Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears: Comparison of Clinical Outcomes With and Without Subscapularis Tear

2020 ◽  
Vol 48 (14) ◽  
pp. 3429-3438
Author(s):  
Teruhisa Mihata ◽  
Thay Q. Lee ◽  
Akihiko Hasegawa ◽  
Kunimoto Fukunishi ◽  
Takeshi Kawakami ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Muscle Strength ◽  
Clinical Outcomes ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Subscapularis Tear ◽  
Subscapularis Tendon Tear ◽  
Group 3 ◽  
Group 2

Background: Arthroscopic superior capsule reconstruction (SCR) was developed to restore shoulder superior stability, muscle balance, and function in patients with irreparable posterior-superior rotator cuff tears. Purpose: To assess the effects of concomitant subscapularis tendon tear, which may reduce glenohumeral stability and force coupling, on clinical outcomes of SCR for irreparable posterior-superior rotator cuff tears. Study Design: Cohort study; Level of evidence, 3. Methods: In total, 193 patients with irreparable posterior-superior rotator cuff tears underwent arthroscopic SCR using fascia lata autograft between 2007 and 2015. They were allocated to 3 groups: group 1, no subscapularis tear (160 patients); group 2, reparable subscapularis tear, which underwent arthroscopic repair (26 patients); and group 3, irreparable subscapularis tear (7 patients). American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, visual analog scale (VAS) score for pain, active shoulder range of motion (ROM), muscle strength (manual muscle test), and acromiohumeral distance were evaluated before surgery and at final follow-up (mean, 3 years, 7 months; range, 2-11 years). Postoperative complications were assessed. Results: In groups 1 and 2, ASES, JOA, and VAS scores and shoulder ROM and muscle strength improved significantly after SCR with subscapularis repair ( P < .001). SCR in group 3 significantly improved ASES, JOA, and VAS scores ( P < .001), whereas shoulder ROM and muscle strength did not increase significantly. Postoperative acromiohumeral distance was significantly smaller in group 3 (5.7 ± 2.9 mm [mean ± SD]) than group 2 (9.1 ± 2.3 mm) ( P = .002). Group 3 had a significantly higher rate of graft tear ( P < .001) and postoperative infection ( P < .001) than group 1. Conclusion: The presence of subscapularis tendon tear affects clinical outcomes and complication rates after SCR. The reparability of the subscapularis affects superior glenohumeral stability; therefore, an intact subscapularis or reparable subscapularis tendon tear is the best indication for arthroscopic SCR in patients with irreparable posterior-superior rotator cuff tendon tears.

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.

scholarly journals Treatment With Glycogen Synthase Kinase 3β Inhibitor Decreases Apoptotic and Autophagic Reactions in Rat Rotator Cuff Tears

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110607
Author(s):  
Yang-Soo Kim ◽  
Yun-Gyoung Lee ◽  
Min-Tae Kim ◽  
Hyo-Jin Lee
Keyword(s):  
Rotator Cuff ◽  
Glycogen Synthase ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Cuff Tear ◽  
Partial Thickness ◽  
Group 3 ◽  
Group 2 ◽  
Gsk 3Β ◽  
Group 1

Background: Apoptosis and autophagy are known to be correlated with the extent of damage in torn rotator cuffs, and there is no biological evidence for self-recovery or healing of the rotator cuff tear. Purpose: To establish in a rat model of partial- and full-thickness rotator cuff tears how a glycogen synthase kinase 3β (GSK-3β) inhibitor affects the expression of apoptotic and autophagic markers. Study Design: Controlled laboratory study. Methods: Twelve-week-old Sprague Dawley rats were divided into 3 groups (n = 16 per group). Group 1 acted as the control, with no treatment; group 2 received partial-thickness (right side) and full-thickness (left side) rotator cuff tears only; and group 3 received the same rotator cuff injuries, with GSK-3β inhibitor injected afterward. The tendons from each group were harvested 42 days after surgery. Evaluation of gene expression, immunohistochemistry, and TUNEL staining (terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling) were performed for the following markers: caspases 3, 8, and 9 as well as Bcl-2 (B-cell lymphoma 2); BAX (Bcl-2-associated X protein); beclin 1; p53; and GSK-3β; which represented apoptotic and autophagic reactions. Statistical analysis was performed using 1-way analysis of variance. Results: In the group 2 rats with partial- and full-thickness tears, there were significant increases in the mRNA levels (fold changes) of all 8 markers as compared with group 1 (control). All these increased markers showed significant downregulation by the GSK-3β inhibitor in partial-thickness tears. However, the response to the GSK-3β inhibitor in full-thickness tears was not as prominent as in partial-thickness tears. The number of TUNEL-positive cells in group 2 (partial, 35.08% ± 1.625% [mean ± SE]; full, 46.92% ± 1.319%) was significantly higher than in group 1 (18.02% ± 1.036%; P < .01) and group 3 (partial, 28.04% ± 2.607% [ P < .01]; full, 38.97% ± 2.772% [ P < .01]), and immunohistochemistry revealed increased expression of all the markers in group 2 as compared with control. Conclusion: The apoptotic and autophagic activity induced in a rat model of an acute rotator cuff tear was downregulated after treatment with a GSK-3β inhibitor, particularly with partial-thickness rotator cuff tears. Clinical Relevance: A GSK-3β inhibitor may be able to modulate deterioration in a torn rotator cuff.

