The use of split deltoid-flap in the treatment of massive rotator cuff defects: a retrospective study of 61 patients

Massive and irreparable rotator cuff tears are a challenge for the orthopaedic surgeon. The purpose of this study was to report our experience with the treatment of massive and irreparable defects of the rotator cuff with a modified deltoid split transfer. Between 1996 and 2004, for all patients suffering from full-thickness tears of the rotator cuff (>5 cm tears in diameter, involving two or more tendons) were operated with a modified deltoid split transfer. A total of 61 patients (39 females and 22 males; age 61.9: range 49-75 years) were operated. Duration of symptoms before surgery averaged 9.6 months (range 3.5-14 months). The patients were followed for an average of 46 months (range 24-64 months). The operation included an arthroscopic evaluation, acromioplasty with resection of the lateral clavicular end, resection of the acromioclavicular joint and where necessary biceps tenodesis. The cuff defect was repaired by transfer of half thickness anterior deltoid-flap (3 cm x 5 cm) into the defect. All patients were evaluated both preoperatively and postoperatively with regard to pain, ability to perform activities of daily life, range of motion, strength and satisfaction. The patients subjectively rated their results-49 (80%) excellent or good outcome, seven moderate and five poor. Preoperatively, the Constant amounted 33.5 +/- 7.74 points. At follow-up, the score significantly increased to 77.57 +/- 19.74 points. The acromiohumeral distance increased from 5.1 +/- 1.4 mm to 9.1 +/- 1.5 mm. Pain free flexion improved from an average 90 degrees to an average 165 degrees (P < 0.01), and abduction improved from an average 110 degrees to an average 160 degrees (P < 0.01). The mean external rotation increased from 40 degrees to 65 degrees (P < 0.01), and internal rotation increased from 50 degrees to 70 degrees (P = 0.06). In the MRI and ultrasound examination, all patients had intact flap, except the three patients with flap necrosis. There were eight complications-three haematomas, two superficial wound infections which did not influence the outcome, and three fibrotic transformation after an early aseptic necrosis of the deltoid flap, which were re-operated. This technique is easy to perform, and it is possible to obtain a satisfactory outcome after repair of massive tears of the rotator cuff. A substantial decrease of pain, increased stability, an increase range of motion and strength can be achieved, with proper rehabilitation.     

Deltoid flap combined with fascia lata autograft for rotator cuff defects: a histologic study

The purpose of this study was to compare the histological characteristics of an autogenous fascia lata graft alone and a fascia lata graft combined with a deltoid flap in the reconstruction of rotator cuff tears. Ten New Zealand white rabbits were divided into two groups. Infraspinatus tendon defects (1 × 1 cm) were created in each animal. Reconstruction consisted of either a fascia lata graft alone or a fascia lata graft combined with a distally based deltoid flap. At 3 months, tissue harvest and histological analysis was performed. Compared to the fascia lata graft alone, there was significantly increased remodeling activity and neovascularization in the group that included a deltoid flap. Also, there was pronounced interdigitation at the graft/flap interface in the latter group. A mutually beneficial relationship may exist when an autogenous fascial graft is combined with a functional deltoid flap for reconstructing large rotator cuff defects.     

