Degeneration Exists along the Entire Length of the Supraspinatus Tendon in Patients with a Rotator Cuff Tear

BACKGROUND: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. METHODS: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. RESULTS: Mean total degeneration scores in the NE group (13.3 +/- 3.21), the FE group (12.5 +/- 2.30), and in the MTJ group (10.8 +/- 3.10) were significantly higher than those in the normal control group (5.0 +/- 2.87; all P>0.001). Mean total degeneration score in the NE group was significantly higher than that in the MTJ group (p=0.012), but was not from that of the FE group. Mean total degeneration score in the FE group was not significantly different from that of the MTJ group. CONCLUSIONS: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair.

The Size of the Rotator Cuff and the Positional Relationship of Bony Landmarks: An Anatomical Study / 체질인류학회지

For treatment of the rotator cuff, locating the structure and position of the rotator cuff is crucial. The aim of this study is to identify the size of each rotator cuff and the locational relationship with bony landmarks, and to provide superficial landmarks for locating the tendon from the surface. Fifty-two shoulders from 26 cadavers were dissected and measured in a supine position. The central point was set as the most protrusive point on the greater tubercle of the humerus. The measurement of angles was described ventral as positive (+) and dorsal as negative (-) placing the long axis of the humeral shaft at 0degrees. The range of the angle which each rotator cuff tendon is attached to the humerus head was: 53.8~103.3 degrees for the subscapularis, -17.1~25.7 degrees for the supraspinatus, -68.4~-1.9 degrees for the infraspinatus, and -117.1~-75.7 degrees for the teres minor. The vertical inferior point drawn from the anterior edge of the acromion to the humerus was 7.5+/-11.7 degrees from the central point. The average position of the point was the midpoint of insertion of the supraspinatus tendon. The lateral horizontal point drawn from the acromial angle to the humerus was -49.4+/-14.3 degrees away and located at an average of 30% inferior to the infraspinatus tendon. Also the lateral horizontal point drawn from the most protrusive point of the coracoid process to the humerus was 63.1+/-14.7 degrees away and located at an average of 20% superior to the subscapularis tendon. Lastly, the most protrusive point of the lesser tubercle of the humerus was located at a range of 80.8+/-11.1 degrees and an average of 60% superior to the insertion of the subscapularis tendon. For the measurements of the size of the rotator cuff, there was no statistical difference between the left and right. However, the four measurements - the proximal width of the teres minor tendon, the proximal and distal width, and the length of the subscapularis tendon - showed statistically significant difference between the sexes (P<0.05). Therefore, to identify the location of the tendon structures by palpation for shoulder treatment, using the lesser tubercle for the subscapularis, the anterior edge of the acromion for the supraspinatus, and the acromial angle for the infraspinatus as landmarks is regarded to be effective.

Degeneration Exists along the Entire Length of the Supraspinatus Tendon in Patients with a Rotator Cuff Tear

BACKGROUND: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. METHODS: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. RESULTS: Mean total degeneration scores in the NE group (13.3 +/- 3.21), the FE group (12.5 +/- 2.30), and in the MTJ group (10.8 +/- 3.10) were significantly higher than those in the normal control group (5.0 +/- 2.87; all P>0.001). Mean total degeneration score in the NE group was significantly higher than that in the MTJ group (p=0.012), but was not from that of the FE group. Mean total degeneration score in the FE group was not significantly different from that of the MTJ group. CONCLUSIONS: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair.

The Integrity after Arthroscopically Repairing the Rotator Cuff Tendon Using the Suture Bridge Technique / 대한정형외과학회잡지

PURPOSE: We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears. MATERIALS AND METHODS: Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The 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). Significance was set at p values < 0.05 RESULTS: In the 42 cases with follow up MRI, the cuff integrity was graded as type I in 10 cases, type II in 28, type III in 2, type IV in 1 and type V in 1 case. Out of the 39 cases having a medium to large tear, the type I and II cuff integrity was 92.3% and two patients had type III cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear, the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity. CONCLUSION: The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.

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.

Expression of MMP-2 in the Healing Process of Acute Tear of the Rotator Cuff Tendon in Rats / 대한정형외과학회잡지

PURPOSE: Rotator cuff diseases combined with cuff tear are the most common causes of pain and disability of the upper extremity. Most rotator cuff tears are of partial thickness and respond well to conservative treatment. Many authors have addressed the capacity of cuff tendon healing, but little is known of the precise healing process. The MMPs (matrix metalloproteinases) are synthesized and secreted from connective tissue cells and are known to participate in the degradation and remodeling of organs in both normal and pathologic states. Using a rat model, we studied the healing process of rotator cuff tendon tear with reference to the expression of MMP-2. MATERIALS AND METHODS: Forty Mature Sprague-Dawley rats were used in this anima study. Twenty rats were assigned to the experimental group, the other twenty to the control group. In the experimental group, a partial thickness tear of the rotator cufft tendon was made and rats were examined 4 weeks after surgery. RESULTS: On gross inspection, the defects were covered with granulation tissue, and on microscopic evaluation, proliferation of fibrob-lasts and vessels at the defect demonstrated the healing capacity of rotator cuff tendon. The expression of MMP-2 was determined by immunohistochemistry and RT-PCR. Immunohistochemistry demonstrated MMP-2 positively stained cells at the defect site. Also, RT-PCR demonstrated MMP-2 expression. CONCLUSION: These results suggest that the remodeling and healing processes of injured rotator cuff tendon are associated with the expression of MMP-2.