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PubMedDate not supplied

Results of early operative treatment of rotator cuff tears with acute symptoms.

The distinction among an acute tear, acute symptoms of a chronic tear, or the acute extension of an existing chronic tear is very difficult, if not impossible, to make. In general, operative treatment of lesions with a sudden onset has yielded favorable results in many studies. However, the timing of the operation for tears with an acute onset of symptoms is still a very controversial issue, as are the treatment options for chronic tears with acute symptoms. This study analyzes the follow-up results of early operative treatment of rotator cuff tears with an acute onset of symptoms, regardless of tear type. Twenty-nine patients with a sudden onset of symptoms and significant impairment of shoulder function had a full-thickness rotator cuff tear. The patients were operated on within 3 weeks from the beginning of the symptoms. Twenty-six patients underwent follow-up. The results were evaluated by use of the UCLA shoulder rating scale. At follow-up, 22 patients (85%) had no pain and 21 (81%) had returned to normal activities and had normal shoulder function. Active forward flexion averaged 51 degrees preoperatively and 167 degrees at follow-up. After repair of the tear, shoulder strength was normal in 22 of 26 shoulders (85%); 3 patients had fair strength, all after repair of a massive tear. Of the patients, 25 (96%) were satisfied with the result. The overall result was excellent in 20 patients (77%), good in 4 (15%), fair in 1 (4%), and poor in 1 (4%). Early operative treatment appears to be better for rotator cuff tears with a sudden onset of symptoms and poor function to achieve maximal return of shoulder function. With time, the tear may enlarge, and the cuff may lose its elasticity, thus making the late surgical repair more difficult or even impossible.

Acute Disease↗
PubMedDate not supplied

Combined pectoralis major and latissimus dorsi tendon transfer for massive rotator cuff deficiency.

This report is a retrospective review of 11 consecutive patients treated with a combined transfer of the latissimus dorsi and pectoralis major tendons for massive rotator cuff deficiency. Each patient's chief complaint was diminished shoulder function and motion with little or no accompanying pain. The primary operative objective was to increase active shoulder motion. All 11 patients were followed up for at least 2 years (range, 24 to 42 months). The mean active elevation improved from 42 degrees preoperatively to 86 degrees postoperatively. The mean active external rotation improved from 0 degrees to 13 degrees. On the basis of the Medical Research Council scale, the mean abduction strength improved from 2.3 to 3.1 and the mean external rotation strength improved from 2.1 to 2.7. Overall, 4 patients made no improvement, 2 improved slightly, and 5 improved significantly. We conclude that a combined transfer of the latissimus dorsi and pectoralis major is a reasonable and safe procedure that may restore active elevation and external rotation in some patients' shoulders with a massive rotator cuff deficiency that have not responded favorably to traditional nonoperative and operative techniques. However, it is difficult to conclude, based on our experience, for which patients this surgery can be predictably successful.

Adult↗
PubMed1995

Repair of the rotator cuff. A comparison of results in two populations of patients.

One hundred and seven shoulders of 103 consecutive patients were evaluated after primary repair of the rotator cuff. Twenty-four patients were receiving Workers' Compensation, and the other seventy-nine were not. Preoperative and postoperative evaluation of both groups included subjective assessment of pain, function, and patient satisfaction as well as objective assessment of the strength and active range of motion of the shoulder. The shoulder-rating scale of the University of California at Los Angeles was used to determine over-all success rates. The duration of follow-up ranged from twenty-four to sixty-eight months (mean, forty-five months). The two groups were comparable with regard to the age and sex of the patients, the size of the tear of the rotator cuff, and the preoperative strength, pain, and active range of motion of the shoulder. Over-all, a successful result was achieved in eighty-nine of the 107 shoulders. Of the twenty-four shoulders of patients who were receiving Workers' Compensation, thirteen (54 per cent) were rated good or excellent, compared with seventy-six (92 per cent) of the eighty-three shoulders of patients who were not receiving Workers' Compensation. Ten (42 per cent) of the twenty-four patients who were receiving Workers' Compensation returned to full activity, compared with seventy-four (94 per cent) of the seventy-nine patients who were not.

