scholarly journals Tendon Repair Leads to better Long-Term Clinical Outcome than Debridement in Massive Rotator Cuff Tears

2017 ◽  
Vol 11 (1) ◽  
pp. 546-553 ◽  
Author(s):  
Matthias Alexander König ◽  
Volker Alexander Braunstein
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcome ◽  
Tendon Repair ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Short Term ◽  
Massive Rotator Cuff Tears ◽  
Massive Tears

Introduction: Massive tears in the rotator cuff are debilitating pathologies normally associated with loss of function and pain. Tendon reconstruction is seen as the standard treatment in order to preserve shoulder function and to inhibit cuff associated osteoarthritis. However, the effect on longer-term shoulder function and patient satisfaction is unknown. Material and Methods: 165 consecutive patients with massive tears were included. 57 debridement (mean age 61.9±8.7 years (range 43-77)) and 108 reconstruction (mean age 57.5±8.9 years (range 45-74)) cases could be followed up 2-4 (short-term), 5-6 (mid-term) and 8-10 (long-term) years after surgery. Evaluation was performed with the Constant, a modified ASES and the DASH score. Statistical analysis was done using Sigma-Stat Version 3.5 with a p-value<0.05 indicating statistical significant differences. Results: All three scoring systems showed no significant differences in the short-term follow-up for the two groups (mean values: Constant debridement/repair: 70±11.9/66±13.6; ASES debridement/repair: 22.3±3.3/ 23.3±3.3; DASH debridement/repair: 22.3±11.0/ 24.3±10.1). In the mid-term (Constant debridement/repair: 51±2.9/68.3±5.2; ASES debridement/repair: 20.3±1.3/24.3±1.7; DASH debridement/repair: 31.0±6.5/20.3±5.4) and long-term follow-up (Constant debridement/repair: 42.3±3.8 /60.7±2.6, ASES debridement/repair: 17.3±0.5/21.7±0.5, DASH debridement/repair: 41.3±6.2/25.0±1.4), rotator cuff reconstruction revealed better objective results and better patients’ satisfaction. Conclusion: Rotator cuff tendon repair leads to better long-term clinical outcome and subjective satisfaction compared to debridement. Tendon reconstruction should be considered as a treatment for patients suffering from massive rotator cuff tears, thus preserving shoulder function and by that means delay indication for reverse arthroplasty.

Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review

2021 ◽  
pp. 155633162110081
Author(s):  
Nihar S. Shah ◽  
Emil Suriel Peguero ◽  
Yuta Umeda ◽  
Zachary T. Crawford ◽  
Brian M Grawe
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Long Term Outcomes ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Massive Rotator Cuff Tears ◽  
Outcome Scores ◽  
Long Term Follow Up

Background: With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. Questions/Purpose: The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. Methods: We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. Results: Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. Conclusions: The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.

scholarly journals Current concepts in the primary management of irreparable posterosuperior rotator cuff tears without arthritis

2018 ◽  
Vol 3 (5) ◽  
pp. 200-209 ◽  
Author(s):  
Alexandre Lädermann ◽  
Philippe Collin ◽  
George S. Athwal ◽  
Markus Scheibel ◽  
Matthias A. Zumstein ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Structural Failure ◽  
Short Term ◽  
Superior Capsular Reconstruction ◽  
Long Term Follow Up ◽  
Primary Management ◽  
Biological Augmentation

Various procedures exist for patients with irreparable posterosuperior rotator cuff tears (IRCT). At present, no single surgical option has demonstrated clinical superiority. There is no panacea for treatment and patients must be aware, in cases of palliative or non-prosthetic options, of an alarming rate of structural failure (around 50%) in the short term. The current review does not support the initial use of complex and expensive techniques in the management of posterosuperior IRCT. Further prospective and comparative studies with large cohort populations and long-term follow-up are necessary to establish effectiveness of expensive or complicated procedures such as superior capsular reconstruction (SCR), subacromial spacers or biological augmentation as reliable and useful alternative treatments for IRCT.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180002

scholarly journals Latissimus Dorsi Tendon Transfer Vs. Superior Capsular Reconstruction for Treatment of Irreparable Massive Rotator Cuff Tears: A Retrospective Comparison Study with Short-Term Clinical Results

