Prevalence and Site of Rotator Cuff Lesions in Shoulders With Recurrent Anterior Instability in a Young Population

Background: Partial articular supraspinatus tendon avulsion (PASTA) lesions are often seen in shoulders of throwing athletes. PASTA lesions in anterior instability are also found in recurrent anterior glenohumeral instability. Purpose: To investigate the prevalence and location of rotator cuff tears (RCTs), including PASTA lesions, in shoulders with recurrent anterior instability. Study Design: Case series; Level of evidence, 4. Methods: A total of 842 shoulders in 801 patients with recurrent anterior instability (647 men, 154 women; mean age, 24 years; age range, 13-40 years) who underwent arthroscopic surgery at the age of 40 years or younger were enrolled. During surgery, the thickness and the sites of RCTs as well as patient factors associated with RCTs were examined. Results: RCTs were found in 57 shoulders (7%) in 56 patients. There were 4 shoulders with full-thickness RCTs and 53 shoulders with PASTA lesions. All lesions but 1 involved the anterior border of the supraspinatus (SSP). Participation in high-level athletics and older age at injury were associated with RCTs. Conclusion: The incidence of RCTs was 7% in shoulders with recurrent anterior instability at age 40 years or younger. Most RCTs were PASTA lesions that involved the anterior border of the SSP.

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Shoulder disorders in an outpatient clinic: an epidemiological study

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172503170849 ◽

2017 ◽

Vol 25 (3) ◽

pp. 78-80 ◽

Cited By ~ 6

Author(s):

Eduardo Angeli Malavolta ◽

Mauro Emilio Conforto Gracitelli ◽

Jorge Henrique Assunção ◽

Gustavo de Mello Ribeiro Pinto ◽

Arthur Zorzi Freire da Silveira ◽

...

Keyword(s):

Rotator Cuff ◽

Adhesive Capsulitis ◽

Case Series ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Glenohumeral Instability ◽

Level Of Evidence ◽

Cross Sectional ◽

Partial Tears ◽

Shoulder Disorders

ABSTRACT OBJECTIVE: To describe shoulder disorders in patients evaluated by two shoulder and elbow surgeons. METHODS: This cross-sectional study analyzed patients evaluated by two authors, excluding acute fractures and dislocations and patients with symptoms not involving the shoulder. Age and sex distribution was determined for the different diagnoses. RESULTS: We evaluated 1001 patients. Mean age was 51.43±15.15 years and 51.0% were female. Disorders of the rotator cuff occurred in 64.3% (41.2% tendinopathy, 11.0% partial tears and 12.2% full-thickness tears). Adhesive capsulitis occurred in 13.5% of cases and glenohumeral instability in 8.1%. Rotator cuff disorders were more common in women, with a peak between 50 and 59 years for tendinopathy and partial tears and between 60 and 69 years for full-thickness tears. Glenohumeral instability was more frequent in men, with a peak between 30 and 39 years. CONCLUSION: The most frequent diagnosis was rotator cuff tendinopathy, followed by adhesive capsulitis, full-thickness rotator cuff tears, partial rotator cuff tears and glenohumeral instability. Rotator cuff lesions were more common in women, with a peak between 60 and 69 years for full-thickness tears. Level of Evidence IV, Case Series.

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

The American Journal of Sports Medicine ◽

10.1177/0363546518801014 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3155-3164 ◽

Cited By ~ 9

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.

