scholarly journals Arthroscopic rotator cuff repair with and without subacromial decompression is safe and effective: a clinical study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Umile Giuseppe Longo ◽  
Stefano Petrillo ◽  
Vincenzo Candela ◽  
Giacomo Rizzello ◽  
Mattia Loppini ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Subacromial Decompression ◽  
Group A ◽  
Ucla Score ◽  
Decompression Procedure ◽  
Group B ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Shoulder Score

Abstract Background Subacromial decompression, that consists of the release of the coracoid-acromial ligament, subacromial bursectomy and anterior-inferior acromioplasty, has traditionally been performed in the management of this pathology. However, the purpose of subacromial decompression procedure is not clearly explained. Our reaserch aimed to analyse the differences among the outcomes of arthroscopic rotator cuff repair (RCR) made with suture anchors, with or without the subacromial decompression procedure. Methods 116 shoulders of 107 patients affected by rotator cuff (RC) tear were treated with Arthroscopic RCR. In 54 subjectes, the arthroscopic RCR and the subacromial decompression procedure (group A) were executed, whereas 53 took only arthroscopic RCR (group B). Clinical outcomes were evaluated through the use of the modified UCLA shoulder rating system, Wolfgang criteria shoulder score and Oxford shoulder score (OSS). Functional outcomes were assessed utilizing active and passive range of motion (ROM) of the shoulder, and muscle strength. The duration of the follow up and the configuration of the acromion were used to realize the comparison between the two groups. Results In patients with 2 to 5 year follow up, UCLA score resulted greater in group A patients. In subjectes with longer than five years of follow up, group B patients showed considerably greater UCLA score and OSS if related with group A patients. In subjectes that had the type II acromion, group B patients presented a significant greater strength in external rotation. Conclusion The long term clinical outcomes resulted significantly higher in patients treated only with RCR respect the ones in patients underwent to RCR with subacromial decompression.

scholarly journals The Effect of Acromioplasty or Bursectomy on the Results of Arthroscopic Repair of Full Thickness Rotator Cuff Tears: Does the Acromion Type Affect These Results?

2020 ◽  
Author(s):  
Ozgun Karakus ◽  
Ahmet Sinan Sari
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Subacromial Decompression ◽  
Significant Difference ◽  
Group A ◽  
Decompression Procedure ◽  
Group B ◽  
Cuff Repair

Abstract Introduction: The aim of this study was to investigate the effect of subacromial decompression on the results of full thickness rotator cuff repair applied arthroscopically. Examination was also made of the effect of acromion type on the subacromial decompression procedure in patients applied with arthroscopic rotator cuff repair. Materials and Methods: The study included a total of 150 patients, comprising 102 (68%) females and 48 (32%) males with a full thickness rotator cuff tear repaired arthroscopically. The patients were separated into 3 groups of 50. Group A comprised those with acromioplasty and bursectomy applied additional to the repair. In Group B, only bursectomy was performed additional to the repair and in Group C, only rotator cuff repair was applied. Evaluation was made of the postoperative long-term pain and functional results. Results: The mean age of the cases was 65.63±9.22 years (range, 46-86 years). The affected side was right side in 95 (63.3%) cases and left side in 55 (36.7%). No statistically significant difference was determined between the groups according to the postoperative Constant Murley and ASES scores (p>0.05). In the paired comparisons, the postoperative VAS scores of Group C were higher than those of Groups A and B (p=0.018, p=0.029, p<0.05). No statistically significant difference was determined between Group A and Group B in respect of the postoperative VAS scores (p>0.05). Conclusions: In the arthroscopic repair of full thickness rotator cuff tears, neither acromioplasty, coraco-acromial ligament loosening nor bursectomy were determined to have any positive effect on the results. Whatever the acromion type, there is no need for an additional subacromial decompression procedure after rotator cuff repair, in respect of pain and functional outcomes. Only acromial spurs should be gently removed paying attention to the coraco-acromial ligament.

scholarly journals Comparison of clinical outcome of decompression of suprascapular nerve at spinoglenoid notch for patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Pu Yang ◽  
Chen Wang ◽  
Dongfang Zhang ◽  
Yi Zhang ◽  
Tengbo Yu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Suprascapular Nerve ◽  
Cuff Tear ◽  
Suprascapular Neuropathy ◽  
Group A ◽  
Group B ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Spinoglenoid Notch

