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PubMed1991

Shoulder surgery for rotator cuff tears. Ultrasonographic 3-year follow-up of 97 cases.

We reexamined 97 of 116 shoulders operated on for rotator cuff lesions after an average follow-up time of 37 months. Seventy percent had a good or excellent clinical result, and 14 percent were graded as poor. Upon ultrasonographic examination of the 97 shoulders, 37 had a normal rotator cuff, 31 had thinning and/or hyperdensity, and 29 had a complete rupture of the cuff. Patients with concomitant anterior acromioplasties did better than those without. There was a poor correlation between clinical and ultrasonographic results. We recommend that rotator cuff tears should be closed only if this can be achieved without undue tension. If extensive tissue mobilization or coverage with alloplastic material or with regional muscle flaps is required, the lesion should be debrided and left open, and only an anterior acromioplasty should be performed.

Adult↗
PubMed1994

Arthroscopic subacromial decompression and rotator cuff debridement for stage II and stage III impingement.

Arthroscopic subacromial decompression and rotator cuff debridement was performed on 61 consecutive patients with either stage II or stage III impingement syndrome: 27 with no actual tear of the cuff (group IIa); 21 with a partial-thickness tear (group IIb); and 13 with full-thickness tears (group III). Patients were seen in follow-up at a minimum of 2 years (mean 27.7 months). Apical oblique and outlet radiographic views of the shoulder were used to evaluate both preoperative subacromial pathology and to document removal of adequate bone postoperatively. Patients were evaluated pre- and postoperatively using both the UCLA Shoulder Rating Scale and Neer's criteria: Twenty-four of the 61 cases were compensation related. Mean motion improved postoperatively for all stages of impingement. For all patients, preoperative UCLA and Neer ratings were unsatisfactory. In group IIa, postoperative UCLA and Neer ratings improved in 22 patients to an 81% satisfactory result rate. In group IIb, 17 patients had major improvement in UCLA and Neer ratings (also an 81% satisfactory result rate). In group III, there were 10 satisfactory and three unsatisfactory results for a 77% satisfactory result rate. Of the 10 satisfactory results, eight were in patients who were either retired or worked at sedentary jobs that did not demand above-shoulder activities and strength, and whose principal preoperative complaint was pain. All 10 of these patients had relief of their pain; the three unsatisfactory results were all compensation cases in manual laborers, one later having a satisfactory result from an open cuff repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromioclavicular Joint↗
PubMed1995

Patterns of glenohumeral motion loss in patients with chronic rotator cuff tendinopathy and subacromial impingement.

Passive glenohumeral motion loss can occur in patients with chronic rotator cuff tendinopathy and subacromial impingement. It is essential for the clinician when evaluating patients with rotator cuff symptoms and subacromial impingement to assess for concomitant passive glenohumeral motion loss. If rehabilitative strategies do not address the motion loss in the shoulder, it is possible that the therapeutic rehabilitative intervention will fail.

Adult↗
PubMed2002

[Primary strength of conventional and alternative suture techniques of the rotator cuff. A biomechanical study].

The aim of this biomechanical study was to evaluate rotator cuff repair strength using different suture anchor techniques compared to conventional repair, taking into consideration the native strength of the supraspinatus tendon. Therefore, a defined defect of the supraspinatus was created in 50 freshly frozen cadaver specimen (group size n = 10; median age at death: 56 years). Five methods were employed for cuff repair: standard transosseous suture, modified transosseous suture with patch augmentation and three suture anchors (Acufex Wedge TAG, Acufex Rod TAG und Mitek GII). The maximum tensile load of the five techniques was: standard transosseous suture, 410 N; modified transosseous suture, 552 N; Wedge TAG, 207 N; Rod TAG, 217 N; Mitek GII, 186 N. The difference between the suture anchor and standard techniques were highly significant (P < 0.001). In this series, the Mitek Gll anchor showed the lowest anchor dislocation rate at 3% (n = 1). The Wedge TAG system had a dislocation rate of 27% (n = 8) and the Rod TAG system 43% (n = 13). Suture anchor techniques revealed about 20%, the standard technique 34% and its modification 60% of the hypothetically calculated native tendon strength. Compared to conventional transosseous suture techniques, the use of the suture anchors tested in this series does not significantly increase the primary fixation strength of rotator cuff repair. The metallic implant with two barbs (Mitek GII) seems to be superior to the polyacetal anchors when inserted into the spongiform bone of the greater tubercle. The considerably weaker repair strength needs to be taken into consideration in postoperative patient rehabilitation, especially after the use of suture anchors.

Adult↗
PubMed1997

The rotator cuff. Large and massive tears. Technique of open repair.

