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PubMed1999

Five year results of rotator cuff repair.

In thirty nine patients with either an acute rotator cuff rupture or a chronic impingement syndrome plus a cuff tear, a standard acromioplasty was performed along with a cuff repair using a bone detaching approach. Postoperative active motion was allowed in all but three. Follow up examination was performed two and five years after the operation. Continuous improvement in function, range of movement, and strength was observed, while pain increased slightly. The size of the tear and delay in treatment were determining factors in the outcome.

Acute Disease↗
PubMed2000

[Rotator cuff rupture. Diagnostic imaging].

Conventional radiography, ultrasound, Magnetic Resonance (MR), Arthrography Computed Tomography (Arthro-CT) and Arthrography Magnetic Resonance (Arthro-MR) are available for diagnosis of rotator cuff tears. Our purpose is to assess the specificity and sensitivity of these examinations and if they could give to the surgeon all the informations to select the more accurate treatment. We have evaluated retrospectively the images of 68 patients, 43 male and 25 female (average age 51 years), which then have been surgically treated for rotator cuff pathology. On the basis of our findings, we think that conventional radiography and ultrasound are excellent in a first evaluation. MR images, particularly in the coronal and sagittal oblique planes, are able to demonstrate partial or complete rotator cuff tears. The use of intra-articular contrast medium (arthro-CT, arthro-MR) should be reserved for partial lesions on specific cases.

Adult↗
PubMed2001

Comparative studies of MRI and operative findings in rotator cuff tear.

A prospective study was performed to determine the accuracy of magnetic resonance imaging (MRI) compared with operative findings in the evaluation of patients associated with rotator cuff tears. Fifty-four of 60 shoulders (58 patients) examined by MRI were confirmed as full-thickness tears and 6 as partial-thickness tears at the time of surgery. The oblique coronal, oblique sagittal, and axial planes of T2-weighted images with the 0.5 tesla MRI system were obtained preoperatively and compared with operative findings. MRI correctly identified 46 of 54 full-thickness rotator cuff tears and 5 of 6 partial-thickness tears. A comparison of MRI and operative findings in full-thickness cuff tears showed a sensitivity of 85%, a specificity of 83%, and a positive prospective value (PPV) of 99%. A comparison of partial-thickness tears showed a sensitivity of 83%, a specificity of 85%, and PPV of 39%. Linear regression analysis showed an excellent correlation between the MRI assessment and measurement at the time of surgery (r = 0.90, P < 0.01). MRI was useful in evaluating large and medium-sized rotator cuff tears, but less useful in distinguishing small full-thickness tears from partial-thickness tears.

Adult↗
PubMed2002

[Reproducibility of CT scan evaluation of muscular fatty degeneration. Intra- and interobserver analysis of 56 shoulders presenting with a ruptured rotator cuff muscles].

PURPOSE OF THE STUDY: This study was undertaken to determine the reproducibility of measurements of fatty degeneration of the rotator cuff using computed tomography (CT). MATERIAL AND METHODS: Fifty-six patients who had undergone surgery for rotator cuff tear were included in this retrospective study. The extent of fatty infiltration was evaluated on CT scans with soft tissue windows in all 56 shoulders using a five-stage scoring system described by Goutallier. Five independent observers made the assessments. The same operation was repeated one month later to test intraobserver agreement. Four parameters were recorded: fatty infiltration of three muscles (supraspinatus, infraspinatus, subscapularis), and overall fatty infiltration grading. Interobserver variability was determined for each parameter using the intercorrelation coefficient (a test of reproducibility of quantitative measurements). RESULTS: The most reproducible measurement was the overall fatty infiltration grade. For this parameter, interobserver agreement was good with an intercorrelation coefficient of 0.75. The interval of confidence was +/- 0.5. Intraobserver agreement depended on the observer's level of experience. It was good for overall fatty infiltration grade assess by three senior observers (r=0.78) and moderate for two junior observers. CONCLUSION: The overall fatty infiltration grade is a reproducible parameter that should be used to evaluate the degree of fatty infiltration as the safety margin of this value (graded 0 to 4) is about 0.5. Fatty infiltration of a torn cuff would not be the only criterion to improve indications for treatment of rotator cuff tears.

Adipose Tissue↗
PubMed2000

[Rotator cuff tears: diagnosis and therapy].

