Partial-thickness Rotator Cuff Tears Research Articles

Finite element-based evaluation of the supraspinatus tendon biomechanical environment necessitates better clinical management based on tear location and thickness

Partial-thickness rotator cuff tears are a common cause of pain and disability and are central to developing full-thickness rotator cuff tears. However, limited knowledge exists regarding the alterations to the mechanical environment due to these lesions. Computational models that study the alterations to the mechanical environment of the supraspinatus tendon can help advance clinical management to avoid tear progression and provide a basis for surgical intervention. In this study, we use three-dimensional validated finite element models from six intact specimens to study the effects of low- and high-grade tears originating on the articular and bursal surfaces of the supraspinatus tendon. Bursal-sided tears generally had a lower failure load, modulus, and strain than articular-sided tears. Thus, caution should be taken when managing bursal-sided tears as they may be more susceptible to tear progression.

Treatment of Partial-Thickness Rotator Cuff Tears with Bio-Inductive Collagen Implant for Paraplegic Tennis Player: A Case Report

In patient with lower limb disability, rotator cuff disorders are prevalent, with partial thickness tears occurring at nearly twice the rate of full thickness tears. For those with acromion spurs unresponsive to conservative treatment, rotator cuff repair via the take-down method poses a retear risk and requires extensive rehabilitation. Conversely, surgery utilizing bio-inductive collagen implants shows a lower retear risk and enables faster recovery, making it an appealing option for wheelchair athletes. Thus, the authors aim to present favorable outcomes from isolated bio-inductive collagen implant repair in a 45-year-old female wheelchair tennis player with a bursal side partial thickness tear, alongside a literature review.

Classifications in Brief: The Ellman and Snyder Classifications of Partial-thickness Rotator Cuff Tears

Classifications in Brief: The Ellman and Snyder Classifications of Partial-thickness Rotator Cuff Tears

Disparities in Rotator Cuff Tear Progression Definitions and Rates: A Systematic Review.

While rotator cuff tears are prevalent in the general population, the natural history of this disease is unclear. Understanding rotator cuff tear progression is crucial for refining surgical indications and evaluating the necessity of early interventions. This study presents an in-depth analysis of the existing literature on the definitions and progression rates of rotator cuff tears, aiming to enhance clinical decision making and patient outcomes. A systematic literature search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using Medline (PubMed), Embase (Elsevier), and Web of Science databases on January 12, 2023. Articles were identified as relevant to the natural history and progression of asymptomatic and symptomatic partial-thickness (PT) and full-thickness (FT) rotator cuff tears. Those written in English reporting rotator cuff progression rates of tears in adults, based on magnetic resonance imaging (MRI) or ultrasound, were included. After reviewing the articles, the data on the rates of tear progression and associated risk factors were extracted, compiled, and analyzed. The risk of bias was determined using the Newcastle-Ottawa Scale. Twenty-one articles met the inclusion criteria, with 1,831 tears included. The progression rate for all partial thickness tears was 26.7% ± 12.8% at an average follow-up of 2.2 ± 0.9 years, with 5 definitions for tear progression. For FT tears, the progression rate was 54.9% ± 18.6% at a follow-up time of 3.0 ± 2.0 years, with 8 definitions for tear enlargement. A significant difference (p < 0.0001) was found between the progression rates of PT and FT tears. Patients who were initially asymptomatic and became symptomatic had higher progression rates (33%-63%) than those who remained asymptomatic (4%-38%). Further research would benefit by identifying a clinically relevant and standardized definition of rotator cuff tear progression, to describe the natural history of rotator cuff disease, making results more comparable and optimizing treatment planning. Level II. See Instructions for Authors for a complete description of levels of evidence.

Arthroscopic management of isolated partial-thickness rotator cuff tears.

