotator cuff tears that are treated nonoperatively. This paucity of information on the natural history of these tears is likely due to the fact that many tears are surgically treated after the development of symptoms. By attempting to understand the natural history of rotator cuff tears, we can gain insight into the etiology of the disease process, which factors contribute to tendon healing, when conservative care should be utilized, and when early surgical intervention is appropriate. This study by Fucentese et al. fills a niche in the current literature regarding …

A PROSPECTIVE MULTIPRACTICE INVESTIGATION OF PATIENTS WITH FULL-THICKNESS ROTATOR CUFF TEARS

Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons. Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function. As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function. Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.

Classification of rotator cuff tears

Classification of rotator cuff tears may yield useful information on diagnosis, treatment, prognosis, and evaluation of treatment results. The shape, localization, etiology, size, topography, pathology, and history of rotator cuff tears, together with the involvement of specific tendons in the occurrence of a tear may be of great value in the hand of expert interpreters. This article intends to give a brief description of rotator cuff tears by way of illustration.