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PubMedDate not supplied

Mini-open rotator cuff repair using a two-row fixation technique: outcomes analysis in patients with small, moderate, and large rotator cuff tears.

Mini-open rotator cuff repair has been used successfully to treat small- and moderate-sized rotator cuff tears but not large tears (>3 cm and <5 cm). We use a 2-row fixation technique of repairing the torn cuff to the humerus. We sought to determine if this technique would produce successful results in patients with larger rotator cuff tears. The results of 75 consecutive patients who underwent arthroscopic subacromial decompression with acromioplasty and mini-open rotator cuff repair were evaluated. All patients were evaluated at a minimum 24 months postoperatively (mean, 27 months). All patients were treated with a mini-open rotator cuff repair using a 2-row fixation technique. Patients were evaluated at follow-up with a focused shoulder examination, Hospital for Special Surgery (HSS) Shoulder Questionnaire, and the University of California Los Angeles (UCLA) Shoulder Rating Scale. There were 49 male and 26 female patients, with a mean age of 54 years (range, 34-72 years). All patients failed a preoperative course of physical therapy and nonoperative management. Thirty patients were found to have a large rotator cuff tear (group I), 35 were found to have a moderate-sized tear (group II), and 10 patients had a small tear (group III) at the time of arthroscopy. There was no statistically significant difference in outcome between groups. The mean UCLA Shoulder Rating Scale for all groups was 33.6/35. Mean HSS Shoulder Questionnaire at follow-up was 91%. The mean time from surgery to full recovery was 7 months. Patient's subjective satisfaction based on their preinjury level of performance at most recent follow-up was 92.6%. Eighty-three percent (74/89) of patients returned to their preinjury activity; 93% of patients reported that they would undergo the procedure again. We believe that mini-open rotator cuff repair using a 2-row fixation technique can yield excellent results in patients with small, moderate, and large rotator cuff tears. There was no detectable difference in outcome between groups at 2-year follow-up on clinical evaluation.

Adult↗
PubMed2006

The role of repair tension on tendon to bone healing in an animal model of chronic rotator cuff tears.

Rotator cuff tendon tears are one of the most common shoulder injuries. Although surgical repair is typically beneficial, re-tearing of the tendons frequently occurs. It is generally accepted that healing is worse for chronic tears than acute tears, but the reasons for this are unknown. One potential cause may be the large tensions that are sometimes required to repair chronically torn tendons back to bone (i.e., repair tension). Therefore, the objective of this study was to utilize an animal model of chronic rotator cuff repairs to investigate the role of increased repair tension on tendon to bone healing. We hypothesized that an increase in repair tension would be related to detrimental changes to the healing insertion site. To test this hypothesis, the supraspinatus tendon of rats was surgically detached and then repaired immediately or after a delay of 2, 4, or 16 weeks. The repair tension was measured using a tensiometer and the mechanical properties, collagen organization, and protein expression of the healing insertion site were evaluated 4 and/or 16 weeks following repair. We found that the repair tension increased with time following detachment, and was related to a decrease in the failure properties and viscoelastic peak stress and an increase in cross-sectional area and stiffness of the insertion site. Therefore, repair tension should be minimized in the clinical setting. Future studies will include additional animal model studies involving the relationship between tension and muscle properties and a clinical study investigating the role of repair tension on repair failure.

Animals↗
PubMedDate not supplied

Arthroscopic management of rotator cuff disease.

Rotator cuff disease (stage 2 impingement, partial-thickness tears, complete cuff tears, and irreparable tears) is as yet only partially understood, and the role of arthroscopy in its management is still under debate. Stage 2 impingement can be managed satisfactorily with arthroscopic techniques. Arthroscopy allows a complete inspection of the glenohumeral joint, enabling the surgeon to diagnose and treat coexisting intra-articular lesions. A thorough bursectomy, coracoacromial ligament resection, and acromioplasty can be performed without the need for deltoid detachment. Arthroscopic technique appears to offer advantages over open technique in the management of partial-thickness tears by allowing accurate inspection of the articular surface of the rotator cuff. The depth and size of the tear can be determined precisely, allowing an appropriate selection of debridement, decompression, and/or tendon repair. The management of complete tears is currently under investigation, with some advocating complete arthroscopic repair and some preferring arthroscopic acromioplasty and "mini-open" repair; there are merits to both approaches. The arthroscopic management of irreparable tears appears to offer the advantages of an open decompression with decreased morbidity. However, the surgeon's ability to accurately determine reparability may be less precise with arthroscopy.

