scholarly journals Could superior capsule findings be used as a predictor for partial bursal-sided rotator cuff tears?

2020 ◽  
Vol 28 (1) ◽  
pp. 230949901989515 ◽  
Author(s):  
Ulunay Kanatlı ◽  
Tacettin Ayanoglu ◽  
Erdinc Esen ◽  
Baybars Ataoglu ◽  
Mustafa Ozer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Arthroscopic Treatment ◽  
Rotator Cuff Tears ◽  
Subacromial Impingement Syndrome ◽  
Control Group ◽  
Study Group ◽  
Coracoacromial Ligament ◽  
Cuff Tear ◽  
Significant Difference

Purpose: The purpose of this study was to investigate the relationship between the superior capsule tear patterns and synovitis with subacromial pathologies, such as bursal-sided rotator cuff tear and subacromial impingement syndrome. Methods: Fifty patients who underwent arthroscopic treatment for isolated bursal-sided tear were included in the study. Fifty more patients who underwent arthroscopic treatment for isolated Superior Labrum Anterior Posterior (SLAP) 2 lesion without pathology in the rotator cuff were included in the control group. Firstly, superior capsule tear and common synovitis on the rotator cable were assessed during glenohumeral joint examination. Coracoacromial Ligament (CAL) degeneration grading was performed according to the Royal Berkshire Hospital classification. Bursal-sided partial tear grading was done using Ellman classification. Whether or not there was a relationship between synovitis, classic capsule tear, plus reverse flap capsule tear, and partial bursal-sided tear existence. Results: There were 21 patients with reverse flap capsule tear in the study group and 3 patients in the control group. In addition, there were 13 patients with synovitis in the study group and 4 in the control group. Compared to the control group, there was also a significant positive correlation in the presence of both synovitis and reverse flap capsule tear with the presence of bursal-sided tear in the study group ( p = 0.000). There was, however, no significant difference between the presence of classical capsule tear and the presence of bursal-sided tear ( p = 0.485). Conclusion: This study shows that the presence of reverse flap capsule tear and synovitis was associated with partial bursal-sided tears. Therefore, if the reverse flap capsule tear or synovitis is detected in the superior capsule, the rotator cuff should be evaluated in more detail during subacromial bursoscopy in order not to miss a bursal-sided partial cuff tear.

Association between the Critical Shoulder Angle and Non-traumatic Rotator Cuff Tears

2019 ◽  
Vol 1 ◽  
pp. 88-91
Author(s):  
Aniket Jadhav ◽  
Sanjay Desai ◽  
Vikas Reddy ◽  
Robin Kuruvilla ◽  
Pranav Mahadeokar
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Study Groups ◽  
Joint Disease ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Study Group ◽  
Chi Square ◽  
Critical Shoulder Angle ◽  
Shoulder Angle

Background: Moor et al. developed a critical shoulder angle (CSA) as a radiological parameter for the development of rotator cuff injury and degenerative changes of the glenohumeral joint. The objective of this study is to evaluate the association between CSA and the development of non-traumatic rotator cuff tears (RCTs) to further validate this study. Materials and Methods: The study was performed as an observational study dividing subjects into control and study groups, differing in the presence of non-traumatic RCT. The study group comprised 50 subjects with 40 subjects in the control group. All acceptable radiographs were evaluated, to measure the CSA in accordance with Moor et al. Results: The mean CSA of control subjects was 31.79° (± 1.89°), while that of study subjects were 37.85° (± 2.25°). The relative variability in the control group was about 6% and that in the study group was also 6%, indicating internal homogeneity of the study groups. Chi-square test applied to the distribution gave a P = 0.00001, representing an excellent association between the study groups and the CSA. Conclusion: There is a significant association between larger CSA and RCTs (P = 0.00001). Individual (quantitative) anatomical parameters may imply altered biomechanics, which are likely to induce RCTs, independent of trauma and degenerative glenohumeral joint disease.

scholarly journals DOES HYPERCHOLESTOLEMIA PREDISPOSE TO ROTATOR CUFF PATHOLOGIES?