Since the life span of our society is increasing and the expectation of high functional demands is growing more and more older people take part in sports activities emphasises the necessity of early diagnosis of rotator cuff lesions and their correct treatment. The goal of any diagnostic means should be a proper treatment of rotator cuff lesions according to the detected pathology. New arthroscopic techniques to surgically reconstruct rotator cuff tears have brought the operative repair techniques another step further. In cases of large and complex cuff tears the surgeon can individually select an adequate reconstruction procedure which includes anatomical-, partial-, tendon-transfer and muscle-transfer repairs. In cases of irreparable tears with cuff-tear arthropathy and consecutive superior migration of the humeral head hemiarthroplasty or the inverse deltoid prosthesis have to be considered. Based on clinical, radiological and arthroscopic findings we developed algorithms that will lead to the best suited procedure for a given lesion.

Algorithms↗
PubMedDate not supplied

Rotator cuff repairs in patients 62 years of age or older.

We retrospectively reviewed 105 consecutive patients aged 62 years and older who had undergone a repair of a rotator cuff tear to evaluate the efficacy of this surgery in patients in this age range. Six patients died, and 7 had less than 2 years of follow-up or were incapable of returning for examination. Ninety-two patients with 97 rotator cuff tears were re-examined. The average preoperative UCLA (University of California, Los Angeles) score was 12.9 (range 8 to 20), and the average postoperative score was 32.4 (range 12 to 35). Five patients (5%) had failure of the repair, accounting for the poor results. Severe complications included infection (1 patient) and brachial plexus stretch injury (1 patient). Four additional patients sustained minor complications, for an overall rate of 6%. Overall, 87% of patients had good or excellent results. Eight additional patients, while satisfied, were classified as fair. Of the 5 failures, 3 were revised to a satisfactory result. Thus 90 of the 92 patients in the study were satisfied with the result of the surgery at final follow-up. Rotator cuff repair in patients 62 years and older results in increased function, decreased pain, and satisfactory results.

Aged↗
PubMed2003

Surgical treatment for large and massive tears of the rotator cuff.

Patients with a large or massive tear of the rotator cuff were, when possible, treated with the McLaughlin procedure. A patch graft was used when it was impossible to perform this procedure. The patch group (group P) consisted of nine patients with nine shoulders (six men, three women) with a mean age of 62.8+/-6.9 years. The McLaughlin group (group M) consisted of 12 patients with 12 shoulders (ten men, two women) with a mean age of 52.3+/-8.6 years. Mean follow-up was 2 years 11 months in group P and 4 years 2 months in group M. Using the shoulder scoring system of the Japanese Orthopaedic Association (JOA score), the total score improved post-operatively in both groups. In group P, the post-operative score was 91.7 (pre-operative score 47.9) and in group M 92.0 (pre-operative score 54.2). Tears recurred in three shoulders within 2 months of the McLaughlin procedure, and these patients were excluded from the study. The rate of 're-tearing' was lower with a patch graft (0/13) than with the McLaughlin procedure (3/17).

Adult↗
PubMedDate not supplied

Comparative and experimental study on different tendinous grasping techniques in rotator cuff repair: a new reinforced stitch.

Arthroscopic repair of wide rotator cuff ruptures is burdened by a percentage of recurrences that is greater than the repair carried out when an open technique is used. One of the main reasons for this difference can be searched for in the minor hold of stitching on the tendinous aspect obtained with arthroscopic repair. In fact, when an open technique is used, good hold can be guaranteed by using reinforced stitches such as the modified Mason-Allen. Thus, arthroscopic repair technique on the tendinous aspect, particularly in wide and massive injuries, must be improved. It was the purpose of this study to compare a new reinforced stitch that can easily be obtained in arthroscopy (simple stitch that orthogonally crosses a horizontal stitch previously knotted on the tendon: SS-HL), with traditional stitches (simple stitch, mattress-stitch and modified Mason-Allen stitch). Tests were carried out on sheep infraspinatus tendons in order to evaluate the resistance of pull-out. The SS-HL stitch showed resistance to loading that was similar to that when the modified Mason-Allen was used, but it was greater than that shown by the simple stitch (+48%) and the mattress stitch (+35%).

Animals↗
PubMed2005

[Conservative management of full-thickness rotator cuff tears. A prospective study of 24 patients].

OBJECTIVE: To evaluate the efficacy of conservative treatment of full-thickness rotator cuff tears. METHOD: A prospective open study of patients with full-thickness rotator cuff tears. The diagnosis was confirmed by ultrasonography examination. Therapeutic efficacy was evaluated before treatment, at the end of the treatment, and at 1, 3 and 6 months. Pain and handicap intensity were measured by a visual analogue scale, by the algo-functional Constant score, by articular mobility and, finally, by the resumption of daily and/or professional activities. Successful treatment was considered with a VAS pain score or=80. RESULTS: Twenty-four patients, mean age 59 years, with full-thickness rotator cuff tears for 9 months, on average, were included in the study. The parameters of pain function and handicap improved significantly since the end of treatment. The Constant score improved greatly, from 44.8 before treatment to 71.8 at the end of treatment and 74.2 at 6 months. This improvement continued until 3 months after treatment. The rate of success was 75% at 6 months. CONCLUSION: Despite the small sample size, our study confirm that rehabilitation should always be performed before a decision of surgical repair.

