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PubMed1988

[Sonographic evaluation of the rotator cuff following reconstruction of complete ruptures].

This is a report on the results of a clinical and sonographical re-examination of 66 shoulder joints after reconstruction of complete rotator cuff tears. One-third of the patients were asymptomatic, in more than half of them pre-operatively existing complaints had improved, and in 15% no improvement was seen. Clinical findings were without abnormalities in half of the patients. In as many patients indications were found of a still existing rotator cuff syndrome. Sonographically, in 49 out of 66 cases the continuity of the rotator cuff was maintained. In 17 cases indications of tears were found. Remarkable features were, in rotator cuffs with maintained tendon continuity, in 50% of the shoulder joints a thinning out of the tendon and/or echogenic patterns. Tears in the non-operated opposite side were found in 7 cases and thinning out and/or enhanced echogenicity in 12 cases.

Adult↗
PubMedDate not supplied

[Translation and psychometric testing of the Western Ontario Rotator Cuff Index (WORC) for use in Germany].

AIM: At the moment a specific subjective measurement tool for evaluation of German-speaking patients with a pathology of the rotator cuff is lacking. Following international guidelines, the German translation and the psychometric testing of the 21-item, multidimensional Western Ontario Rotator Cuff Index (WORC) is the aim of the study. METHOD: After translation and cross-culture adaptation of the English original, the reliability, validity, practicability and the acceptance of the German version of the WORC were tested on 102 patients with an impingement syndrome. Additionally the SF-36, the Constant and UCLA score were evaluated. RESULTS: The Pearson correlation coefficient showed with 0.96 an excellent result for the test-retest reliability. The internal consistency showed a high homogeneity with a Cronbach alpha coefficient of 0.96. A Pearson correlation coefficient between 0.66-0.81 registered a high correlation with the physical subscales of the SF-36, the Constant and the UCLA score. The mean time required for filling out the WORC was 7.5 minutes, the mean time required for evaluation was 10 minutes. The acceptance and the understanding were very high. CONCLUSION: After successful translation and psychometric testing of the German version of the Western Ontario Rotator Cuff Index (WORC), a patient-based measurement tool for evaluating the quality of life of German-speaking patients with pathology of the rotator cuff is available.

Adult↗
PubMed2005

Cyclic loading of rotator cuff repairs: an in vitro biomechanical comparison of bioabsorbable tacks with transosseous sutures.

PURPOSE: This study compares rotator cuff repair strength after cyclic loading of bioabsorbable tacks and traditional transosseous sutures, and correlates the results with bone density, age, and gender. The hypotheses were that tack repair strength would be inferior to transosseous sutures and that repair strength would be directly related to bone quality. TYPE OF STUDY: In vitro randomized biomechanical study. METHODS: Eight paired cadaveric shoulders with a standardized supraspinatus defect were randomized to tack or suture repair and subjected to step-wise cyclic loading. Repair migration was measured by quantifying the motion of markers affixed to tendon and bone using a digital camera. Failure mode, cycles, and load were measured for 50% and 100% loss of repair. Results were correlated with bone density, age, and gender. RESULTS: Tack repairs failed at the tack-tendon interface, whereas suture rupture was the mode of failure for the suture repairs. Mean values for 50% loss of repair were 206 +/- 88 cycles and 44 +/- 15 N for the sutures, and 1,193 +/- 252 cycles and 156 +/- 20 N for the tacks (P < .05). The corresponding values for 100% loss of repair were 2,458 +/- 379 cycles and 294 +/- 27 N for the sutures, and 2,292 +/- 333 cycles and 263 +/- 28 N for the tacks (P > .05). These results did not correlate with bone density, age, or gender. CONCLUSIONS: This study has shown that bioabsorbable tacks provide improved repair strength in comparison with traditional suture techniques. Repair strength did not correlate with bone quality, and this may be attributed to failure primarily through the repair construct or at the tack-tendon interface and not through bone. This report describes a new high-resolution optical method of measuring tendon repair strength that should be a useful model for future studies. CLINICAL RELEVANCE: This study demonstrates the biomechanical advantages of a sutureless tack device for rotator cuff repair compared with a traditional augmented suture repair technique.

Absorbable Implants↗
PubMed1991

Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale.

