Partial Rotator Cuff Tears Research Articles

Predicting Patient Satisfaction With Maximal Outcome Improvement After Biceps Tenodesis.

The goal of this study was to determine the threshold for achieving maximal outcome improvement (MOI) on the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley (CM) questionnaires that predict satisfaction after isolated biceps tenodesis without concomitant rotator cuff repair. A retrospective analysis of prospectively collected data was performed for patients undergoing isolated biceps tenodesis from 2014 to 2017 at a single institution with minimum 6-month follow-up. Receiver operating characteristic curve analysis was used to determine thresholds for MOI for the ASES, SANE, and CM questionnaires. Stepwise multivariate logistical regression analysis was performed to identify predictors for achieving the threshold for MOI. A total of 123 patients were included in the final analysis. Receiver operating characteristic analysis determined that achieving 43.1%, 62.1%, and 61.4% MOI was the threshold for satisfaction for the ASES, SANE, and CM questionnaires, respectively. Regression analysis showed that concomitant superior labrum anterior-posterior (SLAP) repair was predictive of achieving MOI on the ASES and SANE questionnaires, whereas partial rotator cuff tear was predictive of achieving MOI on the CM questionnaire (P<.05 for both). Further, workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors of achieving MOI on the SANE and CM questionnaires (P<.05 for all). Achieving MOI of 43.1%, 62.1%, and 61.4% is the threshold for satisfaction after biceps tenodesis for the ASES, SANE, and CM questionnaires, respectively. Concomitant SLAP repair was positively predictive of achieving MOI, whereas workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors. [Orthopedics. 2021;44(3):e359-e366.].

Arthroscopic Repair of a PASTA of the Shoulder Using a Bursal Split

PASTA (partial articular supraspinatus tendon avulsion) lesions are a subset of partial rotator cuff tears that are commonly treated by surgeons. Multiple surgical techniques exist for managing these lesions, including debridement, transtendinous repair, and completion of the tear and repair. Each of these techniques provides its own set of advantages and disadvantages, and currently there is no consensus on which method provides the best clinical outcomes or ease of procedure. Here, we present our repair technique for PASTA lesions, which involves a bursal split that takes the advantages of previous techniques by allowing improved visualization of the footprint and suture passing while avoiding the takedown any of Sharpey’s fibers.

Predictive factors for failure of conservative management in the treatment of calcific tendinitis of the shoulder.

BackgroundCalcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC). When conservative management fails, arthroscopic surgery for removal of the calcium may be considered. Surgical removal is often followed by RTC repair to address the resulting tendon defect. This study was performed to assess predictive factors for failure of conservative management and to characterize the rate of RTC repair in the setting of calcific tendinitis. We hypothesize that larger calcific lesion would have a higher likelihood to fail conservative treatment.MethodsA retrospective review of patients who were diagnosed with calcific tendinitis at our institution between 2009 and 2019 was performed. Demographics, comorbidities, pain score (visual analog scale), American Shoulder and Elbow Surgeons score, range of motion, and patient-reported quality of life measures were recorded and analyzed. All patients underwent a radiograph and magnetic resonance imaging. Size of the calcific lesion was measured based on its largest diameter on magnetic resonance imaging. Statistical analysis included chi-square test, independent t-test, and analysis of variance.ResultsTwo hundred thirty-nine patients were identified in the study period; 127 (53.1%) were women. The mean age was 54 years, and body mass index was 29.2 with a mean follow-up of 6 months. One hundred and sixty had an intact RTC (67.2%) and 78 had a partial RTC tear (32.8%). Ninety-three of 239 (38.9%) patients failed conservative treatment after an average of 4.4 months, necessitating surgical management. Among patients who underwent surgery, the majority of patients (77 of 93 [82.8%]) required a concomitant RTC repair. Subanalysis demonstrates that calcific lesions >1 cm was significantly associated with failure of conservative treatment (odds ratio = 2.86, 95% confidence interval 1.25-6.29, P < .05). All patients who underwent surgery demonstrated significant improvements in pain scores (6.3 to 2.3 visual analog scale), American Shoulder and Elbow Surgeons score (47.9 to 90.49), forward flexion (133° to 146.8°), and external rotation (49.2° to 57.6°) (P < .05) postoperatively.ConclusionPatients with calcific lesions >1 cm had a 2.8× increased likelihood to undergo operative treatment in the setting of calcific tendinitis of the shoulder. Most patients who undergo surgical management for removal of the calcific deposit required a concomitant RTC repair and had significant improvements in shoulder pain and function. This information can be helpful to guide orthopedic surgeons on preoperative planning and discussion when treating calcific tendinitis of the shoulder.