肩关节镜下肱二头肌长头肌腱转位重建肩关节上关节囊修复巨大肩袖撕裂

目的探讨肩关节镜下利用肱二头肌长头肌腱(LHBT)转位重建肩关节上关节囊修复巨大肩袖撕裂的临床效果。方法采用回顾性病例系列研究分析2017年12月至2019年1月同济大学附属上海市第十人民医院收治的64例巨大肩袖撕裂患者临床资料,其中男26例,女38例;年龄50~75岁[(62.5±4.8)岁]。在关节镜下利用LHBT转位行肩关节上关节囊重建。记录和评估术前及末次随访时肩关节活动度(前屈、外展、外旋)、肩-肱距、视觉模拟评分(VAS)、Constant-Murley评分、美国肩肘外科协会(ASES)评分。借助MRI评估末次随访时重建结构的完整性以及肩袖再撕裂发生率。观察术后并发症情况。结果患者均获随访13~25个月[(18.2±4.3)个月]。末次随访时,肩关节前屈为(149.5±7.8)°,外展为(162.0±6.6)°,外旋为(60.6±11.8)°,肩-肱距为(7.4±0.6)cm,VAS为1.0(0.0,1.0)分,Constant-Murley评分为(90.5±2.6)分,ASES评分为(90.8±4.2)分,均较术前明显改善[前屈:(73.8±5.3)°,外展:(85.8±5.5)°、外旋:(34.3±5.8)°,肩-肱距:(5.9±0.8)cm,VAS:6.5(6.0,7.0)分,Constant-Murley:(41.8±5.4)分,ASES评分:(41.4±6.1)分](P<0.01)。56例患者末次随访时重建结构完好,7例患者重建结构小撕裂予以翻修,1例患者重建失败予以翻修,肩袖修补术后再撕裂率13%(8/64)。患者术后无明显手术并发症出现,切口无感染。结论利用LHBT转位重建肩关节上关节囊修复巨大肩袖撕裂,安全可靠,可有效改善关节活动度,并减轻患肩关节疼痛,恢复肩关节功能。     

Deltoid muscle and tendon tears in patients with chronic rotator cuff tears

Purpose To describe the magnetic resonance imaging (MRI) appearances of tears of the deltoid muscle and tendon in patients with rotator cuff tears and without a prior history of shoulder surgery. Materials and methods Deltoid tears diagnosed on MR examinations were prospectively recorded between February 2003 through June 2004. The images of these patients were then retrospectively reviewed to determine the location of the deltoid tear, the presence of rotator cuff tears, tendon retraction, muscle atrophy, degree of humeral head subluxation, bony erosive changes involving the undersurface of the acromion, and the presence of edema or fluid-like signal intensity in the deltoid muscle and overlying subcutaneous tissues. Results There were 24 (0.3%) patients with deltoid tears; nine men and 15 women. The age range was 54 to 87 (average 73) years. The right side was involved in 20 cases, and the left in four cases. Fifteen patients had full thickness and nine had partial thickness tears of the deltoid. Shoulder pain was the most common presenting symptom. The physical examination revealed a defect in the region of the deltoid in two patients. Nineteen patients had tears in the muscle belly near the musculotendinous junction, and five had avulsion of the tendon from the acromial origin. Full thickness rotator cuff tears were present in all of the patients, and 22 patients had associated muscle atrophy. Subcutaneous edema and fluid-like signal was present in 15 patients. Conclusion Tears of the deltoid muscle or tendon is an unusual finding, but they can be seen in patients with chronic massive rotator cuff tears. Partial thickness tears tend to involve the undersurface of the deltoid muscle and tendon. Associated findings such as intramuscular cyst or ganglion in the deltoid muscle belly and subcutaneous edema or fluid-like signal overlying the deltoid in a patient with a rotator cuff tear should raise the suspicion of a deltoid tear.     

Preliminary results after rotator cuff reconstruction augmented with an autologous periosteal flap

