Medium-sized Rotator Cuff Tears Research Articles

Prognostic Factors Affecting Rotator Cuff Healing After Arthroscopic Repair in Small to Medium-sized Tears

Background: Small and medium-sized rotator cuff tears usually have good clinical and anatomic outcomes. However, healing failure still occurs in some cases. Purpose: To evaluate prognostic factors for rotator cuff healing in patients with only small to medium-sized rotator cuff tears. Study Design: Case-control study; Level of evidence, 3. Methods: Data were prospectively collected from 339 patients with small to medium-sized rotator cuff tears who underwent arthroscopic repair by a single surgeon between March 2004 and August 2012 and who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery. The mean age of the patients was 59.8 years (range, 39-80 years), and the mean follow-up time was 20.8 months (range, 12-66 months). The functional evaluation included the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons score, Constant-Murley score, and Simple Shoulder Test. Results: Postoperative VAS for pain and functional scores improved significantly compared with preoperative values (P < .001). Forty-five healing failures occurred (13.3%), and fatty degeneration of the infraspinatus muscle, tear size (anteroposterior dimension), and age were significant factors affecting rotator cuff healing (P < .001, = .018, and = .011, respectively) in multivariate logistic regression analysis. Grade II and higher infraspinatus fatty degeneration correlated with a higher failure rate. The failure rate was also significantly higher in patients with a tear >2 cm in size (34.2%) compared with patients with a tear ≤2 cm (10.6%) (P < .001). A receiver operating characteristic curve was used to determine the predictive cut-off value for the oldest age and the largest tear size for successful healing, which were calculated as 69 years and 2 cm, respectively, with a specificity of 90%. Conclusion: In small to medium-sized rotator cuff tears, grade II fatty degeneration of the infraspinatus muscle according to the Goutallier classification could be a reference point for successful healing, and anatomic outcomes might be better if repair is performed before the patient is 69 years old and the tear size exceeds 2 cm.

Platelet-Rich Plasma Reduces Retear Rates After Arthroscopic Repair of Small- and Medium-Sized Rotator Cuff Tears but Is Not Cost-Effective

Background: It has been suggested that platelet-rich plasma (PRP) improves healing after arthroscopic rotator cuff repair. The current literature provides ample but inconsistent data on this topic. Purpose: To systematically review the current in vivo evidence for the use of platelet concentrates (PRP) in the arthroscopic treatment of rotator cuff tears to assess effectiveness, safety, and cost-effectiveness. Study Design: Meta-analysis and cost-effectiveness analysis. Methods: Published evidence from controlled, human trials of rotator cuff repair augmented with platelet concentrates was systematically gathered, and data on retear rates were extracted. Mathematical and clinical heterogeneity was evaluated, and fixed-effect meta-analysis was performed to calculate the risk ratio (RR) of retears and the number needed to treat (NNT). Subgroup analyses were made for small/medium tears (n = 404) and large/massive tears (n = 374). Cost-effectiveness was assessed using data from this meta-analysis and using cost data from the literature, including extensive sensitivity analyses, to calculate the incremental cost-effectiveness ratio (ICER). Results: Thirteen studies published between 2010 and 2014 were identified for analysis. The RR for retear for all patients was 0.87 (95% CI, 0.67-1.12; P = .286). For small- and medium-sized tears (<3 cm), the RR for retear was 0.60 (95% CI, 0.37-0.97), consistent with a significant difference in favor of PRP use (P = .038). This translated into an NNT of 14 (95% CI, 7-125). However, at an ICER of US$127,893 per quality-adjusted life year gained, assuming a 5% revision rate, the use of PRP was not cost-effective for small- and medium-sized tears. Conclusion: In large tears, even with double-row repair, the beneficial effects of PRP alone are insufficient to compensate the progressed tissue damage. The study data suggest that PRP may promote healing of small- and medium-sized tears to reduce retear rates. However, despite the substantial biological effect, at current cost, the use of PRP is not cost-effective in arthroscopic repair of small- and medium-sized tears.

