An intact subscapularis tendon and compensatory teres minor hypertrophy yield lower failure rates for non-operative treatment of irreparable, massive rotator cuff tears

2019 ◽  
Vol 27 (10) ◽  
pp. 3240-3245
Author(s):  
Tae-Hwan Yoon ◽  
Sung-Jae Kim ◽  
Chong-Hyuk Choi ◽  
Soon-Phil Yoon ◽  
Yong-Min Chun
Keyword(s):  
Rotator Cuff ◽  
Operative Treatment ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Failure Rates ◽  
Massive Rotator Cuff Tears ◽  
Teres Minor

scholarly journals Biceps Detachment Preserves Joint Function in a Chronic Massive Rotator Cuff Tear Rat Model

2018 ◽  
Vol 46 (14) ◽  
pp. 3486-3494 ◽  
Author(s):  
Mengcun Chen ◽  
Snehal S. Shetye ◽  
Julianne Huegel ◽  
Corinne N. Riggin ◽  
Daniel J. Gittings ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Joint Function ◽  
Massive Rotator Cuff Tears ◽  
Sham Surgery ◽  
Biceps Tenotomy

Background: Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears (MRCTs), and biceps tenotomy is frequently performed for pain relief and functional reservation. However, the efficacy and safety of biceps tenotomy regarding the effects on the surrounding tissues in chronic MRCT are unclear. Hypothesis: Biceps tenotomy would result in improved mechanical and histological properties of the intact subscapularis tendon and improved in vivo shoulder function while not compromising glenoid cartilage properties. Study Design: Controlled laboratory study. Methods: Right supraspinatus and infraspinatus tendons were detached in 25 male Sprague-Dawley rats, followed by 4 weeks of cage activity to create a chronic MRCT condition. Animals were randomly divided into 2 groups and received either biceps tenotomy (n = 11) or sham surgery (n = 14) and were sacrificed 4 weeks thereafter. Forelimb gait and ground-reaction forces were recorded 1 day before the tendon detachment (baseline), 1 day before the surgical intervention (biceps tenotomy or sham), and 3, 7, 10, 14, 21, and 28 days after the intervention to assess in vivo shoulder joint function. The subscapularis tendon and glenoid cartilage were randomly allocated for mechanical testing or histologic assessment after the sacrifice. Results: Compared with sham surgery, biceps tenotomy partially restored the in vivo shoulder joint function, with several gait and ground-reaction force parameters returning closer to preinjury baseline values at 4 weeks. With biceps tenotomy, mechanical properties of the subscapularis tendons were improved, while mechanical properties and histological Mankin scores of the glenoid cartilage were not diminished when compared with the sham group. Conclusion: Biceps tenotomy in the presence of chronic MRCT partially preserves overall shoulder function and potentially restores subscapularis tendon health without causing detrimental effects to joint cartilage. This laboratory study adds to the growing literature regarding the protective effects of biceps tenotomy on the shoulder joint in a chronic MRCT model. Clinical Relevance: This study provides important basic science evidence supporting the use of biceps tenotomy in patients with massive rotator cuff tears.

Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear

2017 ◽  
Vol 45 (11) ◽  
pp. 2555-2562 ◽  
Author(s):  
Sung Hyun Lee ◽  
Dae Jin Nam ◽  
Se Jin Kim ◽  
Jeong Woo Kim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Resonance Imaging ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Massive Rotator Cuff Tears

Background: The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. Purpose: To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. Results: We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. Conclusion: Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.

Effects of Extrinsic Muscle Integrity on Latissimus Dorsi Transfer for Irreparable Rotator Cuff Tears: A Simulation Study

2008 ◽  
Author(s):  
Hang-yin Ling ◽  
Jovito G. Angeles ◽  
MaryBeth Horodyski
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Latissimus Dorsi ◽  
Primary Treatment ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Extrinsic Muscle ◽  
Muscle Transfers ◽  
And Function ◽  
Teres Minor

