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PubMed2005

Ultrasonography of the rotator cuff: a comparison with arthroscopy in one-hundred-and-ninety consecutive cases.

PURPOSE: To evaluate the accuracy of high-resolution ultrasonography compared to arthroscopy in the detection of rotator cuff tears. MATERIAL AND METHODS: Preoperative ultrasonography (US) with a 10-MHz commercially available linear-array transducer and a standardized study protocol was performed in 190 consecutive shoulders in 185 patients with a history of shoulder pain for more than 3 months. The findings at US were classified into intact cuff, partial-thickness, and full-thickness rotator cuff tears, and correlated with findings at shoulder arthroscopy. RESULTS: US correctly depicted 118 of 124 rotator cuff tears with sensitivity 95%, specificity 94%, PPV 97%, NPV 91% and accuracy 95%, all 94 full-thickness tears (sensitivity 100%, specificity 91%, PPV 91%, NPV 100%, and accuracy 95%), 24 of 30 partial-thickness tears (sensitivity 80%, specificity 98%, PPV 86%, NPV 96%, and accuracy 95%). CONCLUSION: US is a highly accurate diagnostic method for detecting full-thickness rotator cuff tears, but is less sensitive in detecting partial-thickness rotator cuff tears.

Adult↗

PubMed1994

Diagnostic performance of magnetic resonance imaging for the diagnosis of rotator cuff tears using supplemental images in the oblique sagittal plane.

RATIONALE AND OBJECTIVES: The authors evaluated the diagnostic utility of supplemental imaging in the oblique sagittal (OS) plane for the magnetic resonance imaging (MRI) diagnosis of rotator cuff tears. METHODS: Two radiologists with varying levels of MRI experience blindly reviewed shoulder MR examinations of 50 patients for rotator cuff tears. Shoulder examinations were interpreted twice, initially using only double-echo spin-echo images obtained in the oblique coronal (OC) plane and later using double-echo spin-echo images obtained in the both the OC and OS planes. Tears were characterized according to size, location, and extent, and levels of diagnostic confidence were evaluated. RESULTS: Sensitivity and specificity of MR for the diagnosis of rotator cuff tear was 85% and 80%, respectively, with the OC series increasing to 95% and 93%, respectively with OCOS scans. However, these increases were not statistically significant. Receiver operating characteristic (ROC) curves suggest a trend toward increased diagnostic confidence when supplemental OS scans are available, especially for the less experienced reader. Characterization of rotator cuff tears was not improved with additional OS images. CONCLUSIONS: Supplemental OS scans did not demonstrate a definite improvement in diagnostic accuracy for rotator cuff tears compared to OC scans alone. Estimations based on sample size calculations indicate that a much larger population of patients would be needed to show a statistically significant difference.

Humans↗

PubMed2005

Evaluation of rotator cuff tears with magnetic resonance arthrography.

The size and morphologic features of rotator cuff tears may influence treatment selection and affect final outcomes. Magnetic resonance arthrography allows observation of these features and other intraarticular structures. To assess the utility of magnetic resonance imaging in assessing size and morphologic features, we retrospectively reviewed observations on 41 shoulders in 37 consecutive surgically treated patients (mean age, 63.2 years) who had magnetic resonance imaging followed by magnetic resonance arthrography. The maximum rotator cuff defect size in the anteroposterior direction defined transverse size, and the maximum rotator cuff defect size in the mediolateral direction defined longitudinal size. Sensitivities for detecting full-thickness rotator cuff tears by magnetic resonance imaging and magnetic resonance arthrography were 90.2% and 100%, respectively. Maximum longitudinal and transverse dimensions of the tear as shown by magnetic resonance arthrography correlated better with intraoperative measurements (r2 = 0.85 transversely, 0.92 longitudinally) than magnetic resonance imaging measurements (r2 = 0.47 transversely, 0.26 longitudinally). The reproducibility of the two methods is similar. Magnetic resonance arthrography also allowed morphologic classification of the torn tendon as blunt end, tapering end, indistinct end, horizontal tear, and global tear. There was good agreement in classifying torn edges; the imaging findings agreed with findings at surgery. Magnetic resonance arthrography was more accurate in evaluating rotator cuff tear size and morphologic features than conventional magnetic resonance imaging.