Arthroscopic mattress locking suture technique for the repair of small- and medium-sized rotator cuff tears

Arthroscopic mattress locking suture technique for the repair of small- and medium-sized rotator cuff tears

A New Technique for Patch Augmentation of Rotator Cuff Repairs

Massive rotator cuff tears defying primary repair have been treated with debridement, arthroscopic subacromial decompression, partial repair, muscle-tendon transfer, and joint prosthesis, among other techniques. However, the treatment results have not been satisfactory compared with those of small- to medium-sized rotator cuff tears; each procedure has its merits and demerits, and currently, there is no single established method. For massive rotator cuff tears defying primary repair, the arthroscopic patch graft procedure has been reported as an effective surgical procedure, and this procedure is chosen as the first-line treatment in our department. In this procedure, suture anchors are generally used to fix the patch graft to the footprint on the side of the greater tuberosity. However, tendon-to-bone healing is frequently difficult to achieve, and bone-to-bone healing seems more advantageous for the repair of the rotator cuff attachment site. To improve the results of treatment, a new patch graft procedure was developed, in which the iliotibial ligament with bone was collected at Gerdy's tubercle and the bone was anchored to the footprint on the side of the greater tuberosity. With this procedure, excellent results were obtained, although only short-term results are available at present. The technique and its results so far are reported.

Effect of Immobilization without Passive Exercise After Rotator Cuff Repair

While animal studies have shown better healing with a longer duration of protection without motion exercise after rotator cuff repair, supporting clinical studies are rare. The purpose of this study was to assess the effect of immobilization following rotator cuff repair and to determine whether there was any difference in clinical outcome related to the duration of immobilization. One hundred patients who underwent arthroscopic single-row repair of a posterosuperior rotator cuff tear (mean, 2.3 cm in the coronal-oblique plane and 2.0 cm in the sagittal-oblique plane) were prospectively randomized to be treated with immobilization for four or eight weeks. During the immobilization period, no passive or active range-of-motion exercise, including pendulum exercise, was allowed. According to the intention-to-treat protocol and full analysis set, eighty-eight patients were evaluated clinically and with magnetic resonance imaging postoperatively, after exclusion of twelve patients without postoperative clinical evaluation. Ranges of motion, clinical scores, and retear rates were compared between the four and eight-week groups. Ninety-eight patients were contacted by telephone at a mean of thirty-five months to investigate the clinical outcomes. The mean duration of immobilization was 4.1 weeks in the four-week group and 7.3 weeks in the eight-week group. There were nine full-thickness retears (10%), and 89% of the patients rated their result as excellent or good. There were five full-thickness retears in the four-week group and four in the eight-week group (p = 0.726). At the time of final follow-up, the two groups showed no differences in range of motion or clinical scores. However, the proportion showing stiffness was higher in the eight-week group (38% compared with 18%, p = 0.038). Eight weeks of immobilization did not yield a higher rate of healing of medium-sized rotator cuff tears compared with four weeks of immobilization.

Treatment Outcomes of Single- Versus Double-Row Repair for Larger Than Medium-Sized Rotator Cuff Tears

