Is Subacromial Balloon Spacer Appropriate 
for Treatment of Irreparable Rotator Cuff Tears 
in Elderly Patients?

Background. The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. Material and methods. Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. Results. Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). Conclusion. Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

Download Full-text

Latissimus Dorsi Tendon Transfer with or Without Superior Capsular Reconstruction for Treatment of Irrepairable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00100 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0010

Author(s):

Anthony F. De Giacomo ◽

Hithem Rahmi ◽

Sevag Bastian ◽

Christopher Klein ◽

John Itamura

Keyword(s):

Rotator Cuff ◽

Latissimus Dorsi ◽

Tendon Transfer ◽

Rotator Cuff Tears ◽

Dash Score ◽

Vas Score ◽

Superior Capsular Reconstruction ◽

Significant Difference ◽

Secondary Outcomes

Objectives: Treatment options for massive irreparable rotator cuff tears, in middle aged adults, consists of tendon transfer or superior capsular reconstruction (SCR). The purpose of this study was to evaluate if transfer of the latissimus dorsi tendon transfer is enhanced with combination of superior capsular reconstruction for treatment of massive irreparable rotator cuff tears. Methods: At a single institution, all consecutive patients undergoing transfer of the latissimus dorsi tendon with or without superior capsular reconstruction, between 2013 and 2016, for treatment of irreparable rotator cuff tears were evaluated. SCR, was indicated, in addition to latissimus transfer, for patients with impaired preoperative active abduction. All clinical notes, diagnostic imaging, and operative reports were reviewed in detail. Demographics, operative techniques, and radiographic parameters were collected and measured. Functional outcome scores were prospectively collected from patients. The primary outcome of the study was the Disability of Arm, Shoulder, Hand (DASH) score. The secondary outcomes of the study were the Visual Analog Scale (VAS) pain score, Single Assessment Numeric Evaluation (SANE) score, and the American Shoulder and Elbow Society (ASES) score. Results: At 3 years, there were a total of 26 latissimus dorsi tendon transfers performed in patients with irreparable rotator cuff tears. Of these, 8 patients underwent only latissimus dorsi tendon transfer and 18 patients underwent latissimus dorsi tendon transfer combined with a superior capsular reconstruction. Average age was 53 years old with the majority of patients being male (88%). The dominant extremity was involved in 22 (85%) of latissimus transfers and 14 (53%) of patients had previous surgery to address a rotator cuff tear. Follow-up, for the entire cohort, was on average 29 months. At final follow-up, there was no significant difference in physical examination or radiographic measurements between patients with latissimus transfer alone and those with latissimus transfer with SCR. All patients, undergoing either technique, showed significant improvement in both the DASH score (preoperative DASH=59.6, postoperative DASH=39.9, P=0.049) and VAS score (preoperative VAS=6.6, postoperative VAS=3.3, P=0.0006). However, those patients undergoing revision surgery, regardless of technique, showed significantly less improvement in the DASH score (P=0.005), VAS score (P=0.002), SANE score (P=0.005), and the ASES score (P=0.001). Transfer of the Latissimus tendon with SCR, in comparison to only tendon transfer, did not show any significant difference in the final DASH score (p-value=0.72). At the same time, there was no significant difference between latissimus transfer, with or without SCR, in the secondary outcomes of the VAS score(P=0.97), the SANE score(P=0.63), or the ASES score (P=0.74). Conclusion: This is the first study to report the outcomes of latissimus dorsi tendon transfer with superior capsular reconstruction in comparison to only latissimus dorsi tendon transfer for treatment of irreparable rotator cuff tears. The study suggests that transfer of the latissimus dorsi tendon in combination with superior capsular reconstruction, at short term follow-up of 2 years, may not significantly influence functional outcome. Rather, patients undergoing revision surgery, regardless of technique, may demonstrate smaller improvements in functional outcomes. [Table: see text][Table: see text]

Download Full-text

Five-year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00194 ◽

2019 ◽

Vol 7 (3_suppl2) ◽

pp. 2325967119S0019 ◽

Cited By ~ 2

Author(s):

Teruhisa Mihata ◽

Thay Q. Lee ◽

Akihiko Hasegawa ◽

Kunimoto Fukunishi ◽

Takeshi Kawakami ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Rates Of Return ◽