Adult↗
PubMed2003

[Reconstruction of big rotator cuff ruptures. A new technique of tendon refixation with the corkscrew suture anchor system].

Tendon retraction and fatty degeneration is a major problem in repair of massive rotator cuff tears. Especially in the transosseous refixation technique, a tension-free refixation cannot be obtained in all cases. The purpose of this prospective study was to evaluate the postoperative results using a new tension-free reinsertion technique with a Corkscrew suture anchor system. Thirty patients (25 males, 5 females) with complete one and two tendon tears underwent open rotator cuff repair (rupture of one tendon: n=14, 47%). The torn tendons were mobilized and reinserted medially to reduce tension. Medialization was achieved by inserting tendon near the osteochondral border in a bony trough. The number of implanted suture anchors ranged from 2 to 6 (mean: 3.56). The mean age was 56 years (39-68 years) with a follow-up of 24 months (17-33 months). In one patient physical and sonographic examination showed a complete and in two patients a partial rerupture. A temporarily frozen shoulder occurred in two cases. No infection or rejection response was seen. In no case was revision surgery necessary. No displacement or loosening of the Corkscrew anchors was noticed. The constant score improved from 45 points preoperatively to 85 points at the time of follow-up (mean). The Corkscrew suture anchor system in combination with the new suture technique offers the possibility of a stable reinsertion even in reduced calcified bone structure. This facilitates good conditions for stable fibroblastic healing. Our midterm results show good osseous union combined with a low rerupture rate.

Adult↗
PubMed2006

MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture.

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months' follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon.

Adult↗
PubMed1998

Impingement syndrome and rotator cuff disease as repetitive motion disorders.

The relationship between repetitive motion and subacromial impingement and rotator cuff disease is controversial and poorly understood. The potential etiology is multifactorial and involves patient related factors (age, supraspinatus outlet anatomy, and preexisting rotator cuff pathology) and worker related factors (arm position, lifting requirements, numbers of repetitions). Radiographic and magnetic resonance imaging abnormalities may represent preexisting disease that could have predisposed the patient to the development of impingement syndrome, but should be interpreted cautiously within the context of the remainder of the clinical picture. Treatment often involves temporary or permanent modifications of the work environment.

Biomechanical Phenomena↗
PubMed1996

[Unusual clinical picture of a rotator cuff lesion].

A case of a 76 year-old male admitted to hospital because of a fast-growing tumour over his right shoulder is described. Malignity was initially suspected, but examination showed that the tumour was a cyst overlying, and arising from, the acromioclavicular joint. Furthermore we found a complete lesion of the rotator cuff. Acromioclavicular joint cysts are a known but unusual presentation of complete rotator cuff lesions, and their treatment includes anterior acromioplasty, acromioclavicular arthroplasty, and repair of the rotator cuff. Isolated surgical cystectomy is without purpose, as the cyst is bound to reappear. Surgical treatment is only indicated if there is severe pain, and/or unacceptable cosmetic problems.

Aged↗
PubMed2006

A biomechanical and radiographic analysis of standard and intracortical suture anchors for arthroscopic rotator cuff repair.

PURPOSE: To compare the fixation strength and radiographic motion of an anchor designed for intracortical (IC) fixation (FT Anchor, Arthrex, Naples, FL) with that of standard anchors used for rotator cuff repair. TYPE OF STUDY: In vitro human cadaveric biomechanical study. METHODS: Four types of metallic suture anchors (8 per group) were randomly inserted into human cadaveric humeri using an IC anchor and 3 types of standard anchors. Anchors were inserted 45 degrees to the humeral head surface and 90 degrees to the rotator cuff line of action. Anchors were tested under physiologic loads for 500 cycles followed by a failure test. The number of cycles, failure mode, and failure load were recorded. Fluoroscopy was used to measure rotation and displacement of the anchor within the humeral head during testing. Data were analyzed using a 1-way analysis of variance with a correction for multiple comparisons. RESULTS: There were no significant differences in anchor displacement or rotation measured by fluoroscopy after cyclic loading. Total construct displacement across anchors ranged from 4.9 to 7.8 mm, well beyond the 3-mm failure criterion reported in the literature. The IC anchor had a statistically significant greater failure load than the other devices. There was no significant difference in failure load between the other 3 anchors. The anchor had the greatest number of cycles to 3 mm of failure. This was not significantly different than the TwinFix anchor (Smith & Nephew, Andover, MA), but both values were significantly greater than both the Super Revo (Linvatec, Largo, FL) and Fastin RC (DePuy Mitek, Raynham, MA) anchors. CONCLUSIONS: Anchor motion accounted for about one third of total displacement of the suture/anchor construct. IC fixation anchors performed well compared with standard anchors in human cadaveric bone. CLINICAL RELEVANCE: Fluoroscopic imaging showed both rotation and displacement of the anchor within the humeral head which may contribute to early gap formation after rotator cuff repairs.

