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PubMed2005

Partial-thickness articular surface supraspinatus tears: a new transtendon suture technique.

The standard technique for repairing partial-thickness tears of the supraspinatus tendon includes completion of the lesion to a full-thickness tear. Partial articular-side supraspinatus tendon avulsions (PASTA) form a subgroup deserving special consideration. We present a transtendon suture technique that is able to preserve the intact tendon fibers and to achieve firm attachment of the tendon to the humeral footprint using 1 double-loaded bone anchor. The surgical technique is described in detail, and pitfalls and complications are noted. The clinical results of the first 22 consecutive patients are reported, showing an increase in the UCLA score from 17.1 to 31.2 points and a patient satisfaction rate of 91%.

Adult↗
PubMed2005

Arthroscopic rotator cuff repair: the learning curve.

PURPOSE: The purpose of this study was to answer the question: How many cases are required for a surgeon to become proficient in performing arthroscopic rotator cuff repair? We hypothesize that as surgical experienced is gained, learning can be quantitatively shown by a significant decrease in operative time. TYPE OF STUDY: Prospective case series. METHODS: Rotator cuff repair time (RCRT) in minutes (as well as other time components comprising total surgical time) was recorded for 100 consecutive patients having arthroscopic rotator cuff repair performed by a single surgeon beginning with his first case in private practice. Mean RCRTs for consecutive blocks of 10 cases were compared. Learning is graphically represented by plotting the RCRT by case number and generating a logarithmic trend curve. A best-fit linear equation (y = mx + b) allows comparison of the initial 10 cases with the subsequent 90 cases, where m , the slope, represents the rate of decrease in RCRT (learning). RESULTS: Mean RCRT decreased significantly (P < .05) from the first block of 10 cases to the second block of 10 cases. There were no significant changes in mean RCRT when comparing other consecutive blocks of 10 cases. The slope of the line fitting the first block of 10 cases is -8.75; the slope (m) of the line fitting the subsequent 90 cases is -0.23. There is no significant difference in mean RCRT when cases are stratified by tear size. CONCLUSIONS: Graphic representation of RCRT by case number generates a learning curve whereby learning is quantitatively shown as a significant decrease in operative time as surgical experience is gained. CLINICAL RELEVANCE: Qualification of the learning curve for arthroscopic rotator cuff repair provides a guide for orthopaedic surgeons contemplating the expected time line for acquiring proficiency in this technique.

Arthroscopy↗
PubMed2005

Open versus arthroscopic rotator cuff repair: a comparative view of 96 cases.

PURPOSE: This study was performed to review and compare the outcome of a consecutive series of 96 rotator cuff repairs performed with an open versus arthroscopic technique. The arthroscopic repairs include the beginning of the learning curve. TYPE OF STUDY: Case series. METHODS: In a 24-month period from 1999 to 2001, 95 patients underwent a cuff repair with bony reattachment by 1 surgeon; 4 patients had surgery on both shoulders. We present subjective outcome data from 96 of 99 operated shoulders by the use of a visual analog scale (VAS), the Simple Shoulder Test (SST), and the question of overall patient satisfaction. Thirty shoulders undergoing surgery before February 2000 had open cuff repair (12 classic open, 18 mini-open) and 66 shoulders undergoing surgery after February 2000 had an arthroscopic cuff repair with suture anchors. All but 3 shoulders had the supraspinatus/infraspinatus tendon refixed, 32% had a subscapularis reattachment, and 21% an additional SLAP repair. RESULTS: Groups A (30 shoulders, open repair) and B (66 shoulders, arthroscopic repair) were comparable concerning tear size, cause of the tear, professional shoulder strain, and preoperative pain intensity. At follow-up evaluation (15-40 months after surgery), group B had significantly better pain relief on the VAS (P < .05), more yes answers in the SST (9.7 vs. 8.7, not significant), and a higher patient satisfaction rate of 92.4% versus 80% (not significant). From the 12 questions of the SST, all but 1 showed a higher percentage of yes answers in group B; for 3 questions concerning mobility the difference was significant (P < .07). There was no correlation between tear size and outcome in the SST. CONCLUSIONS: Arthroscopic cuff repair yielded equal or better results than open repair, even at the beginning of the learning curve. Patients with an arthroscopic repair had a significantly better decrease in pain and a better functional result concerning mobility. Arthroscopic repair is successful for large and small tears. Biomechanically, large tears might even benefit more than small ones. LEVEL OF EVIDENCE: Level IV.

