scholarly journals The Natural History of High-Grade Partial Thickness Rotator Cuff Tears: The Conversion Rate to Full Thickness Tears and Affecting Factors

2020 ◽  
Vol 12 (4) ◽  
pp. 514
Author(s):  
Joo Han Oh ◽  
Ye Hyun Lee ◽  
Tae Ho Lee ◽  
Seok In Jang ◽  
Jieun Kwon
Keyword(s):  
Rotator Cuff ◽  
Natural History ◽  
Conversion Rate ◽  
Rotator Cuff Tears ◽  
High Grade ◽  
Full Thickness ◽  
Affecting Factors ◽  
Partial Thickness ◽  
History Of

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 The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis

2018 ◽  
Vol 47 (7) ◽  
pp. 1734-1743 ◽  
Author(s):  
Chetan Khatri ◽  
Imran Ahmed ◽  
Helen Parsons ◽  
Nicholas A. Smith ◽  
Thomas M. Lawrence ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Natural History ◽  
Treatment Response ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Controlled Trials ◽  
Full Thickness ◽  
Randomized Controlled ◽  
History Of

Background: Rotator cuff tears are the most common tendon injury in the adult population, resulting in substantial morbidity. The optimum management for these patients is not known. Purpose: To assess the overall treatment response to all interventions in full-thickness rotator cuff tears among patients enrolled in randomized clinical trials. Study Design: Systematic review and meta-analysis. Methods: Randomized controlled trials (RCTs) were identified from a systematic search of Medline, Embase, CINHAL, and the Cochrane Central Register of Controlled Trials. Patients were aged ≥18 years with a full-thickness rotator cuff tear. The primary outcome measure was change in Constant shoulder score from baseline to 52 weeks. A meta-analysis to assess treatment response was calculated via the standardized mean change in scores. Results: A total of 57 RCTs were included. The pooled standardized mean change as compared with baseline was 1.42 (95% CI, 0.80-2.04) at 3 months, 2.73 (95% CI, 1.06-4.40) at 6 months, and 3.18 (95% CI, 1.64-4.71) at 12 months. Graphic plots of treatment response demonstrated a sustained improvement in outcomes in nonoperative trial arms and all operative subgroup arms. Conclusion: Patients with full-thickness rotator cuff tears demonstrated a consistent pattern of improvement in Constant score with nonoperative and operative care. The natural history of patients with rotator cuff tears included in RCTs is to improve over time, whether treated operatively or nonoperatively.

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.

Arthroscopic Repair of Partial-Thickness and Small Full-Thickness Rotator Cuff Tears

2014 ◽  
Vol 43 (3) ◽  
pp. 588-596 ◽  
Author(s):  
Seok Won Chung ◽  
Jae Yoon Kim ◽  
Jong Pil Yoon ◽  
Seong Hwa Lyu ◽  
Sung Min Rhee ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Arthroscopic Repair ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness

Tear progression of symptomatic full-thickness and partial-thickness rotator cuff tears as measured by repeated MRI

2016 ◽  
Vol 25 (7) ◽  
pp. 2073-2080 ◽  
Author(s):  
Yang-Soo Kim ◽  
Sung-Eun Kim ◽  
Sung-Ho Bae ◽  
Hyo-Jin Lee ◽  
Won-Hee Jee ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness

Structural Evolution of Nonoperatively Treated High-Grade Partial-Thickness Tears of the Supraspinatus Tendon

2017 ◽  
Vol 46 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Bong Young Kong ◽  
Minjoon Cho ◽  
Hwa Ryeong Lee ◽  
Young Eun Choi ◽  
Sae Hoon Kim
Keyword(s):  
Rotator Cuff ◽  
Univariate Analysis ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Study Cohort ◽  
High Grade ◽  
Partial Thickness ◽  
Structural Progression ◽  
Significant Change

