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Results for “Rotator Cuff Injuries”

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PubMed2006

The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study.

PURPOSE: To assess the accuracy of shoulder infiltrations in the subacromial bursa (SAB) by a posterior or an anteromedial approach. Magnetic resonance imaging (MRI) and clinical outcome were used for evaluation. TYPE OF STUDY: A prospective randomized study. METHODS: Thirty-three patients (22 women, 11 men; average age, 46 years; range, 25 to 64 years) with clinical signs of subacromial impingement were infiltrated with a mixture of bupivacaine, methylprednisolone, and gadolinium-DTPA directly followed by MRI to determine the actual site of injection. The SAB was randomly infiltrated posteriorly (n = 17) or anteromedially (n = 16). Injection confidence of the surgeon and body-mass index of the patient were recorded. Follow-up consisted of the Constant Score, Simple Shoulder Test, and visual analog scale score for pain taken within 24 hours and 6 weeks after infiltration. RESULTS: Thirteen injections (76%) were in the SAB with a posterior approach and 10 (69%) with an anteromedial approach. Many surrounding structures were hit as well, especially the rotator cuff. A positive correlation between the injection confidence of the orthopaedic surgeon and the MRI was found in 66%. Only injection of the SAB alone resulted in a significant decrease of the pain (P = .004) and an increase in the functional scores. Injection in the bursa and rotator cuff muscle showed a significant increase in pain (P = .032) but no change in clinical scores. The body mass index had no influence on the scores. CONCLUSIONS: Injections in the SAB are inaccurate, despite the confident feeling of the clinician. The finding that many different structures can be infiltrated with 1 injection can create both false-positive and -negative results. LEVEL OF EVIDENCE: Level II.

Acromion↗

PubMed2006

All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up.

PURPOSE: To compare the clinical outcomes of patients undergoing all-arthroscopic versus mini-open rotator cuff repair. In addition, ultrasound was used to assess the integrity of the repair. METHODS: A total of 38 patients who had undergone all-arthroscopic repair and 33 patients who had undergone mini-open repair with minimum 2-year follow-up were evaluated. All patients completed the American Shoulder and Elbow Surgeons' Scoring Survey (ASES), the Simple Shoulder Test, the L'Insalata Scoring Survey, and visual analog scales for pain. Physical examination, including strength testing and ultrasound evaluation to determine the integrity of the rotator cuff, was performed. RESULTS: No statistical difference in ASES scores was noted between patients who had all-arthroscopic repair versus mini-open repair, and 24% of all-arthroscopic repairs and 27% of mini-open repairs showed recurrent defects on ultrasound at follow-up. This difference was not statistically significant. Patients with an original tear larger than 3 cm were 7 times more likely to have a recurrent defect at follow-up. Patients with persistent defects had statistically significant deficits in strength on forward elevation and external rotation when compared with those with a normal shoulder. However, no difference was observed with regard to pain or outcome scores between patients with intact repairs and those with persistent defects. CONCLUSIONS: No difference in clinical outcomes was found between patients with rotator cuffs repaired arthroscopically and those repaired with use of a mini-open technique. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Aged↗

PubMed2006

The accessory posteromedial portal revisited: utility for arthroscopic rotator cuff repair.

Arthroscopic rotator cuff repair is a technically challenging procedure. Accessory arthroscopic portals have been described that allow for optimal suture anchor placement, suture management, and knot tying. We describe here the usefulness of an accessory posteromedial portal that facilitates direct suture retrieval through the posterior aspect of a rotator cuff tear. This portal is created approximately 4 to 5 cm medial to the posterolateral corner of the acromion and 2 cm inferior to the scapular spine. The accessory posteromedial portal is especially useful when a retracted tear of the infraspinatus or teres minor is encountered. Because these tendons retract in a posterior and medial direction, the accessory posteromedial portal places the tendon-penetrating device in an ideal position for suture passage through the posterior portion of the rotator cuff tear. This portal also allows placement of margin convergence sutures for large U-shaped or L-shaped tears by permitting a direct "hand-off" of the suture to or from a second penetrating device that is placed through a standard anterior portal. If multiple suture anchors are required (as in the case of large or massive cuff tears, or when double-row fixation is employed), sutures can be pulled out through the accessory posteromedial portal to facilitate suture management.