Adolescent↗
PubMed2005

Cyclic loading of rotator cuff repairs: an in vitro biomechanical comparison of bioabsorbable tacks with transosseous sutures.

PURPOSE: This study compares rotator cuff repair strength after cyclic loading of bioabsorbable tacks and traditional transosseous sutures, and correlates the results with bone density, age, and gender. The hypotheses were that tack repair strength would be inferior to transosseous sutures and that repair strength would be directly related to bone quality. TYPE OF STUDY: In vitro randomized biomechanical study. METHODS: Eight paired cadaveric shoulders with a standardized supraspinatus defect were randomized to tack or suture repair and subjected to step-wise cyclic loading. Repair migration was measured by quantifying the motion of markers affixed to tendon and bone using a digital camera. Failure mode, cycles, and load were measured for 50% and 100% loss of repair. Results were correlated with bone density, age, and gender. RESULTS: Tack repairs failed at the tack-tendon interface, whereas suture rupture was the mode of failure for the suture repairs. Mean values for 50% loss of repair were 206 +/- 88 cycles and 44 +/- 15 N for the sutures, and 1,193 +/- 252 cycles and 156 +/- 20 N for the tacks (P < .05). The corresponding values for 100% loss of repair were 2,458 +/- 379 cycles and 294 +/- 27 N for the sutures, and 2,292 +/- 333 cycles and 263 +/- 28 N for the tacks (P > .05). These results did not correlate with bone density, age, or gender. CONCLUSIONS: This study has shown that bioabsorbable tacks provide improved repair strength in comparison with traditional suture techniques. Repair strength did not correlate with bone quality, and this may be attributed to failure primarily through the repair construct or at the tack-tendon interface and not through bone. This report describes a new high-resolution optical method of measuring tendon repair strength that should be a useful model for future studies. CLINICAL RELEVANCE: This study demonstrates the biomechanical advantages of a sutureless tack device for rotator cuff repair compared with a traditional augmented suture repair technique.

Absorbable Implants↗
PubMed2005

Arthroscopic side-to-side rotator cuff repair.

PURPOSE: To study the results of arthroscopic repair of full-thickness rotator cuff tears using a side-to-side suture technique without fixation to bone. TYPE OF STUDY: Case series study of the long-term results of patients who underwent purely arthroscopic rotator cuff repair with a side-to-side suturing technique. METHODS: A retrospective review was performed of patients who underwent arthroscopic repair of full-thickness rotator cuff defects. Patients with full-thickness rotator cuff tears repaired in a side-to-side fashion without anchoring the repair to bone were selected. Patients were evaluated using a modified UCLA shoulder scoring system. The data collected were analyzed to determine the outcome in patients with a 4- to 10-year follow-up. RESULTS: A total of 105 arthroscopic rotator cuff repairs were performed in 104 patients between February 1990 and February 1996. Forty-two patients had a full-thickness tear of the rotator cuff that was repaired using a purely side-to-side suturing technique. The mean UCLA score of all patients in this group was 33; 23 patients reported excellent results, 18 good results, and 1 poor result according to the UCLA scoring system. CONCLUSIONS: In this series, 98% of patients qualified as a good to excellent result according to the UCLA shoulder score. This study shows that patients with a full-thickness defect of the rotator cuff tendon with anatomy amenable to side-to-side closure may be effectively treated with a purely arthroscopic repair using only a side-to-side suturing technique with excellent long-term clinical results. LEVEL OF EVIDENCE: Level IV.

Arthroscopy↗
PubMed2005

Rotator interval closure after arthroscopic capsulolabral repair: a technical variation.

Rotator interval tear is one of the lesions identified in patients with glenohumeral instability. We present our technique for arthroscopic interval capsule repair. After having performed Bankart reconstruction, we pull the anterosuperior cannula back some millimeters and introduce a Penetrator suture retriever forceps (Arthrex, Naples, FL) through the upper interval capsule into the joint. Then we also remove some millimeters of the anterior cannula and introduce a suture passer (Spectrum; Linvatec, Largo, FL) loaded with a monofilament suture through the lower interval capsule. The suture is pushed into the joint and, using the Penetrator suture retriever forceps, we retrieve it out of the joint. This suture is replaced if desired by a permanent braided suture. Next, a suture passer (Arthrex) advances the end of the suture from the anterosuperior portal into the joint. The suture is retrieved out of the joint from the anterior cannula with a crochet hook. We tie the suture down the anterior cannula to close the anterior capsule. Because we use cannulas, we can use a sliding knot. The degree of tightening can be observed directly under arthroscopic view but the knot is outside of the capsule. We believe that this method is easy, effective, and reproducible.

