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PubMed2001

Arthroscopic repair of partial-thickness tears of the rotator cuff.

Management of partial-thickness tears of the rotator cuff should include consideration of tear size, tear depth, patient age and activity level, and tear etiology. We present an arthroscopic technique for repair of articular surface partial-thickness tears that may promote healing by closing the tendon side-to-side, placing the debrided tendon end in contact with an abraded humeral surface. By repairing selected partial-thickness tears, progression of the tear and the need for subsequent repair may be prevented. Our preliminary results in 28 patients are encouraging and suggest that this technique is a useful adjunct to tendon debridement for articular surface partial-thickness tears of the rotator cuff.

Arthroscopy↗

PubMedDate not supplied

Fibrous cartilage in the rotator cuff: A pathogenetic mechanism of tendon tear?

There is no consensus on the pathogenesis of rotator cuff tears. Fibrous cartilage has been hypothesized to develop in some tendons as a result of shear or compressive forces, resulting in a tissue less capable of resisting normal tensile load and more prone to tearing. To test the hypothesis that metaplastic fibrocartilage in the rotator cuff could be involved in the pathogenic mechanism of its tear, samples from 34 acute and chronic torn rotator cuffs were subjected to histologic and immunohistologic study for the presence and type of cartilage (hyaline, fibrous, or elastic) in the area of the lesion and surrounding tissues. Detection of type I and II collagen, S-100 protein, and chondroitin sulfate allowed areas of fibrous cartilage to be seen in all samples, suggesting that the characteristic of rotator cuff tendons to work both in tension and in compression may stimulate fibrocartilaginous metaplasia and lead to a complete tear.

Adult↗

PubMed2005

Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears.

BACKGROUND: This prospective multi-institutional study was designed to define the accuracy of ultrasonography, when performed in an orthopaedic surgeon's office, for the diagnosis of rotator cuff tears. METHODS: An anatomic diagnosis and a treatment plan were made on the basis of office-based shoulder ultrasonography, physical examination, and radiographs for ninety-eight patients (ninety-nine shoulders) with a clinical diagnosis of a rotator-cuff-related problem. The results of the ultrasonographic studies were then compared with the results of magnetic resonance imaging and the operative findings. RESULTS: Office-based ultrasonography led to the correct diagnosis for thirty-seven (88%) of forty-two shoulders with a full-thickness rotator cuff tear or both full and partial-thickness tears, twenty-six (70%) of thirty-seven shoulders with a partial-thickness rotator cuff tear only, and sixteen (80%) of twenty shoulders with normal tendons. In no case was the surgical approach (open or arthroscopic) that had been planned on the basis of the ultrasonography altered by the operative findings, but the operative finding of a full-thickness tear resulted in an arthroscopic cuff repair in four shoulders. Magnetic resonance imaging led to the correct diagnosis for forty (95%) of forty-two shoulders with a full-thickness rotator cuff tear or both full and partial-thickness rotator cuff tears, twenty-seven (73%) of thirty-seven shoulders with only a partial-thickness tear, and fifteen (75%) of twenty shoulders with normal tendons. There were no significant differences between magnetic resonance imaging and ultrasonography with regard to the correct identification of a full-thickness tear or its size. The sensitivity of ultrasonography for detecting tear size in the anterior-posterior dimension was 86% (95% confidence interval, 71% to 95%), and that of magnetic resonance imaging was 93% (95% confidence interval, 81% to 99%) (p = 0.26). The sensitivity of ultrasonography for detecting tear size in the medial-lateral dimension was 83% (95% confidence interval, 69% to 93%), and that of magnetic resonance imaging was 88% (95% confidence interval, 74% to 96%) (p = 0.41). CONCLUSIONS: A well-trained office staff and an experienced orthopaedic surgeon can effectively utilize ultrasonography, in conjunction with clinical examination and a review of shoulder radiographs, to accurately diagnose the extent of rotator cuff tears in patients suspected of having such tears. Errors in diagnosis made on the basis of ultrasonography most often consist of an inability to distinguish between partial and full-thickness tears that are approximately 1 cm in size. In this study, such errors did not significantly affect the planned surgical approach.