Background: In rotator cuff repair, no practical guidelines exist for deciding which technique is the most beneficial to outcomes. Purpose: To determine which of 2 repair techniques, the single-row (SR) and double-row suture bridge (DR-SB) methods, leads to better therapeutic outcomes in terms of remnant tendon length in patients with larger than medium-sized cuff tears. Study Design: Cohort study; Level of evidence, 3. Methods: Remnant tendon length, muscle atrophy, and fatty degeneration were measured on preoperative magnetic resonance imaging (MRI) in 78 patients with larger than medium-sized rotator cuff tears who were available for follow-up MRI. There were 30 patients with remnant tendons <10 mm in length (group 1) and 48 with remnant tendons ≥10 mm in length (group 2). In group 1, the SR technique was performed on 17 patients and the DR-SB technique on 13 patients. In group 2, the SR technique was performed on 16 patients and the DR-SB technique on 32 patients. The mean follow-up period for all patients was 26.6 months (range, 24-42 months). Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA), Constant, and American Shoulder and Elbow Surgeons (ASES) scores. Results: In group 1, there was 1 retear (6%) with the SR repair and 6 (46%) with the DR-SB repair. In group 2, there were 3 retears (19%) with the SR repair and 2 (6%) with the DR-SB repair. The retear rate was significantly higher in patients with the DR-SB repair in group 1 (P = .025), while there was no significant difference between the 2 techniques in group 2 (P = .316). The UCLA and Constant scores were significantly higher in patients with the SR repair in group 1 (P = .02 and P = .029, respectively), and the UCLA and ASES scores were significantly higher in patients with the DR-SB repair in group 2 (P < .001 and P = .001, respectively). Conclusion: Remnant tendon length should be considered to improve repair integrity. The SR technique may provide superior rotator cuff integrity when remnant tendons are <10 mm in length.

Characteristics of small to medium-sized rotator cuff tears with and without disruption of the anterior supraspinatus tendon

The purpose of this study was to examine the baseline function and results of arthroscopic cuff repair in shoulders with small and medium-sized full-thickness cuff tears with complete supraspinatus disruption compared with those with an intact anterior supraspinatus tendon. The study evaluated 112 subjects with small and medium-sized cuff tears. Subjects were grouped according to anterior supraspinatus integrity (83 shoulders intact, group 1; and 29 shoulders with anterior supraspinatus tendon disruption, group 2). Functional assessments included visual analogue scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and Constant score. Repair integrity was assessed by ultrasound examination. Group 2 shoulders had greater mean tear width, length, and area (P < .0001) and greater supraspinatus muscle degenerative changes (P < .0001) compared with shoulders with an intact anterior supraspinatus tendon. There were no differences in demographics or baseline function (ASES score: 45 group 1 vs 46 group 2, P = .79; Constant score: 56 group 1 vs 52 group 2, P = .29) before surgery. There were no differences in any functional parameter (ASES score: 92 group 1 vs 93 group 2, P = .71; Constant score: 84 group 1 vs 85 group 2, P = .84) after surgery. There was no difference in tendon healing rates (93% group 1 vs 86% group 2; P = .26). In the setting of painful small and medium-sized rotator cuff tears, disruption of the anterior supraspinatus tendon was associated with greater tear size and more advanced supraspinatus muscle degeneration. However, anterior supraspinatus tendon integrity had no influence on the clinical presentation or the functional and structural results of cuff repair surgery.

Are Platelet-Rich Products Necessary during the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears: A Meta-Analysis

BackgroundPlatelet-rich products (PRP) are widely used for rotator cuff tears. However, whether platelet-rich products produce superior clinical or radiological outcomes is controversial. This study aims to use meta-analysis to compare clinical and radiological outcomes between groups with or without platelet-rich products.MethodsThe Pubmed, Embase, and Cochrane library databases were searched for relevant studies published before April 20, 2013. Studies were selected that clearly reported a comparison between the use or not of platelet-rich products. The Constant, ASES, UCLA, and SST scale systems and the rotator cuff retear rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed-effects model.ResultsSeven studies were enrolled in this meta-analysis. No significant differences were found for the Constant scale (0.73, 95% CI, −1.82 to 3.27, P = 0.58), ASES scale (−2.89, 95% CI, −6.31 to 0.53, P = 0.1), UCLA scale (−0.79, 95% CI, −2.20 to 0.63, P = 0.28), SST scale (0.34, 95% CI, −0.01 to 0.69, P = 0.05), and the overall rotator cuff retear rate (0.71, 95% CI, 0.48 to 1.05, P = 0.08). Subgroup analysis according to the initial tear size showed a lower retear rate in small- and medium-sized tears (0.33, 95% CI, 0.12 to 0.91, P = 0.03) after platelet-rich product application but no difference for large- and massive-sized tears (0.86, 95% CI, 0.60 to 1.23, P = 0.42).ConclusionIn conclusion, the meta-analysis suggests that the platelet-rich products have no benefits on the overall clinical outcomes and retear rate for the arthroscopic repair of full-thickness rotator cuff tears. However, a decrease occurred in the rate of retears among patients treated with PRP for small- and medium-sized rotator cuff tears but not for large- and massive-sized tears.Level of EvidenceLevel II