Periosteal augmentation of tendons in the course of refixation to bone has been shown to be a suitable method for early primarily stable osteofibroblastic integration. The aim of this study was to evaluate the clinical and radiological results of open rotator cuff reconstruction using an autologous periosteal flap augmentation technique. The research was performed as a prospective cohort study. Twenty-three prospective patients (average age 59.7 years) with degenerative rotator cuff tears were operated on with an open technique and a subtendinous periosteal flap augmentation using bioabsorbable suture anchors and a modified Mason–Allen technique. Clinical evaluation consisted of the Constant-Score and the Simple Shoulder test. Radiological evaluation included standard radiographs and magnetic resonance imaging (MRI). Twenty patients were evaluated at a mean follow-up of 14.4 months. The average Constant Score increased significantly from 51.7 to 80.9 points (p<0.05) with 12 excellent, seven good and one satisfactory result. The Simple Shoulder test showed a significant increase of an average of 4.8–10.7 questions answered with yes (p<0.05). Four patients (20%) demonstrated a retear of the tendon on postoperative MRI. Ectopic ossifications in the supraspinatus tendon were found in four patients (20%) but these had no impact on the final clinical results. Open rotator cuff repair augmented with an autologous periosteal flap shows high patient satisfaction level with low rerupture rates. Mid- and long-term results remain to be seen. The potential benefits compared with conventional open or arthroscopic rotator cuff surgery must be examined in prospective randomized studies.     

Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial

BACKGROUND: Restoring the anatomical footprint may improve the healing and mechanical strength of repaired tendons. A double row of suture anchors increases the tendon-bone contact area, reconstituting a more anatomical configuration of the rotator cuff footprint. HYPOTHESIS: There is no difference in clinical and imaging outcome between single-row and double-row suture anchor technique repairs of rotator cuff tears. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: The authors recruited 60 patients. In 30 patients, rotator cuff repair was performed with a single-row suture anchor technique (group 1). In the other 30 patients, rotator cuff repair was performed with a double-row suture anchor technique (group 2). RESULTS: Eight patients (4 in the single-row anchor repair group and 4 in the double-row anchor repair group) did not return at the final follow-up. At the 2-year follow-up, no statistically significant differences were seen with respect to the University of California, Los Angeles score and range of motion values. At 2-year follow-up, postoperative magnetic resonance arthrography in group 1 showed intact tendons in 14 patients, partial-thickness defects in 10 patients, and full-thickness defects in 2 patients. In group 2, magnetic resonance arthrography showed an intact rotator cuff in 18 patients, partial-thickness defects in 7 patients, and full-thickness defects in 1 patient. CONCLUSION: Single- and double-row techniques provide comparable clinical outcome at 2 years. A double-row technique produces a mechanically superior construct compared with the single-row method in restoring the anatomical footprint of the rotator cuff, but these mechanical advantages do not translate into superior clinical performance.     

Outcome and structural integrity after arthroscopic rotator cuff repair using 2 rows of fixation: minimum 2-year follow-up

BACKGROUND: Although arthroscopic repairs of the rotator cuff are becoming increasingly popular, security of fixation remains a concern. Two-row repairs have been described, but clinical outcome reports have primarily involved open techniques. HYPOTHESIS: An arthroscopic repair technique that uses 2 rows of fixation produces satisfactory outcome and structural integrity by ultrasonography. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Forty-eight patients (52 shoulders) with a full-thickness, but fully reducible, rotator cuff tear who met the inclusion criteria were treated with an arthroscopic rotator cuff repair using 2 rows of suture anchors. The mean tear size was 2.47 cm (range, 1-4 cm). Patients were evaluated by subjective functional assessment (L'Insalata Shoulder Rating Questionnaire), clinical examination, including measured strength testing, and ultrasonography. RESULTS: At a mean follow-up of 30 months (minimum of 2 years), functional scores improved from a mean of 42 preoperatively to 93 postoperatively (P < .001). Active range of motion was increased in all measured planes (P < .001). Strength was also increased in elevation (P < .001), external rotation (P < .001), and internal rotation (P = .033). Nine of the 52 shoulders (17%) had evidence of retear or persistent defect on postoperative ultrasonography. There were no differences detected in functional scores between those with an intact repair and those with a defect, but those with an intact repair were stronger in elevation (P = .006) and external rotation (P = .001). CONCLUSION: An arthroscopic 2-row rotator cuff repair produces excellent functional outcome and repair integrity comparable with previously reported open repairs. Presence of a defect after repair did not appear to affect patient-reported function and return to preinjury activity but did affect measured strength.     

