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PubMedDate not supplied

A simple suture shuttle in rotator cuff repairs: a technical note.

In rotator cuff repairs, it is often necessary to pass 2 tails of 2 sutures through 1 transosseous hole to maximize the number of sutures per hole. We report on a simple technique with a double-loop suture thread that allows the passing of more than 1 suture limb through the same hole. This simple device, the simple suture shuttle, used in cuff repairs in combination with the modified Mason-Allen suture technique, significantly reduces the difficulty of passing more than 1 suture tail through a single bone tunnel. By reducing the number of bone tunnels, the weakening of a bone that might not be very strong is kept to a minimum. The Simple Suture Shuttle can also be used to pass more sutures through a given number of transosseous holes.

Humans↗
PubMedDate not supplied

Development and use of an animal model for investigations on rotator cuff disease.

Although both intrinsic and extrinsic factors have been implicated in the cause of rotator cuff disease, previous studies have not been designed to test hypotheses of this disease, partly because of the lack of an appropriate animal model. Thirty-three animals were evaluated according to a 34 item checklist of criteria to determine their appropriateness as an animal model for investigations on the rotator cuff. Only the rat shoulder satisfactorily fulfilled all criteria, with a prominent supraspinatus tendon passing under an enclosed arch. Once the rat was identified, 36 rats were randomized to three experimental groups. One group (n = 12) was treated with an intratendinous injection of bacterial collagenase simulating an acute intrinsic injury, another group (n = 12) was treated with an acromial alteration to reduce the subacromial space simulating an external compression, and the third group (n = 12) was treated with a combination of both modifications. Significant increases in cellularity, number of fibroblasts, and collagen disorganization were seen in all experimental tendons compared with a contralateral control group. Semiquantitative grading of histologic sections revealed marked changes in all groups at 4 and 8 weeks. Injuries appeared to be healing at 12 weeks except in the combination group, which seemed to demonstrate persistent alterations. This study supports the rat as an appropriate model for investigating rotator cuff disease. In addition, this study demonstrates that both intrinsic and extrinsic alterations can induce changes in the supraspinatus tendon, which may have similarities to human tendon disease.

Animals↗
PubMed1997

Rotator cuff: evaluation with fast spin-echo versus conventional spin-echo MR imaging.

PURPOSE: To determine if fast spin-echo (SE) magnetic resonance (MR) imaging can provide similar information to that of conventional SE imaging for evaluation of the rotator cuff. MATERIALS AND METHODS: One hundred twenty-six patients underwent MR imaging with conventional SE and non-fat-suppressed fast SE sequences (65 patients) or conventional SE and fat-suppressed fast SE sequences (61 patients). Two radiologists independently graded the rotator cuff with separate and side-by-side assessment of the fast SE and conventional SE images. RESULTS: For detection of full-thickness tears, agreement between non-fat-suppressed fast SE and conventional SE images was 93.8% (kappa = 0.78 [good]) and 95.4% (kappa = 0.82 [very good]) for the two readers, respectively, and agreement between fat-suppressed fast SE and conventional SE images was 98.4% (kappa = 0.96 [very good]) and 91.8% (kappa = 0.73 [good]) for the two readers, respectively. Rotator cuff grading was similar for fast SE and conventional SE: weighted kappa = 0.77 (good) and 0.68 (good) for non-fat-suppressed and weighted kappa = 0.83 (very good) and 0.67 (good) for fat-suppressed fast SE images for the two readers, respectively. CONCLUSION: Fast SE sequences yield similar interpretations as those obtained with a conventional SE sequence for evaluation of the rotator cuff.

Adolescent↗
PubMed1998

Gadolinium MR Arthrography of the Rotator Cuff.

Conventional magnetic resonance imaging (MRI) of the rotator cuff has not done well in distinguishing partial-thickness tears from tendonitis or small, full-thickness tears. However, these are important distinctions for orthopedic surgeons who are deciding whether to operate and what type of surgery to perform on a patient with suspect rotator cuff pathology. Gadolinium magnetic resonance arthrography (MRA) involves injecting dilute gadolinium into the shoulder under fluoroscopy. Subsequent multiplanar T1-weighted fat-suppressed fast spin echo combined with T2-weighted fast spin echo and short tau inversion recovery (STIR) produces images that can accurately differentiate absence of tear from partial-thickness tear and from small, full-thickness tear; as a fringe benefit, this combination of sequences can identify the inflammation associated with tendonitis. Furthermore, the technique differentiates articular from bursal surface partial-thickness tears, and it accurately quantitates the size of full-thickness tears to help surgeons choose between arthroscopic versus open surgery.

