scholarly journals The association between acromial anatomy and articular-sided partial thickness of rotator cuff tears

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cen Tao Liu ◽  
Jia Qing Miao ◽  
Hua Wang ◽  
Heng an Ge ◽  
Xian Hui Wang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Pearson Correlation ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Partial Thickness ◽  
History Of ◽  
Mri Diagnosis ◽  
Magnetic Resonance Imaging Mri ◽  
Acromiohumeral Distance ◽  
The Relationship

Abstract Background Acromial anatomy has been found to be correlated with degenerative full-thickness rotator cuff tears in current studies. However, research on the relationship between acromial anatomy and articular-sided partial thickness of rotator cuff tears (PTRCTs) is still lacking. The purpose of this study was to evaluate whether these imaging graphic parameters exhibit any association between acromial anatomy and degenerative articular-sided PTRCTs. Methods Between January 2016 and December 2018, a total of 91 patients without a history of trauma underwent arthroscopy as an articular-sided PTRCT group. In the control group, with age- and sex-matched patients, we selected 91 consecutive outpatient patients who underwent shoulder magnetic resonance imaging (MRI) because of shoulder pain and an MRI diagnosis of only synovial hyperplasia and effusion. MRI was used to measure the acromial type, acromiohumeral distance (AHD), lateral acromial angle (LAA), acromion index (AI), and critical shoulder angle (CSA) by 2 independent observers. Results The acromion type, AHD and LAA showed no difference between degenerative articular-sided PTRCTs and controls (P = 0.532, 0.277, and 0.108, respectively). AI and CSA were significantly higher in degenerative articular-sided PTRCTs (P = 0.002 and 0.003, respectively). A good correlation was found between AI and CSA to measurement(Pearson correlation coefficient = 0.631). Conclusions Our study revealed that higher AI and CSA were found in degenerative articular-sided PTRCTs. Acromial anatomy with a large acromial extension was associated with the occurrence of degenerative articular-sided PTRCTs.

scholarly journals Supraspinatus-to-Glenoid Contact Occurs During Standardized Overhead Reaching Motion

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110369
Author(s):  
Gaura Saini ◽  
Rebekah L. Lawrence ◽  
Justin L. Staker ◽  
Jonathan P. Braman ◽  
Paula M. Ludewig
Keyword(s):  
Rotator Cuff ◽  
Pearson Correlation ◽  
Supraspinatus Tendon ◽  
Contact Angles ◽  
Magnetic Resonance Images ◽  
Rotator Cuff Tears ◽  
Internal Impingement ◽  
Glenoid Morphology ◽  
Minimum Distances ◽  
The Relationship

Background: Rotator cuff tears may result from repeated mechanical deformation of the cuff tendons, and internal impingement of the supraspinatus tendon against the glenoid is one such proposed mechanism of deformation. Purpose: To (1) describe the changing proximity of the supraspinatus tendon to the glenoid during a simulated overhead reaching task and (2) determine the relationship between scapular morphology and this proximity. Additionally, the patterns of supraspinatus-to-glenoid proximity were compared with previously described patterns of supraspinatus-to-coracoacromial arch proximity. Study Design: Descriptive laboratory study. Methods: Shoulder models were created from magnetic resonance images of 20 participants. Standardized kinematics were imposed on the models to simulate functional reaching, and the minimum distances between the supraspinatus tendon and the glenoid and the supraspinatus footprint and the glenoid were calculated every 5° between 0° and 150° of humerothoracic elevation. The angle at which contact between the supraspinatus and the glenoid occurred was documented. Additionally, the relationship between glenoid morphology (version and inclination) and the contact angle was evaluated. Descriptive statistics were calculated for the minimum distances, and glenoid morphology was assessed using Pearson correlation coefficients and simple linear regressions. Results: The minimum distances between the tendon and the glenoid and between the footprint and the glenoid decreased as elevation increased. Contact between the tendon and the glenoid occurred in all participant models at a mean elevation of 123° ± 10°. Contact between the footprint and the glenoid occurred in 13 of 20 models at a mean of 139° ± 10°. Less glenoid retroversion was associated with lower tendon-to-glenoid contact angles ( r = –0.76; R 2 = 0.58; P < .01). Conclusion: This study found that the supraspinatus tendon progressively approximated the glenoid during simulated overhead reaching. Additionally, all participant models eventually made contact with the glenoid by 150° of humerothoracic elevation, although anatomic factors influenced the precise angle at which contact occurred. Clinical Relevance: Contact between the supraspinatus and the glenoid may occur frequently within the range of elevation required for overhead activities. Therefore, internal impingement may be a prevalent mechanism for rotator cuff deformation that could contribute to cuff pathology.

