Massive Tears Research Articles

The Patient Acceptable Symptom State as a Predictor of the Sports Activity Available State After Arthroscopic Rotator Cuff Repair.

Background:The patient acceptable symptom state (PASS) has emerged as a metric for evaluating patient satisfaction after treatment. There is little research on the relationship between sports activity and PASS values after arthroscopic rotator cuff repair (ARCR).Purpose:To (1) introduce the sports activity available state (SAAS) as an indicator of whether sports activities are possible based on patient symptoms after ARCR, (2) investigate the correlation between the SAAS and PASS, (3) predict the SAAS using derived PASS values, and (4) identify factors for achieving the PASS and SAAS.Study Design:Case-control study; Level of evidence, 3.Methods:Included were 201 patients who underwent ARCR between January 2015 and December 2016. At a mean follow-up of 38.7 ± 7.0 months, anchor questions were used to classify patients as SAAS+ (sports group) or SAAS– (nonsports group) and derive the PASS values for the pain visual analog scale (pVAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE). The authors analyzed the correlation and difference between PASS and SAAS acquisition, and univariate and multivariate logistic regression analyses were performed to determine factors for PASS and SAAS achievement.Results:The final PASS values for the pVAS, ASES, and SANE were 0.5, 93.5, and 82.5, respectively. A significant correlation existed between PASS and SAAS acquisition (phi correlation coefficient, 0.647; P < .001). Sensitivity and specificity were >0.7 for all outcome scores when predicting SAAS using PASS values. A higher preoperative ASES score was significantly associated with achieving both the SAAS (OR, 1.032 [95% CI, 1.005-1.059]; P = .018) and PASS (OR, 2.556 [95% CI, 1.753-3.726]; P < .001). Diabetes (OR, 0.348 [95% CI, 0.130-0.931], P = .036) and a large to massive tear (OR, 0.378 [95% CI, 0.162-0.884]; P = .025) were significantly negatively associated with achieving the SAAS.Conclusion:The authors found the SAAS to be significantly correlated with the PASS. Also, SAAS was able to be predicted using the PASS value. Patients with higher preoperative ASES scores had higher odds of achieving both the PASS and SAAS, and patients with diabetes and those with large to massive tears had lower odds of achieving the SAAS.

Arthroscopic Repair of Large and Massive Tears in Rotator Cuff and its Consequences: a Longitudinal Retrospective Analysis Conducted in a Retrospective Manner

Aim: Assessment of the consequences of arthroscopic repair of large and massive rotator cuffs. Study design: Retrospective analysis Place and duration: This study was conducted at Shaheed Zulifqar Ali Bhutto Medical University/PIMS Islamabad Pakistan from August 2020 to August 2021. Methodology: In the current study, 50 patients were included out of which 37 patients had large tears and 13 had massive tears which were repaired arthroscopically. Average follow up was of 32 months. Modified UCLA shoulder rating scale was used to evaluate the function, strength, range of motion and the pain before and after surgery. Results: Among the included 50 patients, 21 patients were female, and 29 were male. The range of their ages was between 41 and 76 years. The dominant extremity was affected in majority of patients. The average preoperative time of patients was 10 months. According to UCLA, 98% patients experienced satisfactory results, and only 1 patient had to undergo second surgery for the repair. Conclusion: The study concluded that arthroscopic repair of tears in rotator cuffs is the best technique which can be used for repairing large and massive tears in rotator cuff. Keywords: tears, outcome, arthroscopy, rotator cuff

Is the Nomenclature of Massive Rotator Cuff Tear Used Correctly? Systematic Review