Journal Article↗
PubMed2000

Ultrasound investigation of the rotator cuff after computed arthrotomography coupled to bursography.

OBJECTIVES: To evaluate the diagnostic performance of ultrasound rotator cuff imaging after injection of contrast medium into the glenohumeral joint and subacromial bursa. PATIENTS AND METHODS: Twenty-eight patients underwent ultrasonography before and after injection into the glenohumeral joint and subacromial bursa of a mixture of iodinated contrast medium and lidocaine solution. Findings were compared with those from computed tomography of the joint and bursa. RESULTS: Sixteen 16 (16/28, 57%) post-contrast ultrasound scans revealed or confirmed rotator cuff lesions. For supraspinatus and infraspinatus lesions, there were three false-negatives and no false-positives. Three false-negatives were recorded for subscapularis lesions. All false-negatives occurred both before and after the contrast medium injections. CONCLUSION: Injecting contrast medium into the glenohumeral joint and subacromial bursa improves the diagnostic yield of rotator cuff ultrasonography. We suggest that ultrasonography be performed after injections of drugs into the shoulder structures, particularly the subacromial bursa.

Acromioclavicular Joint↗
PubMed1989

Rotator cuff function in the impingement syndrome.

Thirty-three patients with impingement syndrome of the rotator cuff were studied before and at operation. It was shown that the rotator cuff lengthens and twists during elevation of the arm. Elevation is achieved by early glenohumeral abduction and continuous flexion and external rotation. The range of free rotation at the glenohumeral joint diminishes progressively during elevation. Rotator cuff impingement occurs towards the end of the early glenohumeral abduction. Excision arthroplasty of the acromioclavicular joint and anterior acromioplasty is highly effective for impingement under the acromion, but only moderately effective where impingement is under the acromioclavicular joint.

Adolescent↗
PubMed1991

The effect of arm position and capsular release on rotator cuff repair. A biomechanical study.

A cadaver study was performed to determine the effect of arm position and capsular release on rotator cuff repair. Artificial defects were made in the rotator cuff to include only the supraspinatus (small) or both supraspinatus and infraspinatus (large). The defects were repaired in a standard manner with the shoulder abducted 30 degrees at the glenohumeral joint. Strain gauges were placed on the lateral cortex of the greater tuberosity and measurements were recorded in 36 different combinations of abduction, flexion/extension, and medial/lateral rotation. Readings were obtained before and after capsular release. With small tears, tension in the repair increased significantly with movement from 30 degrees to 15 degrees of abduction (p < 0.01) but was minimally affected by changes in flexion or rotation. Capsular release significantly reduced the force (p < 0.01) at 0 degree and 15 degrees abduction. For large tears, abduction of 30 degrees or more with lateral rotation and extension consistently produced the lowest values. Capsular release resulted in 30% less force at 0 degree abduction (p < 0.05).

Arm↗
PubMedDate not supplied

Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing.

The goals of this study were to define biplanar glenohumeral kinematics and glenohumeral-scapulothoracic motion relationships in normal patients with a two-plane radiograph series and then in patients with anterior shoulder instability or rotator cuff tear both before surgery and after surgical repair and postoperative rehabilitation. A two-plane radiographic series of x-ray films in the scapular and horizontal (axillary) planes was performed. With these films, measurements of the relationship between the centers of the humeral head and glenoid and measurements of the component contributions of glenohumeral and scapulothoracic motion to total arm abduction were made. Six normal adults underwent x-ray evaluation to establish normal control values. Kappa analysis was used to determine reliability of technique. Eighteen patients with confirmed anterior shoulder instability (group A) and 15 with confirmed rotator cuff tears (group B) were studied before surgery. Seven (39%) of 18 of the patients in group A and all 15 (100%) of the patients in group B demonstrated superior translation of the humeral head during scapular plane abduction. In the horizontal plane 14 (78%) of 18 patients in group A (instability) and none in group B (rotator cuff tear) demonstrated abnormal anterior translation of the humeral head on the glenoid. Both groups demonstrated altered glenohumeral-scapulothoracic motion relationships compared with the normal control group. Two years after surgery 12 patients from group A and 14 patients from group B were restudied. All of these patients had demonstrated abnormalities of humeral head translation before surgery. For group A 12 (100%) of 12 patients demonstrated normal glenohumeral kinematics in both planes after open anterior stabilization. For group B 12 (86%) of 14 patients demonstrated normal glenohumeral kinematics in both planes after open rotator cuff repair. In group A the altered glenohumeral-scapulothoracic motion relationships persisted, whereas in group B these relationships became normal.