Ten patients with painful, massive (greater than 5 cm), complete rotator cuff tears involving primarily the supraspinatus were treated with arthroscopic acromioplasty and rotator cuff debridement. All patients except one had normal active motion and strength preoperatively. All patients had roentgenographically normal acromiohumeral distance and an anterior-inferior acromial osteophyte. The goal was to obtain pain relief without loss of motion of strength. This was accomplished in all patients. This study shows that normal shoulder function is possible with a massive unrepaired tear of the rotator cuff. Normal function in the face of an unrepaired cuff tear can occur only if there is a balance of two important force couples, one in the coronal plane and the other in the transverse plane. This balance depends upon the functional integrity of the anterior cuff, the posterior cuff, and the deltoid. In patients whose cuff tears satisfy these anatomic and biomechanical criteria, the achievement of pain relief through arthroscopic debridement and decompression seems to be all that is necessary for normal pain-free function.

Aged↗
PubMed2001

All arthroscopic rotator cuff repairs.

The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages of glenohumeral joint inspection, treatment of intra-articular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of this method, which limits its application to surgeons skilled in both open and arthroscopic shoulder operations. This article contains many technical pearls to, as much as possible, simplify and improve all arthroscopic cuff repair.

Acromion↗
PubMed2006

Interpreting positive signs of the supraspinatus test in screening for torn rotator cuff.

The purpose of this study was to investigate the validity of the supraspinatus test as a screening test for detecting torn rotator cuff and to determine what its valuable positive signs were. Both the empty-can test and full-can test were performed on 200 shoulders diagnosed by magnetic resonance imaging (MRI)-and in some cases, surgical findings-to have full-thickness or partial-thickness torn rotator cuff s, or no tear in the rotator cuff . During the maneuver, the presence of pain or weakness or both pain and weakness were recorded as positive signs, and the distribution of these signs were analyzed according to the degree of tear. The predictive values were calculated in 2 ways by considering (1) only full-thickness tears as tears and (2) both full- and partial-thickness tears as tears. The 2 tests and the 2 ways of considering partial-thickness tears were compared. Pain and weakness were severity-dependent, and the empty-can test had a higher incidence of pain. The sensitivities of the 2 supraspinatus tests in all positive signs were higher when including partial-thickness tears in the tear group ; however, their specificities were higher when excluding partial-thickness tears. Both pain and weakness were interpretive for the supraspinatus test, and both tests were sensitive to full- and partial- thickness tears and specific for full-thickness tears.

Adult↗
PubMed2002

[Current concepts in treatment of rotator cuff tears].

The expectation of a functional shoulder joint, even in advanced age, the growing experience and success in shoulder surgery have brought the operative treatment another step further. The goal of any advanced knowledge should be a proper treatment of the patients and the pathology. Complex rotator cuff tears can be repaired by means of muscle transfer and partial reconstruction. In cases of irreparable rotator cuff tear arthropathy prosthetic replacement of the gleno-humeral joint can be performed. In this article a review on the different techniques and indications for rotator cuff repair is given.

Arthroscopy↗
PubMedDate not supplied

Surgery in massive ruptures of the rotator cuff: results as related to prognosis.

The results obtained in the surgical treatment of massive lesions of the rotator cuff are quite often inferior to what is expected, because prognosis is not respected. To demonstrate that the quality of the results obtained is directly proportional to the preoperative prognostic factors a retrospective study was conducted on 28 patients submitted to massive lesion repair of the rotator cuff between 1990 and 1996; the criteria of inclusion was: a) patients aged under 65 years; b) preoperative radiographic findings with acromiohumeral distance not less than 6 mm; c) degeneration of the tendons not greater than a Goutallier stage 2; d) absence of inveterate pseudoparalysis of the limb involved; e) absence of anterosuperior subdislocation of the humeral head. The results obtained with a mean follow-up of 5 years revealed a mean Constant score of 85 points (minimum 79, maximum 91) that may correspond to excellent results, showing how this type of surgery may guarantee good results only when factors of prognosis are respected preoperatively.

Adult↗
PubMed1991

The active abduction view: a new maneuvre in the diagnosis of rotator cuff tears.

The plain film views of the shoulder in the case of a fresh rotator cuff tear are usually normal. Reduction of the space between the under surface of the acromion process of the scapula and the humeral head occurs only in late, neglected cases. A new projection is described, the active abduction view of the shoulder, where in many patients with a complete rotator cuff tear the humeral head is closely apposed to the acromion, obliterating the subacromial space. In such a situation, the medial portion of the torn rotator cuff retracts during active abduction, allowing approximation of the two bones.

Humans↗
PubMedDate not supplied

[Correlation of the degeneration of the AC joint (acromioclavicular) and rupture of the rotator cuff].