The aim of the present study is to provide a comprehensive review on the surgical outcomes following arthroscopic treatments of partial-thickness rotator cuff tears (PT-RCTs) and to compare the postoperative American Shoulder and Elbow Surgeons(ASES)score following in situ transtendon repair and tear completion, followed by repair. Medline, EMBASE, Scopus, CINAHL and CENTRAL bibliographic databases were searched. Papers including patients with PT-RCTs of any grade who underwent treatment using debridement, in situ transtendon repair, tear completion and repair or bioinductive collagen implants were reviewed. Primary PT-RCTs were the sole indication for surgery. Primary postoperative outcomes assessed included the ASESscore,the Absolute Constant-Murley score, the Simple Shoulder Test, the Visual Analogue Scale, the University of California-Los Angeles Shoulder Scale, the Western Ontario Rotator Cuff Score, range of motion, complications and revisions. A meta-analysis of comparative studies compared the postoperative ASES score between patients treated with in situ transtendon repair versus tear completion repair. Twenty-eight studies were included. The ASES score was reported by four comparative studies with contrasting results. The heterogeneity was high (I2 = 86%), and effect sizes ranged from -0.49 in favour of the tear completion and repair technique to an effect size of +1.07 favouring in situ transtendon repair. The overall effect size of 0.02 suggests an equivalence between the two techniques in terms of the ASES score. Two studies with a total sample size of 111 patients reported on debridement, and four studies with a total sample size of 155 patients reported on bioinductive collagen implants. Debridement alone is suitable for Ellman grades I-II PT-RCTs. In situ transtendon and tear completion repair techniques yield similar postoperative outcomes. Bioinductive collagen implants hold promise but lack long-term efficacy data. High-quality comparative studies are needed to determine the best treatment for PT-RCTs. Level IV.

Analyzing practice pattern in treating partial-thickness rotator cuff tears: a dual perspective from national database and American Shoulder and Elbow Surgeons PARCIAL research group

Analyzing practice pattern in treating partial-thickness rotator cuff tears: a dual perspective from national database and American Shoulder and Elbow Surgeons PARCIAL research group

Physiotherapist-supervised exercises versus physiotherapist-prescribed home exercises for treating partial thickness rotator cuff tears: a randomized controlled trial

BackgroundPartial thickness rotator cuff tears significantly affect physical and psychosocial well-being This study aimed to compare the efficacy of physiotherapist-supervised exercise and physiotherapist-prescribed home exercise programs on physical and psychosocial health measures in partial thickness rotator cuff tears. MethodsSeventy patients with partial thickness rotator cuff tears (44 female; mean age, 50.1 ± 5.2 years) were divided into two groups. Both the physiotherapist-supervised exercise group (Group 1, n=35) and physiotherapist-prescribed home exercise group (Group 2, n=35) received a program consisting of glenohumeral joint range-of-motion, stretching, and strengthening exercises (twice a week for eight weeks). The primary outcome measures were the modified Constant-Murley Score (mCMS) and the Hospital Depression and Anxiety Scale (HADS). Secondary outcome measures were the visual analog scale (VAS), active range of motion (AROM), Pain Catastrophizing Scale (PCS), Pittsburg Sleep Quality Index (PSQI), Short Form-12 (SF-12), and Global Rating of Change Scale (GRC). Patients were assessed at baseline and the end of the treatment. The significance level was adjusted to 0.025 after the Bonferroni correction. ResultsBoth groups showed significant improvements in all measures after treatment. There were no statistically significant group-by-time interactions for the mCMS (F=12.47, p=0.03) and the HADS (F=0.89, p=0.14 for depression; F=0.73, p=0.44 for anxiety). However, the improvement in the mCMS was clinically meaningful in both groups. The overall group-by-time interaction was significant for the VAS activity (p=0.004), shoulder flexion (p=0.01) and abduction (p=0.02) AROM, and PCS (p=0.005) in favor of Group 1. ConclusionExercise effectively improves physical and psychosocial health measures in partial thickness rotator cuff tears when delivered in the clinic or at home. However, exercise is more effective for activity pain, AROM, and pain catastrophizing when delivered in the clinic, highlighting the effectiveness of the physiotherapist-supervised exercise program.

Partial-Thickness Rotator Cuff Tears: Current Concepts.

» Partial-thickness rotator cuff tears (PTRCTs) are a common pathology with a likely high asymptomatic incidence rate, particularly in the overhead athlete.» The anatomy, 5-layer histology, and relationship to Ellman's classification of PTRCTs have been well studied, with recent interest in radiographic predictors such as the critical shoulder angle and acromial index.» Depending on the definition of tear progression, rates of PTRCT progression range from 4% to 44% and appear related to symptomatology and work/activity level.» Nearly all PTRCTs should be managed conservatively initially, particularly in overhead athletes, with those that fail nonoperative management undergoing arthroscopic debridement ± acromioplasty if <50% thickness or arthroscopic conversion repair or in situ repair if >50% thickness.» Augmentation of PTRCTs is promising, with leukocyte-poor platelet-rich plasma having the most robust body of supportive data. Mesenchymal signaling cell biologics and the variety of scaffold onlay augments require more rigorous studies before regular usage.

