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PubMed1993

[The value of sonography in ruptures of the rotator cuff].

In 375 patients ultrasonography of the rotator cuff was carried out before operation. All the patients underwent acromioplasty, either alone or with additional repair of a full-thickness tear. The ultrasound findings were then compared with the intraoperative findings. Two hundred and seventy-two tears of the rotator cuff were seen on ultrasonography, and in 262 cases this was confirmed at operation. In 103 patients no rupture was diagnosed by ultrasound, but in 26 of these cases a full-thickness tear was detected on operation. These figures yield sensitivity of 91%, specificity of 89% and accuracy of 90%; the positive predictive value was 96%, the negative predictive value 75%. In most cases of incorrect evaluation the size of the tears was underestimated by ultrasonography.

Adult↗
PubMedDate not supplied

Acromial shapes and extension of rotator cuff tears: magnetic resonance imaging evaluation.

Magnetic resonance imaging makes it possible to inspect the status of the rotator cuff and the shape of the acromion. To clarify the relationship between acromial shapes and rotator cuff tears, we evaluated magnetic resonance images obtained in 192 shoulders. We classified the acromial shapes into 3 types: type I (flat), type II (curved), and type III (hooked). Among a group of 91 shoulders with rotator cuff tears, 33 (36.3%) were type I, 22 (24.2%) type II, and 36 (39.6%) type III. The size of rotator cuff tears in type III acromions was significantly larger than in type I or II acromions. Comparison of the incidence of each acromial shape between groups of specimens with and without rotator cuff tears revealed no significant differences. We suggest that whereas acromial shapes have a bearing on the extent of rotator cuff tears, the correlation between rotator cuff tears and a type III acromion is not as strong as has been suggested in the literature.

Acromion↗
PubMed2002

Failed surgical management of partial thickness rotator cuff tears.

Some authors have recommended that rotator cuff tears <50% of tendon thickness be debrided and those involving >50% of the tendon be treated with miniopen repair. We hypothesize that if indications for selecting between simple debridement and tendon repair were appropriate, then both groups should have comparable outcomes. Thirty-nine patients with partial rotator cuff tears met inclusion criteria and were available for retrospective analysis. Twenty-six percent of patients who underwent debridement and 12.5% of patients who had mini-open repair had unsatisfactory results according to Neer's criteria.

Adult↗
PubMed2002

Arthroscopically assisted mini-open rotator cuff repair.

PURPOSE: To review the results of arthroscopically assisted mini-open rotator cuff repair. TYPE OF STUDY: Retrospective clinical review. METHODS: From 1990 to 1994, 67 patients (69 shoulders) had a rotator cuff repair for a full-thickness tear; 63 of these patients had an arthroscopically assisted mini-open rotator cuff repair. Of these, 22 were lost to follow-up; thus, 41 patients were retrospectively reviewed for this study. The average patient age was 51 years and the average follow-up was 36 months. UCLA scores incorporating preoperative and postoperative pain, function, strength, and range of motion data were used to analyze the results. RESULTS: At follow-up, 38 patients (93%) were rated as excellent or good, 3 patients (7%) were rated as fair, and none was rated as poor. All patients showed improvement in pain and function after surgery and all of the patients were satisfied with the procedure. The average UCLA score was 32.3. There was a small but significant (P <.0001) difference between UCLA scores of Workers' Compensation patients (UCLA score, 29; n = 11) versus noncompensation patients (UCLA score, 33; n = 30). In addition, the return-to-work interval was prolonged in the Workers' Compensation cases. There were no significant differences in UCLA scores on the basis of tear size (P <.4286) or patient age (P <.1131). CONCLUSIONS: Our data suggest that the arthroscopically assisted mini-open technique for rotator cuff repair is an excellent approach for repair of a torn rotator cuff.

Adult↗
PubMed2005

Allograft reconstruction for massive, irreparable rotator cuff tears.

