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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↗
PubMed2005

MRI of rotator cuff muscle atrophy in relation to glenohumeral joint incongruence in brachial plexus birth injury.

PURPOSE: To evaluate rotator cuff muscles and the glenohumeral (GH) joint in brachial plexus birth injury (BPBI) using MRI and to determine whether any correlation exists between muscular abnormality and the development of glenoid dysplasia and GH joint incongruity. MATERIALS AND METHODS: Thirty-nine consecutive BPBI patients with internal rotation contracture or absent active external rotation of the shoulder joint were examined clinically and imaged with MRI. In the physical examination, passive external rotation was measured to evaluate internal rotation contracture. Both shoulders were imaged and the glenoscapular angle, percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) and the greatest thickness of the subscapular, infraspinous and supraspinous muscles were measured. The muscle ratio between the affected side and the normal side was calculated to exclude age variation in the assessment of muscle atrophy. RESULTS: All muscles of the rotator cuff were atrophic, with the subscapular and infraspinous muscles being most severely affected. A correlation was found between the percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) and the extent of subscapular muscle atrophy (r(s)=0.45, P=0.01), as well as between its ratio (r(s)=0.5, P P=0.01). Severity of rotator cuff muscle atrophy correlated with increased glenoid retroversion and the degree of internal rotation contracture. CONCLUSIONS: Glenoid retroversion and subluxation of the humeral head are common in patients with BPBI. All rotator cuff muscles are atrophic, especially the subscapular muscle. Muscle atrophy due to neurogenic damage apparently results in an imbalance of the shoulder muscles and progressive retroversion and subluxation of the GH joint, which in turn lead to internal rotation contracture and deformation of the joint.

Adolescent↗
PubMed1984

[The value of computed tomography in the diagnosis of the rotator cuff tears and bone and soft tissue tumors].

This report consists of 2 parts. Part I: The usefulness of computed tomography (CT) in the diagnosis of rotator cuff tear was assessed. The rotator cuff could not be visualized in detail by CT unless introduction of contrast material into the joint cavity was performed. CT arthrography was performed on 21 cases of rotator cuff tears. The most detailed information was obtained when a relatively low concentration of contrast material (3.25% Angiografin) was filled in the joint cavity, and when the shoulder joint was rotated to the maximum outwards at the side. CT arthrography proved to be the most reliable method for assessing the extent and portion of the rotator cuff tears, so that it demonstrated conclusive evidence of diagnosis and management in 89% of patients studied. Part II: The usefulness of CT in the diagnosis of bone and soft tissue tumors was assessed. CT examination provided unique preoperative information which could imagine a more precise histological characteristics and anatomical localization of the lesion. Contrast enhancement (CE), when used, proved to be helpful in predicting the nature of tumors. The CE by intra-arterial infusion, or intravenous bolus injection of contrast material during the scan was more useful than that by intravenous drip infusion of the material. The information regarding change of tumor size, CT number and CE were appropriate indicators which directly corresponded to responsiveness of the tumor to the chemotherapy and radiotherapy performed. Preoperative ABC classification of the tumor by information regarding its size, location, definition and anatomical relation of tumors to vital structures (neural, vascular, and visceral) was done by using CT. The classification clearly corresponded to the status of patients regarding the treatment required for the patients.

Adolescent↗
PubMed2007

In vitro study comparing two collageneous membranes in view of their clinical application for rotator cuff tendon regeneration.

