Single Tendon Tears Research Articles

Poster 161: Rotator Cuff Repair and Minimum Clinically Important Difference: Does Number of Tendons Involved Affect the Minimum Clinically Important Difference Value?

Objectives: The minimum clinically important difference (MCID) is a commonly used measure to aid in determining significant improvements for patient-reported outcomes (PROs). As MCID and PROs continue to be implemented in shoulder procedures, MCID can greatly differ depending upon the specific patient population, follow-up time, and methodology. In the setting of rotator cuff repair (RCR), there are few studies that discuss the effect of tendon involvement on MCID achievement. Other orthopaedic conditions have calculated separate MCIDs depending on the severity of the fracture or pathology. The purpose of this study was to calculate an MCID for one-, two-, and three-tendon RCR. They hypothesis was that MICD values would be lower for larger repairs compared to smaller repairs. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included evaluating what patient and surgical characteristics affect MCID achievement for each MCID. Methods: A prospectively collected PRO database was queried for patients who underwent primary RCR from 2018 to 2022. Revision procedures, patients with a history of prior shoulder surgery, or patients lacking PROs at any time point were excluded. Demographic and surgery characteristics were extracted through chart review. The primary outcome was the ASES score. ASES is a validated instrument scored on a 100-point scale with 0 indicating the” worst outcome” and 100 being the “best outcome.” MCID was calculated using the anchor-based method as has been done in previous works. The anchor question from PROMIS-10 asks, “In general, how would you rate your physical health?” scored on a 5-point Likert scale. An increase of one point was deemed to be a significant improvement in the anchor to calculate the MCID. An MCID was calculated for the three sizes of RCRs in this sample. Statistical analysis included descriptive statistics, as well as independent sample t-tests, chi-square tests, and fisher exact tests. Results: A total of 799 patients met inclusion criteria. Most patients were male (n=474, 59.3%) and were 61.2 years old. There were 61.5% of patients who had their dominant shoulder treated with RCR. Patients typically presented with at least one tendon that had a full thickness tear (n=643, 80.5%). Many underwent various concomitant procedures including subacromial decompression (83.9%), biceps tendon procedures (tenotomy or tenodesis) (59.0%), distal clavicle excision (24.2%), and arthroscopic debridement (24.0%). The average case length was 130.1 minutes. There were 36 symptomatic retears (4.5%), 10 revisions (1.3%), and 14 other reoperations (1.8%) within one year. ASES scores at baseline and one-year were 48.1 and 84.6, respectively, with an average one-year change of +36.6. MCIDs by number of tendons involved were 40.5, 36.3, and 39.3 for single-, two-, and three-tendon repairs. The number of patients that achieved MCID by tendon size did not statistically differ between groups (Single: 51.0%; Two: 53.0%; Three: 50.0%, p>0.610, respectively). MCID achievement and biceps tendon procedures trended towards significance for the single-tendon cohort (p=0.085), while patient sex trended towards significance in the two-tendon cohort (p=0.055). More acute tears compared to chronic tears met MCID in the three-tendon cohort although this only trended towards significance (p=0.074). MCID achievement was affected by symptomatic retears in the two-tendon RCR group (p<0.001). While reoperation trended towards significance in the single-tendon RCR group (p=0.058). Conclusions: This study found that MCID value varied by the number of tendons involved in RCR, with two-tendon repairs having the lowest MCID (36.3). The number of patients that met MCID in each cohort was similar. Single-tendon tears appear to be more affected by biceps tendon procedures and reoperations, although both of these findings only trended towards significance. Patients with two-tendon tears were shown to be affected by symptomatic retear (p<0.001), and patient sex, although the later finding was not statistically significant (p=0.055). MCID achievement in three-tendon RCRs appear to be influenced by tear chronicity with those with an acute tear being more likely to attain MCID, although this finding was not significant (p=0.074). Surgeons should consider the size of a cuff repair and what corresponding surgical and patient factors may be more pertinent to each patient to help maximize patient outcomes.

Complications of Long Head of the Biceps Tenotomy in Association with Arthroscopic Rotator Cuff Repair: Risk Factors and Influence on Outcomes.