Symptomatic large and massive rotator cuff tears can be successfully managed with operative repair. Five factors that facilitate favorable results include: (1) performing an adequate subacromial decompression; (2) maintaining the integrity of the deltoid origin; (3) mobilizing the torn tendons, performing an interval slide when indicated; (4) repairing the tendons to bone; and (5) carefully staging and supervising the rehabilitation program.

Adult↗
PubMedDate not supplied

[Arthrography in the diagnosis of injuries of the rotator cuff].

The author analyzes 132 arthrograms of patients operated on for involvement of the rotating cuff of the arm. The reliability of this technique for the detection of a complete rupture of the cuff of the arm and its inability to assess the size of the rupture and degree of retraction of the cuff of the arm are shown. Arthrographic patterns of the condition are presented.

Arthrography↗
PubMed2005

Reconstruction of massive rotator cuff lesions with a synthetic interposition graft: a prospective study of 41 patients.

In the present prospective study, we report about our experience with massive rotator cuff tears treated by means of a non-resorbable transosseously fixated patch combined with subacromial decompression. Forty-one patients were followed clinically and radiographically for a mean duration of 43 months. Their mean preoperative Constant and Murley score improved (P<0.001) from 25.7 preoperatively to 72.1 postoperatively. Substantial pain relief and improvement in the performance of activities of daily living were obtained. Anatomically, the repair resulted in a mean acromiohumeral interval of 8.6 mm. At the latest follow-up, three patients presented with a new tear between the inserted mesh and the supraspinatus musculotendinous unit. Reoperations were not performed. For short-term periods, restoring a massive rotator cuff tendon defect with synthetic grafts combined with subacromial decompression can give significant pain relief and improvement of range of motion and strength with few complications.

Acromion↗
PubMed1998

A review of the role of magnetic resonance imaging in the evaluation of shoulder impingement syndrome and rotator cuff tendon tears.

The objective of this paper is to present a review of the role of magnetic resonance imaging in the evaluation of shoulder impingement syndrome and rotator cuff tendon tears. This imaging modality is effective in demonstrating both the soft tissue and bony abnormalities associated with structural shoulder impingement which include subacromial-subdeltoid bursitis, supraspinatus tendinopathy, rotator cuff tendon tears, subacromial osteophytic spurs and acromioclavicular joint capsular hypertrophy and osteophytosis. The detection of a subacromial osteophytic spur is considered specific for shoulder impingement syndrome. The 3 most accurate magnetic resonance imaging signs of a full thickness supraspinatus tendon tear reported are: tendon discontinuity, musculotendinous junction retraction and supraspinatus tendon thinning. The most specific sign is tendon discontinuity and the most sensitive is subacromial-subdeltoid bursal fluid.

Acromioclavicular Joint↗
PubMed2006

[Arthro-C-scan analysis of rotator cuff tears healing after arthroscopic repair: analysis of predictive factors in a consecutive series of 167 arthroscopic repairs].

PURPOSE OF THE STUDY: Arthroscopic repair of rotator cuff tears is a well described technique with good clinical results. The purpose of this work was to use the arthro-CT-scan to evaluate tendon healing after arthroscopic repair and search for epidemiological, anatomic and technical factors predictive of tendon healing. MATERIAL AND METHOD: This prospective consecutive series included 167 non-randomized shoulders. All patients underwent a preoperative assessment using the crude Constant score and a standard x-ray protocol to evaluate cuff status. Cuff repairs were all performed arthroscopically. The crude Constant score was used to follow patients. A control arthroscan was obtained in 148 patients. RESULTS: Mean patient age was 59 years, 46% men and 77% dominant side. Mean duration of symptoms before repair was nine months. The tears resulted from trauma in 28%, including 9% occupational accidents. The preoperative mean crude Constant score was 52.4 (range 15-77). An isolated tear of the supraspinatus was observed in 68%. Frontal retraction of the supraspinatus was distal in 74%. In 29 cases, reduction was difficult. The quality of the tendon was considered normal in 56 cases and non-anatomic repair was necessary in six. At last follow-up (19 months on average) the mean crude Constant score was 80 (range 49-95). Arthro-CT-scan was performed to control healing in 148 patients and revealed anatomic healing in 69, defective healing in 27, and repeated tears in 52 shoulders. Factors predictive of healing were: tear less than six months old, sedentary occupational activity, non-dominant side, young patient, female gender, isolated small non-retracted tear of the supraspinatus, normal appearance of an easily reduced tendon, and good bone quality. DISCUSSION: Time from tear to repair was long in this series. Tendon and muscle changes occurring after the injury could explain in part the healing failures. CONCLUSION: But this study confirmed good functional and anatomic results given by arthroscopic repair of rotator cuff tears.