During the past various factors were quoted to be causative of a degeneration of the rotator cuff. In this study 122 shoulder specimen, aged 58-95 years, were dissected. A high correlation between severe degeneration of the ac-joint and rupture of the rotator cuff was found. The correlation was even higher between distally pointing osteophytes and cuff ruptures. The results demand to clearly define the degeneration of the ac-joint and the rotator cuff in patients suffering from shoulder pain. A simultaneous occurrence has to be considered. If conservative treatment fails in patients with cuff tear and ac-joint degeneration, surgical revision is recommended. This should comprise: 1. suture of the cuff-rupture 2. excision of the coraco-acromial ligament 3. anterior acromioplasty according to Neer 4. excision of the outer end of the clavicle

Acromioclavicular Joint↗
PubMed2005

Early inflammatory reaction after rotator cuff repair with a porcine small intestine submucosal implant: a report of 4 cases.

BACKGROUND: Porcine small intestine submucosal grafts have been successful in enhancing soft tissue repair, as demonstrated by animal studies. Currently, there are no reports of the use of such implants in human rotator cuff repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Over a 6-month period, 25 patients underwent rotator cuff repair by one surgeon using the Restore Orthobiologic Implant to augment the repaired tendon or fill a defect. RESULTS: Four of 25 patients experienced an overt inflammatory reaction at a mean of 13 days postoperatively. All patients underwent open irrigation and debridement of the rotator cuff and porcine small intestine submucosal implant. CONCLUSION: Porcine small intestine submucosal implants should be used in rotator cuff surgery with the awareness that a non-specific inflammatory reaction can occur in the early postoperative period. This inflammatory reaction may cause breakdown of the repair. Further studies are needed to further characterize the reaction and determine which patients are susceptible.

Aged↗
PubMed1995

Acromial angle on radiographs of the shoulder: correlation with the impingement syndrome and rotator cuff tears.

OBJECTIVE: This study was undertaken to determine the reproducibility of measurements of an acromial angle on radiographs and to correlate those measurements with the presence of the impingement syndrome and rotator cuff tears. MATERIALS AND METHODS: Ninety-nine shoulders in 95 patients who had an arch radiograph and had undergone shoulder arthroscopy were included in this retrospective study. The acromial angle was measured on the arch view of the shoulder independently by three observers who were blinded to the name, history, and arthroscopic results. The angle was measured at the intersection of lines drawn along the inferior cortex of the anterior and posterior portions of the acromion. Interobserver variability was determined by the intercorrelation coefficient (a test of reproducibility of quantitative measurements). The average of the three measurements for each patient was correlated with the preoperative diagnosis and the arthroscopic findings. RESULTS: A correlation was found between increasing severity of cuff disease as determined on arthroscopy and increasing acromial angle (p < .01). In 67 patients (70 shoulders) with impingement, patients with a full-thickness tear (29%) accounted for 43% of those with an angle of 30 degrees or greater. The average acromial angle for patients with impingement was greater than that for either patients with instability or patients with trauma (p < .05 for both). An angle of 25 degrees or greater was measured in 63% of patients with impingement but in only 18% of those with instability. The average acromial angle in patients with impingement and an intact rotator cuff was also greater than the average angle in patients with instability (p = .001). The interobserver variability had an intercorrelation coefficient of 0.90. CONCLUSION: The acromial angle is an objective and fairly reproducible measure of anterior acromial shape. The angle is useful in identifying patients with a greater likelihood of having a rotator cuff tear and in distinguishing patients with primary impingement from those with instability.

Acromion↗
PubMedDate not supplied

Fixation strength of rotator cuff repairs with suture anchors and the transosseous suture technique.

The strength of classic transosseous suture repair of rotator cuff tendons was compared with similar repairs with four "third-generation" suture anchors. Results demonstrate the repair construct selected had a significant influence on failure at ultimate load (p = 0.005). Among the anchors tested the Statak design was significantly stronger than the other three. Furthermore Statak, Harpoon, and Superanchor designs were all significantly stronger than the Revo screw. No significant difference was seen between the strength of repairs performed with the Statak, the Harpoon, or the Superanchor compared with the transosseous suture technique. The transosseous suture technique was significantly stronger than repairs performed with the Revo. We conclude suture anchor design has evolved to a point where initial fixation of torn rotator cuff tendons is equivalent to more traditional techniques using only sutures.

Aged↗
PubMed1988

Rotator cuff injuries in the throwing athlete.

Injuries to the rotator cuff have often been attributed to a progressive, degenerative process seen in the older patient. Traditionally, impingement has been implicated as the major etiologic factor. This paper will review the recent literature regarding rotator cuff injuries in the throwing athlete and examine the current thoughts on etiology and treatment.

