scholarly journals A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094097
Author(s):  
In Park ◽  
Jun-Seok Kang ◽  
Hye-Ah Lee ◽  
Yoon-Geol Jo ◽  
Sang-Jin Shin
Keyword(s):  
Rotator Cuff ◽  
Constant Score ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Assessment Score ◽  
Tendon Length ◽  
Complete Repair ◽  
Tear Size

Background: It is difficult to predict the arthroscopic reparability of rotator cuff tears preoperatively when the repair is challenging. This can result in unsatisfactory outcomes and a high retear rate. Purpose: To develop an assessment score reflecting factors in rotator cuff tears that can predict reparability before surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively enrolled 170 patients with rotator cuff tears larger than 2 cm who underwent arthroscopic repair. Patients were categorized into “complete repair” and “partial repair” groups based on the area of the exposed footprint after arthroscopic rotator cuff repair. In each group, preoperative magnetic resonance imaging factors (tear size, fatty infiltration, remnant tendon length, atrophy), clinical factors (range of motion, American Shoulder and Elbow Surgeons score, Constant score), and patient demographics were evaluated. Receiver operating characteristic curve analysis was used to choose the optimal cutoff value. A reparability assessment score was formulated through stepwise selection using variables that showed significant between-group differences on univariate analysis. We selected 4 variables and assigned a relative score for each variable based on estimated coefficient values. The sum of the scores for each factor ranged from 0 to 5. Results: The average rotator cuff tear size was 28 × 26 mm. The torn rotator cuff was repaired completely in 74 patients (43.5%) and partially in 96 patients (56.5%). The following factors were chosen for the reparability assessment score: positive tangent sign (odds ratio [OR], 5.969; P = .001), fatty infiltration of the infraspinatus of grade ≤2 (OR, 3.537; P = .001), coronal tear size ≥26 mm (OR, 3.315; P = .002), and remnant tendon length <15 mm (OR, 2.584; P = .017). Complete repair was possible if the sum of the scores was <3 (area under curve, 0.803; 95% CI, 0.739-0.867; sensitivity, 51.0%; specificity, 95.9%). Conclusion: In patients with a score of <3 on the novel reparability assessment score, complete repair was obtainable, whereas in patients with a score of ≥3, complete repair was difficult and other methods such as biologic grafts or arthroplasty had to be considered for a favorable prognosis.

The Effect of Tendon Delamination on Rotator Cuff Healing

2019 ◽  
Vol 47 (5) ◽  
pp. 1074-1081 ◽  
Author(s):  
Pascal Boileau ◽  
Olivier Andreani ◽  
Martin Schramm ◽  
Mohammed Baba ◽  
Hugo Barret ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Tendon Healing ◽  
Type A ◽  
Rotator Cuff Tears ◽  
Type B ◽  
Partial Coverage ◽  
Type C ◽  
Cuff Repair ◽  
Tear Size

Background: While patient age, tear size, and muscle fatty infiltration are factors known to affect the rate of tendon healing after rotator cuff repair, the effect of tendon delamination is less known. Purpose: To assess the effect of tendon delamination on rotator cuff healing after arthroscopic single-row (SR) repair. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients (N = 117) with chronic full-thickness rotator cuff tears underwent arthroscopic SR repair with the tension-band cuff repair. The mean ± SD age at the time of surgery was 60 ± 8 years. There were 25 small, 63 medium, and 29 large tears. Tendon delamination was assessed intraoperatively under arthroscopy with the arthroscope placed in the lateral portal. Patients were divided into 2 groups: those with nondelaminated (n = 80) and delaminated (n = 37) cuff tears. The 2 groups were comparable for age, sex, body mass index, preoperative pain, strength, and a Constant-Murley score. Repair integrity was evaluated with sonography (mean, 24 months after surgery; range, 6-62 months) and classified into 3 categories: type A, indicating complete, homogeneous, and thick coverage of the footprint; type B, partial coverage with a thin tendon; and type C, no coverage of the footprint. Results: The prevalence of tendon delamination observed under arthroscopy was 32% (37 of 117), which increased with tear size and retraction: from 15% in small tears to 32% in medium tears and 45% in large tears ( P = .028). Postoperatively, 83 patients had complete coverage of footprint (type A = 71%) and the cuff was considered healed, whereas 26 had partial coverage or a thin tendon (type B = 22%) and 8 had no coverage (type C = 7%). Overall, the rate of complete healing was 78% in nondelaminated cuff tears and 57% in the case of tendon delamination ( P = .029). In large retracted tears, the healing rate dropped from 81% in the absence of delamination to 39% when the tendons were delaminated ( P = .027). Conclusion: Tendon delamination increases with tear size and retraction. Patients with chronic delaminated and retracted rotator cuff tears (stage 2 or 3) are at risk of failure after SR cuff repair, whereas patients with small delaminated rotator cuff tears (stage 1) involving only the supraspinatus can be treated with an SR cuff repair with a high chance of tendon healing. These results suggest that SR cuff repair may be insufficient to treat delaminated chronic cuff tears. To improve the anatomic outcomes of rotator cuff repairs, surgeons should consider treating delaminated tears with a double-row or double-layer repair.