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Augmented latissimus dorsi transfer: initial results in patients with massive irreparable posterosuperior rotator cuff tears

Shoulder & Elbow ◽

10.1177/1758573217750832 ◽

2018 ◽

Vol 11 (1_suppl) ◽

pp. 59-67 ◽

Cited By ~ 2

Author(s):

Claudia C. Sidler-Maier ◽

Jennifer A. Mutch ◽

Martin Sidler ◽

Dimitra Leivadiotou ◽

Jubin B. Payandeh ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Latissimus Dorsi ◽

Negative Impact ◽

Case Series ◽

Rotator Cuff Tears ◽

Subscapularis Tendon ◽

Level Of Evidence ◽

Latissimus Dorsi Transfer ◽

Cuff Repair

Background The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA). Methods This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015. Results All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31°; p = 0.016), and abduction by 25° ( p = 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome. Conclusions In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon. Level of evidence Level IV: Therapeutic study (case series)

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Arthroscopic Superior Capsule Reconstruction Can Eliminate Pseudoparalysis in Patients With Irreparable Rotator Cuff Tears

The American Journal of Sports Medicine ◽

10.1177/0363546518786489 ◽

2018 ◽

Vol 46 (11) ◽

pp. 2707-2716 ◽

Cited By ~ 55

Author(s):

Teruhisa Mihata ◽

Thay Q. Lee ◽

Akihiko Hasegawa ◽

Takeshi Kawakami ◽

Kunimoto Fukunishi ◽

...

Keyword(s):

Rotator Cuff ◽

External Rotation ◽

Case Series ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

Graft Healing ◽

Shoulder Range Of Motion ◽

Superior Capsule Reconstruction ◽

Acromiohumeral Distance

Background: Patients with pseudoparalysis and irreparable rotator cuff tears have very poor function. The authors developed a superior capsule reconstruction (SCR) technique for irreparable rotator cuff tears that restores shoulder stability and muscle balance, improving shoulder function and relieving pain. Purpose: To evaluate whether arthroscopic SCR reversed preoperative pseudoparalysis in patients with irreparable rotator cuff tears. Study Design: Case series; Level of evidence, 4. Methods: One hundred consecutive patients with irreparable rotator cuff tears underwent arthroscopic SCR with fascia lata autografts; 7 patients with deltoid weakness from cervical or axillary nerve palsy and 5 with severe presurgical shoulder stiffness were excluded. The remaining 88 were allocated to 3 groups according to their preoperative active shoulder elevation: no pseudoparalysis (45 patients; mean age, 66.2 years; mean tear size, 3.5 cm), moderate pseudoparalysis (28 patients, 68.3 years, 3.5 cm), and severe pseudoparalysis (15 patients, 62.3 years, 4.9 cm). Clinical outcome, active shoulder range of motion, acromiohumeral distance, and healing rate were compared between patients with and without pseudoparalysis, as well as before surgery and at final follow-up (35-110 months). Results: American Shoulder and Elbow Surgeons score, active elevation, active external rotation, and acromiohumeral distance increased significantly after arthroscopic SCR among all patients. Graft healing rates did not differ among the groups ( P = .73): 98% (44 of 45) for no pseudoparalysis, 96% (27 of 28) for moderate pseudoparalysis, and 87% (13 of 15) for severe pseudoparalysis. Pseudoparalysis was reversed in 96% (27 of 28) of patients with preoperative moderate pseudoparalysis and 93% (14 of 15) with preoperative severe pseudoparalysis. Both patients with residual pseudoparalysis postoperatively (1 of 28 with preoperative moderate pseudoparalysis, 1 of 15 with preoperative severe pseudoparalysis) had graft tears. Conclusion: Arthroscopic SCR restored superior glenohumeral stability and improved shoulder function among patients with or without pseudoparalysis who had previously irreparable rotator cuff tears. In the absence of postoperative graft tear, arthroscopic SCR reversed preoperative pseudoparalysis. Graft healing rates after arthroscopic SCR did not differ between patients with and without pseudoparalysis.