Background: The term massive refers to a quantitative measure of the rotator cuff tears. Irreparable rotator cuff tear is indicated by ratings that qualitatively evaluate the repairability of the tendon. These two terms should be considered separately. Methods: Between 2016 and 2022, publications in the last about 5 years were searched from Pubmed and MEDLINE online databases. The search terms (irreparable OR massive) AND (rotator cuff tear), (repairable OR massive) AND (rotator cuff tear), (massive OR retracted) AND (rotator cuff tear), (irreparable OR retracted) AND (rotator cuff tear) ”were used. For each search term, it was checked whether the title of the search term was mentioned in the title of the article, and whether the title and the content were compatible in the studies in which the searched term was mentioned in the title. Results: Of the 934 scanned articles, 69 of them were evaluated in terms of study title and material-method compatibility. 22 articles with the term “massive rotator cuff tear” in the title were identified. It was seen that in 11 of these 22 articles (50%), the title and the material method were compatible and in 11 of them (50%) the title and the content were incompatible, and the term “massive” was used instead of the term “irreparable”. Conclusions: We see that most of the studies on massive tears were actually done to emphasize irreparable tears. Since most of the massive tears are repairable, the quality feature of massive tears, which are in the group that poses a problem, as irreparable rotator cuff tear or massive irreparable rotator cuff tear should be emphasized. Keywords: Rotator cuff tears, Shoulder, Arthroscopy, Ireparable, Massive

Arthroscopic-assisted versus all-arthroscopic massive rotator-cuff repair: a cohort study of postoperative return to work

ObjectiveTo evaluate arthroscopic-assisted versus all-arthroscopic suture-anchor repair of massive rotator-cuff tears (RCTs), especially regarding postoperative patient's return to work.BackgroundMassive RCTs represent a challenging problem for shoulder surgeons. Management of RCT aims at pain relief, movement restoration, and improvement of the shoulder function.Patients and methodsA prospective study of 38 patients having massive RCT, conducted at Menoufia University Hospital and Neurosurgery Hospital between September 2019 and March 2021. Patients were divided into group A, which included 19 patients who were managed by arthroscopic-assisted technique. Group B included 19 patients who were managed by all-arthroscopic technique. Full history taking with complete clinical examination. All patients have completed 6-month postoperative follow-up.Primary outcomePostoperative patient's time to return to work.ResultsOur results found that postoperatively, there was statistically highly significant improvement in range of motion and University of California, Los Angles score in each group with a statistically nonsignificant difference between both groups. Comparison between both groups in time to return to work: postoperatively, there was a statistically nonsignificant difference between both groups in time to return to work, but in the all-arthroscopic group (group B), the patient returned to work slightly earlier.ConclusionBoth arthroscopic-assisted and all-arthroscopic procedures are effective in management of massive RCTs and result in significant improvement in clinical, functional outcomes, and patients' return to preinjury level of activity and work with a statistically nonsignificant difference between them, and both procedures could be used as an alternative repair method for massive RCTs.

Physiotherapy Rehabilitation in Arthroscopic Rotator Cuff Repair Patient- A Case Report

Rotator cuff pathology is usual, and the ailment's natural history suggests that tears enlarge with age. Rotator cuff tears are a familiar origin of pain and ailment in the shoulder. The research on treatment of rotator cuff tears is mixed. The aim of this review is to evaluate the evidence regarding the effectiveness of physiotherapy in lowering pain and enhance shoulder function in patients with symptomatic rotator cuff tears. Rotator cuff injuries are typically followed by a gradual onset of pain, but they can also be the result of an acute injury. Chronicity, underlying anatomic and physical factors, age, and the presence and severity of tendon tears all influence how rotator cuff conditions are managed. Conservative care, such as physical therapy, is typically used as the first line of defence, but surgical repair may be required later on. Rotator cuff (RC) tears can range from partial to full thickness tears of a single tendon to massive cuff tears. Rotator cuff tearing can be caused by glenohumeral trauma as well as pathological process. As a result, Treatment necessitates a diligent diagnosis as well as a distinguished approach that considers morphological and patient-specific effects. The therapeutic approach is determined by the patient's pathogenicity, tear morphology, clinical symptoms, and functional demands. The current case is about an 51 year old male who was admitted to the hospital with tear injury to right shoulder due to fall from truckmuscle strength and range of motion were main focus of physiotherapy intervention. The prime goal of this case study was to assess the patient’s response to physiotherapy for reinforcement and functional task.