BACKGROUND: There is currently no widely accepted treatment for massive, irreparable rotator cuff tears. HYPOTHESIS: Allograft reconstruction to span the remaining defect in massive, irreparable rotator cuff tears will lead to increased functional results and will demonstrate healing of the allograft on follow-up magnetic resonance imaging studies. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1989 and 2003, 32 patients underwent allograft reconstruction of massive rotator cuff tears. University of California, Los Angeles shoulder scores were compared preoperatively and postoperatively and analyzed using paired Student t tests. In addition, 15 patients underwent postoperative magnetic resonance imaging to evaluate the structural integrity of the allograft reconstruction at the greater tuberosity insertion. RESULTS: Of 32 patients, 28 were available for review at a mean follow-up of 31.3 months; 23 of the 28 patients were satisfied with their outcome. There was 1 postoperative infection and 1 acute allograft rejection. The mean University of California, Los Angeles score increased from 12.1 preoperatively to 26.1 postoperatively (P < .001). All 15 patients evaluated with postoperative magnetic resonance imaging arthrograms demonstrated complete radiographic failure of the allograft rotator cuff reconstruction. Despite radiographic failure, the mean University of California, Los Angeles score increased from 13.2 preoperatively to 28.3 postoperatively in this subset of patients. CONCLUSION: The functional results of this reconstruction method are similar to those reported for debridement and subacromial decompression alone and are satisfactory, despite magnetic resonance imaging arthrogram evaluation demonstrating failure of the structural integrity of the allograft. Allograft reconstruction carries increased risk of infection and rejection and is technically more difficult than other less expensive treatment options with similar functional results. Therefore, we do not recommend allograft reconstruction of massive and otherwise irreparable rotator cuff tears.

Adult↗
PubMed2005

Arthroscopic rotator cuff debridement without decompression for the treatment of tendinosis.

PURPOSE: The treatment of rotator cuff injury in the absence of a full-thickness tear has traditionally consisted of acromioplasty. However, this disorder may also be treated by arthroscopic rotator cuff debridement without acromioplasty. Our previous study of 79 shoulders so treated reported 87% good or excellent results at an average 53-month follow-up. The purpose of this article is to report the long-term, average 9.5-year follow-up of this cohort. TYPE OF STUDY: Long-term follow-up of case series. METHODS: We retrospectively reviewed the records of 62 shoulders in 60 patients who had undergone arthroscopic rotator cuff debridement for partial-thickness rotator cuff tears. Demographic criteria, residual pain, and the ability to return to recreational athletics were noted. The UCLA Shoulder Score and the Simple Shoulder Test scores were determined and statistical analysis performed. RESULTS: Using the UCLA Shoulder Score, there were 79% excellent or good results at an average 114 months of follow-up. Patients with Workers' Compensation claims had significantly worse results, with only 40% rated good or excellent. Of the 60 patients, 77% had no or only minimal pain, 57% were still able to perform recreational athletics without difficulty, and 20% could participate at a lower level of intensity. CONCLUSIONS: Arthroscopic debridement of rotator cuff injury in the absence of a full-thickness tear has good long-term results and minimizes additional surgical trauma. LEVEL OF EVIDENCE: Level IV, case series.

Adolescent↗
PubMed2000

[Arthroscopic rotator cuff reconstruction].

Although most subacromial decompressions are performed arthroscopically, rotator cuff repair is still performed using an open or mini-open procedure. Arthroscopic techniques have improved in the last decade, however, so that rotator cuff repair can also be performed arthroscopically. The potential complications of open repair are thus reduced and the superior functional results of cuff repair in comparison to débridement alone are maintained. The proposed advantages of the arthroscopic method are that it provides access to the glenohumeral joint for inspection and treatment of intra-articular lesions. The skin incisions are smaller, detachment of the deltoid muscle is not necessary, and there is less soft tissue dissection. By inspecting the bursal and articular side of the ruptured cuff, it is possible to measure the size of the tear and assess the quality of the tendon and whether it can be repaired. We present our arthroscopic technique of rotator cuff repair using bioabsorbable suture anchors and demonstrate our 1- to 6-years results with various suture anchors.

Aged↗
PubMed2005

Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques.

