Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT).@*METHODS@#The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared.@*RESULTS@#All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation ( P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation ( P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group ( P<0.05). There was no significant difference in other baseline data between the two groups ( P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group ( P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups ( P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B ( P>0.05).@*CONCLUSION@#Tendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.

Evaluación funcional del manejo de rupturas masivas del manguito de los rotadores con el uso del balón subacromial / Functional evaluation of the management of massive rotator cuff ruptures with the use of the subacromial balloo

Resumen: Introducción: Las rupturas del manguito de los rotadores (MR) se presentan en más de 50% de los pacientes mayores de 60 años y pueden causar cambios en la biomecánica normal del hombro que pueden desencadenar una artropatía por desgarro del MR. Actualmente, no existe un consenso sobre el tratamiento para el desgarro masivo del MR. Objetivo: Evaluar los resultados clínicos y radiográficos de la colocación del balón subacromial en estas lesiones. Material y métodos: Estudio analítico, longitudinal y retrospectivo de 10 pacientes consecutivos tratados con el uso del balón subacromial. Se utilizaron escalas de Constant (CS) y ASES prequirúrgicas, a los seis y 12 meses de seguimiento postquirúrgico. Los resultados radiográficos fueron valorados por medio del intervalo acromio-humeral (IAH) en una radiografía anteroposterior (AP) verdadera de hombro. Resultados: La mejoría promedio en la CS fue de 41.7 ± 8.93 a los 12 meses de seguimiento, la escala de ASES mostró una mejoría promedio de 64.6 ± 4.9 a los 12 meses de seguimiento. El IAH prequirúrgico fue de 6.1 ± 1.10 y la media a los 12 meses de seguimiento fue de 7.1 ± 0.9. Se observó una mejoría clínica y radiográfica en todas las escalas; sin embargo, no se encontraron resultados estadísticamente significativos. Conclusión: El balón subacromial previene el ascenso de la cabeza humeral en los primeros 12 meses de colocado; suponemos que podría restaurar la cinemática glenohumeral normal mejorando movilidad y disminuyendo dolor.

Abstract: Introduction: Rotator cuff (MR) ruptures occur in more than 50% of patients over the age of 60, and can cause changes in normal shoulder biomechanics that can trigger rotator cuff tear arthropathy. There is currently no consensus on treatment for massive rotator cuff tears. Objective: To evaluate the clinical and radiographic outcomes of subacromial balloon placement in these lesions. Material and methods: Analytical, longitudinal and retrospective study of 10 consecutive patients treated with the use of the subacromial balloon. Constant (CS) and ASES scales were used preoperatively and at 6, 12 months of post-surgical follow-up. Radiographic results were assessed using the Acromio-humeral Interval (AHI) on a true AP shoulder X-ray. Results: The average improvement in CS was 41.7 ± 8.93 at 12 months of follow-up, the ASES scale showed an average improvement of 64.6 ± 4.9 at 12 months of follow-up. The presurgical AHI was 6.1 ± 1.10 and the mean at 12 months of follow-up was 7.1 ± 0.9. Clinical and radiographic improvement was observed at all scales, however no statistically significant results were found. Conclusion: The subacromial balloon prevents the ascent of the humeral head in the first 12 months of placement; we assume that it could restore normal glenohumeral kinematics by improving mobility and decreasing pain.

Effect of arthroscopic treatment of massive rotator cuff tears / 中国内镜杂志

Objective To investigate the effect of arthroscopic treatment of massive rotator cuff tears. Methods 62 patients with massive rotator cuff tears underwent arthroscopic treatment from January 2010 to February 2016 were enrolled in the study and divided into elder group (≥ 65 years old, n = 23) and control group (< 65 years old, n = 39) according to age. Scores of American Shoulder and Elbow Surgeons scale (ASES), University of California Los Angeles (UCLA) and Constant-Murley were compared before surgery and at 12 months after surgery between the two groups. Results The age in elder group was significantly higher than that in control group (P < 0.05). There were no significant differences in baseline data including gender, disease duration, etiology and history of shoulder trauma between the two groups (P > 0.05). No perioperative complication occurred in all cases and all surgery were completed safely and successfully. The scores of ASES, UCLA and Constant-Murley at 12 months after surgery in the two groups were all significantly higher than that before surgery (P > 0.05). There were no significant differences in the scores of ASES, UCLA and Constant-Murley before surgery and at 12 months after surgery between the two groups (P > 0.05). Conclusions Arthroscopic minimally invasive surgery could effectively improve shoulder function in patients with massive rotator cuff tears, and it could also achieve good results in elderly patients and is worthy of clinical application.

Current Concepts of Arthroplasty for the Treatment of Massive Rotator Cuff Tears / 대한정형외과학회잡지

The purpose of this article was to explore current concepts of arthroplasty as a treatment for massive rotator cuff tears. Pubmed was searched using the words 'massive rotator cuff tears' and 'arthroplasty' for suitable articles, which were then reviewed and investigated with respect to history, indications, clinical outcomes, and treatment algorithms of arthroplasty in patients of massive rotator cuff tear. Arthroplasty can be considered a primary surgical treatment for patients with irreparable massive rotator cuff tears and hemiarthroplasty may be the treatment of choice in younger patients with an intact coracoacromial arch and no pseudoparalysis. Reverse total shoulder arthroplasty is the best surgical treatment for pain relief and the restoration of active forward flexion in elderly patients with cuff tear arthropathy and pseudoparalysis. Proper selection of arthroplasty can provide pain relief and functional improvement in patients with massive rotator cuff tears. However, complication rates remain high, and emphasize the importance of appropriate patient selection and careful operative technique.