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Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120970502 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097050

Author(s):

Seung-Jun Lee ◽

Young-Kyoung Min ◽

Il-Kwon Chung ◽

Suk-Woong Kang ◽

Scott A. Banks

Keyword(s):

Rotator Cuff ◽

Humeral Head ◽

Case Series ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

3 Dimensional ◽

Superior Capsular Reconstruction ◽

Before And After ◽

Shoulder Kinematics

Background: Superior capsular reconstruction (SCR) is an alternative surgical option for young active patients with irreparable rotator cuff tears without arthritis. Although cadaveric studies have shown superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo. Purpose: To analyze the change in glenohumeral translation in patients before and after SCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients who underwent SCR by a single surgeon for irreparable rotator cuff tears were included. Among them, 14 patients had intact grafts, and 8 patients were diagnosed with retears on 1-year postoperative magnetic resonance imaging (MRI) scans. Fluoroscopy was performed in all patients preoperatively and at 3-month, 6-month, and 1-year follow-up. Moreover, 3-dimensional bone models from computed tomography, MRI, and fluoroscopic scans during scapular plane abduction of the shoulder joints were analyzed. Results: In the intact graft group, 3-dimensional dynamic shoulder kinematics at 6 months ( P = .026) and 1 year ( P = .032) postoperatively showed statistically significant decreases in humeral head superior translation compared with preoperatively. The ≥6-mm acromiohumeral distance (AHD) subgroup had a larger decrease in humeral head superior translation from preoperatively than did the <6-mm AHD subgroup (6 months: P = .026; 1 year: P = .032). The retear group had significantly greater humeral head superior translation at 1 year postoperatively than did the ≥6-mm and <6-mm AHD subgroups (post hoc test: P < .001; ≥6-mm AHD vs retear group: P = .001; <6-mm AHD vs retear group: P = .012). Conclusion: SCR with intact grafts resulted in decreased humeral head superior translation after 6 months. Patients with retears showed no improvement in humeral head superior translation. Patients with a preoperative AHD <6 mm had less improvement in humeral head superior translation than did those with a preoperative AHD ≥6 mm. Early surgical treatment before an excessive decrease in preoperative AHD could be helpful for postoperative humeral head translation recovery.

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Cell-Based Therapies for the Treatment of Shoulder and Elbow Tendinopathies: A Scoping Review

Stem Cells International ◽

10.1155/2021/5558040 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Berardo Di Matteo ◽

Riccardo Ranieri ◽

Angelo Manca ◽

Simone Cappato ◽

Maurilio Marcacci ◽

...

Keyword(s):

Rotator Cuff ◽

Clinical Improvement ◽

Scoping Review ◽

Therapeutic Potential ◽

Case Reports ◽

Case Series ◽

Tendon Healing ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

Current Application

Introduction. Tendinopathies are a common cause of disability among the general population, and their management is challenging due to the degenerative nature of these disorders. The aim of this paper is to perform a scoping review of the available clinical evidence on the application of cell-based therapies for the management of elbow and rotator cuff tendinopathies, in order to summarize the current application methods and to shed light on the therapeutic potential and current limitations of these biologic approaches. Materials and Methods. A scoping review of the literature was performed on the PubMed and Scopus databases using the following inclusion criteria: clinical reports of any level of evidence, written in English, with no time limitation, on the use of cell-based approaches to treat rotator cuff or elbow tendinopathies, including studies on biological augmentation during the surgical procedure. Exclusion criteria were as follows: case reports or mini case series (<5 patients), articles not written in English, and reviews. Relevant data were then extracted and collected in a single database with the consensus of the two observers to be analyzed for the purposes of the present manuscript. Results. Seven papers dealing with rotator cuff tears were included. Four of them investigated the effect of injections, either MSCs alone or in combination with PRP, whereas three studies investigated the use of MSCs in combination with surgery. In all cases, an improvement was found in terms of clinical scores, with even evidence of tendon healing documented at second-look arthroscopy. Six papers dealt with elbow tendinopathies: three studies described the use of MSCs either with or without surgery, reporting significant clinical improvement and three studies analyzed the use of different types of cells (collagen-producing cells and autologous tenocytes) and, even in this case, clinical improvement was reported. Conclusion. All the papers included suggested a beneficial role of cell-based approaches to treat common upper limb tendinopathies, with an overall satisfactory safety profile. However, the lack of high-level evidence and the presence of controversial issues, such as interproduct variability, harvest source, and application strategies, do not allow standardization of these novel biologic approaches, whose efficacy needs to be confirmed with properly designed randomized trials.