Repair of rotator cuff tears in tennis players.

Twenty-three tennis players with a symptomatic full-thickness rotator cuff tear underwent anterior acromioplasty and rotator cuff repair. There were 8 small tears (less than 1 cm), 5 moderate tears (1 to 3 cm), 2 large tears (3 to 5 cm), and 8 massive tears (greater than 5 cm). The dominant shoulder was involved in all patients and all were unable to play tennis before surgery. Eleven patients experienced a traumatic event that caused an injury, 6 while playing tennis, and 12 patients had a gradual onset of symptoms. At average follow-up of 42 months, 19 patients (83%) achieved a good result, were pain-free, and were able to play tennis at their presymptomatic competitive level. Three patients (13%), all with massive tears, had a satisfactory result and were able to play tennis, although at a lower competitive level secondary to weakness. One patient (4%), who also had a massive tear, had an unsatisfactory result and was unable to play tennis.     

Patterns of vascular and anatomical response after rotator cuff repair

BACKGROUND: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion. PURPOSE: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded fashion. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Fifty patients undergoing rotator cuff repair were enrolled: 28 mini-open, 14 open, and 8 arthroscopic repairs; 20 patients were controls. Patients underwent Power Doppler sonography at 6 weeks, 3 months, and 6 months postoperatively. Power Doppler sonography analysis examined 6 areas of the rotator cuff repair: discretely marginated intrasubstance, partial-thickness defects, full-thickness defects, focal thinning of repair, presence of bursal or joint fluid, and location of anchors. A subjective scoring system assessed blood flow in each region. RESULTS: There was a predictable, significant decrease in vascular scores after rotator cuff repair over time. The mean vascular score was 11.6 at 6 weeks, 8.3 at 3 months, 7.0 at 6 months, and 2.4 for controls. There was a significant difference (P < .05) in vascular recruitment scores between each time period, with the most robust flow at the peritendinous region. The lowest vascular score was at the anchor site or cancellous trough. Forty-eight percent of the patients had a rotator cuff repair defect postoperatively. These findings did not correlate with functional assessment and outcome at 6 months. There was no significant difference in vascular scores between the defect and no-defect groups. Mean University of California, Los Angeles; L'Insalata; and American Shoulder and Elbow Surgeons scores at 6 months were 28.6, 86.3, and 81.5, respectively. Thirty-three percent of asymptomatic controls had a rotator cuff tear that averaged 7.6 x 7.1 mm. CONCLUSION: The robust vascular response dropped with time, which is not seen in asymptomatic shoulders. Nearly half of the patients demonstrated persistent rotator cuff defects after rotator cuff repair that did not correlate with functional outcome and physical findings at 6 months.     

MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects

Objective. To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings. Design and patients. Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27–53 months (mean 39 months) after open transosseous reinsertion of the rotator cuff. Coronal T2-weighted turbo spin-echo and turbo STIR or T2-weighted fat-suppressed MR images were obtained. The prevalence and extent of residual defects or retears of the rotator cuff and bursitis-like subacromial abnormalities were determined. Results. Residual defects or retears were detected in three (21%) and bursitis-like abnormalities in 14 (100%) of the 14 asymptomatic patients. Fifteen (47%) residual defects or retears and 31 (97%) bursitis-like abnormalities were diagnosed in the 32 patients with residual symptoms. The size of the residual defects/retears was significantly smaller in the asymptomatic group (mean 8 mm, range 6–11 mm) than in the symptomatic group (mean 32 mm, range 7–50 mm) (t-test, P=0.001). The extent of the bursitis-like subacromial abnormalities did not significantly differ (t-test, P>0.05) between asymptomatic (mean 28×3 mm) and symptomatic patients (mean 32×3 mm). Conclusion. Small residual defects or retears (<1 cm) of the rotator cuff are not necessarily associated with clinical symptoms. Subacromial bursitis-like MR abnormalities are almost always seen after rotator cuff repair even in patients without residual complaints. They may persist for several years after rotator cuff repair and appear to be clinically irrelevant. Received: 19 November 1999 Revision requested: 7 February 2000 Revision received: 28 February 2000 Accepted: 14 March 2000     