Tenocytes were isolated from the rotator cuff tendons of healthy (HT) and glucocorticoid (GC)-treated rats (GCT) and were cultured on polystyrene wells (TCP) as control, and on 2 de-cellularized collagen matrices: porcine small intestinal submucosa (SIS), and human dermal matrix (Graftjacket, GJ). At 3 and 7 days cell proliferation and synthesis were evaluated. Proliferation of HT tenocytes increased between experimental times for both tested membranes, but already at 3 days, HT tenocytes cultured on GJ showed the highest WST-1 value. The collagen-I (CICP) synthesis on GJ membrane did not change between experimental times and was significantly higher than TCP and SIS at 7 days. Proteoglycans (PG), and fibronectin (FBN) synthesis increased when HT were cultured on GJ, between experimental times, and both PG and FBN synthesis on GJ membrane were higher than TCP and SIS at 7 days. GC determined decreases in cell proliferation, CICP and PG syntheses at 3 days of culture on TCP when compared to HT tenocytes while a decrease in WST-1 was maintained at 7 days. CICP, PG and FBN (only at 3 days) syntheses were significantly higher in GCT tenocytes cultured on GJ. The negative effects on GC on GCT tenocytes cultured on membrane were particularly evident on SIS for CICP (-18%) and FBN (-67%) synthesis. The obtained results support the conclusion that GJ is more suitable than SIS as a scaffold for in situ tissue engineering and for the in vitro bioengineering of tendons to heal massive tears of the rotator cuff tendon.

Animals↗
PubMed1991

[Sources of error in sonographic diagnosis of the rotator cuff].

Sonography of the shoulder joint has developed into an established examination technique in the diagnosis of periarticular lesions of the shoulder. Sonographic diagnosis of the rotator cuff in particular contains a multitude of possible errors, which are gone into by this study by means of 149 clinically, radiologically and sonographically examined shoulder patients with an average age of 50.5 years. Besides errors made by wrong examination technique such of the transducer as incorrect adjustment of the equipment, insufficient contact of the transducer with the skin and unsuitable choice of the examination plane, there are sources of errors in the interpretation of the sonogram caused by lack of knowledge about physically caused artifacts and sonoanatomical qualities of the shoulder joint. Calcification inside the rotator cuff and the so-called "sonographic inhomogeneity of the rotator cuff" are numbered among the sources of error particular to the shoulder joint. Most errors in sonographic diagnosis of the rotator cuff can be avoided by careful examination of both shoulder joints with an exactly tuned ultrasound device, taking into account the sonoanatomical and ultrasonic qualities. Radiological examination of the affected shoulder joint cannot be replaced by ultrasound.

Diagnostic Errors↗
PubMed2002

The trans-rotator cuff approach to SLAP lesions: technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years.

PURPOSE: To discuss a new technique for the surgical treatment of type II SLAP lesions as well as the evaluation of the technique's effectiveness with a minimum 2-year follow-up. TYPE OF STUDY: Retrospective clinical follow-up study. METHODS: We present a clinical follow-up of 31 patients who were treated arthroscopically for type II SLAP lesions using a trans-rotator cuff portal at an average follow-up time of 3.7 years. Patients were screened for concomitant procedures including rotator cuff repairs, shoulder stabilizations, thermal capsullographies, and previous surgeries. These patients were subsequently excluded from the study. Patients were given a standard physical examination of the upper extremity at our institution and they completed both the L'Isalata and American Shoulder and Elbow Surgeons questionnaires. RESULTS: All 31 patients identified were available for follow-up at an average time of 3.7 years postoperatively (range, 2.0 to 7.4 years). The average L'Insalata score was 87.0 points (range, 46.1-100 points); the average ASES score was 87.2 points (range, 46.7-100 points). The average pain score was 1.5 (range, 0-5) and only 4 of the 31 patients complained of moderate pain with activity. Sixteen of the 31 patients returned to their preinjury level of sports; 11 of the 31 patients returned to limited activity and 2 patients were inactive at the time of follow-up. Overall satisfaction with the procedure averaged 3.79 points (range, 0-5 points): 22 patients rated overall satisfaction as good or excellent, 6 patients reported a fair outcome, and only 3 patients were unsatisfied with the results of the surgery. One patient who was unsatisfied with the procedure had reinjured his superior labrum and required a second operation. None of the 31 patients had symptoms suggestive of rotator cuff pathology. Of the 30 patients found to have a positive Active Compression test preoperatively, 26 of these patients now had a negative sign. CONCLUSIONS: The trans-rotator cuff approach allows for a more optimal placement of a biodegradable fixation device and/or suture anchors into the superior labrum. Furthermore, we believe that this approach does not compromise the function of the rotator cuff. The trans-rotator cuff technique is an effective and safe modality to address superior labral pathology.

