Structural Evolution of Nonoperatively Treated High-Grade Partial-Thickness Tears of the Supraspinatus Tendon

2017 ◽  
Vol 46 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Bong Young Kong ◽  
Minjoon Cho ◽  
Hwa Ryeong Lee ◽  
Young Eun Choi ◽  
Sae Hoon Kim
Keyword(s):  
Rotator Cuff ◽  
Univariate Analysis ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Study Cohort ◽  
High Grade ◽  
Partial Thickness ◽  
Structural Progression ◽  
Significant Change

Background: High-grade partial-thickness rotator cuff tears (hPTRCTs) are frequently encountered in the shoulder. However, little information is available on the prevalence or timing of tear progression. Purpose/Hypothesis: The purpose was to prospectively evaluate the structural progression of hPTRCTs with a minimum follow-up of 1 year using magnetic resonance imaging (MRI). The hypothesis was that a substantial portion of hPTRCT patients would experience tear progression or evolution to a full-thickness rotator cuff tear. Study Design: Case series; Level of evidence, 4. Methods: Between May 2010 and December 2015, 362 patients were diagnosed with hPTRCT (tear involvement >50% of the mediolateral length of the footprint) of the supraspinatus and were treated nonoperatively. Among these patients, 81 underwent follow-up MRI at least 1 year after initial presentation, and these patients were included in the final analysis. Initial and follow-up MRIs were used to determine whether tears had improved, had not changed, or had progressed. A change in tear involvement of >20% was defined as a significant change. Patients were categorized as follows: (1) a decrease in tear involvement of >20% (improved), (2) an increase or decrease of ≤20% (no change), or (3) an increase in tear involvement of >20% (progressed). Demographic data and morphologic data were analyzed to identify variables related to tear progression. Among them, severity of tendinosis was graded using MRIs: grade 1 (mild tendinosis), mild focal increase in tendon signal; grade 2 (moderate tendinosis), moderate focal increase in tendon signal; and grade 3 (marked tendinosis), marked generalized increase in tendon signal. Results: At initial diagnosis, 23 were articular-side (28%) and 58 were bursal-side (72%) hPTRCTs. The study cohort was composed of 51 women and 30 men, and the mean patient age was 62.3 years (range, 41-77 years). Follow-up MRI was performed at a mean 19.9 ± 10.9 months (range, 12-52 months). A significant change in tear involvement was observed at follow-up. In 13 patients (16%, 2 articular-side and 11 bursal-side tears), tears were classified as progressed (the progressed group); in 48 patients (59%), tears exhibited no change (the unchanged group); and in 20 patients (25%, 9 articular-side and 11 bursal-side tears), tears were improved (the improved group). Univariate analysis showed initial tendinosis grade was significantly different in the 3 groups (grade 1, 2, and 3: 5, 4, and 4 in progressed; 36, 11, and 1 in unchanged; 10, 8, and 2 in improved group, respectively, P = .007). Conclusion: Although progression of hPTRCT in the long term is uncertain, after 1-year follow-up with MRI, tears progressed in 16% of the tears in this study. Furthermore, some tears were healed or reduced in size, which indicates that decisions to undertake surgical repair at time of presentation may be excessive.

scholarly journals Ultrasound and Functional Assessment of Transtendinous Repairs of Partial-Thickness Articular-Sided Rotator Cuff Tears

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769737 ◽  
Author(s):  
Roger V. Ostrander ◽  
Jeffrey M. Klauser ◽  
Sanjay Menon ◽  
Joshua G. Hackel
Keyword(s):  
Los Angeles ◽  
Rotator Cuff ◽  
Functional Outcomes ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
High Grade ◽  
Partial Thickness ◽  
Ultrasound Evaluation ◽  
Functional Scores

Background: Partial-thickness articular-sided rotator cuff tears are a frequent source of shoulder pain. Despite conservative measures, some patients continue to be symptomatic and require surgical management. However, there is some controversy as to which surgical approach results in the best outcomes for grade 3 tears. Hypothesis/Purpose: The purpose of this study was to evaluate repair integrity and the clinical results of patients treated with transtendinous repair of high-grade partial-thickness articular-sided rotator cuff tears. Our hypothesis was that transtendinous repairs would result in reliable healing and acceptable functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients with a minimum follow-up of 2 years were included in the study. All patients underwent arthroscopic repair of high-grade partial-thickness rotator cuff tears utilizing a transtendinous technique by a single surgeon. At latest follow-up, the repair integrity was evaluated using ultrasound imaging, and functional scores were calculated. Results: Ultrasound evaluation demonstrated that 18 of 20 patients had complete healing with a normal-appearing rotator cuff. Two patients had a minor residual partial tear. Sixteen of 20 patients had no pain on visual analog scale. Four patients complained of mild intermittent residual pain. All patients were rated as “excellent” by both the University of California at Los Angeles Shoulder Score and the Simple Shoulder Test. Conclusion: The transtendon technique for the repair of articular-sided high-grade partial rotator cuff tears results in reliable tendon healing and excellent functional outcomes.