Arthroscopic treatment of chronic calcific tendinitis with complete removal and rotator cuff tendon repair

Relatively large calcific materials on radiographs of shoulders with persistent symptoms after extended periods of conservative treatment are candidates for operative treatment. But complete removal of calcific materials sometimes leaves a large defect in the rotator cuff tendon, and tendon repair might be essential if defects are large. We evaluated the clinical results of complete removal of calcific deposits with or without repair of the rotator cuff tendon in 35 consecutive patients. Eighteen patients underwent calcific material removal, which resulted in a complete tear in the rotator cuff tendon, and suture anchor repair. And the other 17 patients received either side-to-side repair or simple debridement. Clinical outcomes improved at a median 31 (range 24–45) months after surgery, and pain relief was achieved within 6 months of surgery in 30 of 35. However, ten patients developed a secondary stiff shoulder. Repair with or without suture anchor after complete removal of calcific material provides good clinical results and earlier pain relief when it was compared to previous literatures of minimal removal technique.     

Muscle atrophy as a consequence of rotator cuff tears: should we compare the muscles of the rotator cuff with those of the deltoid?

Purpose The quantitative assessment of muscle atrophy has a degree of importance in prognosticating rotator cuff treatment. However, it has been conjectured that muscle fat increases with aging. Therefore, we thought that the quantitative assessment of the supraspinatous would be better if made in comparison with a standard of reference such as the deltoid. Consequently, we performed a two-part study, first evaluating supraspinatous changes compared with the deltoid in “normals” with aging, and second, determining if in patients with cuff tears the supraspinatous fat exceeds that of the deltoid. Materials and methods In part 1, we studied 50 patients stratified by decade. In the first sitting, two blinded independent observers quantitatively graded the deltoid (with the supraspinatous obscured) and in the second sitting the same two observers quantitatively graded the supraspinatous (with the deltoid obscured). In part 2 of the study, we evaluated patients with moderate rotator cuff tears (>2 cm) and performed the same blinded, two-sitting, quantitative assessment (with the comparison muscle obscured). Results We found that muscle atrophy increases with age in patients without tears (0.011/0.028 U/year), although to a greater degree in the deltoid (p = 0.032). Also, in similarly aged patients, quantitative scores of the deltoid closely matched those of the supraspinatous (p = 0.071). Notably, however, in patients with large tears, the supraspinatous showed significant changes disproportionate to those of the deltoid, regardless of patient age (p = 0.044). Conclusion In the presence of a normal rotator cuff, fatty infiltration increases with age. Age-related changes occur more frequently in the deltoid, verifying this muscle’s potential as a standard of reference. With cuff tears, supraspinatous atrophy was disproportionate to that of the deltoid. Therefore, systematic assessment of supraspinatous muscle atrophy may be more reliable using the deltoid as a control for comparison than assessing it in isolation.     

老年巨大肩袖损伤治疗面临的挑战

老年人肩袖组织退变显著,常伴有骨关节炎、肌力下降、肌肉萎缩等问题。肩袖损伤是肩痛最为常见的病因。老年巨大肩袖损伤发生率高,损伤的肩袖组织难以修复,修复后再撕裂率高,严重降低患者生活质量。为此.笔者着重对老年巨大肩袖损伤的特点、治疗选择及康复锻炼等问题进行概述,为老年巨大肩袖损伤的治疗提供借鉴。     

