Portal-Extension Approach for the Repair of Small and Medium Rotator Cuff Tears

2000 ◽  
Vol 28 (3) ◽  
pp. 312-316 ◽  
Author(s):  
Jin-Young Park ◽  
William N. Levine ◽  
Guido Marra ◽  
Roger G. Pollock ◽  
Evan L. Flatow ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Result ◽  
Joint Pain ◽  
Acromioclavicular Joint ◽  
Deltoid Muscle ◽  
Rotator Cuff Tears ◽  
Anterolateral Portal ◽  
Arthroscopically Assisted ◽  
Cuff Repair

One hundred ten consecutive cases (110 patients) of arthroscopically assisted rotator cuff repair through a limited, portal-extension approach were retrospectively reviewed. The average age of our patients was 58 years (range, 30 to 79). There were 35 women and 75 men. The dominant shoulder was affected in 67 patients (61%). All patients underwent a standard arthroscopic decompression. Acromioclavicular resections were performed in 15% of patients. The anterolateral portal was extended in the direction of Langer's lines to a total length of no more than 3 cm. The torn tendon was accessed through a small deltoid muscle split and repaired with nonabsorbable sutures. At an average follow-up of 35 months (range, 24 to 86), 106 patients (96%) had achieved excellent or satisfactory results. The average American Shoulder and Elbow Surgeons pain score improved from 7 preoperatively to 2 postoperatively. All but four patients were satisfied with the clinical result and reported significant improvement in active elevation and strength and a significant lessening of pain. Late acromioclavicular joint pain contributed to failure in three of the four patients with unsatisfactory results in this series. The results of this study suggest that, in selected patients with small to medium rotator cuff tears, arthroscopically assisted repair through an anterolateral portal-extension approach can produce excellent results.

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 Lateral acromioplasty for correction of the critical shoulder angle

2020 ◽  
Vol 15 (3) ◽  
pp. 228-232
Author(s):  
Mark Tauber ◽  
Peter Habermeyer ◽  
Nikolaus Zumbansen ◽  
Frank Martetschläger
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Logical Consequence ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Critical Shoulder Angle ◽  
Cuff Repair ◽  
Shoulder Angle

Abstract The critical shoulder angle (CSA) was introduced as a radiological parameter associated with a higher incidence of rotator cuff tears. As a logical consequence, correcting the CSA together with rotator cuff repair should prevent re-tear and provide reliable and good clinical results. We present an all-arthroscopic technique resecting the lateral edge of the acromion (lateral acromioplasty) in order to reduce and correct the CSA after preoperative planning. Preliminary results from 20 patients with an average age of 62 years after rotator cuff repair are reported showing good clinical outcome with a Constant score of 88 points and no re-tear after an average follow-up of 16 months. The CSA was reduced from 39.7° to 32.1°. Previous concerns regarding weakening of the deltoid origin were not confirmed and there were no complications linked to lateral acromioplasty.

scholarly journals Long-term Follow-up of Extensive Peri-anchor (Poly-L/D-lactic Acid) Cyst Formation after Arthroscopic Rotator Cuff Repair: A Case Report

2019 ◽  
Vol 22 (2) ◽  
pp. 100-105
Author(s):  
Jong-Ho Kim ◽  
Jong-Ick Kim ◽  
Hyo-Jin Lee ◽  
Dong-Jin Kim ◽  
Gwang Young Sung ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Cyst Formation ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Long Term Follow Up ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Suture anchors are commonly used in shoulder surgeries, especially for rotator cuff tears. Peri-anchor cyst formation, however, is sometimes detected on follow-up radiologic image after surgery. The purpose of this report is to discuss the case of a patient who presented with regression of extensive peri-anchor cyst on postoperative 4-year follow-up magnetic resonance imaging and had good clinical outcome despite peri-anchor cyst formation after arthroscopic rotator cuff repair.

scholarly journals All-Suture and Solid Medial Row Anchors Produce Similar Clinical Outcomes for Double Row Suture Bridge Rotator Cuff Repair (227)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0033
Author(s):  
John Feldman ◽  
Mims Ochsner ◽  
Glenn Fleisig ◽  
Rob Tatum ◽  
Lindsay Grosz ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Sports Medicine ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Suture Bridge ◽  
Cuff Repair ◽  
Anchor Fixation