Partial-Rotator Cuff Tears in Throwing Athletes

Partial rotator cuff tears in the throwing athlete is a complex problem that can lead to debilitating pain and inability to perform their athletic duties. The etiology and pathogenesis of these tears are multi-factorial and still the topic of much debate. It is known that the act of overhead throwing places significant stress on the glenohumeral joint, requiring the rotator cuff to overcome these forces as it acts to stabilize the glenohumeral joint. Evaluation of an athlete with such pathology includes a thorough history and physical exam, followed by specific imaging modalities. Treatment options include both non-operative and operative. Non-operative measures include activity restriction, physical therapy, and the possibility of corticosteroid or biologic injection. Operative measures include arthroscopic debridement, in-situ repair, and completion of the partial tear followed repair. The purpose of this article is to review the topic of partial rotator cuff tears in throwing athletes and discuss the senior author's (JRA) guide to evaluation and management of these injuries.

The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review.

(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.

Arthroscopic repair with footprint ending shift for massive rotator cuff tear

To investigate the method and clinical effects of arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear. From March 2015 to April 2019, 27 patients with massive rotator cuff tear underwent arthroscopic repair, including 12 males and 15 females, ranging in age from 37 to 74 years old, with an average age of (56.1±8.9) years. According to the tension of rotator cuff, 5 patients were treated with double row suture bridge technique, and 22 patients were treated with single row technique, among which 7 patients underwent partial rotator cuff repair. Before and after operation, University of California Los Angeles(UCLA) score, American Shoulder and Elbow Surgeons (ASES) score and visual analogue scale (VAS) were used to evaluate shoulder joint function. All the patients were followed up, and the duration ranged from 8 to 40 months, with an average of (18.0±5.9) months. The UCLA score increased from preoperative 8.67±0.78 to final follow-up 30.89±1.07(t=43.56, P<0.001);ASES score increased from preoperative 8.56±0.67 to final follow-up 12.63±0.33(t=15.28, P<0.001);and the VAS decreased from preoperative 6.00(5.00 to 7.00) scores to final follow-up 0.00 (0.00 to 2.00) scores (Z=-4.56, P<0.001). Three patients could not lift the shoulder above the head, without pain. The symptom had no effects on daily work and life, 2 of these patients underwent partial rotator cuff repair. Arthroscopic rotator cuff repair with footprint ending shift for massive rotator cuff tear has satisfactory results, and single-row can be chosen to completely or partial repair rotator cuff tear for most patients.

Evaluation of Diagnostic Precision of Ultrasound for Rotator Cuff Disorders in Patients with Shoulder Pain.