2017 ◽  
Vol 10 (4) ◽  
pp. 373 ◽  
Author(s):  
Surendra Umesh Kamath ◽  
Sunil Murthy
Keyword(s):  
Rotator Cuff ◽  
Total Cholesterol ◽  
Rotator Cuff Tear ◽  
Indian Population ◽  
Statistical Significance ◽  
Elevated Serum ◽  
Density Lipoprotein ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Cuff Tear

Background:  Rotator cuff tear are one of most common orthopedic musculoskeletal problem gaining importance due to large health scale expenditure. Causes of rotator cuff tears are multifactorial and unclear.  Previous studies have suggested relation between elevated serum lipid profile and rotator cuff tear in western population. We therefore undertook study in our Indian population to correlate association of hypercholesterolemia with rotator cuff tear.Objective: To find association of rotator cuff pathology with hypercholesterolemia in Indian patients.Materials and methods: After obtaining clearance from institutional ethics committee. We prospectively collected fasting lipid samples of population who came to our hospitals with complaints of shoulder pain during our study period. 50 patients had rupture of rotator cuff which was confirmed by ultrasound of involved shoulder. 50 were seen for non-cuff related complaints.  We followed strict inclusion and exclusion criteria.Results: Total cholesterol, Triglycerides and low density lipoprotein concentration of patients with rotator cuff tendon tear were on higher side than control group. High density lipoprotein trend showed being lower than control group.  21 of 50 (42%) had high cholesterol (total cholesterol greater than 240mg/dl) than compared to 18 of 50 (36%) in control group. however P value=0.539 and showed no statistical significance between groups.Conclusion: In Indian population there was no correlation between hypercholesterolemia and rotator cuff tear which is statistically significant.Key words Rotator cuff tear, Hypercholesterolemia, Indian population.   

scholarly journals Irreparable Rotator Cuff Tears: A Biomechanical Comparison of Superior Capsuloligamentous Complex Reconstruction Techniques and an Interpositional Graft Technique

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986459 ◽  
Author(s):  
Tim Leschinger ◽  
Katharina Besch ◽  
Cansu Aydin ◽  
Manfred Staat ◽  
Martin Scaal ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Neutral Position ◽  
Management Options ◽  
Significant Difference ◽  
Intact Condition ◽  
Point Condition ◽  
Biomechanical Comparison

Background: Irreparable rotator cuff tears lead to superior translation of the humeral head. Numerous surgical management options are available to treat the condition. Purpose: To compare superior capsule stability among different types of patch grafting in irreparable rotator cuff tears. Methods: Six cadaveric shoulders were tested in a custom-designed shoulder testing system. Superior translation of the humerus and subacromial contact pressure were quantified in an intact condition (condition 1), after cutting the supraspinatus tendon (condition 2), and after additionally cutting the superior capsuloligamentous complex (condition 3). The results were compared among 3 types of patch grafting, in which capsule reconstruction was achieved by glenoidal 3-point (condition 4) or 2-point (condition 5) fixation or by affixing a graft below the acromion (condition 6). Results: No significant difference in subacromial pressure was measured by reconstruction with 2 or 3 anchors compared with conditions 1 and 2 ( P > .05). However, with 3-point fixation, lower levels of pressure were measured than with 2-point fixation. Moreover, superior translation values were lower with 3-point fixation; the same applied for values of the preserved capsule as compared with the torn capsule. In condition 6, a significant increase in pressure in the neutral position was documented ( P < .05). Conclusion: The superior capsuloligamentous complex plays an important role in stabilizing the glenohumeral joint. The results suggest that with additional medial anchoring at the coracoid base, the depressing and centering effect of the superior complex can probably be regained in a more physiological way compared with a reconstructed capsule with 2 glenoid attachments or with an interpositional graft below the acromion.