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0038
Author(s):  
Tiffany Kadow ◽  
Daniel Garcia ◽  
Rebecca Minorini ◽  
Mark Baratz ◽  
Ruth Delaney ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Short Term ◽  
Forward Flexion ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsular Reconstruction ◽  
Patient Reported

Objectives: Irreparable massive rotator cuff tears, particularly those that occur in younger patients, represent a particularly challenging clinical scenario with limited options. Treatments such as reverse total shoulder arthroplasty are typically not well indicated for this patient population. We compared two treatment methods, latissimus dorsi tendon transfer (LDTT) vs arthroscopic superior capsular reconstruction (SCR), to determine if one is superior to the other regarding improvement in range of motion (ROM) and patient reported outcomes (PROs). We hypothesize that both treatments would have similar outcomes regarding functional restoration and subjective outcomes. Methods: A retrospective cohort study assessed 43 patients with an irreparable posterosuperior rotator cuff tear after failed conservative or surgical treatment who underwent either LDTT (14 patients, 16 shoulders) or SCR (27 patients, 27 shoulders). Patients with a minimum of 6 month follow-up were included (mean follow up: 17.9 months, 14.9 months respectively). Changes in preoperative and postoperative forward flexion and external rotation were evaluated. Patient reported outcomes (PROs) including ASES, VAS, and SSV were assessed. T-test and Chi-Square statistical tests were performed. Results: The mean age at the time of surgery was 59.9yo vs 60yo for LDTT and SCR respectively (p=0.98). There were significantly more patients in the LDTT group that had undergone prior rotator cuff surgery (p<0.005) and significantly greater number of patients who had subscapularis tears which required repair in patients that underwent SCR (p<0.01). There was no difference in gender (p=0.75). Both cohorts demonstrated similar improvement in forward flexion with mean active forward flexion improving from 123° (90-160°) pre-operatively to 139° (80-180°) postoperatively in the LDTT group (p=0.157) and 85° (0-170°) preoperatively to 138° (40-175°) postoperatively in the SCR group (p =0.001). The average improvement in forward flexion was significantly greater in the SCR group with an improvement of 52° for SCR vs 14° for LDTT (p=0.035). External rotation improved in the LDTT cohort from 41° preoperatively (10-60°) to 62° (10-80°) (p=0.032) while external rotation stayed unchanged for the SCR cohort with 43° preoperatively (0-70°) to 44° (20-80°) postoperatively (p=0.868). The improvement in external rotation was significantly greater in the LDTT cohort with improvement of 19° vs 0.5° in the SCR group (p=0.011). There was no significant difference in reported ASES scores (LDTT: 65.6 vs SCR:70.9)(p=0.569), VAS (LDTT:1.78 vs SCR 2.26) (p=0.645), or SSV (LDTT:55 vs SCR:72.6) (p=0.087). Conclusion: LDTT and SCR both result in functional improvement of motion with SCR improving forward flexion to a greater extent and LDTT improving external rotation to a greater extent. Patient reported outcomes are similar between the two groups at short term follow up. Longer term outcomes are necessary before determining whether one treatment is optimal over the other as well as establishing the appropriate indications for each. [Table: see text]

scholarly journals Complete and partial repair of massive rotator cuff tears provide sustainable long term improvement in clinical scores

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0000
Author(s):  
Marion Besnard ◽  
Benjamin Freychet ◽  
Julien Clechet ◽  
Yannick Carrillon ◽  
Arnaud Godenèche
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Long Term Results ◽  
Massive Rotator Cuff Tears ◽  
Clinical Scores ◽  
Goutallier Classification

