scholarly journals Scaffolds in the management of massive rotator cuff tears: current concepts and literature review

2019 ◽  
Vol 4 (9) ◽  
pp. 557-566 ◽  
Author(s):  
Karthik Karuppaiah ◽  
Joydeep Sinha
Keyword(s):  
Rotator Cuff ◽  
Functional Outcome ◽  
Rotator Cuff Tear ◽  
Research Question ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tear ◽  
Biological Scaffolds ◽  
Cuff Tear ◽  
Superior Capsular Reconstruction ◽  
Synthetic Grafts

Injuries to the rotator cuff (RC) are common and could alter shoulder kinematics leading to arthritis. Synthetic and biological scaffolds are increasingly being used to bridge gaps, augment RC repair and enhance healing potential. Our review evaluates the clinical applications, safety and outcome following the use of scaffolds in massive RC repair. A search was performed using EBSCO-Hosted Medline, CINAHL, Cochrane and PubMed using various combinations of the keywords ‘rotator cuff’, ‘scaffold’, ‘biological scaffold’, ‘massive rotator cuff tear’ ‘superior capsular reconstruction’ and ‘synthetic scaffold’ between 1966 and April 2018. The studies that were most relevant to the research question were selected. All articles relevant to the subject were retrieved, and their bibliographies hand searched. Synthetic, biosynthetic and biological scaffolds are increasingly being used for the repair/reconstruction of the rotator cuff. Allografts and synthetic grafts have revealed more promising biomechanical and early clinical results than xenografts. The retear rates and local inflammatory reactions were alarmingly high in earlier xenografts. However, this trend has reduced considerably with newer versions. Synthetic patches have shown lower retear rates and better functional outcome than xenografts and control groups. The use of scaffolds in the treatment of rotator cuff tear continues to progress. Analysis of the current literature supports the use of allografts and synthetic grafts in the repair of massive cuff tears in reducing the retear rate and to provide good functional outcome. Though earlier xenografts have been fraught with complications, results from newer ones are promising. Prospective randomized controlled trials from independent centres are needed before widespread use can be recommended.Cite this article: EFORT Open Rev 2019;4:557-566. DOI: 10.1302/2058-5241.4.180040

scholarly journals Superior Capsular Reconstruction With Superimposition of Rotator Cuff Repair for Massive Rotator Cuff Tear

2017 ◽  
Vol 6 (5) ◽  
pp. e1775-e1779 ◽  
Author(s):  
George Sanchez ◽  
Jorge Chahla ◽  
Gilbert Moatshe ◽  
Márcio B. Ferrari ◽  
Nicholas I. Kennedy ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Repair ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Superior Capsular Reconstruction ◽  
Cuff Repair

Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear

2017 ◽  
Vol 45 (11) ◽  
pp. 2555-2562 ◽  
Author(s):  
Sung Hyun Lee ◽  
Dae Jin Nam ◽  
Se Jin Kim ◽  
Jeong Woo Kim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Resonance Imaging ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Massive Rotator Cuff Tears

Background: The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. Purpose: To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. Results: We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. Conclusion: Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.

scholarly journals Reverse Total Shoulder Arthroplasty in the Massive Rotator Cuff Tear

2014 ◽  
Vol 17 (3) ◽  
pp. 145-150 ◽  
Author(s):  
Jin Young Jeong ◽  
Hong Eun Cha
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Biceps Tenotomy ◽  
Reverse Total Shoulder

In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis.

scholarly journals Arthroscopic Partial Repair of Massive Contracted Rotator Cuff Tears

2014 ◽  
Vol 17 (1) ◽  
pp. 44-47 ◽  
Author(s):  
Sung Jae Kim ◽  
Young Hwan Kim ◽  
Yong Min Chun
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Functional Outcomes ◽  
Muscle Quality ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Partial Repair ◽  
Tendon Coverage

Typically, massive rotator cuff tears have stiff and retracted tendon with poor muscle quality, in such cases orthopaedic surgeons are confronted with big challenging to restore the cuff to its native footprint. Furthermore, even with some restoration of the footprint, it is related with a high re-tear rate due to less tension free repair and less tendon coverage. In this tough circumstance, the partial repair has yielded satisfactory outcomes at relatively short follow-up by re-creating the transverse force couple of the rotator cuff. Through this partial repair, the massive rotator cuff tear can be converted to the "functional rotator cuff tear" and provide improvement in pain and functional outcomes in patient's shoulder.

scholarly journals Massive Rotator Cuff Tear in an Adolescent Athlete: A Case Report

2009 ◽  
Vol 2 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Kimberly A. Turman ◽  
Mark W. Anderson ◽  
Mark D. Miller
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Traumatic Event ◽  
Young Athlete ◽  
Rotator Cuff Tears ◽  
Shoulder Injuries ◽  
Massive Rotator Cuff Tear ◽  
Excellent Outcome ◽  
Adolescent Athlete ◽  
Cuff Tear

Full-thickness rotator cuff tears in the young athlete are a rare injury. These injuries typically result from an acute traumatic event in a contact athlete, as opposed to overuse injuries more commonly seen in throwing athletes. Acute tears may be initially overlooked, with the symptoms attributed to other, more common causes, such as cuff contusion or brachial plexus neuropraxia (“stinger” or “burner”). If undiagnosed, the tear may progress to an irreparable state at the time of eventual diagnosis. Therefore, rotator cuff tear must be included in the differential for acute shoulder injuries in the young athlete. This article presents a case of an adolescent athlete with a traumatic, massive rotator cuff tear that was diagnosed and managed promptly with excellent outcome.

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.

Biceps Detachment Preserves Joint Function in a Chronic Massive Rotator Cuff Tear Rat Model: Response

2019 ◽  
Vol 47 (5) ◽  
pp. NP34-NP35
Author(s):  
Mengcun Chen ◽  
Snehal S. Shetye ◽  
Julianne Huegel ◽  
Corinne N. Riggin ◽  
Daniel J. Gittings ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rat Model ◽  
Joint Function ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Model Response
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