Arthroscopic Rotator Cuff Repair With Graft Augmentation of 3-Dimensional Biological Collagen for Moderate to Large Tears: A Randomized Controlled Study

2018 ◽  
Vol 46 (6) ◽  
pp. 1424-1431 ◽  
Author(s):  
You-Zhi Cai ◽  
Chi Zhang ◽  
Ri-Long Jin ◽  
Tong Shen ◽  
Peng-Cheng Gu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Randomized Controlled ◽  
3D Collagen ◽  
Cuff Repair ◽  
Retear Rate

Background: Due to the highly organized tissue and avascular nature of the rotator cuff, rotator cuff tears have limited ability to heal after the tendon is reinserted directly on the greater tubercle of the humerus. Consequently, retears are among the most common complications after rotator cuff repair. Augmentation of rotator cuff repairs with patches has been an active area of research in recent years to reduce retear rate. Hypothesis: Graft augmentation with 3D collagen could prevent retears of the repaired tendon and improve tendon-bone healing in moderate to large rotator cuff tears. Study Design: Randomized controlled study; Level of evidence, 2. Methods: A prospective, randomized controlled study was performed in a consecutive series of 112 patients age 50 to 85 years who underwent rotator cuff repair with the suture-bridge technique (58 patients, control group) or the suture-bridge technique augmented with 3-dimensional (3D) collagen (54 patients, study group). All patients were followed for 28.2 months (range, 24-36 months). Visual analog scale score for pain, University of California Los Angeles (UCLA) shoulder score, and Constant score were determined. Magnetic resonance imaging was performed pre- and postoperatively (at a minimum of 24 months) to evaluate the integrity of the rotator cuff and the retear rate of the repaired tendon. Three patients in each group had biopsies at nearly 24 months after surgery with histological assessment and transmission electron microscopy. Results: A total of 104 patients completed the final follow-up. At the 12-month follow-up, the UCLA shoulder score was 28.1 ± 1.9 in the study group, which was significantly better than that in the control group (26.9 ± 2.1, P = .002). The Constant score was also significantly better in the study group (87.1 ± 3.2) than in the control group (84.9 ± 4.2, P = .003). However, at the final follow-up, no significant differences were found in the UCLA shoulder scores (29.4 ± 1.9 in the control group and 30.0 ± 1.6 in the study group, P = .052) or Constant scores (89.9 ± 3.2 in the control group and 90.8 ± 3.5 in the study group, P = .18). In terms of structural integrity, more patients in the study group had a favorable type I retear grade (18/51) than in the control group (10/53) ( P = .06). The postoperative retear rate was 34.0% in the control group and 13.7% in the study group, thus indicating a significantly lower retear rate in the study group ( P = .02). Biopsy specimens of the tendon-bone interface in 6 patients revealed more bone formation and more aligned fibers with larger diameters in the study group than in the control group. No intraoperative or postoperative complications were noted in either group. Conclusion: 3D collagen augmentation could provide effective treatment of moderate to large rotator cuff tears, providing substantial functional improvement, and could reduce the retear rate. This technique could also promote new tendon-bone formation, thus exerting a prominent effect on tendon-bone healing.

scholarly journals Ultrasound study of the asymptomatic shoulder in patients with a confirmed rotator cuff tear in the opposite shoulder

2007 ◽  
Vol 19 (1) ◽  
pp. 23 ◽  
Author(s):  
Z Oschman ◽  
C Janse van Rensburg ◽  
NGJ Maritz ◽  
H Borain ◽  
R Owen
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Sports Medicine ◽  
Glenohumeral Joint ◽  
Rotator Cuff Tears ◽  
Joint Effusion ◽  
Cuff Tear ◽  
Ultrasound Study ◽  
Ultrasound Findings ◽  
Long Head