Arthroscopy↗

PubMed2006

Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results.

PURPOSE: Although stiffness of the shoulder has been evaluated after rotator cuff repair, it has not been studied in patients with cuff tears that occurred before repair. The primary purpose of this study was to determine whether preoperative stiffness persists after cuff repair. We also evaluated the incidence and possible causes of stiffness in patients who underwent arthroscopic rotator cuff repair. METHODS: This was a retrospective evaluation of 72 arthroscopic patients who underwent rotator cuff repair. Preoperative range-of-motion (ROM) deficits in abduction, forward flexion, external rotation, and internal rotation were recorded and were added together to determine the total ROM deficit (TROMD). Patients were then divided into 3 groups on the basis of TROMD. Group 1 comprised 42 patients with 0 degrees to 20 degrees TROMD. Group 2 consisted of 24 patients with 25 degrees to 70 degrees TROMD, and group 3 included 6 patients with a TROMD greater than 70 degrees. Preoperative medical history, intraoperative condition of the capsule and bursa, and cuff tear size were recorded. RESULTS: Capsular and bursal abnormalities were more common in stiffer patients, but arthroscopic evidence of adhesive capsulitis was found only in group 3 (3 of 6 patients). Postoperatively, average TROMD deficit decreased from 10 degrees to 4 degrees in group 1, from 36 degrees to 12 degrees in group 2, and from 89 degrees to 31 degrees in group 3. No reoperations or postoperative manipulations were reported in group 1 or 2. In group 3, 3 patients (the only 3 with adhesive capsulitis) showed no or minimal improvement in postoperative ROM. These 3 patients required a secondary arthroscopic capsular release. After all 3 repairs had completely healed, the TROMD averaged 35 degrees in this subgroup. CONCLUSIONS: Preoperative stiffness is common in patients who undergo rotator cuff repair. Mild and moderate stiffness generally resolve after surgery followed by routine therapy. Patients with a TROMD of 70 degrees or more may have adhesive capsulitis as well as a cuff tear and may not do well with cuff repair alone. LEVEL OF EVIDENCE: Level IV, case series.

Adult↗

PubMed2006

Concomitant rotator cuff and capsuloligamentous lesions of the shoulder: a cadaver study.

PURPOSE: Rotator cuff lesions have not yet been evaluated in association with capsuloligamentous lesions in an otherwise intact shoulder model. Our hypothesis was that less extensive capsuloligamentous lesions are necessary to allow dislocation in the presence of rotator cuff lesions. METHODS: The supraspinatus and infraspinatus, or the subscapularis, or all 3 tendons were carefully detached from their insertion without damage to the underlying capsule. Adjacent combinations of 4 zones of the capsuloligamentous complex were then sequentially detached from the glenoid or from the humerus in 80 cadaver shoulders. Stability was tested before and after each resection step; this included testing of inferior stability with a sulcus test, and of anterior stability with a drawer test and with an apprehension maneuver. Findings from these specimens were statistically compared with those from the same types of tests in specimens with intact rotator cuffs. RESULTS: Subluxation during the drawer and sulcus tests is already reached after the tendon lesion has been created, or after only 1 ligamentous zone has been cut. In the presence of a tendon lesion, at least 1 less cutting step is necessary for dislocation to occur in the apprehension position. There is a difference, however, between glenoid- and humerus-based lesions. CONCLUSIONS: The humeral head dislocates easily with less extensive capsuloligamentous lesions when rotator cuff lesions are present. In the present experimental model, passive stabilization provided by the rotator cuff appears more easily disrupted when associated with ligamentous lesions on the humeral side than with lesions on the glenoid side. This may be so because interdigitation of the cuff tendons with each other and with the capsule through the rotator cable is maintained with glenoid-sided lesions. CLINICAL RELEVANCE: Rotator cuff lesions destabilize the glenohumeral joint. This effect is less pronounced when cuff tendons continue to interact with underlying capsuloligamentous structures. This finding may be relevant for small cuff tears and for partial cuff tears, especially those seen after dislocation.