BACKGROUND: Interface contact pressure between the tendon and bone has been shown to influence healing. This study evaluates the interface pressure of the rotator cuff tendon to the greater tuberosity for different rotator cuff repair techniques. HYPOTHESIS: The transosseous tunnel rotator cuff repair technique provides larger pressure distributions over a defined insertion footprint than do suture anchor techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Simulated rotator cuff tears over a 1 x 2-cm infraspinatus insertion footprint were created in 25 bovine shoulders. A transosseous tunnel simple suture technique (n = 8), suture anchor simple technique (n = 9), and suture anchor mattress technique (n = 8) were used for repair. Pressurized contact areas and mean pressures of the repaired tendon against the tuberosity were determined using pressure-sensitive film placed between the tendon and the tuberosity. RESULTS: The mean contact area between the tendon and tuberosity insertion footprint was significantly greater for the transosseous technique (67.7 +/- 5.8 mm(2)) compared with the suture anchor simple (34.1 +/- 9.4 mm(2)) and suture anchor mattress (26.0 +/- 5.3 mm(2)) techniques (P < .05). The mean interface pressure exerted over the footprint by the tendon was also greater for the transosseous technique (0.32 +/- 0.05 MPa) compared with the suture anchor simple (0.26 +/- 0.04 MPa) and suture anchor mattress (0.24 +/- 0.02 MPa) techniques (P < .05). CONCLUSION: The transosseous tunnel rotator cuff repair technique creates significantly more contact and greater overall pressure distribution over a defined footprint when compared with suture anchor techniques. CLINICAL RELEVANCE: Stronger and faster rotator cuff healing may be expected when beneficial pressure distributions exist between the repaired rotator cuff and its insertion footprint. Tendon-to-tuberosity pressure and contact characteristics should be considered in the development of improved open and arthroscopic rotator cuff repair techniques.

Animals↗
PubMed2003

Surgical management of large rotator cuff tears combined with instability in elite rugby football players.

Large rotator cuff tears are extremely uncommon in young people and when they occur they may be associated with shoulder instability. This paper reports on a series of six elite rugby union and rugby league footballers who presented with shoulder instability and large rotator cuff tears. They were treated with a two stage procedure: an open rotator cuff repair followed by an open shoulder stabilisation some 10 weeks later. All had successful outcomes. The paper also highlights the risk of tearing the rotator cuff when a patient continues to play contact sport with an untreated unstable shoulder.

Adult↗
PubMedDate not supplied

The use of the supraclavicular fossa portal in arthroscopic rotator cuff repair.

SUMMARY: Advances in arthroscopic technology allow rotator cuff repair through a minimally invasive approach. However, fixation of the rotator cuff tendon to suture anchors can be tedious and time consuming. The supraclavicular fossa portal allows improved access to the tear for passing suture. The authors describe the relevant anatomy, positioning, and surgical technique for use of the supraclavicular fossa portal to simplify arthroscopic rotator cuff repair.

Arthroscopy↗
PubMed1986

Sonography of the postoperative rotator cuff.

In experienced hands, high-resolution real-time sonography has been shown to be an accurate noninvasive method for diagnosis of rotator cuff tears. The sonographic appearance of the postoperative rotator cuff has not been previously reported. Forty postoperative patients were studied sonographically 1 week to 6 years after rotator cuff repair. The postoperative rotator cuff is abnormally echogenic and can be very similar in appearance to a small rotator cuff tear in a nonoperated patient. Soft-tissue planes about the tendon are distorted or absent. Criteria for diagnosis of retear must be different from those used in detecting new tears in a nonoperated cuff. Postoperative echogenicity is normal, but the finding of a defect or gap within the rotator cuff tendon is the only accurate sign of a recurrent rotator cuff tear.

Humans↗
PubMed1988

The long-term outcome of rotator cuff tendinitis--a review study.

Rotator cuff tendinitis is believed to resolve in the majority but the long-term outcome has not been well documented. This review of 137 patients treated conservatively found active tendinitis in 35 individuals at a mean of 19 months after presentation. In addition, 40 patients had residual pain and eight developed pain due to another cause. Early presentation and a history of overuse unrelated to occupation distinguished the 54 who had resolved from those with active tendinitis (p less than 0.01). Dominant arm involvement was associated with a poorer prognosis (p less than 0.05). Functional impairment occurred in 29 patients, two having lost employment. The sizeable proportion of patients with chronic tendinitis resistant to conservative treatment suggests that rotator cuff tendinitis is not an early self-limiting condition and improvement in management is required.

Adult↗
PubMed2005

Patterns of vascular and anatomical response after rotator cuff repair.