Abstract Purpose In the present study, we aimed to determine whether decompression of suprascapular nerve (SSN) at the spinoglenoid notch could lead to a better functional outcome for the patients who underwent repairment of rotator cuff due to posterosupeior massive rotator cuff tear (MRCT) and suprascapular neuropathy. Methods A total of 20 patients with posterosuperior MRCT and suprascapular neuropathy were analyzed in the present work. The preoperative magnetic resonance imaging (MRI) showed rotator cuff tear in supraspinatus and infraspinatus. All patients underwent arthroscopic rotator cuff repair. Patients were divided into two groups (group A: non-releasing, group B: releasing) according to whether the SSN at the spinoglenoid notch was decompressed. The modified University of California at Los Angeles shoulder rating scale (UCLA) and visual analog scale (VAS) questionnaire were adopted to assess the function of the affected shoulder preoperatively and 12 months after the operation. Electromyography (EMG) and nerve conduction study (NCS) were used to evaluate the nerve condition. Patients underwent MRI and EMG/NCS at 6 months after operation and last follow-up. Results All patients were satisfied with the treatment. MRI showed that it was well-healed in 19 patients at 6 months after the operation. However, the fatty infiltration of supraspinatus and infraspinatus was not reversed. Only one patient in the non-releasing group showed the retear. The retear rate of group A and group B were 30% (3/10) and 20% (2/10) respectively at 12 months after the operation. One patient undergoing SSN decompression complained of discomfort in the infraspinatus area. His follow-up EMG after 6 months showed fibrillation potentials (1+) and positive sharp waves (1+) in the infraspinatus. The other patients’ EMG results showed no abnormality. The postoperative UCLA and VAS scores were improved in both groups, and there was no significant difference in the follow-up outcomes between the two groups. Conclusions Patients with postersuperior MRCT and suprascapular neuropathy, decompression of suprascapular nerve at spinoglenoid notch didn’t lead to a better functional outcome with the repairment of rotator cuff. Arthroscopic rotator cuff repair could reverse the suprascapular neuropathy. Level of evidence Level III.

Arthroscopic Rotator Cuff Repair Using Modified Mason-Allen Medial Row Stitch

2012 ◽  
Vol 40 (11) ◽  
pp. 2440-2447 ◽  
Author(s):  
Yong Girl Rhee ◽  
Nam Su Cho ◽  
Chong Suck Parke
Keyword(s):  
Rotator Cuff ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Knot Tying ◽  
Suture Bridge ◽  
Group A ◽  
Group B ◽  
Arthroscopic Rotator Cuff ◽  
Suture Bridge Technique

Background: When using a method of suture bridge technique, there may be a possibility of strangulation of the rotator cuff tendon at the medial row. The style of knots chosen to secure the medial row might conceivably be a factor to reduce this possibility. Purpose: To compare the clinical results and repair integrity of arthroscopic rotator cuff repair between a knotless and a conventional knot-tying suture bridge technique for patients with full-thickness rotator cuff tears and to evaluate retear patterns in the cases with structural failure after arthroscopic repair by magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 2. Methods: After arthroscopic repair for medium-sized rotator cuff tears, 110 patients available for postoperative MRI evaluation at least 6 months were enrolled in this study. According to the repair technique, 51 shoulders were enrolled in a knotless suture bridge technique group (group A) and 59 shoulders in a conventional knot-tying suture bridge technique group (group B). The mean age at the time of the operation was 61.0 years (range, 44-68 years) in group A and 57.6 years (range, 45-70 years) in group B. The mean follow-up period was 21.2 months (range, 12-34 months) and 22.1 months (range, 13-32 months), respectively. Results: The Constant score of group A increased from the preoperative mean of 65.2 points to 79.1 points at the last follow-up ( P < .001). The corresponding figures for group B improved from 66.6 points to 76.3 points ( P < .001). The preoperative Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score was 21.1 points in group A and 18.3 points in group B. The UCLA score at the last follow-up was 31.0 points in group A and 27.9 points in group B ( P < .001, P < .001). Retear rate was significantly lower in group A (5.9%) than group B (18.6%) ( P < .001). In group B, retear occurred at the musculotendinous junction in 72.7%, but group A had no medial cuff failure. Conclusion: In arthroscopic suture bridge repair of full-thickness rotator cuff tears, clinical results of both a knotless and a conventional knot-tying group showed improvement without significant difference between the 2 groups. However, the knotless group had a significantly lower retear rate compared with the conventional knot-tying group. A knotless suture bridge technique could be a new supplementary repair technique to conventional technique.