Partial-Thickness Rotator Cuff Tears

2005 ◽  
Vol 33 (9) ◽  
pp. 1405-1417 ◽  
Author(s):  
Matthew J. Matava ◽  
Derek B. Purcell ◽  
Jonas R. Rudzki
Keyword(s):  
Rotator Cuff ◽  
Natural History ◽  
Diagnostic Techniques ◽  
Relative Accuracy ◽  
Diagnostic Methods ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Operative Repair ◽  
Partial Thickness ◽  
History Of

Partial-thickness tears of the rotator cuff have been diagnosed with increased frequency because of a heightened awareness of the condition by clinicians and improved diagnostic methods. Research into the causes, natural history, and optimal treatment of this condition lags behind that of full-thickness tears. However, despite the limitations in the existing literature, there has emerged a consensus among shoulder experts that partial-thickness rotator cuff tears should be aggressively treated in the active athlete because of the unfavorable natural history of these lesions and success of accepted surgical algorithms. This review will provide an overview of the theories regarding the origins of partial-thickness rotator cuff tears, discuss the relative accuracy of accepted diagnostic techniques, and summarize the indications and methods of operative repair with an emphasis on the results of various treatment approaches.

scholarly journals Association Between Rotator Cuff Tears and Superior Migration of the Humeral Head: An MRI-Based Anatomic Study

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110098
Author(s):  
Matthew Y. Siow ◽  
Brendon C. Mitchell ◽  
Michael Hachadorian ◽  
Wilbur Wang ◽  
Tracey Bastrom ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Inclusion Criteria ◽  
Rotator Cuff Disease ◽  
Level Of Evidence ◽  
Shoulder Mri ◽  
Magnetic Resonance Imaging Mri ◽  
The Relationship

Background: Superior humeral migration has been established as a component of rotator cuff disease, as it disrupts normal glenohumeral kinematics. Decreased acromiohumeral interval (AHI) as measured on radiographs has been used to indicate rotator cuff tendinopathy. Currently, the data are mixed regarding the specific rotator cuff pathology that contributes the most to humeral head migration. Purpose: To determine the relationship between severity of rotator cuff tears (RCTs) and AHI via a large sample of magnetic resonance imaging (MRI) shoulder examinations. Study Design: Cohort study; Level of evidence, 3. Methods: A search was performed for 3-T shoulder MRI performed in adults for any indication between January 2010 and June 2019 at a single institution. Three orthopaedic surgeons and 1 musculoskeletal radiologist measured AHI on 2 separate occasions for patients who met the inclusion criteria. Rotator cuff pathologies were recorded from imaging reports made by fellowship-trained musculoskeletal radiologists. Results: A total of 257 patients (mean age, 52 years) met the inclusion criteria. Of these, 199 (77%) had at least 1 RCT, involving the supraspinatus in 174 (67.7%), infraspinatus in 119 (46.3%), subscapularis in 80 (31.1%), and teres minor in 3 (0.1%). Full-thickness tears of the supraspinatus, infraspinatus, or subscapularis tendon were associated with significantly decreased AHI (7.1, 5.3, and 6.8 mm, respectively) compared with other tear severities ( P < .001). Having a larger number of RCTs was also associated with decreased AHI (ρ = –0.157; P = .012). Isolated infraspinatus tears had the lowest AHI (7.7 mm), which was significantly lower than isolated supraspinatus tears (8.9 mm; P = .047). Conclusion: Although various types of RCTs have been associated with superior humeral head migration, this study demonstrated a significant correlation between a complete RCT and superior humeral migration. Tears of the infraspinatus tendon seemed to have the greatest effect on maintaining the native position of the humeral head. Further studies are needed to determine whether early repair of these tears can slow the progression of rotator cuff disease.