Adult↗

PubMed2005

Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography.

OBJECTIVES: Reliable assessment of fatty degeneration of rotator cuff muscles is desirable to predict the outcome of shoulder surgery. Currently used qualitative assessments are limited by relatively high inter- and intraobserver variability. It was hypothesized that a quantitative measurement of muscle density using computed tomography (CT) was more reliable and reproducible. MATERIALS AND METHODS: Thirty shoulders from patients with rheumatoid arthritis were analyzed using parasagittal multiplanar reconstructions acquired from a 16-slice CT scanner. Three observers visually rated the severity of fatty degeneration and independently outlined the rotator cuff muscles, after which the mean density was calculated. Inter- and intraobserver agreement on both measurements was expressed by the interclass correlation coefficient (ICC) and the standard deviation of the differences (SDD) between the measurements. RESULTS: A strong correlation was found between the quantitative measure and the visual rating (R2 = 0.94; P < 0.0001). The SDD in muscle density did not exceed 2.3 Hounsfield units, and the mean rotator cuff ICC (0.98) was substantially greater than that of the visual rating (0.63). CONCLUSIONS: This study describes a reproducible method to quantify fatty degeneration of the rotator cuff muscles in CT images, with a higher interobserver agreement than the visual score, and may prove a reliable tool to evaluate the quality of the rotator cuff muscles.

Adipose Tissue↗

PubMed2005

Allograft reconstruction for massive, irreparable rotator cuff tears.

BACKGROUND: There is currently no widely accepted treatment for massive, irreparable rotator cuff tears. HYPOTHESIS: Allograft reconstruction to span the remaining defect in massive, irreparable rotator cuff tears will lead to increased functional results and will demonstrate healing of the allograft on follow-up magnetic resonance imaging studies. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1989 and 2003, 32 patients underwent allograft reconstruction of massive rotator cuff tears. University of California, Los Angeles shoulder scores were compared preoperatively and postoperatively and analyzed using paired Student t tests. In addition, 15 patients underwent postoperative magnetic resonance imaging to evaluate the structural integrity of the allograft reconstruction at the greater tuberosity insertion. RESULTS: Of 32 patients, 28 were available for review at a mean follow-up of 31.3 months; 23 of the 28 patients were satisfied with their outcome. There was 1 postoperative infection and 1 acute allograft rejection. The mean University of California, Los Angeles score increased from 12.1 preoperatively to 26.1 postoperatively (P < .001). All 15 patients evaluated with postoperative magnetic resonance imaging arthrograms demonstrated complete radiographic failure of the allograft rotator cuff reconstruction. Despite radiographic failure, the mean University of California, Los Angeles score increased from 13.2 preoperatively to 28.3 postoperatively in this subset of patients. CONCLUSION: The functional results of this reconstruction method are similar to those reported for debridement and subacromial decompression alone and are satisfactory, despite magnetic resonance imaging arthrogram evaluation demonstrating failure of the structural integrity of the allograft. Allograft reconstruction carries increased risk of infection and rejection and is technically more difficult than other less expensive treatment options with similar functional results. Therefore, we do not recommend allograft reconstruction of massive and otherwise irreparable rotator cuff tears.

Adult↗

PubMedDate not supplied

Comparison of open and arthroscopically assisted rotator cuff repairs.

Open rotator cuff repair has shown reliable results in terms of pain relief and improved shoulder function. Recently, however, arthroscopically assisted rotator cuff repair has shown promising preliminary results. We compared the results of these two procedures with regard to pain, function, range of motion, strength, patient satisfaction, and return to previous activity. Thirty-seven rotator cuff repairs were evaluated in 36 patients with a minimum followup of 2 years. The open repair group comprised 20 shoulders with an average followup of 3.3 years; the arthroscopically assisted repair group comprised 17 shoulders with an average followup of 3.2 years. Overall, the open repair group had 80% good-to-excellent results and 88% patient satisfaction, and the arthroscopically assisted repair group had 85% good-to-excellent results and 92% patient satisfaction. Shoulder flexion and abduction strength, the size of the tear repaired, and the functional outcome did not differ significantly between the two groups. In general, however, small and moderate-sized tears (< 3 cm) had better functional outcome with arthroscopically assisted repair. The arthroscopically assisted repair group was hospitalized 1.2 days less and returned to previous activity an average of 1 month earlier. In the surgical treatment of symptomatic complete rotator cuff tears, arthroscopically assisted rotator cuff repair is as effective as open repair.