Accidents, Traffic↗
PubMed1997

Partial-thickness rotator cuff tears. Pathogenesis and treatment.

Partial-thickness rotator cuff tears are now acknowledged to be an important entity in the spectrum of the impingement syndrome. The pathogenesis of partial-thickness tears is often age- and activity-related. Surgical decision making is influenced by the extent of the tear and the associated bony and soft-tissue pathology.

Aging↗
PubMedDate not supplied

The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient?

We evaluated the clinical outcome of arthroscopic acromioplasty and debridement in 162 patients who had either normal rotator cuffs, grade 1 (frayed tendon) partial-thickness tears, or grade 2 (less than 50% of the tendon) partial-thickness tears. The mean time from surgery to the response to the L'Insalata outcome questionnaire was 52.7 months (4.5 years) among the 105 respondents (107 shoulders). The mean score was 90 points; eight patients (8%) scored less than 70 points (range, 30 to 65.5), and their treatment failed early on. The patients with grade 2B (bursal) partial-thickness rotator cuff tears had a significantly higher failure rate (38%). Although the clinical outcome of patients with partial-thickness tears of the rotator cuff comprising less than 50% of the tendon (grade 1 and 2) was not significantly different from that of patients without partial rotator cuff tears, the subgroup of patients with grade 2B partial tears had a statistically significantly higher failure rate and may have been better served with primary repair. With follow-up to 10 years, there was no evidence that clinically relevant or symptomatic intrinsic rotator cuff pathologic conditions progress in those patients with partial-thickness tears treated with arthroscopic anterior acromioplasty.

Acromion↗
PubMed2005

Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis.

BACKGROUND: Outcomes assessment after the treatment of shoulder disorders has involved the use of various condition-specific outcome instruments. The purpose of this study was to determine the psychometric properties of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. METHODS: Test-retest reliability, internal consistency, content validity, criterion validity, construct validity, and responsiveness to change were determined for the American Shoulder and Elbow Surgeons shoulder scale within subsets of an overall study population of 455 patients with shoulder instability, 474 patients with rotator cuff disease, and 137 patients with glenohumeral arthritis. RESULTS: There was acceptable test-retest reliability for the overall American Shoulder and Elbow Surgeons shoulder scale (intraclass correlation coefficient = 0.94) and ten of eleven domains. There was acceptable internal consistency for patients with instability (Cronbach alpha = 0.61), rotator cuff disease (0.64), and arthritis (0.62). There were acceptable floor and ceiling effects for patients with instability (0% and 1.3%, respectively), rotator cuff disease (0% for both), and arthritis (0% for both). There was acceptable and appropriate criterion validity, with significant correlations (p < 0.05) between the overall American Shoulder and Elbow Surgeons scale and the physical functioning, role-physical, and bodily pain domains of the Short Form-12 scale, and nonsignificant correlations (p > 0.05) with the role-emotional, mental health, vitality, and social function domains. There was acceptable construct validity, with all twenty-three hypotheses demonstrating significance (p < 0.05), and acceptable responsiveness to change for patients with instability (standardized response mean, 0.93), rotator cuff disease (1.16), and arthritis (1.11). CONCLUSIONS: The use of outcome instruments with psychometric properties that have been vigorously established is essential. The American Shoulder and Elbow Surgeons subjective shoulder scale demonstrated overall acceptable psychometric performance for outcomes assessment in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis.

Adolescent↗
PubMed2003

Suspected rotator cuff lesions: tissue harmonic imaging versus conventional US of the shoulder.