EFFECT OF PRP INJECTION IN CASES OF PARTIAL THICKNESS ROTATOR CUFF TEAR IN KING FAHD ARMED FORCES HOSPITAL: A RETROSPECTIVE STUDY

Objective:To evaluate the clinical outcomes of PRP (Platelet-Rich Plasma) injections in treating partial thickness rotator cuff tears at King Fahd Armed Forces Hospital. Methods:This retrospective study reviewed patients treated with PRP injections for partial thickness rotator cuff tears between April 2021 and December 2023. Patient demographics, tear characteristics, treatment protocols, and follow-up data were analyzed. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the American Shoulder and Elbow Surgeons (ASES) score. Results:A total of 60 patients (35 males, 25 females mean age 48.3 years) were included. The mean follow-up period was 12 months. VAS pain scores significantly decreased from a mean of 7.2 pre-treatment to 2.9 post-treatment. ASES scores improved from a mean of 55.4 pre-treatment to 85.7 post-treatment. No significant complications were reported. Conclusion:PRP injections appear to be an effective treatment for partial thickness rotator cuff tears, resulting in significant pain reduction and functional improvement. Further randomized controlled trials are warranted to confirm these findings.

Comparative efficacy of platelet-rich plasma (PRP) injection versus PRP combined with vitamin C injection for partial-thickness rotator cuff tears: a randomized controlled trial

BackgroundThe optimal approach for managing partial-thickness rotator cuff tears (PTRCT) remains controversial. Recent studies related to PTRCTs have shown that platelet-rich plasma (PRP) injection might be an effective treatment option. Despite the role of vitamin C in collagen synthesis and its antioxidant properties, the effects of combined PRP and vitamin C treatment on rotator cuff repair are not well understood. This study investigated the effect of combined treatment of PRP and vitamin C treatment on PTRCTs.MethodsOne hundred-ten patients with PTRCTs were randomly allocated to two groups and underwent subacromial injections of either (A) normal saline and platelet-rich plasma or (B) vitamin C and platelet-rich plasma. The Constant score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale were used to evaluate the outcomes before, 1 month after, and 3 months after injection.ResultsAt the 3-month follow-up, no statistically significant differences were observed between the two groups in terms of ASES and Constant scores. Although a slight difference favoring group B was noted in functional scores and pain reduction, this difference was not statistically significant. However, both groups demonstrated significant pain reduction over time (p-value < 0.001). Additionally, the enhancement of ASES and Constant scores in both groups was statistically significant (p-value < 0.001).ConclusionsIn conclusion, both PRP injection alone and PRP combined with vitamin C led to significant reductions in pain and enhancements in function scores over time (p < 0.001), suggesting the effectiveness of PRP as a non-surgical treatment for PTRCTs within 3 months. While PRP alone showed significant benefits, further research is required to ascertain if the combination therapy offers statistically significant advantages over PRP alone.Trial registrationClinical trial registration code: IRCT20230821059205N1.

Comparison of the clinical efficacy and prognosis of the two techniques for treating partial articular-sided supraspinatus tendon tears under arthroscopy

BackgroundAt present, shoulder arthroscopy is usually used for treatment of rotator cuff injuries. There is still debate over the precise technique of using shoulder arthroscopy to treat partial articular-sided supraspinatus tendon injuries.ObjectiveTo compare the clinical efficacy of the arthroscopic transtendon repair method and the arthroscopic full-thickness repair method in the treatment of patients with Ellman III partial articular-sided supraspinatus tendon tears and to analyze the influencing factors of postoperative efficacy.Study designCohort study; level of evidence,4.MethodsA total of 84 partial-thickness rotator cuff tear (PTRCT) patients with Ellman III injuries who underwent surgical treatment in our hospital between January 2017 and January 2020 were selected and divided into the arthroscopic trans-tenon repair group (32 cases) and the arthroscopic full-thickness repair group (52 cases). Shoulder joint pain and functional status were assessed by the Constant score, ASES score and VAS score; shoulder mobility was assessed by measuring shoulder ROM. The clinical outcomes of the two groups of patients were compared, and the factors affecting the postoperative efficacy of the patients were investigated.ResultsAll patients were followed up for at least 2 years. The Constant score, ASES score, and VAS score of the two groups of patients were all improved compared with those before surgery, and the differences were statistically significant (P < 0.05). There were no significant differences in the Constant score, ASES score, or VAS score between the two groups (P > 0.05). The results of binary logistic regression analysis showed that the preoperative ASES score and whether biceps tenotomy was performed were independent risk factors for satisfactory postoperative efficacy (P < 0.05).ConclusionFor patients with Ellman III partial articular-sided supraspinatus tendon tears, the arthroscopic transtendon repair method and the arthroscopic full-thickness repair method can both significantly improve the shoulder pain and function of the patient, but there is no significant difference between the efficacy of the two surgical methods. The preoperative ASES score and whether biceps tenotomy was performed were independent risk factors for satisfactory postoperative efficacy in PTRCT patients with Ellman III injury.