Aged↗

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↗

PubMed2006

Arthroscopic technique for patch augmentation of rotator cuff repairs.

The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a "T" or an "L." The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the cuff, with respect to the line of repair, just medial to the most medial point of the tear. The sutures are placed in accordance with margin convergence suture passing methods. Next, 2 double-stranded suture anchors are placed into the lateral aspect of the greater tuberosity, which can be used to secure the anterior and posterior portions of the rotator cuff as well as the patch. The cuff sutures are tied first; then, the patch is addressed. The graft is sized by placement of a ruled probe or similar device into the subacromial space. The length of each side of the "rectangle" is measured to obtain the dimensions of the patch. The patch is then cut to fit the measurements. If the patch material is elastic, a slightly smaller than measured graft is cut to provide tension on the repair. The arthroscope is then moved to the posterior portal, and a large (8 mm) cannula, with a dam, is placed into the lateral portal. All sutures are brought out of the lateral cannula, and corresponding ends of each suture are held together in a clamp. The sutures are placed in their respective orientations once outside the cannula (e.g., anterior-medial, anterior-lateral), covering all 4 quadrants. Care is taken to ensure that the sutures have no twists and are not wrapped around one another. The sutures are passed through the graft, in mattress fashion, with a free needle, in their respective corners and clamped again. The graft is then grasped with a small locking grasper on its medial edge and is passed through the cannula into the subacromial space. The clamps holding the sutures are then gently pulled to remove the slack. A smaller (5 mm) cannula is placed through 1 of the anchor incisions into the subacromial space. The medial 2 sutures are retrieved, a pair at a time, through the small cannula and are tied according to standard arthroscopic techniques; then, the lateral 2 sutures are retrieved from the anchor. The graft should cover the area of repair completely and should be under slight tension. Additional sutures may be placed to further secure or tension the graft as necessary, with the use of standard suture passing techniques, similar to those used when margin convergence is performed. Passive shoulder motion, pendulum exercises, and active elbow and wrist motion begin 2 days after surgery when the dressing is removed. Active assisted motion and active motion begin at 6 weeks, with integrated periscapular stabilization exercises. Formal cuff strengthening begins no sooner than 12 weeks after surgery for large and massive tears.

Arthroscopy↗

PubMed2006

Engaging needles: a simple technique for arthroscopic side-to-side rotator cuff repair.

We present a simplified technique for the side-to-side arthroscopic rotator cuff repair. The instruments required for this technique are a 45 degrees Suture Lasso (SL; Arthrex, Naples, FL) and a 17F spinal needle (SN). With the arthroscope in the lateral portal, the SL is inserted through the posterior cannulas to grab healthy tissue at the posterior margin of the cuff. Through the anterior cannulas or through a skin puncture, the SN is inserted to catch healthy tissue at the anterior margin. Once both instruments are through the tissues, we manipulate them to make their tips converge. Because the SN diameter is small, it is very easy to engage its tip into the SL tip. Once engaged, a No. 1 PDS monofilament suture is easily passed through both instruments. When the suture comes out of the SL handle, both instruments can be pulled out, leaving the suture in place. Using a suture retriever clamp, the sutures are retrieved through a cannula for knot tying. This technique can be repeated as many times as necessary to place enough sutures in a side-to-side fashion to achieve the repair.

Arthroscopy↗

PubMed2006

Evaluation of residual rotator cuff defects after in vivo single- versus double-row rotator cuff repairs.