Shoulder Range Of Motion ◽

Superior Capsule Reconstruction ◽

Significant Difference ◽

Graft Thickness ◽

Glenohumeral Osteoarthritis

Objectives: For irreparable rotator cuff tears, we developed a new surgical treatment—arthroscopic superior capsule reconstruction (SCR)—to restore superior shoulder stability, muscle balance, and shoulder function. The objective of this study was to assess (1) changes in functional outcome; (2) changes in graft thickness; (3) rates of graft tear; and (4) rates of glenohumeral osteoarthritis during a 5-year follow-up period. Methods: From 2007 to 2013, arthroscopic SCR using autograft of fascia lata was performed on 37 shoulders with irreparable rotator cuff tears. Seven patients were lost to follow-up. Consequently, 30 shoulders (mean age, 68.0 years) were enrolled in the study. Shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, acromiohumeral distance (AHD), Hamada grade, and Goutallier grade were compared among before surgery, 1 year after SCR, and 5 years after SCR. Graft thickness, which was measured in MRI, was compared among 3 months, 1 year, and 5 years after SCR. One-way analysis of variance followed by Fisher’s LSD post-hoc test was performed for statistical analysis. In addition, rates of return to sport or work were investigated in those patients who had been employed (12 patients: 5 carpenters, 5 farmers, and 2 construction workers) or played sports (8 patients: 2 table tennis, 1 golf, 1 martial arts, 1 yoga, 1 badminton, 1 mountain-climbing, and 1 ground golf) before injury. Results: Both ASES and JOA scores after arthroscopic SCR improved significantly at both 1 year ( P < 0.001) and 5 years after SCR ( P < 0.001). ASES score at 5 years after SCR was significantly better than that at 1 year after SCR ( P = 0.02). Postoperative ASES scores at both 1 year and 5 years after SCR were better in healed patients (27 patients) than in unhealed patients suffering from graft tear (3 patients). Active elevation was significantly improved at both 1 year and 5 years after SCR ( P < 0.001). At five years after SCR, 11 patients were still working and one patient, who had returned to part-time work at 1 year, had retired. All 8 patients were still playing sport before their injuries at 5 years after SCR. AHD was increased significantly at both 1 and 5 years after SCR ( P < 0.001). There was no significant difference in AHD between 1 and 5 years after SCR ( P = 0.16). In the 27 patients in whom the graft remained intact, graft thickness did not differ significantly among 3 months, 1 year, and 5 years after SCR ( P = 0.67). Hamada grade was significantly improved at both 1 and 5 years after SCR (preoperative: 2.3 ± 0.8; 1 year: 1.3 ± 0.7; 5 years: 1.3 ± 0.7, P < 0.001). All patients who had graft healing had no progression of glenohumeral osteoarthritis during the 5-year follow-up period. Two of the 3 patients with graft tear were suffering severe glenohumeral osteoarthritis (with narrowing of the glenohumeral joint space) at 5 years after SCR. The Goutallier grade did not change significantly after SCR in any patients. Conclusion: In a 5-year follow-up study, arthroscopic SCR restored shoulder function and resulted in high rates of return to recreational sport and work. Shoulder function and ROM were likely to get better with time. Graft tear exacerbated the clinical outcome after SCR and caused glenohumeral osteoarthritis in 2 of 3 patients by 5 years after SCR. Graft thickness and postoperative AHD did not change significantly between 1 and 5 years of follow-up, suggesting that we can expect excellent functional outcomes with long-term follow-up. [Table: see text]

Download Full-text

Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x428261 ◽

2009 ◽

Vol 91 (5) ◽

pp. 414-416 ◽

Cited By ~ 29

Author(s):

M Bhatia ◽

B Singh ◽

N Nicolaou ◽

KJ Ravikumar

Keyword(s):

Rotator Cuff ◽

Causative Factor ◽

Rotator Cuff Tears ◽

Controlled Study ◽

Distribution Analysis ◽

Subacromial Impingement ◽

Subacromial Space ◽

Retrospective Case ◽

Significant Difference ◽

Magnetic Resonance Imaging Mri

INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.