Background: High-grade partial-thickness rotator cuff tears (hPTRCTs) are frequently encountered in the shoulder. However, little information is available on the prevalence or timing of tear progression. Purpose/Hypothesis: The purpose was to prospectively evaluate the structural progression of hPTRCTs with a minimum follow-up of 1 year using magnetic resonance imaging (MRI). The hypothesis was that a substantial portion of hPTRCT patients would experience tear progression or evolution to a full-thickness rotator cuff tear. Study Design: Case series; Level of evidence, 4. Methods: Between May 2010 and December 2015, 362 patients were diagnosed with hPTRCT (tear involvement >50% of the mediolateral length of the footprint) of the supraspinatus and were treated nonoperatively. Among these patients, 81 underwent follow-up MRI at least 1 year after initial presentation, and these patients were included in the final analysis. Initial and follow-up MRIs were used to determine whether tears had improved, had not changed, or had progressed. A change in tear involvement of >20% was defined as a significant change. Patients were categorized as follows: (1) a decrease in tear involvement of >20% (improved), (2) an increase or decrease of ≤20% (no change), or (3) an increase in tear involvement of >20% (progressed). Demographic data and morphologic data were analyzed to identify variables related to tear progression. Among them, severity of tendinosis was graded using MRIs: grade 1 (mild tendinosis), mild focal increase in tendon signal; grade 2 (moderate tendinosis), moderate focal increase in tendon signal; and grade 3 (marked tendinosis), marked generalized increase in tendon signal. Results: At initial diagnosis, 23 were articular-side (28%) and 58 were bursal-side (72%) hPTRCTs. The study cohort was composed of 51 women and 30 men, and the mean patient age was 62.3 years (range, 41-77 years). Follow-up MRI was performed at a mean 19.9 ± 10.9 months (range, 12-52 months). A significant change in tear involvement was observed at follow-up. In 13 patients (16%, 2 articular-side and 11 bursal-side tears), tears were classified as progressed (the progressed group); in 48 patients (59%), tears exhibited no change (the unchanged group); and in 20 patients (25%, 9 articular-side and 11 bursal-side tears), tears were improved (the improved group). Univariate analysis showed initial tendinosis grade was significantly different in the 3 groups (grade 1, 2, and 3: 5, 4, and 4 in progressed; 36, 11, and 1 in unchanged; 10, 8, and 2 in improved group, respectively, P = .007). Conclusion: Although progression of hPTRCT in the long term is uncertain, after 1-year follow-up with MRI, tears progressed in 16% of the tears in this study. Furthermore, some tears were healed or reduced in size, which indicates that decisions to undertake surgical repair at time of presentation may be excessive.

Arthroscopic Challenges in Treating Rotator Cuff Tears of the Shoulder

2009 ◽  
Author(s):  
Maxwell C. Park
Keyword(s):  
Rotator Cuff ◽  
New Technologies ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Healing Environment ◽  
Partial Thickness ◽  
Partial Tears ◽  
Progression Of Disease ◽  
Structural Loss ◽  
Invasive Techniques

Rotator cuff tears can be the source of significant morbidity. Impingement syndrome involving repetitive and prolonged mechanical irritation of the rotator cuff against the roof of the shoulder creates a progression of disease. Chronic tendon inflammation can lead to structural loss of integrity, leading to partial tears, and if left unchecked, full-thickness tears. Currently, the surgeon has the ability to repair full-thickness tears using minimally invasive techniques. However, the persistent tear rate after repair is remarkably high, more than 50% in some studies. One surgical goal is to alter progression of disease, and repair partial-thickness tears, for example. Another goal is to optimize the healing environment with the repair construct itself, accounting for biomechanical considerations. When using an arthroscopic approach, the challenges for treating partial- versus full-thickness tears varies significantly given anatomic restrictions—particularly, during repair of partial-thickness tears, the surgeon is “blind” for portions of the procedure as the arthroscope is typically placed intra-articularly, while instruments are passed from above the tendon, extra-articularly. Ideally, new technologies can be developed to optimize rotator cuff repair and healing in this setting.

scholarly journals Ultrasound and Functional Assessment of Transtendinous Repairs of Partial-Thickness Articular-Sided Rotator Cuff Tears

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769737 ◽  
Author(s):  
Roger V. Ostrander ◽  
Jeffrey M. Klauser ◽  
Sanjay Menon ◽  
Joshua G. Hackel
Keyword(s):  
Los Angeles ◽  
Rotator Cuff ◽  
Functional Outcomes ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
High Grade ◽  
Partial Thickness ◽  
Ultrasound Evaluation ◽  
Functional Scores

Background: Partial-thickness articular-sided rotator cuff tears are a frequent source of shoulder pain. Despite conservative measures, some patients continue to be symptomatic and require surgical management. However, there is some controversy as to which surgical approach results in the best outcomes for grade 3 tears. Hypothesis/Purpose: The purpose of this study was to evaluate repair integrity and the clinical results of patients treated with transtendinous repair of high-grade partial-thickness articular-sided rotator cuff tears. Our hypothesis was that transtendinous repairs would result in reliable healing and acceptable functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients with a minimum follow-up of 2 years were included in the study. All patients underwent arthroscopic repair of high-grade partial-thickness rotator cuff tears utilizing a transtendinous technique by a single surgeon. At latest follow-up, the repair integrity was evaluated using ultrasound imaging, and functional scores were calculated. Results: Ultrasound evaluation demonstrated that 18 of 20 patients had complete healing with a normal-appearing rotator cuff. Two patients had a minor residual partial tear. Sixteen of 20 patients had no pain on visual analog scale. Four patients complained of mild intermittent residual pain. All patients were rated as “excellent” by both the University of California at Los Angeles Shoulder Score and the Simple Shoulder Test. Conclusion: The transtendon technique for the repair of articular-sided high-grade partial rotator cuff tears results in reliable tendon healing and excellent functional outcomes.

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