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

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.

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Arthroscopic Partial Repair of Massive Contracted Rotator Cuff Tears

Clinics in Shoulder and Elbow ◽

10.5397/cise.2014.17.1.44 ◽

2014 ◽

Vol 17 (1) ◽

pp. 44-47 ◽

Cited By ~ 1

Author(s):

Sung Jae Kim ◽

Young Hwan Kim ◽

Yong Min Chun

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Functional Outcomes ◽

Muscle Quality ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Partial Repair ◽

Tendon Coverage

Typically, massive rotator cuff tears have stiff and retracted tendon with poor muscle quality, in such cases orthopaedic surgeons are confronted with big challenging to restore the cuff to its native footprint. Furthermore, even with some restoration of the footprint, it is related with a high re-tear rate due to less tension free repair and less tendon coverage. In this tough circumstance, the partial repair has yielded satisfactory outcomes at relatively short follow-up by re-creating the transverse force couple of the rotator cuff. Through this partial repair, the massive rotator cuff tear can be converted to the "functional rotator cuff tear" and provide improvement in pain and functional outcomes in patient's shoulder.

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A Follow-Up Study of Rotator Cuff Tear Using Magnetic Resonance Imaging

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2018.53.1.38 ◽

2018 ◽

Vol 53 (1) ◽

pp. 38 ◽

Cited By ~ 1

Author(s):

Jun-Sung Won ◽

Woo-Seung Lee ◽

Jae-Hong Park ◽

Seung-Nam Ko ◽

In-Wook Seo

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Resonance Imaging ◽

Cuff Tear ◽

Follow Up Study

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Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review

HSS Journal ® ◽

10.1177/15563316211008137 ◽

2021 ◽

pp. 155633162110081

Author(s):

Nihar S. Shah ◽

Emil Suriel Peguero ◽

Yuta Umeda ◽

Zachary T. Crawford ◽

Brian M Grawe

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Long Term Outcomes ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Massive Rotator Cuff Tears ◽

Outcome Scores ◽

Long Term Follow Up

Background: With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. Questions/Purpose: The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. Methods: We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. Results: Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. Conclusions: The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.

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Diagnostic value of the axial view of magnetic resonance imaging to identify two-dimensional shapes of full-thickness rotator cuff tears

Acta Radiologica ◽

10.1177/0284185120905098 ◽

2020 ◽

Vol 61 (11) ◽

pp. 1545-1552

Author(s):

Sung-Weon Jung ◽

Jin-Woo Jin ◽

Dong-Hee Kim ◽

Hyeon-Soo Kim ◽

Gwang-Eun Lee ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Fatty Infiltration ◽

Rotator Cuff Tears ◽

Two Dimensional ◽

Resonance Imaging ◽

Cuff Tear ◽

Tear Size

Background Coronal and sagittal views of magnetic resonance imaging (MRI) were used to determine rotator cuff tear size and fatty infiltration, but these images were not enough to identify the tear shape. Purpose To correlate the preoperative axial MRI views and arthroscopic surgical findings to identify the two-dimensional shapes in rotator cuff tears. Material and Methods This study included 166 patients who underwent arthroscopic repair between 2015 and 2018. Preoperative coronal, sagittal, and axial MRI views were evaluated for tear size and geographic configuration in axial sections, and the length and the width were measured and were matched with arthroscopic surgical views by lateral portals. Results The agreement of axial MRI views with the arthroscopic view was 88.0% in crescent, 97.2% in longitudinal, 78.6% in massive, and 100% in rotator cuff tear arthropathy. The mean agreement rate of axial MRI views with arthroscopic view was 81.9%. Mean mediolateral and anteroposterior tear sizes on axial MRI were 16.68 mm and 19.33 mm, respectively. Mean mediolateral and anteroposterior tear sizes by arthroscopic view were 21.49 mm and 21.04 mm, respectively. Tear sizes by MRI axial images were 71.3% of arthroscopic view. SST/IST degenerative changes were noted in most patients with massive tears and rotator cuff arthropathy ( P = 0.001). Conclusion Rotator cuff tear shape on preoperative axial MRI view had close agreement (81.9%) with arthroscopic findings by lateral portal, and tear size by preoperative axial MRI views was 71.3% of that of arthroscopic view. Axial MRI views helped to predict the geometric tear shape of rotator cuff tears.

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Relationship between calcific tendinopathy and rotator cuff tear on shoulder magnetic resonance imaging: case-controlled comparison

Polish Journal of Radiology ◽

10.5114/pjr.2020.92709 ◽

2020 ◽

Vol 85 (1) ◽

pp. 8-13 ◽

Cited By ~ 1

Author(s):

Hamza Sucuoğlu ◽

Abdülkadir Asan

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Resonance Imaging ◽

Calcific Tendinopathy ◽

Cuff Tear

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Can Preoperative Magnetic Resonance Imaging Predict the Reparability of Massive Rotator Cuff Tears?