Long-term outcomes after arthroscopic transosseous-equivalent repair: clinical and magnetic resonance imaging results of rotator cuff tears at a minimum follow-up of 10 years.

The objective of this study was to evaluate the long-term functional outcomes and structural integrity of medium to massive rotator cuff tears at 10-12 years of follow-up after arthroscopic transosseous-equivalent (TOE) repair. This was a retrospective study of a consecutive series of patients who underwent primary arthroscopic TOE repair of medium- to massive-sized degenerative rotator cuff tears performed by a single surgeon between January 2007 and August 2009. Patients were examined at a minimum follow-up of 10 years, and magnetic resonance imaging (MRI) was performed to assess tendon integrity. The Constant score (CS), American Shoulder and Elbow Surgeons score, and pain level documented using a visual analog scale were compared between intact repairs and recurrent defects. Univariate analysis was performed to identify factors related to recurrent defects. A total of 102 patients met the inclusion criteria, and 79 shoulders in 76 patients (74.5% of eligible patients) with a mean age at surgery of 55 ± 8 years (range, 40-72 years) were available for clinical evaluation at a mean follow-up time of 10.9 years (range, 10-12 years). The mean anteroposterior tear size was 3.1 ± 1.1 cm, and there were 41 medium (52%), 26 large (33%), and 12 massive (15%) tears. MRI was performed in 72 shoulders in 69 patients (91% of available shoulders) and revealed that 13 shoulders had recurrent defects (Sugaya stages 4 and 5). During the follow-up period, 3 patients underwent revision surgery, and the overall recurrent defect rate was 21.3%. A clinically meaningful improvement was observed in all outcome measures at the final follow-up regardless of tendon integrity. Patients with intact repairs showed superior outcomes compared with those with recurrent defects; however, only the overall CS met the threshold for clinical relevance. A significant linear correlation was observed between the Sugaya classification and all outcome scores except the CS pain subscale; however, the strength of correlation was weak. The presence of diabetes (odds ratio [OR], 8.6; 95% confidence interval [CI], 2.25-33.2; P = .002), tear size (OR, 2.08; 95% CI, 1.16-3.46; P = .012), and tear retraction (OR, 4.07; 95% CI, 1.11-14.83; P = .033) were associated with recurrent defects in the univariate analysis. Arthroscopic TOE repair of rotator cuff tears provided improved clinical outcomes with a recurrent defect rate of 21.3% at 10-12 years after surgery. Future research focusing on tendon healing is needed as repair integrity on MRI correlates with clinical outcomes.

Human Dermal Allograft Superior Capsule Reconstruction With Graft Length Determined at Glenohumeral Abduction Angles of 20° and 40° Decreases Joint Translation and Subacromial Pressure Without Compromising Range of Motion: A Cadaveric Biomechanical Study

To compare the biomechanical effects of superior capsule reconstruction (SCR) graft fixation length determined at 20° and 40° of glenohumeral (GH) abduction. Humeral translation, rotational range of motion (ROM), and subacromial contact pressure were quantified at 0°, 30°, and 60° of GH abduction in the scapular plane in 6 cadaveric shoulders for the following states: intact, massive rotator cuff tear, SCR with dermal allograft fixed at 20° of GH abduction (SCR 20), and SCR with dermal allograft fixed at 40° of GH abduction (SCR 40). Statistical analysis was conducted using a repeated-measures analysis of variance and a paired t test (P < .05). A massive cuff tear significantly increased total ROM compared with the intact state at 0° and 60° of abduction. SCR 20 or SCR 40 did not affect ROM. Compared with the intact state, the massive cuff tear model significantly increased superior translation by an average of 4.6 ± 0.5 mm in 9 of 12 positions (P ≤ .002). Both SCR 20 and SCR 40 reduced superior translation compared with the massive cuff tear model (P < .05); however, SCR 40 significantly decreased superior translation compared with SCR 20 at 0° of abduction (P≤ .046). Peak subacromial pressure for the massive cuff tear model increased by an average of 486.8 ± 233.9 kPa relative to the intact state in 5 of 12 positions (P ≤ .037). SCR 20 reduced peak subacromial pressure in 2 of 12 positions (P ≤ .012), whereas SCR 40 achieved this in 6 of 12 positions (P ≤ .024). SCR with dermal allograft fixed at 20° or 40° of GH abduction decreases GH translation and subacromial pressure without decreasing ROM. With an increasing abduction angle for graft fixation, the medial-to-lateral graft length is decreased and the graft tension is effectively increased. Surgeons may increase shoulder stability without restricting ROM by fixing the graft at higher abduction angles. However, surgeons should remain cognizant of potential graft failure due to increased tension.