Background: This study aims to report the rate of biceps-related complications after LHB tenotomy, investigating related risk factors and their influence on the outcome. The hypothesis is that these complications have a limited clinical influence. Methods: A single-center prospective observational study was performed between 2015 and 2017 on consecutive patients who underwent RCR associated with LHB tenotomy. Patients were clinically and radiologically evaluated preoperatively, at six months and one year, and screened for postoperative popeye deformity, cramps, and bicipital discomfort. Each complication was analyzed for the following risk factors: age, sex, body mass index (BMI), dominant arm, manual work, tear patterns, and tendon healing. Finally, the clinical outcome was compared between patients with and without complications. Results: 207 patients were analyzed. Cramps, popeye deformity, and discomfort, were respectively, present in 16 (7.7%), 38 (18.4%) and 52 (25.1%) cases at six months and 17 (8.2%), 18 (8.7%) and 24 (11.6%) cases at one year. Cramps were associated with lower age (p = 0.0005), higher BMI (p = 0.0251), single tendon tear (p = 0.0168), manual work (p = 0.0086) at six months and manual work (p = 0.0345) at one year. Popeye deformity was associated with male sex at six months (p < 0.0001). Discomfort was associated with lower age (p = 0.0065), manual work (p = 0.0099), popeye deformity (p = 0.0240) at six months and manual work (p = 0.0200), single tendon tear (p = 0.0370), popeye deformity (p = 0.0033) at one year. Patients without complications showed a significant higher Constant score, pain and subjective shoulder value (SSV) (75.3 vs. 70.4, p = 0.00252; 0.9 vs. 1.9, p < 0.00001; 80.2 vs. 76.4; p = 0.00124) at six months and pain and SSV (0.6 vs. 2.0; p = 0.00044; 91.1 vs. 77.8; p ≤ 0.00001) at one year. Conclusions: Younger age, male sex, higher BMI, manual work, and single tendon tears are risk factors associated with the development of biceps-related symptoms during the first year after tenotomy in association with rotator cuff repair. Nevertheless, the clinical influence of these symptoms on shoulder outcomes is limited.

Biceps-related complications after tenotomy associated with arthroscopic rotator cuff repair: risk factors and clinical impact

Objectives:Many studies have investigated the differences between tenotomy and tenodesis, while only a few have specifically examined the results of tenotomy associated with rotator cuff repair (RCR). Our aim is to report the rate of biceps-related complications after long head of biceps (LHB) tenotomy associated with RCR.Methods:A single-center prospective observational study was conducted between 2015 and 2017 on consecutive patients who underwent RCR associated with LHB tenotomy. Patients were clinically evaluated preoperatively, at 6 months (also by ultrasound) and 1 year, and screened for postoperative Popeye deformity, cramps and bicipital discomfort. Each complication was analyzed for the following risk factors: age, gender, BMI, dominant arm, manual work, type of tear, tendon healing. Finally, clinical outcome was compared between patients with at least one complication and those with none.Results:207 patients were analyzed. Cramps, Popeye deformity, and discomfort, were, respectively, present in 16 (7.7%), 38 (18.4%) and 52 (25.1%) cases at 6 months and 17 (8.2%), 18 (8.7%) and 24 (11.6%) cases at 1 year. Cramps were associated with lower age (1 year-increase OR = 0.88-95% CI, 0.81-0.96-), higher BMI (1 point-increase OR = 1.1-95% CI, 1.02 -1.23-), single tendon tear (P = 0.0168), manual work (OR = 5.0-95% CI, 1.5-16.0-) at 6 months and manual work (OR = 2.9-95% CI, 1.1-8.3-) at 1 year. Objective Popeye deformity was associated with male gender at 6 months (OR = 6.9-95% CI, 3.0-15.5-). Discomfort was associated with lower age (OR = 0.94-95% CI, 0.90-0.98-), manual work (OR = 2.3 -95% CI, 1.2-4.3-), Popeye deformity (OR = 2.3-95% CI, 1.1-4.9-) at 6 months and manual work (OR = 2.8-95% CI, 1.1-6.6-), single tendon tear (OR = 4.9 -95% CI, 1.1-21.3-) and Popeye deformity (OR = 3.4 -95% CI, 1.1-10.7-) at 1 year. Patients without complications showed a significantly higher Constant, pain and SSV score (75.4 vs 70.4, P = .00252; 0.9 vs 1.9, P <0.00001; 80.2 vs 76.4; P =.00124) at 6 months, and pain and SSV score (0.6 vs 2.0; P = 0.00044; 91.1 vs 77.8; P = <0.00001) at 1 year.Conclusion:Younger age, higher BMI, manual work and single tendon tears are risk factors associated with biceps-related symptoms during the first year. Popeye deformity occurs more frequently in males and is associated with discomfort. Nevertheless, the short-term clinical influence of biceps complications on shoulder outcome is very limited.