PURPOSE: To compare tissue harmonic imaging (THI) of the shoulder with conventional ultrasonography (US) in patients suspected of having rotator cuff lesions. MATERIALS AND METHODS: THI and conventional US images were obtained in 50 patients suspected of having rotator cuff lesions. Images were graded for visibility of acromioclavicular (AC) joint surfaces and rotator cuff tendon contours and substances: Grade 1 meant poor; grade 2, moderate; and grade 3, good visibility. Accuracy, sensitivity, and specificity of the diagnosis of AC joint osteoarthritis and accuracy of the diagnosis and rates of underestimation and overestimation of the extent of rotator cuff tears were evaluated. Visibility grade differences were evaluated with the Wilcoxon signed rank test. The McNemar test was used to assess differences in diagnoses. Magnetic resonance (MR) arthrography was the reference standard. RESULTS: Mean visibility grades for readers 1 and 2, respectively, were as follows: for AC joint bone surfaces, 2.1 and 2.0 with THI and 1.7 (P =.010) and 1.7 (P =.16) with conventional US; for AC joint capsule surfaces, 2.2 and 1.9 with THI and 1.8 (P =.005) and 1.8 (P =.34) with US; for supraspinatus tendon contour, 2.6 and 2.2 with THI and 2.1 (P =.001) and 1.9 (P =.055) with US; for supraspinatus tendon substance, 2.2 and 1.9 with THI and 2.0 (P =.036) and 1.7 (P =.070) with US; for subscapularis tendon contour, 2.4 and 2.1 with THI and 2.2 (P =.07) and 2.0 (P =.25) with US; and for subscapularis tendon substance, 1.8 and 1.7 with THI and 2.0 (P =.86) and 1.7 (P =.91) with US. Diagnostic accuracies for the supraspinatus tendon for readers 1 and 2, respectively, were 84% and 74% with THI and 86% and 70% with US (P >.99 for both readers). Corresponding values for the subscapularis tendon were 78% and 72% with THI and 64% (P =.27) and 52% (P =.006) with US. CONCLUSION: Joint and tendon surface visibility improves with THI, as compared with the visibility achieved with conventional US. THI is superior to conventional US for diagnosis of subscapularis tendon abnormalities.

Adult↗
PubMed2005

Application of tissue engineering techniques for rotator cuff regeneration using a chitosan-based hyaluronan hybrid fiber scaffold.

BACKGROUND: The current surgical procedures for irreparable rotator cuff tears have considerable limitations. Tissue engineering techniques using novel scaffold materials offer potential alternatives for managing these conditions. HYPOTHESIS: A chitosan-based hyaluronan hybrid scaffold could enhance type I collagen products with seeded fibroblasts and thereby increase the mechanical strength of regenerated tendon in vivo. STUDY DESIGN: Controlled laboratory study. METHODS: The scaffolds were created from chitosan-based hyaluronan hybrid polymer fibers. Forty-eight rabbit infraspinatus tendons and their humeral insertions were removed to create defects. Each defect was covered with a fibroblast-seeded scaffold (n = 16) or a non-fibroblast-seeded scaffold (n = 16). In the other 16 shoulders, the rotator cuff defect was left free as the control. At 4 and 12 weeks after surgery, the engineered tendons were assessed by histological, immunohistochemical (n = 2), and biomechanical (n = 6) analyses. RESULTS: Type I collagen was only seen in the fibroblast-seeded scaffold and increased in the regenerated tissue. The tensile strength and tangent modulus in the fibroblast-seeded scaffold were significantly improved from 4 to 12 weeks postoperatively. The fibroblast-seeded scaffold had a significantly greater tangent modulus than did the non-fibroblast-seeded scaffold and the control at 12 weeks. CONCLUSION: This scaffold material enhanced the production of type I collagen and led to improved mechanical strength in the regenerated tissues of the rotator cuff in vivo. CLINICAL RELEVANCE: Rotator cuff regeneration is feasible using this tissue engineering technique.

Animals↗
PubMed1992

Screw fixation of a complete rotator cuff tear.