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Variation among Argentinean orthopedic surgeons in the therapeutic indications for rotator cuff tears

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/issn.1852-7434.2020.85.1.928 ◽

2019 ◽

Vol 85 (1) ◽

pp. 11-22

Author(s):

Gerardo Luis Aguirre ◽

Cristian Robles ◽

Mauro Cristiani ◽

Alejandra Juarez ◽

Esteban Lobos ◽

...

Keyword(s):

Rotator Cuff ◽

Nonoperative Treatment ◽

Rotator Cuff Tears ◽

Consensus Guidelines ◽

Open Technique ◽

Level Of Evidence ◽

Orthopedic Surgeons ◽

Rotator Cuff Injuries ◽

Rotator Cuff Lesions ◽

Mini Open

Introduction: Indications in the operative and nonoperative treatment of rotator cuff tears are widely discussed and not standardized. The aim of this study is to evaluate the variability among Argentinean orthopedic surgeons regarding the indications of treatment for different rotator cuff injuries. Materials and Methods: A questionnaire was developed based on the study carried out by Dunn et al. Our aim was to gather the opinions of Argentinean orthopedic surgeons on decision-making concerning thetreatment of different rotator cuff lesions. The questionnaire was sent to 2 groups: general orthopedic surgeons and shoulder specialist surgeons, included according to the number of shoulders treated surgically and non-surgically in 2017. The questionnaire has two sections: 4 hypothetical clinical cases and 11 questions on factors that could influence treatment selection. Results: Out of 556 questionnaires sent, 162 were completed, 117 by general orthopedic surgeons and 45 by shoulder specialists. The specialists reported mostly arthroscopic repairs (60%), general orthopedic surgeons reported repairing these injuries mainly by mini-open or by standard open technique (49% and 22% respectively). The failure rate was considered to be 20%, not evidencing differences between professionals (P=0.42). There was also agreement in the contraindication of the use of corticosteroids before surgery(P=0.74). Conclusion: This study evidences significant variability in the management of these patients (for which we selected potentially controversial injuries), making it difficult to establish protocols or consensus guidelines to help standardize treatments for these injuries. Level of evidence: IIb

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Fluoroscopically Guided Subacromial Spacer Implantation for Massive Rotator Cuff Tears: Two Years of Prospective Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121993469 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712199346

Author(s):

Enrico Gervasi ◽

Eran Maman ◽

Assaf Dekel ◽

Elana Markovitz ◽

Enrico Cautero

Keyword(s):

Rotator Cuff ◽

Local Anesthesia ◽

Case Series ◽

The Elderly ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

Safety And Efficacy ◽

Massive Rotator Cuff Tears

Background: Massive rotator cuff tears (MRCTs) are common and have been estimated to account for nearly 40% of all rotator cuff tears. An evolving strategy for management of MRCTs has been the implantation of a degradable subacromial spacer balloon that attempts to restore normal shoulder biomechanics. Purpose: To assess the safety and efficacy of fluoroscopically guided balloon spacer implantation under local anesthesia in a cohort of patients with 2 years of postoperative follow-up. Study Design: Case series; Level of evidence, 4. Methods: The safety and efficacy of using fluoroscopically guided subacromial spacer implantation was assessed in 46 patients. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Constant and American Shoulder and Elbow Society (ASES) scores. Results: Overall, 87.5% (35/40) of patients saw clinically significant improvement in the total Constant and ASES scores from 6 weeks postoperatively, with improvement maintained up to 24 months postoperatively. Conclusion: The data suggest that fluoroscopically guided subacromial spacer implantation under local anesthesia is a low-risk, clinically effective option, especially for the elderly population and those patients who have multiple comorbidities or a contraindication to general anesthesia. Patients undergoing subacromial spacer implantation for the treatment of MRCTs had satisfactory outcomes at 2-year follow-up, with a low rate of complications.