BACKGROUND: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion. PURPOSE: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded fashion. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Fifty patients undergoing rotator cuff repair were enrolled: 28 mini-open, 14 open, and 8 arthroscopic repairs; 20 patients were controls. Patients underwent Power Doppler sonography at 6 weeks, 3 months, and 6 months postoperatively. Power Doppler sonography analysis examined 6 areas of the rotator cuff repair: discretely marginated intrasubstance, partial-thickness defects, full-thickness defects, focal thinning of repair, presence of bursal or joint fluid, and location of anchors. A subjective scoring system assessed blood flow in each region. RESULTS: There was a predictable, significant decrease in vascular scores after rotator cuff repair over time. The mean vascular score was 11.6 at 6 weeks, 8.3 at 3 months, 7.0 at 6 months, and 2.4 for controls. There was a significant difference (P < .05) in vascular recruitment scores between each time period, with the most robust flow at the peritendinous region. The lowest vascular score was at the anchor site or cancellous trough. Forty-eight percent of the patients had a rotator cuff repair defect postoperatively. These findings did not correlate with functional assessment and outcome at 6 months. There was no significant difference in vascular scores between the defect and no-defect groups. Mean University of California, Los Angeles; L'Insalata; and American Shoulder and Elbow Surgeons scores at 6 months were 28.6, 86.3, and 81.5, respectively. Thirty-three percent of asymptomatic controls had a rotator cuff tear that averaged 7.6 x 7.1 mm. CONCLUSION: The robust vascular response dropped with time, which is not seen in asymptomatic shoulders. Nearly half of the patients demonstrated persistent rotator cuff defects after rotator cuff repair that did not correlate with functional outcome and physical findings at 6 months.

Adult↗
PubMedDate not supplied

Greater tuberosity notch: an important indicator of articular-side partial rotator cuff tears in the shoulders of throwing athletes.

We examined the location of rotator cuff tears, associated labral injuries, and notches on the greater tuberosity of the humeral head in shoulders of throwing athletes. Arthroscopic findings (rotator cuff tear, labral condition, and greater tuberosity notch) as well as other factors (duration of playing baseball, range of motion, and joint laxity) of 61 baseball players were retrospectively studied. The presence of a greater tuberosity notch was also evaluated for by plain radiographs. Forty patients had articular-side partial rotator cuff tears, most of which occurred in the interval between the supraspinatus and infraspinatus tendons. The existence of a rotator cuff tear was not related to the range of motion, joint laxity, the detachment of the superior glenoid labrum, or posterosuperior labral injury. Greater tuberosity notches were recognized in 38 shoulders by arthroscopy and most were detected on plain radiographs. The presence of a notch was significantly related to the existence of a rotator cuff tear, while the size of the notch was significantly related to the depth and width of the tear. The greater tuberosity notch seems to be one of the most important diagnostic indicators for a rotator cuff tear in throwing athletes.

Adolescent↗
PubMed1999

Partial-thickness tears of the rotator cuff: evaluation and management.

The approach to management of a partial-thickness rotator cuff tear is best made with the understanding that this is not a singular condition. Rather, partial tears represent the common outcome of a variety of insults to the rotator cuff. Degenerative changes due to aging, anatomic impingement, and trauma may all be etiologic agents. Overhead athletes may develop tears due to repetitive microtrauma or internal impingement. Outlet radiographs and magnetic resonance imaging are recommended for routine preoperative evaluation. A nonoperative treatment program for rotator cuff strengthening and stretching is appropriate as initial treatment; modification of activities and anti-inflammatory medication are often used as well. Operative management may be considered when nonoperative treatment fails. Arthroscopic evaluation is required to determine the true extent of the cuff lesion. Arthroscopic subacromial decompression is recommended when outlet impingement is present. Rotator cuff debridement or formal cuff repair is dependent on the size of the cuff defect and the age and activity level of the patient. The importance of recognizing the different causes of partial-thickness rotator cuff tears is emphasized in this review of pathogenesis, clinical diagnosis, imaging, and treatment.

Acromion↗
PubMed1988

Rotator cuff impingement syndrome: MR imaging.