Comparison of repair techniques in small and medium-sized rotator cuff tears in cadaveric sheep shoulders

The aim of this study was to compare new knotless single-row and double-row suture anchor techniques with traditional transosseous suture techniques for different sized rotator cuff tears in an animal model. The study included 56 cadaveric sheep shoulders. Supraspinatus cuff tears of 1 cm repaired with new knotless single-row suture anchor technique and supraspinatus and infraspinatus rotator cuff tears of 3 cm repaired with double-row suture anchor technique were compared to traditional transosseous suture techniques and control groups. The repaired tendons were loaded with 5 mm/min static velocity with 2.5 kgN load cell in Instron 8874 machine until the repair failure. The 1 cm transosseous group was statistically superior to 1 cm control group (p=0.021, p<0.05) and the 3 cm SpeedBridge group was statistically superior to the 1 cm SpeedFix group (p=0.012, p<0.05). The differences between the other groups were not statistically significant. No significant difference was found between the new knotless suture anchor techniques and traditional transosseous suture techniques.

An in-vitro study of rotator cuff tear and repair kinematics using single- and double-row suture anchor fixation

Purpose:Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder.Materials and Methods:Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs) were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm) tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device.Results:Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen.Conclusions:This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference (P ≥ 0.10) was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs.Clinical Relevance:Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease.

Arthroscopic Rotator Cuff Repair Using Modified Mason-Allen Medial Row Stitch

Background: When using a method of suture bridge technique, there may be a possibility of strangulation of the rotator cuff tendon at the medial row. The style of knots chosen to secure the medial row might conceivably be a factor to reduce this possibility. Purpose: To compare the clinical results and repair integrity of arthroscopic rotator cuff repair between a knotless and a conventional knot-tying suture bridge technique for patients with full-thickness rotator cuff tears and to evaluate retear patterns in the cases with structural failure after arthroscopic repair by magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 2. Methods: After arthroscopic repair for medium-sized rotator cuff tears, 110 patients available for postoperative MRI evaluation at least 6 months were enrolled in this study. According to the repair technique, 51 shoulders were enrolled in a knotless suture bridge technique group (group A) and 59 shoulders in a conventional knot-tying suture bridge technique group (group B). The mean age at the time of the operation was 61.0 years (range, 44-68 years) in group A and 57.6 years (range, 45-70 years) in group B. The mean follow-up period was 21.2 months (range, 12-34 months) and 22.1 months (range, 13-32 months), respectively. Results: The Constant score of group A increased from the preoperative mean of 65.2 points to 79.1 points at the last follow-up (P < .001). The corresponding figures for group B improved from 66.6 points to 76.3 points (P < .001). The preoperative Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score was 21.1 points in group A and 18.3 points in group B. The UCLA score at the last follow-up was 31.0 points in group A and 27.9 points in group B (P < .001, P < .001). Retear rate was significantly lower in group A (5.9%) than group B (18.6%) (P < .001). In group B, retear occurred at the musculotendinous junction in 72.7%, but group A had no medial cuff failure. Conclusion: In arthroscopic suture bridge repair of full-thickness rotator cuff tears, clinical results of both a knotless and a conventional knot-tying group showed improvement without significant difference between the 2 groups. However, the knotless group had a significantly lower retear rate compared with the conventional knot-tying group. A knotless suture bridge technique could be a new supplementary repair technique to conventional technique.