Transtendon Suture Bridge Repair of Both-Sided Partial-Thickness Rotator Cuff Tears: Midterm Outcomes

2021 ◽  
pp. 036354652110345
Author(s):  
Dongwhan Suh ◽  
Sang-Eun Park ◽  
Young-Hun Han ◽  
Eung-Sic Kim ◽  
Jong-Hun Ji
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Suture Bridge ◽  
Partial Thickness ◽  
Partial Tears ◽  
Mri Scans

Background: Among symptomatic partial-thickness rotator cuff tears (PTRCT) indicated for surgery, both-sided (concurrent articular and bursal side) PTRCT are rarely reported and discussed in the literature. Without clinical data on and definite guidelines for treating these rare partial tears, appropriate management cannot be expected. Purpose: To calculate the prevalence of both-sided PTRCT and to evaluate clinical outcomes after arthroscopic transtendon suture bridge repair of both-sided PTRCT at a minimum 3-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Among symptomatic PTRCT that required arthroscopic surgery (765 patients) between March 2008 and December 2014, 178 both-sided partial tears were confirmed arthroscopically, and arthroscopic transtendon suture bridge repair was performed in 100 patients enrolled in our study after exclusion criteria were applied. The presence of concurrent articular and bursal side partial tears was confirmed via arthroscopy, with Ellman grade >2 on either the bursal or the articular side of these both-sided partial tears. Without tear completion, transtendon suture bridge repair was performed in all cases. Clinical outcomes including clinical scores and range of motion were evaluated at a mean of 5.3 ± 1.4 years (range, 3-8 years). Follow-up magnetic resonance imaging (MRI) was performed at 6 to 12 months (mean ± SD, 11 ± 5.20 months) after surgery to evaluate the tendon integrity (Sugaya classification) of the repaired rotator cuff. Results: The mean age was 57.5 ± 7.8 years, and 65% of patients were women. Mean preoperative American Shoulder and Elbow Surgeons, University of California Los Angeles, Simple Shoulder Test, and Constant-Murley outcome scores of 52 ± 14, 19 ± 4, 6 ± 2, and 69 ± 10 significantly improved postoperatively to 94 ± 5, 33 ± 2, 11 ± 1, and 93 ± 5, respectively ( P < .001). Mean forward flexion, abduction, external rotation, and internal rotation improved significantly from 148°± 31°, 134°± 39°, 22°± 13°, and L2 preoperatively to 154°± 17°, 151°± 60°, 29°± 14°, and T10 postoperatively, respectively ( P < .001). The retear rate on follow-up MRI scans was 2%. As per Sugaya classification on postoperative MRI scans, type 1 healing was found in 29%; type 2, in 60%; type 3, in 9%; and type 4, in 2%. Conclusion: Among all symptomatic PTRCT that required surgery, both-sided PTRCT were more common than expected. Arthroscopic transtendon suture bridge repair of these both-sided PTRCT showed satisfactory clinical outcomes at a minimum 3-year follow-up.

Rotator Cuff Repair in Adolescent Athletes

2018 ◽  
Vol 46 (5) ◽  
pp. 1084-1090 ◽  
Author(s):  
Michael G. Azzam ◽  
Jeffrey R. Dugas ◽  
James R. Andrews ◽  
Samuel R. Goldstein ◽  
Benton A. Emblom ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
High Grade ◽  
Pain Rating ◽  
Overhead Athletes ◽  
Western Ontario Rotator Cuff ◽  
Cuff Repair