Adult↗

PubMedDate not supplied

Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder.

Thirty shoulders in 20 volunteers (average age, 29 years; range, 17 to 49) with no shoulder symptoms or known abnormalities were scanned using magnetic resonance imaging. All scans were interpreted by one radiologist who was blinded to clinical data. Appearance of rotator cuff tendons on the images was graded. Grade 0 was normal, homogeneous low signal intensity structure. Grade 1 lesion was focal, linear, or diffuse intermediate signal through the tendon. Grade 2 lesion was high signal intensity within the tendon and less than full thickness. Grade 3 was high signal intensity through full thickness of the tendon. No supraspinatus or infraspinatus tendons were grade 0 (normal); all supraspinatus and infraspinatus tendons had grade 1 changes through the tendons; and 7 of 30 (23%) of the tendons had grade 2 changes. None of the 30 shoulders had grade 3 changes in the rotator cuff tendons. There is a wide array of abnormal magnetic resonance imaging signals in shoulders of young asymptomatic individuals, but they do not have full-thickness rotator cuff tears (grade 3 lesion). Nonenhanced magnetic resonance imaging may be of limited value in defining rotator cuff injury in a patient with shoulder pain unless a full-thickness rotator cuff tear is suspected clinically.

Adolescent↗

PubMedDate not supplied

Rotator cuff injury in contact athletes.

The causes and incidence of rotator cuff injuries in patients under the age of 40 has not been clearly established. The present study focuses on a group of 10 male contact athletes with rotator cuff injuries related to trauma sustained during football (ages from 24 to 36 years). Symptoms included pain and dysfunction in all 10 patients and a positive shrug sign in 8 of 10. The diagnoses for these patients were two isolated contusions, five partial-thickness tears, and three full-thickness tears. Surgery was performed on all patients after nonoperative treatment failed. Three partial-thickness tears were arthroscopically debrided. One full-thickness and two partial-thickness tears were repaired using the arthroscopically assisted miniarthrotomy technique. An open repair was performed in two patients. Two isolated rotator cuff contusions were arthroscopically debrided. The average followup was 21 months. Nine of 10 athletes returned to active participation in football, 7 of these at their preinjury levels. The diagnosis of rotator cuff injury should be considered in a contact athlete who has persistent shoulder pain, impingement signs, weakness, and a positive shrug sign. Arthroscopic debridement of the subacromial space followed by debridement or repair of rotator cuff tears, as clinically indicated, resulted in a marked improvement in function and rapid return to sport for these patients.

Acromion↗

PubMed2006

All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: a protocol for a randomized trial [NCT00128076].

BACKGROUND: Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. METHODS/DESIGN: This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator cuff tears. A national consensus meeting of investigators in the Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS Canada) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC)) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, Constant score), secondary dimensions of health (general health status (SF-12) and work limitations), and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12, and 24 months post-operatively by blinded research assistants and musculoskeletal radiologists. Patients (n = 250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to statistically detect a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score (alpha = 0.05). A central methods centre will manage randomization, data management, and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopic repair procedures will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. We will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2 years post-operatively. As a secondary analysis, we will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2 years. The trial will commence when funding is in place. DISCUSSION: These results will have immediate impact on the practice behaviors of practicing surgeons and surgical trainees at JOINTS centres across Canada. JOINTS Canada is actively engaged in knowledge exchange and will publish and present findings internationally to facilitate wider application. This trial will establish definitive evidence on this question at an international level.

Arthroscopy↗

PubMed1991

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

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

Arm↗

PubMed1999

Evaluation of chronic tears of the rotator cuff by ultrasound. A new index.

