Massive Rotator Cuff Research Articles

Arthroscopic suture-bridge repair for moderate to massive full-thickness rotator cuff tear

Objective To evaluate the early clinical outcomes of arthroscopic suture-bridge repair of media to large full-thickness rotator cuff tear. Methods One hundred patients that underwent arthroscopic suture-bridge (suture-bridge group, n=50) or single-row repair (single-row suture group, n=50) for media to massive full-thickness rotator cuff tear from June 2010 to June 2014 were enrolled in this study. The patients (63 males and 37 females), aged 58.7 years (range, 46 to 75 years), were all available to the follow-up. Thirty-one patients were injured in traffic crashes, 30 in falls, 27 in strains and 12 with no apparent reasons. Early passive activity was allowed in suture-bridge group, while shoulder abduction was maintained for 6 weeks postoperatively in control group. Clinical and functional outcomes were measured using the visual analogue scale (VAS), range of motion, University of California at Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score. Results Mean duration of follow-up was 16.7 months (range, 8 to 24 months). Prior to the surgery, these measurements were similar between the two groups. After a follow-up of 3 months, the differences were significant in suture-bridge group compared to control group: VAS [(1.7±1.5) points vs (3.9±2.1) points], forward flexion [(168.3±30.2)° vs (120.2±51.6)°], external rotation [(47.0±11.0)° vs (31.8±13.8)°], UCLA score [(31.7±4.2) points vs (18.2±4.8) points], ASES score [(86.2±14.6) points vs (35.9±17.7) points] (P<0.05). No re-tear occurred after operation. Conclusion Arthroscopic suture-bridge repair of moderate to massive full-thickness rotator cuff tear results in significant improvement of function outcomes and clinical results, indicating a reliable and effective treatment technique. Key words: Arthroscopy; Shoulder; Suture bridge technique

Results of reconstruction of massive irreparable rotator cuff tears using a fascia lata allograft.

Background:Despite the advances in surgical treatment options, massive rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. This study assesses the effectiveness of fascia lata allograft in reconstruction of massive and irreparable r-c tear and to evaluate the healing and functional outcomes.Materials and Methods:68 patients (38 men, 30 women, mean age 64.9 years) with massive or irreparable r-c tears were treated with placement of fascia lata allograft to fill the defect between February 2006 and February 2010. At 43 months followup they were evaluated clinically using the constant score, preoperatively and postoperatively. Magnetic resonance imaging (MRI) and ultrasound were used postoperatively, to assess the integrity of the allograft at the repair site. Postoperatively, standard rehabilitation protocol was followed with gradual restoration.Results:Postoperative constant score increased from 32.5 preoperatively to 88.7 postoperatively. The most important was the pain relief from 2.4 preoperatively to 14.1 postoperatively and range of motion. The results of the MRI were not reliable, but the ultrasound was satisfactory. Finally, there was no infection or rejection of the graft in any of the patients.Conclusions:Despite advances in surgical methods, there is still not a universally accepted treatment for massive and irreparable rotator cuff tears, because the standard methods have dubious results, with excessive retear rates and poor outcomes, necessitating the need for new repair strategies. We documented significant clinical improvement using fascia lata allograft in the repair of massive irreparable r-c tear, acting as scaffold to bridge the defect, enhancing the healing at the repair site.

Outcome of open massive rotator cuff repairs with double-row suture knotless anchors: case series.

The aim of the present study was to evaluate functional and quality of life outcomes after transosseous equivalent (TOE) double row suture technique for massive rotator cuff (RTC) tear repair using validated subjective and objective measures. This technique has shown promising preliminary results in RTC repair; however, a paucity of evidence regarding these outcomes in massive RTC (MRTC) tear repair exists. Patients were identified using the Hospital Inpatient Enquiry Scheme. Pre-operative MRI and medical records were reviewed. A massive RTC tear was defined as the detachment of two or more tendons from their point of insertion on the humeral head. The Constant and Oxford Shoulder Scores (OSS) and SF-12 questionnaire were used for evaluation. Twenty-two patients were studied (72.7 % male; mean age at surgery, 62.6 years). Mean follow up was 14 (range six to 30) months. At six weeks postoperatively, 68 % achieved good or excellent shoulder function as measured by the OSS and Constant score. The cohort's mean SF-12 physical and emotional scores were significantly lower (p = 0.0002 and 0.037) and the vitality and mental health scores were higher (p = 0.005 and 0.006) than the reference norm scores. The TOE double row surgical repair for MRTC tears provides good to excellent functional outcomes and is associated with high vitality and mental health scores at a mean of 14 months. Physical and emotional scores were lower than reference norm. These results suggest this repair technique is appropriate for massive rotator cuff tears, and future randomised control studies are warranted.