Is There a Decrease in the Acromiohumeral Distance Among Recreational Overhead Athletes With Rotator Cuff–Related Shoulder Pain?

2020 ◽  
pp. 1-7
Author(s):  
Fábio Carlos Lucas de Oliveira ◽  
Amanda L. Ager ◽  
Jean-Sébastien Roy
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Pearson Correlation ◽  
Functional Limitations ◽  
Shoulder Injuries ◽  
Overhead Athletes ◽  
Recreational Athletes ◽  
Shoulder Condition ◽  
Acromiohumeral Distance ◽  
The Relationship

Context: Recreational overhead athletes are exposed to high overload, which increases the risk of shoulder injuries. Reduction of the acromiohumeral distance (AHD) is often associated with rotator cuff–related shoulder pain (RCRSP) among the general population. However, the AHD of symptomatic shoulders of recreational athletes has not yet been compared with their asymptomatic shoulders. Objective: To compare the AHD of a symptomatic to asymptomatic shoulder at rest (0°) and 60° abduction. To establish the relationship between AHD, pain, and functional limitations of recreational athletes with RCRSP. Design: Cross-sectional study. Setting: University laboratory. Participants: A total of 45 recreational overhead athletes with RCRSP were examined. Main Outcome Measures: The AHD was measured by ultrasonography at 0° and 60° abduction (angles). Shoulder pain was assessed using a numeric pain scale, whereas functional limitations were assessed using the The Disabilities of the Arm, Shoulder, and Hand questionnaire. Differences in the between-shoulders condition (symptomatic and asymptomatic) were determined using 2-way analysis of variance for repeated measures. A Pearson correlation established the relationship between AHD, pain, and functional limitations. Results: No angles × shoulder condition interactions (P = .776) nor shoulder condition effects (P = .087) were detected, suggesting no significant differences (P > .05) between asymptomatic and symptomatic shoulders in the AHD at 0° or 60°. The AHD at 60° reduced significantly compared with 0° (3.05 [1.36] mm [2.77–3.33], angle effects: P < .001). The AHD at 0° and 60° was not correlated with pain or functional limitations (−.205 ≤ r ≤ .210, .167 ≤ P ≤ .585). Conclusions: The AHD of recreational athletes is not decreased in symptomatic shoulders compared with asymptomatic shoulders. Reduction of the AHD in symptomatic shoulders is not associated with an increase in pain or functional limitations of recreational athletes with RCRSP.

scholarly journals Partial Thickness Rotator Cuff Tears: Current Concepts

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Graeme Matthewson ◽  
Cara J. Beach ◽  
Atiba A. Nelson ◽  
Jarret M. Woodmass ◽  
Yohei Ono ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Surgical Techniques ◽  
Rotator Cuff Tears ◽  
Nonsurgical Management ◽  
Partial Thickness ◽  
High Prevalence ◽  
History Of ◽  
Cuff Repair ◽  
Repair Techniques

Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized.

Arthroscopic Superior Capsular Reconstruction With Mesh Augmentation for the Treatment of Irreparable Rotator Cuff Tears: A Comparative Study of Surgical Outcomes

2020 ◽  
Vol 48 (13) ◽  
pp. 3328-3338
Author(s):  
Erica Kholinne ◽  
Jae-Man Kwak ◽  
Hyojune Kim ◽  
Kyoung Hwan Koh ◽  
In-Ho Jeon
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Mesh Group ◽  
Superior Capsular Reconstruction ◽  
Mesh Augmentation ◽  
Acromiohumeral Distance

