scholarly journals Will Preoperative Atrophy and Fatty Degeneration of the Shoulder Muscles Improve after Rotator Cuff Repair in Patients with Massive Rotator Cuff Tears?

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Hiroshi Yamaguchi ◽  
Naoki Suenaga ◽  
Naomi Oizumi ◽  
Yoshihiro Hosokawa ◽  
Fuminori Kanaya
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Before And After ◽  
Magnetic Resonance Imaging Mri ◽  
Cuff Repair ◽  
Retear Rate

Recently, retear rate after repair for massive cuff tear have been improved through devised suture techniques. However, reported retear rate is relevant to preoperative atrophy and fatty degeneration. The purpose of this study was to investigate whether preoperative atrophy and fatty degeneration of rotator cuff muscles improve by successful repair. Twenty-four patients with massive rotator cuff tear were evaluated on the recovery of atrophy and fatty degeneration of supraspinatus and infraspinatus muscle after surgery. Atrophy was classified by the occupation ratio and fatty degeneration by modified Goutallier's classification. Both were assessed on magnetic resonance imaging (MRI) before and after the operation. When the cuff was well repaired, improvement of the atrophy and fatty degeneration were observed in a half and a one-fourth of the cases, respectively. In retear cases, however, atrophy and fatty degeneration became worse. Improvement of atrophy and fatty degeneration of the rotator cuff muscles may be expected in the cases with successful achievement of rotator cuff repair for large and massive tear.

scholarly journals Rotátorköpeny-szakadás után kialakult zsíros degeneráció változása az ín rekonstrukcióját követően, 65 éves kor után

2019 ◽  
Vol 160 (14) ◽  
pp. 533-539
Author(s):  
Imre Sallai ◽  
Márton Weidl ◽  
Attila Szatmári ◽  
Imre Antal ◽  
Gábor Skaliczki
Keyword(s):  
Rotator Cuff ◽  
Muscle Atrophy ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Fatty Degeneration ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Before And After ◽  
Cuff Repair

Abstract: Introduction: In the case of rotator cuff tears, the severity of the muscle atrophy and fatty degeneration has an effect on the success of the repair and on the functional outcome after surgery. Aim: The ability of regeneration reduces with ageing; therefore, the study examined the atrophy and the fatty degeneration after rotator cuff repair in patients over 65. Method: Eleven patients over 65 years of age were involved whose surgery was performed at the Department of Orthopaedics of Semmelweis University between 2012 and 2015. Their average age was 71.9 years and the average follow-up period was 39.9 months. Tear sizes were C1 in 3 cases, C2 in 3 cases, C3 in 4 cases, and C4 in 1 case. Each patient had magnetic resonance examination before and after the repair; the muscle atrophy and fatty degeneration were evaluated together with the type of the tear. Visual analogue scale and Constant score were used for the assessment of the pain and the shoulder function. Results: The average Constant score was 75 points. The occupancy ratio – referring to the severity of the atrophy – did not show significant improvement. The change in fatty degeneration and the atrophy were examined in different groups according to the size of the tears. In each group, the results showed progression. Conclusions: After rotator cuff repair in patients over 65, fatty degeneration and muscle atrophy also show progression. No significant relationship was found between the size of the tear and fatty degeneration or between the size of the tear and muscle atrophy. Orv Hetil. 2019; 160(14): 533–539.

scholarly journals Superior Capsular Reconstruction With Superimposition of Rotator Cuff Repair for Massive Rotator Cuff Tear

2017 ◽  
Vol 6 (5) ◽  
pp. e1775-e1779 ◽  
Author(s):  
George Sanchez ◽  
Jorge Chahla ◽  
Gilbert Moatshe ◽  
Márcio B. Ferrari ◽  
Nicholas I. Kennedy ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Repair ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Superior Capsular Reconstruction ◽  
Cuff Repair

scholarly journals The Effect of Rotator Cuff Repair on the Clinical and Psychological Meaningful Improvement in Patients with Rotator Cuff Tear and Insomnia.

2020 ◽  
Author(s):  
Yahui Tong ◽  
Kailun Wu ◽  
An Liu ◽  
Hongxia Zhu ◽  
Huilin Yang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Repair ◽  
Depression Scale ◽  
Rotator Cuff Tears ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Positive Correlation ◽  
Cuff Tear ◽  
Cuff Repair