Partial and sometimes full-thickness rotator cuff tears can be managed by arthroscopic debridement and anterior acromioplasty. The recent literature on shoulder arthroscopy does not however mention any alternative operation techniques for this very common lesion. We present a case of a distal avulsion of the supraspinatus vendar tendon which was reattached with one screw and washer under arthroscopic control. Indications for this type of fixation are discussed.

Arthroscopy↗
PubMed1993

The influence of variations of the coracoacromial arch on the development of rotator cuff tears.

In order to define the geometry of the coracoacromial arch in both its bony and soft parts and to bring it into relationship with rotator cuff tears, 54 cadaver shoulders (from subjects aged 47-90 years) were dissected and X-rayed (anteroposterior projection and supraspinatus outlet view). Partial rotator cuff tears were assessed additionally by transillumination and polarized microscopy. After transfixation of the coracoacromial arch with a polyurethane mould, sections were made along the coracoacromial ligament. The morphology of the acromion was described following the classification of Bigliani et al. [5]. Amongst other parameters, measurements were taken between the long axis of the scapula, the spina, and the acromion. In 19 of 22 cases, a traction osteophyte was associated with rotator cuff tears. In incomplete tears, spurs were completely encased within the ligament and did not impair the subacromial space. The number of rotator cuff tears was significantly increased in shoulders with "curved" acromia, flat acromial slope, and increased angle between the scapular plane and the spina (intact, mean 58 degrees; tears, mean 47 degrees). The morphology of the subacromial space was secondarily determined by this angle. In contrast to Bigliani et al. we were unable to find a "hooked" acromion. These results indicate that the combination of a flat and curved acromion or a position of the acromioclavicular joint above the cranial pole of the glenoid must be regarded as considerable risks for the development of rotator cuff tears. The concept of anterior acromioplasty is supported by our results.

Acromioclavicular Joint↗
PubMed2000

MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects.

OBJECTIVE: To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings. DESIGN AND PATIENTS: Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27-53 months (mean 39 months) after open transosseous reinsertion of the rotator cuff. Coronal T2-weighted turbo spin-echo and turbo STIR or T2-weighted fat-suppressed MR images were obtained. The prevalence and extent of residual defects or retears of the rotator cuff and bursitis-like subacromial abnormalities were determined. RESULTS: Residual defects or retears were detected in three (21%) and bursitis-like abnormalities in 14 (100%) of the 14 asymptomatic patients. Fifteen (47%) residual defects or retears and 31 (97%) bursitis-like abnormalities were diagnosed in the 32 patients with residual symptoms. The size of the residual defects/retears was significantly smaller in the asymptomatic group (mean 8 mm, range 6-11 mm) than in the symptomatic group (mean 32 mm, range 7-50 mm) (t-test, P = 0.001). The extent of the bursitis-like subacromial abnormalities did not significantly differ (t-test, P > 0.05) between asymptomatic (mean 28 x 3 mm) and symptomatic patients (mean 32 x 3 mm). CONCLUSION: Small residual defects or retears (< 1 cm) of the rotator cuff are not necessarily associated with clinical symptoms. Subacromial bursitis-like MR abnormalities are almost always seen after rotator cuff repair even in patients without residual complaints. They may persist for several years after rotator cuff repair and appear to be clinically irrelevant.

Adult↗
PubMed2006

Comparison of the MR findings on indirect MR arthrography in patients with rotator cuff tears with and without symptoms.

PURPOSE: To compare indirect magnetic resonance (MR) arthrography findings in patients with rotator cuff tears with and without symptoms. MATERIALS AND METHODS: Indirect MR arthrography results of 15 asymptomatic and 23 symptomatic rotator cuff tears were retrospectively reviewed, comparing the type and size of tears and amount of subacrominal-subdeltoid bursal fluid. RESULTS: There were 14 partial-thickness tears and one full-thickness tear in the asymptomatic group, with 4 small and 11 medium tears. In the symptomatic group, there were 16 partial-thickness and 7 full-thickness tears, with 14 small, 5 medium, and 4 large tears. In the asymptomatic group, the amount of subacrominal-subdeltoid bursal fluid was grade 0, 6 patients; grade 1, 6 patients; grade 2, 2 patients; and grade 3, 1 patient. In the symptomatic group, the amount of subacrominal-subdeltoid bursal fluid was grade 0, 4 patients; grade 1, 3 patients; grade 2, 8 patients; and grade 3, 8 patients. We found no statistically significant difference between symptomatic and asymptomatic tears in the kind and size of tears, and in the amount of subacrominal-subdeltoid bursal fluid. CONCLUSION: We found no difference in the MR findings between symptomatic and asymptomatic rotator cuff tears.