Adolescent↗
PubMedDate not supplied

Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa.

Small intestinal submucosa (SIS) has been used for reinforcement of other tissues in the body with success and has been shown to act as a bioabsorbable tissue scaffold that promotes and assists healing. The effectiveness of using porcine SIS as a tissue scaffold for reinforcement of rotator cuff repair is unclear. This study evaluates both clinical and magnetic resonance imaging (MRI) follow-up at 6 months in patients with large and massive rotator cuff tears treated with open repair and SIS reinforcement or interpositional grafting. Eleven consecutive patients who underwent open rotator cuff repair with SIS augmentation for large or massive tears were selected retrospectively, and their charts were reviewed. Magnetic resonance images were then obtained at least 6 months after the index procedure. Patients were evaluated clinically and with a questionnaire, and an American Shoulder and Elbow Surgeons shoulder score was calculated. Results showed retear on MRI in 10 of 11 patients with recurrence of large, retracted tears. One repair remained intact by MRI evaluation at 10 months. Clinically, there was no statistically significant difference between preoperative and postoperative shoulder scores by use of a paired t test analysis (P =.70). Five patients had worse scores postoperatively. We concluded that, though SIS xenografting may be effective in other areas of the body for tendon healing, its use in reinforcement of large and massive rotator cuff repairs seems to be ineffective and does not improve clinical outcome.

Aged↗
PubMed2002

Use of an allograft bone button for rotator cuff repair.

Bone button anchors constructed from allograft bone were investigated as an alternative for rotator cuff repair. Bone button anchors were used in 59 consecutive procedures after mechanical pullout strength and cyclical loading bench testing. Sequential radiographs demonstrated that the anchors locked in cancellous bone and provided consistent fixation with no loosening or lysis in 1 year of clinical follow-up. Mechanical testing demonstrated mean, pullout strength of 160.2 N (36 lbs), and the anchors did not migrate when cyclically loaded. Clinical results showed an allograft anchor is viable for rotator cuff tendon repair.

Adult↗
PubMedDate not supplied

The anatomy of the subscapularis tendon insertion as applied to rotator cuff repair.

The tendons constituting the rotator cuff (RC) are often torn, and several techniques for their repair have been established. The existence of an extension of the supraspinatus tendon into that of the subscapularis has often been overlooked. The purpose of this study was to study this extension in human dissections. The possible posterolateral extension of the subscapularis tendon and the interdigitating of this extension with the supraspinatus tendon were addressed. A horizontal band of tissue 1 cm below the superior ridge of the greater tuberosity of the humerus was harvested from 43 cadavers and thus included tissue constituting the greater tuberosity, bicipital groove, and lesser tuberosity. The sample extended 2 cm medially along the lesser tuberosity and 1 cm laterally along the greater tuberosity. Macroscopic findings suggest a continuous band of tissue extending across the bicipital groove. High collagen content was microscopically confirmed at different sections, and the collagen was densely distributed along the horizontal axis of the tissue samples.