scholarly journals Relationship of Posterior Decentering of the Humeral Head with Tear Size and Fatty Degeneration in Rotator Cuff Tear

2019 ◽  
Vol 22 (3) ◽  
pp. 121-127
Author(s):  
Jung-Han Kim ◽  
Hyeong-Won Seo
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Humeral Head ◽  
Fatty Degeneration ◽  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Level Of Evidence ◽  
Cuff Tear ◽  
Subscapularis Tendon Tear ◽  
Tear Size

Background: Posterior decentering is not an uncommon finding on rotator cuff tear patients’ shoulder magnetic resonance imaging. No previous study has reported on the relationship between posterior decentering and rotator cuff tear.Methods: We assessed patients’ rotator cuff tear humeral head positions based on humeral?scapular alignment (HSA). Subjects were classified into centering and decentering groups based on a <2 mm or >2 mm HSA value, respectively. Differences in rotator cuff tear size, degree of tear, and fatty degeneration between the two groups were evaluated.Results: One hundred seventy-five patients (80 males, 95 females; mean age: 59.7 ± 6.5 years old) were selected as subjects (casecontrol study; level of evidence: 3). Tear size, degree of subscapularis tendon tear, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles were significantly different between the two groups (<i>p</i><0.001, <i>p</i><0.001, <i>p</i><0.001).Conclusions: The occurrence of decentering was related to rotator cuff tear size, degree of subscapularis tendon tear, and fatty degeneration of the rotator cuff muscles.

Clinical Relevance of Classifying Massive Rotator Cuff Tears: Results Based on Functional and Radiological Findings After Arthroscopic Repair

2016 ◽  
Vol 45 (1) ◽  
pp. 157-166 ◽  
Author(s):  
Hyun Soo Ok ◽  
Byung Guk Kim ◽  
Won Chul Choi ◽  
Chul Gie Hong ◽  
Jee Woong Kim ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Functional Results ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Group 3 ◽  
Group 2 ◽  
Tear Size ◽  
Retear Rate ◽  
Group 1

Background: Studies on the results of arthroscopic repair of massive rotator cuff tears have reported widely varied prognoses. Among other factors, the sizable discrepancy can be attributable to the fact that the current definition of massive rotator cuff tears covers an extensive area of tendons. Hypothesis: Functional and radiological results according to subgroups would show significant inter-subgroup differences preoperatively and postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 104 patients who required arthroscopic repair for massive rotator cuff tears were prospectively evaluated. The patients were allocated into 3 groups according to tendon involvement as diagnosed by preoperative magnetic resonance imaging: group 1 (anterosuperior type involving the subscapularis and supraspinatus), group 2 (posterosuperior type involving the infraspinatus and supraspinatus), and group 3 (anteroposterior type involving the subscapularis, supraspinatus, and infraspinatus). We compared functional results (at 2 years postoperatively) and radiological findings (at 1 year postoperatively) for each group. Results: There were 34 patients in group 1, 54 in group 2, and 16 in group 3. In all 3 groups, functional results significantly improved after surgery. There were no statistically significant intergroup differences in functional results among the 3 groups. On the radiological evaluations, each group (groups 1, 2, and 3) showed a significantly different result in the preoperative acromiohumeral distance (AHD) (7.19, 5.44, and 5.22 mm, respectively), tear size (38.8, 39.3, and 46.4 mm, respectively), extent of retraction (33.9, 40.0, and 41.4 mm, respectively), postoperative AHD (8.92, 7.37, and 6.71 mm, respectively), and retear rate (23.5%, 51.9%, and 56.2%, respectively) ( P < .001 for all). Conclusion: Massive rotator cuff tears can be divided into 3 types: anterosuperior (group 1), posterosuperior (group 2), and anteroposterior (group 3). Each group has distinctive characteristics and shows different results in the preoperative AHD, tear size, extent of retraction, postoperative AHD, and retear rate, which provide a reasonable basis for categorization. So far, massive rotator cuff tears have only been broadly defined, consequently being understood as a single category by many. However, to clearly understand and evaluate this injury, we suggest identifying differences within the category through proper subclassification.

scholarly journals Partial-thickness Rotator Cuff Tear Itself Did Not Cause Shoulder Pain Or Muscle Weakness In Baseball Players

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0043
Author(s):  
Teruhisa Mihata ◽  
Rei Morikura ◽  
Kunimoto Fukunishi ◽  
Yukitaka Fujisawa ◽  
Takeshi Kawakami ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Muscle Strength ◽  
Shoulder Pain ◽  
Muscle Weakness ◽  
Return To Play ◽  
Rotator Cuff Tears ◽  
Tendon Tear ◽  
Baseball Players ◽  
Partial Thickness ◽  
Significant Difference