Download Full-text

A comparative study on treatment outcomes of bandage and casting in non-displaced extra-articular fracture of distal radius: A clinical trial study

Polish Journal of Surgery ◽

10.5604/01.3001.0014.3760 ◽

2020 ◽

Vol 92 (5) ◽

pp. 1-5

Author(s):

Hamid Reza Arti ◽

Reza farahnak

Keyword(s):

Clinical Trial ◽

Distal Radius ◽

Dash Score ◽

Articular Fracture ◽

Appropriate Treatment ◽

Significant Difference ◽

Vas Scores ◽

The Difference ◽

Fracture Of Distal Radius

Background: There are some therapeutic choices in non-displaced extra-articular fracture of distal radius that confront with some controversy in their selection. We tried to study these two methods in this article. Methods: This was a prospective randomized clinical trial conducted on the patients (n=62) with NDEA fracture of distal radius, during 2015. The patients were randomly assigned to casting (n-32) or bandage (n=30) group to receive the respective fracture healing procedure. The patients were followed-up at the first, second, third, and sixth weeks after the treatment. The Disabilities of the DASH and the VAS questionnaire were completed. All patients underwent an X-ray radiographic assessment to evaluate any potential complication. Results: At the end of the study, in the bandage and casting group 30 and 32 patients finished the study. The statistical analyses showed that the bandage group showed significantly higher mean DASH score than the casting group at the first week, but for the second week the difference decreased so that for the third week, the casting group showed significantly higher value than the bandage group. Finally, at the sixth week the two groups showed no significant difference in the DASH value. The two groups showed no significant differences in the VAS scores for all follow up assessments. The returning time to work was shorter in the bandage group and the treatment cost was also lower in this group. Conclusion: Bandage is more appropriate treatment option for the NDEA fractures of distal radius.

Download Full-text

Arthroscopic Bankart Repair vs. Open Latarjet Procedure: A Comparative Study of Clinical and Functional Results.

10.21203/rs.3.rs-36217/v1 ◽

2020 ◽

Author(s):

Binod Sherchan ◽

Saroj Rai ◽

Nira Tamang ◽

Siddhartha Dhungana ◽

Laxmi Kanta Sharma ◽

...

Keyword(s):

Clinical Outcomes ◽

External Rotation ◽

Operating Cost ◽

Bankart Repair ◽

Dash Score ◽

Latarjet Procedure ◽

Arthroscopic Bankart Repair ◽

Significant Difference ◽

Quick Dash

Abstract Background The primary aim of this study was to compare the clinical outcomes of patients undergoing arthroscopic Bankart repair and open Latarjet procedure for recurrent dislocation of the shoulder. Secondary aims were to assess and compare the cost-effectiveness, satisfaction and complications, including recurrence and infection. Methods We retrospectively evaluated the patients who underwent either arthroscopic Bankart repair with or without Remplissage procedure or open Latarjet procedure between May 2015 and May 2018. The preoperative data were collected from the hospital records, and the postoperative data were collected during the follow-up visit. At the final follow-up, 41(male=32, female=9) patients in the Bankart group and 40(male=34 and female=6) patients in the Latarjet group were included in the study. Clinical outcomes were assessed using the ASES score, Rowe score, and Quick DASH score. A self-constructed scale that consisted of satisfied and dissatisfied was used to measure the level of satisfaction. Any complications were recorded in every follow-up visit. Collected data were analyzed using SPSS version 25. Results There was no statistically significant difference regarding the age (p=0.401), gender (p=0.569), site of involvement (p=0.158), number of preoperative dislocations (p=0.085), follow-up (p=0.061), between the two groups. Similarly, no statistically significant difference existed regarding the ASES score (p=0.388), Rowe score (p=0.211), and Quick DASH score (p=0.713). The average external rotation was 83 degrees in the Bankart group and 85 degrees in the Latarjet group (p=0.140). Functional satisfaction was higher in the Laterjet group compared to the Bankart group (p=0.482). Hundred percent of the patients were cosmetically satisfied in the Bankart group, whereas only 32(80%) patients were cosmetically satisfied in the Latarjet group (p=0.002). There was a significantly higher operating cost for arthroscopic Bankart repair compared to open Latarjet procedure (p<0.001). Three patients had a recurrence in the Bankart group, whereas no recurrence occurred in the Latarjet group. And, 2 superficial infections occurred in the Latarjet group. Conclusion These results provide the fact that arthroscopic Bankart repair might be a fancy and minimally invasive procedure, Latarjet procedure should still be a priority in a developing country like Nepal, where financial cost is a huge burden.

