Early repair of trauma-related full-thickness rotator cuff tears does not eliminate the problem of healing failure

2019 ◽  
Vol 101-B (5) ◽  
pp. 603-609 ◽  
Author(s):  
K. E. Aagaard ◽  
K. Lunsjö ◽  
R. Frobell
Keyword(s):  
Rotator Cuff ◽  
Structural Integrity ◽  
Prospective Trial ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Mr Images ◽  
Early Repair ◽  
Western Ontario Rotator Cuff ◽  
One Year ◽  
Eq Vas

Aims Failure of healing is a well-known problem after repair of the rotator cuff. This study aimed to investigate if early repair of trauma-related full-thickness rotator cuff tears (FTRCTs) could prevent this failure. Patients and Methods In this prospective trial, 62 consecutive patients (14 women (23%), 48 men (77%); median age 61 years (interquartile range (IQR) 54 to 65)) with trauma-related FTRCT underwent arthroscopic single-row repair within six weeks of trauma. Tendon integrity was assessed one year after surgery using the Sugaya score on MR images. Patients were followed up with Western Ontario Rotator Cuff (WORC) index, EuroQol visual analogue scale (EQ VAS), and the Constant–Murley score (CS) two years after repair. Results A total of 57 patients (92%) had MR images available at one year; 59 patients (95%) had CS (one year), WORC (two years), and EQ VAS scores (two years). Intact repair was found on MRI in 36 patients (63%); 13 patients (23%) displayed healing failure of at least one repaired tendon and eight patients (14%) displayed total healing failure. Median WORC index and relative CS improved from 30.8 points (IQR 20.1 to 38.6) at baseline to 85.0 points (IQR 60.6 to 95.7) at two years and 26.5 points (IQR 21.2 to 37.4) to 83.2 points (IQR 71.9 to 97.5) at one year, respectively. The relative CS at one year was significantly better among those with intact repairs compared with those with healing failure (91.6 vs 78.1 points; p = 0.031). Conclusion Although early repair of trauma-related FTRCT improved patient relevant outcomes over two years for the entire cohort, only two out of three repaired rotator cuffs displayed intact structural integrity on MRI after one year. Consequently, early repair did not seem to prevent healing failure after trauma-related FTRCT. Cite this article: Bone Joint J 2019;101-B:603–609.

scholarly journals Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ignacio Carbonel ◽  
Angel A. Martínez ◽  
Elisa Aldea ◽  
Jorge Ripalda ◽  
Antonio Herrera
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Functional Outcome ◽  
Rotator Cuff Repair ◽  
Structural Integrity ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Double Row ◽  
Massive Rotator Cuff Tears ◽  
Cuff Repair

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears.Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair.Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear.Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

scholarly journals Arthroscopic Repair of Rotator Cuff Tears by Human Dermal Allograft Reconstruction vs Maximal Repair

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0033
Author(s):  
Jian Xu ◽  
Anjaneyulu Purnachandra Tejasw Ravipati ◽  
John-Paul King ◽  
Catherine Coady ◽  
Ivan Wong
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Structural Integrity ◽  
Rating Scale ◽  
Rotator Cuff Tears ◽  
X Rays ◽  
Western Ontario Rotator Cuff ◽  
Patient Reported ◽  
Repair Group ◽  
Reconstruction Group