Aged↗
PubMed2003

Surgical repair of the rotator cuff: a biomechanical evaluation of different tendon grasping and bone suture fixation techniques.

OBJECTIVE: This study investigated the initial strength and failure mode of different rotator cuff repair techniques. BACKGROUND: Full or partial re-rupture of the repair is one of the main post-operative complications for rotator cuff repair. The rate of failure is strongly affected by the extension of the tear, increasing in case of large or massive tears up to 62%. DESIGN: The study was planned to assess the three individual components of the tendon-to-bone repair (tendon grasping, suture knotting, suture-to-bone fixation) and to identify the best combinations in terms of mechanical strength to failure. The best combinations were tested to compare the mechanical behaviour of the entire repair and suggest potential improvements in the repair technique. METHODS: Experimental tests were performed using sheep shoulders. Three tendon-grasping techniques, two suture knotting techniques, and the effect of bone augmentation with metallic plate and bone quality on suture-to-bone fixation were investigated. RESULTS: This study assessed the mechanical behaviour of different repair components. The best combinations of the investigated techniques showed that the weakest link was the tendon-suture interface. More importantly, the compliance of the investigated repairs was large. CONCLUSIONS: The initial strength of the rotator cuff repair can be improved by changing the repair technique. Nevertheless, even a low physiological load stressing the repaired tendon may cause a gap formation at the tendon-bone interface without necessarily producing failure of the repair. RELEVANCE: Post-operative protection of the repaired rotator cuff from tension load is necessary to reduce the risk of delaying or preventing of the healing process.

Animals↗
PubMedDate not supplied

Rotator cuff tearing and inferior subluxation of the humeral head: report of two cases.

We encountered two patients with atraumatic rotator cuff tears who exhibited inferior subluxation of the humeral head. In both patients shoulder motion was limited by pain. Repair of the rotator cuff tear relieved the pain and restored glenohumeral joint motion. Although the cause of this unusual complication of rotator cuff damage remains unclear, the inferior subluxation was associated with reflex muscle hypotonia, which would have reduced the pressure in the subacromial space and thus would have decreased the pain caused by the cuff lesion. No similar case seems to have been documented in the literature.

Adult↗
PubMedDate not supplied

[Stress on the rotator cuff sutures in relation to joint position].

UNLABELLED: In a vitro study we evaluated the influence of surgical technique on the postoperative tension of the supraspinatus tendon in rotator cuff ruptures. In ten shoulder specimens Hall-Effect Strain Gauge (HEST) were implanted in the supraspinatus tendon close to the insertion at the humerus. We documented the tension in specimens with intact rotator cuff as well as after reconstruction of small and large tears in different joint positions. In the specimens with an intact rotator cuff there was almost no tension registered. Only in adduction with external rotation and flexion we found slightly increased values. After reconstruction we found the highest tension in adduction, flexion, and external rotation of the humerus. Release of the coracohumeral ligament resulted in a decrease of tension in flexion and external rotation. Whereas in extension coracohumeral ligament release had no influence on the tension of the tendon. However, after complete capsule release the tension in extension also decreased. CLINICAL RELEVANCE: If mobilisation in cases of rotator cuff reconstruction is necessary we recommend first release of the coracohumeral ligament in small and moderate tears. In major tears a complete capsule release is necessary. During physical therapy in the early postoperative course, flexion in the adducted and externally rotated arm should be avoided.

Adult↗