Revisional Rotator Cuff Repair / 대한정형외과학회잡지

Most patients experience pain relief and functional improvement after arthroscopic rotator cuff repair. In some patients, however, symptoms still remain after surgery. Failed rotator cuff repair is a complex outcome of biological, technical, and traumatic factors. Moreover, re-tears might or might not be the main cause for patients with persistent pain after rotator cuff repair. Therefore, a thorough understanding of the patient's history, physical examination, and appropriate imaging studies will be needed to evaluate and manage these patients. The patient's age, functional requirement, quality of the rotator cuff, preoperative range of motion, quality of the deltoid, and glenohumeral arthritis are factors to consider before performing revisional rotator cuff repair. Preoperative patient education is as important as the surgical technique for successful revisional rotator cuff repair.

What Influences Rehabilitation Outcomes after Arthroscopic Rotator Cuff Repair? Investigation of Risk Factors for Prolonged Rehabilitation / The Japanese Journal of Rehabilitation Medicine

Purpose：Good functional results have been reported for arthroscopic repair of rotator cuff tears (ARCR) by several orthopedic surgeons, but few studies have examined the factors affecting rehabilitation outcomes.This study was conducted to identify the factors associated with clinical outcome and the duration of rehabilitation after ARCR.Subjects and methods：This was a retrospective evaluation of 576 patients who underwent ARCR between January 2009 and December 2013 (Men：331, Women：245；mean age：63.9±12.3 years).Patients were divided into groups based on the duration of rehabilitation：less than or more than 6 months. Preoperative and postoperative evaluations, including outcome assessments and physical examination parameters, were reviewed：① type of insurance, ② duration of illness, ③ pain on motion, ④ Japanese Orthopaedic Association Score, ⑤ site of cuff tear, ⑥ thickness of cuff tear, ⑦ repair conditions, ⑧ range of motion (ROM) before surgery, ⑨ ROM at 3 months after surgery, ⑩ ROM at 6 months after surgery, ⑪ muscle strength before surgery, and ⑫ muscle strength at 6 months after surgery．Results：Factors influencing the duration of rehabilitation included traffic accident and workman's compensation insurance coverage, thickness of tear, range of motion of flexion and external rotation at 3 months after surgery, and strength on abduction at 6 months after surgery.Conclusions：When beginning rehabilitation, the type of insurance and thickness of tear must be considered；during rehabilitation, ROM at 3 months and strength at 6 months after surgery must be considered.

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.

Comparison of Analgesic Efficacy between Single Interscalene Block Combined with a Continuous Intra-bursal Infusion of Ropivacaine and Continuous Interscalene Block after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study evaluated the effectiveness of a continuous interscalene block (CISB) by comparing it with that of a single interscalene block combined with a continuous intra-bursal infusion of ropivacaine (ISB-IB) after arthroscopic rotator cuff repair. METHODS: Patients who had undergone CISB (CISB group; n = 25) were compared with those who had undergone ISB-IB (ISB-IB group; n = 25) for more than 48 hours after surgery. The visual analog scale (VAS) for pain, motor and/or sensory deficit, supplementary analgesics and adverse effects were recorded. RESULTS: There were no significant differences between the postoperative VAS of the CISB and ISB-IB groups, except at 1 hour after surgery. Their supplementary analgesics of the two groups were similar. Transient motor weakness (52%) and sensory disturbance (40%) of the affected arm were observed in patients in the CISB group. The catheters came out accidentally in 22% of the CISB group but in only 4% of the ISB-IB group. CONCLUSIONS: ISB-IB provides similar analgesia to CISB. However, the ISB-IB group had a lower incidence of neurological deficits and better catheter retention.

Mid-term Results of Biceps Incorporating Suture Without Deteaching the Biceps Tendon from the Flenoid in the Large or Massive Cuff Tear

PURPOSE: The aim of this study is to analyze the clinical results of using the technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff. MATERIAL AND METHODS: Form January 2005 to January 2007, we performed the arthroscopic biceps repair with incorporating suture to the rotator cuff for 21 patients with large or massive rotator cuff tear. The mean follow up period was 23 months (range: 6-48months). The number of males and females was 9 and 13, respectively. The age distribution ranged from 47 to 73 years with a mean age of 60.3 years. We compared the preoperative score with the postoperative scores using the University of California Los Angeles (UCLA) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES) and a simple shoulder test (SST). RESULTS: The improvement in the VAS, ASES and the UCLA and SST scores was statistically significant at the final follow up (average follow-up 23 months) (p>0.05). Two of nine cases were found to have partial tear with continuity but seven cases were found to have complete tear according to the ultrasonography and MRI. CONCLUSION: The technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff is considered to be recommendable.