Evaluation of clinico-radiological outcome of conservative treatment in patients with partial-thickness rotator cuff tears

ObjectiveWhile some patients may require surgical treatment a lot of patients do recover on conservative treatment alone while the optimal treatment being unclear. The purpose of this study was to treat the PT-RCTs conservatively for a period of 6 months and to determine its clinical outcome, radiological outcome on MRI and the baseline clinical factors predictive of that outcome. MethodologyAll patients with a partial tear of supraspinatus and/or infraspinatus on their 1st MRI and aged 18–80 years were eligible and 47 patients (22 males, 25 females) were enrolled. Patients were evaluated using a standardised format including clinical history, imaging, and ASES(American Shoulder and Elbow Surgeons) score. Patients underwent a course of physical therapy for a period of minimum of 6 months which was augmented with the use of analgesics and/or anti-inflammatory drugs, multivitamins and supplements which were patient specific. Patients were followed up at 3 months and 6 months, ASES score was calculated, and a follow-up MRI was done at 6 months to determine if their tear had healed, remained the same, or progressed. A patient that had a better ASES score at 6 months was tagged as “clinically improved”. Radiologically, patients were considered treated “successfully” if the tear size was reduced or remained the same while some “failed” that had an increased size of tear. ResultNon-operatively treated patients demonstrated a mean ASES score of 63.45 ± 16.24 at the end of 6 months. Overall, 35 patients (74.5 %) had the same size, seven patients (14.9 %) demonstrated tear progression and 5 (10.6 %) patients showed a decrease in size of their tear on MRI done at 6 months. In the end, 30 (63.8 %) patients improved clinically and 40 (85.1 %) patients improved radiologically. Statistical analysis also showed that patients with their non-dominant side involved and with an atraumatic onset of their injury were more likely to improve clinically. ConclusionConservative treatment of PT-RCTs may lead to a successful clinical outcome but it may or may not reveal itself radiologically. ASES score is an effective tool to evaluate and manage various conditions of the shoulder and not just the rotator cuff. The baseline factors such as onset (traumatic versus atraumatic) and shoulder involved (dominant versus non-dominant) can predict the outcome of conservative treatment.

Arthroscopic Margin Convergence Repair Without Suture Anchors Improves Clinical Outcomes for Full- and Partial-Thickness Rotator Cuff Tears

To evaluate the clinical outcome scores of an arthroscopic margin convergence technique without the use of suture anchors to repair different types of rotator cuff tears and to determine whether the type or extent of the tear has an effect on clinical outcome scores after this procedure. Patients receiving arthroscopic margin convergence repair without suture anchors for rotator cuff tears from 2013 to 2018 were retrospectively analyzed. Arthroscopically determined partial- or full-thickness rotator cuff tears with a minimum follow-up period of 20 months were included. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) shoulder score; University of California, Los Angeles (UCLA) shoulder score; and visual analog scale (VAS) score. A 2-tailed distribution paired t test was used to determine statistical significance (P < .05) between preoperative scores and scores at final follow-up. Correlation tests and linear regression analysis were used to determine the correlation between various clinical variables and outcomes. A cohort-specific minimal clinically important difference analysis was performed for each outcome score, calculated as one-half of the standard deviation of the delta score. A total of 38 patients were included for analysis: 12 with partial-thickness tears and 26 with full-thickness tears. The mean postoperative follow-up period was 33.9 months (range, 22.2-94.5 months), with a minimum follow-up period of 22 months. The mean age of the patients was 62 ± 15.1 years. The minimal clinically important difference values for the ASES, UCLA, and VAS scores were 9.68, 2.92, and 1.13, respectively. There were significant improvements in the ASES (from 29.3 ± 18.3 preoperatively to 93.7 ± 8.3 postoperatively, P= .001), UCLA (from 14.3 ± 6.2 to 32.8 ± 2.6, P= .001), and VAS (from 7.37 ± 1.8 to 0.63 ± 1.02, P= .001) clinical outcome scores. However, patients with either Patte stage 3 retraction (P= .033 for ASES score and P=.020 for UCLA score) or U-shaped tears (P= .047 for ASES score and P= .050 for UCLA score) had significantly lower clinical outcome scores than patients with less severe retraction or differently shaped tears. The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with partial- or full-thickness rotator cuff tears. Level IV, therapeutic case series.