Rotator cuff disorders are a leading cause of shoulder symptoms. Accurate imaging, detecting the type of the involved muscle, and severity of the injury have important effects on the choice of treatment. Accordingly, the current study was conducted to evaluate the diagnostic accuracy of ultrasound for rotator cuff disorders in patients suffering from shoulder pain and to explore the precision of ultrasound in determining the exact dimensions of a tear in comparison with magnetic resonance imaging (MRI). This prospective research was performed on patients clinically suspected of rotator cuff tendinopathy. An ultrasound of the shoulder was initially performed for the candidates. In this study, MRI was regarded as the modality of choice for examining the images of shoulder disorders. The European Society of Musculoskeletal Radiology (ESSR) guidelines were used to design the protocols and implement imaging measures. Based on the reference standard of MRI, the specificity and sensitivity as well as positive and negative predictive values of ultrasound in detection of rotator cuff disorders were calculated. A total of48 patients (22 women, 23 dominant right hands) with an average age of 51.6±8.3 years were enrolled in this study. Based on MRI findings, rotator cuff disorders were detected in 43 patients (89.5%). The most commonly observed disorders were partial-thickness rotator cuff tear (n=17, 35.4%), full-thickness rotator cuff tear (n=16, 33.3%), and tendinopathy (n=10, 20.8%). Among rotator cuff disorders, the highest sensitivity of ultrasound was observed in the detection of full-thickness tear (93.7%) and rotator cuff tendinopathy (90%). The highest specificity was found in the detection of full-thickness rotator cuff tear (100%) and partial-thickness rotator cuff tear (96.7%). Based on our findings, ultrasound could be considered as a high-quality diagnostic tool to rule in partial and full-thickness rotator cuff tears and rule out the rotator cuff pathologies.

Partial and full-thickness rotator cuff tears in patients younger than 45 years.

The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age. Fifty patients (26 women and 24 men; mean age: 41.4±3.96 years; range: 31-45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems. At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p<0.01). The mean ASES and UCLA scores improved significantly to 70.7 and 25.3, respectively, in the bursal-side group (p<0.01). The mean ASES and UCLA scores improved significantly to 75.3 and 27.1, respectively, in the joint-side group (p<0.01). There were no significant differences between the groups according to the postoperative ASES score (p>0.06) and UCLA score (p<0.37). The arthroscopic repair of the joint-sided tears and bursal-sided tears has good functional outcomes as full thickness rotator cuff tears, and the surgical option should be considered in younger population if the conservative treatment fails. Level IV, Therapeutic study.

To determine the efficacy of Neer’s test in the diagnosis of subacromial impingement of the shoulder

Introduction: Subacromial impingement syndrome (SIS) is a clinical syndrome most often attributed to patients presenting with shoulder pain1 and encompasses a spectrum of subacromial pathologies ranging from bursitis, rotator cuff tendinosis, and partial tears leading up to full-thickness tear of the rotator cuff.. Several tests or maneuvers, like the Neer’s test, are used in daily clinical practice to demonstrate the presence of SIS and to localize the periarticular lesions, but their accuracy is still questioned. Here we seek to determine the efficacy of Neer’s test by comparing the clinical findings with that of MRI findings. Materials and Methods: The study was performed on 100 shoulders over a period of 2 years at a tertiary care hospital. In patients who satisfied the inclusion criteria, a working diagnosis of Shoulder Impingement Syndrome was made by performing classical tests like Hawkin’s and Neer’s Sign which was followed by a Neer’s test. MRI was then performed on each of the shoulders after 7 days to avoid fluid signals post injection and the findings were noted after the MRI was evaluated by a radiologist. Diagnostic efficacy of the Neer’s test was then determined by 2x2 table for calculating the specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy using the “openepi’’ software with confidence interval being kept at 95%.Results and Conclusion: Neer’s test is a sensitive test for diagnosis of SIS, especially for diagnosis of partial rotator cuff tears and with a higher specificity for diagnosing rotator cuff pathology than bursitis. A negative test is especially useful in ruling out presence of partial or total rotator cuff tears with a positive test encouraging the examiner towards the diagnosis of SIS.

Are platelet-rich plasma injections superior to corticosteroid injections for partial rotator cuff tears?

Are platelet-rich plasma injections superior to corticosteroid injections for partial rotator cuff tears?