Ten patients with clinically suspected rotator cuff impingement syndrome were evaluated with magnetic resonance (MR) imaging, double contrast arthrography, and conventional radiography. An area of increased signal intensity in the tendinous portion of the rotator cuff was seen in eight of ten patients on images obtained with a short repetition time (TR) and short echo time (TE) and those obtained with a long TR and long TE with spin-echo sequences. Microscopic findings, available in five patients, indicated that these areas of increased intensity corresponded to degeneration and inflammation of the rotator cuff. A previously injected long-acting steroid preparation combined with a local anesthetic, which also produces an area of increased signal intensity on long TR, long TE images, can cause problems with image interpretation. No tears of the rotator cuff were detected with MR imaging. However, a full-thickness cuff tear was detected with arthrography in three patients. Although based on a relatively small group of patients, these preliminary findings suggest that MR imaging is capable of demonstrating rotator cuff abnormalities in patients with impingement syndrome.

Humans↗
PubMed1994

[Results of the surgical repair of the rotator cuff. Radio-clinical correlation].

INTRODUCTION: This study was undertaken to evaluate the functional results of rotator cuff tear repair. MATERIAL AND METHODS: This retrospective study concerned 108 shoulders operated with a minimal follow up of 1 year (mean 5.5 years). The average age of this masculine population was 55 years. The rotator cuff tear involved: 39 times the supra-spinatus, 59 times the supra-spinatus and infra-spinatus, 6 times the supra and infra-spinatus and the teres minor, 4 times the supra-spinatus and superior part of the sub-scapularis. All these patients were reviewed using the Constant's score. The functional results were compared with an ultrasonographic study and a radiographic protocol including 5 views. Muscle strength was measured objectively with the aid of an isokinetics testing (Cybex II). RESULTS: The results were satisfactory concerning pain (67 per cent did not suffer anymore) daily activity (78 per cent experienced a slight disability) and mobility (92 per cent of the patients had an anteflexion > 120 degrees and 82 per cent an external rotation > 40 degrees). Concerning strength, the results were variable and related to the posterior extension of the tear. Most of the patients complained of weakness (mean objective deficit of strength = 25 per cent), specially a disability during repetitive over head activities. The radiographic protocol analysed the humeral head position (16 per cent of spontaneous acromio-humeral interval narrowing on the standard X Ray and 43 per cent of dynamic narrowing on Leclercq view). The spontaneous narrowing was correlated with a severe omarthrosis and a re-rupture of the rotator cuff. All these re-ruptures involved an infraspinatus lesion. Dynamic narrowing, with an acromial interval < 7 mm, were seen in 71 per cent of the patients with posterior extension of the rotator cuff tear explaining the poor final result; the ultrasonographic assessment found a thinning (75 per cent of patient) and a heterogeneity in the infraspinatus even after repair. We found 14 re-ruptures and 6 ultrasonographic disorganised structures. DISCUSSION: A well preserved external rotation and a centred head gave good result because they were associated with the integrity of the infra-spinatus, essential to the muscular balance of the rotator cuff and necessary for the dynamic and static centering of the humeral head. In 71 per cent of the cases, the suture of the posterior cuff tear did not allow a good dynamic position of the humeral head. A spontaneous narrowing (static view) of the acromio-humeral interval was in relation with a re-rupture which evolved to omarthrosis. A dynamic narrowing with a Leclercq radiograph was associated with a functional deficit after rotator cuff repair. CONCLUSION: Humeral head stabilisation, supplied by posterior muscles of the rotator cuff, is essential in prevention of omarthrosis and in recovery of good strength. In several specific cases, we think that the transfer of an external rotator muscle, with a good humeral head stabilization action, may restore strength.

Acromion↗
PubMedDate not supplied

Diagnosis and treatment of rotator cuff tears in the emergency department.

This article will review the diagnosis and management of rotator cuff tears in the emergency department. Rotator cuff disease is a common source of shoulder pain. It encompasses a wide range of pathology of the rotator cuff tendons. These lesions can include impingement or tendinitis, and may progress to rupture of the tendons. In considering the emergency department management of cuff tears, it is useful to classify patients by the mechanism of their injury. Proper classification of patients requires a careful history and physical examination. Interpretation of these data is based on an understanding of the entire range of pathology that can affect the tendons of the rotator cuff.

Diagnosis, Differential↗