Objective. To document the incidence of asymptomatic rotator cuff tears in patients with a confirmed symptomatic tear in the opposite shoulder, and to identify ultrasound findings that may distinguish symptomatic from asymptomatic tears. Design. When patients are referred for an ultrasound examination for the confirmation of symptomatic rotator cuff tear the opposite shoulder is often used for comparison. However, patients often have a similar tear on the asymptomatic side. Fifty patients with a confirmed symptomatic rotator cuff tear and an asymptomatic shoulder on the opposite side were chosen for inclusion. The patients were examined using a Siemens Sonoline Elegra 7.5 MHz linear multi-frequency probe. The appearance of the rotator cuff, long head of the biceps and the subacromial-subdeltoid bursa (SASD bursa) were documented. The antero-posterior (AP) dimension of the supraspinatus muscle and fat between the trapezius and supraspinatus muscles were measured, which indicated if a tear was acute or chronic. The width and length of the rotator cuff tear were measured. Setting. Division of Sports Medicine, University of Pretoria. Results. Fifty-four per cent of the asymptomatic shoulders had tears. We found that the symptomatic tears were larger, appeared more chronic and had an associated biceps tendinopathy and glenohumeral joint effusion. Conclusion. As other authors have found, the high incidence of asymptomatic tears indicates that rotator cuff tears can be regarded as a natural correlate of aging and that bilateral tears are common. Initial treatment should be conservative, but larger tears may benefit from early surgery before becoming chronic and causing glenohumeral dysfunction. South African Journal of Sports Medicine Vol. 19 (1) 2007: pp. 23-28

scholarly journals Arthroscopic Rotator Cuff Repair With Muscle Advancement and Artificial Biodegradable Sheet Reinforcement for Massive Rotator Cuff Tears

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096016
Author(s):  
Shin Yokoya ◽  
Yohei Harada ◽  
Hiroshi Negi ◽  
Ryosuke Matsushita ◽  
Norimasa Matsubara ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Failure Rate ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Study Group ◽  
Massive Rotator Cuff Tears ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Isometric Muscle

Background: Because high failure rates have frequently been reported after arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (mRCTs), we introduced the technique of ARCR with supraspinatus and infraspinatus muscle advancement (MA). However, for cases where the original footprint cannot be completely covered, additional surgery using an approved artificial biomaterial is performed. Purpose: To investigate the postoperative clinical outcomes and failure rate after MA-ARCR, with and without our reinforcement technique. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 74 patients (mean ± SD age, 68.7 ± 7.7 years) diagnosed with mRCT with a minimum postoperative follow-up of 2 years were included in the current study. Of these patients, 47 underwent MA-ARCR with polyglycolic acid (PGA) sheet reinforcement (study group), and 27 patients underwent MA-ARCR alone (control group). PGA reinforcement was performed when full coverage of the footprint could not be achieved by MA alone, but where the latter was possible, reinforcement was not required. Thus, the study group had significantly worse muscle quality than the control group ( P < .05). The pre- and postoperative range of motion (ROM), isometric muscle strength, acromiohumeral interval, and clinical outcomes were evaluated and compared between these 2 groups. Cuff integrity during the last follow-up period was assessed with magnetic resonance imaging, and the failure rate was calculated. In addition, the postoperative foreign body reaction was investigated in the study group. Results: In both groups, significant postoperative improvements were seen in acromiohumeral interval, clinical scores, ROM in anterior flexion, and isometric muscle strength in abduction, external rotation, and internal rotation ( P < .001 for all). The failure rate of the study group was 12.8% (6 patients) and that of the control group was 25.9% (7 patients). No significant differences were noted between the 2 groups on any of the data findings, even regarding the failure rate. Foreign body reactions in the early period were found in 3 patients, although these spontaneously disappeared within 3 months. Conclusion: Patients who underwent PGA patch reinforcement for MA-ARCR when the footprint could not be completely covered had clinical results similar to isolated MA-ARCR when the footprint could be covered. Both procedures resulted in significant improvement in symptoms and function compared with preoperatively.