Arthroscopy↗
PubMed2005

A comparison of arthroscopic and open rotator cuff repair.

PURPOSE: The purpose of this study was to compare the results of all-arthroscopic repair of full-thickness rotator cuff tears including massive tear with those of open repair. TYPE OF STUDY: Nonrandomized control study. METHODS: We evaluated 100 consecutive patients (100 shoulders) who were treated for full-thickness rotator cuff tears either by all-arthroscopic (50 patients) or open repair (50 patients). The mean age was 57 years (range, 24 to 78 years). The mean follow-up period was 49 months (range, 25 to 83 months). Of all the patients, 7 had a small tear, 63 a medium tear, 17 a large tear, and 13 a massive tear; in the arthroscopic group, 5 had a small tear, 28 a medium tear, 9 a large tear, and 8 a massive tear. The results of the arthroscopic and open groups were compared using the shoulder rating scale of the University of California at Los Angeles (UCLA) and the Japanese Orthopaedic Association (JOA). RESULTS: The 2 groups were statistically similar in terms of age, gender, trauma incidence, tear size, duration of symptoms, and preoperative shoulder scores. The UCLA and JOA scores improved significantly in both groups postoperatively. Outcomes and the postoperative UCLA and JOA scores were not significantly different between the 2 groups. The postoperative UCLA and JOA scores in patients with a large-to-massive tear were significantly lower than those with a small-to-medium tear, but outcomes were not statistically different between the arthroscopic and open groups depending on the tear size. The percentage of satisfactory results of arthroscopic and open repair for small-to-medium tears was 97.0% and 94.6%, respectively. Those of arthroscopic and open repair for large-to-massive tears was 82.4% and 76.9%, respectively. CONCLUSIONS: Arthroscopic repair of small-to-massive tears had outcomes equivalent to those of open repair. Outcomes in patients with large-to-massive tears were inferior to those in patients with small-to-medium tears, regardless of repair method. LEVEL OF EVIDENCE: Level III, case-control study.

Activities of Daily Living↗
PubMed2005

Proinflammatory cytokines and metalloproteases are expressed in the subacromial bursa in patients with rotator cuff disease.

PURPOSE: The pathophysiology of subacromial impingement syndrome is poorly understood. We investigated the expression of inflammatory cytokines, metalloproteases, and the cyclooxygenases in the subacromial bursa in control patients and in patients with rotator cuff tear. TYPE OF STUDY: Basic science evaluation. METHODS: Eighteen patients undergoing shoulder surgery had a subacromial bursa biopsy examination. Patients were divided into 2 groups. Group I (study group) had 10 patients with a full-thickness rotator cuff tear (RCT). Group II (control group) had 8 patients. Seven of 8 underwent shoulder arthroscopy with anterior capsular reconstruction for instability; 1 of 8 underwent open reduction internal fixation for acute proximal humerus fracture. None of the patients in group II had any history of symptoms or signs consistent with subacromial impingement. H&E and immunohistochemical antibody (MMP-1, MMP-9, IL-1, IL-6, TNF-alpha, COX-1, and COX-2) stained specimens were examined by 2 blinded observers using a histologic scale (grade 0 = no staining to grade 4 = intense staining). RESULTS: Histologic evidence of inflammation was present in all patients with RCT (group I). No or mild inflammation was noted in group II. The average staining grade for inflammatory cytokines (IL-1, IL-6, TNF-alpha) and proteinases (MMP-1 and MMP-9) was significantly more pronounced in the RCT group (P < .001). Cyclooxygenase enzymes (COX-1 and COX-2) were also increased in group II (P < .001). CONCLUSIONS: A high level of expression of inflammatory cytokines, proteinases, and cyclooxygenase enzymes, known to produce a catabolic environment, is present in the subacromial bursa of patients with rotator cuff tear. CLINICAL RELEVANCE: These findings support the role of nonsteroidal anti-inflammatory drugs and corticosteroids in RCT treatment, and emphasize the importance of subacromial bursectomy to reduce inflammation in RCT surgery.

Adrenal Cortex Hormones↗
PubMed2005

Relation between narrowed coracohumeral distance and subscapularis tears.