PURPOSE: As arthroscopic rotator cuff surgery has advanced, new techniques have emerged to maximize the biomechanical strength of the repair construct. The double-row repair has been recommended as a means of increasing the contact area of the repaired rotator cuff to the native bone bed. This study attempts to sequentially examine and measure the rotator cuff footprint (in vivo) before cuff repair, after an initial lateral-row repair (before the medial-row sutures are tied), and finally, after the double-row repair. In this way, the rotator cuff footprint of single- and double-row repairs can be quantified and compared. METHODS: Between October 2004 and February 2005, 26 patients were enrolled in the study. These patients had rotator cuff tears that were amenable to double-row repair by means of performing the lateral-row repair before the medial-row repair. After preparation of the greater tuberosity footprint, the native footprint was measured in the medial-to-lateral direction. Next, the medial-row anchors and sutures were passed through the cuff (but not tied), and then the lateral row was secured via suture anchors and the arthroscope was reinserted into the intra-articular space. A depth gauge was introduced through the repaired cuff (lateral row only), and the residual bare footprint was measured. The medial row was then tied, and the cuff was again visualized from the intra-articular position to measure any remaining bare footprint. RESULTS: The mean footprint measured 17.0 +/- 1.9 mm from medial to lateral. After repair of the lateral row, the mean residual uncovered footprint measured 9.0 +/- 2.0 mm. This constituted a 52.7% +/- 9.2% uncovered area after a single lateral-row repair. After the medial row was secured, there were no remaining residual deficits of the cuff footprint. CONCLUSIONS: After an isolated lateral-row repair, 52.7% +/- 9.2% of the rotator cuff footprint remains uncovered. On average, the double-row repair offered over twice the footprint coverage yielded by a single-row repair. CLINICAL RELEVANCE: The arthroscopic shoulder surgeon should be aware of the enhanced footprint coverage offered by double-row rotator cuff fixation as opposed to single-row rotator cuff fixation.

Arthroscopy↗

PubMed2006

Arthroscopic debridement in the treatment of patients with isolated tears of the subscapularis.

PURPOSE: To evaluate the treatment of properly selected patients with isolated subscapularis tears by arthroscopic debridement and release of the long head of the biceps. METHODS: Eleven shoulders that had undergone arthroscopic debridement in the treatment of subscapularis tears were reviewed. In all patients, 3 months of appropriate nonoperative management had been unsuccessful. Patients were selected for arthroscopic debridement if the tear was thought to be irreparable, or if the patient was older and unwilling to participate in the rehabilitation required after repair had been completed. Mean age at surgery was 64 years. The mean time interval from onset of symptoms to surgery was 11 months. Seven tears were traumatic, and 4 were degenerative. Four tears involved the superior third of the subscapularis tendon, 2 involved the superior two thirds of the subscapularis tendon, and 5 were complete tears. Nine shoulders also had dislocation or subluxation of the long head of the biceps tendon; these patients underwent concomitant biceps tenotomy. Patients were evaluated clinically and radiographically at a mean 34-month follow-up (range, 24 to 48 months). RESULTS: The mean Constant score increased from 49 points preoperatively to 80 points postoperatively (P < .0001). Nine patients were satisfied or very satisfied with the results. Preoperatively, 2 patients had mild glenohumeral arthritis. Postoperatively, radiographs demonstrated no progression of arthritis and no new-onset arthritis in these 2 patients. CONCLUSIONS: The combination of arthroscopic debridement and biceps tenotomy in the treatment of subscapularis tears with biceps disease in selected patients yields good objective improvement and a high degree of patient satisfaction. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Female↗

PubMed2006

A new technique to improve tissue grip: "the lasso-loop stitch".

In the chain of reattachment of the rotator cuff, links extend from the tendon to the anchor within the bone. Passage of the suture through the tendon is noted at the start of the chain, but as shown before, this is most vulnerable, depending on the quality of the tendon. We present a new technique of suture placement designed to improve tissue grip: "The lasso-loop stitch." One side of the wire is passed through the edge of the tendon, which is ruptured by the wire in the middle-not at the end. The wire is not pulled through completely. Through this process, a loop is created at the upper side of the tendon. The end of the wire, at the same side used to make the loop, is passed through the loop with a grasp. The wire is passed through the loop, and the end of the wire is brought extra-articularly. Through this technique, the reduction force of a suture is augmented, and a constricting factor is added. We have not changed the location of the anchors. So far, we have used the technique in rotator cuff repair, biceps tenodesis, and the Bankart procedure.

Arthroscopy↗

PubMed2006

Arthroscopic fixation of bursal-sided rotator cuff tears.