Adult↗
PubMed2006

The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique.

BACKGROUND: Patients who have pain and dysfunction from glenohumeral arthritis associated with severe rotator cuff deficiency have few treatment options. The goal of this study was to retrospectively evaluate the short-term results of arthroplasty with use of the Reverse Shoulder Prosthesis in the management of this problem. METHODS: We report the results for sixty patients (sixty shoulders) with a rotator cuff deficiency and glenohumeral arthritis who were followed for a minimum of two years. Thirty-five patients had no previous shoulder surgery, whereas twenty-three had had either an open or arthroscopic rotator cuff repair, one had had a subacromial decompression, and one had had a biceps tendon repair. All patients were assessed preoperatively and postoperatively with the American Shoulder and Elbow Surgeons scoring system for pain and function and with visual analog scales for pain and function. They were also asked to rate their satisfaction with the outcome. The shoulder range of motion was measured preoperatively and postoperatively. RESULTS: The average age of the patients was seventy-one years. The average duration of follow-up was thirty-three months. All measures improved significantly (p < 0.0001). The mean total score on the American Shoulder and Elbow Surgeons system improved from 34.3 to 68.2; the mean function score, from 16.1 to 29.4; and the mean pain score, from 18.2 to 38.7. The score for function on the visual analog scale improved from 2.7 to 6.0, and the score for pain on the visual analog scale improved from 6.3 to 2.2. Forward flexion increased from 55.0 degrees to 105.1 degrees , and abduction increased from 41.4 degrees to 101.8 degrees . Forty-one of the sixty patients rated the outcome as good or excellent; sixteen were satisfied, and three were dissatisfied. There were a total of thirteen complications in ten patients (17%). Seven patients (12%) had eight failures, requiring revision surgery to another Reverse Shoulder Prosthesis in five patients (one shoulder had two revisions) and revision to a hemiarthroplasty in two patients because of deep infection. CONCLUSIONS: The data from this study suggest that arthroplasty with the Reverse Shoulder Prosthesis may be a viable treatment for patients with glenohumeral arthritis and a massive rotator cuff tear. However, future studies will be necessary to determine the longevity of the implant and whether it will provide continued improvement in function.

Adult↗
PubMed2005

Dynamic ultrasonography of rotator cuff muscles.

PURPOSE: To confirm the neuromuscular integrity of the rotator cuff and to investigate the effect of different contraction patterns on shoulder function, we sonographically analyzed dynamic contraction patterns of this muscle group. METHODS: Fifty supra- and 50 infraspinatus muscle contraction patterns of patients with different shoulder pathologies examined with a 7.5-MHz transducer were recorded and saved as video files. Both data sets were analyzed by 3 independent observers who then assigned a grade to each contraction pattern: normal, slightly disturbed, severely disturbed, or no contraction. Intra- and inter-observer variations were calculated. In 43 patients with isolated supraspinatus tears, the clinical relation to shoulder function as measured with the Constant score was evaluated. RESULTS: In the 100 cases tested, the intraclass correlations for the 3 observers were 0.82, 0.88, and 0.88. The inter-observer reliability was 0.74. No pair of first and second readings for either the supraspinatus or infraspinatus muscle differed by more than 1 grade. In patients with a supraspinatus tear, the contraction type of the supraspinatus correlated significantly with the Constant score (p=0.02). CONCLUSIONS: When dynamic ultrasonography is used to assess the contraction patterns of the supra- and infraspinatus muscles, good intra- and inter-observer reliability is attained. Because a better contraction type correlates significantly with better shoulder function, this new diagnostic criterion may improve decision-making in the treatment of shoulder diseases.

Humans↗
PubMed1992

Conservative treatment of rotator cuff tears.

Among 124 shoulders in 114 patients with complete rotator cuff tears who had been treated conservatively from 1980 until 1989, 62 shoulders in 54 patients were observed to identify the findings on initial examinations and correlate them with the final results. The follow-up period averaged 3.4 years. According to modified criteria of Wolfgang, 51 shoulders in 45 patients (82%) rates satisfactory (excellent or good). The overall scores of pain, motion, and function improved significantly. The results were less satisfactory in patients observed more than six years. The patients with satisfactory results (Group 1) and unsatisfactory results (Group 2) among those observed more than five years were compared. In Group 1, the scores of pain, motion, and strength improved significantly at follow-up examinations, whereas those of function did not. In Group 2, no improvement was recognized in any categories. The only significant differences in the initial findings between the two groups were the active abduction angle and the abduction strength: the patients in Group 1 retained a good range of motion and strength, whereas those with unsatisfactory results had a limited range and muscle weakness on first examinations. Conservative treatment affords satisfactory results when it is given to the patients with well-preserved motion and strength, although in some cases function may deteriorate with time.

