Osteolysis is observed around both bioabsorbable and nonabsorbable anchors on serial magnetic resonance images of patients undergoing arthroscopic rotator cuff repair

ObjectivesThe objective of this study was to evaluate the incidence of osteolysis around the bioabsorbable and nonabsorbable anchors using serial magnetic resonance imaging (MRI) and to determine the relationship between osteolysis and the retear rate after arthroscopic rotator cuff repair.MethodsFrom July 2012 to July 2014, 50 patients [28 men and 22 women; mean age, 56.4 (range: 45–56) years] underwent arthroscopic rotator cuff repair for a medium-to large-size tear with double-row suture-bridge technique. The bioabsorbable anchors used in the medial row comprised hydroxyapatite-polylactic acid enantiomer, and the nonabsorbable anchors in the lateral row were polyetheretherketone (PEEK)-type anchors. All patients underwent MRI evaluation at 3, 6, and 12 months postoperatively to determine osteolysis and identify any retear.ResultsThe incidences of osteolysis at 3, 6, and 12 months postoperatively were 1%, 4%, and 6% with nonabsorbable anchors and 13%, 29%, and 39% with bioabsorbable anchors, respectively. The incidences of osteolysis were significantly higher with the bioabsorbable anchors than with the nonabsorbable anchors (P < 0.005 for all three follow-ups). There was no significant difference between osteolysis and non-osteolysis groups regarding the retear rate or retear size (P = 0.189 and 0.069, respectively).ConclusionsOsteolysis was common around bioabsorbable anchors used for arthroscopic rotator cuff repair, and it also occurred around the PEEK-type nonabsorbable anchors. The incidence of osteolysis of nonabsorbable anchors was significantly lower than that of bioabsorbable anchors. Osteolysis did not significantly affect rotator cuff retear after arthroscopic repair with either bioabsorbable or nonabsorbable anchors.Level of evidenceLevel III, Therapeutic Study.     

Accuracy of ultrasonography and magnetic resonance imaging for detection of full thickness rotator cuff tears

Background:

Rotator cuff problems are frequently seen by orthopedic surgeons and accurate diagnosis is essential for appropriate management. Value of the clinical assessment of a shoulder is often limited, therefore, imaging studies have important implications in the management of rotator cuff pathologies.

Aim:

The purpose of this retrospective study is to compare the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) for detection of full-thickness rotator cuff tears.

Materials and Methods:

We reviewed 91 consecutive cases of shoulder arthroscopy and open rotator cuff repair, who had undergone preoperative investigation in the form of either an ultrasound or MRI. Thirty-six patients had an ultrasound and 55 had an MRI for their affected shoulders. We compared the accuracy of US and MRI for detection of full-thickness rotator cuff tears, using the operative findings as the ‘gold standard’. Data regarding a supraspinatus tear was assessed for the purpose of this study.

Results:

Ultrasonography correctly diagnosed 15 out of 17 tears (sensitivity of 0.88). There were 17 true-negative and two false-positive ultrasounds (specificity of 0.89). MRI accurately identified 33 of the 36 tears (sensitivity of 0.91). There were 16 true-negative and three false-positive tears on MRI (specificity of 0.84). The positive predictive value (PPV) was 88% for US and 92% for MRI. The negative predictive value (NPV) was 89% for US and 84% for MRI. The overall accuracy of the ultrasound was 88.89% (95% confidence interval (CI) = 74.09 to 96.18) as compared to 89.09% (95% CI = 77.82% to 95.26%) for the MRI.

Conclusion:

Full-thickness rotator cuff tears can be identified using ultrasound and MRI with comparable accuracy. US being a dynamic study and better tolerated by the patient, can therefore be used as the first-line investigation for rotator cuff tear, where appropriate skills are available to reduce the waiting time and cost of investigation.     