AAOS Rotator Cuff Clinical Practice Guideline Misses the Mark

AAOS Rotator Cuff Clinical Practice Guideline Misses the Mark

The Efficacy of Acromioplasty in the Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears Without Acromial Spur: Prospective Comparative Study

To assess the role of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears. A prospective randomized trial of 120 patients who had small- to medium-sized rotator cuff tears and various types of acromions without spurs were included. Sixty patients received arthroscopic rotator cuff repair with acromioplasty (group I), and another sixty received the same procedure without acromioplasty (group II). The mean age at surgery was 57.8 ± 9.3 years in group I and 55.8 ± 8.0 years in group II. The shape of the acromion was flat in 18 patients, curved in 32, and hooked in 10 in group I, and it was flat in 15 patients, curved in 36, and hooked in 9 in group II. The mean tear size was similar in the two groups (14.6 ± 5.2 mm in group I and 15.3 ± 7.0 mm in group II). Pain and satisfaction were estimated and range of motion was measured at a mean of 35 months after surgery. Functional outcomes were assessed with American Shoulder and Elbow Surgeons: Constant; and University of California, Los Angeles scores. Tendon healing was evaluated by magnetic resonance imaging postoperatively. Clinical outcome was significantly improved in both groups after arthroscopic rotator cuff repair (P < .05). There were no significant differences with respect to pain and range of motion between the groups at the final follow-up (1.1 ± 0.9 v 1.3 ± 1.4 on visual analog scale). Functional outcomes also showed no significant differences between the 2 groups (American Shoulder and Elbow Surgeons score, 90.7 ± 13.1 v 87.5 ± 12.0; Constant score, 85.0 ± 11.3 v 83.3 ± 13.0; and University of California, Los Angeles score, 33.4 ± 3.3 v 32.3 ± 3.5). Postoperative imaging showed that the retear rate was 17% in group I and 20% in group II (P = .475). Arthroscopic repair of small- to medium-sized rotator cuff tears provided pain relief and improved functional outcome with or without acromioplasty. Clinical outcomes were not significantly different, and acromioplasty may not be necessary in the operative treatment of patients with small- to medium-sized rotator cuff tears in the absence of acromial spurs. Level II, prospective comparative study.

Compliance with Sling-Wearing after Rotator Cuff Repair and Anterior Shoulder Stabilization

Background Compliance with postoperative sling immobilization after shoulder surgery has not been previously studied. In the present study, we examined the compliance with sling-wearing in patients who had had either undergone anterior stabilization or rotator cuff repair. Methods Patients who had undergone either an arthroscopic rotator cuff repair or shoulder stabilization anonymously answered a detailed standardized questionnaire regarding sling-wearing. Routine postoperative instructions require patients to wear a sling for 3 weeks after repair of a small or medium-sized rotator cuff tear, 4 weeks after anterior stabilization of the shoulder and 6 weeks after repair of a large or massive rotator cuff tear. All patients were contacted within 6 months of surgery. Results Older patients were more likely to be compliant with postoperative instructions, as were patients who had longer periods of acute pain requiring oral analgesia. There was no difference in compliance between patients who had a small rotator cuff tear and those who had a large rotator cuff tear. Nor was there any difference between open and arthroscopic shoulder stabilization groups. Discussion In the present study, despite written instructions regarding sling-wearing, there were differences between patient groups with regard to compliance with sling-wearing instructions.

Surgery or Physiotherapy for Small and Medium-Sized Rotator Cuff Tears?

Surgery or Physiotherapy for Small and Medium-Sized Rotator Cuff Tears?

The association between retraction of the torn rotator cuff and increasing expression of hypoxia inducible factor 1α and vascular endothelial growth factor expression: an immunohistological study