The American Journal of Sports Medicine ◽

10.1177/0363546517694160 ◽

2017 ◽

Vol 45 (7) ◽

pp. 1654-1663 ◽

Cited By ~ 31

Author(s):

Jung Youn Kim ◽

Ji Seon Park ◽

Yong Girl Rhee

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Fatty Infiltration ◽

Preoperative Magnetic Resonance Imaging ◽

Rotator Cuff Tears ◽

Resonance Imaging ◽

Massive Rotator Cuff Tears ◽

Preoperative Magnetic Resonance ◽

Auc Value

Background: Numerous studies have shown preoperative fatty infiltration of rotator cuff muscles to be strongly negatively correlated with the successful repair of massive rotator cuff tears (RCTs). Purpose: To assess the association between factors identified on preoperative magnetic resonance imaging (MRI), especially infraspinatus fatty infiltration, and the reparability of massive RCTs. Study Design: Case-control study; Level of evidence, 3. Methods: We analyzed a total of 105 patients with massive RCTs for whom MRI was performed ≤6 months before arthroscopic procedures. The mean age of the patients was 62.7 years (range, 46-83 years), and 46 were men. Among them, complete repair was possible in 50 patients (48%) and not possible in 55 patients (52%). The tangent sign, fatty infiltration of the rotator cuff, and Patte classification were evaluated as predictors of reparability. Using the receiver operating characteristic curve and the area under the curve (AUC), the prediction accuracy of each variable and combinations of variables were measured. Results: Reparability was associated with fatty infiltration of the supraspinatus ( P = .0045) and infraspinatus ( P < .001) muscles, the tangent sign ( P = .0033), and the Patte classification ( P < .001) but not with fatty infiltration of the subscapularis and teres minor ( P = .425 and .132, respectively). The cut-off values for supraspinatus and infraspinatus fatty infiltration were grade >3 and grade >2, respectively. The examination of single variables revealed that infraspinatus fatty infiltration showed the highest AUC value (0.812; sensitivity: 0.86; specificity: 0.76), while the tangent sign showed the lowest AUC value (0.626; sensitivity: 0.38; specificity: 0.87). Among 2-variable combinations, the combination of infraspinatus fatty infiltration and the Patte classification showed the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96). The combination of 4 variables, that is, infraspinatus and supraspinatus fatty infiltration, the tangent sign, and the Patte classification, had an AUC of 0.866 (sensitivity: 0.28; specificity: 0.98), which was lower than the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96) among the 2-variable combinations. Conclusion: The tangent sign or Patte classification alone was not a predictive indicator of the reparability of massive RCTs. Among single variables, infraspinatus fatty infiltration was the most effective in predicting reparability, while the combination of Goutallier classification <3 of the infraspinatus and Patte classification ≤2 of the rotator cuff muscles was the most predictive among the combinations of variables. This information may help predict the reparability of massive RCTs.

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Use of preoperative magnetic resonance imaging to predict rotator cuff tear pattern and method of repair (SS-78)

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2004.02.074 ◽

2004 ◽

Vol 20 ◽

pp. e37 ◽

Cited By ~ 1

Author(s):

J.F.James Davidson ◽

Stephen S. Burkhart ◽

David P. Richards ◽

Scot E. Campbell

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Preoperative Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Cuff Tear ◽

Tear Pattern ◽

Preoperative Magnetic Resonance

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Reverse Total Shoulder Arthroplasty in the Massive Rotator Cuff Tear

Clinics in Shoulder and Elbow ◽

10.5397/cise.2014.17.3.145 ◽

2014 ◽

Vol 17 (3) ◽

pp. 145-150 ◽

Cited By ~ 3

Author(s):

Jin Young Jeong ◽

Hong Eun Cha

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Biceps Tenotomy ◽

Reverse Total Shoulder

In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis.

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Pseudoparalysis and pseudoparesis of the shoulder

Obere Extremität ◽

10.1007/s11678-021-00658-5 ◽

2021 ◽

Author(s):

Roland Stefan Camenzind ◽

Laurent Lafosse ◽

Thibault Lafosse

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Rotator Cuff Tear ◽

Rotator Cuff Tears ◽

Subscapularis Tendon ◽

Cuff Tear ◽

Active Range Of Motion ◽

Definition Of ◽

Shoulder Elevation ◽

Scapular Plane

Abstract Background Clinical presentation of massive rotator cuff tears range from pain to loss of active range of motion. Pseudoparalysis and pseudoparesis are defined inconsistently in the literature, but both include limited active with maintained passive range of motion. Objective This article aims to provide a consistent definition of pseudoparalysis and pseudoparesis of the shoulder and show structural and biomechanical differences between these two types of rotator cuff tear with their implications for treatment. Methods A literature review including key and basic papers discussing clinical symptoms, biomechanical differences, and their impact on therapeutic options for pseudoparalysis and pseudoparesis was performed. Results Biomechanically, structural differences between pseudoparalysis (active scapular plane abduction <45°) and pseudoparesis (active scapular plane abduction 45–90°) exist. For massive posterosuperior rotator cuff tears, the integrity of the inferior subscapularis tendon is the most predictive factor for active humeral elevation. Patients with pseudoparalysis have a higher grade of subscapularis tendon involvement (>50%) and fatty infiltration of the subscapularis muscle. Treatment options depend on the acuteness and repairability of the tear. Rotator cuff repair can reliably reverse the active loss of active range of motion in acute and reparable rotator cuff tears. In chronic and irreparable cases reverse total shoulder arthroplasty is the most reliable treatment option in elderly patients. Conclusion The most concise definition of pseudoparalysis is a massive rotator cuff tear that leads to limited active (<45° shoulder elevation) with free passive range of motion in the absence of neurologic deficits as the reason for loss of active elevation. The integrity of the subscapularis tendon is the most important difference between a pseudoparalytic and pseudoparetic (active shoulder elevation 45–90°) shoulder. Decision-making for surgical options depends more on reparability of the tendon tear and patient age than on differentiation between pseudoparalysis and pseudoparesis.

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