The influence of rotator cuff pathology on functional outcome in total shoulder replacement

Introduction:

Total shoulder replacement (TSR) is a reliable treatment for glenohumeral osteoarthritis. In addition to proper component orientation, successful arthroplasty requires accurate restoration of soft tissues forces around the joint to maximize function. We hypothesized that pathological changes within the rotator cuff on preoperative magnetic resonance imaging (MRI) adversely affect the functional outcome following TSR.

Materials and Methods:

A retrospective analysis of case notes and MRI of patients undergoing TSR for primary glenohumeral osteoarthritis over a 4-year period was performed. Patients were divided into three groups based upon their preoperative MRI findings: (1) normal rotator cuff, (2) the presence of tendonopathy within the rotator cuff, or (3) the presence of a partial thickness rotator cuff tear. Intra-operatively tendonopathy was addressed with debridement and partial thickness tears with repair. Functional outcome was assessed with the Oxford Shoulder Score (OSS), and quick disabilities of the arm, shoulder and hand score (quick-DASH).

Results:

We had a full dataset of complete case-notes, PACS images, and patient reported outcome measures available for 43 patients, 15 in group 1, 14 in group 2, and 14 in group 3. Quick-DASH and OSS were calculated at a minimum of 24 months following surgery. There was no statistically significant difference between the results obtained between the three groups of either the OSS (P = 0.45), or quick-DASH (P = 0.46).

Conclusions:

TSR is an efficacious treatment option for patients with primary glenohumeral osteoarthritis in the medium term, even in the presence of rotator cuff tendonopathy or partial tearing. Minor changes within the cuff do not significantly affect functional outcome following TSR.     

Clinical comparison between double-row and transosseous-equivalent repairs for medium to large size rotator cuff tears

Background

The transosseous-equivalent (TOE) repair of the rotator cuff tears was invented to make up for several shortcomings of the double-row (DR) repair. However, no studies have compared the clinical aspects of the DR repair and the TOE technique, supporting the superior results of the TOE technique over the DR repair, including the benefit of minimizing surgical steps. We asked whether differences existed between the two repairs regarding clinical outcomes, time and costs.

Materials and methods

Subjects included 55 using the DR repair and 119 using the TOE repair for the medium to large sized rotator cuff tears. Clinical outcomes were measured with a Visual Analog Scale, American Shoulder and Elbow Surgeons score, Constant score, and shoulder strength. For practical aspects, operative time and number of suture anchors used for the medial and lateral rows were compared.

Results

Both repairs brought substantial improvements in pain and function. However, significant differences were not detected between the repairs in all the clinical measurements. Regarding operative time and costs, in the medium size tears, a statistical difference was found only in the anchors used for the lateral row. In the large size tears, the DR repair required more operation time than the TOE repair, while the TOE repair used more anchors for the lateral row.

Conclusion

This study failed to demonstrate clinical differences between the techniques. However, when stratifying rotator cuff tears according to the tear sizes, significant differences were found in operative time and cost: the DR repair had the advantage of cost effectiveness by saving anchors for the lateral row, while the TOE repair required less operative time with more anchors used for the lateral row in the large size tears. This finding provides evidence to support the use of the TOE repair to reduce surgical steps.     

Clinical outcomes of arthroscopic single and double row repair in full thickness rotator cuff tears

Background:

There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears.

Materials and Methods:

22 patients of arthroscopic single row repair (group I) and 25 patients who underwent double row repair (group II) from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES).

Results:

In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method.

Conclusions:

Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.     

Osteolysis after rotator cuff repair with bioabsorbable anchors

Purpose  

The current study was designed to evaluate the rate of osteolysis and the clinical and functional outcomes in patients who underwent mini-open rotator cuff repairs using first generation bioabsorbable suture anchors. Our hypothesis was that patients with osteolysis noted on post-repair MRI would have an accompanying decrease in functional and clinical patient outcomes when compared with patients who did not have osteolysis evident on post-repair MRI.     

Arthroscopic rotator cuff repair in elite rugby players

Background

Rugby is an increasingly popular collision sport. A wide spectrum of injuries can be sustained during training and match play. Rotator cuff injury is uncommon in contact sports and there is little published literature on the treatment of rotator cuff tears in rugby players.