Subacromial decompression and debridement of partial-thickness bursal-sided rotator cuff tears are often reported with a high rate of unsatisfactory outcomes. We describe an arthroscopic procedure to repair partial-thickness bursal-sided rotator cuff tears without converting to a full-thickness tear in patients with a normal articular-sided rotator cuff and an A0B2 or A0B3 pattern of tear (minimum thickness of 25% to 75%). The articular side of the rotator cuff experiences greater tension than the bursal side of the cuff. As such, by leaving the articular footprint intact, we accomplish 3 goals: the intact articular fibers act as an internal splint to protect the bursal-sided repair, a wide and anatomic footprint is recreated, and we are able to minimize any length-tension mismatch because the tissue is not excessively lateralized with repair. After bursectomy and acromioplasty, the frayed edges of the bursal flap are gently debrided and the tuberosity is excoriated to bleeding bone. One or two bioabsorbable anchors are placed, and both sutures are placed through the full thickness of the rotator cuff (one anterior and one posterior) by use of a percutaneous suture lasso in this manner: (1) the lasso is passed through the full thickness of the cuff, and the nitinol wire is shuttled out of a single cannula along with the more medial of the suture limbs; (2) the nitinol wire is then pulled back out of the percutaneous portal along with the suture limb, with the suture being passed through the full thickness of the cuff; and (3) the procedure is repeated for the posterior limb of the suture after a lasso is again passed through the full thickness of the rotator cuff in a more posterior position. This subset of patients is treated with an aggressive rehabilitation protocol because the intact articular rotator cuff fibers act as an internal splint to protect the bursal repair.

Absorbable Implants↗

PubMed2006

Arthroscopic placement of a modified Mason-Allen stitch.

Recent studies have shown all-arthroscopic rotator cuff repairs to have comparable clinical results to mini-open or open repairs. Previous drawbacks to arthroscopic repair have included not being able to place a modified Mason-Allen stitch with a suture anchor technique. We present a technique using the Arthrex Scorpion device (Arthrex, Naples, FL) to place a modified Mason-Allen stitch arthroscopically via a double-loaded FiberWire metal suture anchor (Arthrex). The Scorpion suture passer places a stitch from inferior to superior through the torn rotator cuff. The suture is grabbed and reloaded into the Scorpion device. The device is then turned upside down, and a horizontal stitch is placed from superior to inferior. The stitch is retrieved again and reloaded a third time. The last pass is placed so that the final stitch passes anterior to the inferior suture but beyond the previously placed horizontal mattress stitch. This effectively reproduces the described biomechanically superior modified Mason-Allen stitch.

Arthroscopy↗

PubMed2006

The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study.

PURPOSE: The purpose of this study was to compare the initial mechanical strength of 3 rotator cuff repair techniques. METHODS: A total of 30 fresh-frozen cadaveric shoulders were prepared, and full-thickness supraspinatus tears were created. Specimens were randomized and placed into 3 groups: (1) transosseous suture technique (group I: TOS, n = 10, 6F/4M), (2) single-row suture anchor fixation (group II: SRSA, n = 10, 6F/4M), and (3) double-row suture anchor fixation (group III: DRSA, n = 10, 6F/4M). Each specimen underwent cyclic load testing from 5 N to 180 N at a rate of 33 mm/sec. The test was stopped when complete failure (repair site gap of 10 mm) or a total of 5,000 cycles was attained. RESULTS: Group I (TOS) failed at an average of 75.3 +/- 22.49 cycles, and group II (SRSA) at an average of 798.3 +/- 73.28 cycles; group III (DRSA) had no failures because all samples were stopped when 5,000 cycles had been completed. Fixation strength of the DRSA technique proved to be significantly greater than that of SRSA (P < .001), and both suture anchor groups were significantly stronger than the TOS group (P < .001). CONCLUSIONS: Suture anchor repairs were significantly stronger than transosseous repairs. Furthermore, double-row suture anchor fixation was significantly stronger than was single-row repair. Therefore, double-row fixation may be superior to other techniques in that it provides a substantially stronger repair that could lead to improved biologic healing. CLINICAL RELEVANCE: A high incidence of incomplete healing occurs in rotator cuff repair. Use of double-row fixation may help the clinician to address some deficiencies in current methods by increasing the strength of the repair, potentially leading to improved healing rates.

Aged↗

PubMed2006

"Transosseous-equivalent" rotator cuff repair technique.