Download Full-text

Five Years Follow-up After Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique: Evaluation of the Retear Rate and the Impairment of the Shoulder Function

10.21203/rs.3.rs-41951/v1 ◽

2020 ◽

Author(s):

Zhang Sheng ◽

Shi Huisheng ◽

Liu Xiaohua ◽

Wang Zheng ◽

Li Yan ◽

...

Keyword(s):

Rotator Cuff ◽

Muscle Strength ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Suture Bridge ◽

The Difference ◽

Arthroscopic Rotator Cuff ◽

Retear Rate

Abstract Purpose: To evaluate the retear rate after arthroscopic rotator cuff repair using a suture bridge (SB) technique for patients with full thickness rotator cuff tears and whether the non- healing cuff impaired the shoulder function.Methods: From January 2013 to January 2014, 92 patients in our institution underwent arthroscopic double-row suture bridge repair for the treatment of full-thickness rotator cuff tear 55 patients who have completed the 5 years follow-up were enrolled in this study. There were 36 female and 19 male patients, and the average age was 58.6 years (range, 41- 70 years). The tears were classified into small (<1 cm), medium (1-3 cm), large (3-5 cm), and massive (> 5 cm) according to the classification of DeOrio and Cofield. According to the intraoperative measurement, small tears were found in 5 shoulders (9%), medium tears in 19 shoulders (34.5%), large tears in 23 shoulders (41.8%), and massive tears in 8 shoulders (14.5%). The mean follow-up was 71.2 months (range, 66-78 months). Post-operative cuff integrity was evaluated with ultrasound (US) according to the published literature which was comparable to Sugaya MRI classification. Types I-III indicated cuff healing and types IV or V indicated retear. The retear patterns were divided into type 1 (failure at the original repair site) or 2 (failure around the medial row). At baseline and final follow-up, shoulder functional outcomes were measured using validated, shoulder-specific outcome scores, including the Constant-Murley score (CS) and the American Shoulder and Elbow Score (ASES). The difference in abduction muscle strength was also evaluated between the integrity and the retear group.Results: At final follow-up, the rotator cuff was completely healed in 45 of the 55 shoulders. There were recurrent tears in 10 shoulders, and the retear rate was 18.2%. The type 1 re- tear pattern was found in 4 shoulders (40%), and type 2 in 6 shoulders (60%). The Constant and ASES scores improved from 41.00 to 92.00, and from 41.33 to 88.00, respectively. The mean differences in shoulder scaption strength between the healing and the retear group were 1.1±0.82Kg and 3.0±0.88Kg respectively. The difference in muscle strength between the retear and the healing group was statistically significant (p<0.001).Conclusion: Arthroscopic suture bridge repair of full-thickness rotator cuff tears led to excellent improvement in shoulder function, but maintained a high retear rate. Although the retear group had inferior muscle strength, the patients were still satisfied, and shoulder function was improved due to pain relief. Whether such changes in muscle strength impair patients' long-term quality of life and shoulder function remains to be discussed.Level of evidence IV

Download Full-text

Comparison of Superior Capsular Reconstruction and Partial Infraspinatus Repair: A Matched-Pair Analysis of Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120984264 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098426

Author(s):

Stefan Greiner ◽

Max Kaeaeb ◽

Andreas Voss ◽

Robert Lawton ◽

Pushkar Bhide ◽

...