Quantitative SSM-based analysis of humeral head migration in rotator cuff tear arthropathy patients.

Rotator cuff tear arthropathy (RCTA) is characterized by massive rotator cuff tearing combined with humeral head migration (HHM). The aim of this study is to investigate the quantitative characteristics of this migration and its association with glenoid erosions and prearthropathy scapular anatomy. We quantified HHM and prearthropathy scapular anatomy of 64 RCTA patients with statistical shape modeling-based techniques. Glenoid erosion was classified according to Sirveaux et al.A cutoff value for confirming HHM was 5 mm based on a control group of 49 patients. Group 1 (RCTA without HHM) consisted of 21 patients, with a mean subluxation distance (SLD) of 3 mm. Group 2 (RCTA with HHM) consisted of 43 patients, with mean SLD of 9 mm, SLD in the anteroposterior plane of -1 mm (SD ± 4 mm), SLD in the superoinferior plane of 7 mm (SD ± 3 mm), and subluxation angle (SLA) of -5° (SD ± 40°). Analysis with Fisher's exact test showed a clear association between HHM and glenoid erosions (p = 0.002). Multivariate regression analysis of Group 2 showed that prearthropathy lateral acromial angle combined with critical shoulder angle (p = 0.004) explained 21% of the observed variability in SLD. The prearthropathy glenoid version explained 23% of the variability in SLA (p = 0.001). HHM in RCTA patients has a wide variation in both magnitude and direction leading to a distorted glenohumeral relationship in the coronal and axial plane. HHM is highly associated with the occurrence of glenoid erosions. There is a correlation between the prearthropathy scapular anatomy and the magnitude and direction of HHM.

The influence of preoperative teres minor muscle fatty degeneration on active external rotation following reverse total shoulder arthroplasty

BackgroundReverse total shoulder arthroplasty (rTSA) improves shoulder elevation in patients treated for cuff tear arthropathy (CTA) or irreparable massive cuff tears. Patient satisfaction can be limited by reduced active external rotation (AER). Rotator cuff muscles that externally rotate the shoulder are infraspinatus and teres minor (TM). AimThe purpose of this study was to assess the correlation between preoperative TM fatty degeneration and postoperative AER after rTSA performed for CTA or irreparable cuff tears. MethodsConstant scores and active range of motion were consecutively collected for 109 shoulders in 97 patients (mean: 75.73 ± 8.94 years; 31 male, 66 female) over a 10-year period. AER was evaluated with the humerus in adduction (AER1) and in abduction. TM muscle atrophy was scored according to Goutallier's classification, assessed on preoperative computed tomography scans. ResultsMultivariate analysis showed that TM fatty infiltration was a predictor of AER1. AER1 decreased by 4.9 degrees preoperatively and by 6.4 degrees at the final follow-up, for each increment in Goutallier grade (P = .02). Postoperatively, AER evaluated with humerus in abduction improved significantly (P < .001), but did not correlate with TM Goutallier grade. At a mean follow-up of 38 months (range: 24 to 96), mean Constant score improved from 20.5 ± 11.1 to 68.4 ± 14.9 (P < .001), as did shoulder active range of motion in all planes including AER1 (P < .001). ConclusionThis is the first study to quantify the inverse correlation between AER and TM Goutallier grade, both preoperatively and after rTSA; this information guides prognosis for patients with TM degeneration undergoing rTSA. Further studies are necessary to have a better understanding and find reliable solutions. Level of evidenceLevel III; Case Series

Glenohumeral joint loading is impacted by rotator cuff tear severity during functional task performance