Portal-extension approach for the repair of small and medium rotator cuff tears

One hundred ten consecutive cases (110 patients) of arthroscopically assisted rotator cuff repair through a limited, portal-extension approach were retrospectively reviewed. The average age of our patients was 58 years (range, 30 to 79). There were 35 women and 75 men. The dominant shoulder was affected in 67 patients (61%). All patients underwent a standard arthroscopic decompression. Acromioclavicular resections were performed in 15% of patients. The anterolateral portal was extended in the direction of Langer's lines to a total length of no more than 3 cm. The torn tendon was accessed through a small deltoid muscle split and repaired with nonabsorbable sutures. At an average follow-up of 35 months (range, 24 to 86), 106 patients (96%) had achieved excellent or satisfactory results. The average American Shoulder and Elbow Surgeons pain score improved from 7 preoperatively to 2 postoperatively. All but four patients were satisfied with the clinical result and reported significant improvement in active elevation and strength and a significant lessening of pain. Late acromioclavicular joint pain contributed to failure in three of the four patients with unsatisfactory results in this series. The results of this study suggest that, in selected patients with small to medium rotator cuff tears, arthroscopically assisted repair through an anterolateral portal-extension approach can produce excellent results.     

Operative treatment of deep chondral defects of the patella: results after abrasive arthroplasty and periosteal arthroplasty

This prospective, non-randomized study was aimed to evaluate the effects of abrasive arthroplasty and periosteal arthroplasty in the treatment of deep chondral defects of the patella. A total of 30 patients in group A (13 male, 17 female, age: 28.7±6.9 years) underwent arthroscopic abrasive arthroplasty. The other patients in group B (n=17, 11 male, 8 female, age 26.8±7.0 years) underwent periosteal arthroplasty by an autologous periosteal flap. The maximal diameter of the defects was 31.1±6.7 (range 20–45 mm). The Lysholm score and the intensity of pain were evaluated preoperatively and at the time of follow-up (3.1±1.1, range 2–5 years). The Tegner activity score was evaluated before onset of the symptoms and at the time of follow-up. The Lysholm score increased significantly in both groups (in group a from 36.1±7.1 to 42.5±6.6 points and in group B from 42.7±2.4 to 67.6±7.8 points). The result in group B was significantly better than in group A. In group A the intensity of pain was unchanged, whereas patients from group B reported a significant reduction of pain. The level of physical activity (Tegner score) was 5.5±2.1 in group A and 5.5±2.1 in group B before onset of the complaints. In follow-up, patients from group B (4.9±1.2) had a reduced Tegner score in tendency. The patients in group A had a significantly reduced level of physical activity (2.7±0.6). A total of 12 patients from group B had a range of motion lesser than 80° in flexion. These patients underwent joint mobilization and control arthroscopy. During control arthroscopy there was always found a stable periosteal flap. Short-term clinical results with periosteal arthroplasty produced a significant reduction in pain and improved Lysholm score in comparison to abrasive arthroplasty.     

Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings

OBJECTIVE: Our goal in this study was to evaluate by means of MRI the clinical significance of tendon integrity, muscle fatty degeneration, and muscle atrophy in surgically repaired massive rotator cuff tears and to correlate these and other prognostic factors with intraoperative and clinical findings. MATERIALS AND METHODS: Twenty-eight surgically proven massive rotator cuff tears were retrospectively included in the study. Twenty-two patients underwent complete repair, and six patients underwent partial repair. Preoperative and postoperative clinical assessment was performed by using the University of California at Los Angeles score. Preoperative and postoperative MRI studies were evaluated for the presence and extent of rotator cuff tear and for the degree of fatty degeneration and atrophy of the rotator cuff muscles. RESULTS: At a mean 44.4 months' follow-up, 20 patients (71.4%) had a favorable result. A total of 25 patients (89.2%) showed postoperative full-thickness rotator cuff tear, 19 of which were reruptures. A sagittal preoperative rotator cuff tear of less than or equal to 34 mm showed a specificity of 100% for predicting a favorable outcome. A coronal postoperative rotator cuff tear of less than or equal to 34 mm showed a specificity of 85.7% and a positive predictive value of 92.9% for predicting a favorable outcome. A postoperative fatty degeneration of infraspinatus muscle less than or equal to 2 had a specificity of 87.5% and a positive predictive value of 90.9% for predicting a favorable outcome. CONCLUSION: Open repair of massive rotator cuff tears may reach a favorable outcome in a significant proportion of patients, despite a high rate of recurrent or residual tears. Oblique coronal sizes of the recurrent or residual tear of less than or equal to 34 mm and postoperative fatty degenerations of infraspinatus muscle of less than or equal to 2 may allow a favorable outcome.     