Bone morphogenetic protein signaling in rotator cuff muscle atrophy and fatty infiltration

reduced mass (atrophy) and increased fat content (fatty infiltration) of rotator cuff muscles are common complications of large or massive rotator cuff (RC) tears, and are believed to be irreversible even after tendon repairs. Clinically, both muscle atrophy and fatty infiltration are important factors contributing to poor functional outcomes after tendon repairs. The molecular mechanism of RC muscle atrophy and FI remains undefined. In this study, we investigated the role of bone morphogenetic proteins (BMP) signaling in RC muscle atrophy and fatty infiltration using a rat model. unilateral massive RC tears was induced in adult rats. RC muscles were harvested at 2 and 6 weeks after injury for BMP signaling analysis. In a separate experiment, BMP inhibitor (LDN-193189) was injected to rats through daily intraperitoneal injection. RC muscles from rats in the treated and control groups were harvested at 6 weeks after injury for biochemistry and histology analysis. we found significantly increased BMP-14 and BMP-7 expression in rotator cuff muscles after RCT. Inhibiting BMP signaling resulted in increased muscle atrophy and reduced fatty infiltration in rotator cuff muscle after RC tears. this result suggests that BMP signaling inhibits RC muscle atrophy but promotes fatty infiltration.

Tendon Transfers for Massive Irreparable Rotator Cuff Tear

Management of massive irreparable rotator cuff tears can be challenging. In patients who are not candidates for shoulder arthroplasty, either because of age or higher levels of activity, tendon transfers remain a good surgical option to reconstruct the deficient rotator cuff. The latissimus dorsi is the most commonly described tendon transfer for posterior-superior rotator cuff deficiency. Additional options include teres major and lower trapezius transfers. For anterior-superior irreparable rotator cuff tears, the pectoralis major transfer, whether superficial or deep to the conjoined tendon, is the most commonly described transfer. Additional transfers include those of pectoralis minor, teres major, and latissimus dorsi. The purpose of this article is to provide an evidence-based overview of the different types of tendon transfers that have been described to reconstruct massive, irreparable rotator cuff tears.

The minimal detectable change of the Constant score in impingement, full-thickness tears, and massive rotator cuff tears

The purpose of this study was to determine the minimal detectable change (MDC) for the Constant score in patients with impingement, a supraspinatus tear, or a massive rotator cuff (RC) tear as observed changes smaller than the MDC might be the result of measurement error. The Constant score was recorded in a total of 180 patients, including 34 patients with impingement, 105 with supraspinatus tears, and 41 with massive RC tears. We assessed the MDC in the 3 subgroups and total group using the samples standard deviation (SD), internal consistency (Cronbach α), and standard error of the measurement. Floor and ceiling effects were also reported. The absolute mean Constant score was 72 (SD, 11.2) in the impingement group, 44 (SD, 14.7) in the supraspinatus tear group, and 46 (SD, 18.9) in the massive RC tear group. There were no floor and ceiling effects for the absolute Constant score. In the total group, the internal consistency was 0.8 and the standard error of the measurement was 8. The MDC was 23 points on the Constant score in the total group and 17, 18, and 23 points on the Constant score for impingement, RC tears, and massive RC tears, respectively. This study demonstrates that the MDCs of the Constant score are different in patients with impingement, supraspinatus tears, and massive RC tears. Studies reporting the Constant score should be interpreted by use of the population-specific MDC and minimal clinical important change.

Does the Posterior Interval Slide Show Better Outcomes for Repairing the Large to Massive Contracted Rotator Cuff Tear? A Comparison to Rotator Cuff Repair Without Posterior Interval Slide

Does the Posterior Interval Slide Show Better Outcomes for Repairing the Large to Massive Contracted Rotator Cuff Tear? A Comparison to Rotator Cuff Repair Without Posterior Interval Slide

Cutting-Edge Arthroscopic Surgeons Report Excellent Results for Complex Knee and Shoulder Conditions

Cutting-Edge Arthroscopic Surgeons Report Excellent Results for Complex Knee and Shoulder Conditions

English

Introduction Suprascapular nerve neuropathy related to rotator cuff tears has become a topic of discussion. However, there are a few studies to support suprascapular nerve neuropathy in cases of (massive) rotator cuff tears. There are also a few studies showing the indication for concomitant suprascapular nerve release; however, several clinical and basic studies provide some evidence that suprascapular nerve injury may be a part of the disease spectrum of rotator cuff pathology. In this short review article, suprascapular neuropathy related to rotator cuff tears is discussed. Conclusion Till date, there are a few studies to support suprascapular nerve neuropathy in cases of (massive) rotator cuff tears. Future studies will hopefully serve to elucidate these issues.