Keyword(s):

Rotator Cuff ◽

Constant Score ◽

Rotator Cuff Tears ◽

Matched Pair ◽

Dash Score ◽

Western Ontario Rotator Cuff ◽

Superior Capsular Reconstruction ◽

Patient Reported ◽

The Mean

Background: Superior capsular reconstruction (SCR) represents a new option for the treatment of irreparable rotator cuff tears. Purpose/Hypothesis: This study aimed to evaluate the clinical and radiologic outcomes of SCR and compare them with the outcomes of partial repair (PR) of the infraspinatus tendon. The hypothesis was that there would be no significant differences between the clinical and radiologic outcome parameters of SCR and PR after a minimum follow-up of 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Of 21 patients who underwent SCR, 20 patients were matched in a 1:1 ratio according to sex, age, and tear configuration with 20 of 60 patients who had undergone PR; all patients were prospectively evaluated for a minimum follow-up of 2 years. The investigated outcome measures included the Constant score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiologic analysis of acromiohumeral distance (AHD) and humeral head centralization (HHC). Results: There were no differences in the demographic data between the SCR and PR groups. The mean age of both groups was 62.3 years (range, 47-79 years), the mean tear configuration was Bateman 3.0 and Patte 2.8, and the mean follow-up period was 29.4 months (range, 24-53 months). At final follow-up, no significant differences were seen between the SCR and PR groups with regard to Constant score (77.1 vs 82.7), age- and sex-adapted Constant score (85.5% vs 91.4%), DASH score (15.6 vs 7.8), or WORC index (81.1 vs 90.4). No significant differences in the AHD or HHC were seen between the groups. The reoperation rate was 4.8% (1/21) in the SCR cohort and 15% (9/60) in the PR cohort. Conclusion: Both SCR and PR resulted in significant improvements in patient-reported outcomes at 2-year follow-up, with no significant differences in clinical outcomes between the 2 techniques. Further follow-up is needed to determine whether there are long-term differences in HHC and development of cuff tear arthropathy. Further investigations should also focus on the cost-effectiveness of the respective procedures.

Download Full-text

Short-term results (1 year) of vented versus solid polyetheretherketone anchors in treatment of rotator cuff tears

SICOT-J ◽

10.1051/sicotj/2019026 ◽

2019 ◽

Vol 5 ◽

pp. 32

Author(s):

Marco C. Sarmento ◽

António E. Cartucho ◽

Jacinto M. Monteiro

Keyword(s):

Rotator Cuff ◽

Constant Score ◽

Healing Process ◽

Randomized Study ◽

Rotator Cuff Tears ◽

First Year ◽

Dash Score ◽

Short Term ◽

Cuff Tear

Background: Due to the rotator cuff retear after being surgically repaired, some strategies have been developed. The authors verified that the possibility of polyetheretherketone (PEEK) vented anchors promoted a better clinical and healing process than PEEK solid anchors. Methods: A prospective and randomized study was designed with 38 patients treated with PEEK anchors, 18 of whom with vented anchors and 20 with solid ones. Demographic, clinical and radiologic data were collected before and during surgery (time 0) and at 12 months of follow-up. Results: In the final follow-up (12 months), there was no difference in the visual analogic scale (VAS) scale between groups (1.7 points vs 1.9 points; p = 0.731), neither in the DASH score (34.2 points vs 23.9 points; p = 0.268), nor in absolute Constant score (76.9 points vs 77.3 points; p = 0.910). In MRI, 10 patients had their cuff tear healed in the vented group and 15 in the solid group (p = 0.173). Conclusion: The new designed vented anchors do not add any advantage when compared to solids ones, at least within the first year after surgery.

Download Full-text

Primary versus revision arthroscopic bridging reconstruction using dermal allograft: a clinical and radiographic analysis (243)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00351 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0035

Author(s):

Ivan Wong ◽

Sara Sparavalo ◽

Jie Ma ◽

Nedal Alkhatib

Keyword(s):