Background: Rotator cuff tears are rare injuries in adolescents but cause significant morbidity if unrecognized. Previous literature on rotator cuff repairs in adolescents is limited to small case series, with few data to guide treatment. Hypothesis: Adolescent patients would have excellent functional outcome scores and return to the same level of sports participation after rotator cuff repair but would have some difficulty with returning to overhead sports. Study Design: Case series; Level of evidence 4. Methods: A retrospective search of the practice’s billing records identified all patients participating in at least 1 sport who underwent rotator cuff repair between 2006 and 2014 with an age <18 years at the time of surgery and a minimum follow-up of 2 years. Clinical records were evaluated for demographic information, and telephone follow-up was obtained regarding return to play, performance, other surgery and complications, a numeric pain rating scale (0-10) for current shoulder pain, American Shoulder and Elbow Surgeons (ASES) Shoulder Assessment Form, and the Western Ontario Rotator Cuff Index. Results: Thirty-two consecutive adolescent athletes (28 boys and 4 girls) with a mean age of 16.1 years (range, 13.2-17.9 years) met inclusion criteria. Twenty-nine patients (91%) had a traumatic event, and 27 of these patients (93%) had no symptoms before the trauma. The most common single tendon injury was to the supraspinatus (21 patients, 66%), of which 2 were complete tendon tears, 1 was a bony avulsion of the tendon, and 18 were high-grade partial tears. Fourteen patients (56%) underwent single-row repair of their rotator cuff tear, and 11 (44%) underwent double-row repair. All subscapularis injuries were repaired in open fashion, while all other tears were repaired arthroscopically. Twenty-seven patients (84%) completed the outcome questionnaires at a mean 6.2 years after surgery (range, 2-10 years). The mean ASES score was 93 (range, 65-100; SD = 9); mean Western Ontario Rotator Cuff Index, 89% (range, 60%-100%; SD = 13%); and mean numeric pain rating, 0.3 (range, 0-3; SD = 0.8). Overall, 25 patients (93%) returned to the same level of play or higher. Among overhead athletes, 13 (93%) were able to return to the same level of play, but 8 (57%) were forced to change positions. There were no surgical complications, but 2 patients did undergo a subsequent operation. Conclusion: Surgical repair of high-grade partial-thickness and complete rotator cuff tears yielded successful outcomes among adolescents, with excellent functional outcomes at midterm follow-up. However, overhead athletes may have difficulty playing the same position after surgery.

Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

2018 ◽  
Vol 46 (13) ◽  
pp. 3155-3164 ◽  
Author(s):  
Vasanth Seker ◽  
Lisa Hackett ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
External Rotation ◽  
Case Series ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Irreparable Tear ◽  
Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

scholarly journals Atelocollagen Injection Improves Tendon Integrity in Partial-Thickness Rotator Cuff Tears: A Prospective Comparative Study

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090401
Author(s):  
Jong-Ho Kim ◽  
Dong-Jin Kim ◽  
Hyo-Jin Lee ◽  
Baek-Kyu Kim ◽  
Yang-Soo Kim
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Type I ◽  
Pain Scores ◽  
Partial Thickness ◽  
Functional Scores ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Ongoing controversy surrounds the best treatment modality for partial-thickness rotator cuff tears. Purpose: To investigate the effects of atelocollagen injection in patients with small, symptomatic, intratendinous rotator cuff tears. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From January 2014 to December 2017, 94 patients who had small, symptomatic, intratendinous rotator cuff tears were enrolled and randomly allocated to 1 of 3 groups: intratendinous injection with 0.5 mL of type I atelocollagen (group 1, n = 32), intratendinous injection with 1 mL of type I atelocollagen (group 2, n = 30), and no injection of type I atelocollagen (group 3, n = 32). American Shoulder and Elbow Surgeons score, Constant Shoulder Score, visual analog scale pain score, and range of motion were evaluated before injection; at 3, 6, and 12 months after injection; and at final follow-up. Magnetic resonance imaging (MRI) was performed at least 6 months after injection to evaluate rotator cuff integrity. Results: Demographic data did not differ significantly among the 3 groups before injection ( P > .05). The mean follow-up period was 24.7 months. The functional and pain scores in groups 1 and 2 were significantly improved at final follow-up ( P < .05). No significant improvement was seen in functional or pain scores at final follow-up in group 3 ( P > .05). Groups 1 and 2 had significantly better functional scores compared with group 3 at final follow-up ( P < .05). The proportion of patients with a decrease in size of the torn tendon on follow-up MRI at least 6 months after atelocollagen injection was significantly higher in group 1 (28.1%; P = .02) and group 2 (36.7%; P = .003) compared with group 3 (6.3%). Conclusion: Atelocollagen injection can improve the functional outcome and integrity of the tendon in intratendinous rotator cuff tears.

Sign in / Sign up

Export Citation Format

Share Document