Functional outcome of patients undergoing open rotator cuff repair

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Rotator cuff tears are a common source of shoulder pain. The incidence of rotator cuff damage increases with age and is most frequently due to degeneration of the tendon rather than injury from sports or trauma. Rotator cuff tear can be treated arthroscopically, arthroscopically assisted (mini-open) or by an open procedure. Because of the technical demands of arthroscopic repair many surgeons consider open repair for the treatment of rotator cuff tears. This study was done to evaluate the functional outcome of shoulder after open rotator cuff repair.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 26 patients with partial and complete rotator cuff tears underwent open rotator cuff repair and acromioplasty. Cases were followed up at 3 months and 6 months intervals and shoulder function was assessed using Constant-Murley scoring system and compared with the preoperative scores and analyzed using SPSS software.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean preoperative constant score was 33.95±7.545 while the mean constant score at 6 months post-surgery was 79.83±8.51 which was highly significant according to paired t test. The difference between preoperative, 3 months and 6 months constant scores of complete and partial tear patients was found to be statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There was highly significant increase in Constant-Murley score after 6 months in patients treated by open rotator cuff repair. Open repair still stands as an effective treatment for rotator cuff tears and doing acromioplasty during the procedure adds to better outcome after surgery.&lt;/p&gt;

Preoperative partial-thickness rotator cuff tears do not compromise anatomic total shoulder replacement outcomes: medium-term follow-up

Reverse total shoulder replacement (TSR) in elderly patients with primary osteoarthritis (OA) and rotator cuff pathology is increasingly being performed. The purpose of our study was to determine the medium-term results of anatomic TSRfor OA in patients with established preoperative partial-thickness rotator cuff tears on magnetic resonance imaging (MRI) scans. We reviewed a cohort of patients who had undergone anatomicTSR for OA with a preoperative MRI diagnosis of partial-thickness rotator cuff tear. Patients were assessed with preoperative and post operative Oxford Shoulder Scores, evaluation of their range-of-movement and clinical rotator cuff assessment. Anteroposterior and axillary radiographs were used to assess for any proximal humeral migration (using the Torchia classification) and any evidence of loosening. The Lazarus score was used to grade glenoid radiolucencies. The study comprised 36 patients (14 men and 22 women) who underwent TSR and had partial-thickness rotator cuff tears on MRI; preoperatively, all showed mild to moderate fatty infiltration. The mean age of the patients was 79.2 years (range, 75-88 years); the mean follow-up period was 5.8 years (range, 5-9 years). Significant improvements in pain and range of movement were reported in all cases. At the final follow-up, the mean Oxford Shoulder Score was 42 points (range, 32-46 points), with a minimum improvement of 14 points (P = .001). External rotation (20° vs. 40°, P = .001), forward flexion (80° vs. 140°, P = .015), abduction (45° vs. 90°, P = .015), and internal rotation also improved. Lucencies were observed in 8 glenoids, with 6 showing grade 1 Lazarus changes, 2 showing grade 2, and none showing grade 3. There were no cases of implant loosening. Clinically, 4 patients had rotator cuff weakness but only 2 showed evidence of proximal migration. One patient remained satisfied, whereas the other patient, with moderate-grade proximal migration according to the Torchia classification, underwent revision for rotator cuff failure; one further patient underwent washout and DAIR (débridement, antibiotics, and implant retention) for infection. There is a paucity of literature on whether a preoperative partial-thickness rotator cuff tear has an adverse effect on the outcome of TSR. Our results show that the presence of a partial cuff tear on preoperative MRI does not significantly affect function after anatomic TSR in the medium term. With anatomic TSR having less morbidity for patients and allowing greater potential options for revision, we believe that the use of reverse shoulder arthroplasty in this cohortof patients, with partial rotator cuff tears, may not be necessary and we advocate consideration of anatomic TSR in this patient group.

Tolerance and effectiveness of eccentric vs. concentric muscle strengthening in rotator cuff partial tears and moderate to severe shoulder pain. A randomized pilot study

