Surgical repair of the supraspinatus: pre- and postoperative architectural changes in the muscle

INTRODUCTION@#Shortening of the tendon and muscle is recognised as a strong predictor of surgical failure of supraspinatus tendon tears. Changes in muscle architecture following repair have not been thoroughly investigated. Hence, we aimed to compare the pre- and postoperative architecture of the supraspinatus.@*METHODS@#We recruited eight participants with full-thickness supraspinatus tears. Images of the supraspinatus were captured preoperatively (pre-op) and postoperatively at one month (post-op1), three months (post-op2) and six months (post-op3) in relaxed and contracted states (0º and 60º glenohumeral abduction). Fibre bundle length (FBL), pennation angle (PA) and muscle thickness were quantified. Self-reported function, and maximal isometric abduction and external rotation strengths were assessed.@*RESULTS@#The mean FBL increased from pre-op to post-op1 (p = 0.001) in the relaxed state and from pre-op to post-op2 (p = 0.002) in the contracted state. Decrease in FBL was observed from post-op2 to post-op3 in the relaxed state. The mean PA decreased from pre-op to post-op1 (p < 0.001) in the relaxed state, but increased from post-op2 to post-op3 in both relaxed (p = 0.006) and contracted (p = 0.004) states. At post-op3, external rotation (p = 0.009) and abduction (p = 0.005) strengths were greater than at post-op2. Overall function increased by 47.67% from pre-op to post-op3.@*CONCLUSION@#Lengthening of the supraspinatus occurs with surgery, altering the length-tension relationship of the muscle, which can compromise muscle function and lead to inferior surgical outcomes. These findings may guide clinicians to optimise loads, velocities and shoulder ranges for effective postoperative rehabilitation.

Prospective Comparative Study of Arthroscopic Repair Versus Debridement for the Full-Thickness Tear of Upper Subscapularis

PURPOSE: To evaluate the results from arthroscopic repair versus debridement for full-thickness tears of the upper subscapularis tendon. MATERIALS AND METHODS: Ninety-nine patient outcomes were evaluated and compared prospectively. Sixty-nine patients with full-thickness tears of the upper subscapularis tendon underwent arthroscopic repair (group I) and thirty patients underwent simple debridement (group II) between May 2003 and October 2007. In all patients, the tear was localized to the superior one third of the upper subscapularis tendon. The results of the treatment were assessed by evaluating the UCLA, ASES, and VAS for pain and internal rotation strength scores before and after the operation. RESULTS: In groups I and II, UCLA, ASES, VAS, and internal rotation muscle power (perfect score = 5) scores were improved after surgery. In comparing group I and group II, the UCLA and VAS scores were not significantly different (p>0.05), while the ASES and internal rotation strength scores were significantly different (p<0.05). CONCLUSION: The arthroscopic repair of full-thickness tears of the upper subscapularis tendon was a better surgical method than simple debridement.

Outcome of Arthroscopic Suture Bridge Technique for Rotator Cuff Tear: Short Term Clinical Outcome In Full-thickness Tear With Fatty Degeneration Less Than Moderate Degree

PURPOSE: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. MATERIALS AND METHODS: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. RESULTS: Postoperative UCLA scores improved from16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. CONCLUSION: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.

Arthrographic Pitfalls in the Diagnosis of Full-Thickness Tears of the Rotator Cuff: A Case Report / 대한정형외과학회잡지

We report a case of full-thickness rotator cuff tear with operative confirmation, which was arthrographically intact. In this case, there was a discrepancy between conventional arthrography and magnetic resonance imaging (MRI), which suggested a full-thickness tear of the rotator cuff. The cause was confirmed to be an intact synovial capsule of the shoulder joint with a torn rotator cuff.