scholarly journals Non-Operative Management of Rotator Cuff Tears

2016 ◽  
Vol 10 (1) ◽  
pp. 349-356 ◽  
Author(s):  
M. Petri ◽  
M. Ettinger ◽  
S. Brand ◽  
T. Stuebig ◽  
C. Krettek ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Tendon Repair ◽  
Operative Management ◽  
Nonoperative Treatment ◽  
Rotator Cuff Tears ◽  
Patient Counseling ◽  
Non Operative Management ◽  
Tear Size ◽  
Over Time

Background: The role of nonoperative management for rotator cuff tears remains a matter of debate. Clinical results reported in the literature mainly consist of level IV studies, oftentimes combining a mixed bag of tear sizes and configurations, and are contradictory to some extent. Methods: A selective literature search was performed and personal surgical experiences are reported. Results: Most studies show an overall success rate of around 75% for nonoperative treatment. However, the majority of studies also present a progression of tear size and fatty muscle infiltration over time, with however debatable clinical relevance for the patient. Suggested factors associated with progression of a rotator cuff tear are an age of 60 years or older, full-thickness tears, and fatty infiltration of the rotator cuff muscles at the time of initial diagnosis. Conclusion: Non-operative management is indicated for patients with lower functional demands and moderate symptoms, and/or of course for those refusing to have surgery. Close routinely monitoring regarding development of tear size should be performed, especially in patients that remain symptomatic during nonoperative treatment. To ensure judicious patient counseling, it has to be taken into account that 1) tears that are initially graded as reparable may become irreparable over time, and 2) results after secondary surgical therapy after failed nonoperative treatment are usually reported to be inferior to those who underwent primary tendon repair.

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

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.

scholarly journals Preoperative Korean Shoulder Scoring System Correlates with Preoperative Factors of Rotator Cuff Tears

2018 ◽  
Vol 21 (1) ◽  
pp. 30-36
Author(s):  
Eun Yeol Kim ◽  
Byung Yoon Park ◽  
In Bo Kim
Keyword(s):  
Rotator Cuff ◽  
Old Age ◽  
Scoring System ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Type Iii ◽  
Group I ◽  
Group Ii ◽  
Tear Size ◽  
Preoperative Factors

BACKGROUND: The Korean Shoulder Scoring System (KSS) is a reliable and valid procedure for discriminative assessment of the clinical status of patients with rotator cuff tears. This study evaluates the correlation between the preoperative KSS and factors in patients with rotator cuff tears.METHODS: From November 2009 to June 2016, 970 patients who underwent arthroscopic rotator cuff repair were retrospectively evaluated. A total of 490 patients met the study criteria. Preoperative factors included age, sex, symptom duration, mediolateral (ML) and anteroposterior (AP) tear size, acromiohumeral distance (AHD), tangent sign, tendon involvement (type I, supraspinatus; type II, supraspinatus and subscapularis; type III, supraspinatus and infraspinatus; type IV, all 3 tendons), fatty infiltration of rotator cuff muscles (group I, Goutallier stages 0 and 1; group II, Goutallier stages 2, 3, and 4), and KSS.RESULTS: Old age, ML tear size, and AP tear size negatively correlated with the preoperative KSS (p < 0.001). AHD showed a positive correlation with the preoperative KSS (p < 0.001). A significantly inferior preoperative KSS was found in females and type III tendon involvement (p < 0.001). For supraspinatus and infraspinatus, the preoperative KSS of group II fatty infiltration showed a significantly lower score than group I fatty infiltration (p < 0.05).CONCLUSIONS: A relatively lower preoperative KSS was associated with old age, large tear size, narrow AHD, female, type III tendon involvement, and group II fatty infiltration of the supraspinatus and infraspinatus. Our study indicates that preoperative KSS can be a good measurement for the preoperative status of patients with rotator cuff tears.