Acute Proximal Hamstring Tears Can be Defined Using an Imaged-Based Classification

PurposeTo develop a clinically meaningful proximal hamstring tear classification system and to present outcome data for defined subtypes.MethodsRetrospective review was undertaken of patients diagnosed with proximal hamstring tears at a single institution from 2012 to 2019. Images were reviewed by an orthopedic surgeon and musculoskeletal radiologist. Tears were classified as Type 1: partial with subtypes (1A, 1 cm or mild complete tear; 1B, 1-2 cm or full tear with <2 cm retraction), Type 2: complete single-tendon tears with subtypes (2c conjoint tendon only; 2s semimembranosus tendon only); or Type 3: complete tears with >2 cm retraction. Demographics, patient-reported outcome measures including Hip Outcome Score, Activities of Daily Living Subscore (HOS-ADL) and patient satisfaction were evaluated. A poor outcome was defined as HOS-ADL < 80%, and the patient acceptable symptom state (PASS) was defined as HOS-ADL 89.7%.ResultsAt a mean follow-up of 38.6 (range: 12-94) months for 114 patients, distributions were as follows: 18.4% Type 1A, 19.2% Type 1B, 7.8% Type 2c, 3.5% Type 2s, and 50.9% Type 3. Intra-observer and inter-observer reliability had a mean Kappa of 0.985 (95% CI: .956, 1.01) and .905 (95% CI: .895 .915). 66 patients underwent surgery, with 68.97% of them being Type 3. The mean HOS-ADL and PASS rate were higher for operatively treated patients (95%, 93.4%) than for nonoperatively treated patients (81.86%, 44.7%). There were significantly more patients satisfied in the surgery group in both Type 1 and Type 3 tears (P = .046 and P = .049). Body mass index was a significant predictor of a poor outcome in Type 3 tears (P = .039). History of corticosteroid or PRP injection, smoking, and diabetes were not significant predictors of a poor outcome.ConclusionWe present an MRI-based classification system for proximal hamstring injuries with both excellent intra-observer and inter-observer reliability. Outcome measures were improved in patients who underwent surgery.Level of EvidenceIV, cohort study: diagnostic case series.

Complications liées au biceps après ténotomie associée à la réparation arthroscopique de la coiffe des rotateurs : facteurs de risque et influence clinique

Lots of studies investigated differences between tenotomy and tenodesis, while just a few specifically investigated the results of tenotomy in association with rotator cuff repari (RCR). Our aim is to report the rate of biceps related complications after long head of the biceps (LHB) tenotomy in association with RCR. A single-center prospective observational study was performed between 2015 and 2017 on consecutive patients who underwent RCR associated with LHB tenotomy. Patients were clinically evaluated preoperatively, at 6 months (also with ultrasound) and 1 year, and screened for postoperative popeye deformity, cramps and bicipital discomfort. Each complication was analyzed for the following risk factors: age, sex, BMI, dominant arm, manual work, tear kind, tendon healing. Finally, clinical outcome was compared between patients with at least one complication and without complications. Two hundred and seven patients were analyzed. Cramps, popeye deformity, and discomfort, were, respectively, present in 16 (7.7%), 38 (18.4%) and 52 (25.1%) cases at 6 months and 17 (8.2%), 18 (8.7%) and 24 (11.6%) cases at 1 year. Cramps were associated with lower age (1 year-increase OR = 0.88–95%CI, 0.81–0.96−), higher BMI (1 point-increase OR = 1.1–95% CI, 1.02–1.23−), single tendon tear (P = 0.0168), manual work (OR = 5.0–95%CI, 1.5–16.0−) at 6 months and manual work (OR = 2.9–95% CI, 1.1–8.3−) at 1 year. Objective popeye deformity was associated with male sex at 6 months (OR = 6.9–95%CI, 3.0–15.5−). Discomfort was associated with lower age (OR = 0.94–95%CI, 0.90–0.98−), manual work (OR = 2.3–95%CI, 1.2–4.3−), popeye deformity (OR = 2.3–95%CI, 1.1–4.9−) at 6 months and manual work (OR = 2.8–95% CI, 1.1–6.6−), single tendon tear (OR = 4.9–95%CI, 1.1–21.3−), popeye deformity (OR = 3.4–95% CI, 1.1–10.7−) at 1 year. Patients without complications showed a significant higher Constant score, pain and SSV (75.4 vs. 70.4, P = 0.00252 ; 0.9 vs. 1.9, P < 0.00001 ; 80.2 vs. 76.4 ; P = 0.00124) at 6 months, pain and SSV (0.6 vs. 2.0; P = 0.00044; 91.1 vs. 77.8; P = <.00001) at 1 year. Younger age, higher BMI, manual work and single tendon tears are risk factors associated with biceps related symptoms during the first year. Popeye occurs more frequently in males and is associated with discomfort. Nevertheless, the short-term clinical influence of biceps complications on shoulder outcome is very limited.