Arthroscopic repair of massive contracted rotator cuff tears using a “slide” technique

Objective To evaluate the “slide“ technique used in arthroscopic repair of massive contracted rotator cuff tears.Methods Between January 2007 and December 2010,21 patients (8 men and 13 women) underwent arthroscopic repair of massive contracted rotator cuff tears using the ” slide” technique.Their mean age was 60.5 years,ranging from 42 to 73 years.Seven cases had the tear on the left side and 14 on the right.All patients were followed up until the last time by X-ray and MRI evaluations.The postoperative range of motion (ROM) and functional recovery were evaluated by comparing the preoperative visual analog scale (VAS) pain score,University of California at Los Angeles (UCLA) and Constant-Murley scores with those at the last follow-up.Results All patients were followed up for an average of 23.2 months (range,12 to 36 months).Good healing was achieved in all cases.The last follow-ups showed good alignment of the shoulder joint and no upper advancement of the humeral head.The average postoperative VAS,UCLA and Constant-Murley scores were respectively 4.6 ± 1.3,8.7 ± 2.5 and 38.1 ± 7.7,significantly better than those at the last follow-up (9.0 ± 1.2,29.4 ±4.5 and 86.9 ± 10.0 respectively) (P ＜0.05).No infection,nonunion or paresthesia of the shoulder joint was observed.Conclusion Arthroscopic repair of massive contracted rotator cuff tears using the ”slide” technique can lead to satisfactory clinical outcomes with respect to pain,ROM,muscle strength and functional recovery. Key words: Shoulder joint; Arthroscopy; Shoulder impingement syndrome; Reoperation

(i) The management of irreparable rotator cuff tears

Abstract The management of massive irreparable rotator cuff tears can be challenging. There are, however, a number of operative and non-operative options available to the shoulder surgeon. Non-operative management with simple analgesics, steroid injections and a deltoid re-education programme may be appropriate for patients with few symptoms, particularly elderly, lower demand patients with lower expectations. In more symptomatic patients, especially younger patients with higher demands, surgical intervention may be considered. Arthroscopic debridement and/or, sub-acromial decompression (with or without biceps tenotomy) may suffice, but partial or augmented rotator cuff repair or tendon transfer surgery is available. In the presence of arthrosis, cuff tear arthroplasty or reverse geometry arthroplasty are valid options. Treatment should be individualized depending on the patient's symptoms, age, expectations, needs and the presence or absence of associated glenohumeral joint arthrosis.

Clinical Success with Dermal Tissue Allograft for Massive Irreparable Rotator Cuff Tears

Clinical Success with Dermal Tissue Allograft for Massive Irreparable Rotator Cuff Tears

Suprascapular nerve: is it important in cuff pathology?

Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting.

Midterm Outcome of Arthroscopic Revision Repair of Massive and Nonmassive Rotator Cuff Tears

The purpose of this study was to evaluate the midterm functional outcome of arthroscopic revision rotator cuff repair and compare the outcomes of nonmassive and massive rotator cuff tears. We performed a retrospective review of patients over a 10-year period who underwent arthroscopic revision rotator cuff repair. The cohort was divided into 2 groups based on tear size (nonmassive and massive tears). The cohort consisted of 21 nonmassive tears and 53 massive tears with a mean follow-up of 63 months. The 2 groups had similar baseline characteristics. In the overall cohort, after arthroscopic revision repair, there was a significant reduction in pain (P < .001) and increase in active forward elevation (P = .003) and functional outcome by American Shoulder and Elbow Surgeons score (P < .001) and University of California, Los Angeles score (P < .001). The rate of patient satisfaction was 78%. There was no significant difference between the 2 groups (nonmassive v massive) in postoperative forward elevation, pain, or functional outcome. A poor functional outcome according to the University of California, Los Angeles score was associated with female sex (P = .005), preoperative active forward flexion below 136° (P = .004), and preoperative pain score greater than 5 points (P = .002). The results of this study suggest that arthroscopic revision rotator cuff repair is a reasonable treatment option, even in cases of massive retears. Tear size does not appear to affect final outcome. This technique can yield reliable improvements in active forward elevation and functional outcome and a decrease in pain at an acceptably high rate in this difficult patient population. Female sex, preoperative forward elevation less than 136°, and preoperative pain score greater than 5 points are poor prognostic risk factors for obtaining a satisfactory functional outcome with arthroscopic revision repair. Level IV, therapeutic case series.

