Repair of full-thickness rotator cuff tears is recommended regardless of tear size and age: A retrospective study of 218 patients

Objectives: Magnetic resonance imaging (MRI) is the advanced imaging modality of choice for the evaluation and diagnosis of full thickness rotator cuff tears (RCT). Tear size progression has been correlated with increasing pain. However, there is little data on tear size progression in symptomatic RCT with regard to time from MRI to actual rotator cuff repair (RCR). The purpose of the study was to evaluate the effect of time (from date of MRI measured tear dimensions to date of RCR measured intraoperative tear dimensions) on tear size progression. Methods: In the course of a study on physical examination manual muscle tests in patients with known full thickness RCT requiring repair, MRI was obtained for each patient undergoing RCR. Tears were measured intraoperatively in the Anterior-Posterior (A-P) and Medial-Lateral (M-L) dimensions with a graduated probe. Location (anterior, central, posterior in the supraspinatus tendon), area of the tear, and anterior band of supraspinatus status (intact/ not intact) were recorded.The preoperative MRI was evaluated by the same examiner blinded to the operative results at least 4 weeks after the RCR and the same parameters measured.There were 64 consecutive shoulders with 40 male, 24 female at an average age of 58 yrs (40-76) that had MRI and underwent RCR. The mean MRI dimensions were: A-P tear:16.53 mm (SD 9.70); M-L tear: 17.3 mm (SD 9.75); Tear area: 366.7 square mm. The average time from preoperative MRI to RCR was 107.3 days (range 12-399 days). Operative mean RCT dimensions were: A-P tear: 18.38 mm (SD 10.0); M-L tear: 14.06 mm (SD 8.15); Tear area: 307.7 square mm.Descriptive statistical analysis with two-sample T-test was performed to determine the temporal effect on tear size from date of MRI to the date of surgery, and whether there was a change.Patients were grouped in the following time cohorts based on the length of time elapsed between the preoperative MRI and date of RCR: ≤1 month, 1 month to 2 months, 2 months to 3 months, 3 months to 9 months, and ≥9 months. The delta, or difference between intraoperative measurements and preoperative MRI measurements, was calculated for each cohort. Results: The t-test revealed a significant time effect with regard to tear size between the MRI and the intraoperative measured tear requiring repair. This was significant for the A-P dimension (p<0.001), the Medial-Lateral dimension (p<0.001), and the total area of the tear (p=0.009). In an attempt to determine a “watershed” or critical time interval where MRI and RCT size correlated, an additional analysis was performed. The change in A-P tear dimension between MRI and RCR findings showed increasing delta with increasing time. Positive mean delta in A-P dimension was seen in the 2-3 month group (2.64), with larger differences seen in the 3 month to 9 month (5.89) and ≥9 month (7.3) groups. A similar trend was seen for mean delta values in the M-L dimension among the cohorts. Conclusion: In a consecutive series of RCTs undergoing repair, the measured MRI dimensions and the intraoperative dimensions were recorded and analyzed. A surgeon can have a level of confidence that the RCT size will correlate with MRI tear size within a certain time frame. There is a significant effect of time on tear size progression from MRI dimensions to actual RCT dimensions at time of repair.

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Arthroscopically Assisted Mini-Open Rotator Cuff Repairs

The American Journal of Sports Medicine ◽

10.1177/03635465000280030401 ◽

2000 ◽

Vol 28 (3) ◽

pp. 301-311 ◽

Cited By ~ 43

Author(s):

Jonathan C. Hersch ◽

Nicholas A. Sgaglione

Keyword(s):

Los Angeles ◽

Rotator Cuff ◽

External Rotation ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Duration Of Symptoms ◽

Excellent Outcome ◽

Rehabilitation Protocols ◽

Arthroscopically Assisted ◽

Tear Size

The functional outcome of 22 consecutive patients with full-thickness rotator cuff tears repaired using an arthroscopically assisted technique was evaluated. The average follow-up was 39 months (24 to 80), and the average tear size was 3.5 cm (1 to 7). There were 14 men and 8 women, with a mean age of 56 years (29 to 80); 86% of patients (N 19) were satisfied with the results of surgery and 95% (N 21) had improvement of their symptoms. All patients had a statistically significant improvement in pain and active abduction in the scapular plane and in external rotation. Postoperative strength in external rotation and abduction averaged 95% and 97% of the contralateral shoulder, respectively. Preoperative duration of symptoms, strength, age, and tear size were found to be independent predictors of outcome. The average Constant and Murley score was 84 of 100, the average American Shoulder and Elbow Surgeons score was 81 of 100, and the average University of California, Los Angeles, score was 31 of 35. Our results show that an arthroscopically assisted repair of full-thickness, moderate-to-large rotator cuff tears using uniform surgical technique and rehabilitation protocols provides excellent outcome with regard to function, pain, and activities of daily living.