BackgroundRotator cuff tear is a common musculoskeletal injury, negatively affecting shoulder function. Rotator cuff tear severity ranges from small to massive tears, but it is unclear how tear severity affects glenohumeral joint loading and how changes contribute to secondary injury. This study's objective was to determine how glenohumeral joint contact force changes with tear severity during functional task performance using computational models. MethodsEight models of increasing tear severity were developed, ranging from no rotator cuff tear to massive three-tendon tears. Simulations were performed using models representing increasing tear severity and kinematics for five functional tasks (n = 720 simulations). For each task, magnitude and orientation of peak resultant joint contact force for each tear severity was identified, then compared to the no rotator cuff tear model. FindingsFor all tasks, compared to the no rotator cuff tear model, joint contact force magnitude decreased 9.5% on average with infraspinatus involvement, then plateaued at 20.8% average decrease with subscapularis involvement. Projected orientation of peak joint contact force vector was located more superior in the glenoid with increased tear severity, with significant changes (p < 0.0003) for all tasks with infraspinatus involvement. InterpretationDecreased magnitude and superior orientation of joint contact force suggest fewer intact muscles contribute to force distribution across the joint, although more work is needed characterizing associated compensation strategies. All force vectors remained oriented within the glenoid rim for all tasks and models, suggesting the system prioritizes joint stability. This work identifies how joint contact force changes with rotator cuff tear severity.

Functional and Structural Outcomes After Retears of Arthroscopically Repaired Large and Massive Rotator Cuff Tears.

Background:Most studies have shown acceptable clinical results in patients with large or massive tears treated by arthroscopic rotator cuff repair (ARCR); however, the effects of retears after surgery in these patients remain unknown.Purpose:To evaluate functional and structural outcomes after retears of large and massive rotator cuff tears treated by ARCR.Study Design:Case series; Level of evidence, 4.Methods:A total of 196 consecutive patients with large to massive rotator cuff tears underwent physical examination and magnetic resonance imaging before and after ARCR at 6, 12, and 24 months. Of these, 9 patients were lost at 6 months after surgery. Therefore, 187 patients were followed up for 24 months after surgery; 148 patients showed no postsurgical ruptures. Consequently, the remaining 39 patients with postsurgical ruptures were included in this study (mean age at surgery, 64.2 ± 8.7 years). Functional outcome measures comprised the University of California, Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. Structural outcome measures consisted of the global fatty degeneration index (GFDI), mediolateral tear size, and residual tendon attachment area as evaluated by our own scoring system.Results:The mean UCLA and JOA scores significantly improved from 16.3 ± 3.9 and 63.2 ± 10.7 preoperatively to 27.9 ± 5.5 (P < .0001) and 84.5 ± 9.4 (P < .0001) at final follow-up, respectively. The mean mediolateral tear size (P = .03, .02, and .02, respectively) and residual tendon attachment area (P = .04, .03, and .04, respectively) significantly improved from preoperatively to 6, 12, and 24 months postoperatively. The correlation analysis between the functional and structural variables confirmed significant associations between the residual tendon attachment area, the JOA and UCLA scores at 24 months postoperatively, and the preoperative GFDI (r = –0.81 to 0.78).Conclusion:The residual tendon attachment area after a retear was significantly larger at 24 months after surgery than before surgery. In addition, significant associations were confirmed between preoperative fatty degeneration, the residual tendon attachment area, and functional outcomes after a retear. These results may explain why functional outcomes significantly improved even after retears in this series.

Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis.

Background:With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears.Purpose:To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds.Study Design:Systematic review; Level of evidence, 3.Methods:The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model.Results:In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears (P = .13-.81).Conclusion:For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

Large to massive rotator cuff tendon tears: a protocol for a systematic review investigating the effectiveness of exercise therapy on pain, disability and quality of life.