BackgroundDiffering levels of tendon retraction are found in full-thickness rotator cuff tears. The pathophysiology of tendon degeneration and retraction is unclear. Neoangiogenesis in tendon parenchyma indicates degeneration. Hypoxia inducible factor 1α (HIF) and vascular endothelial growth factor (VEGF) are important inducers of neoangiogenesis. Rotator cuff tendons rupture leads to fatty muscle infiltration (FI) and muscle atrophy (MA). The aim of this study is to clarify the relationship between HIF and VEGF expression, neoangiogenesis, FI, and MA in tendon retraction found in full-thickness rotator cuff tears.MethodsRotator cuff tendon samples of 33 patients with full-thickness medium-sized rotator cuff tears were harvested during reconstructive surgery. The samples were dehydrated and paraffin embedded. For immunohistological determination of VEGF and HIF expression, sample slices were strained with VEGF and HIF antibody dilution. Vessel density and vessel size were determined after Masson-Goldner staining of sample slices. The extent of tendon retraction was determined intraoperatively according to Patte's classification. Patients were assigned to 4 categories based upon Patte tendon retraction grade, including one control group. FI and MA were measured on standardized preoperative shoulder MRI.ResultsHIF and VEGF expression, FI, and MA were significantly higher in torn cuff samples compared with healthy tissue (p < 0.05). HIF and VEGF expression, and vessel density significantly increased with extent of tendon retraction (p < 0.05). A correlation between HIF/VEGF expression and FI and MA could be found (p < 0.05). There was no significant correlation between HIF/VEGF expression and neovascularity (p > 0.05)ConclusionTendon retraction in full-thickness medium-sized rotator cuff tears is characterized by neovascularity, increased VEGF/HIF expression, FI, and MA. VEGF expression and neovascularity may be effective monitoring tools to assess tendon degeneration.

Surgery Was Superior to Physiotherapy for Small and Medium-Size Rotator Cuff Tears

Question: In patients with small or medium-size rotator cuff tears, how do surgery and physiotherapy compare? Design: Randomized (allocation concealed), blinded (outcome assessor) controlled trial with 12-month follow-up. Setting: A hospital in Baerum, Norway. Patients: 103 patients (mean age 60 y, 71 % men) with small (<1 cm) or medium-size (1 to 3 cm) tears of the rotator cuff. Inclusion criteria were lateral shoulder pain at rest or with exercise, a painful arc of shoulder motion, positive impingement signs, and a passive range of movement of ≥140° for abduction and flexion. Exclusion criteria included age of < 18 years, tears absolutely requiring surgery, concomitant local or systemic diseases affecting shoulder function, previous tendon surgery on the relevant shoulder, and medical comorbid conditions. Follow-up data were available for all patients. Intervention: Patients were allocated to surgery (n = 52) or physiotherapy (n = 51). Surgery involved mini-open oropen tendon repair. Following diagnostic arthroscopy and a deltoid-splitting approach, an anteroinferior acromioplasty was performed. The deltoid was repaired to the acromion through drill-holes. Patients in the physiotherapy group received outpatient treatment by 1 of 4 physiotherapists. 40-minute sessions were given on the average of twice weekly for 12 weeks, and thereafter at increasing intervals during the next 6 to 12 weeks. Exercises to center the humeral head in the glenoid fossa were done to achieve glenohumeral control, and then progressed to more challenging positions. Additional exercises were given, tailored to specific demands in work, sports, and leisure activities. Patients who did not improve after 15 sessions were reassessed and offered surgery if deemed necessary. Main outcome measures: The primary outcome measure was an assessment of shoulder function with use of the Constant score (range, 0 to 100; higher scores represent better function). Secondary outcomes included the self-report section of the American Shoulder and Elbow Surgeons (ASES) score (range, 0 to 100); the Short Form (SF)-36 (0 to 100 points; higher scores indicate better health condition); Constant subscores on pain-free active shoulder abduction, pain-free active shoulder flexion, and shoulder strength; and ASES subscore on shoulder pain. Main results: Analysis was by intention to treat. 9 patients (18%) in the physiotherapy group showed no improvement after a mean of 24 sessions and underwent secondary surgical treatment. Missing nonoperative follow-up data of these patients after secondary surgical treatment were handled by a last-observation-carried-forward principle, meaning that the last scoring result before secondary surgical treatment was used for analysis. Differences between the surgery and physiotherapy groups on the Constant and ASES scores showed greater improvement from baseline in the surgery group than in the physiotherapy group (Table). Among the subscores, the surgery group patients had larger increases in shoulder abduction and decreases in pain; groups did not differ with regard to shoulder flexion or shoulder strength (Table). The groups were not different with regard to SF-36 scores. Conclusion: In patients with small or medium-size rotator cuff tears, 1-year outcomes were better after surgery than after physiotherapy.

