Correlation Between Age and Tendon Strength in Supraspinatus Tendon With Full-Thickness Tears

2013 ◽  
Author(s):  
R. Matthew Miller ◽  
Daisuke Araki ◽  
Yoshimasa Fujimaki ◽  
Volker Musahl ◽  
Richard E. Debski
Keyword(s):  
Rotator Cuff ◽  
Treatment Outcomes ◽  
Clinical Problem ◽  
Supraspinatus Tendon ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Insufficient Information ◽  
Poor Treatment ◽  
The Relationship

Degenerative tears of the rotator cuff tendons are a significant clinical problem, with an incidence of more than 30% in asymptomatic persons over the age of 60 [1]. As the population continues to age, the incidence of partial and full-thickness rotator cuff tears continues to increase [2], with previous studies finding that greater age also correlates with worse surgical outcomes and increased fatty degeneration in the tissue [3]. Although the relationship between age, rotator cuff injury, and poor treatment outcomes has been previously established, insufficient information exists on the biological and mechanical changes in the tissue due to aging.

scholarly journals Supraspinatus-to-Glenoid Contact Occurs During Standardized Overhead Reaching Motion

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110369
Author(s):  
Gaura Saini ◽  
Rebekah L. Lawrence ◽  
Justin L. Staker ◽  
Jonathan P. Braman ◽  
Paula M. Ludewig
Keyword(s):  
Rotator Cuff ◽  
Pearson Correlation ◽  
Supraspinatus Tendon ◽  
Contact Angles ◽  
Magnetic Resonance Images ◽  
Rotator Cuff Tears ◽  
Internal Impingement ◽  
Glenoid Morphology ◽  
Minimum Distances ◽  
The Relationship

Background: Rotator cuff tears may result from repeated mechanical deformation of the cuff tendons, and internal impingement of the supraspinatus tendon against the glenoid is one such proposed mechanism of deformation. Purpose: To (1) describe the changing proximity of the supraspinatus tendon to the glenoid during a simulated overhead reaching task and (2) determine the relationship between scapular morphology and this proximity. Additionally, the patterns of supraspinatus-to-glenoid proximity were compared with previously described patterns of supraspinatus-to-coracoacromial arch proximity. Study Design: Descriptive laboratory study. Methods: Shoulder models were created from magnetic resonance images of 20 participants. Standardized kinematics were imposed on the models to simulate functional reaching, and the minimum distances between the supraspinatus tendon and the glenoid and the supraspinatus footprint and the glenoid were calculated every 5° between 0° and 150° of humerothoracic elevation. The angle at which contact between the supraspinatus and the glenoid occurred was documented. Additionally, the relationship between glenoid morphology (version and inclination) and the contact angle was evaluated. Descriptive statistics were calculated for the minimum distances, and glenoid morphology was assessed using Pearson correlation coefficients and simple linear regressions. Results: The minimum distances between the tendon and the glenoid and between the footprint and the glenoid decreased as elevation increased. Contact between the tendon and the glenoid occurred in all participant models at a mean elevation of 123° ± 10°. Contact between the footprint and the glenoid occurred in 13 of 20 models at a mean of 139° ± 10°. Less glenoid retroversion was associated with lower tendon-to-glenoid contact angles ( r = –0.76; R 2 = 0.58; P < .01). Conclusion: This study found that the supraspinatus tendon progressively approximated the glenoid during simulated overhead reaching. Additionally, all participant models eventually made contact with the glenoid by 150° of humerothoracic elevation, although anatomic factors influenced the precise angle at which contact occurred. Clinical Relevance: Contact between the supraspinatus and the glenoid may occur frequently within the range of elevation required for overhead activities. Therefore, internal impingement may be a prevalent mechanism for rotator cuff deformation that could contribute to cuff pathology.

scholarly journals Does the Interval Slide Procedure Reduce Supraspinatus Tendon Repair Tension?: A Biomechanical Cadaveric Study

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110668
Author(s):  
Felix Porschke ◽  
Philip Christian Nolte ◽  
Christian Knye ◽  
Christel Weiss ◽  
Stefan Studier-Fischer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Intervention Group ◽  
Tendon Repair ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Full Thickness ◽  
Time Points ◽  
Tendon Tears ◽  
And Control