Background: Chronic non-traumatic rotator cuff tendon tears are inextricably linked with the natural process of aging often resulting in severe disability, poor quality of life and an added burden to the health care system. The occurrence of rotator cuff tendon tears increases exponentially with every decade of life to approximately 60% in individuals over 80 years of age. Exercise is a commonly prescribed intervention although research on its efficacy is in its infancy and often conflicting. The purpose of this systematic review is to investigate the effectiveness of exercise interventions for people diagnosed with large to massive rotator cuff tendon tears. Methods: This systematic review will adhere to the PRISMA reporting guidelines. A comprehensive search of five databases will be conducted. Randomised clinical trials (RCT) or quasi-randomised control trials will be included if they evaluate exercise as the core intervention or as part of the intervention in the management of large to massive rotator cuff tears. To quantify response to treatment we will compare changes in pain, disability and quality of life (QoL). The Consensus on Exercise Reporting Template (CERT) will be used to characterise the different types of exercise intervention. The Cochrane Risk of Bias Tool will be used to assess study quality. A narrative synthesis with meta-analysis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Discussion: This review will synthesise the totality of GRADE A and B evidence on the effectiveness of exercise for large to massive rotator cuff tendon tears. It will provide clinically important information and guidance for immediate implementation by clinicians, health policymakers and may be used to guide future research. PROSPERO registration: 244502 (24/03/2021).

Bridging Allograft Reconstruction Is Superior to Maximal Repair for the Treatment of Chronic, Massive Rotator Cuff Tears: Results of a Prospective, Randomized Controlled Trial

Background: Despite advances in surgical techniques, the use of maximal repair to treat large or massive rotator cuff tears results in a high retear rate postoperatively. Currently, no randomized controlled trials have compared the outcomes of maximal repair with interposition dermal allograft bridging reconstruction. Hypothesis: We hypothesized that large or massive rotator cuff tendon tears reconstructed using bridging dermal allograft would have better clinical outcomes 2 years postoperatively, as measured using the Western Ontario Rotator Cuff (WORC) index, than would those receiving the current gold standard treatment of debridement and maximal repair alone. We also expected that patients treated via bridging reconstruction using dermal allograft would have fewer postoperative failures as assessed using postoperative magnetic resonance imaging scans. Study Design: Randomized controlled trial; Level of evidence 1. Methods: A sample size of 30 patients (determined using a priori sample size calculation) with massive, retracted rotator cuff tears were randomly allocated to 1 of 2 groups: maximal repair or bridging reconstruction using dermal allograft. All patients completed questionnaires (WORC and Disabilities of the Arm, Shoulder and Hand [DASH]) preoperatively and postoperatively at 3 months, 6 months, 1 year, and 2 years. The primary outcome of this study was the WORC index at 2 years. Secondary outcomes included healing rate, progression of rotator cuff arthropathy, and postoperative acromiohumeral distance in both groups. Results: Patients treated via bridging reconstruction using dermal allograft had better postoperative WORC and DASH scores (23.93 ± 24.55 and 15.77 ± 19.27, respectively) compared with patients who received maximal repair alone (53.36 ± 31.93 and 34.32 ± 23.31, respectively). We also noted increased progression to rotator cuff arthropathy in the maximal repair group with an increased retear rate when compared with the reconstruction group (87% and 21%, respectively; P < .001). The acromiohumeral distance was maintained in the reconstruction group but significantly decreased in the maximal repair group. Conclusion: Rotator cuff bridging reconstruction using a dermal allograft demonstrated improved patient-reported outcomes as measured using the WORC index 2 years postoperatively. This technique also showed favorable structural healing rates and decreased progression to arthropathy compared with maximal repair. Trial Registration: ClinicalTrials.gov (NCT01987973)

Effect of reverse total shoulder arthroplasty humeral inclination on glenohumeral range of motion, deltoid force, and glenoid strain: a biomechanical study