In order to optimize healing biology at a repaired rotator cuff footprint, we have developed a "transosseous-equivalent" rotator cuff repair that can be performed arthroscopically. What the arthroscopically repaired tendon experiences is "equivalent" to what is experienced with a traditional open suture-bridge technique. This repair maximizes the utility of a single-row repair technique by preserving the suture limbs of the medial single-row and bridging these sutures over the footprint insertion with distal-lateral interference screw suture fixation; the medial row uses a mattress suture configuration. The geometry of the construct compresses the tendon, optimizing tendon-to-tuberosity contact dimensions, while providing strength sufficient to withstand immediate postoperative rehabilitation.

Arthroscopy↗

PubMed2006

Reverse rotator interval closure.

We describe a technique for reducing capsular volume arthroscopically by shifting the anterior inferior glenohumeral ligament (AIGHL) and capsule up to the top of the subscapularis. This procedure is performed when laxity exists in the absence of a Bankart lesion. The AIGHL is first released from the capsule. This allows sutures to be placed through the capsule inferiorly so that it can be shifted up superiorly during the repair. The AIGHL and capsule are then released from the underlying subscapularis. Sutures are then passed through the capsule and out of the accessory anterior portal, progressing laterally. A BirdBeak suture passer (Arthrex, Naples, FL) is inserted through the superior edge of the subscapularis and is used to grasp each undersurface strand of suture and pull it through and out of the anterior portal. The sutures are then tied sequentially, effectively shifting the capsule and ligament up in a superior direction.

Arthroscopy↗

PubMed2006

Arthroscopic subscapularis repair: surgical tips and pearls A to Z.

Arthroscopic subscapularis repair can be technically challenging. This article summarizes a number of technical tips that can greatly simplify and expedite what otherwise might be a daunting surgical procedure. Specific tips and pearls include the following: 1. A description of a new clinical test--the bear-hug test--for detecting subscapularis tears on physical examination. 2. How to accurately place portals for precise subscapularis repair. 3. How to safely and accurately perform a coracoplasty. 4. How to identify and mobilize a retracted subscapularis tear. 5. How the comma sign can be used to simplify arthroscopic subscapularis repair. 6. How to securely repair all sizes of subscapularis tear. 7. A description of postoperative immobilization and rehabilitation to optimize results of arthroscopic subscapularis repair.

Arthroscopy↗

PubMed2007

Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations.

PURPOSE: The purpose of this study was to evaluate arthroscopically the frequency and type of instability of the long head of the biceps (LHB) tendon in patients undergoing rotator cuff repair. METHODS: In 200 consecutive patients undergoing arthroscopic rotator cuff repair, LHB instability was assessed statically and dynamically in the anteroposterior direction. In addition, macroscopic lesions of the LHB, as well as lesions of the adjacent rotator cuff tendons, were documented. RESULTS: LHB instability (subluxation or dislocation) was found in 45% of patients, with isolated anterior instability in 16%, isolated posterior instability in 19%, and combined anteroposterior instability in 10%. Whereas LHB subluxations were observed in both directions, dislocations were only seen in anterior LHB instability. Anterior instability was more associated with a subscapularis lesion, whereas posterior instability was more associated with a supraspinatus tear. Lesions of the LHB tendon were strongly associated with LHB instability and the size of the rotator cuff tear. CONCLUSIONS: In 200 patients with rotator cuff tears LHB instability could be observed arthroscopically in 45%, with 16% being anterior, 19% being posterior, and 10% being anteroposterior. LHB instability was associated with LHB lesions, with 15% of the LHB tendons showing a normal appearance when unstable versus 70% when stable. Preoperative O'Brien and Speed tests did not correlate with intraoperative observed LHB pathology. The size of the rotator cuff tear could be correlated with the grade of LHB lesion, becoming more significant with augmenting tear size. On the basis of these observations, we created a new arthroscopic classification of LHB instability with respect to the direction and extent of LHB instability, lesions of the LHB, and status of the adjacent rotator cuff tendons. LEVEL OF EVIDENCE: Level IV, diagnostic study with poor reference standard.

Activities of Daily Living↗