Objectives: The aim was to report results of arthroscopic repair of 86 massive cuff tears and decided to assess whether or not clinical scores were maintained 5 years later. Methods: Of the initial series of 86 shoulders, 2 patients died, 16 were lost to follow-up and 4 had a repeat surgery. Therefore, it was possible to reevaluate 64 patients. Repairs were complete in 44 cases and partial in 20 cases. Seventeen shoulders were pseudoparalytic. Tears with fatty degeneration at stage 4 or higher according to the Goutallier classification were not eligible for repair. Preoperatively, the Constant Score (CS), shoulder strength, location of the tear, tendon retraction and degree of fatty infiltration were assessed. Patients were assessed at 8.1±0.6 years [7.1-9.3] using absolute and age- and sex-adjusted CS, the subjective shoulder value (SSV) and the simple shoulder test (SST). Results: The absolute CS was 80.0±11.7 at the first follow-up (at 2-5 years) and decreased to 76.7±10.2 at the last follow-up (at 7-10 years) (p<0.001). The adjusted CS was 99.7±15.9 at the first follow-up and remained at 98.8±15.9 at the last follow-up (ns.). In terms of the other criteria, strength decreased over time (p<0.001) but pain, SSV and SST remained the same. Partial repairs had less strength at the first and last follow-up (p<0.05). Pseudoparalytic shoulders had a lower absolute and adjusted CS at the last follow-up (p<0.05) but the improvement in CS was greater (p=0.014). Conclusion: Partial and complete arthroscopic repair provide good long-term results in patients with massive rotator cuff tears, regardless of the location of the tear, the degree of fat infiltration (I to III according to the Goutallier classification) and even in case of a pseudoparalytic shoulder.

scholarly journals The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review

2020 ◽  
Vol 10 (1) ◽  
pp. 51
Author(s):  
Edoardo Giovannetti de Sanctis ◽  
Edoardo Franceschetti ◽  
Ferdinando De Dona ◽  
Alessio Palumbo ◽  
Michele Paciotti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Platelet Rich Plasma ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Therapeutic Modality ◽  
Cochrane Library ◽  
Long Term Follow Up

(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.

scholarly journals Fluoroscopically Guided Subacromial Spacer Implantation for Massive Rotator Cuff Tears: Two Years of Prospective Follow-up

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199346
Author(s):  
Enrico Gervasi ◽  
Eran Maman ◽  
Assaf Dekel ◽  
Elana Markovitz ◽  
Enrico Cautero
Keyword(s):  
Rotator Cuff ◽  
Local Anesthesia ◽  
Case Series ◽  
The Elderly ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Safety And Efficacy ◽  
Massive Rotator Cuff Tears

Background: Massive rotator cuff tears (MRCTs) are common and have been estimated to account for nearly 40% of all rotator cuff tears. An evolving strategy for management of MRCTs has been the implantation of a degradable subacromial spacer balloon that attempts to restore normal shoulder biomechanics. Purpose: To assess the safety and efficacy of fluoroscopically guided balloon spacer implantation under local anesthesia in a cohort of patients with 2 years of postoperative follow-up. Study Design: Case series; Level of evidence, 4. Methods: The safety and efficacy of using fluoroscopically guided subacromial spacer implantation was assessed in 46 patients. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Constant and American Shoulder and Elbow Society (ASES) scores. Results: Overall, 87.5% (35/40) of patients saw clinically significant improvement in the total Constant and ASES scores from 6 weeks postoperatively, with improvement maintained up to 24 months postoperatively. Conclusion: The data suggest that fluoroscopically guided subacromial spacer implantation under local anesthesia is a low-risk, clinically effective option, especially for the elderly population and those patients who have multiple comorbidities or a contraindication to general anesthesia. Patients undergoing subacromial spacer implantation for the treatment of MRCTs had satisfactory outcomes at 2-year follow-up, with a low rate of complications.

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