Objectives: Rotator cuff tears are common shoulder injuries in baseball players. In some severe tears (i.e. through more than 50% of the cuff’s thickness), conservative treatment does not work well, and surgical treatment is sometimes chosen in an effort to ensure return to play. In contrast, some partial thickness rotator cuff tears do not cause shoulder symptoms, even during throwing motion. The objective of this study was to assess whether partial thickness rotator cuff tears cause shoulder pain and muscle weakness in baseball players. Methods: We studied 87 university baseball players (age: 19.5±0.8 years; baseball career: 11.5±1.6 years). Rotator cuff tendons were ultrasonographically examined (Fig 1), then divided into 4 groups; (1) no tear, (2) supraspinatus tendon tear, (3) infraspinatus tendon tear, (4) both supraspinatus and infraspinatus tendons tear. Current shoulder pain and shoulder muscle strength (Dominant/Non-dominant) in abduction, external rotation, and internal rotation were compared using Chi square test and t-test. Results: Forty-one (47%) players were diagnosed with articular-sided partial-thickness rotator cuff tears using ultrasonography. Nineteen tears were in the supraspinatus, 13 in the infraspinatus, and 9 in both the supraspinatus and the infraspinatus. Tear depth was 4.6±2.3 mm in the supraspinatus and 6.2±3.6 mm in the infraspinatus. There was no significant difference in rate of shoulder pain (p=0.96) and muscle strength among four groups (p=0.15 - 0.70). Conclusion: In this study, articular-sided partial-thickness rotator cuff tears did not cause shoulder pain and muscle weakness in university baseball players. Most of articular-sided partial-thickness rotator cuff tears are tears of the superior capsule but not the rotator cuff tendons, because the superior capsule is attached in the articular half of the greater tuberosity. Therefore, most so-called articular-sided partial-thickness rotator cuff tears may not be pathological tendon tear.

scholarly journals How do massive immobile rotator cuff tears behave after arthroscopic interval slides? Comparison with mobile tears

Joints ◽  
2014 ◽  
Vol 02 (02) ◽  
pp. 66-70 ◽  
Author(s):  
Chiara Fossati ◽  
Paolo Arrigoni ◽  
Vincenza Ragone ◽  
Pietro Spennacchio ◽  
Giuseppe Banfi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Massive Rotator Cuff Tears ◽  
Group 2 ◽  
Group 1

Purpose: the aim of this study was to compare clinical outcomes of contracted immobile massive rotator cuff tears mobilised through an arthroscopic interval slide technique versus massive mobile cuff tears directly repaired without any mobilisation. Methods: twenty-five patients who underwent arthroscopic repair for massive rotator cuff tears with a minimum of 18 months follow-up were included. The patients were retrospectively divided into two groups. In group 1, a single or double interval slide was performed to achieve adequate tendon mobilisation. In group 2 (control group), massive rotator cuff tears were arthroscopically repaired without any additional release. Patients were evaluated with validated outcomes scores: subjective and objective Constant score, a Visual Analogue Scale (VAS) for pain, and single Assessment Numeric Evaluation (SANE). Results: the two groups were comparable in terms of age, gender and involvement of the dominant arm. The mean follow-up duration was 31 months in group 1 and 28 months in group 2 (p = 0.4). The two groups showed no significant differences in SANE and VAS results (group 1: SANE 77%, VAS 1.3; group 2: SANE 88%, VAS 1.6), or in total Constant score (group1: 66.5 ± 11; group 2: 75 ± 14; p = 0.1) and subjective Constant score (Group 1: 31 ± 5; group 2: 30.8 ± 7; p = 0.9). A significant difference was found for the objective Constant score, which was higher in the control group (group 1: 35.5 ± 7; group 2: 44 ± 8; p = 0.009). Conclusions: Subjective clinical outcomes of arthroscopic repair with or without interval slides did not differ and were satisfactory. Objectively, immobile cuff tears showed inferior results.The use of interval slides might be considered a first step or an alternative to more invasive procedures for low demanding patients. Level of evidence: Level III, retrospective comparative study.

scholarly journals Comparison of Clinical and Anatomical Outcomes between Delaminated Rotator Cuff Tear and Single Layer Rotator Cuff Tear

2018 ◽  
Vol 21 (4) ◽  
pp. 207-212 ◽  
Author(s):  
Jin Woo Park ◽  
Sung Hoon Moon ◽  
Jun Hee Lee
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Tear ◽  
Muscle Atrophy ◽  
Single Layer ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Cuff Tear ◽  
Group 2 ◽  
Group 1

BACKGROUND: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears.METHODS: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS).RESULTS: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be 15.46 ± 3.60 mm and 14.17 ± 3.16 mm (p=0.013), and muscle atrophy of SS (occupation ratio) was 60.54 ± 13.15 and 56.55 ± 12.88 (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups.CONCLUSIONS: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.

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