Cadaver↗
PubMed2026

The Effect of Game-Based Virtual Reality Rehabilitation and Its Impact on Upper Extremity Function After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) often results in prolonged recovery and limited shoulder function. Conventional physical therapy rehabilitation programs require sustained patient engagement; however, adherence is frequently low. Game-based virtual reality (VR) offers an interactive and engaging environment that may enhance rehabilitation outcomes. OBJECTIVE: To evaluate the effect of a game-based VR program on the function of the upper limb in patients following ARCR. METHODS: A randomized controlled trial was conducted with patients who underwent ARCR. Participants were randomized into two groups: game-based VR or conventional rehabilitation. Outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand score, pain severity by the Numerical Pain Rating Scale, range of motion measures, and muscle strength testing. Assessments were performed at baseline and at 6 weeks and 12 weeks post surgery. RESULTS: Results have shown significant within-group improvements in pain, function, range of motion, and isometric muscle strength across all time points (P < 0.05). Between-group analysis revealed greater improvements in pain, function, flexion range, and abduction and external rotation strength in the experimental group at both time points (P < 0.05). Abduction range improved significantly only at 12 weeks (P = 0.02), whereas external rotation range showed no significant difference between groups at either time point (P > 0.05). CONCLUSION: The findings indicate that integrating game-based VR rehabilitation provides additional benefits over conventional therapy in improving pain and upper extremity function following ARCR. These findings support the use of VR as an effective alternative to the conventional rehabilitation for postoperative rehabilitation.

Humans↗
PubMed1992

Incomplete rotator cuff tears. Results of operative treatment.

Thirty-eight shoulders of 36 patients with incomplete rotator cuff tears surgically repaired were evaluated, with an average follow-up period of 4.9 years. The average age at operation was 52.2 years. Three types of incomplete tears were identified: superficial (12 shoulders), intratendinous (three), and deep surface tears (23). Full-thickness cuff involving the lesion was resected and repaired by side-to-side suture (13 shoulders), side-to-bone suture (eight), fascial patch grafting (16), or side-to-bone suture with fascial patch grafting (one). The overall results were satisfactory in 31 shoulders (82%). The results were not affected by the tear types, operative methods, or follow-up period. The patients with poor results were associated with major complications other than rotator cuff tears or with insufficient resection of the damaged cuff. When the full-thickness cuff involving the lesion is completely resected and repaired, long-term satisfactory results can be anticipated in a high percentage of patients regardless of tear types.

Adolescent↗
PubMedDate not supplied

Biomechanical evaluation of a rotator cuff defect model augmented with a bioresorbable scaffold in goats.

A bioresorbable patch used for augmentation of rotator cuff repair was evaluated to determine if it would increase strength of cuff repairs associated with tendon defects and also show histologic incorporation over time. Forty goats underwent rotator cuff repairs of the infraspinatus tendon bilaterally. Tendons were detached and a defect was created prior to repair. One side was repaired and augmented with a 4 cm2 polylactic acid patch in each animal. On the other side, the same size defect was repaired in the same manner but without the patch to serve as a control. Animals were sacrificed at 3, 6, 12, and 24 weeks. Ultimate load to failure and histology were reported. No significant difference in load to failure was found between groups. A cellular fibrous tissue occupied the patch at 6 weeks, which over time matured into a dense, homogeneous fibrous tissue with alignment of collagen between the scaffold bundles.

Absorbable Implants↗
PubMed2006

Preliminary results after rotator cuff reconstruction augmented with an autologous periosteal flap.

Periosteal augmentation of tendons in the course of refixation to bone has been shown to be a suitable method for early primarily stable osteofibroblastic integration. The aim of this study was to evaluate the clinical and radiological results of open rotator cuff reconstruction using an autologous periosteal flap augmentation technique. The research was performed as a prospective cohort study. Twenty-three prospective patients (average age 59.7 years) with degenerative rotator cuff tears were operated on with an open technique and a subtendinous periosteal flap augmentation using bioabsorbable suture anchors and a modified Mason-Allen technique. Clinical evaluation consisted of the Constant-Score and the Simple Shoulder test. Radiological evaluation included standard radiographs and magnetic resonance imaging (MRI). Twenty patients were evaluated at a mean follow-up of 14.4 months. The average Constant Score increased significantly from 51.7 to 80.9 points (p<0.05) with 12 excellent, seven good and one satisfactory result. The Simple Shoulder test showed a significant increase of an average of 4.8-10.7 questions answered with yes (p<0.05). Four patients (20%) demonstrated a retear of the tendon on postoperative MRI. Ectopic ossifications in the supraspinatus tendon were found in four patients (20%) but these had no impact on the final clinical results. Open rotator cuff repair augmented with an autologous periosteal flap shows high patient satisfaction level with low rerupture rates. Mid- and long-term results remain to be seen. The potential benefits compared with conventional open or arthroscopic rotator cuff surgery must be examined in prospective randomized studies.