BackgroundReverse total shoulder arthroplasty (RSA) primarily varies between 2 implant design options: a 135 humeral stem inclination that closely resembles anatomic orientation, versus the Grammont-style 155 humeral stem inclination that further medializes and distalizes the center of rotation (COR). The purpose of this study was to compare deltoid force, glenoid strain, and simulated glenohumeral range of motion (ROM) between RSA 135 and RSA 155 designs, with a series of standardized permutations of glenosphere offset and rotator cuff pathology. MethodsTwelve fresh-frozen cadaveric shoulder specimens were studied using a shoulder simulator. Native shoulder motion profiles for reproducible abduction range of motion were established using a customized testing device. Optical 3-dimensional tracking and pressure sensors were used to accurately record glenohumeral range of motion (ROM), deltoid force, and glenoid strain for RSA 135 and RSA 155 designs. For each cohort, all combinations of glenosphere offsets and rotator cuff tendon involvement were evaluated. ResultsThere was no significant difference in the overall abduction ROM between the 155 and the 135 humeral stem implants (P = .75). Resting abduction angle and maximum abduction angle were significantly greater with a 155 + STD (standard offset) construct than with a 135 + STD construct (P < .001 and P = .01, respectively). Both stem inclinations decreased combined deltoid force requirements as compared the native shoulder with a massive cuff tear. Effective glenoid strain did not vary significantly between 135 + STD and 155 + STD constructs (P = .66). ConclusionOverall, range of motion between the 135 and the 155 humeral stem inclinations was not significantly different. The cumulative deltoid force was lower in RSA shoulders when compared to native shoulders with massive rotator cuff tears, highlighting the utility of both implant designs. The Grammont-style 155 stem coupled with a 2.5 mm inferior offset glenosphere required less deltoid force to reach maximum abduction than did the more anatomic, lateralized 135 stem coupled with a 4 mm lateral offset glenosphere. Level of EvidenceBasic Science, Biomechanics Controlled Laboratory Study

Functional outcomes of arthroscopic transosseous rotator cuff repair using a 2-mm tape suture in a 137-patient cohort.

BackgroundAlthough being the historical gold standard for rotator cuff repair, open transosseous (TO) repair was largely replaced by anchor-based methods with the advent of arthroscopic surgery owing to their comparative ease of use. However, suture anchors are at risk of dislodgement, especially among older patients, who have more osteopenic bone or those presenting large tears. Considering the ever-increasing active life expectancy and associated increased quality of life expectations by older generations, the need to offer safe and efficient surgical treatments to these patients imposes itself. Arthroscopic TO repairs would combine the best of both worlds and be well adapted to these populations. The primary objective of this study was to evaluate the functional outcome and complication rate of the TO arthroscopic repair technique when using a 2-mm braided suture tape. The secondary objective of this study was to assess functional outcome of TO repair in older patients and patients with >3-cm tears.MethodsOne hundred thirty-seven consecutive patients with full-thickness rotator cuff tear who underwent arthroscopic TO (anchorless) rotator cuff repair between January 2011 and December 2013 were reviewed. The surgery was performed by a single surgeon with a reusable curved suture passer and 2-mm braided tape suture. Follow-up was 3 to 5 years (mean = 50 months). All patients underwent preoperative and postoperative functional assessments (American Shoulder and Elbow Surgeons and Quick Dash) and were questioned with their overall satisfaction.ResultsThirty-eight (28%) of the 137 patients were 65 years and older, and 62 (45%) had a large or massive tear. One patient (0.7%) had early retear at the suture-tendon interface after trauma 3 weeks postoperatively. The average Quick Dash score improved by 55.6 points and the average American Shoulder and Elbow Surgeons score improved by 69.7 points 3.5 and 6.3 times their minimal clinically important differences, respectively. There was no significant difference in final functional outcomes between patients 65 years and older and younger patients or between patients with large and massive (>3 cm) and smaller tears (≤3 cm). Mean operative time was 68 min ± 16.ConclusionsArthroscopic TO repair using a 2-mm tape material has achieved significant mid-term functional improvement, with results statistically unaffected by larger tear size (>3 cm) or older age (≥65 years).

WITHDRAWN: Shoulder pseudoparalysis in a child after massive cuff tear interposed within the glenohumeral joint: a case report

<h2>Abstract</h2> We report an unusual case of a complete rotator cuff tendon avulsion with glenohumeral joint incarceration in skeletally-immature patient after significant trauma to the shoulder. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Surgical treatment was performed confirming the injury and the rotator cuff interposition. It is important that orthopedic surgeons and radiologists become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma. Furthermore, this case documents the youngest patient ever to sustain such an injury in the orthopedic literature.