IntroductionRotator cuff tears are the main cause of shoulder pain and disability. First line of treatment is conservative; there is evidence regarding the advantage of using eccentric over concentric exercises in tendinopathies, but there are no evidence-based recommendations on starting strengthening exercise during painful phases nor on the effectiveness and advantages of eccentric vs. concentric exercise in rotator cuff tears. ObjectiveTo evaluate the tolerance of a resistance strengthening program and to compare eccentric vs. concentric programs. DesignA pilot, experimental, randomized controlled study. SettingOutpatient Rehabilitation Center. PatientsTwenty-six patients with a diagnosis of partial rotator cuff tear were randomly assigned to: the experimental group (eccentric, n = 12) and the control (concentric, n = 14). InterventionThe experimental group performed muscle strengthening with eccentric technique directed to shoulder and scapular girdle muscles, while the control group performed the concentric technique. Main outcome measures.Visual Analogue Scale (VAS), Constant Scale, Strength, Structure (Ultrasound report). ResultsThe tolerance rate was 96% in both groups. Median age (experimental vs. control) was 54.5 vs. 54 years (p = 0.69). Results at baseline, and at months 1, 3, and 12 (median) were as follows: for VAS (mm), experimental: 55, 30, 30, and 10, p < 0.001 (intra-group); control: 50, 30, 30, and 5, p = 0.01; Constant scale (points): experimental 58.5, 88, 93, and 85, p < 0.001; control 50.62, 80, and 91.5, p = 0.038; normalized strength (Kg); experimental: 0.23, 0.29, 0.73, and 0.72, p = 0.001, and control: 0.24, 0.21, 0.54, and 0.66, p = 0.01. We found inter-group differences in the Constant scale at 1 and 3 months (p < 0.05), and in strength at months 1 and 3 (p < 0.05). We observed structural differences in tendon (healing) between groups at 3 and 12 months. ConclusionsEccentric and concentric strengthening were well tolerated; both show early improvement in pain, functionality and tendon structure. Eccentric training appears to be more effective than concentric in the early improvement of functionality, strength and tendon healing.

The relationship between high-signal intensity changes in the glenohumeral joint capsule on MRI and clinical shoulder symptoms

Background/objectiveHigh-signal intensity changes in the glenohumeral joint capsule on T2-and proton density-weighted magnetic resonance imaging are known as characteristic finding that is often observed in patients with frozen shoulder. We investigated the associations between high-signal intensity changes in the joint capsule on magnetic resonance imaging and the presence of rotator cuff tears and shoulder symptoms in patients with shoulder pain. MethodsThe medical records of 230 patients with shoulder pain who underwent magnetic resonance imaging at our hospital were reviewed. Patients were divided into three groups according to the presence and/or degree of rotator cuff tears (none, partial, or complete). The frequency of high-signal intensity changes in the joint capsule and its relationship with shoulder symptoms and the severity of rotator cuff tears were assessed. By quantitatively evaluating the intensity on MRI, the ratio between the joint capsule and the long head of the biceps (HSIC ratio) was calculated and compared with 15 healthy subjects. ResultsHigh-signal intensity changes were diagnosed in 165 (72%) patients, and it was significantly associated with night pain and range of motion limitation (p < 0.01). High-signal intensity changes were present in 66 patients (70%) with no rotator cuff tears, in 69 (71%) with partial rotator cuff tears, and in 36 (80%) with complete rotator cuff tears, without differences in their occurrence (p = 0.60), but were significantly associated with night pain in all the groups (p < 0.01) without differences in tear severity (p = 0.63). The ratio in the high-signal intensity changes (HSIC) positive group was approximately six times higher than that in the HSIC-negative and control groups (P < 0.01). Multivariate logistic regression analysis revealed that night pain is significantly associated with high-signal intensity changes (p < 0.01). ConclusionShoulder pain is a common and reliable clinical finding in patients with high–signal intensity changes, regardless of the presence and/or degree of rotator cuff tears, Such changes may indicate night pain and range of motion limitation in patients.

Synovial Fluid Volume at the Time of Arthroscopic Rotator Cuff Repair Correlates With Tear Size.

