scholarly journals Changes in Matrix Metalloproteinase and Tissue Inhibitors of Metalloproteinase in Patients with Rotator Cuff Tears

2014 ◽  
Vol 17 (2) ◽  
pp. 64-67
Author(s):  
Oh Soo Kwon ◽  
Young Yul Kim ◽  
Ji Yoon Ha ◽  
Han Bit Kang
Keyword(s):  
Rotator Cuff ◽  
Matrix Metalloproteinase ◽  
Range Of Motion ◽  
Size Range ◽  
Defect Size ◽  
Rotator Cuff Tears ◽  
Clinical Parameters ◽  
Mrna Levels ◽  
Duration Of Symptoms ◽  
Clinical Variables

BACKGROUND: The purpose of this study was to determine whether in patients with rotator cuff tears a correlation exists between molecular changes and clinical parameters such as age, duration of symptom, range of motion, and tear size. Molecular changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) were assessed by measuring messenger RNA (mRNA) levels of the two proteins.METHODS: The rotator cuff tissue from was obtained from the edge of a torn tendon revealed after debridement by a motorized shaver. Using the sample of rotator cuff tissue, the reverse transcription polymerase chain reaction was performed to quantify MMP-2 and TIMP-2 mRNA expression. To determine whether mRNA levels and the clinical variables, such as age, defect size, range of motion (ROM) of shoulder, and duration of symptoms, show any correlation, Spearman's correlation coefficients were used to test for significant differences.RESULTS: There was an inverse correlation between the mRNA levels of MMP-2 and TIMP-2 from the torn rotator cuff tendons regardless of the clinical variables. However, comparison of mRNA levels versus clinical parameters such as age, defect size, range of motion and duration of symptoms revealed a number of findings. We found a significant correlation between age and mRNA levels of MMP-2 from torn cuffs (r = 0.513, p = 0.021). Further, we found a significant correlation between defect size in the full thickness tears and mRNA levels of MMP-2 (r = 0.454, p = 0.045). Conversely, no significant association between mRNA levels of MMP-2 and ROM or duration of symptom was found.CONCLUSIONS: Our results suggest that both MMP-2 and TIMP-2 may be involved in the disease process of rotator cuff tears. Although the level of mRNA expression of MMP-2 and TMP-2 remain constant in torn rotator cuffs irrespective of the clinical variables, their levels may be influenced by age and defect size, which could account to change in tendon degradation and the healing process.

scholarly journals Recovery of Range of Motion and Decrease in Pain after Progression of Supraspinatus Tendon Tear: A Case Report

2019 ◽  
Vol 13 (1) ◽  
pp. 84-88
Author(s):  
Yoshihiro Hagiwara ◽  
Junichiro Hamada ◽  
Akira Ando ◽  
Kenji Kanazawa ◽  
Yutaka Yabe ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
The Elderly ◽  
Supraspinatus Tendon ◽  
Operative Management ◽  
Rotator Cuff Tears ◽  
Tendon Tear ◽  
Duration Of Symptoms ◽  
First Case ◽  
The Right

Rotator cuff disease is one of the most prevalent shoulder disabilities especially in the elderly population. Tear progression is significantly greater in the symptomatic patients than in the asymptomatic ones. From these aspects, shoulder surgeons interpret surgical indications and counsel patients regarding the risk of non-operative treatments. However, there were a few reports that pain and duration of symptoms were not strongly associated with severity of rotator cuff tears, and non-operative management with physical therapy was effective. There have remained controversies for the treatment of rotator cuff tears.A 59-year-old man with a sedentary work life experienced right shoulder pain with abduction at night. However, the pain kept worsening after two months, and he finally visited our clinic three months after the onset of pain. Magnetic resonance imaging in the coronal and axial planes showed effusion around the subacromial and subcoracoid bursae and joint-side tear of the supraspinatus tendon. A range of motion in the right shoulder was severely restricted at the initial visit of our clinic. After sufficient rehabilitation, the symptoms were not changed and an arthroscopic rotator cuff repair was scheduled. However, during waiting for surgery, he felt something popped in the right shoulder while wearing a jacket. Immediately after this, pain during motion and at night decreased, and he experienced no difficulty with activities of daily living and the surgery was cancelled. This is the first case with a recovery of range of motion and a decrease in pain after progression of a supraspinatus tendon tear.

Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

2018 ◽  
Vol 46 (13) ◽  
pp. 3155-3164 ◽  
Author(s):  
Vasanth Seker ◽  
Lisa Hackett ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
External Rotation ◽  
Case Series ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Irreparable Tear ◽  
Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

scholarly journals Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear

2021 ◽  
Vol 24 (1) ◽  
pp. 21-26
Author(s):  
Yon-Sik Yoo ◽  
Jin-Young Park ◽  
Myung-sun Kim ◽  
Nam-Su Cho ◽  
Yong-Beom Lee ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Mean Value ◽  
Calcific Tendinitis ◽  
Older Age ◽  
Korean Population ◽  
Rotator Cuff Tears ◽  
Treatment Modalities ◽  
Duration Of Symptoms ◽  
Cuff Tear

Background: To evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear.Methods: Between October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images. Results: There were 402 female patients (79%) with mean age of 55 years (range, 31–87 years). Mean duration of symptoms was 15.5 months. Mean size of calcific materials was 11.4 mm (range, 0.9-35). Mean value of VAS and ASES scores were 6.5 (range, 1–10) and 47 (range, 8–95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all P<0.05).Conclusions: This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in Korean population, which were not different from those of Western population. Coexisting rotator cuff tear was found with 15% incidence in this large series, suggesting that further radiographic study to evaluate rotator cuff tear might be needed in some calcific tendinitis patients of older age and presenting with recurrent symptoms.

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.

Arthroscopically Assisted Mini-Open Rotator Cuff Repairs

2000 ◽  
Vol 28 (3) ◽  
pp. 301-311 ◽  
Author(s):  
Jonathan C. Hersch ◽  
Nicholas A. Sgaglione
Keyword(s):  
Los Angeles ◽  
Rotator Cuff ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Duration Of Symptoms ◽  
Excellent Outcome ◽  
Rehabilitation Protocols ◽  
Arthroscopically Assisted ◽  
Tear Size

The functional outcome of 22 consecutive patients with full-thickness rotator cuff tears repaired using an arthroscopically assisted technique was evaluated. The average follow-up was 39 months (24 to 80), and the average tear size was 3.5 cm (1 to 7). There were 14 men and 8 women, with a mean age of 56 years (29 to 80); 86% of patients (N 19) were satisfied with the results of surgery and 95% (N 21) had improvement of their symptoms. All patients had a statistically significant improvement in pain and active abduction in the scapular plane and in external rotation. Postoperative strength in external rotation and abduction averaged 95% and 97% of the contralateral shoulder, respectively. Preoperative duration of symptoms, strength, age, and tear size were found to be independent predictors of outcome. The average Constant and Murley score was 84 of 100, the average American Shoulder and Elbow Surgeons score was 81 of 100, and the average University of California, Los Angeles, score was 31 of 35. Our results show that an arthroscopically assisted repair of full-thickness, moderate-to-large rotator cuff tears using uniform surgical technique and rehabilitation protocols provides excellent outcome with regard to function, pain, and activities of daily living.

scholarly journals Mechanics and Differential Healing Outcomes of Small and Large Defect Injuries of the Tendon-Bone Attachment in the Rat Rotator Cuff

2020 ◽  
Author(s):  
Anna Lia Sullivan ◽  
Ryan C. Locke ◽  
Rachel K. Klink ◽  
Connor C. Leek ◽  
Megan L. Killian
Keyword(s):  
Mechanical Properties ◽  
Rotator Cuff ◽  
Bone Volume ◽  
Defect Size ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Volume Percentage ◽  
Local Bone ◽  
Defect Groups

ABSTRACTThe size of rotator cuff tears affects clinical outcomes following rotator cuff repair and is correlated with risk of re-injury. This study aimed to understand how defect size influences the structural and mechanical outcomes of the injured rotator cuff attachment in vivo. We used our previously established model of full-thickness injury of the rotator cuff tendon-bone attachment in Long Evans rats to compare differences in healing outcomes between small and large defects. Biomechanical properties, gross morphology, bone remodeling, and cell and tissue morphology were assessed at 3- or 8-weeks of healing. At the time of injury (no healing), large defects had decreased mechanical properties compared to small defects, and both defect sizes had decreased mechanical properties compared to intact attachments. The mechanical properties of the defect groups were comparable after 8-weeks of healing and significantly improved compared to no healing but failed to return to intact levels. Local bone volume at the defect site was higher in large compared to small defects on average and increased from 3- to 8-weeks. Contrastingly, bone quality, measured as bone volume percentage and trabecular morphometry, of the total epiphysis and greater tubercle decreased from 3- to 8-weeks of healing and these changes were not dependent on defect size. Qualitatively, we observed that large defects had increased disorganized collagen and neovascularization compared to small defects. In this study, we demonstrated that not only small but also large defects do not regenerate the mechanical and structural integrity of the intact rat rotator cuff attachment following healing in vivo.Statement of Clinical SignificanceOur rat model of full-thickness rotator cuff tears may be beneficial to understand and prevent tear enlargement in vivo.