Arthroscopy↗
PubMed2006

Using support vector machines to optimally classify rotator cuff strength data and quantify post-operative strength in rotator cuff tear patients.

Shoulder strength data are important for post-operative assessment of shoulder function and have been used in diagnosis of rotator cuff pathology. Support vector machines (SVM) employ complex analysis techniques to solve classification and regression problems. A SVM, a machine learning technique, can be used for analysis and classification of shoulder strength data. The goals of this study were to determine the diagnostic competency of SVM based on shoulder strength data and to apply SVM analysis in efforts to derive a single representative shoulder strength score. Data were taken from fourteen isometric shoulder strength measurements of each shoulder (involved and uninvolved) in 45 rotator cuff tear patients. SVM diagnostic proficiency was found to be comparable to reported ultrasound values. Improvement of shoulder function was accurately represented by a single score in pairwise comparison of the pre-operative and the 12 month post-operative group (P < 0.004). Thus, the SVM-based score may be a promising metric for summarizing rotator cuff strength data.

Artificial Intelligence↗
PubMed2001

[Rotator cuff rupture].

Rotator cuff tears can result separately or from any combination of vascular, degenerative, mechanical, or traumatic causes. A correct diagnosis is sometimes difficult since the clinical findings and symptoms vary largely. Treatment requires an early surgical intervention either with a suture of the tear or a reconstruction in case of larger tears or defects depending on the tear size, since early surgical treatment leads to better results. With surgery also it is more likely to prevent cuff arthropathy with subsequent joint destruction and painful loss of function.

Adult↗
PubMed1995

[Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 2: postoperative functional and anatomical evaluation of ruptures of the rotator cuff].

PURPOSE OF THE STUDY: The authors examined the anatomic condition and the function of the rotator cuff obtained after an average period of four years following surgical repair in a series of 100 full thickness rotator cuff tears. The aim was to assess the validity of Constant's scoring method and to analyse risk factors and the frequency of recurrent tears. MATERIAL AND METHODS: The series comprised 98 patients, 62 men and 36 women whose average age was 56 years. It included 69 tears of less than 2 cm in size (39 cases) or between 2 to 4 cm (3 cases) of the supra-spinatus, 22 tears of the supra- and infraspinatus measuring between 2 to 4 cm, and 9 massive tears. The tendon of the long head of the biceps was pathological in 1/3 of cases. All 98 patients were operated on by the same surgeon using the same repair technique, and all followed ambulatory rehabilitation along the same principles of self-rehabilitation applied pre operatively. In each patient function was assessed using Constant's scoring method, and the condition of the repaired cuff was determined by ultrasonography at the time of clinical follow-up. The average follow-up period was 4 years (2 to 6 years). RESULTS: Ultrasonography revealed intact cuffs in 65 per cent, thinned cuffs in 11 per cent and recurrent full thickness tears in 24 per cent of cases. The risk of recurrent tear increased with the extent of the tear to be repaired (57 per cent), in older patient (25 per cent) and with a higher level of post-surgical occupational use (18 per cent). A drop in the post-operative Constant score had a predictive value for a full thickness recurrent defect. DISCUSSION: Constant's scoring method appears to be a reliable, reproducible method for analysing functional results following surgical repair of full thickness cuff tears and to reflect the anatomic condition of the repaired cuff. At clinical follow-up, the anatomic condition of the cuff is more determinant of final functional results than initial tear size. CONCLUSIONS: Assessment of functional results must be complemented by anatomic examination using ultrasonography in order to specify the size of any possible recurrent defect and to detect thinning of the cuff which cannot be identified by Constant's score. Analysis of the risk factors for recurrent tear led the authors to question the necessity of repairing massive tears in older patients and pointed to the valuable advantages of reinforcing fragile cuffs during initial repair especially in very active patients.

Adult↗
PubMed2006

Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma.