Background: Arthroscopic superior capsular reconstruction (ASCR) is an alternative to open surgery for irreparable chronic rotator cuff tears (RCTs). This approach can provide static restraint while avoiding upward migration of the humeral head. However, graft tears and their effect on clinical outcomes after ASCR remain a debated topic. Purpose: To evaluate the clinical outcomes of ASCR with mesh augmentation for the treatment of irreparable RCTs. Study Design: Cohort study; Level of evidence, 3. Methods: The data of 72 patients with irreparable RCTs who underwent ASCR between 2013 and 2018 were retrospectively evaluated. Among them, 64 patients who met the inclusion and exclusion criteria were enrolled in this study. Fascia lata grafts augmented with a polypropylene mesh were used for 30 patients (mesh group), and grafts without mesh augmentation were used for 34 patients (control group). Clinical outcomes were evaluated using range of motion, the American Shoulder and Elbow Surgeons (ASES) questionnaire, and visual analog scale for pain. Radiological outcomes were evaluated according to acromiohumeral distance and stage of rotator cuff arthropathy. The status of fatty infiltration and graft integrity was evaluated using magnetic resonance imaging. Outcomes were assessed preoperatively and at the final follow-up. Results: Both groups showed improvement in clinical and radiological outcomes at the final follow-up. The mesh group demonstrated a larger improvement in ASES score (mean ± SD, 29.1 ± 15.8) than the control group (18.1 ± 15.9) ( P = .006). The mean improvement in active forward flexion was significantly higher in mesh group (40°± 26°) than in control group (28°± 23°) ( P = .003). The mean improvement in active external rotation was also significantly higher in the mesh group (11°± 5°) than in the control group (6°± 3°) ( P = .004). Graft healing rate was significantly higher in the mesh group (83.3%) than in the control group (58.8%) ( P = .039), and acromiohumeral distance was significantly greater in the mesh group (9.1 ± 2.4 mm) than in the control group (6.3 ± 1.8 mm) at the final follow-up ( P = .001). Subgroup analysis revealed that patients with graft failure generally showed progression of fatty infiltration without improvement in the stage of rotator cuff arthropathy. Patients with intact grafts demonstrated a more substantial improvement in functional outcomes (ASES score and forward flexion motion). Conclusion: ASCR with mesh augmentation reduced graft failure rate to restore superior shoulder joint stability.

Integrity of the Untorn Articular-Sided Tendon in Bursal-Sided Partial-Thickness Rotator Cuff Tear: A Comparative Study of Apoptotic Activity in Torn and Untorn Layers

2018 ◽  
Vol 46 (10) ◽  
pp. 2478-2485 ◽  
Author(s):  
Hyo Yang ◽  
Hyo-Jin Lee ◽  
Yun-Gyoung Lee ◽  
Jang-Woon Kim ◽  
Yang-Soo Kim
Keyword(s):  
Gene Expression ◽  
Rotator Cuff ◽  
Caspase 3 ◽  
Rotator Cuff Tears ◽  
Terminal Deoxynucleotidyl Transferase ◽  
Histological Evaluation ◽  
Control Group ◽  
Tunel Staining ◽  
Apoptotic Gene ◽  
Partial Thickness