Accidents, Occupational↗
PubMedDate not supplied

Surgical treatment of os acromiale with and without associated rotator cuff tears.

Nineteen consecutive patients treated surgically for meso-os acromiale and subacromial pathology were reviewed retrospectively, with a mean length of follow-up of 40 months (range, 24-94 months). Of the patients, 11 (58%) were treated with acromioplasty in the presence of a stable os acromiale; 8 patients (42%) underwent open reduction-internal fixation for an unstable and painful os fragment. Of the 19 patients, 8 (42%) with an os acromiale had an associated full-thickness rotator cuff tear. Overall, only 10 of 19 patients (53%) achieved a satisfactory result. All 8 patients (100%) treated with open reduction-internal fixation achieved union of the os fragment, although only 3 (37.5%) achieved a satisfactory result. Of the 11 patients who underwent acromioplasty, only 7 (64%) achieved a satisfactory result. The outcome of surgical management of symptomatic meso-os acromiale with concomitant rotator cuff pathology was satisfactory in 4 of 8 patients in our study group. The rate of satisfactory results was similar in patients with (50%) and without (55%) associated rotator cuff tears. When we analyzed our results to exclude workers' compensation patients, 80% achieved satisfactory results (compared with only 22% in our workers' compensation group).

Acromion↗
PubMed2002

Subacromial decompression. Treatment for small- and medium-sized tears of the rotator cuff.

We report the results of arthroscopic subacromial decompression and debridement of the rotator cuff for chronic small- and medium-sized tears in 114 patients (118 shoulders) between two and five years after surgery. The mean Constant score was improved to 69.8, and 88 shoulders (74.6%) had a satisfactory outcome. Of patients under the age of 60 years the outcome was satisfactory in 59.3%, and in those over 60 years, in 87.5% (p < 0.001). An unsatisfactory outcome was related to manual work (p < 0.001) and a duration of symptoms of more than 12 months (p < 0.05). The outcome was not related to the size of the tear, the muscles involved or biceps pathology. Further surgery was required in 25 patients after a mean of 13.7 months (3 to 35); ten tears had progressed in size, but none became irreparable. There was no relationship between the increase in the size of the tear and its initial size, the muscles involved or the presence of biceps pathology. No tear became smaller with time.

Activities of Daily Living↗
PubMed1992

[Surgical treatment of rotator cuff rupture. Prognostic factors].

A retrospective study of 67 total ruptures of the rotator cuff operated on was carried on, with an average follow-up of 25 months. The lesions were characterised by their size (19 tears of less than 2 cm, 30 between 2 and 4 cm, 18 over 4 cm) and location (27 tears of the supraspinatus, 15 tears of the supraspinatus extending to the front (coraco-humeral, long biceps, subscapular), 20 supra and infra-spinatus, 5 "massive" tears). The tendon of the long biceps was pathological in half of the cases. Fourteen patients presented with a subacromial osteoarthritis. All patients benefited from a decompression and repair of the rupture. Whereas the subjective results indicate 92 per cent satisfied patients, from the objective point of view the average score with Constant's rating was 62.5 pts with 53 per cent favorable results. Evaluation of force was a particular subject of attention: the results obtained with three charts were compared; the conclusion was in favour of an objective measurement using a dynamometer but with a weighting according to age and sex. The characteristics of the tear (location especially), the state of the long biceps, the presence of a subacromial osteoarthritis and the pre-operative mobility affected statistically and significantly the final result. The authors reserve reconstructive surgery for tears without osteoarthritis, isolated lesions of the supraspinatus having the best prognosis. The existence of a subacromial osteoarthritis, always a sign of a massive tear, in elderly patients should lead one to choose a procedure a minima under arthroscopy.

Adult↗
PubMed2004

Transfer of the long head of the triceps tendon for irreparable rotator cuff tears.

This study presents the clinical and anatomic findings of the use of the long head of the triceps tendon for treatment of massive, irreparable rotator cuff tears. The clinical study included 19 shoulders in 18 patients with a minimum followup of 2 years who were prospectively reviewed. All patients had preoperative and postoperative functional evaluations using the UCLA scoring system. The anatomic study included 20 upper extremities that had been injected with Microfil. All patients in the clinical study were satisfied with their outcome. There was an improvement in the UCLA pain and function scores. The long head of the triceps tendon is a myotendinous vascularized transfer that is a useful reconstructive procedure in patients with massive, irreparable rotator cuff tears that continue to be symptomatic despite conventional attempts at repair.

Adult↗
PubMedDate not supplied

Rotator cuff repair. A biomechanical comparison of three techniques.