Aims

We therefore reviewed the results and functional outcomes of arthroscopic rotator cuff repair in elite rugby players.

Materials and Methods

Eleven professional rugby players underwent arthroscopic rotator cuff repair at our hospital over a 2-year period. We collected data on these patients from the operative records. The patients were recalled for outcome scoring and ultrasound scans.

Results

There were seven rugby league players and four rugby union players, including six internationals. Their mean age was 25.7 years. All had had a traumatic episode during match play and could not return to the game after the injury. The mean time to surgery was 5 weeks. The mean width of the cuff tear was 1.8 cm. All were full- thickness cuff tears. Associated injuries included two Bankart lesions, one bony Bankart lesion, one posterior labral tear, and two 360° labral tears. The biceps was involved in three cases. Two were debrided and a tenodesis was performed in one. Repair was with suture anchors. Following surgery, all patients underwent a supervised accelerated rehabilitation programme. The final follow-up was at 18 months (range: 6–31 months) post surgery. The Constant scores improved from 44 preoperatively to 99 at the last follow-up. The mean score at 3 months was 95. The Oxford shoulder score improved from 34 to 12, with the mean third month score being 18. The mean time taken to return to full match play at the preinjury level was 4.8 months. There were no complications in any of the patients and postoperative scans in nine patients confirmed that the repairs had healed.

Conclusion

We conclude that full-thickness rotator cuff tears in the contact athlete can be addressed successfully by arthroscopic repair, with a rapid return to preinjury status.     

An in-vitro study of rotator cuff tear and repair kinematics using single- and double-row suture anchor fixation

Purpose:

Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder.

Materials and Methods:

Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs) were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm) tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device.

Results:

Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen.

Conclusions:

This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference (P ≥ 0.10) was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs.

Clinical Relevance:

Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease.     

Outcome analysis of arthroscopic treatment of partial thickness rotator cuff tears

Background:

Partial thickness rotator cuff tears occupy an important position in the spectrum of rotator cuff disease. The development of a more comprehensive classification has been sought to address both the tear location and extent, which may influence clinical results. The purpose of this study is to classify partial thickness rotator cuff tears according to the arthroscopic findings and to evaluate the clinical outcomes after arthroscopic repair of partial thickness tears.

Materials and Methods:

One hundred and two patients had arthroscopic treatment of partial thickness rotator cuff tears. The inclusion criterion for the study was a partially torn supraspinatus tendon involving articular or bursal side, verified by direct arthroscopic visualization. Outcome analysis was exclusively applied to patients who underwent transtendon repair, using the shoulder index of American Shoulder and Elbow Society and the University of California Los Angeles (UCLA) rating system.

Results:

Partial thickness rotator cuff tears were divided into five groups according to arthroscopic findings. There was significant improvement after surgery in all parameters of clinical evaluation in the tears that warranted repair. Arthroscopic repair in situ (transtendon technique) may be the preferred option in unstable partial thickness tear.

Conclusion:

The proposed classification system may assist decision making in the treatment of partial thickness rotator cuff tears.     

Rates of medial and lateral row failure and risk factors for Re-tear in arthroscopic double row rotator cuff repair

A common postoperative complication after rotator cuff repair is re-tear requiring a secondary procedure. Double row and trans-osseous equivalent repair techniques have become increasingly popular in recent years, however repair failure remains a relatively common complication after primary rotator cuff repair. A retrospective observational study of 389 consecutive patients undergoing arthroscopic double-row rotator cuff repair from February 1, 2014 to March 31, 2020 was conducted. Univariate and multivariate statistics were used to assess differences in demographics, comorbidities, and tear characteristics between patients who experienced re-tear and those who did not. Repair failures were confirmed by plain MRI or intraoperatively during repeat surgical treatment. A subgroup analysis of patients who experienced re-tear due to medial row failure was conducted. The overall re-tear rate was 8.2% (32 patients). Six patients (1.5%) experienced medial row failure, while 26 patients (6.7%) experienced lateral row failure. The average time to re-tear was 279.3 ± 291.2 days. On multivariate analysis, patients with Goutallier Classification ≥3 (OR: 4.274, p = 0.046) and 3 anchor repair (OR: 5.387, p = 0.027) were at significantly increased risk for any re-tear after controlling for other tear characteristics. No statistically significant independent risk factors for medial row failure were identified after controlling for confounding variables. Goutallier classification greater than 3 and a primary repair with 3 anchors are significant risk factors for re-tear after double row rotator cuff repair, however they are not associated with increased occurrence of medial row failure. Further evaluation of risk factors for medial row failure is required to avoid this rare but serious re-tear pattern.     