Athletic Injuries↗
PubMedDate not supplied

Evaluation of interventions for rotator cuff pathology: a systematic review.

A systematic review of published evidence was conducted investigating surgical and conservative management of rotator cuff disease. Medical databases searched included Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), and the Cochrane Collaboration library. Two independent reviewers evaluated each article for inclusion. Established criteria were used to assess the methodologic quality of articles examining outcomes of treatment interventions for rotator cuff disease. Due to the low methodologic quality of the studies that are currently available in this area, there is insufficient evidence to strongly support or refute the effectiveness of any available treatment intervention for rotator cuff pathology. The best available evidence supports open and primary surgery over arthroscopic debridement and revision surgery; and in the area of conservative management, electrotherapy, steroid use, exercise therapy, and acupuncture. There is a clear need for more methodologically sound studies to achieve strong evidence on which treatment practices can be based.

Acupuncture Therapy↗
PubMed2004

The effect of comorbidity on self-assessed function in patients with a chronic rotator cuff tear.

BACKGROUND: The results of preoperative assessment of factors that might affect the outcome of orthopaedic surgery have rarely been studied. In this study, we evaluated the relationship between the number of medical comorbidities and the preoperative performance on outcome assessment tools in patients with a chronic rotator cuff tear. METHODS: One-hundred and ninety-nine patients (206 shoulders) with a chronic rotator cuff tear who were treated with surgery were evaluated preoperatively with a detailed history (including medical comorbidities), physical examination, and the following outcome instruments: (1) the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, (2) the Simple Shoulder Test, (3) visual analog scales (pain, function, and quality of life), and (4) the Short Form-36 (SF-36). RESULTS: The patients had a mean of 2.07 comorbidities (range, zero to seven comorbidities). With use of univariate regression analysis, a greater number of comorbidities was associated with worse function (DASH [p = 0.0064], Simple Shoulder Test [p = 0.0001 for the best-case scenario and p = 0.0009 for the worst-case scenario], and visual analog scale for function [p = 0.0003] and increased pain [p = 0.05]) and with worse general health status (physical function [p < 0.0001], role-physical [p = 0.0286], general health [p < 0.0001], vitality [p = 0.0014], social function [p = 0.0004], role-emotional [p = 0.0003], and visual analog scale for quality of life [p = 0.0102]). These results were confirmed with significant associations (p < 0.05) between the number of comorbidities and the scores on the Simple Shoulder Test; DASH questionnaire; visual analog scales for function, pain, and quality of life; and seven of the eight items (all but mental health) on the SF-36 in a multivariate regression analysis, which included age, gender, Workers' Compensation status, number of previous operations, smoking history, size of the tear, duration of symptoms, and average patient expectations as possible confounding variables. CONCLUSIONS: Medical comorbidities have a negative impact on patient-reported preoperative baseline pain, function, and general health status associated with chronic rotator cuff tears. We postulate that this effect may ultimately influence the evaluation of the results of surgical treatment of rotator cuff tears and should be considered when treating patients and analyzing outcomes.

Adult↗
PubMed1992

Rotator cuff tears in anterior dislocation of the shoulder.

We diagnosed 16 rotator cuff tears in 109 shoulders in 104 patients with a traumatic anterior dislocation. Twelve of these were followed up for an average of 32 months. A surgical repair of the cuff was carried out in eleven and the results were satisfactory in eight (73%) regardless of a Bankart lesion. The repair of a torn cuff seems to be sufficient to stabilise the shoulder in elderly patients, even when a Bankart lesion is present and is not repaired.

Aged↗
PubMedDate not supplied

Effect of rotator cuff pathology on shoulder rhythm.

The purpose of this study was to test the hypothesis that shoulder rhythm is affected by rotator cuff pathology during arm elevation. We divided 42 subjects into 3 groups: those with full-thickness rotator cuff tears (RCTs) (n = 14), those with tendinopathy (n = 13), and control subjects (n = 15). Shoulder kinematics was recorded while subjects performed elevation in the sagittal and scapular planes. Euler angles were computed for scapular and humeral elevation. Data were divided into 3 equal phases. Lines were fit and the slope determined for each phase. Significant differences in slopes ( P < .05) were found between experimental groups for both motions. The RCT group had higher slopes in the initial and middle phases for sagittal elevation and in the middle phase for scapular abduction. The scapula was elevated more in the RCT group in the initial two thirds of movement. This motion may change the length of remaining muscles so that they operate on a more effective part of their length-tension curve.

Adult↗