BACKGROUND: The most common complication of rotator cuff repair is structural failure at the repair site. A single-layer repair does not adequately reproduce the anatomic insertion and may not optimize fixation strength. HYPOTHESIS: A double-layer rotator cuff repair will have greater initial fixation strength than a single-layer repair. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve fresh-frozen matched pairs of cadaveric shoulders were repaired by using dual-site fixation with both suture anchors and transosseous tunnels on one side (technique 1). Fixation was achieved by using suture anchors with horizontal mattress sutures and bone tunnels with modified Mason-Allen sutures. Half of the contralateral matched shoulders underwent fixation with suture anchors and simple sutures to simulate commonly used arthroscopic methods (technique 2) and, in the rest, fixation was achieved by using transosseous tunnels and modified Mason-Allen sutures (technique 3). Repaired specimens then underwent cyclic loading at physiologic rates and loads. The number of cycles to failure, which was defined as a 1-cm gap at the repair site, was then recorded. An arbitrary cut-off point of 5000 cycles was chosen. RESULTS: The mean number of cycles to failure with technique 1 (3694 +/- 1980 cycles) was significantly greater than that with either technique 2 (1414 +/- 1888 cycles) or technique 3 (528 +/- 683 cycles). Failure was predominantly through bone. CONCLUSIONS: The initial fixation strength of our double-layer repair exceeds that of isolated single-layer repairs with either suture anchors or transosseous tunnels.

Aged↗
PubMed1988

Sonographic evaluation of the rotator cuff. Accuracy in patients without prior surgery.

Since 1982 a sonographic technique has been devised to evaluate the integrity of the rotator cuff. In a series of 139 shoulders in 134 consecutive patients without prior surgery, sonographic results were correlated with surgical findings and/or arthrography. When sonography was compared with surgical findings (n = 90 shoulders), the overall accuracy was 95%. The sonographic diagnosis was the same as the arthrographic diagnosis in 91% of the cases (n = 50). Cuff lesions were also created in two cadavers, and images were made to confirm sonographic appearances. Because in the authors' experience sonography is accurate, safe, painless, rapid, and inexpensive, it has now been adopted as the primary study for the examination of the rotator cuff at the authors' institution. Arthrography is recommended in cases in which sonography is negative but there is significant clinical evidence of rotator cuff tear.

Arthrography↗
PubMed1994

Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc histologic sections.

Histologic sections from 17 en bloc surgical specimens were studied to clarify the pathogenesis of intratendinous tears of the rotator cuff. The specimens consisted of the bony insertion, the partially torn area, and the musculotendinous junction of the supraspinatus tendon. An intratendinous tear alone was present in two patients, and was associated with bursal side cuff tears in seven patients and joint side cuff tears in eight. There were 13 men and 4 women, whose average age was 49.8 years. Trauma was noted in all intratendinous tears and combined intratendinous and joint side cuff tears and in two of the seven patients who had intratendinous plus bursal side tears. All patients exhibited clinical evidence of subacromial impingement. Histologic sections were stained with azan and hematoxylin and eosin. Microscopically, the sections demonstrated several abnormalities in addition to degeneration. The intratendinous tears was located in the midlayer of the tendon in 15 specimens and eccentrically in two, the axis of which were parallel to tendon fibers in all. The intratendinous tears continued to local disruptions of the enthesis in 11 cases. The inner surface of the tear appeared smooth in 16 specimens. Despite the presence of granulation tissue and vessel proliferation near the intratendinous tears, there was no evidence of closure of the defect in any specimen. Intratendinous tears develop between superficial and deep layers of the degenerated rotator cuff. Shear within the tendon appears to be responsible in pathogenesis. Concomitant subacromial bursitis is very common.

Adult↗
PubMedDate not supplied

Superior excursion of the humeral head: a diagnostic tool in rotator cuff tear surgery.

Superior excursion of the humeral head on the face of the glenoid was investigated to determine whether a relationship exists between the degree of humeral head excursion and the identity of the injured tendon in a shoulder with a torn rotator cuff. Twenty-seven patients with unilateral full-thickness rotator cuff tears diagnosed by either positive arthrogram or magnetic resonance imaging were included in this study. Three groups were formed based on intraoperative findings: 10 patients had isolated supraspinatus tendon tears (group 1), 11 patients had supraspinatus and infraspinatus tears (group 2), and 6 patients had supraspinatus, infraspinatus, and subscapularis tendon tears (group 3). There was no statistically significant difference between the degree of humeral head excursion in groups 1 and 2. However, patients in group 3 had a statistically significantly higher degree of excursion of the humeral head (P < .05) when compared with groups 1 and 2. In addition, an inverse relationship between the degree of humeral head excursion and preoperative Constant scores was found. Superior excursion of the humeral head on the glenoid had a significantly higher incidence in patients with subscapularis tears, and a larger amount of excursion was present in patients who had lower preoperative Constant scores.

Adult↗