Arthroscopy↗

PubMed2006

Arthroscopic rotator cuff debridement in patients with rheumatoid arthritis.

There is little information available concerning the results of rotator cuff debridement in patients with rheumatoid arthritis (RA). We performed a review of 16 shoulders with underlying RA that underwent arthroscopic rotator cuff tear debridement; there were 10 full-thickness tears and 6 partial-thickness tears. Of the 10 patients with full-thickness rotator cuff tears, 8 had unsatisfactory results, whereas none of the patients with partial-thickness tears had unsatisfactory results. Pain was improved in 5 of 6 shoulders with partial-thickness cuff tears, whereas only 5 of 10 with full-thickness tears had an improvement with regard to pain. Motion did not improve in either group. Patients with RA who require operative intervention for pain relief because of rotator cuff tearing can be treated successfully with debridement alone. However, pain relief was less predictable with large or massive tears when compared with partial-thickness tears, and functional gains were not achieved in either group.

Adult↗

PubMed1994

Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff.

Thirty-three patients (35 full-thickness rotator cuff tears) who underwent arthroscopically assisted mini open repair between June 1987 and January 1990 were evaluated for shoulder function and cuff integrity. The study population was composed of 19 women and 14 men with an average age of 63 years (range 35-76) and an average follow-up of 3.7 years (range 2.5-5.1). Functional results were obtained using the UCLA Shoulder Rating Scale. Integrity of the rotator cuff was established by shoulder arthrography at a minimum 2 years postoperatively. UCLA Shoulder Rating Scale showed 86% good/excellent results with 92% patient satisfaction. The shoulder arthrography showed 12 (34%) full-thickness tears, seven (20%) partial tears, and 16 (46%) no tears. The size of the arthrographic defect correlated well with the size of the intraoperative tear. Seventy percent of the large tears had follow-up full-thickness defects and 80% of the small tears had no defect. Eighty percent and 88% good/excellent functional results were achieved in patients with full-thickness defects and no defects, respectively, without significant differences. The size of the tear at the time of the repair is a major determinant of the integrity of the cuff after repair. The integrity of the cuff at follow-up does not determine the functional outcome of the operated shoulder.

Adult↗

PubMed2003

Rotator cuff repair. Long-term results.

OBJECTIVES: To evaluate the results of rotator cuff repair and to look for preoperative and/or intraoperative predictors of long-term outcomes. PATIENTS AND METHODS: All patients who underwent open rotator cuff repair surgery for a full-thickness tear between 1990 and 1996 and who were subsequently followed-up for at least 4 years were contacted. The surgical technique and postoperative rehabilitation program were standardized. We recorded factors potentially associated with outcomes (age, sex, dominant hand, pain, symptom duration, and active range-of-motion limitation). RESULTS: Of the 56 patients identified, 26 men and 24 women with a mean age of 58.52 years were included in the study. Mean symptom duration was 12 months (range, 3-48 months). Before surgery, mean active range of motion of the shoulder was 144.6 degrees for forward elevation, 135.2 degrees for abduction, and 39.4 degrees for lateral rotation with the elbow at the side. The size of the tear measured during surgery was 1-5 cm. Mean time to recovery of shoulder power (75% of the value before the tear) as assessed by the patients was 10 months. After a mean follow-up of 6 years, a significant reduction in pain was noted (from 2.18/3 to 0.98/3; P < 0.001), although two-thirds of the patients reported occasional pain. Six patients were dissatisfied. Range of motion had improved in one-fourth of the patients. Constant's score after surgery was 65/100. Persistent difficulty in taking objects down from high shelves was noted. None of the preoperative or intraoperative factors studied predicted the long-term outcomes. CONCLUSION: In this series of patients, rotator cuff repair reduced pain severity. Nearly a year was needed to achieve the final result. Only a minority of patients experienced an improvement in range of motion.