Objectives: All-suture anchor use for rotator cuff repair is increasing. Potential benefits of these anchors include less bone loss from anchor hole drilling and decreased injury to the chondral surface with anchor pullout. Minimal evidence exists comparing clinical outcomes of all suture to solid medial row anchor fixation in double row suture bridge rotator cuff repair. The purpose of this study was to compare patient-reported outcomes for rotator cuff tears treated with all-suture medial row anchors to those treated with more traditional solid anchors. The null hypothesis was that there is no difference in outcomes between the all-suture and solid anchor rotator cuff repairs. Methods: Three sports medicine fellowship trained surgeons performed rotator cuff repairs using the double row suture bridge technique with minimum 3 years of follow up. Patients were separated into two groups based on whether or not they received all-suture or solid anchor fixation for the medial row of their repair. All lateral row fixation was performed with solid anchors. Primary outcomes were evaluated with telephone follow-up and included the American Shoulder and Elbow Surgery Score (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS). The Rehabilitation protocol was the same for all subjects in the study. Results: 3 sports medicine fellowship trained orthopaedic surgeons performed 153 rotator cuff repairs. 91 of these subjects had all-suture fixation of the medial row and 62 received solid anchor fixation. Follow up was 3.6 years ± 0.6 for the all-suture group and 3.7 years ± 0.6 in the solid anchor group (p= 0.28). ASES scores were 92 ± 16 in the all-suture group and 90 ± 17 in the solid group (p =0.35). SANE scores were 91 ± 13 in the all-suture and also 91 ± 13 in the solid anchor cohort (p = 0.97). VAS scores were 1.1 ± 2.0 in the all-suture and 0.7± 1.8 in the solid anchor group (p=0.17). There were no significant differences between groups with regards to re-operation rate or anchor configuration. Conclusions: All suture anchors used in medial row fixation for double row suture bridge rotator cuff repairs have similar clinical outcomes to rotator cuff tears treated in similar fashion with solid medial row anchors.

scholarly journals Rotator cuff tears: functional outcomes of open surgery

2020 ◽  
Author(s):  
Zafer Volkan Gokce
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Tendon Healing ◽  
The Elderly ◽  
Rotator Cuff Tears ◽  
Functional Assessments ◽  
Before And After ◽  
Correlation Tests ◽  
Cuff Repair

Abstract Background: The aim of the present study was to evaluate the clinical and radiological outcomes of the patients who underwent open surgical repair with the diagnosis of rotator cuff rupture. Methods: Twenty-eight rotator cuff tear patients refractory to conservative treatment and underwent open rotator cuff repair between April 2012 and April 2017 were retrospectively included in the study. Patients were assessed radiologically and clinically before and after surgery. Patients' age, gender, duration of complaints, the type of the rupture, the data obtained during operation (rupture size, shape, affected tendon, the presence of retraction if any), postoperative complications were recorded. Functional assessments of the patients were performed at 6th and 12th months preoperatively and postoperatively with objective assessments using Constant and UCLA scoring. All patients' operated shoulders were evaluated with MRI during their recent follow-up. Results: The mean postoperative follow-up period of the patients was 30.4 (range: 13-72) months. Preoperative and postoperative mean UCLA scores of the patients were 10.85±1.89, and 28.8±3.34, respectively (p < 0.001). Pre-, and postoperative average Constant scores were 38.1 (range, 7.0 to 56.0), and 72.4 (range, 52.0 to 98.0), respectively (p < 0.001). Rotator cuff continuity was assessed in shoulder MRIs obtained during recent follow-ups of patients, and four recurrent tears were observed. Correlation tests revealed that tear size observed during surgery showed a significant (p = 0.002) and a weakly negative (r = -0.468) correlation with preoperative Constant scores, and a significant (p = 0.0001) and moderately negative (r = -0.645) relationship with postoperative Constant scores. UCLA and Constant functional outcomes were worse in patients over 60 years of age, than younger patients and recurrent tears were more often observed in the elderly population. A significant relationship was revealed between the age of the patients and tendon healing (p < 0.05). Conclusion: The results of this study suggest that open repair is a reasonable and successful treatment option in patients with rotator cuff tears. Overall satisfactory clinical outcomes could be achieved.

