Physical Therapy Following Arthroscopic Rotator Cuff Repair with Graft Augmentation: A Case Report with Magnetic Resonance Imaging

Background: Retear of repaired rotator cuff tendons worsens patient outcome and decreases patient satisfaction. Superior capsule reconstruction (SCR) was developed to center the humeral head and thus restore the force couple for patients with rotator cuff tears. Purpose: To evaluate whether SCR for reinforcement before arthroscopic rotator cuff repair (ARCR) improves cuff integrity. Study Design: Cohort study; Level of evidence, 3. Methods: Thirty-four consecutive patients (mean age, 69.1 years) with severely degenerated but reparable rotator cuff tears underwent SCR with fascia lata autografts for reinforcement before ARCR. All tears were medium (1-3 cm) or large (3-5 cm), and the number of torn tendons was 2 (supraspinatus and infraspinatus) in 29 shoulders and 3 (supraspinatus, infraspinatus, subscapularis) in 5 shoulders. To assess the benefit of SCR for reinforcement, all data were compared with those after ARCR alone among 91 consecutive patients with medium or large rotator cuff tears (mean age, 63.6 years). The American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, active shoulder range of motion, and cuff integrity (Sugaya magnetic resonance imaging classification) were compared ( t test and chi-square test) between ARCR with and without SCR, as well as before surgery and at final follow-up. Results: All 34 patients who underwent SCR before ARCR had neither postoperative retear nor type III cuff integrity, whereas those treated with ARCR alone had a 4% incidence (4 of 91) of retear and 8% incidence of type III cuff integrity. ASES and JOA scores, active elevation, active external rotation, and active internal rotation increased in both treatment groups ( P < .001). Postoperative ASES score and active range of motion did not differ between groups, although the Goutallier grade of the supraspinatus was higher for ARCR with SCR (mean, 2.8) than ARCR alone (mean, 2.1; P < .0001). Conclusion: SCR for reinforcement prevented retear at 1 year after ARCR and improved the quality of the repaired tendon on magnetic resonance imaging. Functional outcomes were similar between groups, even though degeneration of the torn tendons was greater among patients who underwent ARCR with SCR.

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Changes of fatty infiltration according to the immediate postoperative time point in magnetic resonance imaging after arthroscopic rotator cuff repair

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-017-4604-9 ◽

2017 ◽

Vol 26 (1) ◽

pp. 152-160 ◽

Cited By ~ 3

Author(s):

Ji Wan Park ◽

Chris Hyunchul Jo ◽

Ji Sun Shin

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Fatty Infiltration ◽

Resonance Imaging ◽

Postoperative Time ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Time Point

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Changes of Muscle Atrophy According to the Immediate Postoperative Time Point in Magnetic Resonance Imaging After Arthroscopic Rotator Cuff Repair

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2016.04.032 ◽

2016 ◽

Vol 32 (12) ◽

pp. 2477-2487 ◽

Cited By ~ 12

Author(s):

Chris Hyunchul Jo ◽

Ji Wan Park ◽

Ji Sun Shin

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Muscle Atrophy ◽

Rotator Cuff Repair ◽

Resonance Imaging ◽

Postoperative Time ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Time Point

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Characteristic Retear Patterns Assessed by Magnetic Resonance Imaging After Arthroscopic Double-Row Rotator Cuff Repair

Yearbook of Orthopedics ◽

10.1016/j.yort.2012.05.006 ◽

2012 ◽

Vol 2012 ◽

pp. 217-218

Author(s):

B.F. Morrey

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Resonance Imaging ◽

Double Row ◽

Cuff Repair

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Evaluation of 3 different rehabilitation protocols after rotator cuff repair, and the effectiveness of pool therapy: a randomized control study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00007 ◽

2021 ◽

Vol 9 (2_suppl) ◽

pp. 2325967121S0000

Author(s):

Alex Laedermann ◽

Fayssal Kadri ◽

Alec Cikes

Keyword(s):

Physical Therapy ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

The Self ◽

Arthroscopic Rotator Cuff Repair ◽

Independent Observer ◽

Early Results ◽

Group 2 ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Objectives: Exercises performed in water have shown to improve strength and range of motion in various joint pathologies. This study aims to identify the best rehabilitation protocol for patients who undergo arthroscopic rotator cuff repair, and the effectiveness of a pool therapy protocol. Methods: Patients who underwent arthroscopic rotator cuff repair for small to medium sized rotator cuff tears, with small to moderate retraction of the affected tendon and who underwent surgery between 2013 and 2016, were randomized in 3 different groups at the time of surgical indication. Groups: 1. Patients who had rehabilitation with physical therapy and no aquatic protocol; The "Dry group", 2. Patients who had rehabilitation with physical therapy, including an aquatic protocol; The "Pool Group", 3. Patients who had self-rehabilitation alone, with no physical therapist. The "Self Group" follow-up: all patients were assessed by an independent observer. The mean outcome measures consisted of pre and postoperative SSV, Constant score, and patient satisfaction. Patients were followed-up at 4, 8 and 12 weeks postoperatively, as well as in 1 and 2 years. Results: Group 1 (Dry group) and Group 2 (Pool group) showed better Constant scores 2 months postoperatively, although this was not statistically significant. However, patients in group 2 (Pool group) showed statistically better Constant scores and overall satisfaction 3 months postoperatively. All the groups had similar results 6 months, 1 year and 2 years postoperatively, with slightly better outcomes for the Dry and Pool groups compared to the Self group. Conclusion: Water therapy after rotator cuff repair provides better early results compared to traditional "dry" rehabilitation or self-exercise therapy. The results remain better for patients who had pool or dry rehabilitation 1 and 2 years postoperatively, although the difference is not statistically significant in the long term.

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Pulmonary Embolism after Arthroscopic Rotator Cuff Repair: A Case Report

Clinics in Shoulder and Elbow ◽

10.5397/cise.2014.17.1.31 ◽

2014 ◽

Vol 17 (1) ◽

pp. 31-35

Author(s):

Ji Yong Gwark ◽

Jin Sin Koh ◽

Hyung Bin Park

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Case Report ◽

Rotator Cuff ◽

Orthopedic Surgery ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Arthroscopic Shoulder Surgery ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Pulmonary embolism (PE) is a serious complication that can occur after orthopedic surgery. Most instances of PE in the orthopedic field have occurred after hip or knee arthroplasties or after fracture surgeries. The occurrence of PE related to arthroscopic shoulder surgery is very rare. We report a case of PE that developed after arthroscopic rotator cuff repair, in which the patient did not show preoperatively any remarkable risk factors for PE. We also review the current literature related to this topic.

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Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546517695789 ◽

2017 ◽

Vol 45 (9) ◽

pp. 2000-2009 ◽

Cited By ~ 22

Author(s):

Pietro Randelli ◽

Carlo Alberto Stoppani ◽

Carlo Zaolino ◽

Alessandra Menon ◽

Filippo Randelli ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Randomized Controlled Trial ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Controlled Trial ◽

Resonance Imaging ◽

Randomized Controlled ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. Purpose: To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. Results: Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). Conclusion: No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical repair of the rotator cuff. Registration: NCT01815177 ( ClinicalTrials.gov identifier).

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