Adult↗

PubMed1992

Rotator cuff tears. Results of surgical repair.

A prospective study was done on 73 patients who underwent surgical repair of a rotator cuff tear. The patients were divided into four groups according to the active shoulder flexion and the trophism of the rotator cuff muscles: group A--range of motion > 100 degrees; group B--ROM 60-100 degrees; group C--ROM < 60 degrees; group D--ROM < 100 degrees and significant muscle hypotrophy. The rotator cuff tears were classified into four groups at surgery according to size: grade I measured < 2 cm; grade II measured 2-4 cm, grade III measured > 4 cm but was reparable; and grade IV was irreparable. The results were evaluated after an average follow-up of 2.3 years and correlated to several factors including the preoperative clinical assessment, the size of the lesion, the type of lesion (tear or detachment), and the mechanism of injury (traumatic or atraumatic). Seventy-three percent of the cases had satisfactory results. The preoperative clinical assessment and the size of the tear were the most important indicators of the final outcome. The proportion of satisfactory results underwent a progressive decline from group A (88%) to group D (14%) and from grades I and II (88% and 89%, respectively) to grade III (56%) and grade IV (none). Rotator cuff repair is almost always successful in patients with more than 60 degrees of active arm flexion and either small or medium-size tears. Less than two-thirds of the patients with major tears and less than 60 degrees of motion achieve satisfactory results. Failure is highly probable in irreparable tears and in the presence of significant hypotrophy of the rotator cuff muscles.

Adult↗

PubMed2004

Arthroscopic rotator cuff repair: 4- to 10-year results.

PURPOSE: The purpose of this article is to report the 4- to 10-year results of arthroscopic repair of full- thickness rotator cuff tears. TYPE OF STUDY: This is a retrospective study evaluating a series of arthroscopic rotator cuff repairs performed by a single surgeon from February 1990 to February 1996. METHODS: Retrospective chart reviews and telephone interviews were performed to evaluate the results of arthroscopic repair of rotator cuff tears. Results were evaluated using a modified University of California, Los Angeles (UCLA), shoulder scoring system. RESULTS: One-hundred five arthroscopic rotator cuff repairs were performed in 104 patients between February 1990 and February 1996. Of these, 95 patients (96 shoulders) were available for follow-up evaluation at the time of this review. The mean UCLA score of all shoulders involved was 32. Fifty-one patients showed excellent results; 39, good; 2, fair; and 4, poor according to the modified UCLA scoring system. In no case was any loss of motion noted as a result of the surgical intervention. CONCLUSIONS: This retrospective study is the largest series of arthroscopic rotator cuff repairs with the longest period of follow-up thus far reported. Of the patients available for follow-up evaluation, 94% of patients qualified as a good to excellent result according to the UCLA shoulder scoring system. This study shows that patients treated with this arthroscopic rotator cuff repair technique have maintained excellent clinical outcomes 4 to 10 years after surgery. LEVEL OF EVIDENCE: Level IV.

Adult↗

PubMed1989

Rotator cuff tears: prospective comparison of MR imaging with arthrography, sonography, and surgery.

Thirty-eight patients with suspected rotator cuff tears were examined at 1.5 T by using a loop-gap resonator surface coil. The MR findings were compared prospectively in a blinded fashion with the results from double-contrast arthrography in all 38 patients, high-resolution sonography in 23 patients, and surgery in 16 patients. In the total group of 38 patients, MR imaging detected 22 of 22 tears and 14 of 16 intact cuffs as determined by arthrography. In the 16 surgically proved cases, MR and arthrography showed identical results, with 92% sensitivity in the diagnosis of 12 tears and 100% specificity in the diagnosis of four intact cuffs. In a subgroup of 23 patients, sonography detected nine of 15 tears and seven of eight intact cuffs as determined by comparison with arthrography. In 10 surgically proved cases, sonography was 63% sensitive in the diagnosis of eight rotator cuff tears and 50% specific in the diagnosis of two intact cuffs. For the diagnosis of rotator cuff tears, MR imaging is comparable to arthrography in both sensitivity and specificity. In this study, sonography was not as accurate in the diagnosis of rotator cuff tears as were the other two techniques. These results suggest that MR imaging should be considered the noninvasive test of choice for patients with suspected rotator cuff disease.