Value of radiographic measurements in depiction of glenohumeral and acromial anatomical changes in patients with subacromial impingement syndrome and rotator cuff tears

2018 ◽  
pp. 98-108
Author(s):  
V. E. Gazhonova ◽  
Е. M. Bachurina ◽  
M. V. Emelianenko ◽  
I. E. Popova ◽  
T. A. Soina ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Mr Arthrography ◽  
Diagnostic Value ◽  
Rotator Cuff Tears ◽  
Subacromial Impingement Syndrome ◽  
Control Group ◽  
Clinical Value ◽  
Mean Values ◽  
Radiographic Measurements ◽  
And Control

The purpose.Optimization of radiographic study of the shoulder in patients with SIS and estimation of the clinical value of radiographic measurements in SIS diagnosis and rotator cuff tears (RCT).Materials and methods.128 patients with a painful shoulder (67 women, 61 men), mean age 57.3 ± 12.8 y.o. and 35 patients without shoulder pain mean age 56 ± 10.4 y.o. underwent a complex study including radiography, MRI, MDCTor MR-arthrography, arthroscopy. Special angles and distances were estimated on a Radiographic Work Station by 2 radiologists (acromion tilt (AT), acromion slope, inferior acromion protrusion, acromio-humeral distance, acromio-humeral index, critical shoulder angle (CSA), lateral acromion angle, transverse acromion angle). Mean values of these parameters were compared between patients with SIS and control group, and between patients with RCT and without . Test-retest reproducibility and inter rater agreement were calculated with Kohen’s kappa. Diagnostic value of the most informative parameters was compared with estimation of AUC under the ROC curve.Results.CSA and AT demonstrated independence with age and excellent test-retest reproducibility. In SIS patients mean values of CSA were statistically higher (35.78 ± 4.64°), AT values – lower (25.90 ± 4.27°), then in controls. In all patients with CSA more then 35, the frequency of RCT was 74%. In patients with RCT were detected higher values of CSA (36.70 ± 2.61°) and lower values of AT (23.67 ± 3.07°), then in patients without tears. Lateral acromion angle (acromion type) demonstrated correlation with patient’s age and moderate reproducibility in test-retest studies.Conclusion.AT (measured on the outlet X-ray view) and CSA (measured in direct views) could be recommended for clinical use for evaluation of patients with SIS and prognosing RCT.

Effects of Supraspinatus Tear and Repair on Glenohumeral Joint Biomechanics

2002 ◽  
Author(s):  
Michelle H. McGarry ◽  
Jennifer L. Bissell ◽  
Bruce Y. Yang ◽  
Ranjan Gupta ◽  
Thay Q. Lee
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Glenohumeral Joint ◽  
Rotator Cuff Tears ◽  
Patient Factors ◽  
Subacromial Decompression ◽  
Orthopaedic Surgeons ◽  
Cuff Tear ◽  
Supraspinatus Tear ◽  
Joint Biomechanics

Rotator cuff tears are common injuries seen by orthopaedic surgeons. Management may vary depending on patient factors, size and location of tear, and severity of symptoms. Treatment for symptomatic rotator cuff tear often includes subacromial decompression, debridement, and/or repair. The objective of this study was to determine the change in glenohumeral joint (GHJ) forces after repair of pathologic supraspinatus tears.

scholarly journals Decreased axial coracoid inclination angle is associated with rotator cuff tears

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769032 ◽  
Author(s):  
Carlos Torrens ◽  
Eduard Alentorn-Geli ◽  
Juan Francisco Sanchez ◽  
Anna Isart ◽  
Fernando Santana
Keyword(s):  
Rotator Cuff ◽  
Coracoid Process ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Subacromial Space ◽  
Coracoacromial Ligament ◽  
Coracoid Impingement ◽  
Computed Tomography Scans ◽  
Inclination Angles ◽  
Glenoid Surface