Percutaneous bone marrow concentrate and platelet products versus exercise therapy for the treatment of rotator cuff tears: a randomized controlled, crossover trial with 2-year follow-up

BackgroundSurgical repair is recommended for the treatment of high-grade partial and full thickness rotator cuff tears, although evidence shows surgery is not necessarily superior to non-surgical therapy. The purpose of this study was to compare percutaneous orthobiologic treatment to a home exercise therapy program for supraspinatus tears.MethodsIn this randomized-controlled, crossover design, participants with a torn supraspinatus tendon received either ‘BMC treatment’, consisting of a combination of autologous bone marrow concentrate (BMC) and platelet products, or underwent a home exercise therapy program. After three months, patients randomized to exercise therapy could crossover to receive BMC treatment if not satisfied with shoulder progression. Patient-reported outcomes of Numeric Pain Scale (NPS), Disabilities of the Arm, Shoulder, and Hand, (DASH), and a modified Single Assessment Numeric Evaluation (SANE) were collected at 1, 3, 6, 12, and 24 months. Pre- and post-treatment MRI were assessed using the Snyder Classification system.ResultsFifty-one patients were enrolled and randomized to the BMC treatment group (n = 34) or the exercise therapy group (n = 17). Significantly greater improvement in median ΔDASH, ΔNPS, and SANE scores were reported by the BMC treatment group compared to the exercise therapy group (-11.7 vs -3.8, P = 0.01; -2.0 vs 0.5, P = 0.004; and 50.0 vs 0.0, P < 0.001; respectively) after three months. Patient-reported outcomes continued to progress through the study’s two-year follow-up period without a serious adverse event. Of patients with both pre- and post-treatment MRIs, a majority (73%) showed evidence of healing post-BMC treatment.ConclusionsPatients reported significantly greater changes in function, pain, and overall improvement following BMC treatment compared to exercise therapy for high grade partial and full thickness supraspinatus tears.Trial registrationThis protocol was registered with www.clinicaltrials.gov (NCT01788683; 11/02/2013).

Three-dimensional sonography has satisfied accuracy for detecting rotator cuff tears.

Rotator cuff injuries and tears are common causes of shoulder pain and dysfunction, necessitating accurate diagnostic methods to guide clinical decision-making. This study evaluates the diagnostic utility of three-dimensional (3D) shoulder sonography in identifying rotator cuff injury and tear patterns. A comprehensive search across seven electronic databases, which included Cochrane Library, Embase, PubMed, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database. These databases were utilized to retrieve articles that assess the diagnostic value of 3D shoulder sonography for identifying rotator cuff injuries and tear patterns. The effectiveness of 3D shoulder sonography was assessed in terms of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). For each parameter, the 95% confidence intervals were calculated. Additionally, summary receiver operating characteristic curves (SROCs) were constructed, allowing for a comprehensive evaluation of diagnostic accuracy, which is reflected in the area under the SROC curve (AUC). Screening of 8,508 identified nine literatures eligible for inclusion in the meta-analysis, encompassing a total of 366 patients. The analysis of detecting any rotator cuff tear revealed a sensitivity of 0.97 and specificity of 0.87, yielding a DOR of 90.03 and an AUC of 0.98. Furthermore, 3D shoulder sonography demonstrated satisfactory accuracy in detecting both full and partial-thickness rotator cuff tears (Sensitivity: 0.92 vs. 0.83, specificity: 0.94 vs. 097, and AUC: 0.96 vs. 0.95). This study indicates that three-dimensional sonography has satisfied accuracy for detecting rotator cuff tears.