Single-row,double-row,and transosseous equivalent techniques for isolated supraspinatus tendon tears with minimal atrophy: A retrospective comparative outcome and radiographic analysis at minimum 2-year followup

Purpose:

The purpose of this study was to measure and compare the subjective, objective, and radiographic healing outcomes of single-row (SR), double-row (DR), and transosseous equivalent (TOE) suture techniques for arthroscopic rotator cuff repair.

Materials and Methods:

A retrospective comparative analysis of arthroscopic rotator cuff repairs by one surgeon from 2004 to 2010 at minimum 2-year followup was performed. Cohorts were matched for age, sex, and tear size. Subjective outcome variables included ASES, Constant, SST, UCLA, and SF-12 scores. Objective outcome variables included strength, active range of motion (ROM). Radiographic healing was assessed by magnetic resonance imaging (MRI). Statistical analysis was performed using analysis of variance (ANOVA), Mann — Whitney and Kruskal — Wallis tests with significance, and the Fisher exact probability test <0.05.

Results:

Sixty-three patients completed the study requirements (20 SR, 21 DR, 22 TOE). There was a clinically and statistically significant improvement in outcomes with all repair techniques (ASES mean improvement P = <0.0001). The mean final ASES scores were: SR 83; (SD 21.4); DR 87 (SD 18.2); TOE 87 (SD 13.2); (P = 0.73). There was a statistically significant improvement in strength for each repair technique (P < 0.001). There was no significant difference between techniques across all secondary outcome assessments: ASES improvement, Constant, SST, UCLA, SF-12, ROM, Strength, and MRI re-tear rates. There was a decrease in re-tear rates from single row (22%) to double-row (18%) to transosseous equivalent (11%); however, this difference was not statistically significant (P = 0.6).

Conclusions:

Compared to preoperatively, arthroscopic rotator cuff repair, using SR, DR, or TOE techniques, yielded a clinically and statistically significant improvement in subjective and objective outcomes at a minimum 2-year follow-up.

Level of Evidence:

Therapeutic level 3.     

Are shoulder surgeons any good at diagnosing rotator cuff tears using ultrasound?: A comparative analysis of surgeon vs radiologist

High-resolution ultrasound has gained increasing popularity as an aid in the diagonsis of rotator cuff pathology. With the advent of portable machines, ultrasound has become accessible to clincians.

Aim:

This study was conducted to evaluate the accuracy and reliability of ultrasound in diagnosing rotator cuff tears by a shoulder surgeon and comparing their ability to that of a musculoskeletal radiologist.

Materials and Methods:

Seventy patients undergoing shoulder arthroscopy for rotator cuff pathology underwent preoperative ultrasonography (US). All patients were of similar demographics and pathology. The surgeon used a Sonosite Micromax portable ultrasound machine with a 10-MHz high frequency linear array transducer and the radiologist used a 9-12 MHz linear array probe on a Siemens Antares machine. Arthroscopic diagnosis was the reference standard to which ultrasound findings were compared.

Results:

The sensitivity in detecting full thickness tears was similar for both the surgeon (92%) and the radiologist (94%). The radiologist had 100% sensitivity in diagnosing partial thickness tears, compared to 85.7% for the surgeon. The specificity for the surgeon was 94% and 85% for the radiologist.