Background: Conversion to full-thickness tear in partial-thickness rotator cuff tears (PTRCTs) is based on the quality and thickness of the normal-looking untorn rotator cuff layer. However, whether the untorn tendon is a healthy tissue remains to be elucidated. Purpose: To compare the apoptotic gene expression of the untorn articular layer with the torn bursal layer in PTRCTs. Study Design: Controlled laboratory study. Methods: Tendon tissues were harvested from 20 patients undergoing arthroscopic surgery for partial-thickness rotator cuff repair. As a control group, the tissues were harvested during intramedullary nail fixation in 10 proximal humeral fractures. In the experimental group, the samples were harvested from 2 sites: the torn bursal-sided tendon and the untorn articular-sided tendon. Hematoxylin and eosin (H&E) staining was conducted for basic histological evaluation, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining was used to detect apoptosis of tissue cells. The expression of caspase 3, 8, and 9 was confirmed immunohistochemically. Western blot analysis was used to assay the caspase activities. Results: In H&E staining, the direction of collagen bundles in untorn tendon was disoriented when compared with those of control tendon. However, the shape of the nuclei was not different, although the nuclei of the untorn tendon showed apoptosis in the TUNEL staining similar to those of the torn tendon. The immunohistochemical staining of caspase 3, 8, and 9 was increased concomitantly in untorn and torn tendons. All of the caspase activities in the untorn articular layer and torn bursal layer were significantly higher than in controls ( P < .05). However, no significant differences were found between the two layers ( P > .05). Conclusion: The study demonstrates that apoptotic gene expression is increased not only in the torn bursal layer but also in the untorn articular layer of PTRCTs. Clinical Relevance: The untorn articular layer of PTRCTs is abnormal, which triggers postoperative pain and further rotator cuff tears. Therefore, treatment of the abnormal untorn articular layer is essential in bursal-sided PTRCTs.

Tear Completion Versus In Situ Repair for 50% Partial-Thickness Bursal-Side Rotator Cuff Tears: A Biomechanical and Histological Study in an Animal Model

2020 ◽  
Vol 48 (8) ◽  
pp. 1818-1825
Author(s):  
Anil Pulatkan ◽  
Wasim Anwar ◽  
Omer Ayık ◽  
Ergun Bozdag ◽  
Ayse Nur Yildirim ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Bone Healing ◽  
Histological Study ◽  
Rabbit Model ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Mean Values ◽  
Partial Thickness ◽  
In Situ Repair

Background: Tear completion followed by repair (TCR) and in situ repair (ISR) have been widely used for bursal-side partial-thickness rotator cuff tears (PTRCTs). Both techniques have shown favorable results; however, controversy continues in terms of the best management. Purpose: To compare the histological and biomechanical outcomes of these 2 techniques for 50% partial-thickness bursal-side rotator cuff tear repair in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 27 rabbits were used in this experimental study. Seven rabbits were sacrificed at the beginning of the study to form an intact tendon control group. A chronic 50% partial-thickness bursal-side tear model was created in 20 rabbits, and 5 rabbits were sacrificed for biomechanical testing of chronic partial-thickness tears (control group) without repair. In 15 rabbits, partial-thickness tears were repaired after 8 weeks. Partial-thickness tears in the right shoulders were completed to full thickness and repaired; in contrast, left shoulders were repaired in situ. All rabbits were euthanized 8 weeks after the repair. The tendons were tested biomechanically for ultimate failure, linear stiffness, and displacement. Histological evaluations of tendon-to-bone healing were performed via the modified Watkins score. Results: Macroscopically, all repaired tendons were attached to the greater tuberosity. The TCR group had a higher failure load than the ISR group, with mean values of 140.4 ± 13.8 N and 108.1 ± 16.6 N, respectively ( P = .001). The modified Watkins score was significantly higher in the TCR group (23.5; range, 22-27) than in the ISR group (19.5; range, 16-22) ( P = .009). Conclusion: Both repair techniques are effective for 50% partial-thickness bursal-side rotator cuff tears; however, TCR yields significantly superior biomechanical and histological characteristics compared with ISR. Clinical Relevance: Tear completion and repair technique may increase tendon-to-bone healing and thereby reduce re-rupture rate in the partial thickness bursal side rotator cuff tears.

Accuracy of Rotator Cuff Tears and Tendinosis Diagnoses on Shoulder Ultrasound Performed by a Short-experienced Operator

2018 ◽  
Vol 1 ◽  
pp. 9
Author(s):  
Harshad Arvind Vanjare ◽  
Jyoti Panwar
Keyword(s):  
Rotator Cuff ◽  
Negative Predictive Value ◽  
Rotator Cuff Tear ◽  
Predictive Value ◽  
Rotator Cuff Tears ◽  
Mri Findings ◽  
Cuff Tear ◽  
Experienced Operator ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Objective The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

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