Hyaluronate Acid Plus Platelet-Rich Plasma Is Superior to Steroids for Pain Relief Less Than 6 Months Using Injection Therapy of Partial Rotator Cuff Tears: A Systematic Review and Network Meta-analysis

PurposeWe conducted our network meta-analysis to compare the efficacy of the steroid injections to other injectable therapies in partial-thickness rotator cuff tears (PTRCTs). MethodsA systematic literature search was performed until October 25, 2021 in three databases (CENTRAL, Embase, MEDLINE). Eligible studies compared the efficacy of steroid, hyaluronic acid (HA), platelet-rich plasma (PRP), the combination of HA and PRP (HA+PRP), and adipose-derived regenerative cells (ADRC) in RC tears. The primary outcomes were the Visual Analogue Scale (VAS), Constant Murley Score (CMS), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. Using paired and network meta-analysis, we calculated pooled mean differences (MDs) with 95% confidence intervals (CIs). ResultsWe included a total of seven articles in the quantitative synthesis. In shorter periods, the HA+PRP combination was superior to the other substances we investigated (HA+PRP: VAS (0-4 weeks): MD: −0.99 [CI = −1.62, −0.36]; CMS (0-3 months): 20.56 [CI = 16.18, 24.94]. This combination was followed by the use of HA or PRP alone, depending on the duration of follow-up and the outcome being studied. In our study, short-term results suggest that saline is superior to steroids for partial tears, but this trend is reversed at six-month follow-up. ConclusionOur results suggest the combination of HA and PRP to be a more effective therapeutic option for partial RC ruptures for short terms, but there is no significant difference after 6 months. Level of EvidenceII, Included of Level of Evidence studies I-II

Critical Shoulder Angle in Patients With Cuff Tears.

The pathogenesis of rotator cuff tears (RCTs) is multifactorial. Critical shoulder angle (CSA), which represents the lateral extension of the acromion over the cuff, has been proposed as an extrinsic risk factor. The aim of the present systematic review and meta-analysis was to analyze the available literature regarding the correlation between RCT and CSA. A review was carried out in accordance with the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" guidelines on July 17, 2023, using the following databases: PubMed, Ovid, and Cochrane Reviews. The following keywords were used: "critical shoulder angle," "rotator cuff tears," and "rotator cuff lesions." The methodological quality of the studies was assessed with the MINORS SCORE. Twenty-eight studies were included. The average CSA among the 2110 patients with full-thickness RCT was 36.7 degrees, whereas the same value among the 2972 controls was 33.1 degrees. The average CSA in the 348 patients with partial-thickness RCT was 34.6 degrees, whereas it was 38.1 degrees in the 132 patients with massive RCT. The average MINORS score was 15.6. CSA values were significantly higher in patients with RCT compared with the asymptomatic population. In addition, it appears that CSA values increase with the severity of rotator cuff involvement.

Biceps tenotomy vs. tenodesis in patients undergoing transtendinous repair of partial thickness rotator cuff tears

BackgroundPatients with partial-thickness rotator cuff tears (PTRCTs) often present with concurrent pathology of the long head of the biceps (LHB) tendon. To address both conditions simultaneously, LHB tenotomy or tenodesis can be performed at the time of arthroscopic rotator cuff repair (RCR). This study aims to compare postoperative shoulder active range of motion (AROM) and complications following transtendinous RCR with concurrent LHB tenodesis or tenotomy. MethodsA total of 90 patients with PTRCTs met inclusion criteria for this study. Patients who underwent tear-completion-and-repair, revision surgery, or open repair of the LHB tendon were excluded. Patients were stratified into tenotomy, arthroscopic suprapectoral tenodesis, or no biceps operation cohorts and were propensity matched 1:1:1 on age, sex, body mass index (BMI), and smoking status. Primary outcome measures included AROM in forward flexion, abduction, external rotation, and internal rotation at 6 weeks, 3 months, and 6 months postoperatively. The development of severe stiffness and rates of rotator cuff retear at final follow-up were recorded as secondary outcomes. ResultsWhen comparing the tenotomy and tenodesis cohorts, tenotomy patients were found to have increased AROM at 3 months in forward flexion (153.2° vs 130.1°, p=0.004), abduction (138.6° vs 114.2°, p=0.019), and external rotation (60.4° vs 43.8°, p=0.014), with differences in forward flexion remaining significant at 6 months (162.4° vs 149.4°, p=0.009). There were no significant differences in interval rates of recovery in any plane between cohorts. Additionally, there were no significant differences in rates of symptomatic retears between groups (p=0.458). Rates of severe postoperative stiffness approached but did not achieve statistical significance between tenotomy (4.2%) and tenodesis (29.2%) cohorts (p=0.066). Smoking status was a significant predictor of severe stiffness (odds ratio, 13.69; p=0.010). ConclusionDespite significant differences in absolute AROM between cohorts, the decision to perform tenotomy or tenodesis was not found to differentially affect rates of AROM recovery for patients undergoing arthroscopic transtendinous RCR for PTRCT. Notably, however, transient stiffness complications were more commonly observed in smokers, and data trends suggested an increased risk of stiffness for patients undergoing LHB tenodesis. Overall, postoperative stiffness is likely multifactorial and attributable to both patient- and procedure-specific factors, and LHB tenotomy may be more appropriate for patients with risk factors for developing stiffness postoperatively.