scholarly journals Pseudoparalysis and pseudoparesis of the shoulder

2021 ◽  
Author(s):  
Roland Stefan Camenzind ◽  
Laurent Lafosse ◽  
Thibault Lafosse
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Cuff Tear ◽  
Active Range Of Motion ◽  
Definition Of ◽  
Shoulder Elevation ◽  
Scapular Plane

Abstract Background Clinical presentation of massive rotator cuff tears range from pain to loss of active range of motion. Pseudoparalysis and pseudoparesis are defined inconsistently in the literature, but both include limited active with maintained passive range of motion. Objective This article aims to provide a consistent definition of pseudoparalysis and pseudoparesis of the shoulder and show structural and biomechanical differences between these two types of rotator cuff tear with their implications for treatment. Methods A literature review including key and basic papers discussing clinical symptoms, biomechanical differences, and their impact on therapeutic options for pseudoparalysis and pseudoparesis was performed. Results Biomechanically, structural differences between pseudoparalysis (active scapular plane abduction <45°) and pseudoparesis (active scapular plane abduction 45–90°) exist. For massive posterosuperior rotator cuff tears, the integrity of the inferior subscapularis tendon is the most predictive factor for active humeral elevation. Patients with pseudoparalysis have a higher grade of subscapularis tendon involvement (>50%) and fatty infiltration of the subscapularis muscle. Treatment options depend on the acuteness and repairability of the tear. Rotator cuff repair can reliably reverse the active loss of active range of motion in acute and reparable rotator cuff tears. In chronic and irreparable cases reverse total shoulder arthroplasty is the most reliable treatment option in elderly patients. Conclusion The most concise definition of pseudoparalysis is a massive rotator cuff tear that leads to limited active (<45° shoulder elevation) with free passive range of motion in the absence of neurologic deficits as the reason for loss of active elevation. The integrity of the subscapularis tendon is the most important difference between a pseudoparalytic and pseudoparetic (active shoulder elevation 45–90°) shoulder. Decision-making for surgical options depends more on reparability of the tendon tear and patient age than on differentiation between pseudoparalysis and pseudoparesis.

scholarly journals Healing Rates of Massive Rotator Cuff Tears by Allograft Reconstruction vs Maximal Repair - A Prospective Randomized Controlled Trial

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0038
Author(s):  
Purnachandra Tejaswi ◽  
Ivan H. Wong
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Structural Integrity ◽  
Controlled Trial ◽  
Patient Reported Outcome ◽  
Rotator Cuff Tears ◽  
X Rays ◽  
Patient Reported ◽  
Repair Group ◽  
Reconstruction Group

Objectives: To determine the healing rate of rotator cuff reconstruction with an acellular human dermal allograft compared with the current 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 1.5 T MRI at an average of 15 months after surgery. Rotator cuff arthropathy (RCA) and acromio-humeral distance (AHD) were graded using X-rays. WORC, DASH, MARX scores, range of motion (ROM) of shoulder were also analyzed. Results: The re-tear rate in reconstruction group was 13% (2 of 15 patients) compared to 67%(10/15) in repair group (p=0.008). Progression of RCA was seen in 7.14%(1/14) and 35.71%(4/14) of patients in reconstruction and repair group; respectively (p=0.006). The change in AHD (preop-postop) was significantly higher in 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. Reconstruction group had statistically significant better forward flexion (p= 0.01) and scapular plane abduction (p=0.03) compared to repair. Conclusion: Rotator cuff reconstruction with a dermal allograft demonstrated favourable structural healing rates and improved range of motion compared to maximal repair in the short term. Moreover, those in the maximal repair group were more likely to develop RCA compared to reconstruction.

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]

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