A Prospective Therapeutic Comparison of Simple Suture Repairs to Massive Cuff Stitch Repairs for Treatment of Small- and Medium-Sized Rotator Cuff Tears

A Prospective Therapeutic Comparison of Simple Suture Repairs to Massive Cuff Stitch Repairs for Treatment of Small- and Medium-Sized Rotator Cuff Tears

Humeral Insertion of the Supraspinatus and Infraspinatus. New Anatomical Findings Regarding the Footprint of the Rotator Cuff

It is generally believed that the supraspinatus is the most commonly involved tendon in rotator cuff tears. Clinically, however, atrophy of the infraspinatus muscle is frequently observed in patients with even small to medium-size rotator cuff tears. This fact cannot be fully explained by our current understanding of the anatomical insertions of the supraspinatus and infraspinatus. The purpose of this study was to reinvestigate the humeral insertions of these tendons. The study included 113 shoulders from sixty-four cadavers. The humeral insertion areas of the supraspinatus and infraspinatus were investigated in ninety-seven specimens. In sixteen specimens, all muscular portions of the supraspinatus and infraspinatus were removed, leaving the tendinous portions intact, in order to define the specific characteristics of the tendinous portion of the muscles. Another twenty-six shoulders were used to obtain precise measurements of the footprints of the supraspinatus and infraspinatus. The supraspinatus had a long tendinous portion in the anterior half of the muscle, which always inserted into the anteriormost area of the highest impression on the greater tuberosity and which inserted into the superiormost area of the lesser tuberosity in 21% of the specimens. The footprint of the supraspinatus was triangular in shape, with an average maximum medial-to-lateral length of 6.9 mm and an average maximum anteroposterior width of 12.6 mm. The infraspinatus had a long tendinous portion in the superior half of the muscle, which curved anteriorly and extended to the anterolateral area of the highest impression of the greater tuberosity. The footprint of the infraspinatus was trapezoidal in shape, with an average maximum medial-to-lateral length of 10.2 mm and an average maximum anteroposterior width of 32.7 mm. The footprint of the supraspinatus on the greater tuberosity is much smaller than previously believed, and this area of the greater tuberosity is actually occupied by a substantial amount of the infraspinatus.

A Prospective Therapeutic Comparison of Simple Suture Repairs to Massive Cuff Stitch Repairs for Treatment of Small- and Medium-Sized Rotator Cuff Tears

The purpose of this study was to compare the massive cuff stitch (MCS) with the simple stitch in terms of integrity at 2 years after surgery when used to repair small-sized to medium-sized full-thickness rotator cuff tears. Seventy-one patients underwent arthroscopic repair of full-thickness rotator cuff tears between December 2004 and June 2006. The tear sizes ranged from 0.5 to 1.5 cm. The mean patient age was 53 years (range, 40 to 69 years), and the mean follow-up time was 33 months (range, 24 to 41 months). Group I (n = 35) underwent MCS repair, and group II (n = 36) underwent simple stitch repair. Results were analyzed by use of the Wilcoxon signed rank test and the Mann-Whitney test. Follow-up ultrasound was performed 24 to 41 months after repair. All patients showed improvements in the visual analog scale for pain, activities of daily living, and University of California, Los Angeles scores (P < .05), but there were no significant differences in scores between groups (P > .05). The satisfaction rating was similar for group I (4.7) and group II (4.3) (P > .05). The failure (retear) rate was significantly lower in group I (14.3%) than in group II (27.8%) (P < .05). The clinical outcomes between the MCS and simple stitch were not significantly different, but the MCS was superior to the simple stitch in maintaining repair integrity on ultrasound evaluation after arthroscopic repair of small-sized to medium-sized full-thickness rotator cuff tears. Level III, prospective therapeutic comparative study.