Complications Within 6 Months After Arthroscopic Rotator Cuff Repair: Registry-Based Evaluation According to a Core Event Set and Severity Grading

To report complications after arthroscopic rotator cuff repairs (ARCRs) in a large patient cohort based on clinical application of a newly defined core event set (CES) and severity grading. Consecutive primary ARCRs documented in a local clinical registry between February 2010 and September 2016 were included. Clinicians documented adverse events (AEs) reported until the final, 6-month postoperative follow-up according to the CES. The CES is an organized list of relevant AEs sorted into 3 intraoperative event groups (device, osteochondral, and soft tissue) and 9 postoperative event groups (device, osteochondral, pain, rotator cuff, surgical-site infection, peripheral neurologic, vascular, superficial soft tissue, and deep soft tissue). Severity was determined using an adaptation of the Clavien-Dindo classification. Cumulative complication risks were calculated per event group and stratified by severity and rotator cuff tear extent. A total of 1,661 repairs were documented in 1,594 patients (mean age, 57 years [standard deviation, 9 years]; 38% women); 21% involved partial tears. All events were recorded according to the CES. Intraoperative events occurred in 2.2% of repairs. We identified 329 postoperative events in 307 repairs (305 patients); 93% had 1 AE. The cumulative AE risk at 6 months was 18.5%; AE risks were 21.8% for partial tears, 15.8% for full-thickness single-tendon tears, 18.0% for tears with 2 ruptured tendons, and 25.6% for tears with 3 ruptured tendons. AE risks per event group were as follows: 9.4% for deep soft tissue, with shoulder stiffness (7.6%) being the most common event; 3.4% for persistent or worsening pain; 3.1% for rotator cuff defects; 1.7% for neurologic lesions; 0.8% for surgical-site infection; 0.7% for device; 0.4% for osteochondral; 0.2% for superficial soft tissue, and 0.1% for vascular. Most AEs had severity grades I (160 [49%]) and II (117 [36%]). Comprehensive local AE documentation according to the CES and severity grading was possible and showed that about one-fifth of ARCRs were affected, mostly by one AE of low severity. Shoulder stiffness was the most frequent event. Level IV, case series.

Critical Postoperative Time For Rotator Cuff Healing And Re-Tear Predisposing Risk Factors. Retrogression Curve Type of Diagram On Cuff Integrity Over Time