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Rotator Cuff Tear Pain and Tear Size and Scapulohumeral Rhythm

Journal of Athletic Training ◽

10.4085/1062-6050-44.2.148 ◽

2009 ◽

Vol 44 (2) ◽

pp. 148-159 ◽

Cited By ~ 26

Author(s):

Jason S. Scibek ◽

James E. Carpenter ◽

Richard E. Hughes

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

The Body ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Scapular Kinematics ◽

Cuff Tear ◽

Before And After ◽

Lidocaine Injection ◽

Tear Size

Abstract Context: The body of knowledge concerning shoulder kinematics in patients with rotator cuff tears is increasing. However, the level of understanding regarding how pain and tear size affect these kinematic patterns is minimal. Objective: To identify relationships between pain associated with a full-thickness rotator cuff tear, tear size, and scapulohumeral rhythm (SHR) and to determine whether pain and tear size serve as predictors of SHR. Design: A test-retest design was used to quantify pain and SHR before and after a subacromial lidocaine injection. Correlation and multivariate analyses were used to identify relationships among pain, tear size, and SHR. Setting: Orthopaedic biomechanics research laboratory. Patients or Other Participants: Fifteen patients (age range, 40–75 years) with diagnosed full-thickness rotator cuff tears participated. They were experiencing pain at the time of testing. Intervention(s): Shoulder kinematic data were collected with an electromagnetic tracking system before and after the patient received a lidocaine injection. Main Outcome Measure(s): Pain was rated using a visual analog scale. Three-dimensional scapular kinematics and glenohumeral elevation were assessed. Scapular kinematics included anterior-posterior tilt, medial-lateral tilt, and upward-downward rotation. A regression model was used to calculate SHR (scapular kinematics to glenohumeral elevation) for phases of humeral elevation and lowering. Results: Linear relationships were identified between initial pain scores and SHR and between tear size and SHR, representing an increased reliance on scapular motion with increasing pain and tear size. Pain was identified as an independent predictor of SHR, whereas significant findings for the effect of tear size on SHR and the interaction between pain and tear size were limited. Conclusions: We noted an increased reliance on scapular contributions to overall humeral elevation with increasing levels of pain and rotator cuff tear size. Pain associated with a rotator cuff tear serves as a primary contributor to the kinematic patterns exhibited in patients with rotator cuff tears.

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Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.o.00444 ◽

2016 ◽

Vol 98 (4) ◽

pp. 251-256 ◽

Cited By ~ 70

Author(s):

James D. Wylie ◽

Thomas Suter ◽

Michael Q. Potter ◽

Erin K. Granger ◽

Robert Z. Tashjian

Keyword(s):

Mental Health ◽

Rotator Cuff ◽

Shoulder Pain ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Patient Reported ◽

And Function ◽

Tear Size

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Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders

The American Journal of Sports Medicine ◽

10.1177/0363546517709780 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2524-2531 ◽

Cited By ~ 23

Author(s):

Nobuyuki Yamamoto ◽

Mitsuyoshi Mineta ◽

Jun Kawakami ◽

Hirotaka Sano ◽

Eiji Itoi

Keyword(s):

Risk Factors ◽

Rotator Cuff ◽

Alcohol Drinking ◽

Sports Participation ◽

Rotator Cuff Tears ◽

Hand Dominance ◽

Full Thickness ◽

Partial Thickness ◽

The Mean ◽

Tear Size

Background: The risk factors for tear progression in symptomatic rotator cuff tears have not been clarified yet. It is important for orthopaedic surgeons to know the natural course of tear progression when nonoperative management is to be chosen. Hypothesis: Tears in younger patients, high-activity patients, or heavy laborers would progress in size more than those in older patients, low-activity patients, or light laborers. Study Design: Case-control study; Level of evidence, 3. Methods: Two hundred twenty-five consecutive patients with symptomatic rotator cuff tears visited our institute between 2009 and 2015. Of these, 174 shoulders of 171 patients (mean age, 66.9 years) who underwent at least 2 magnetic resonance imaging (MRI) examinations were prospectively enrolled. The mean follow-up was 19 months. Tear progression was defined as positive when the tear size increased by ≥2 mm. The demographic factors that were analyzed by multivariate analysis included age, sex, hand dominance, smoking, alcohol drinking, hypercholesterolemia, sports participation, job type, tear size, and tear type (full or partial thickness). Results: Of the 174 shoulders, 82 shoulders (47%) showed tear progression. The mean (±SD) tear length and width in the progression group on final MRI were 23.1 ± 12.5 mm and 17.3 ± 9.6 mm, respectively; the tear size progressed by a mean 5.8 ± 5.6 mm in length and 3.1 ± 5.2 mm in width. The mean propagation speed was 3.8 mm/y in length and 2.0 mm/y in width. The size of full-thickness tears significantly increased compared with that of articular-sided partial-thickness tears ( P = .0215). The size of medium tears significantly increased compared with that of other tears ( P < .0001). According to the logistic regression analysis, smoking was significantly correlated with tear progression ( P = .026). Subgroup analyses showed that male sex, hand dominance, and trauma were correlated with tear progression. Age, alcohol drinking, hypercholesterolemia, sports participation, and job type did not show any correlation with tear progression. Conclusion: The tear size of symptomatic rotator cuff tears progressed in 47% of the shoulders during a mean of 19 months, and the speed of progression was 3.8 mm/y in length and 2.0 mm/y in width. The risk factors for tear progression were (1) a medium-sized tear, (2) a full-thickness tear, and (3) smoking.

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Full-Thickness Rotator Cuff Tears in the Throwing Athlete

Operative Techniques in Sports Medicine ◽

10.1016/j.otsm.2021.150800 ◽

2021 ◽

pp. 150800

Author(s):

Robert A Jack ◽

Michael C Ciccotti ◽

Steven B Cohen ◽

Michael G Ciccotti

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Throwing Athlete

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Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00477-2 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Aniket Agarwal ◽

Kavita Vani ◽

Anurag Batta ◽

Kavita Verma ◽

Shishir Chumber

Keyword(s):

Rotator Cuff ◽

Biceps Tendon ◽

Surgical Correction ◽

Statistical Testing ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Partial Thickness ◽

Linear Probe ◽

Significant Difference ◽

Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

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