Discussion:

Our study shows that the surgeons are capable of diagnosing rotator cuff tears with the use of high-resolution portable ultrasound in the outpatient setting.

Conclusion:

Office ultrasound, by a trained clinician, is a powerful diagnostic tool in diagnosing rotator cuff tears and can be used effectively in running one-stop shoulder clinics.     

Pulmonary embolism following rotator cuff repair

Background:

Previous studies have provided data on the incidence of pulmonary embolism following shoulder arthroplasty and repair of fractures of the proximal humerus. However, there is no information on the risk of pulmonary embolism following the surgical management of rotator cuff tears.

Methods:

We performed a review of 1176 patients who underwent operative procedures for rotator cuff tears between January 1^st, 2001 and December 31^st, 2005 to identify all patients who developed a symptomatic pulmonary embolism postoperatively.

Results:

Three patients developed pulmonary embolisms that were diagnosed with computed tomography angiography. The overall incidence was calculated to be 0.26%. None of the patients died as a result of the pulmonary embolism.

Conclusions:

The data from this review indicates that the risk of pulmonary embolism following surgery for rotator cuff repair is low, but not nonexistent. The most common presenting symptoms of pulmonary embolism were chest pain, shortness of breath, and hypoxia. This study should raise surgeons'' awareness about this possible complication following rotator cuff repair surgery.     

Mid-term results of arthroscopic subacromial decompression in patients with or without partial thickness rotator cuff tears

Aim:

To evaluate mid-term outcome in patients who underwent arthroscopic subacromial decompression (ASD) for shoulder impingement syndrome with intact and partially torn rotator cuffs.

Materials and Methods:

A total of 80 consecutive patients (83 shoulders) who underwent ASD for impingement syndrome between 2003 and 2006 were analyzed. Mean age was 57.1 years. Patients’ self-reported Oxford Shoulder Score (OSS) for pain was collected prospectively and was used as an instrument to measure surgical outcome.

Results:

The mean initial and final OSS for patients with an intact rotator cuff was 26.1 and 40.3, respectively, at a mean follow up of 71.9 months (nearly 7 years). The mean initial and final OSS for patients with a partially torn articular sided tear was 22.6 and 41.9, respectively, at mean follow up of 70.7 months. Both groups showed significant sustained improvement (P < 0.0001). The mean improvement of OSS following ASD was statistically greater (P < 0.03) for partially torn rotator cuff group (19.3 points) as compared to those with normal rotator cuff (14.2 points).

Conclusion:

Patients with dual pathology (partial rotator cuff tear and impingement) appreciated a significantly greater improvement following ASD compared to those with impingement alone. Both groups of patients had a similar final outcome at a mid-term follow up.

Level of Evidence:

IV, retrospective study on consecutive series of patients.     

The lateral Jobe test: A more reliable method of diagnosing rotator cuff tears

Purpose:

The most reliable clinical investigations to diagnose rotator cuff tears reported in the literature is a triad of weakness on resisted external rotation, pain on impingement, and weakness on supraspinatus testing, or a combination of two of the above in a patient over 60 years of age. We present a simple new clinical test “The lateral Jobe Test” and compare it to these combined tests. The lateral Jobe test is performed with the patient’s shoulder abducted 90° in the coronal plane and internally rotated so that with the elbows flexed 90° the fingers point inferiorly and thumbs medially. A positive test is pain or weakness on resisting an inferiorly directed force applied to the distal arms or an inability to perform the test.

Materials and Methods:

A consecutive series of 175 patients undergoing shoulder arthroscopy were reviewed prospectively and examined by two independent orthopedic surgeons blinded to the diagnosis. The results of the clinical tests were validated against arthroscopic findings.

Results:

The lateral Jobe test had a significantly higher sensitivity (81 vs. 58%) than the combined tests. The specificity of both was similar at 89 and 88%, respectively.

Conslusion:

The lateral Jobe test is a simple single test which can help in the clinical diagnosis of rotator cuff tears.