Background: The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial. Purpose: The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon. Study Design: Controlled laboratory study. Methods: A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t1) was evaluated. In the intervention group, AIS (t2), PIS (t3), and CR (t4) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention. Results: A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t1 vs t4: 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t1 vs t2: 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t2 vs t3: 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t3 vs t4: 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001). Conclusion: The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally. Clinical Relevance: These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure.

scholarly journals Sonographic and MRI Presentation of Geyser Sign in Rotator Cuff Tears

2021 ◽  
Vol 0 ◽  
pp. 1-3
Author(s):  
Amandeep Singh ◽  
Aaina Devgan ◽  
Jasmin Khatana ◽  
Gauravdeep Singh
Keyword(s):  
Rotator Cuff ◽  
Ganglion Cyst ◽  
Incidental Finding ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Left Shoulder ◽  
Full Thickness ◽  
Ac Joint ◽  
Benign Process

Limited cases of rotator cuff tears with acromioclavicular (AC) degeneration in association with cystic swelling or ganglion cyst have been described till date. The “geyser radiographic sign” was originally described by Craig in 1984. Its significance was to document a tear in the articular capsule of the AC joint in the setting of a chronic full-thickness tear of the rotator cuff, which gave the appearance of a geyser arising from the subacromial bursa as radiographic contrast tracked through the AC joint to project superiorly from the shoulder. An 82-year-old male presented with pain on rest in the left shoulder and with difficulty in overhead abduction from last few months. MRI showed near complete full-thickness tear of supraspinatus tendon with retraction of the tendon and reduced bulk of the supraspinatus muscle with associated superior subluxation of humerus with AC arthropathic changes causing ganglion cyst and incidental finding of superior labrum anterior and posterior tear. AC cysts are further divided into Type 1 and Type 2. Repeated aspirations of these masses are not advised, as they often recur and repeated attempts at aspiration may lead to formation of a draining fistula. MRI geyser sign is highly suggestive of a benign process, which suggests underlying rotator cuff pathology.

Hybrid Technology Fusion MRI/US and Sonoelastography in Diagnosis of Fatty Degeneration and Atrophy of Supraspinatus Muscle of the Shoulder

2017 ◽  
pp. 112-123
Author(s):  
V. E. Gazhonova ◽  
M. V. Emelianenko ◽  
M. P. Onishchenko
Keyword(s):  
Rotator Cuff ◽  
Muscle Atrophy ◽  
Diagnostic Performance ◽  
Interobserver Reliability ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Point Scale ◽  
Supraspinatus Muscle ◽  
Us Elastography

Evaluation of the rotator cuff muscles is of value for surgical indications and successful postoperative prognosis. Ultrasound is  widely used for detection of rotator cuff tears, but it’s role in  evaluation of the rotator cuff muscles is not yet defined. A new  method Fusion MRI/US with elastography is able to show differences  in tissue stiffness, and a simultaneous combination of two methods  helps to overcome limitations from US – narrow field of view, and  from MRI – impossibility for real time examination and low space resolution.Purpose.To investigate diagnostic performance and interobserver  reliability of US elastography and to study possibilities of Fusion  MRI/US technique in grading fatty degeneration and atrophy of the supraspinatus muscle.Materials and methods.72 patients from 128 with shoulder pain  and disability with written diagnostic confirm were specially selected  for the study with US elastography and MRI and 29 patients were  enrolled for Fusion MRI/US study. Oblique sagittal scans through the  supraspinatus muscle were performed during US elastography study  in the standard manner for comparance with MRI. The amount of  fatty degeneration was graded according to the modified Goutallier five-point scale, with use of a 3-point scale – with US elastography.  US results for grade of atrophy and fatty degeneration were  retrospectively reviewed by 2 blinded to each other results experts.  Sensitivity and interobserver reliability was estimated.Results.The sensitivity of standard US in comparance to US  elastography in assessment of muscle atrophy with the reference to  MRI was 53% and 76%, respectively. The sensitivity of US and US  elastography increased with increasing of the grade of muscle  atrophy. The sensitivity of US and US elastography in detection of  fatty degeneration was slightly better 65% and 85%, respectively.  US elastography were more sensitive in evaluation of fatty  degeneration in full thickness than in partial thickness rotator cuff tears. In all cases of full thickness tears US with elastography had a 100% sensitivity in assessment of atrophy and fatty degeneration in the reference to MRI. While in partial tears  the sensitivity decreased to 66%. The agreement between MRI and US elastography for the grade of fatty degeneration of the  supraspinatus was substantial (kappa = 0.78). The interobserver  reliability for US was fair (kappa = 0.41), and for US elastography  substantial (kappa=0,71).Conclusion. Sonoelastography helps to increase the diagnostic  performance of US in identifying and grading fatty degeneration and  atrophy of the supraspinatus. US with elastography can be used as a  primary modality for fatty changes and atrophy of the supraspinatus.