The aim of this study was to evaluate the epidemiologic data of patients with an acute soft-tissue injury to the shoulder, with an emphasis on improving the early diagnosis of acute rotator cuff tears. This study included 104 patients, with a median age of 49 years (range, 19-75 years). The patients were evaluated clinically and with ultrasonography at a median of 13 days (range, 3-49 days) after the injury. A total of 60 patients (58%) had some degree of cuff lesion on the ultrasonographic examination. Of these patients, 33 (32%) had a full-thickness rotator cuff tear, 14 (13%) had a partial-thickness cuff tear in the tendon substance, and 13 (13%) had a partial cuff tear at the insertion site on the major tubercle. The injury mechanism or activity at the moment of injury did not correlate with the presence of a rotator cuff lesion, but we found a strong age correlation, with a prevalence of any rotator cuff tear, above 50%, for patients aged above 50 years and with a prevalence of full-thickness tears of 50% in the groups aged 50 to 59 years and aged 60 to 69 years. In conclusion, this study found a high incidence of rotator cuff lesions by further evaluation of patients undergoing consultation at the emergency department, with an inability to perform active abduction above 90 degrees and normal radiographs, after an acute shoulder trauma.

Adult↗
PubMed2002

Effect of rotator cuff exercise on humeral rotation torque in healthy individuals.

Conservative management of rotator cuff pathology often involves certain therapeutic exercises. Although a major goal of these exercises is to increase strength of the rotator cuff, little empirical evidence supports this assertion. In this study, 34 nonpathologic young adults were pretested using a LIDO Multijoint II isokinetic device for average and peak torque generated during internal and external rotation. Subjects were arbitrarily assigned to a right-arm- or left-arm-trained group, exercised for 4 weeks, and then posttested for changes in humeral rotation torque. Moderate but significant increases in torque (8-10%) as well as in total work done were observed in both groups, only in the trained arm. Subjects who trained the nondominant (left) arm experienced gains similar to those who trained the right arm. Gains were significant in the case of both internal and external rotation (also average as well as peak torque), with men and women experiencing the same relative increases. These data, in addition to supporting the use of selected exercises to increase humeral rotation torque in a healthy population, offer a potential model for the rehabilitation of patients with rotator cuff injury.

Adult↗
PubMed2004

Matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase mRNA levels are specifically altered in torn rotator cuff tendons.

BACKGROUND: Rotator cuff tears are a cause of pain and disability in the shoulder. The molecular changes associated with rotator cuff tearing are unclear. A subset of matrix metalloproteinases and tissue inhibitors of metalloproteinase, which are involved in extracellular matrix remodeling and degradation, were evaluated. HYPOTHESIS: There would be an increase in the mRNA level of specific matrix metalloproteinase and a decrease in the mRNA level of specific tissue inhibitors of metalloproteinase in rotator cuff tendon tissue obtained from patients with rotator cuff tears. STUDY DESIGN: Controlled laboratory study. METHODS: Tissue was obtained from 10 patients undergoing rotator cuff repair for full-thickness rotator cuff tears. Also, tissue was obtained from cadaveric specimens with no gross evidence of rotator cuff tearing. Reverse transcription polymerase chain reaction was performed for the collagenases (MMP-1, MMP-8, MMP-13), the stromelysins (MMP-3, MMP-10, MMP-11), and the tissue inhibitors of metalloproteinase (TIMP-1, TIMP-2, TIMP-3, TIMP-4). Western blotting was performed to confirm the mRNA changes demonstrated in collagenase-3 (MMP-13). RESULTS: There was a significant increase in collagenase-3 (MMP-13) mRNA levels, a decrease in stromelysin-1 (MMP-3) mRNA levels, and a decrease in tissue inhibitor of metalloproteinase-2, -3, and -4 mRNA levels. Western blotting demonstrated an increase in the active form of collagenase-3 (MMP-13) in rotator cuff tendon tears. CONCLUSIONS: The mRNA levels of specific matrix metalloproteinases and tissue inhibitors of metalloproteinase are altered in torn rotator cuff tendons. CLINICAL RELEVANCE: With the known action of the matrix metalloproteinases and tissue inhibitors of metalloproteinase in extra-cellular matrix remodeling, these findings suggest that their roles in remodeling of rotator cuff tears should be further investigated.

Aged↗
PubMed1978

The repair of chronic massive ruptures of the rotator cuff of the shoulder by use of a freeze-dried rotator cuff.

In sixteen patients with massive tears of the rotator cuff of the shoulder, bridging of the defect with a freeze-dried graft of a rotator cuff from a cadaver produced a satisfactory repair in all cases. A good or excellent functional result was obtained in all but two patients, with a definite decrease or absence of nocturnal pain in all sixteen. The operative technique includes avoidance of a complete acromionectomy and an adequate suture of the deltoid muscle to the acromion after an acromioplasty.