Large to massive rotator cuff tendon tears: a protocol for a systematic review investigating the effectiveness of exercise therapy on pain, disability and quality of life

Background: Chronic non-traumatic rotator cuff tendon tears are inextricably linked with the natural process of aging often resulting in severe disability, poor quality of life and an added burden to the health care system. The occurrence of rotator cuff tendon tears increases exponentially with every decade of life to approximately 60% in individuals over 80 years of age. Exercise is a commonly prescribed intervention although research on its efficacy is in its infancy and often conflicting. The purpose of this systematic review is to investigate the effectiveness of exercise interventions for people diagnosed with large to massive rotator cuff tendon tears.Methods: This systematic review will adhere to the PRISMA reporting guidelines. A comprehensive search of five databases will be conducted. Randomised clinical trials (RCT) or quasi-randomised control trials will be included if they evaluate exercise as the core intervention or as part of the intervention in the management of large to massive rotator cuff tears. To quantify response to treatment we will compare changes in pain, disability and quality of life (QoL). The Consensus on Exercise Reporting Template (CERT) will be used to characterise the different types of exercise intervention. The Cochrane Risk of Bias Tool will be used to assess study quality. A narrative synthesis with meta-analysis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.Discussion: This review will synthesise the totality of GRADE A and B evidence on the effectiveness of exercise for large to massive rotator cuff tendon tears. It will provide clinically important information and guidance for immediate implementation by clinicians, health policymakers and may be used to guide future research.PROSPERO registration: 244502 (24/03/2021)

Anterior Capsular Reconstruction With Proximal Biceps Tendon for Large to Massive Rotator Cuff Tears

Massive rotator cuff tears (RCT) have traditionally been a challenging clinical problem for shoulder surgeons. A broad variety of treatment options have been proposed to address this problem, but outcomes have been as variable as the techniques themselves. Superior capsular reconstruction has been presented as a way to restore the restraining effect of the superior joint capsule and balanced force couples in massive tears of the superior rotator cuff. The purpose of this article is to propose a technical modification of the superior capsular reconstruction in large to massive RCT, and, especially in anterior L-shaped RCT, using the long head of the biceps tendon autograft to reinforce the weakest area of the anterior capsule, not as an augmentation of the rotator cuff, but as a static stabilizer of the humeral head, allowing the rotator cuff repair to heal without tension.

Large to massive rotator cuff tendon tears: a protocol for a systematic review investigating the effectiveness of exercise therapy on pain, disability and quality of life

Background: Rotator cuff tendon tears are inextricably linked with the natural process of aging often resulting in severe disability, poor quality of life and an added burden to the health care system. The occurrence of rotator cuff tendon tears increases exponentially with every decade of life to approximately 60% in individuals over 80 years of age. Exercise is a commonly prescribed intervention although research on its efficacy is in its infancy and often conflicting. The purpose of this systematic review is to investigate the effectiveness of exercise interventions for people diagnosed with large to massive rotator cuff tendon tears. Methods: This systematic review will adhere to the PRISMA reporting guidelines. A comprehensive search of five databases will be conducted. Randomised clinical trials (RCT) or quasi-randomised control trials will be included if they evaluate exercise as the core intervention or as part of the intervention in the management of large to massive rotator cuff tears. To quantify response to treatment we will compare changes in pain, disability and quality of life (QoL). The Consensus on Exercise Reporting Template (CERT) will be used to characterise the different types of exercise intervention. The Cochrane Risk of Bias Tool will be used to assess study quality. A narrative synthesis with meta-analysis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Discussion: This review will synthesise the totality of GRADE A and B evidence on the effectiveness of exercise for large to massive rotator cuff tendon tears. It will provide clinically important information and guidance for immediate implementation by clinicians, health policymakers and may be used to guide future research. PROSPERO registration: 244502 (24/03/2021)