Activities of Daily Living↗
PubMed1998

Fractures of the greater tuberosity presenting as rotator cuff abnormality: magnetic resonance demonstration.

BACKGROUND: To show that magnetic resonance imaging (MRI) can be useful to diagnose radiographically invisible greater tuberosity fractures in patients with clinical presentations suspicious for rotator cuff injury. METHODS: Six patients with subtle greater tuberosity fractures who were sent for MRI because of possible rotator cuff tear are reviewed (age range, 27-51 years; mean, 40.5 +/- 8.4 years). Five of the patients recount direct trauma to their shoulders, whereas one noticed shoulder pain after a fall in which she fractured her ankle. RESULTS: MRI showed an area of edema confined to the greater tuberosity with linear low signal extending through the tuberosity consistent with a fracture in all cases. Although five patients had a complete set of shoulder radiographs before MRI, these were interpreted as normal in all cases. Full-thickness rotator cuff tears were not present in any of the cases. All of the patients were treated conservatively with good results. CONCLUSIONS: MRI can prevent unnecessary arthroscopy in patients clinically suspected of rotator cuff damage by showing subtle fractures of the greater tuberosity not visible on radiographs.

Accidental Falls↗
PubMedDate not supplied

Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically.

The purpose of this study was to examine longitudinally the natural history of asymptomatic rotator cuff tears over a 5-year period and to assess the risk for development of symptoms and tear progression. Since 1985 through the present, bilateral sonograms were done on all patients. A review of consecutive sonograms done from 1989 to 1994 revealed 58 potential patients with unilateral symptoms who had contralateral asymptomatic rotator cuff tears. Of these 58 patients, 45 (22 men, 23 women) responded to a comprehensive questionnaire and 23 additionally returned for examination and repeat sonographic evaluation. The questionnaire was based on the American Shoulder and Elbow Surgeons score and included several outcome-based questions. A physical examination was performed in a standardized fashion along American Shoulder and Elbow Surgeons guidelines. Repeat high-resolution sonograms were performed by a single experienced radiologist. Primary and repeat sonograms were then reassessed for tear size and location by two independent experienced radiologists blinded to the clinical data results. Twenty-three (51%) of the previously asymptomatic patients became symptomatic over a mean of 2.8 years. The average Activities of Daily Living score for those remaining asymptomatic was 28.5 of 30 and for those becoming newly symptomatic, 22.9 of 30 (P <.5). The mean visual analog pain score (1 = no pain) for those remaining asymptomatic was 1.1 and for the newly symptomatic patients, 4.0. Of the 23 patients who returned for ultrasound, 9 were asymptomatic and 14 symptomatic. Only 2 of the 9 patients remaining asymptomatic had progression of their tears. Overall, 9 of 23 patients had tear progression. No patient had a decrease in the size of the tear. Our results demonstrate that symptoms can develop in patients with previously asymptomatic rotator cuff tears when seen in the context of a contralateral symptomatic tear. Development of symptoms was associated with a significant increase in pain and decrease in the ability to perform activities of daily living (P <.05). There appears to be a risk for tear size progression over time.

Activities of Daily Living↗
PubMed2000

Mini-deltoid splitting rotator cuff repair: do results deteriorate with time?

To determine whether the results of arthroscopically assisted rotator cuff repair deteriorate with time, 60 shoulders were evaluated on 2 separate occasions. There were 7 small, 16 medium, 20 large, and 17 massive tears. Patients were evaluated with a detailed questionnaire that included the UCLA shoulder scale and physical examination. Average initial follow-up was at 21 months (range, 12 to 68 months), and the second follow-up was at an average of 62 months (range, 24 to 103 months); only 4 patients had a change of more than 3 points on the UCLA scoring scale. No statistically significant difference was found in pain, function, range of motion, strength score, satisfactory results (80% on both occasions), and UCLA score (30.8 v 31.4) at second follow-up. The results of our study indicate that there is no significant deterioration over time of results of rotator cuff repair using the mini-deltoid splitting technique.

Arthroscopy↗