The aim of this study was to evaluate at different period postoperatively tendon integrity by ultrasonographic evaluation (USE). We hypothesize that failures of tendon healing (TH) appears early before 3 months post-operatively. From January 2007 to January 2009, 298 patients scheduled for full thickness RCR were prospectively enrolled in this study. Clinical outcomes were evaluated with Constant score and the repair integrity of RCR was evaluated with USE at 3, 6, 12, and 24 months and at the latest follow up (FU) period postoperatively. Finally, 216 patients were included. The average last FU was 2.6 years (range 21 to 62 months). Preoperatively, Constant score was an average 56 and postoperatively at last FU was 80. Thirty-two percent of the patients had single tendon tears and their TH rate was 94 %, while 68% had multitendon tears and their TH rate was 82% (p=0.008 x2 test). Fatty infiltration of the infraspinatus >2 was significantly associated with a lower rate of TH (p=0.007). At 3 months postoperatively 22 out of 216 patients presented rotator cuff re-tear (10 %). At 6 months 10 patients added still (32 out of 216) and the percentage of re-tear was 4.6%. At 12 and 24 months and the last FU postoperatively there were only one patient with a re-torn rotator cuff. Injections of corticoids pre- and postoperatively seem to have no effect in re-tear appearance (Spearman rho=-0.076, p=0.270 and Spearman rho=0.079, p=0.251, respectively). On the other hand older patients (>61 years old) had more re-tears than younger patients (p=0.001). There was no statistical significance difference in re-tears between men and women (p=0.423). Factors as diabetes, hypertensive, cardiac diseases, smokers had no effect on rate of re-tear (p=0.825, p=0.873, p=0.133, p=0.825, respectively). Two-third of the re-tears occur before 3 months postoperatively. The hypothesis is confirmed.

Prevalence of rotator cuff tears in adults with traumatic brachial plexus injuries.

Restoration of shoulder function is a primary goal when treating patients with traumatic brachial plexus injury. A concomitant rotator cuff tear may alter the treatment approach and prognosis for these individuals. The purpose of this study was to define the prevalence of rotator cuff tears in patients with traumatic brachial plexus injuries. This is a retrospective review of 280 adult patients with traumatic brachial plexus injury treated at a single institution over a twelve-year period. An upper-extremity magnetic resonance imaging (MRI) scan was acquired for all patients as part of the initial evaluation for posttraumatic brachial plexus injury. The radiographic and clinical data on these patients were reviewed to document partial or full-thickness rotator cuff tears, mechanism and location of the brachial plexus injury, and age. Twenty-three patients (8.2%) had a full-thickness rotator cuff tear: one patient had tears involving three tendons, eight patients had tears involving two tendons, twelve patients had a single-tendon tear, one patient had a single-tendon tear in each shoulder, and one patient had a single-tendon tear in one shoulder and a two-tendon tear in the other. Twenty-one tears involved the supraspinatus, eight involved the infraspinatus, and seven involved the subscapularis. Thirteen patients underwent surgical repair of the rotator cuff. The average age of the patients in this cohort was 33.4 years, and older age was associated with an increased risk of full-thickness rotator cuff tears (odds ratio [OR], 1.06 per year). Patients with infraclavicular brachial plexus injury had a significantly higher rate of full-thickness rotator cuff tears. Concomitant rotator cuff tears are present in approximately one in ten patients with traumatic brachial plexus injury. These injuries may contribute to shoulder dysfunction; therefore, evaluation of the rotator cuff with imaging studies is appropriate when formulating treatment strategies. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Complications After Arthroscopic Revision Rotator Cuff Repair

The purpose of this study was to determine the complication rate of arthroscopic revision rotator cuff repair (ARRCR). The retrospective review included 94 patients who underwent ARRCR performed by the 2 senior authors between January 2000 and June 2009 (mean age, 52 years; age range, 44 to 72 years). Sixty-four patients underwent 1 revision rotator cuff repair, 23 patients underwent 2 revisions, and 7 patients underwent 3 or more revisions. The rotator cuff tear at the time of the revision was characterized as massive (>5 cm) in 51 patients (54%), large (>3 to 5 cm) in 14 patients (15%), medium (1 to 3 cm) in 17 patients (18%), and small (<1 cm) in 12 patients (13%). There was a single-tendon tear in 12 patients (13%), 2 tears in 31 patients (33%), and 3 or 4 tears in 51 patients (54%). Additional procedures included revision acromioplasty (n= 66), distal clavicular excision (n= 19), biceps tenodesis (n= 52), suprascapular nerve release (n= 14), and loose anchor removal (n= 6). Complications developed in 19 patients (20.2%) within 1 year of undergoing ARRCR. The complications included failure to heal (10.6%, n= 10), stiffness (7.4%, n= 7), infection (2.1%, n= 2), and nerve injury (1.1%, n= 1). A direct correlation was found between the complication rate and the number of revision surgeries: 14% after 1 revision, 17.4% after 2 revisions, 33% after 3 revisions, and 50% after 4 or more revisions. The minimum follow-up of all the patients in this study was 1 year. We continued to follow up every patient who was diagnosed with complications during this year until resolution of the complication, or we are still continuing to perform follow-up of these patients. The complication rate after ARRCR is about twice the published rate for primary rotator cuff repair. There is a direct correlation between the complication rate and the number of revision surgeries. The most common complication recognized was failure to heal because of poor tissue quality. Level IV, therapeutic case series.

Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II–prognostic factors for clinical and radiographic outcomes

A rotator cuff registry was established to prospectively evaluate the effectiveness of all-arthroscopic repairs. The purpose of this study is to report prognostic factors for successful clinical and radiographic outcomes at 5 years. One-hundred ninety-three patients underwent all-arthroscopic rotator cuff repairs. Pre- and intraoperative data were compared to the American Shoulder and Elbow Surgeon (ASES) score, range of motion, muscle strength, and ultrasound results at 5 years using univariate, and multivariate analyses. At 5 years, 106 patients completed follow-up. There were no pre- or intraoperative variables that were predictive of an ASES score >90. Factors predictive of a radiographic defect were larger size of the lesion (OR 1.72, 95% CI 1.04-2.85, P = .03), multiple tendon involvement (OR 5.56, 95% CI 1.23-25.22, P= .02), older age (OR 1.15, 95% CI 1.04-1.28, P = .01), concomitant biceps (OR 16.16, 95% CI 3.01-86.65, P = .001), and acromioclavicular joint procedures (OR 6.70, 95% CI 1.46-30.73, P = .01). Radiographic healing did not correspond to clinical outcomes. Resolution of a radiographic defect was seen in 14 patients. Younger age (OR 0.84, 95% CI 0.74-0.95, P = .004) and single-tendon tears (OR 7.59, 95% CI 1.71-84.45, P = .04) were predictive. Larger tears in older patients who undergo concomitant procedures are predictive of radiographic defects at 5 years; however, radiographic healing did not correspond to clinical results. Younger patients with single tendon tears are more likely to undergo spontaneous resolution of a radiographic defect. This information can be useful in counseling patients regarding the mid-term results of this procedure.

The influence of age, delay of repair, and tendon involvement in acute rotator cuff tears

Background and purpose Few authors have considered the outcome after acute traumatic rotator cuff tears in previously asymptomatic patients. We investigated whether delay of surgery, age at repair, and the number of cuff tendons involved affect the structural and clinical outcome.Patients and methods 42 patients with pseudoparalysis after trauma and no previous history of shoulder symptoms were included. A full-thickness tear in at least 1 of the rotator cuff tendons was diagnosed in all patients. Mean time to surgery was 38 (6–91) days. Follow-up at a mean of 39 (12–108) months after surgery included ultrasound, plain radiographs, Constant-Murley score, DASH score, and western Ontario rotator cuff (WORC) score.Results At follow-up, 4 patients had a full-thickness tear and 9 had a partial-thickness tear in the repaired shoulder. No correlation between the structural or clinical outcome and the time to repair within 3 months was found. The patients with a tendon defect at follow-up had a statistically significantly lower Constant-Murley score and WORC index in the injured shoulder and were significantly older than those with intact tendons. The outcomes were similar irrespective of the number of tendons repaired.Interpretation A delay of 3 months to repair had no effect on outcome. The patients with cuff defects at follow-up were older and they had a worse clinical outcome. Multi-tendon injury did not generate worse outcomes than single-tendon tears at follow-up.