Adult↗
PubMed1981

Advancement of the supraspinatus muscle in the repair of ruptures of the rotator cuff.

In ruptures of the rotator cuff, the supraspinatus tendon frequently is retracted and repair without excessive tension is difficult to achieve. The technique of supraspinatus advancement, as described by Debeyre et al., may be a useful technique for such patients. We reviewed the results of this operation in eighteen patients seen by us. In fourteen (77 per cent) of them satisfactory results were obtained after a minimum follow-up of two years. Meticulous technique and preservation of the neurovascular supply of the supraspinatus tendon enhanced the outcome. An approach to the supraspinatus muscle utilizing resection of the acromioclavicular joint facilitated the repair.

Acromioclavicular Joint↗
PubMed1995

[Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff].

Shoulder sonography was performed prospectively in 4172 patients with 4588 shoulders affected with pathology of the subacromial space, among them 1227 operated cases with 425 rotator cuff tears (292 total tears and 133 partial tears). A two-criterion model with formal as well as echogenic and dynamic criteria was used for the diagnosis of cuff tears. The overall sensitivity in diagnosing rotator cuff tears was 95.3% (97.3% in total tears and 91.0% in partial tears). False-negative results were found overall in 1.6% of cases. Overall accuracy for all defects was 94.9%. Involvement of the supraspinatus tendon was found in 95.8%, of the infraspinatus in 39.3% and of the subscapularis in 10.1%. In 33.6% of cases, involvement of the long head of biceps was found. It was clearly correlated with the size of the tears: 25.9% in isolated supraspinatus tears and 68.8% in three-tendon tears of subscapularis, supraspinatus and infraspinatus. Differentiation between fresh, traumatic tears and degenerative tears is possible by means of measuring retraction, determining the length of the distal cuff stump and by formal criteria of the stump configuration as well as by bursal criteria. Differentiation of old tears of suspected traumatic origin from those with degenerative causes is impossible.

Adolescent↗
PubMed1989

Rotator cuff tear: clinical experience with sonographic detection.

Between June 1986 and April 1988, 86 sonographic examinations of the shoulder were performed on patients suspected of having rotator cuff tears. Major sonographic diagnostic criteria included (a) a well-defined discontinuity usually visible as a hypoechoic focus within the cuff, (b) nonvisualization of the cuff and (c) an echogenic focus within the cuff. Seventy-five patients underwent both sonography and arthrography. Compared with arthrography alone, ultrasound examinations enabled detection of 92% of rotator cuff tears (24 of 26 tears), with a specificity of 84% and a negative predictive value of 95%. Correlation was obtained in 30 of these patients who underwent surgery for rotator cuff tear or other soft-tissue abnormality. In this group, the sensitivity of sonography for detection of a tear was 93%, with a specificity of 73%, while for arthrography sensitivity was 87% and specificity was 100%. These data indicate that sonography is a useful, noninvasive screening procedure for patients suspected of having rotator cuff injury.

Adolescent↗
PubMed2006

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

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

Aged↗
PubMed1989

Rotator cuff tendinitis: basic concepts of pathoetiology.

A discussion of the etiologic and pathologic factors associated with rotator cuff tendinitis and rupture concludes that intrinsic muscle contractile tension overload rather than primary impingement is the major factor in the etiology of rotator cuff tendinitis. Treatment is predicated on restoring health to the rotator cuff rather than enlarging the coracoacromial space.

Athletic Injuries↗
PubMed1987

High-resolution MR imaging of the normal rotator cuff.

The shoulders of six normal volunteers were imaged with high-resolution MR in the axial, sagittal, and coronal planes. An angled pair of counter-rotating current loop-gap resonators designed specifically for the shoulder was used as a local coil. All images were compared with corresponding cryomicrotome sections from cadaver shoulders. The rotator cuff was analyzed in detail. It appeared as a complex, heterogeneous band to tissue superficial to the humeral head. The areas of low signal intensity corresponded to the central tendons of the four rotator cuff muscles. These tendons could be distinguished from each other as well as from the intervening components of the cuff, which have a moderate intensity. We concluded that MR is capable of imaging the normal rotator cuff and of separating the various components. This may allow for improved precision in the diagnosis of rotator cuff disorders.

Adult↗