Postoperative Outcomes of Single-Stage Versus Staged Bilateral Rotator Cuff Repair in Patients with Bilateral Rotator Cuff Tear: A Retrospective Study

2021 ◽  
Author(s):  
Chen Wang ◽  
Pu Yang ◽  
Dongfang Zhang ◽  
In-Ho Jeon ◽  
Tengbo Yu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Single Stage ◽  
Arthroscopic Rotator Cuff Repair ◽  
Vas Score ◽  
Ucla Score ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Background: In the present study, we aimed to compare the clinical outcomes of patients who underwent single-stage or staged bilateral arthroscopic rotator cuff repair.Methods: From March 2013 to May 2018, a retrospective review on all patients who underwent bilateral arthroscopic rotator cuff repair at our department was performed. There were 24 patients in the single-stage group and 27 patients in the staged group. The minimum follow-up period was 2 years. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, Constant-Murley (Constant) score, and the range of motion (ROM) of the shoulder were evaluated for comparison between the two groups before and after the operation. Moreover, the hospitalization costs in the two groups were also recorded.Results: All 51 patients were available throughout follow-up. There was no significant difference in the VAS score (P=0.424), ASES score (P=0.325), UCLA score (P=0.170), and Constant score (P=0.275) between the single-stage group and the staged group before the operation. Postoperative clinical scores were significantly improved in both groups. The VAS score, ASES score, UCLA score, and Constant score were significantly different between the two groups at 6 months postoperatively (P<0.05). At 12, 18, and 24 months after the operation, the VAS score, UCLA score, Constant score, and ASES score were not significantly different between the two groups. At follow-up, the ROM of the shoulder was not significantly different between the two groups. Besides, there was a significant difference in hospitalization costs between the two groups (P<0.05). Furthermore, there was no significant difference in the VAS score, UCLA score, Constant score, ASES score, and ROM between the first surgery and second surgery in the single-stage group postoperatively.Conclusion: Patients receiving single-stage or staged bilateral arthroscopic rotator cuff repair showed similarly good clinical outcomes at follow-up. Moreover, good outcomes were observed on both sides of the single-stage group.

All-Suture Anchor Settling After Arthroscopic Repair of Small and Medium Rotator Cuff Tears

2019 ◽  
Vol 47 (14) ◽  
pp. 3483-3490
Author(s):  
Kyunghan Ro ◽  
Sung-Min Rhee ◽  
Jung Youn Kim ◽  
Myung Seo Kim ◽  
Jong Dae Kim ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Suture Anchor ◽  
Rotator Cuff Tears ◽  
Suture Anchors ◽  
Rotator Cuff Tendon ◽  
Group A ◽  
Group B ◽  
Cuff Repair

Background: All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors. Purpose: To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm2; n = 31), group B (BMD, 0.4-0.6 g/cm2; n = 32), and group C (BMD, >0.6 g/cm2; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21). Results: On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) ( P = .001). The DA was deeper in patients with a higher BMD at time zero ( r = 0.374; P = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA ( r = 0.769; P < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) ( P = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) ( P = .550). Conclusion: In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.

Effects of Anxiety and Depression Measured via the Hospital Anxiety and Depression Scale on Early Pain and Range of Motion After Rotator Cuff Repair