scholarly journals The association between Interleukin-6 rs1800795/rs1800797 polymorphisms and risk of rotator cuff tear in a Chinese population

2020 ◽  
Vol 40 (4) ◽  
Author(s):  
Jin Li ◽  
Lifeng Jiang ◽  
Xindie Zhou ◽  
Lidong Wu ◽  
Dong Li ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Constant Score ◽  
Enzyme Linked Immunosorbent Assay ◽  
Mutant Genotype ◽  
Cuff Tear ◽  
Increased Risk ◽  
Polymerase Chain ◽  
Tear Size

Abstract Expression of proinflammatory cytokines, such as interleukin (IL)-6 (IL-6) and metalloproteases, are elevated in patients with rotator cuff tear (RCT). In order to investigate the role of IL-6 gene polymorphisms on RCT risk, we genotyped two SNPs on IL-6 gene (rs1800795 and rs1800797) in 138 RCT patients and 137 healthy controls using polymerase chain reaction (PCR) and Sanger sequencing. The IL-6 expression in shoulder joint synovial fluid was determined by using enzyme-linked immunosorbent assay (ELISA) method. The constant score and visual analog scale (VAS) were used to evaluate the clinical outcome of two s (surgicsal vs. conservative) for RCT patients. For rs1800795, individuals with the GG genotype or G allele had significantly higher risk of RCT. Elevated risk of tear size was associated with the GG genotype of the rs1800795 polymorphism. The IL-6 rs1800797 polymorphism was also associated with an increased risk of RCT, especially among female, drinkers, and individuals with B(MI) &lt; 25 kg/m2. The elevated levels of IL-6 gene were observed among the mutant genotype of rs1800795/rs1800797 polymorphism. Surgical group is significantly better than conservative treatment from the perspective of constant score and VAS. Furthermore, CG genotype of rs1800795 polymorphism increased the constant score at 6 months in comparison with CC genotype. In conclusion, our study supports a role of IL-6 rs1800795/rs1800797 polymorphisms on increased RCT risk. The RCT patients with CG genotype of rs1800795 polymorphism have more obvious surgical treatment effects by influencing the IL-6 expression.

scholarly journals Retear rates after rotator cuff surgery: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Umile Giuseppe Longo ◽  
Arianna Carnevale ◽  
Ilaria Piergentili ◽  
Alessandra Berton ◽  
Vincenzo Candela ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Meta Analysis ◽  
Fatty Infiltration ◽  
Surgical Techniques ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Factors Influencing ◽  
Main Factors ◽  
Tear Size

Abstract Background Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. Methods A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. Results Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). Conclusions Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

scholarly journals The Radiologic and Clinical Changes after Open Complete Repair of Massive Rotator Cuff Tears

2009 ◽  
Vol 12 (2) ◽  
pp. 109-114
Author(s):  
Eun-Sun Moon ◽  
Min-Sun Choi ◽  
Myung-Sun Kim ◽  
Il-Kyu Kong ◽  
Byoung-Jin Kim
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Complete Repair ◽  
Clinical Changes

scholarly journals Classification Systems in Rotator Cuff Tears

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Ram Chidambaram ◽  
Reet Mukhopadhyay
Keyword(s):  
Rotator Cuff ◽  
Review Article ◽  
Classification Systems ◽  
Rotator Cuff Tears ◽  
Rotator Cuff Tendon ◽  
Cuff Tear ◽  
Orthopedic Literature ◽  
Comprehensive Classification ◽  
Tear Size ◽  
Massive Tears

Rotator cuff pathology is one of the most common conditions affecting the shoulder joint. Several classification systems have been used to describe rotator cuff tears in orthopedic literature. However, no comprehensive classification inclusive of all types and characteristics currently exists. Rotator cuff tears are classified based on various parameters. These include: 1. Tear depth 2. Tear Size/Extent 3. Tear Retraction 4. Tendon Quality 5. Tear Progression 6. Arthroscopic Classification. This review article aims to establish an algorithm based on the various existing classification systems so as to arrive at the best surgical or non-surgical solution as well as prognosticate the patient regarding the outcome. Special consideration needs to be made for massive tears which are irreparable. Keywords: Rotator cuff tears; Rotator cuff tear classification; Massive irreparable rotator cuff tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.

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