Aged↗
PubMed1993

[Results of endoscopic treatment of tendinopathies of the rotator cuff (excluding total ruptures). 1: Non-calcifying tendinopathies].

The authors have studied the result of endoscopic treatment in 129 non ruptured and non calcified tendinitis of the rotator cuff as well as 33 partial thickness tears included in a multicentric study made by the french arthroscopic society. The files included a revision form using Constant's functional evaluation and filled by a physician different from the operator, and a radiological standardized evaluation allowing to appreciate, from A.P. and lateral views, the acromion shape and the importance of the resection. From the analysis of our results it appears that acromioplasty associated with a section of the coraco-acromial ligament (C.A.L.) under arthroscopic control is very efficient in tears of the superficial, bursal face of the rotator cuff. The same did not apply to the tears of the deep, articular face, as their origin is probably different. In non ruptured and non calcified tendinitis, 90 per cent of our patients were subjectively better. According to Constant's index, we noticed 75 per cent of satisfactory results. The importance of acromioplasty was not related to good results. We therefore think that one should relativise the notion of impingement between the coraco-acromial arch and the tendons of the rotator cuff. Acromioplasty is only effective on one of the factors of tendinous pain. The improvement of our indication by a better knowledge of this pathology should allow us to improve the results of an endoscopic procedure which is now well known and whose advantages do not need to be demonstrated any more.

Activities of Daily Living↗
PubMedDate not supplied

Local corticosteroid injections in the treatment of rotator cuff tendinitis (except for frozen shoulder and calcific tendinitis). Groupe Rhumatologique Français de l'Epaule (G.R.E.P.).

OBJECTIVE: This review discusses the efficacy of local corticosteroid injections in the treatment of rotator cuff tendinitis (except for frozen shoulder and calcific tendinitis) according to the controlled studies published in the literature. STUDY SELECTION: All controlled studies (13) published between 1955 and 1993 have been included in this review. However, this work is not a metaanalysis because these studies are not comparable. DATA SYNTHESIS: Several studies are open to criticism. Local corticosteroid injections seem to be more effective than placebo and oral non-steroidal antiinflammatory drugs, especially for pain. Several questions remain unanswered: the true position of this treatment in the therapeutic strategy of rotator cuff tendinitis, the long term efficacy and deleterious effects of local corticosteroid injections and the optimal technique and number of injections. CONCLUSION: Local corticosteroid injections seem to be effective in the treatment of rotator cuff tendinitis. However, a controlled study more closely reflecting clinical practice is needed to confirm these data.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging.

Forty-one patients scheduled for shoulder surgery underwent computed tomography (CT) and magnetic resonance imaging (MRI) examination of their affected shoulder to verify whether fatty degeneration of the rotator cuff muscles could reproducibly be assessed by CT or by MRI and whether the grading with the 2 methods was comparable. In addition, rotator cuff muscle cross-sectional areas were measured on parasagittal MRI scans to establish a possible correlation between rotator cuff muscle atrophy and fatty degeneration. Interobserver reproducibility for grading fatty degeneration was good to excellent for CT and for MRI. The correlation between MRI and CT was fair to moderate and remained unsatisfactory, even if the classification system was simplified with only a 3- rather than a 5-grade scale as originally proposed. The degree of fatty degeneration was significantly related to the amount of atrophy of the respective muscles.

Adult↗
PubMed1995

Débridement of degenerative, irreparable lesions of the rotator cuff.