2021 ◽  
Vol 49 (2) ◽  
pp. 314-320
Author(s):  
Joo Hyun Park ◽  
Sung-Min Rhee ◽  
Hyong Suk Kim ◽  
Joo Han Oh
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Preoperative Anxiety ◽  
Arthroscopic Rotator Cuff Repair ◽  
Psychological Status ◽  
Anxiety And Depression ◽  
Group B ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Preoperative anxiety and depression are independent predictors of clinical outcomes after arthroscopic rotator cuff repair. However, few studies have evaluated correlations between outcomes such as pain and range of motion (ROM) after arthroscopic rotator cuff repair and preoperative anxiety and depression. Purpose: To evaluate the effects of preoperative anxiety and depression, measured using the Hospital Anxiety and Depression Scale (HADS), on early pain and ROM after rotator cuff repair. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 144 consecutive patients who underwent arthroscopic rotator cuff repair were enrolled and divided into 2 groups according to HADS scores: group A, those with a healthy psychological status (n = 103; anxiety ≤7 and depression ≤7), and group B, those with psychological distress (n = 41; anxiety ≥8 or depression ≥8). Clinical outcomes were assessed using the visual analog scale for pain (pVAS) and ROM at 3 and 6 months postoperatively and annually. Results: There were no significant preoperative differences in age, sex, tear size, pVAS scores, and ROM. However, at 3 months postoperatively, group A showed significantly lower mean pVAS scores (2.2 ± 1.3 vs 3.4 ± 1.8, respectively; P = .001) and significantly higher mean forward flexion (146.4°± 23.0° vs 124.1°± 28.2°, respectively; P < .001) than group B, as well as significantly higher mean levels of internal rotation at the back (T11.5 ± 2.8 vs L1.9 ± 2.5, respectively; P < .001) and significantly higher mean external rotation (42.4°± 15.9° vs 35.2°± 16.8°, respectively; P = .019). At 6 months postoperatively, the mean pVAS score was still significantly lower in group A than in group B (0.8 ± 1.6 vs 1.8 ± 2.1, respectively; P = .016), but other ROM measurements had no significant differences. There was also no significant difference in clinical and functional outcomes at the final follow-up. Conclusion: Anxiety and depression negatively affected clinical outcomes after rotator cuff repair. Recovery from pain and of ROM after arthroscopic rotator cuff repair occurred more quickly in patients with a healthy psychological status. Therefore, assessments of preoperative psychological status should be emphasized to improve early clinical outcomes after arthroscopic rotator cuff repair.

scholarly journals Surgeon-operated ultrasonography in a one-stop shoulder clinic

2011 ◽  
Vol 93 (7) ◽  
pp. 528-531 ◽  
Author(s):  
R Seagger ◽  
T Bunker ◽  
P Hamer
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Rotator Cuff Tears ◽  
Financial Cost ◽  
Time Saving ◽  
One Stop ◽  
Group A ◽  
Group B ◽  
Portable Ultrasonography

INTRODUCTION Nearly 1 in 40 of the population seeks medical advice related to a shoulder problem every year. The majority pertain to rotator cuff pathology. Prior to intervention in such patients it is imperative to define whether the tendons are intact or torn. Ultrasonography has become an essential adjunct to clinical assessment in diagnosing rotator cuff tears. This study was designed to investigate if a surgeon using a portable ultrasonography machine in a one-stop shoulder clinic could significantly reduce the time a patient waited from initial outpatient presentation to the end of the treatment episode (be it surgery, injection or conservative management). METHODS A total of 77 patients were allocated to one of two groups: Group A, consisting of 37 patients who were assessed and had ultrasonography as outpatients, and Group B, consisting of 40 patients who were assessed and referred for departmental ultrasonography where appropriate. Three clear outcome groups were defined: those who required surgical repair, those who had irreparable tears and those who declined surgery. RESULTS For all outcomes (surgery, irreparable tears and conservative treatment), the patients in Group A all completed their clinical episodes significantly quicker than those in Group B (p<0.02). As well as the time saving benefits, there was a substantial financial saving for Group A. By performing ultrasonography in the outpatients department, those patients avoided the requirement of departmental imaging (£120) and subsequent follow-up appointments (£73) to discuss results and management, resulting in a saving of nearly £200 per patient. CONCLUSIONS The use of a portable ultrasonography machine by an orthopaedic surgeon can significantly reduce the time to treatment and the financial cost for patients with rotator cuff tears.

Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up

2011 ◽  
Vol 20 (4) ◽  
pp. 518-528 ◽  
Author(s):  
Pietro Randelli ◽  
Paolo Arrigoni ◽  
Vincenza Ragone ◽  
Alberto Aliprandi ◽  
Paolo Cabitza
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Platelet Rich Plasma ◽  
Arthroscopic Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair
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