Is sarcopenia a risk factor for rotator cuff tears?

BACKGROUND: Sarcopenia is the loss of muscle mass and consequent loss of muscle function with aging. Currently, it is considered an independent risk factor for falls and fractures, disability, postoperative complications, and mortality. Rotator cuff tears are known to be influenced by systemic diseases such as diabetes mellitus, hypercholesterolemia, thyroid disease, and osteoporosis. The aim of our study was to determine if there is a correlation between sarcopenia prevalence and rotator cuff tears. METHODS: This is a prospective case-control study. Between May 2017 and May 2018, 106 patients were evaluated and divided into 2 groups. Group 1 (cases) included 53 consecutive patients with chronic symptomatic full-thickness rotator cuff tears (mean age, 72 ± 5 years), and group 2 (controls) included 53 patients without rotator cuff tears (mean age, 71 ± 6 years). Sarcopenia was diagnosed with the presence of 2 of 3 criteria: low skeletal muscle mass, inadequate muscle strength, and inadequate physical performance. Rotator cuff integrity was evaluated with magnetic resonance imaging in all patients. RESULTS: No significant differences were found in baseline data and demographic factors between the groups, except for the smoking habit (P = .02). The prevalence of sarcopenia was not significantly different between the groups, nor were gait speed, grip strength, and skeletal muscle mass index (P = .15, .99, and .9, respectively). CONCLUSION: The prevalence of sarcopenia in patients with rotator cuff tears was similar to an age- and sex-matched control population. Thus, with these results, we are not able to consider sarcopenia as an independent risk factor for rotator cuff tears.

Arthroscopic Acute Bony Bankart Repair in Lateral Decubitus.

The optimal management of anterior shoulder instability continues to be a challenge. The presence of an anterior glenoid rim fracture in the context of a glenohumeral dislocation, also called "bony Bankart lesion," can alter therapeutic behavior. Reduction and fixation of the bone fragment has been shown to greatly reduce the risk of recurrence once bone consolidation is achieved. However, there is no gold standard surgical technique. Stability of fixation and the healing of the bony fragment are still a concern, and there are no clinical studies comparing the different techniques to date. The aim of this report is to describe an arthroscopic double-point fragment fixation technique in lateral decubitus for the treatment of an acute traumatic shoulder dislocation with a bony Bankart lesion.

Long-Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears.

PURPOSE: To analyze clinical outcomes, return to sports, and complications in a series of patients with painful partial-thickness rotator cuff tears treated with arthroscopic in situ repair with suture anchors who had a minimum of 8 years of follow-up. METHODS: Sixty-two patients who had undergone an arthroscopic in situ repair for partial-thickness rotator cuff tears were evaluated. All injuries involved the supraspinatus tendon. Clinical assessment consisted of glenohumeral range-of-motion measurement and the American Shoulder and Elbow Surgeons score. Pain was rated by using a visual analog scale. We assessed return to sports and the level of performance achieved after surgery. Postoperative complications were also assessed. RESULTS: Mean age was 52.4 years (range, 32 to 67 years), and mean duration of follow-up was 10.4 years (range, 8 to 12 years). All active range-of-motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons score improved from 45.6 to 85.1; and the visual analog scale scores improved from 6.4 to 1.6 (P < .0001). Thirty patients participated in sports before injury: 21 were recreational athletes and 9 were competitive athletes. Twenty-six (87%) were able to return to sports, and 24 (80%) returned to the same level they had achieved before injury. No significant difference regarding functional outcomes or return to sports was found between patients with articular-sided tears and those with bursal-sided tears. No revision surgeries were performed. Three patients had postoperative adhesive capsulitis that responded favorably to physical therapy. CONCLUSIONS: During long-term follow-up, arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, and revision rates are low. Most patients return to their chosen sport at the same level they had achieved before injury. The results are equally favorable for articular-sided and bursal-sided tears. LEVEL OF EVIDENCE: IV, therapeutic case series.

Arthroscopic in Situ Repair of Partial Bursal Rotator Cuff Tears Without Acromioplasty.

PURPOSE: To evaluate functional outcomes and complications in a consecutive group of patients with partial bursal rotator cuff tears (PBRCTs) treated with insitu repair without acromioplasty. METHODS: Seventy-four patients who had undergone an arthroscopic single row in situ repair for bursal-sided rotator cuff tears were evaluated. Clinical assessment consisted of glenohumeral range of motion measurement, the American Shoulder and Elbow Surgeons score, and the University of California at Los Angeles score. Pain was recorded using a visual analog scale. Postoperative complications were also assessed. RESULTS: Mean age was 55.2 years (±6.3) with a minimum of 2-year follow-up. After arthroscopic repair, all active range of motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons scores improved from 42.5 to 86.1; the University of California at Los Angeles scores improved from 15.8 to 31.4, and the visual analog scale scores improved from 6.6 to 0.7 (P < .0001). Only 3 patients developed a postoperative adhesive capsulitis that responded to physical therapy. CONCLUSIONS: In the midterm follow-up (42 months), arthroscopic in situ repair of PBRCTs without acromioplasty is a reliable procedure that produces significant functional improvements and pain relief. LEVEL OF EVIDENCE: Level IV, therapeutic case series.