The diagnosis of chronic lesions of the rotator cuff is challenging. We have developed a new index to improve the sonographic diagnosis of chronic tears of the cuff. In a pilot study, we examined 50 asymptomatic healthy volunteers by ultrasound to establish the diameter of the rotator cuff in relation to the tendon of the long head of biceps. Subsequently, the index was calculated in 64 patients who had had shoulder pain for more than three months caused by clinically diagnosed lesions of the rotator cuff. The compensatory hypertrophy of the biceps tendon was quantified sonographically in relation to the diameter of the cuff. Comparison with the contralateral shoulder revealed a significantly higher biceps rotator-cuff ratio (p < 0.05) for patients with torn rotator cuffs. A ratio greater than 0.8 was considered pathological (index positive); the mean ratio in the control group was 0.43. The sensitivity of a positive index was 97.8%, the specificity 63.2%, the positive predictive value 86.3%, and the negative predictive value 92.4% in comparison with surgical findings. Use of the index improves sensitivity in the diagnosis of chronic tears of the cuff by ultrasound.

Adult↗

PubMed2006

Pathology of the torn rotator cuff tendon. Reduction in potential for repair as tear size increases.

We have studied cellular and vascular changes in different stages of full thickness tears of the rotator cuff. We examined biopsies from the supraspinatus tendon in 40 patients with chronic rotator cuff tears who were undergoing surgery and compared them with biopsies from four uninjured subscapularis tendons. Morphological and immunocytochemical methods using monoclonal antibodies directed against leucocytes, macrophages, mast cells, proliferative and vascular markers were used. Histological changes indicative of repair and inflammation were most evident in small sized rotator cuff tears with increased fibroblast cellularity and intimal hyperplasia, together with increased expression of leucocyte and vascular markers. These reparative and inflammatory changes diminished as the size of the rotator cuff tear increased. Marked oedema and degeneration was seen in large and massive tears, which more often showed chondroid metaplasia and amyloid deposition. There was no association between the age of the patient and the duration of symptoms. In contrast, large and massive tears showed no increase in the number of inflammatory cells and blood vessels. Small sized rotator cuff tears retained the greatest potential to heal, showing increased fibroblast cellularity, blood vessel proliferation and the presence of a significant inflammatory component. Tissue from large and massive tears is of such a degenerative nature that it may be a significant cause of re-rupture after surgical repair and could make healing improbable in this group.

Adult↗

PubMed2006

Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence.

INTRODUCTION: Rotator cuff tears are a common pathology, with a varied prevalence reported. PATIENTS AND METHODS: A literature review was undertaken to determine the cadaveric and radiological (ultrasonography and magnetic resonance imaging [MRI]) prevalence of rotator cuff tear. The radiological studies were subdivided into symptomatic and asymptomatic subjects. RESULTS: Cadaveric rotator cuff tears were found in 4629 shoulders of which only 2553 met the inclusion criteria. The prevalence of full-thickness tears was 11.75% and partial thickness 18.49% (total tears 30.24%). The total tear rate in ultrasound asymptomatic was 38.9% and ultrasound symptomatic 41.4%. The total rate in MRI asymptomatic was 26.2% whilst MRI symptomatic was 49.4%. DISCUSSION: The unselected cadaveric population should contain both symptomatic and asymptomatic subjects. A prevalence of tears between the symptomatic and asymptomatic radiological groups would be expected. However, apart from the MRI asymptomatic group, the radiological prevalence of rotator cuff tears exceeds the cadaveric. CONCLUSIONS: Rotator cuff tears are frequently asymptomatic. Tears demonstrated during radiological investigation of the shoulder may be asymptomatic. It is important to correlate radiological and clinical findings in the shoulder.

Aged↗

PubMed2026

Application of musculoskeletal ultrasound in postoperative rehabilitation assessment and monitoring after rotator cuff repair: A systematic review.