Acromioclavicular Joint↗
PubMed2005

A prospective, double-blind, randomized clinical trial comparing subacromial injection of betamethasone and xylocaine to xylocaine alone in chronic rotator cuff tendinosis.

BACKGROUND: Rotator cuff tendinosis is a common problem with significant health and economic effects. Nonoperative management includes the widespread use of subacromial steroid injections despite the lack of evidence of its efficacy. HYPOTHESIS: A subacromial injection of betamethasone will be more effective than xylocaine alone in improving the quality of life, impingement sign, and range of motion in patients who have chronic rotator cuff tendinosis or partial rotator cuff tears. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Patients with rotator cuff tendinosis or partial cuff tear with symptoms longer than 6 months, with failure of 6 weeks of physical therapy and 2 weeks of nonsteroidal anti-inflammatory drugs, who were older than 30 years of age, and who showed >50% improvement with the Neer impingement test were stratified for Workplace Safety and Insurance Board status and previous injection. Outcome measures--the Western Ontario Rotator Cuff Index; American Shoulder and Elbow Surgeons standardized form; Disabilities of the Arm, Shoulder and Hand; active forward elevation; active internal rotation; active external rotation; and the Neer impingement sign--were assessed at 2, 6, 12, and 24 weeks after injection. The injection into the subacromial space contained either 5 mL of 2% xylocaine alone or 4 mL of 2% xylocaine and 1 mL (6 mg) of betamethasone in an opaque syringe. RESULTS: In 58 patients (betamethasone group, n = 30; xylocaine group, n = 28), the authors found no statistically significant difference between the 2 treatment groups for all outcomes and time intervals. The scores for the Western Ontario Rotator Cuff Index at 3 months were xylocaine = 45.4% +/- 13% and betamethasone = 56.3% +/- 17% (P = .13). At 6 months, the scores were xylocaine = 51% +/- 32% and betamethasone = 59% +/- 26% (P = .38). All other outcomes showed similar values. As well, similar results were found for 2 and 6 weeks after injection. Both groups showed improvement from baseline in all outcomes. CONCLUSIONS: With the numbers available for this study, the authors found betamethasone to be no more effective in improving the quality of life, range of motion, or impingement sign than xylocaine alone in patients with chronic rotator cuff tendinosis for all follow-up time intervals evaluated.

Anesthetics, Local↗
PubMed2003

[Rotator cuff rupture].

The rotator cuff is the complex of four muscles that arise from the scapula; supscapularis, supraspinatus, infraspinatus and teres minor. The long head of the biceps tendon may be considered a functional part of the rotator cuff. The rotator cuff is key structure of the shoulder which gives dynamic stability and movements. Rotator cuff tears my occur as consequence of impingement syndrome or degenerative changes. Most tears occur in the supraspinatus tendon. The patients are usually older than 40 years. On clinical examination there is weakness of abducation and external rotation of the arm. Open or arthroscopic repair should be performed in active individuals.

Humans↗
PubMed2003

Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff.

OBJECTIVE: This study was performed to examine the relationship and association of abnormalities seen in the long head of the biceps brachii tendon to abnormal findings in the rotator cuff. MATERIALS AND METHODS: One hundred eleven patients underwent MR imaging for shoulder pain followed by arthroscopic or open shoulder surgery from January 1997 to December 2000. Patients were identified by a retrospective search, and all consecutive patients having undergone both MR imaging and surgery were included in the patient cohort. Official MR imaging interpretations were compared with operative reports, and all findings were recorded. RESULTS: Twenty-three patients were identified with partial- or full-thickness tears of the long head of the biceps tendon. The sensitivity, specificity, and accuracy of unenhanced MR imaging of the shoulder for detecting these bicipital tears were 52%, 86%, and 79%, respectively. When a tear was present in the biceps tendon, the prevalence of supraspinatous, infraspinatus, and subscapularis tendon tears was 96.2%, 34.6%, and 47.1%, respectively. Patients with biceps tendon tears were significantly more likely to also have subscapularis tendon tears (p < 0.0001) and supraspinatous tendon tears (p < 0.008) than those patients who did not have biceps tendon tears. No significant relationship was found between the presence or absence of a biceps tendon tear and the presence or absence of a infraspinatus or teres minor tendon tear (p = 0.17). CONCLUSION: Tears of the long head of the biceps tendon have a statistically significant association with tears of the anterior and superior rotator cuff and are highly correlated with tears of the supraspinatous and subscapularis tendons. When tears of these tendons are detected, specific attention directed toward the long biceps tendon is warranted to characterize the status of this structure that provides additional stability to the shoulder joint.