Abstract Background: Rotator cuff repair is widely used to treat rotator cuff tear, but its impact on the psychological status in patients with rotator cuff tears and insomnia is still poorly understood.Methods: 240 patients were enrolled who underwent rotator cuff repair at the first affiliated hospital of soochow university from 2014-2018. During the 2-year follow-up period, the patients were assessed preoperatively and postoperatively at 3 months, 6 months, 12 months and 24 months by using Constant, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), American Shoulder and Elbow Surgeons’ Scale (ASES), Hospital Anxiety and Depression Scale, depression subsection (HADS-D), Hospital Anxiety and Depression Scale, anxiety subsection (HADS-A), and World Health Organization Quality-of-life Scale Abbreviated Version (WHOQOL-BREF).Results: Finally, a total of 240 patients were enrolled in this study and finished the 2 year follow-up.There were 107 men(43.8%) and 133 women(56.2%), and the mean age of the patients was 54.2±7.5 years. With the prolongation of postoperative time, pain, activity of daily life, joint mobility and muscle strength were gradually improved from 4.8 ± 2.2, 7.2 ± 3.4, 14.2 ± 5.5, 7.8 ± 3.5, and 34.0 ± 11.3, respectively, before surgery to 13.2 ± 3.2, 17.8 ± 2.8, 34.0 ± 6.4, 21.0 ± 4.0, and 85.9 ± 12.4, at 2 years after surgery, which was statistically significant (P < 0.001).The scores of ASES and WHOQOL-BREF also increased significantly from 40.5 ± 9.6, 58.3 ± 8.6 before operation to 87.7 ± 10.2, 69.3 ± 7.9 at two years after operation (P < 0.001). HADS-A decreased linearly from 4.8±2.4 before operation to 1.4 ± 1.2 at two years after operation (P < 0.01). The pain scores had a highly positive correlation with the Constant and the ASES scores. The PSQI and the ISI scores had a positive correlation with the HADS-A scores.Conclusion: For the patients with rotator cuff tears and insomnia, rotator cuff repair may contribute to the improvement of clinical outcome and status of anxiety.

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.

Restoration of Shoulder Biomechanics in the Massive Rotator Cuff Tear According to Degree of Repair Completion

2010 ◽  
Author(s):  
Bong Jae Jun ◽  
Joo Han Oh ◽  
Michelle H. McGarry ◽  
Akash Gupta ◽  
Kyung Chil Chung ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Minimum Degree ◽  
Surgical Techniques ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Partial Repair ◽  
Limited Function ◽  
Cuff Repair ◽  
New Instruments

The development of new instruments and surgical techniques has improved the outcome of rotator cuff repair even with massive tears. Based on cuff integrity or amount of retraction with massive cuff tears a complete repair may not be possible allowing for only partial repair. The ability to mobilize the cuff to the footprint can affect the degree of partial repair that can be performed. Partial repair may lead to abnormal biomechanics that may predispose patients to limited function and subsequent pathology following rotator cuff repair. Therefore, the purpose of this study is to compare the biomechanical characteristics of massive rotator cuff repair according to the degree of repair completion and to determine a minimum degree of repair required to restore normal biomechanics.

scholarly journals Revision Rotator Cuff Repair Versus Primary Repair for Large to Massive Tears Involving the Posterosuperior Cuff: Comparison of Clinical and Radiological Outcomes

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199879
Author(s):  
Prashant Meshram ◽  
Bei Liu ◽  
Sang Woo Kim ◽  
Kang Heo ◽  
Joo Han Oh
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Odds Ratio ◽  
Fatty Degeneration ◽  
High Grade ◽  
Cuff Tear ◽  
Revision Rotator Cuff Repair ◽  
Cuff Repair ◽  
Retear Rate

Background: The retear rate after revision rotator cuff repair (rRCR) ranges from 50% to 90%. Patients who undergo primary RCR (pRCR) for large to massive rotator cuff tear (mRCT) also have unpredictable outcomes. Purpose: To compare the clinical outcomes after rRCR for a posterosuperior rotator cuff tear of any size with those after pRCR for mRCT and to identify the risk factors for poor outcomes and retear after rRCR. Study Design: Cohort study; Level of evidence, 3. Methods: Among patients with posterosuperior cuff tear treated between 2010 and 2017, the clinical outcomes of 46 patients who underwent rRCR were compared with 106 patients who underwent pRCR for mRCT. Between-group differences in patient-reported outcomes (visual analog scale [VAS] for pain, VAS for satisfaction and American Shoulder and Elbow Surgeons [ASES] and Constant scores) at final follow-up were evaluated and compared with previously published minimal clinically important difference (MCID) values. Radiological outcomes were evaluated using magnetic resonance imaging or ultrasonography at a minimum 1-year follow-up. Multivariate linear regression analysis was performed to identify the risk factors for poor ASES score, and multivariate logistic regression analysis was used to assess the risk factors for retear after rRCR. Results: The mean follow-up was 26.4 months (range, 24-81 months). Although final VAS for pain, VAS for satisfaction, and ASES scores in the rRCR group were significantly worse than those in the pRCR group, the Constant score was similar between the groups. These differences in outcomes did not exceed the MCID threshold. The retear rate in the rRCR group was 50% compared with 39% for the pRCR group ( P = .194). In the rRCR group, risk factors for worse ASES score were retear ( P = .043; r = –11.3), lower body mass index ( P = .032; r = 1.9), and lower preoperative VAS for pain ( P = .038; r = 2.3), and risk factors for retear were preoperative high-grade fatty degeneration (Goutallier grades 3 and 4) of the supraspinatus muscle ( P = .026; odds ratio, 5.2) and serum hyperlipidemia ( P = .035; odds ratio, 11.8). Conclusion: Both study groups had similar clinical and radiological outcomes. Patients with symptomatic failed rotator cuff repairs having high-grade fatty degeneration of the supraspinatus muscle and/or serum hyperlipidemia had a greater likelihood of retear after rRCR.

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