BackgroundInflammatory biomarkers are increased in the synovium and tendon of rotator cuff tears. Several studies demonstrate an associated increase in these markers and size of the tear, with implications of chondral destruction leading to rotator cuff tear arthropathy and glenohumeral arthritis.MethodsThis is a prospective study of 105 patients undergoing arthroscopic rotator cuff repair in which intra-articular synovial fluid was aspirated just prior to arthroscopy. Adult patients with a partial or full-thickness rotator cuff tear undergoing arthroscopic repair were included, and those with inflammatory arthritis, active infection, open cuff repair, intraoperative findings of osteoarthritis, or those undergoing revision cuff repair were excluded.ResultsThe average patient age was 58 years (range 33-74 years), with 59 (56.2%) males. The mean aspirate volume of partial tears was 0.76 ± 0.43 mL, small tears 1.46 ± 1.88 mL, medium tears 3.04 ± 2.21 mL, and large tears 6.60 ± 3.23 mL. Full-thickness versus partial tears had significantly more synovial fluid (3.64 vs. 0.76 mL, respectively, p < 0.0001). An aspiration volume of 1.5 mL or greater resulted in 91.3% specificity and 96.8% positive predictive value for a full-thickness tear. Smoking (p = 0.017), tear size (p < 0.0001), and tears of the infraspinatus (p = 0.048) were significantly correlated with synovial fluid volume. Age, body mass index, chronicity of tear, sex, subscapularis involvement, supraspinatus involvement, and teres minor involvement had no association to synovial fluid volume.ConclusionPreoperative aspiration of the glenohumeral joint to identify the volume of synovial fluid can aid to identify full-thickness rotator cuff tears, and increased fluid volume should alert the clinician of a large tear.

Mental health and tobacco use are correlated with PROMIS upper extremity and pain interference scores in patients with shoulder pathology.

To determine whether patient demographics have predictive influence on patient-reported outcomes measurement information system (PROMIS) domains of pain interference (PROMIS-PI), depression (PROMIS-D), and upper extremity (PROMIS-UE) for patients with shoulder pathology treated nonoperatively. Patients with partial rotator cuff tears, impingement, scapular dyskinesia, osteoarthritis, muscle strains, biceps tendonitis, instability, and acromioclavicular arthritis were retrospectively identified. Patients who underwent surgery were excluded. Demographic characteristics were documented, and PROMIS scores before and after nonoperative intervention were analyzed for correlations between each domain. A total of 638 questionnaires (PROMIS-UE, PROMIS-PI, and PROMIS-D) were analyzed. PROMIS-UE had a strong negative correlation with PROMIS-PI (R = - 0.73, P < .001). PROMIS-PI and PROMIS-D demonstrated a positive correlation of moderate strength (R = 0.54, P < .001). Patients who never used tobacco, compared to current or former users, had significantly higher PROMIS-UE scores (34.5 vs. 30.6 and 31.9; P < .001), lower PROMIS-PI (59.7 vs. 63.1 and 60.9; P < .001), and lower PROMIS-D scores (47.3 vs. 52.1 and 49.3; P < .001). Patients with body mass index < 24.8 had significantly higher PROMIS-UE scores than those with > 24.8 (P < .05). There is an inverse relationship between upper extremity physical function and pain and depression, as measured by PROMIS scores. Smoking and increased BMI are significant contributors to worse outcomes in patients with shoulder pathology, even in nonoperative populations. Counseling patients regarding prognosis and functional outcomes is important in managing their expectations in this patient population.

Repairing PASTA Lesions Without Violation of the Rotator Cuff

Partial-thickness articular-sided rotator cuff tears are a common cause of shoulder pain in adults. Although partial rotator cuff tears have a high prevalence, there is still controversy over their proper surgical treatment. Different surgical procedures have been suggested when partial tears involve the articular side of the rotator cuff, such as arthroscopic debridement of the tear with or without acromioplasty, tear completion and repair, and transtendinous in situ repair. Although multiple repair techniques have been described, significant clinical data to definitively support one technique over the others are currently lacking. We describe an arthroscopic technique for repair of a partial articular supraspinatus tendon avulsion that avoids the transtendinous insertion of suture anchors to preserve the tendon integrity.

Clinical outcome of ultrasound-guided atelocollagen injection for patients with partial rotator cuff tear in an outpatient clinic: a preliminary study.