Rotator Cuff ◽

Muscle Atrophy ◽

Fatty Infiltration ◽

Rotator Cuff Tears ◽

Primary Group ◽

Dash Score ◽

Massive Rotator Cuff Tears ◽

Western Ontario Rotator Cuff ◽

Goutallier Classification

Objectives: Large or massive rotator cuff tears make up between 10-40% of all rotator cuff tears, yet there is no agreement on the best treatment. Previous studies have shown that acellular human dermal allograft (AHDA) can be used for bridging reconstruction with positive patient outcomes. The use of this surgical technique has not been extensively studied in the primary or revision surgical setting. The main objective of this study was to compare the clinical and radiographic outcomes of patients who received primary or revision arthroscopic bridging reconstruction. Methods: This study is a retrospective review of a sequential series of patients who underwent arthroscopic bridging reconstruction (ABR) using AHDA by the primary author (IW). A total of 130 patients underwent ABR between 2010 and 2018. The inclusion criteria were patients with completed Western Ontario Rotator Cuff (WORC) questionnaire, Disabilities of the Arm, Shoulder, and Hand (DASH) score, or both pre-operatively and at multiple post-operative timepoints. Patients with missing WORC scores were excluded from the study. Eighty-three patients were included following chart review. Patients with available post-operative MRIs were also used for radiological assessment by an independent MSK-trained radiologist. Post-operative MRIs were reviewed to assess for graft integrity and changes to rotator cuff muscle atrophy (using the Warner classification) and fatty degeneration (using the Goutallier classification). Results: There were 46 patients who received primary ABR and 37 who received revision ABR. Forty-eight patients had a post-operative MRI available for review (Primary: 25; Revision: 23). The demographics are summarized in Table 1. Both groups showed a significant improvement in WORC score post-operatively (p<0.001). Primary ABR resulted in higher post-operative WORC scores as compared to revision ABR (p=0.015; Figure 1). The incidence of complete re-tears in the primary group was 8% and 17.4% in the revision group. More than 35% of patients in the primary group showed improvement in fatty infiltration of the infraspinatus and supraspinatus muscles. There was a higher progression in muscle atrophy in the revision group as compared to the primary group (74% and 30%, respectively). Conclusions: Arthroscopic primary arthroscopic bridging reconstruction for large/massive rotator cuff tears using acellular human dermal allograft had better improvement in their WORC scores compared to revision group at the final follow-up. Although the revision group had improved at the two-year follow-up, these changes in WORC score were not sustained at the final follow-up while the improvements were maintained for the primary group. The primary group had a smaller re-tear rate, better fatty infiltration and muscle atrophy as compared to the revision group. This suggests that primary bridging reconstruction provides better outcomes than a revision surgery.

Download Full-text

Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later!

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06602-y ◽

2021 ◽

Author(s):

Hanna C. Björnsson Hallgren ◽

Lars Adolfsson

Keyword(s):

Rotator Cuff ◽

Elective Surgery ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

Critical Shoulder Angle ◽

Glenohumeral Osteoarthritis ◽

The Difference ◽

Acromion Index ◽

Shoulder Angle

Abstract Purpose The critical shoulder angle (CSA) and the acromion index (AI) are measurements of acromial shape reported as predictors of degenerative rotator cuff tears (RCT) and glenohumeral osteoarthritis (GH OA). Whether they are the cause or effect of shoulder pathologies is uncertain since pre-morbid radiographs most often are lacking. The main aim of this study was to investigate if CSA or AI were related to the development of RCT or GH OA after 20 years. A secondary aim was to investigate if the CSA and AI had changed over time. Methods In the hospital archive, 273 preoperative plain shoulder radiographs were found of patients scheduled for elective surgery other than cuff repair and arthroplasty. Forty-five images fulfilled the strict criteria published by Suter and Henninger (2015) and were used to measure CSA and AI with two independent assessors. No patient had any sign of OA in the index radiographs or any information in the medical records indicating RCT. After a median of 20 (16–22) years, 30 of these patients were radiologically re-examined with bilateral true frontal views and ultrasound of the rotator cuff. There were 19 men (20 study shoulders) and 11 females (12 study shoulders). Results Mean age at follow-up was 56 (32–78) years. There was no correlation between CSA (r = 0.02) (n.s) or AI (r = − 0.13) (n.s) in the primary radiographs and OA at follow-up. Nor was any correlation found between index CSA (r = 0.12) (n.s) or AI (r = − 0.13) (n.s) and RCT at follow-up. Mean difference in CSA was − 1.7 (− 10–3) degrees and mean AI difference was − 0.04 (− 0.13–0.09) between the first and the second radiographs, 20 years later. Bilaterally, mean CSA was 32 and AI 0.61 at follow-up. Conclusion In this study, no correlation between the CSA, AI and development of OA or RCT could be found. The mean CSA and AI decreased over a 20-year period but the difference was very small. No difference was found between the study shoulders and the contralaterals. These findings question previously reported etiological associations between scapular anatomy and the development of OA or RCT and thereby the use of these calculations as the basis of treatment. Level of evidence III.

Download Full-text