Purpose: Coracoid morphology has been related to coracoid impingement mainly resulting in anterior shoulder pain aggravated by forward flexion and internal rotation. However, the coracoid process morphology can also affect the inclination of the coracoacromial ligament and subsequently the subacromial space in the same way that acromial slope does. The purpose of this study was to evaluate the influence of the coracoid body–glenoid surface, coracoid tip–glenoid surface, and coracoid body–coracoid tip angles (coracoid inclination angles) on rotator cuff tears (RCTs). Methods: Fifty patients with documented RCT and 50 patients with normal rotator cuff (control) were included. The coracoid inclination angles were determined in both groups by measuring on computed tomography scans the angle created by the coracoid body and the glenoid surface (A1), the angle created by the coracoid tip and the glenoid surface (A2), and the angle created by the coracoid body and the coracoid tip (A3). Results: All angles were significantly lower in the RCT group compared to the control group: mean A1 angle of 49.7° and 54.61°, respectively ( p = 0.011); mean A2 angle of 76.45° and 93.6°, respectively ( p < 0.001); and mean A3 angle of 132.33° and 144.34°, respectively ( p < 0.001). Conclusions: Decreased coracoid body–glenoid surface, coracoid tip–glenoid surface, and coracoid body–coracoid tip angles are associated with RCT. Decreased angles may reduce subacromial space by projecting the coracoacromial ligament more vertically.

Outcomes of Arthroscopic Nerve Release in Patients Treated for Large or Massive Rotator Cuff Tears and Associated Suprascapular Neuropathy: A Prospective, Randomized, Double-Blinded Clinical Trial

2021 ◽  
pp. 036354652110218
Author(s):  
Nikolaos Platon Sachinis ◽  
Sotirios Papagiannopoulos ◽  
Ioannis Sarris ◽  
Pericles Papadopoulos
Keyword(s):  
Rotator Cuff ◽  
Suprascapular Nerve ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Suprascapular Neuropathy ◽  
Significant Difference ◽  
Nerve Recovery ◽  
Release Group ◽  
Cuff Repair ◽  
Nerve Release

Background: Suprascapular neuropathy has been observed in the setting of rotator cuff tears (RCTs), but its association with these tears and their treatment are unclear. Hypothesis: Arthroscopic suprascapular nerve release during rotator cuff repair will not alter the outcomes of neuropathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 42 patients with large/massive reparable RCTs and suprascapular neuropathy were recruited and followed up at 6 and 12 months. Electrophysiological results as well as Disabilities of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), and Constant scores were evaluated at selected time periods. Patients were randomly assigned to 2 groups. Patients in the control group underwent arthroscopic repair of the rotator cuff without combined arthroscopic release of the superior transverse scapular ligament; in the second group, the superior transverse ligament was released. The primary outcome was to examine full suprascapular nerve recovery through electrophysiological changes between groups. The secondary/tertiary outcomes were analysis of clinical outcomes and assessment of the relation between RCT size and the degree of suprascapular nerve recovery. Patients, clinical staff members, and the neurologist were blinded to the type of surgical procedure. Results: Of 42 patients, 37 completed the follow-up at 12 months (median age, 64 years [range, 50-75 years]). Overall, 17 of 19 (89.5%) patients in the control group and 15 of 18 (83.3%) patients in the nerve release group had full nerve recovery, with no significant difference between the 2 groups. Clinically, all patients in both groups showed a significant improvement ( P < .001), but no significant difference was observed between the 2 groups in terms of 12-month postoperative scores (control group: DASH: median, 5 [range, 0-21]; ASES: median, 88 [range, 83-98]; Constant: median, 86 [range, 70-98]) (nerve release group: DASH: median, 6 [range, 0-25]; ASES: median, 90 [range, 83-98]; Constant: median, 88 [range, 75-98]). Also, no significant difference was found between the 2 groups regarding other secondary and tertiary outcomes. Conclusion: Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone. Registration: NCT02318381 (ClinicalTrials.gov identifier).

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