scholarly journals Surgical repairs of the Rotator Cuff Tears

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
S M H Jafri ◽  
W A Khan ◽  
M Pervaiz ◽  
A Ghaffar ◽  
S Raziq
Keyword(s):  
Pain Relief ◽  
Rotator Cuff ◽  
Old Age ◽  
Rotator Cuff Repair ◽  
Surgical Repair ◽  
Senior Author ◽  
Rotator Cuff Tears ◽  
Cuff Repair ◽  
Cause Of Pain

Evaluation of 15 cases who underwent surgical rotator cuff repair is presented. This study extends from 1995 to 2001. Cases operated by senior author have been included in this study. The follow up ranges from 9 months to 4 years. Evaluation includes study as regard to pain relief, range of motion and strength achieved after surgery. In all cases acromion- plasty was done. Rotator cuff problem is a well-know cause of pain and disability in shoulder especially in old age. Good results after surgical repair of rupture rotator cuff have been well documented. To our best knowledge this is the first study in this country about results of surgical rotator cuff repair.

Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears

2007 ◽  
Vol 35 (8) ◽  
pp. 1254-1260 ◽  
Author(s):  
Francesco Franceschi ◽  
Laura Ruzzini ◽  
Umile Giuseppe Longo ◽  
Francesca Maria Martina ◽  
Bruno Beomonte Zobel ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Suture Anchor ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Single Row ◽  
Group 2 ◽  
Cuff Repair ◽  
Repair Group ◽  
Group 1

Background Restoring the anatomical footprint may improve the healing and mechanical strength of repaired tendons. A double row of suture anchors increases the tendon-bone contact area, reconstituting a more anatomical configuration of the rotator cuff footprint. Hypothesis There is no difference in clinical and imaging outcome between single-row and double-row suture anchor technique repairs of rotator cuff tears. Study Design Randomized controlled trial; Level of evidence, 1. Methods The authors recruited 60 patients. In 30 patients, rotator cuff repair was performed with a single-row suture anchor technique (group 1). In the other 30 patients, rotator cuff repair was performed with a double-row suture anchor technique (group 2). Results Eight patients (4 in the single-row anchor repair group and 4 in the double-row anchor repair group) did not return at the final follow-up. At the 2-year follow-up, no statistically significant differences were seen with respect to the University of California, Los Angeles score and range of motion values. At 2-year follow-up, postoperative magnetic resonance arthrography in group 1 showed intact tendons in 14 patients, partial-thickness defects in 10 patients, and full-thickness defects in 2 patients. In group 2, magnetic resonance arthrography showed an intact rotator cuff in 18 patients, partial-thickness defects in 7 patients, and full-thickness defects in 1 patient. Conclusion Single- and double-row techniques provide comparable clinical outcome at 2 years. A double-row technique produces a mechanically superior construct compared with the single-row method in restoring the anatomical footprint of the rotator cuff, but these mechanical advantages do not translate into superior clinical performance.

All-Suture Anchor Settling After Arthroscopic Repair of Small and Medium Rotator Cuff Tears

2019 ◽  
Vol 47 (14) ◽  
pp. 3483-3490
Author(s):  
Kyunghan Ro ◽  
Sung-Min Rhee ◽  
Jung Youn Kim ◽  
Myung Seo Kim ◽  
Jong Dae Kim ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Suture Anchor ◽  
Rotator Cuff Tears ◽  
Suture Anchors ◽  
Rotator Cuff Tendon ◽  
Group A ◽  
Group B ◽  
Cuff Repair

Background: All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors. Purpose: To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm2; n = 31), group B (BMD, 0.4-0.6 g/cm2; n = 32), and group C (BMD, >0.6 g/cm2; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21). Results: On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) ( P = .001). The DA was deeper in patients with a higher BMD at time zero ( r = 0.374; P = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA ( r = 0.769; P < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) ( P = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) ( P = .550). Conclusion: In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.

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