Objectives: To determine healing rate of rotator cuff reconstruction with an acellular human dermal allograft compared with the gold standard arthroscopic maximal rotator cuff repair of large, chronic tears of the rotator cuff. Methods: Thirty patients with a two-tendon chronic retracted rotator cuff tear were enrolled in the study and were randomly allocated (15) to each group. All the patients were evaluated for structural integrity of repair using a 1.5T MRI at an average of 15 months after surgery. Rotator cuff arthropathy (RCA) and acromio-humeral distance (AHD) were graded using X-rays. Western Ontario Rotator Cuff (WORC), Disabilities of the Arm, Shoulder, and Hand (DASH), Marx Activity Rating Scale (MARX) scores, range of motion (ROM) of shoulder were analyzed. Results: The re-tear rate in the reconstruction group was 13% (2 of 15 patients) compared to 73% (11/15) in the repair group (p=0.008). Progression of RCA was seen in 7% (1/15) and 35.71% (5/15) of patients in the reconstruction and repair group, respectively (p=0.006). The change in AHD (preop-postop) was significantly higher in the repair (reduced by 2.27 mm) than the reconstruction group (increased by 0.1 mm) (P=0.006). Both groups had significant improvements in patient reported outcome scores. The reconstruction group had statistically significant better forward flexion (p= 0.01) and scapular plane abduction (p=0.03) compared to the repair group. Conclusions: Rotator cuff reconstruction with a dermal allograft demonstrated favorable structural healing rates and improved range of motion compared to maximal repair in the short term. Moreover, the maximal repair group were more likely to develop RCA than reconstruction. [Table: see text]

The significance of urgent ultrasound scan for shoulder dislocation in patients above the age of 40: A prospective British Elbow and Shoulder Society pathway implementation study

2020 ◽  
pp. 175857322091328
Author(s):  
R Zhou ◽  
G Prasad ◽  
S Robinson ◽  
S Shahane ◽  
A Sinha
Keyword(s):  
Rotator Cuff ◽  
Shoulder Dislocation ◽  
Senior Author ◽  
Rotator Cuff Tears ◽  
Diagnostic Process ◽  
Anterior Shoulder Instability ◽  
Ultrasound Scan ◽  
Full Thickness ◽  
Set Up ◽  
One Year

Background The highlight of the British Elbow and Shoulder Society pathway for the management of traumatic anterior shoulder instability is early imaging in patients aged over 40 years to assess rotator cuff integrity and early repair, if indicated to optimise function. The senior author set up a protocol in our institute to streamline the diagnostic process for this cohort of patients. This was a retrospective analysis from a prospectively collected database to highlight the importance of early specialist imaging. Methods Our protocol is to perform urgent ultrasound scans for all suitable patients above 40 years after first-time traumatic shoulder dislocation. Demographics, associated injuries, ultrasound scan results, operations and functional outcomes were collated. Results One year following the introduction of our protocol, 40 patients with a mean age of 67 (range, 42–89; SD = 13.1) had ultrasound. The incidence of full-thickness rotator cuff tears was 57.5% (n = 23). Eleven patients with confirmed full-thickness rotator cuff tears underwent surgery. The mean age of surgical patients was significantly younger than the non-surgical group (p = 0.004). Discussion The use of early diagnostic imaging demonstrated a high incidence of full-thickness rotator cuff tears in this cohort of patients. This allowed early surgical repair to optimise function.

Full-Thickness Rotator Cuff Tears in the Throwing Athlete

2021 ◽  
pp. 150800
Author(s):  
Robert A Jack ◽  
Michael C Ciccotti ◽  
Steven B Cohen ◽  
Michael G Ciccotti
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Throwing Athlete

scholarly journals Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aniket Agarwal ◽  
Kavita Vani ◽  
Anurag Batta ◽  
Kavita Verma ◽  
Shishir Chumber
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Surgical Correction ◽  
Statistical Testing ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Linear Probe ◽  
Significant Difference ◽  
Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

Long-term survivorship and outcomes after surgical repair of full-thickness rotator cuff tears

2011 ◽  
Vol 20 (4) ◽  
pp. 591-597 ◽  
Author(s):  
Peter J. Millett ◽  
Marilee P. Horan ◽  
Katie E. Maland ◽  
Richard J. Hawkins
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Rotator Cuff Tears ◽  
Full Thickness

Arthroscopic assessment of full-thickness rotator cuff tears

2000 ◽  
Vol 16 (4) ◽  
pp. 367-372 ◽  
Author(s):  
Hervé Thomazeau ◽  
Pascal Gleyze ◽  
Laurent Lafosse ◽  
Gilles Walch ◽  
François Kelbérine ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Full Thickness
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