A modified Neer acromioplasty, subacromial decompression, and débridement of massive, irreparable lesions of the supraspinatus and infraspinatus tendons was performed in fifty-seven patients. Fifty patients (fifty-three shoulders) were followed for an average of six and one-half years. The average age of the patients was sixty years (range, thirty-eight to seventy-four years). The results, as rated on the basis of pain, function, range of motion, strength, and satisfaction of the patient, were satisfactory in forty-four shoulders (83 per cent) and unsatisfactory in nine (17 per cent). A favorable outcome was observed in shoulders in which both the anterior portion of the deltoid muscle and the long head of the biceps tendon were intact and in which a previous acromioplasties or operations on the rotator cuff had been performed. An unsatisfactory outcome was observed in shoulders in which the anterior part of the deltoid muscle was weak or absent or in which a previous acromioplasty and attempted repair of the rotator cuff had been performed. The active forward flexion of the shoulder improved from an average of 105 degrees preoperatively to an average of 140 degrees postoperatively. The results of the present study suggest that, with proper rehabilitation, adequate decompression of the subacromial space, anterior acromioplasty, and débridement of massive tears of the rotator cuff can lead to the relief of pain and the restoration of shoulder function.

Acromion↗
PubMed2003

Real-time compound sonography of the rotator-cuff: evaluation of artefact reduction and image definition.

PURPOSE: The aim of this study was to compare real time compound sonography with conventional sonography in the evaluation of rotator cuff tears. MATERIALS AND METHODS: A prospective study was performed on 50 supraspinatus tendons in 101 patients treated by surgical acromioplasty. The surgeon described 33 (66%) full-thickness tears and 17 (34%) partial-thickness tears. All tendons were examined by conventional sonography and real time compound sonography on the day before surgery. The techniques were compared by evaluating the images for freedom from artefacts, contrast resolution and overall image definition. RESULTS: Real time compound sonography proved to be superior to conventional sonography as regards freedom from artefacts in 50 cases out of 50 (100%). It was superior to conventional sonography in evaluating the image contrast resolution in 45 cases out of 50 (90%), and superior to conventional sonography in overall image definition in 45 out of 50 cases (90%). CONCLUSIONS: Real-time compound sonography reduces the intrinsic artefacts of conventional sonography and allows better overall image definition. In particular, the digital technique allowed us to study the rotator cuff with better contrast resolution and sharper and more detailed images than did conventional sonography.

Adult↗
PubMedDate not supplied

Rotator cuff regeneration using chitin fabric as an acellular matrix.

Twenty-one rabbits were used to investigate the feasibility of using nonwoven chitin fabric as an acellular matrix for rotator cuff regeneration. Infraspinatus tendons were cut bilaterally to create 10 x 10-mm defects. The defect in the right shoulder was covered with chitin fabric. The contralateral defect was left free as a control. The specimens were evaluated histologically and immunohistochemically at 2, 4, 8, and 12 weeks and biomechanically at 12 weeks after surgery. The acellular matrix increased cell numbers and improved collagen fiber alignment. The regenerated tissues were composed of type III collagen. The structural properties of the grafted shoulder were significantly greater than those of the control. This study revealed that using chitin fabric as an acellular matrix has advantages in enhancing both biologic and mechanical regeneration of rotator cuff tendons.

Animals↗
PubMed1996

Subscapularis transfer for reconstruction of massive tears of the rotator cuff.

Twenty patients who had a massive tear greater than five centimeters (of the rotator cuff that was not amenable to direct tendon-to-bone or tendon-to-tendon repair had reconstruction consisting of transfer of the subscapularis tendon in conjunction with subacromial decompression. At a mean of thirty months (range, twenty-three to seventy months) after the operation, seventeen of the patients were satisfied with the result. Nineteen patients reported a decrease in pain compared with preoperatively. However, nine patients had weakness and discomfort with prolonged or repetitive overhead activities, and two patients had most active elevation of the shoulder despite substantial relief of pain. Subscapularis transfer is a useful adjunct in the operative treatment of massive tears of the rotator cuff; it facilitates the closure of larger defects that are not amenable to simpler, more traditional reconstructive techniques. However, because there is a risk of the procedure adversely affecting active elevation of the shoulder, it should be used with caution in patients who have full functional elevation preoperatively.