Arthrography↗

PubMed2002

[Usefulness of ultrasonography in the diagnosis of rotator cuff tears].

UNLABELLED: The purpose of this study was to determine the diagnostic performance of high-resolution ultrasonography compared with arthroscopy examination for the detection and characterization of rotator cuff tears. 31 patients with shoulder pain who had undergone preoperative ultrasonography and subsequent arthroscopy were identified. RESULTS: Ultrasonography for full-thickness rotator cuff tears has sensitivity of 80%, specificity of 100%, PPV of 100%, NPV of 82%. Ultrasonography for partial-thickness rotator cuff tears has sensitivity of 78.5%, specificity of 82%, PPV of 85%, NPV of 75%. CONCLUSION: Ultrasonography was highly accurate for detecting full-thickness rotator cuff tears; it was less sensitive and specific for detecting partial-thickness rotator cuff tears. Because of its low cost ultrasonography could be the first diagnostic tool for the rotator cuff tears.

Arthroscopy↗

PubMed2006

Rotator cuff repair using an acellular dermal matrix graft: an in vivo study in a canine model.

PURPOSE: Large rotator cuff tears present a challenge to orthopaedic surgeons. Because tissue may be insufficient or of inadequate quality to undergo repair, a variety of materials have been used as adjuncts. Human dermal tissue may be processed to render it acellular, and thus less immunogenic, but with the extracellular matrix left intact, creating a collagen scaffold with favorable characteristics. Because of these traits, use in rotator cuff repair was proposed. METHODS: A canine model for a full-thickness infraspinatus tendon tear was used. Tendon was excised from the bony interface to the myotendinous junction, and a human acellular dermal matrix graft (experimental) or the autologous excised tendon (control) was used to bridge the defect. Animals were sacrificed, and shoulders were evaluated histologically and biomechanically. RESULTS: At time 0, strength of control and experimental repairs was similar. At 6 weeks, the strength of the experimental repair was half that of the control side. Strength of control specimens remained the same at 6 and 12 weeks, but by 12 weeks, the strength of the experimental repair was equal to that of the control. Histologically, cells infiltrated the control and experimental specimens by 6 weeks; chronic inflammation was consistent with surgery and repair. At 6 months, control and experimental specimens mimicked normal tendon structure grossly and histologically. CONCLUSIONS: Use of human acellular dermal matrix as a patch is a viable option in this model of large rotator cuff defects. Within 6 weeks, histologic evidence of native cell infiltration and neotendon development was observed. Within 12 weeks, the strength of the dermal matrix graft repair was equivalent to that of autologous tendon. At 6 months, control and graft specimens mimicked normal tendon structure grossly and histologically. CLINICAL RELEVANCE: This study provides in vivo animal data to support the use of this acellular dermal matrix graft for repair of full-thickness rotator cuff defects. Additional studies are indicated to determine the role of this material in the treatment of humans with rotator cuff tears.

Animals↗

PubMed2026

Open repairs with biceps rerouting does not impact retears in large to massive rotator cuff tears compared to conventional open repair: a randomized clinical trial.