BACKGROUND: The development of rehabilitation protocols after rotator cuff repair has long lacked objective benchmarks. Traditional time‑based regimens are limited by considerable inter‑individual variability and an increased risk of re‑tear. Musculoskeletal ultrasound allows dynamic assessment of tendon healing and muscle morphology, yet evidence for directly linking its use to rehabilitation decisions remains scarce. OBJECTIVE: To systematically synthesize the evidence on the use of musculoskeletal ultrasound monitoring to inform rehabilitation decision‑making after rotator cuff repair. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines, we searched PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data from January 2020 to April 2026. Original studies were included if they involved patients who had undergone rotator cuff repair, used musculoskeletal ultrasound (including gray‑scale ultrasound, elastography, etc.) to evaluate the rotator cuff tendons or shoulder muscles, and reported at least one parameter related to rehabilitation decision-making or functional outcomes. RESULTS: Eleven studies were included. Shear wave velocity (SWV), cross‑sectional area (CSA), and echo intensity (EI) were the most frequently reported ultrasound parameters. Available evidence indicated that SWV increased progressively after surgery, with an overall increase of approximately 22% to 25% from one week to 12 months postoperatively. This dynamic trajectory may serve as a reference baseline for judging rehabilitation progress. An abnormally elevated SWV in the early postoperative period was associated with an increased risk of re‑tear, suggesting that a more conservative rehabilitation strategy should be adopted. Tendon stiffness measured at 12 weeks after surgery independently predicted long‑term return to sport. Regarding muscle parameters, changes in CSA and EI were positively correlated with shoulder function scores, and the combination of these two parameters effectively identified patients with rehabilitation bottlenecks. CONCLUSION: Musculoskeletal ultrasound parameters are associated with the initiation of active movement, adjustment of exercise load, prediction of return‑to‑sport prognosis, and identification of retear risk. Among these, SWV shows particular promise as an objective monitoring parameter for supporting rehabilitation assessment after rotator cuff repair. Future randomized controlled trials are needed to determine whether ultrasound-informed assessment can improve rehabilitation outcomes compared with traditional time-based regimens, and to establish standardized measurement protocols and clinically applicable reference values. Key findings of this review are summarized in S1 File.

Humans↗

PubMed1998

Continuous passive motion after repair of the rotator cuff. A prospective outcome study.

Despite the apparent success of continuous passive motion after soft-tissue procedures or joint replacements, its effect after repair of the rotator cuff is still unknown. The purpose of this prospective, randomized outcome study was to compare the results of continuous passive motion with those of manual passive range-of-motion exercises after repair of the rotator cuff. Thirty-one patients (thirty-two rotator cuffs) were randomly assigned to one of two types of postoperative management: continuous passive motion (seventeen patients) or manual passive range-of-motion exercises (fifteen patients). There were seventeen women and fourteen men, and the mean age was sixty-three years (range, thirty to eighty years). The patients were followed for a mean of twenty-two months (range, six to forty-five months). Five tears of the rotator cuff were small, eighteen were medium, and nine were large. All of the operations were performed by one surgeon. The patients who were managed with continuous passive motion used the device for the first four weeks postoperatively. The patients who were managed with manual passive range-of-motion exercises were assisted by a trained relative, friend, or home-care nurse. After the four-week period, the two groups were managed similarly for two to five months. According to the Shoulder Pain and Disability Index, a valid and reliable self-administered questionnaire, the treatment was extremely successful in both groups. The overall score was excellent for twenty-seven shoulders (84 per cent), good for two (6 per cent), fair for two (7 per cent), and poor for one (3 per cent). With the numbers available, we could detect no significant differences (p > 0.05) between the two groups with respect to the score according to the Index, pain (according to a visual-analog scale), range of motion, or isometric strength. Manual passive range-of-motion exercises were more cost-effective than continuous passive motion. The limited number of physical-therapy visits associated with the manual passive range-of-motion exercises in the present study appeared to be more cost-effective than a traditional physical-therapy schedule of three visits per week. Postoperative therapy with continuous passive motion or manual passive range-of-motion exercises appears to yield favorable results after repair of a small, medium, or large tear of the rotator cuff.

Adult↗

PubMed2004

Associations between body-mass index and surgery for rotator cuff tendinitis.