Factors Affecting Healing Rates after Arthroscopic Double-Row Rotator Cuff Repair

Background Double-row arthroscopic rotator cuff repairs were developed to improve initial biomechanical strength of repairs to improve healing rates. Despite biomechanical improvements, failure of healing remains a clinical problem. Purpose To evaluate the anatomical results after double-row arthroscopic rotator cuff repair with ultrasound to determine postoperative repair integrity and the effect of various factors on tendon healing. Study Design Case series; Level of evidence, 4. Methods Forty-eight patients (49 shoulders) who had a complete arthroscopic rotator cuff repair (double-row technique) were evaluated with ultrasound at a minimum of 6 months after surgery. Outcome was evaluated at a minimum of 1-year follow-up with standardized history and physical examination, visual analog scale for pain, active forward elevation, and preoperative and postoperative shoulder scores according to the system of the American Shoulder and Elbow Surgeons and the Simple Shoulder Test. Quantitative strength was measured postoperatively. Results Ultrasound and physical examinations were performed at a minimum of 6 months after surgery (mean, 16 months; range, 6 to 36 months) and outcome questionnaire evaluations at a minimum of 12 months after surgery (mean, 29 months; range, 12 to 55 months). Of 49 repairs, 25 (51%) were healed. Healing rates were 67% in single-tendon tears (16 of 24 shoulders) and 36% in multitendon tears (9 of 25 shoulders). Older age and longer duration of follow-up were correlated with poorer tendon healing (P < .03). Visual analog scale for pain, active forward elevation, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores all had significant improvement from baseline after repair (P < .0001). Conclusion Increased age and longer duration of follow-up were associated with lower healing rates after double-row rotator cuff repair. The biological limitation at the repair site, as reflected by the effects of age on healing, appears to be the most important factor influencing tendon healing, even after maximizing repair biomechanical strength with a double-row construct.

Repair integrity and clinical outcome after arthroscopic rotator cuff repair using single-row anchor fixation: A prospective study of single-tendon and two-tendon tears

This prospective study determined whether single-row anchor fixation would reliably improve clinical outcome and maintain structural integrity after arthroscopic repair of single-tendon and 2-tendon rotator cuff tears. In 39 patients, 21 shoulders had single-tendon tears and 18 had 2-tendon tears. Mean follow-up was 38 months (minimum, 24 months). A standardized assessment was done preoperatively and postoperatively at yearly intervals. Postoperative magnetic resonance imaging (MRI) was performed at a minimum 1-year follow-up. Mean forward elevation, pain, satisfaction, and American Shoulder and Elbow Surgeons scores significantly improved for both groups (P < .01). Postoperative MRI examinations showed 19 cuffs (90%) were intact for single-tendon tears and 15 (83%) were intact for 2-tendon tears. A recurrent tear on postoperative MRI was significantly correlated with the intraoperative finding of asymmetric retraction. Arthroscopic rotator cuff repair using single-row anchor fixation resulted in significant improvements in clinical outcome and reliable repair integrity for both single-tendon and 2-tendon tears.

Assessment of the canine model of rotator cuff injury and repair

Animal shoulder models are used to systematically investigate the factors influencing rotator cuff injury and repair. Each model has advantages and disadvantages that must be considered in the context of the specific research questions being asked. This study evaluated the utility of the canine model for studies of acute, full-thickness rotator cuff tendon injury and repair. We found that time-zero failure load is dependent on the suture type and configuration used for repair. Acute, full-width tendon repairs fail anatomically within the first days after surgery in the canine model, regardless of suture type, suture configuration, or postoperative protocol. Robust scar tissue forms in the gap between the failed tendon end and the humerus, which can be visually, mechanically, and histologically misconstrued as tendon if an objective test of repair connectivity is not performed. We conclude that a full-width injury and repair model in the canine will provide a rigorous test of whether a new repair strategy or postoperative protocol, such as casting or temporary muscle paralysis, can maintain repair integrity in a high-load environment. Alternatively, a partial-width tendon injury model allows loads to be shared between the tendon repair and the remaining intact portion of the infraspinatus tendon and prohibits complete tendon retraction. Thus a partial-width injury in the canine may model the mechanical environment of many single tendon tears in the human injury condition and warrants further investigation.

SINGLE-TENDON TEARS OF THE ROTATOR CUFF: Evaluation and Treatment of Subscapularis Tears and Principles of Treatment for Supraspinatus Tears

Successful surgical treatment of single-tendon tears, which involve the supraspinatus or the subscapularis requires careful attention to technical details. In supraspinatus tears, careful mobilization and secure repair of the tendon will usually give a good outcome. In subscapularis tears, the diagnosis is not difficult if one carefully evaluates the patient for the classic pathognomonic findings of such a tear. If the tear is confirmed by CT or MR imaging and an acute repair is performed, the outcome is usually satisfactory.