Long-term Functional and Pain Outcomes Following Arthroscopic Partial-Thickness Rotator Cuff Tear Completion and Repair

Objective: There remains little consensus on the optimal treatment approach for partial-thickness rotator cuff tears and few studies have examined the long-term outcomes of different surgical repair techniques. The purpose of this study is to identify the long-term functional and pain outcomes of arthroscopic tear completion followed by repair. The authors hypothesize that this technique will allow patients to have long-term pain relief and return to a pre-injury level of function. Methods: Patients (n=16) who underwent arthroscopic tear completion and repair for a partial-thickness rotator cuff tear were included in this case series. Each patient returned for a one-time follow-up visit, with an average follow-up time of 7.09 years, at which time physical and neurological exams were performed, quality of life was assessed through subjective questionnaires, American Shoulder and Elbow Society (ASES) and the University of California at Los Angeles (UCLA) shoulder scores were obtained, and magnetic resonance imaging was performed. Results: The average ASES score was 85.3, with 81% of patients reporting that they were able to return to a pre-injury level of function. Half of the patients reported the highest possible UCLA shoulder score of 35. Physical examination showed that patients had excellent strength and range of motion. Magnetic resonance imaging demonstrated continuity of the repair in all but one patient. However, 25% of patients reported return of symptoms since surgery, including pain and limited mobility. Conclusion: At an average of 7.09 years follow-up, most patients were found to have full mobility, pre-injury level of activity, and maintenance of rotator cuff integrity in the surgically treated shoulder. However, one fourth of patients reported return of symptoms. The authors conclude that the tear completion and repair technique can lead to long-term functional improvement, but has less favorable results in terms of subjective pain level and quality of life.

The effect of shear wave elastography in the diagnosis of delaminated partial-thickness rotator cuff tears.

To assess the effectiveness of shear wave elastography (SWE) in diagnosing delaminated partial-thickness rotatorcuff tears (DPT-RCT). A retrospective study was carried out on 137 patients with DPT-RCT. Thestudy included complete clinical data, including the images of conventional ultrasound (US), SWE, Magnetic Resonance Imaging (MRI) and shoulder arthroscopic surgery. The features of US, SWE, and MRI were evaluated. The study analysed theShear-Wave Velocity (SWV) among three types of DPT-RCT, and between the regions of tears, normal contralateral, and affected unilateral supraspinatus tendon. Furthermore, receiver operating characteristic (ROC) curves were evaluated. The SWE detection rate was significantly higher (91.2%) compared to US (73.7%) and MRI (87.6%) for the overall diagnosisof DPT-RCT. Similarly, SWE yielded higher rates of detection for types 1 (89.5%) and 2 (92.3%) of DPT-RCT as comparedto US (71.7%, 69.2%) and MRI (81.6%, 94.9%), respectively. However, there was no significant difference in the accuracy ofdiagnosing type 3 among the three methods. The SWV of the 137 supraspinatus tendon tears was 3.64±0.60 m/s, which was higher than that of the normal supraspinatus tendon (2.43±0.47 m/s, p<0.01) as well as the region of tears (1.61±0.54 m/s, p<0.01). Nevertheless, there was no significant difference in SWV among the three types of DPT-RCT. The cutoff thresholds ofSWV for identifying normal tendon from DPT-RCT and for identifying DPT-RCT from the region of tears were 2.96m/s and2.39m/s, respectively. SWE with SWV can provide both quantitative and qualitative diagnostic information for DPT-RCT, which can be used as a crucial supplement imaging method.