BACKGROUND: Rotator cuff tendinopathy is a common entity. We hypothesized that obesity, because of biomechanical and systemic risk factors, increases the risks of rotator cuff tendinitis, tears, and related surgical procedures. METHODS: A frequency-matched case-control study was conducted. Three hundred and eleven patients who were fifty-three to seventy-seven years old and who underwent rotator cuff repair, arthroscopy, and/or other repair of the shoulder in a large hospital from 1992 to 2000 were included in the study. These surgical procedures were used as proxies for the risk of rotator cuff tendinitis. These patients were age and frequency-matched to 933 controls, who were randomly drawn from a pool of 10,943 potential controls consisting of Utah state residents who were enrolled in a large cancer-screening trial. Age-adjusted odds ratios were calculated with use of the International Classification of Diseases, Ninth Revision procedural codes and body-mass-index groups. The data were stratified according to gender and age. Multiple linear regression analyses also were performed. RESULTS: There was an association between increasing body-mass index and shoulder repair surgery. The highest odds ratios for both men (odds ratio = 3.13; 95% confidence interval = 1.29 to 7.61) and women (odds ratio = 3.51; 95% confidence interval = 1.80 to 6.85) were for individuals with a body-mass index of > or =35.0 kg/m(2). Tests for trend also were highly significant for both men (p = 0.002) and women (p < or = 0.001). Multiple linear regression analysis also indicated a significant association between increasing body-mass index and shoulder surgery (beta = 1.57; 95% confidence interval = 0.97 to 2.17; p < or = 0.001). CONCLUSIONS: There is an association between obesity and shoulder repair surgery in men and women who are fifty-three to seventy-seven years of age. The results of the present study suggest that increasing body-mass index is a risk factor for rotator cuff tendinitis and related conditions.

Aged↗

PubMed2004

Biomechanical evaluation of arthroscopic rotator cuff stitches.

BACKGROUND: The suture configurations in arthroscopic rotator cuff repairs have been limited to simple and horizontal stitches. Recent objective evaluations have demonstrated high failure rates of arthroscopic repairs of rotator cuff tears. A novel stitch for arthroscopic repair of the rotator cuff, the massive cuff stitch, was developed to increase the strength of the suture-tendon interface. The goal of this study was to determine the biomechanical properties of the massive cuff stitch and to compare it with other stitches commonly used for rotator cuff repair. METHODS: Eight pairs of sheep infraspinatus tendons were harvested and split in half to yield a set of four tendon specimens from each animal. Four stitch configurations (simple, horizontal, massive cuff, and modified Mason-Allen) were randomized and biomechanically tested in each set of tendon specimens. Each specimen was first cyclically loaded on an MTS uniaxial load frame under force control from 5 to 30 N at 0.25 Hz for twenty cycles. Each specimen was then loaded to failure under displacement control at a rate of 1 mm/sec. Cyclic elongation, peak-to-peak displacement, ultimate tensile load, and stiffness were measured with use of an optical motion analysis system and load-cell output. The type of failure (suture breakage or pull-out) was also recorded. A repeated-measures analysis of variance was performed on the results, with the alpha level of significance set at p < 0.05. RESULTS: There was no difference in cyclic elongation or peak-to-peak displacement among the four stitches. Ultimate tensile load was significantly higher (p < 0.05) for the massive cuff stitch (233 +/- 40 N) and the modified Mason-Allen stitch (246 +/- 40 N) than it was for either the simple stitch (72 +/- 18 N) or the horizontal stitch (77 +/- 15 N). There was no significant difference in the ultimate load between the massive cuff and modified Mason-Allen stitches. There was also no difference in stiffness among the four stitches. The simple and horizontal stitches failed by tissue pull-out, whereas the massive cuff and Mason-Allen stitches failed by a mixture of suture breakage and pull-out. CONCLUSIONS: The massive cuff stitch provides strength comparable with that of the modified Mason-Allen stitch commonly used in open rotator cuff repair. The ultimate tensile load before failure of the massive cuff stitch was significantly higher (p < 0.05) than that of the simple and horizontal stitches.

Animals↗

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↗