Massive rotator cuff tears are one of the most common shoulder problems among the elderly, leading to pain and disability of the upper extremity. Muscle transfer, which can compensate for some of the deficits, has been advocated as the primary treatment of irreparable massive rotator cuff tears or as a salvage procedure after failed repairs. Latissimus dorsi transfers offer a promising solution in the treatment of irreparable posterosuperior rotator cuff tears, resulting in pain relief and function improvement of patients with the tears. However, the clinical results are variable and the factors which determine outcome are poorly understood. Prior studies have revealed that the functional outcomes of latissimus dorsi transfers were adversely affected if there was a deficit in deltoid and teres minor muscles [1, 2]. For the patient with a deltoid injury, the transfer that follows a failed rotator cuff repair produces less functional improvement than if the transfer is performed as the primary treatment to repair the rotator cuff. It was revealed that the presence of a tear of the teres minor muscle might have some predictive value prior to surgery with regard to motion and function [1], whereas the degree of fatty infiltration also played a critical role after the transfer [2]. Outcomes of muscle transfers have been reported in the literature, but the effects of extrinsic muscle integrity on the functional outcomes in the latissumus dorsi transfer have not been addressed quantitatively. The purpose of this work was to study the effects of the extrinsic muscle integrity on the functional outcomes in the latissumus dorsi transfer using a three-dimensional integrated model of the upper extremity [3]. First, the effects of extrinsic muscle integrity on the preoperative functions of shoulders with massive rotator cuff tears were investigated. Second, these effects on the functional outcomes of muscle transfers were evaluated quantitatively.

scholarly journals What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?

2015 ◽  
Vol 473 (9) ◽  
pp. 2959-2966 ◽  
Author(s):  
Philippe Collin ◽  
Thomas Treseder ◽  
Patrick J. Denard ◽  
Lionel Neyton ◽  
Gilles Walch ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Clinical Test ◽  
Massive Rotator Cuff Tears ◽  
Teres Minor

Isolated Subscapularis Repair in Irreparable Posterosuperior Massive Rotator Cuff Tears Involving the Subscapularis Tendon

2017 ◽  
Vol 45 (6) ◽  
pp. 1269-1275 ◽  
Author(s):  
Sung-Jae Kim ◽  
Yun-Rak Choi ◽  
Min Jung ◽  
Won-Yong Lee ◽  
Yong-Min Chun
Keyword(s):  
Rotator Cuff ◽  
Structural Integrity ◽  
Young Patients ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Massive Rotator Cuff Tears ◽  
Pain Scores ◽  
Shoulder Scores

Background: No previous study has examined whether isolated subscapularis tendon repair in irreparable posterosuperior massive rotator tears involving the subscapularis tendon in relatively young patients without arthritis can yield satisfactory outcomes. Hypothesis: We hypothesized that this procedure would produce favorable outcomes in patients who might otherwise be candidates for reverse arthroplasty. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study included 24 patients in their 50s and 60s, without shoulder arthritis, who underwent arthroscopic isolated subscapularis repair for an irreparable massive rotator cuff tear involving the subscapularis tendon. Preoperative and postoperative visual analog scale (VAS) pain scores, subjective shoulder values (SSVs), University of California at Los Angeles (UCLA) shoulder scores, American Shoulder and Elbow Surgeons (ASES) scores, subscapularis strength (modified bell-press test; maximum of 5), and shoulder active range of motion (ROM) were assessed. Postoperative magnetic resonance arthrography (MRA) was performed 6 months postoperatively to assess structural integrity of the repaired subscapularis. Results: At a mean 34.8 months (range, 24-49 months) of follow-up, VAS pain scores (improved from 7.1 to 2.5), SSVs (33.3 to 75.2), ASES scores (35.9 to 76.0), UCLA shoulder scores (11.6 to 24.8), subscapularis strength, and ROM were significantly improved compared with preoperative measurements ( P < .001). Subscapularis muscle strength improved from 3.7 to 4.2 ( P < .001). For active ROM, forward flexion and internal rotation improved significantly ( P < .001); however, external rotation exhibited no significant improvement. Follow-up MRA was performed in 22 patients (92%) and showed retear of the repaired subscapularis in 6 (27% of the 22). Conclusion: Isolated repair of the subscapularis tendon in irreparable massive rotator cuff tears involving the subscapularis tendon yielded satisfactory short-term outcomes and structural integrity in patients in their 50s and 60s without arthritis. If patients with irreparable massive rotator cuff tears involving the subscapularis tendon are relatively young or have minimal concomitant arthritis, this repair can be worthwhile.

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