Level of Evidence:

Level IIb     

Healing rates for challenging rotator cuff tears utilizing an acellular human dermal reinforcement graft

Purpose:

This study presents a retrospective case series of the clinical and structural outcomes (1.5 T MRI) of arthroscopic rotator cuff repair with acellular human dermal graft reinforcement performed by a single surgeon in patients with large, massive, and previously repaired rotator cuff tears.

Materials and Methods:

Fourteen patients with mean anterior to posterior tear size 3.87 ± 0.99 cm (median 4 cm, range 2.5–6 cm) were enrolled in the study and were evaluated for structural integrity using a high-field (1.5 T) MRI at an average of 16.8 months after surgery. The Constant-Murley scores, the Flexilevel Scale of Shoulder Function (Flex SF), scapular plane abduction, and strength were analyzed.

Results:

MRI results showed that the rotator cuff repair was intact in 85.7% (12/14) of the patients studied. Two patients had a Sugaya Type IV recurrent tear (2 of 14; 14.3%), which were both less than 1 cm. The Constant score increased from a preoperative mean of 49.72 (range 13–74) to a postoperative mean of 81.07 (range 45–92) (P value = 0.009). Flexilevel Scale of Shoulder Function (Flex SF) Score normalized to a 100-point scale improved from a preoperative mean of 53.69 to a postoperative mean of 79.71 (P value = 0.003). The Pain Score improved from a preoperative mean of 7.73 to a postoperative mean of 13.57 (P value = 0.008). Scapular plane abduction improved from a preoperative mean of 113.64° to a postoperative mean of 166.43° (P value = 0.010). The strength subset score improved from a preoperative mean of 1.73 kg to a postoperative mean of 7.52 kg (P value = 0.006).

Conclusions:

This study presents a safe and effective technique that may help improve the healing rates of large, massive, and revision rotator cuff tears with the use of an acellular human dermal allograft. This technique demonstrated favorable structural healing rates and statistically improved functional outcomes in the near term.

Level of Evidence:

4. Retrospective case series.     

Long-term outcome and structural integrity following open repair of massive rotator cuff tears

Background:

Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit.

Materials and Methods:

During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST) and a pain visual analog scale (VAS). At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol.

Results:

The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05). Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs.

Conclusions:

Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did not equal that of the contralateral shoulder after 6 years.

Level of evidence:

Level IV     

Partial-thickness articular surface rotator cuff tears in patients over the age of 35: Etiology and intra-articular associations

Purpose:

Partial-thickness articular-sided rotator cuff tears have a multifactorial etiology and are associated with degeneration of the tendon. They are often described as an injury of the young athlete, although they are also found in the older population. The aim of this study was to investigate the frequency and associations of partial-thickness articular-sided tears in patients over the age of 35 years.

Design:

Retrospective

Materials and Methods:

A retrospective study of all arthroscopic procedures for rotator cuff pathology in patients over the age of 35 years over a 2-year period by a single surgeon was performed. The included patients were divided into two groups based on the arthroscopic findings: those with a partial-thickness articular-sided rotator cuff tear and those with pure tendinopathy. The groups were then compared to identify the associated pathology with the rotator cuff lesions. 2×2 contingency table analysis and unpaired Student''s t-test were used for statistical analysis.

Results:

One hundred patients were included in the study of whom 62 had a partial articular-sided tear. Those with a partial articular-sided tear were older (P=0.0001), were more commonly associated with a documented injury (P=0.03), and more commonly had biceps degeneration (P=0.001) and synovitis (P=0.02) within the joint.

Conclusion:

Partial-thickness articular-sided tears are a common occurrence in patients requiring arthroscopic surgery for rotator cuff pathology over the age of 35 years. This probably reflects an injury in an already degenerate cuff. This would support the theory of intrinsic degeneration of the tendon in this age group and probably represent a different etiology to those seen in the young athletes.

Level of Evidence:

Level 3     

Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

INTRODUCTION

Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space.

PATIENTS AND METHODS

In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids.

RESULTS

With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0).

CONCLUSIONS

This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.