scholarly journals Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity

2018 ◽  
Vol 6 (3_suppl) ◽  
pp. 2325967118S0000
Author(s):  
Teruhisa Mihata ◽  
Thay Q. Lee ◽  
Kunimoto Fukunishi ◽  
Takeshi Kawakami ◽  
Yukitaka Fujisawa ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Rotator Cuff Repair ◽  
Supraspinatus Tendon ◽  
Fatty Degeneration ◽  
Fascia Lata ◽  
Rotator Cuff Tears ◽  
Grade 3 ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: We developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function and relieving pain. In this study, we evaluated whether SCR for reinforcement before arthroscopic rotator cuff repair (ARCR) improves cuff integrity, especially in the case of severely degenerated supraspinatus tendon. Methods: A series of 32 consecutive patients (mean age, 69.0 years) with severely degenerated but reparable rotator cuff tears (medium size: 1-3 cm, and large size: 3-5 cm) underwent SCR using fascia lata autografts for reinforcement before ARCR. To determine the indications for SCR for reinforcement, the severity of degeneration in the torn supraspinatus tendon was assessed. We evaluated fatty degeneration in the muscle by using the Goutallier grade; we also scored retraction of the torn tendon (grade 0: no retraction; grade 1: torn edge on the greater tuberosity; grade 2: torn edge on the lateral half of the humeral head; grade 3: torn edge on the medial half of the humeral head; grade 4: torn edge on the glenoid) and tendon quality (grade 0: normal; grade 1: slightly thin, or slight fatty degeneration in the tendon part; grade 2: severely thin, or severe fatty degeneration in the tendon part; grade 3: severely thin, and severe fatty degeneration in the tendon part; grade 4: no tendon). In patients classified with grade 3 or 4 in at least two of these three categories, arthroscopic SCR was performed for reinforcement, after which the torn tendon was repaired over the fascia lata graft. To assess the benefit of SCR for reinforcement, the results from these 32 patients were compared with those after ARCR alone in 91 consecutive patients with medium (1-3 cm) to large (3-5 cm) rotator cuff tears (mean age, 66.7 years). Torn tendons were repaired by using double-row suture-bridges with and without SCR for reinforcement. By using t- and chi-square tests, we compared the American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion (ROM), and cuff integrity (Sugaya MRI classification) between ARCR with and without SCR as well as between before surgery and at final follow-up (mean, 19 months; 12 to 40 months). A significant difference was defined as P < 0.05. Results: All 32 patients who underwent SCR before ARCR had no postoperative re-tear and demonstrated type I cuff integrity (sufficient thickness with homogeneously low intensity), whereas those treated with ARCR without SCR had a 5.5% incidence (5/91 all patients) of postoperative re-tear, and 22.1% (19/86 healed patients) had type II (partial high-intensity area) or III (insufficient thickness) cuff integrity. ASES score, active elevation, active external rotation, and active internal rotation increased significantly after ARCR both with and without SCR ( P < 0.001) (Table). Postoperative ASES score and active ROM did not differ significantly between ARCR with and without SCR, but the Goutallier grade of the supraspinatus was significantly higher for ARCR with SCR (mean, 2.8) than for ARCR alone (mean, 2.1) ( P < 0.0001). Conclusion: SCR for reinforcement prevented postoperative re-tear after ARCR and improved the quality of the repaired tendon on MRI. Furthermore, postoperative functional outcomes were similar in patients who underwent ARCR alone and those who also underwent SCR, even though degeneration of the torn tendons was greater in the latter group. [Table: see text]

Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable

2017 ◽  
Vol 45 (11) ◽  
pp. 2532-2539 ◽  
Author(s):  
Nam Su Cho ◽  
Seong Cheol Moon ◽  
Se Jung Hong ◽  
Seong Hae Bae ◽  
Yong Girl Rhee
Keyword(s):  
Rotator Cuff ◽  
Supraspinatus Tendon ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Rotator Cable ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Retear Rate

Background: The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. Purpose: To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. Study Design: Cohort study; Level of evidence, 3. Methods: One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively. Results: There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P < .001, respectively). At final follow-up, the mean visual analog scale (VAS) for pain score during motion was 1.31 ± 0.98 and 1.24 ± 0.90 in groups A and B, respectively ( P = .587). The mean Constant score was 77.5 ± 11.2 and 78.0 ± 11.9 points in groups A and B, respectively ( P = .875). The mean University of California, Los Angeles score was 30.5 ± 4.1 and 31.0 ± 3.0 points in groups A and B, respectively ( P = .652). In assessing the repair integrity on postoperative MRI, the retear rate was 23.9% and 14.7% in groups A and B, respectively ( P = .029). Conclusion: Irrespective of involvement in the anterior attachment of the rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.

scholarly journals Minimum Five-Year Outcomes and Clinical Survivorship Following Arthroscopic Double-Row Repair for Full-thickness Supraspinatus Tears

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0007
Author(s):  
Jonas Pogorzelski ◽  
Erik M. Fritz ◽  
Marilee P. Horan ◽  
Zaamin B. Hussain ◽  
Christoph Katthagen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Double Row ◽  
Survivorship Analysis ◽  
Double Row Repair ◽  
Cuff Repair

Objectives: Rotator cuff tears lead to significant morbidity due to pain and decreased function. Despite the prevalence of cuff repairs, mid-term outcomes have been scarcely reported. The purpose of this study is to report minimum 5-year outcomes and clinical survivorship after double-row rotator cuff repair for full-thickness supraspinatus tendon tears. Methods: Patients at least five years out from arthroscopic double-row repair for a full-thickness cuff tear involving the supraspinatus tendon were included. Pre- and postoperative ASES, SF-12 PCS, QuickDASH, SANE, and satisfaction scores were collected. The relationship between outcomes and (1) tear chronicity, (2) number of tendons involved, (3) type of repair, and (4) primary versus revision procedure, was also evaluated. Kaplan-Meier survivorship analysis was conducted defining failures as progression to revision rotator cuff surgery. Results: From November 2005 to February 2012, a total of 189 shoulders were eligible for inclusion. Fifteen shoulders (7.9%) underwent revision rotator cuff repair and were considered failures. Outcomes data were reported at a mean follow-up of 6.6 (range, 5.0-11.0) years. All outcome scores significantly improved from pre- to postoperative time point, including mean ASES (57.9 to 92.9, P < 0.001), SF-12 PCS (43.4 to 52.0, P < 0.001), QuickDASH (35.2 to 10.5, P < 0.001), and SANE scores (61.5 to 86.5, P < 0.001). Acute tears demonstrated significantly better ASES and SANE scores than chronic tears (ASES 95.1 ± 8.9 versus 91.7 ± 11.2, P = 0.025; SANE 89.6 ± 19.9 versus 85.7 ± 21.3, P = 0.042). No other analyzed variable had a significant association with outcomes scores ( P > 0.05). Survivorship analysis demonstrated a postoperative clinical survivorship of the repair of 96.5% at two years and 93.8% at five years (Figure 1). Conclusion: Patients can expect excellent clinical outcomes and a low failure rate following arthroscopic double-row repair of full-thickness supraspinatus tears at mid-term follow-up. The repair of acute tears and primary repairs were associated with better postoperative outcomes.

Full-Thickness Rotator Cuff Tears in the Throwing Athlete

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

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

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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