Adolescent↗
PubMed2000

Osteochondroma of the distal clavicle: an unusual cause of rotator cuff impingement.

Rotator cuff impingement symptoms may arise from intrinsic pathologic shoulder lesions related to instability or from extrinsic factors, primarily involving the coracoacromial arch. This report describes 2 unusual cases in which extrinsic impingement resulted from a distal clavicular osteochondroma. In both cases symptoms resolved after resection of the osteochondroma.

Adult↗
PubMed2002

Effect of recombinant basic fibroblast growth factor (bFGF) on fibroblast-like cells from human rotator cuff tendon.

Rotator cuff tendon cells (RCC) derived from surgical samples showed fibroblast-like morphology. Histological staining demonstrated collagen secretion by RCC. Immunohistological findings revealed that RCC secreted type I and III collagen, but not type II collagen. In addition, the SDS-PAGE analysis suggested that RCC predominantly produced type I collagen. Basic fibroblast growth factor (bFGF) had a stimulatory effect on the proliferation of RCC dose-dependently up to 1 ng/ml. Administration of bFGF suppressed the secretion of collagens from RCC in a dose-dependent manner.

Cell Count↗
PubMed2000

[Recommendations for diagnosis and expert assessment of traumatic rotator cuff lesions].

Traumatic rotator cuff lesions are a very rare condition. However, this article represents a comprehensive survey according to current knowledge on anatomy, biomechanics, and pathogenesis of rotator cuff pathology. Because of the relatively high prevalence of degenerative changes with increasing age, including partial and complete rotator cuff tears, it may be difficult to demonstrate the causality of an acute traumatic rotator cuff tear. Therefore, a catalogue of potential adequate and inadequate trauma mechanisms is proposed. Emphasis is also placed on posttraumatic diagnostic steps following persistent rotator cuff deficient shoulder function (e.g., ultrasound, MRI). From a legal aspect (e.g., private accident insurance, workers compensation claim), different minor and major criteria are defined, which could help experts to judge the causality of posttraumatic rotator cuff deficiency. These criteria mainly refer to distinct details concerning patients' history, trauma mechanism, primary clinical appearance, and diagnostic findings.

Diagnosis, Differential↗
PubMed2004

Associations between body-mass index and surgery for rotator cuff tendinitis.

BACKGROUND: Rotator cuff tendinopathy is a common entity. We hypothesized that obesity, because of biomechanical and systemic risk factors, increases the risks of rotator cuff tendinitis, tears, and related surgical procedures. METHODS: A frequency-matched case-control study was conducted. Three hundred and eleven patients who were fifty-three to seventy-seven years old and who underwent rotator cuff repair, arthroscopy, and/or other repair of the shoulder in a large hospital from 1992 to 2000 were included in the study. These surgical procedures were used as proxies for the risk of rotator cuff tendinitis. These patients were age and frequency-matched to 933 controls, who were randomly drawn from a pool of 10,943 potential controls consisting of Utah state residents who were enrolled in a large cancer-screening trial. Age-adjusted odds ratios were calculated with use of the International Classification of Diseases, Ninth Revision procedural codes and body-mass-index groups. The data were stratified according to gender and age. Multiple linear regression analyses also were performed. RESULTS: There was an association between increasing body-mass index and shoulder repair surgery. The highest odds ratios for both men (odds ratio = 3.13; 95% confidence interval = 1.29 to 7.61) and women (odds ratio = 3.51; 95% confidence interval = 1.80 to 6.85) were for individuals with a body-mass index of > or =35.0 kg/m(2). Tests for trend also were highly significant for both men (p = 0.002) and women (p < or = 0.001). Multiple linear regression analysis also indicated a significant association between increasing body-mass index and shoulder surgery (beta = 1.57; 95% confidence interval = 0.97 to 2.17; p < or = 0.001). CONCLUSIONS: There is an association between obesity and shoulder repair surgery in men and women who are fifty-three to seventy-seven years of age. The results of the present study suggest that increasing body-mass index is a risk factor for rotator cuff tendinitis and related conditions.

Aged↗