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The Use of a Bio-Inductive Collagen Patch to Supplement Repair of Large and Massive Rotator Cuff Tears Including Revisions: Clinical and Radiographic Outcomes at 2-year Follow Up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00082 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0008 ◽

Cited By ~ 1

Author(s):

Stephen Thon ◽

Lawrence K. O’Malley ◽

Michael John O’Brien ◽

Felix H. Savoie

Keyword(s):

Rotator Cuff ◽

Case Series ◽

Collagen Scaffold ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

Massive Rotator Cuff Tears ◽

Radiographic Outcomes ◽

Early Results ◽

Tendon Thickness

Objectives: Failures of large, massive, and revision rotator cuff repairs is a challenging problem within orthopedics. Poor tendon tissue and vascularity are known causes for failure of rotator cuff repairs. The purpose of this study was to assess the outcomes and healing rates when large and massive rotator cuff repairs are augmented with a bio-inductive collagen scaffold patch. Methods: Twenty-three patients undergoing repair of large (two tendon) or massive (three tendon) rotator cuff tears augmented with a bio-inductive collagen patch were followed prospectively for 2 years. Postoperative ultrasound (US) assessed tendon thickness at 3, 6, 12, and 24 months. MRI was utilized to confirm healing and tendon thickness at least 6 months post-operatively. Results: 16 of 23 patients had previous failed rotator cuff repairs. Eleven patients had large rotator cuff tears while twelve patients had massive rotator cuff tears. 21 of 23 patients successfully healed their rotator cuff repairs and new tissue formation was appreciated in all 23 patients. Ultrasound rotator cuff thickness ranged from 4.5-9mm at most recent follow-up. Overall, a 91% (21/23) success rate was confirmed on US and MRI. Conclusion: Clear indications for the use of this bio-inductive collagen scaffold have yet to be established. Our results show that it may have utility in improving the healing rates of large and massive rotator cuff repairs. New tendon formation was apparent on both US and MRI with relatively high healing rates at two years. While these early results are promising, long term-follow up is needed to identify the proper indications for its use. Level of Evidence:: Level IV - Case series.

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EVALUATION OF SURGICAL TREATMENT OF ROTATOR CUFF ANTEROSUPERIOR TEARS ARTHROSCOPICALLY

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192703169516 ◽

2019 ◽

Vol 27 (3) ◽

pp. 160-163

Author(s):

Roberto Yukio Ikemoto ◽

Luis Gustavo Prata Nascimento ◽

Luiz Henrique Oliveira Almeida ◽

Rogerio Serpone Bueno ◽

Guilherme Henrique Vieira Lima ◽

...

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Adhesive Capsulitis ◽

Case Series ◽

Arthroscopic Treatment ◽

Rotator Cuff Tears ◽

Rank Test ◽

Postoperative Results ◽

Level Of Evidence ◽

Subscapularis Tear

ABSTRACT Objective: To evaluate the functional result of arthroscopic treatment in anterosuperior rotator cuff tears. Methods: Fifty-six patients submitted to arthroscopic repair of anterosuperior rotator cuff tears were evaluated. The follow-up time was five year and five months. All the tears were diagnosed by detailed physical and imaging examination. Statistical analysis was used to compare the preoperative and postoperative results of range of motion and the UCLA score, with Wilcoxon signed-rank test, 5% significance level (p≤0.05), the relationship between the subscapularis tear and postoperative results using the Mann-Whitney test, and between the pain length and the UCLA scale using Spearman's correlation. Results: A statistically significant improvement (p<0.001) was found, comparing the range of motion and the UCLA preoperatively and postoperatively. 39% of the cases were classified as excellent, 33.9% as good, 23.7% as regular and 3.4% as bad results. A statistically significant relationship was found between the subscapularis tear type and the functional state, the pain length and the postoperative UCLA scale. Five complications, four reruptures and one adhesive capsulitis were found. Conclusions: The arthroscopic treatment for anterosuperior tears presented satisfactory results, with 8.5% of complications. Level of Evidence IV, Case series.

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