BACKGROUND: The treatment of large to massive rotator cuff tears leads to a high failure rate and several techniques have been proposed to improve these results. Rerouting the long head of the biceps tendon (LHBT) appears to be a biological reinforcement to increase tendon healing. Therefore, this study aimed to compare the clinical and radiological outcomes of open repair for large and massive rotator cuff tears reinforced with the LHBT to conventional open repair. METHODS: A prospective randomized study was conducted with patients diagnosed with large to massive rotator posterosuperior rotator cuff tear and intact LHBT, randomized into 2 groups: biceps rerouting and conventional open repair. The functional outcomes were assessed by the American Shoulder and Elbow Surgeon score, University of California at Los Angeles score, and SF-12 questionnaire preoperatively and at 6, 12, and 24 months postoperatively. Pain level was also assessed by the visual analog scale including the first day and 2 weeks postoperatively. Structural outcomes were rotator cuff and LHBT healing with magnetic resonance imaging and acromiohumeral distance (AHD) through radiography. RESULTS: We evaluated 58 patients, 29 in each group. At the end of the follow-up there were no statistically significant differences between groups in American Shoulder and Elbow Surgeon (76.1 vs. 80.4, P = .761), University of California at Los Angeles (27.1 vs. 29.1, P = .634), or visual analog scale scores (1.3 vs. 1.1, P = .781). Additionally, rotator cuff healing rates (48.3% vs. 44.8%, P = .402) and LHBT healing rates (79.3% vs. 82.7%, P = .738) were similar. AHD increased in both groups, with no significant difference in delta AHD (P = .513). Both groups showed significant clinical improvement over time in all evaluated outcomes (P < 0,01). No postoperative complications were reported. CONCLUSIONS: We could not identify an advantage of open repair with LHBT rerouting as reinforcement over conventional open repair. Nonetheless, all clinical scores improved at the end of the 24 months of follow-up in both groups.

Humans↗

PubMed1987

Ruptures of the rotator cuff.

Tears of the rotator cuff are a common entity. These tears frequently require surgical decompression and reconstruction. A number of options are available, depending on the quality of the tissues and one's ability to close the tear directly. Fortunately, in almost all cases direct closure of the cuff is possible after decompression. Early postoperative passive motion is useful in hastening recovery. Resistive exercises should be avoided early in the rehabilitation period.

Acute Disease↗

PubMed2005

Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings.

OBJECTIVE: Our goal in this study was to evaluate by means of MRI the clinical significance of tendon integrity, muscle fatty degeneration, and muscle atrophy in surgically repaired massive rotator cuff tears and to correlate these and other prognostic factors with intraoperative and clinical findings. MATERIALS AND METHODS: Twenty-eight surgically proven massive rotator cuff tears were retrospectively included in the study. Twenty-two patients underwent complete repair, and six patients underwent partial repair. Preoperative and postoperative clinical assessment was performed by using the University of California at Los Angeles score. Preoperative and postoperative MRI studies were evaluated for the presence and extent of rotator cuff tear and for the degree of fatty degeneration and atrophy of the rotator cuff muscles. RESULTS: At a mean 44.4 months' follow-up, 20 patients (71.4%) had a favorable result. A total of 25 patients (89.2%) showed postoperative full-thickness rotator cuff tear, 19 of which were reruptures. A sagittal preoperative rotator cuff tear of less than or equal to 34 mm showed a specificity of 100% for predicting a favorable outcome. A coronal postoperative rotator cuff tear of less than or equal to 34 mm showed a specificity of 85.7% and a positive predictive value of 92.9% for predicting a favorable outcome. A postoperative fatty degeneration of infraspinatus muscle less than or equal to 2 had a specificity of 87.5% and a positive predictive value of 90.9% for predicting a favorable outcome. CONCLUSION: Open repair of massive rotator cuff tears may reach a favorable outcome in a significant proportion of patients, despite a high rate of recurrent or residual tears. Oblique coronal sizes of the recurrent or residual tear of less than or equal to 34 mm and postoperative fatty degenerations of infraspinatus muscle of less than or equal to 2 may allow a favorable outcome.

Adipose Tissue↗

PubMed1986

Chronic rotator cuff tears.

The treatment of chronic rotator cuff tears is a controversial topic. Proponents of conservative therapy cite cadaver studies and postulate that with time the inflammatory reaction will subside and that although the structural integrity of the cuff may not be completely intact, the patient will nevertheless have an excellent functional result. On the other hand, operative intervention proponents contend that better mechanical advantage to shoulder motion will be present with an intact rotator cuff and that excision of necrotic tissue will alleviate impingement and pain. This paper is an overview of the topic and discusses some of the treatment modalities.