PURPOSE: To determine whether coracohumeral distance was significantly narrowed in the presence of a torn subscapularis. TYPE OF STUDY: Retrospective cohort study. METHODS: The coracohumeral distance of a consecutive series of patients (n = 35, 36 shoulders) requiring an arthroscopic repair of the subscapularis was compared with a control group (n = 35). The control group consisted of patients who underwent shoulder arthroscopy but who did not have any rotator cuff, subscapularis, or subcoracoid pathology. The coracohumeral distance was measured from the tip of the coracoid to the cortex of the proximal humerus on an axial cut of preoperative magnetic resonance imaging. A Student t test was used to determine the statistical differences between the 2 groups. RESULTS: The average coracohumeral distance in the subscapularis group was 5.0 +/- 1.7 mm and the average coracohumeral distance in the control group was 10.0 +/- 1.3 mm. Statistical analysis, using the Student t test, showed that the coracohumeral distance was significantly narrowed in the group of patients with a torn subscapularis. CONCLUSIONS: These results show a significant relationship between a narrowed coracohumeral distance and subscapularis pathology. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Aged↗
PubMed2005

Arthroscopic repair of rotator cuff tears associated with large bone cysts of the proximal humerus: compaction bone grafting technique.

Large bone cysts associated with symptomatic rotator cuff tears may pose significant treatment problems. Bone loss associated with these cysts or with implant removal in cases of revision rotator cuff surgery may be so large that secure suture anchor fixation cannot be achieved with traditional techniques. This report describes how to arthroscopically bone graft these defects with a compaction technique that creates a densely packed bone bed into which suture anchors can be securely placed.

Arthroscopy↗
PubMed2006

Long-term clinical and ultrasound evaluation after arthroscopic acromioplasty in patients with partial rotator cuff tears.

PURPOSE: Clinical and ultrasound evaluation of patients who had undergone debridement of a partial rotator cuff tear in conjunction with an arthroscopic acromioplasty. TYPE OF STUDY: Retrospective follow-up study. METHODS: Thirty-three consecutive patients were included in the study; 26 of the 33 (79%) patients underwent ultrasound evaluation of both shoulders and were examined by independent observers after a follow-up period of 101 months (range, 60 to 128 months; minimum, 5 years). RESULTS: The median time between onset of symptoms and surgery was 24 months (range, 6 to 360 months). At follow-up, the Constant score was 65 points (range, 15-98). The Constant score on the contralateral side was 84 points (range, 15-96; P < .0001). The strength in abduction was 4.7 kg (range, 1.2 to 11.1 kg) on the operated side and 5.1 kg (range, 1.8 to 10.4 kg) on the contralateral side (not significant). Twelve of the 26 patients reported discomfort or pain in the contralateral shoulder and during the follow-up period, and 3 of 26 had undergone an arthroscopic acromioplasty of the contralateral shoulder. Two of 26 patients underwent further surgery of the index shoulder during the follow-up period. The visual analogue score for pain for the index shoulder was 20 mm (range, 0 to 85). The ultrasound evaluation revealed that 9 of 26 patients had a full-thickness rotator cuff tear in the index shoulder and, of these, 3 of 9 were bilateral. CONCLUSIONS: It appears that an arthroscopic acromioplasty and rotator cuff debridement in patients with partial tears does not protect the rotator cuff from undergoing further degeneration. LEVEL OF EVIDENCE: Level IV.

Acromion↗
PubMed2005

Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation.

PURPOSE: The purpose of this study was to compare the functional as well as the structural outcomes of single-row and dual-row fixation after arthroscopic full-thickness rotator cuff repair. TYPE OF STUDY: Retrospective cohort study. METHODS: A consecutive series of 80 shoulders in 78 patients with full-thickness rotator cuff tears was evaluated using the rating scale of the University of California Los Angeles (UCLA) and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) at an average of 35 months (range, 24 to 60 months) after arthroscopic rotator cuff repair. Thirty-nine shoulders were repaired using the single-row technique and 41 shoulders using the dual-row technique. Postoperative cuff integrity was determined through magnetic resonance imaging and was classified into 5 categories: type I, sufficient thickness with homogenously low intensity; type II, sufficient thickness with partial high intensity; type III, insufficient thickness without discontinuity; type IV, presence of a minor discontinuity; type V, presence of a major discontinuity. RESULTS: The average UCLA score improved significantly to 32.4 in the single-row and to 33.1 in the dual-row group. The ASES shoulder index improved significantly to 93.0 in the single-row group and to 94.6 in the dual-row group. However, there was no statistical difference between the groups in the postoperative scores. Postoperative MRI revealed 11 type I, 6 type II, 12 type III, 4 type IV, and 6 type V in the single-row group, and 22 type I, 8 type II, 7 type III, 4 type IV, and no type V in the dual-row group. A statistical difference was observed between the groups (P < .01). CONCLUSIONS: Arthroscopic rotator cuff repair yielded successful functional outcomes without significant difference between single and dual-row fixation techniques. However, dual-row repairs excelled in structural outcome over the single-row technique. LEVEL OF EVIDENCE: Level III.