Adult↗
PubMed1983

Acute tears of the rotator cuff. The timing of surgical repair.

Thirty-seven patients had surgical repair within three months after significant ruptures of the shoulder rotator cuff. Twelve were repaired within three weeks (Group 1), six within three to six weeks (Group 2), and 19 within six to 12 weeks after injury (Group 3). Follow-up periods averaged 7.0 years (range, 1.25-21.00 years). Pain relief was generally satisfactory; however, active postoperative abduction averaged 168 degrees for Group 1, 126 degrees for Group 2, and only 129 degrees for Group 3. At open operation, the tear size was graded as small, medium, or large. The correlation of average values of postoperative abduction (148 degrees, 152 degrees, and 133 degrees) with tear size was not statistically significant. Roentgenograms showed that rotator cuff disease is associated with glenohumeral arthritis. With evidence of an acute and complete disruption of the rotator cuff if one must consider surgery, early surgical repair (with 3 weeks of injury) affords the best opportunity for maximal recovery of shoulder function.

Adult↗
PubMed1992

Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation.

Standard proton-density- and T2-weighted magnetic resonance (MR) imaging and MR arthrography were used to depict rotator cuff disease in 36 shoulders in 36 patients; the findings were compared with arthroscopic findings in every patient. In 19 rotator cuffs normal at arthroscopy, MR arthrography revealed no tear in 16 patients, a partial tear in one patient, and a full-thickness tear in two patients. Standard proton-density- and T2-weighted images were normal in 15 of these patients and revealed a partial tear in two patients and a full-thickness tear in two patients. In 13 partial tears found at arthroscopy, MR arthrography showed a partial tear in six patients, no tear in five patients, and a full-thickness tear in two patients; standard MR imaging revealed a partial tear in one patient, no tear in 10 patients, and a full-thickness tear in two patients. All four full-thickness tears proved with arthroscopy were correctly diagnosed with both MR imaging methods. The main advantage of MR arthrography was better depiction of partial tears in the articular surface.

Adolescent↗
PubMed2006

Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome.

BACKGROUND: The purpose of this study was to evaluate the clinical results of latissimus dorsi tendon transfer in patients with an irreparable posterosuperior rotator cuff tear to help determine which patient and anatomic factors affect clinical outcome. METHODS: Fourteen patients with a latissimus dorsi tendon transfer were clinically evaluated with use of the PENN (University of Pennsylvania) shoulder score as well as with quantitative measurement of isometric muscle strength and the range of motion of both shoulders at a minimum of twenty-four months postoperatively. The anatomic results were evaluated with postoperative magnetic resonance imaging and electromyography. RESULTS: Nine patients were satisfied with the outcome, had significant clinical improvement, and reported that they would have the operation again under similar circumstances. The other five patients were dissatisfied with the result and had significantly worse PENN scores, active elevation, and objective measures of strength. Eight of the nine patients with a good clinical result were male, and four of the five with a poor result were female. Patients with a good clinical result had had significantly better preoperative function in active forward flexion and active external rotation compared with the patients with a poor result. The magnetic resonance imaging demonstrated healing of the tendon to the greater tuberosity in twelve patients and equivocal healing in two. There was no significant atrophy of any of the transferred muscles. Electromyography demonstrated clear activity in the transferred latissimus muscle during humeral adduction in all fourteen patients, some electrical activity with active forward elevation in only one patient, and some electrical activity with active external rotation in six of the nine patients with a good clinical result. None of the patients with a poor clinical result demonstrated electrical activity of the transferred muscle with active forward flexion or external rotation. CONCLUSIONS: Synchronous in-phase contraction of the transferred latissimus dorsi is a variable finding following the surgical treatment of irreparable posterosuperior rotator cuff tears, but when it is present it is associated with a better clinical result. Preoperative shoulder function and general strength influence the clinical result. Female patients with poor shoulder function and generalized muscle weakness prior to surgery have a greater likelihood of having a poor clinical result.

Adult↗