BackgroundAtelocollagen has been studied for restoration of rotator cuff tendon. In this study, we attempted to evaluate the clinical outcome of ultrasound-guided atelocollagen injection in an outpatient clinic for patients with partial rotator cuff tear.MethodsWe recruited 42 outpatients who visited our hospital from May 2019 to September 2019. Atelocollagen injection was performed in patients with partial rotator cuff tear diagnosed by magnetic resonance imaging and ultrasound. American Shoulder and Elbow Surgeons (ASES), Constant, Korean Shoulder Score (KSS) and Simple Shoulder Test (SST) scores, and range of motion were assessed before injection and after 2 months. Statistically, we analyzed the clinical results using the Wilcoxon signed-rank test.ResultsFinally, 15 patients were enrolled for analysis. There was no significant difference between pre- and post-injection in terms of range of motion, ASES (57.0 vs. 60.4), Constant (56.4 vs. 58.9), KSS (64.6 vs. 68.5), and pain-visual analog scale (4.2 vs. 3.7), except function-visual analog scale (F-VAS; 6.3 vs. 7.1) and SST (6.6 vs. 6.9). A significant difference was found in SST (P=0.046) and F-VAS (P=0.009). According to the ultrasound results at 2 months, we found hyperechoic materials in three of seven patients. The most common complication of atelocollagen injection was post-injection pain (53%, 8/15).ConclusionsUltrasound-guided atelocollagen injection for partial rotator cuff tear showed no significant change in terms of clinical outcomes, except for F-vas and SST score. Tendon regeneration was not clear due to the remnants of atelocollagen present at 2-month follow-up ultrasound. There seems to be alarming post-injection pain for 2 to 3 days in the patients who received atelocollagen injection in an outpatient clinic.

CORR Synthesis: What Is the Role of Platelet-rich Plasma Injection in the Treatment of Tendon Disorders?

CORR Synthesis: What Is the Role of Platelet-rich Plasma Injection in the Treatment of Tendon Disorders?

PMS40 REAL-WORLD TREATMENT PATTERNS AND ECONOMIC BURDEN OF ROTATOR CUFF TEAR PATIENTS IN THE US

This study examined treatment characteristics and associated economic burden of Rotator cuff tears (RCT). Patients aged ≥18 years with ≥1 inpatient or ≥2 outpatient RCT diagnosis ≥30 days apart were identified in 1/1/2013-6/30/2017 using the IBM Watson Health MarketScan® Commercial database (index date=first observed RCT diagnosis). All patients had 1-year pre-index and post-index periods. Patient characteristics, all-cause costs, RCT-related costs (plan paid and patient out-of-pocket), healthcare resource utilization (HRU), and rotator cuff repairs (RCR) were reported by RCT type (partial or complete tears). Among 102,488 RCT patients identified, 45.7% were partial tear (46,856) and 54.3% were complete tear RCT (55,632). Partial were younger (56.3 years) than complete RCT (60 years). Complete RCT had higher rates of hypertension (49%), hypercholesterolemia (11%) and diabetes (19%). Physical therapy (82%), opioid (77%), and non-opioid medication (51.0%) were the most common conservative treatments. Post-index opioid use was significantly higher for complete (82%) compared to partial RCT (71%). About 30% of partial progressed to complete tear status with an average time of 79 days. About half of RCT patients had an RCR procedure (37% partial RCT, 61% complete RCT). Average time to first RCR was shorter for complete (46 days) than partial RCT (62.5 days). Among patients with 12-month post-RCR eligibility, around 6.1% partial and 6.4% of complete RCT had repeat surgery. Complete RCT patients had an average total baseline (within 12 months pre-index) costs of $17,096 and post-index costs of $32,110. Similarly, partial thickness patients had baseline costs of $16,385 and post-index costs of $27,017. Complete RCT patients had higher RCT-related post-index total cost compared to partial RCT ($9,183 vs. $7,283, p<0.0001). Despite almost all RCT patients seeking conservative treatment, half of RCT diagnosed patients require surgical treatment eventually. High opioid use, HRU and costs highlight the importance of efficiently managing patients with RCT diagnosis