Adult↗
PubMed2005

Use of preoperative magnetic resonance imaging to predict rotator cuff tear pattern and method of repair.

PURPOSE: To determine the magnetic resonance imaging (MRI) criteria for predicting rotator cuff tear pattern and method of repair. TYPE OF STUDY: Retrospective MRI/arthroscopy correlation. METHODS: Sixty-six preoperative MRI scans were evaluated. The maximum medial to lateral length (L) of the tear was measured on T2-weighted coronal cuts. The maximum anterior to posterior width (W) was measured on T2-weighted sagittal cuts. The cases were divided into 3 groups: group 1, short-wide tears, L < or = W, L < 2 cm; group 2, long-narrow tears, L > W, W < 2 cm; and group 3, long-wide tears, L > or = 2 cm, W > or = 2 cm. RESULTS: Of the 66 MRI scans, 55 were adequate for standardized measurement. Group 1, 16 cases: 15 were found at arthroscopy to be crescent-shaped tears repaired end-to-bone; 1 was repaired with interval slides. Group 2, 22 cases: all 22 were repaired side-to-side/margin convergence. Group 3, 17 cases: 12 required interval slides, 1 partial repair was performed, and 4 were repaired side-to-side/margin convergence. CONCLUSIONS: Tear pattern and method of repair can be predicted on high-quality MRI scan. Group 1, L < or = W and L < 2 cm, predicts a crescent-shaped tear and end-to-bone repair (positive predictive value, 93.8%). Group 2, L > W and W < 2 cm, predicts a longitudinal tear and side-to-side/margin convergence repair (positive predictive value 100%). Group 3, L > or = 2 cm and W > or = 2 cm, predicts a massive contracted tear and that primary end-to-bone or side-to-side repairs are usually not possible and that interval slides or partial repair may be necessary (positive predictive value, 76.5%). The overall diagnostic model based on usable MRI scans significantly predicted arthroscopic findings (P < .001 for chi-square test). LEVEL OF EVIDENCE: Level III, development of diagnostic criteria with universally applied reference (nonconsecutive patients).

Adult↗
PubMed2005

Arthroscopic repair of full-thickness rotator cuff tears using bioabsorbable tacks.

PURPOSE: The purpose of this study was to evaluate the clinical results of bioabsorbable tacks (Suretac; Smith & Nephew Endoscopy, Mansfield, MA) for the arthroscopic repair of full-thickness rotator cuff tears. TYPE OF STUDY: Prospective case series. METHODS: A prospective clinical review was performed on 53 patients (38 men, 15 women) with full-thickness rotator cuff tears repaired arthroscopically using bioabsorbable tacks. Minimum follow-up was 24 months and patients were evaluated using preoperative and postoperative American Shoulder and Elbow Society (ASES) scores and Short-Form 36 Health Surveys (SF-36). A Constant and Murley score was performed at a minimum of 2 years postoperatively. RESULTS: The average patient age was 51 years (range, 23 to 74 years) and the average time for review was 29 months (range, 24 to 60 months). The average size of rotator cuff tears measured 2.5 cm (range, 1 to 5 cm) and an average of 2 Suretacs (range, 1 to 4) were used for the repair. Ten patients had tears larger than 3 cm and 5 patients had tears that measured 5 cm or larger. The average total score according to the ASES shoulder index improved from 33 to 85 points. The average score for pain improved from 6.9 to 1.3 points. The score for function improved from 11 to 25 points. These results were statistically significant (P < 0.01). There was a significant improvement in all components of the SF-36 survey. The average postoperative Constant score was 87 with the pain component measuring 12 points, range of movement 38 points, and power 21 points. CONCLUSIONS: Arthroscopic repair of full-thickness rotator cuff tears using bioabsorbable tacks produces satisfactory outcomes with regard to objective orthopaedic criteria as well as overall patient satisfaction in terms of pain relief and function. Arthroscopic rotator cuff repairs are technically demanding procedures. The use of tacks facilitates this procedure without any apparent deterioration in clinical results. LEVEL OF EVIDENCE: Level IV, case series.