Paper # 117: Platelet-Rich Fibrin Matrix Augmentation for Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Our study does not support the use of autologous PRFM for augmentation of a double row repair of a small or medium RC tear to improve the healing of the RC Following reinsertion on the humerus the rotator cuff (RC) has limited ability to heal. Growth factors augmentation has been proposed to be able to enhance healing in such procedure. To assess the efficacy and safety of the addition of growth factor augmentation during rotator cuff repair. Randomised controlled trial; Level of evidence, 1. Eighty-eight patients with a rotator cuff tear were randomly assigned by a computer-generated sequence to receive arthroscopic rotator cuff repair without (n=45) or with (n=43) augmentation with autologous platelet-rich fibrin matrix (PRFM). The primary endpoint was the post-operative difference in the Constant score between the 2 groups. The secondary endpoint was the integrity of the repaired rotator cuff, as evaluated by MRI. Analysis was on an intention to treat basis. All the patients completed follow-up at 16 months. There was no statistically significant difference in total Constant Score when comparing the results of arthroscopic repair of the 2 groups (95% confidence interval [CI], -3.43 - 3.9) (P=0.44). There was no statistically significant difference in MRI tendon score when comparing arthroscopic repair with or without PFRM (P=0.07). Our study does not support the use of autologous PRFM for augmentation of a double row repair of a small or medium RC tear to improve the healing of the RC. Our results are applicable to small and medium RC tears: it is possible that PRFM may be beneficial for large and massive RC tears. Also, given the heterogeneity of PRFM preparation products available on the market, it is possible that other preparations may be more effective.

Arthroscopic Repair of a Traumatic Massive Posterior Rotator Cuff Tear in a 14-year-old Teenager

Rotator cuff tears in adolescents are extremely rare, with no reported cases of arthroscopic repair being available in the literature thus far. A 14-year-old boy sustained a traumatic tear of his supraspinatus and infraspinatus muscles of the rotator cuff during a fall off his motorcycle during a motocross race. He also sustained a contralateral mid-shaft clavicle fracture. The rotator cuff was repaired arthroscopically with two rows of double loaded suture anchors. The clavicle was fixed with an elastic intramedullary nail. This was followed by intensive physiotherapy, and the patient returned to full pre-injury function in his shoulder by 6 months postoperatively.

I trapianti tendinei

In massive and irreparable rotator cuff tears the decision-making process for tendon transfer depends on the existence of any possibility of recovering tendon continuity in the presence of muscle fatty degeneration. Function of the deltoid and the remaining muscles of the rotator cuff must be preserved, without osteoarthritis or joint stiffness. Tendon transfers are taken from the scapular/humeral thoracic region; the procedure allows the recover of lost function of the shoulder, in particular abduction, extrarotation and intrarotation, and also of humeral head stability.

Cuff Tear Arthropathy Humeral Head Replacement: When More Is Better

When confronted with the diagnosis of shoulder arthritis, it is incumbent on the treating physician to discern the complete nature of the pathology. Arthritic processes about the shoulder predictably involve disease both to the bony elements and to the soft tissues about the joint. While there are many options available for the surgical management of shoulder arthritis, the exact type of shoulder replacement depends on both the bone issues and the soft tissue issues as well. For the patient with a massive and irreparable rotator cuff tear, a cuff tear arthropathy (CTA) head may be most appropriate. Indications for humeral head replacement with the CTA head depend on specific anatomic and physiologic factors. For the patient with a massive and irreparable cuff tear who retains an intact coracoacromial arch, this type of prosthetic replacement provides predictable relief of pain while allowing significant improvement in function. Recovery of function requires a structured muscle re-education program.

Intramuscular ganglion arising from the acromioclavicular joint

We report a case of a 80-year-old White woman presenting with a localized painless swelling in the upper parascapular region of the right shoulder. Ultrasound (US) showed a ganglion arising from the acromioclavicular joint (ACJ) and extending inside the trapezius muscle, together with a massive tear of the rotator cuff (RC). Magnetic resonance imaging (MRI) confirmed the US findings. Ganglia arising from the ACJ are rare and usually associated with massive RC tears. Their intramuscular extension, to the best of our knowledge, has never been reported in the radiological literature and can mimic a tumor.

Shoulder reconstruction using Grammont (Delta III) total arthroplasty after resection for malignant bony tumours of proximal humerus

The Grammont total shoulder prosthesis (Delta III) is an original reversed constrained prosthesis. Classical indication is glenohumeral osteoarthritis with massive and irreparable rotator cuff tears. The authors report a Delta III arthroplasty for a rare histological variant of proximal chondrosarcoma, by pointing out the technical and biomechanical principles of this arthroplasty. Clinical and radiological results are presented with a 9-year follow-up. To our mind, in case of malignant bony tumours of proximal humerus with carcinologic cuff resection, the Grammont total shoulder arthroplasty is of interest and its proposal must be discussed.