Humans↗

PubMed2007

Indications for rotator cuff repair: a systematic review.

Despite the popularity of surgical repair of rotator cuff tears, literature regarding the indications for and timing of surgery are sparse. We performed a systematic review of the literature to investigate factors influencing the decision to surgically repair symptomatic, full-thickness rotator cuff tears. Specifically, how do demographic variables, duration of symptoms, timing of surgery, physical examination findings, and size of tear affect treatment outcome and indications for surgery? We reviewed the best available evidence, which offers some guidelines for surgical decision making. Variables suggest earlier surgical intervention may be needed in the setting of weakness and substantial functional disability. With regard to demographic variables, the evidence is unclear regarding their association with treatment outcome. However, older chronological age does not seem to portend a worse outcome. Pending worker's compensation claims does seem to negatively affect treatment results. Further research is required to define the indications for surgery for full thickness rotator cuff tears. However, the design and conduct of an ethical study to obtain Level I evidence on this issue will be a major challenge.

Age Factors↗

PubMed2002

[2D-SPLASH spectroscopy to determine the fat/water ratio in the muscle of the rotator cuff].

AIM: The degree of fatty infiltration of the rotator cuff is an important factor for the prognosis of an operative reconstruction afterrotator cuff tear. The aim of this work was to develop a method using a clinical MR scanner that allows the quantification of the fat/water ratio with the necessary spatial resolution. METHOD: A SPLASH sequence consisting of 19 complex 2D-FLASH images was implemented on a clinical 1.5 T MR scanner. The echo time was gradually increased from 5.0 ms to 50.0 ms. A spatial in plane resolution of 1.17 mm, a spectral resolution of 0.33 ppm and a spectral width of 6.25 ppm were achieved in a total acquisition time of about 3 min. The quantitative evaluation of the spectra in arbitrarily shaped regions of interest (ROIs) was obtained using a home-built reconstruction program and the time domain fit program AMARES. RESULTS: Phantom studies show a linear relation of the concentration determined by SPLASH spectroscopy (r = 0.997). Because of the high spatial resolution and the possibility to evaluate arbitrarily shaped ROIs, the determination of the fat/water ratio in single muscles in the shoulder has been possible. CONCLUSIONS: By the use of the 2D-SPLASH sequence the degree of fatty infiltration in the rotator cuff can now be determined quantitatively for the first time.

Adipose Tissue↗

PubMedDate not supplied

[Tenoplasty of the long head of the biceps in massive rotator cuff tear].

AIM: It was the aim of this study to investigate the success of biceps tenoplasty in massive interval rotator cuff tears. METHOD: Fifteen patients, who had a massive rotator cuff tear in the area of the interval and a pathology of the long head of the biceps tendon, were examined clinically and by MRI. A primary reconstruction of the rotator cuff tear was possible in none of the patients. All patients had a secondary reconstruction with a biceps tenoplasty. The Constant Score was determined postoperatively and the satisfaction of the patients was explored. RESULTS: The mean age at the time of the operation was 55 years. The examination was 23 months postoperatively. A simultaneous rupture of the supraspinatus- and subscapularis tendon was seen in 12 patients, an additional rupture of the infraspinatus tendon in 3 patients intraoperatively. The long head of the biceps was dislocated in 10 patients and subluxated in 5 patients. The postoperative determined Constant Score was 82.7 points. The personal satisfaction was investigated by asking for the German schoolmarks, which extend from 1 (excellent) to 6 (not satisfactory). The preoperative schoolmark was 5.2 and the postoperative schoolmark 1.4. In the MRI examination one rerupture could be seen, an atrophy of the supraspinatus tendon was evaluated in four patients. Knowing the postoperative result, all patients would have repeated the operation. CONCLUSION: The biceps tenoplasty is a suitable operative method to achieve a better function and relief of pain in massive interval rotator cuff tears with simultaneous pathology of the long head of the biceps tendon. A high degree of personal satisfaction for the patient can be achieved.

Adult↗