Absorbable Implants↗
PubMed2006

Arthroscopic insertion of a biologic rotator cuff tissue augmentation after rotator cuff repair.

Tissue augmentation has been used to reinforce repairs of massive chronic rotator cuff tears. This report describes a new technique for arthroscopic insertion of a biologic rotator cuff tissue augmentation. Double-loaded suture anchors are needed for the technique. One suture is used for the rotator cuff repair and 1 suture is used for the tissue augmentation. The sutures for the tissue augmentation are left exiting through accessory portals. Two free sutures are then passed through the repaired rotator cuff, 1 anteromedially and 1 posteromedially via the anterior and posterior cannulae, respectively. One limb from each of these 4 sutures is retrieved through the lateral portal. Each of the 4 limbs exiting through the lateral portal are then passed through the corresponding corner of the tissue augmentation and Mulberry knots are tied in each suture limb, on top of the tissue augmentation. The suture limbs of the 4 sutures exiting through the anterior and posterior cannulae and accessory portals are pulled simultaneously to reduce the tissue augmentation down onto the repaired rotator cuff. A trocar is used to help push the tissue augmentation through the lateral cannula. The Mulberry knots from each of the sutures are sequentially retrieved and tied arthroscopically to secure the tissue augmentation.

Arthroscopy↗
PubMed2006

Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip.

PURPOSE: To compare a standard suture material with a newer material using multiple arthroscopic knot configurations and to evaluate the biomechanical performance of a new sliding-locking knot compared with 4 surgical standards. TYPE OF STUDY: Controlled laboratory study. METHODS: Five knots were evaluated (Weston, Tennessee, Duncan, SMC, and the new San Diego knot) using 2 suture materials, No. 2 Ethibond (Ethicon, Somerville, NJ) or No. 2 Fiberwire (Arthrex, Naples, FL). Eight samples were tested for each knot-suture configuration. Samples were pretensioned to 10 N and then loaded from 10 to 45 N for 1,000 cycles. Intact knots were loaded to failure. RESULTS: Fiberwire had significantly higher load-to-failure (276 +/- 24 N) compared with Ethibond (111 +/- 13 N) (P < .001), although there was no significant difference as a function of knot configuration. Of the 40 Fiberwire knots, 3 failed by early slippage during cyclic loading and 8 slipped at very low tension during load-to-failure. None of the Ethibond knots and none of the San Diego knots failed by early slippage. CONCLUSIONS: Surface characteristics and suture construction affect the tendency for knot slippage. CLINICAL RELEVANCE: Surgeons should understand the impact of handling characteristics, frictional properties, and ultimate failure load when selecting suture materials and knots for arthroscopic repair.

Arthroscopy↗
PubMed2006

Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years.

PURPOSE: To report our experience with the arthroscopic treatment of patients aged 40 to 60 years with rotator cuff lesions, shoulder instability, or both, and to seek a relationship among capsular-labral complex lesions, cuff tears, number of dislocations, and patient age. TYPE OF STUDY: Case series. METHODS: From January 2000, all patients aged between 40 and 60 years undergoing an arthroscopic procedure for rotator cuff lesions, shoulder instability, or both were divided into 3 cohorts: shoulder instability (group I), complete cuff tear (group C), and instability and complete cuff tear (group IC). In May 2002 there were 50 patients per group. Arthroscopic findings were analyzed using the Pearson correlation coefficient and the chi2 test to seek correlations between the lesions. The Student t test was used to highlight significant differences between preoperative and postoperative scores. RESULTS: There was a strong correlation between the rising number of dislocations and associated lesions of the supraspinatus and infraspinatus (P < .001); this correlation became stronger after 7 episodes of dislocation (P < .0001). There was no correlation between capsular or Bankart lesion and presence or absence of rotator cuff tears (P > .5). Two cases of recurrence of instability were recorded in group IC. Postoperatively, the Constant and Rowe scores rose significantly and consistently in all patients (P < .001). CONCLUSIONS: Rotator cuff tears and glenohumeral instability appear to be closely related. Patient age and number of dislocations do not appear to correlate with Bankart or capsular lesions, whereas posterosuperior cuff tears seem to be influenced by number of dislocations. Although data do not permit us to conclude whether repair of the sole cuff tear can achieve shoulder stability nor whether shoulder stabilization alone can resolve the instability, treatment of both lesions should be performed arthroscopically. LEVEL OF EVIDENCE: Level IV, case series.

Adult↗