Lower trapezius activity during supported and unsupported scapular retraction exercise

Objective: To determine if the lower trapezius muscle responds to scapular retraction exercise in ranges of motion available to rotator cuff repair patients in the first two weeks following surgery. Study design Randomized repeated measures. Setting Biomechanics laboratory in a University setting. Participants Twelve healthy women and eight men free of rotator cuff pathology. Main outcome measures: Integrated (iEMG) and normalized EMG values. Results: ANOVA revealed a main effect and follow-up comparisons showed that mean iEMG values of the lower trapezius, infraspinatus, and upper trapezius were on average 65% greater for the 130° condition. For the 90° condition, the normalized values of the lower trapezius and deltoid were 40·3% and 7·2% of the 130° condition respectively. Conclusions: These findings suggest the lower trapezius muscle is more active in the 130° condition. Normalised iEMG data for the 90° condition suggest the lower trapezius muscle can be recruited in a range of motion attainable for acute rotator cuff repair patients.     

Enhancement of rotator cuff tendon–bone healing with injectable periosteum progenitor cells-BMP-2 hydrogel in vivo

Purpose  

The fixation and incorporation of ruptured rotator cuff tendon to bone is a major concern in rotator cuff repair surgery. Rotator cuff repair usually fails at the tendon–bone interface, especially in case of large or massive tears. To enhance tendon–bone healing, an injectable hydrogel made with periosteal progenitor cells(PPCs) and poly (ethylene glycol) diacrylate (PEGDA) tethered with bone morphogenic protein-2(BMP-2) was developed to encourage extracellular matrix synthesis for tendon-to-bone healing in rotator cuff repair.     

Reconstruction of massive rotator cuff lesions with a synthetic interposition graft: a prospective study of 41 patients

In the present prospective study, we report about our experience with massive rotator cuff tears treated by means of a nonresorbable transosseously fixated patch combined with subacromial decompression. Forty-one patients were followed clinically and radiographically for a mean duration of 43 months. Their mean preoperative Constant and Murley score improved (P<0.001) from 25.7 preoperatively to 72.1 postoperatively. Substantial pain relief and improvement in the performance of activities of daily living were obtained. Anatomically, the repair resulted in a mean acromiohumeral interval of 8.6 mm. At the latest follow-up, three patients presented with a new tear between the inserted mesh and the supraspinatus musculotendinous unit. Reoperations were not performed. For short-term periods, restoring a massive rotator cuff tendon defect with synthetic grafts combined with subacromial decompression can give significant pain relief and improvement of range of motion and strength with few complications.Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.Each author certifies that his institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with the ethical principles of research.     

Arthroscopic rotator cuff repair: clinical outcome of 607 patients

The purpose of this study was to evaluate the clinical results of rotator cuff tendon tears treated by arthroscopic repair with suture anchors. This prospective study included a cohort of 607 consecutive patients who underwent arthroscopic rotator cuff repair surgery. Most patients had a single-row type of repair using metal anchors. All patients were independently assessed pre- and post-operatively utilizing the UCLA (University of California at Los Angeles) scoring system with a minimum of 1 year follow-up. Demographic and operative details were noted; including the patient age, workers compensation status, tear size, type of repair performed, and concomitant procedures. The median UCLA score improved from 13 (0–28) to 35 (8–35) with a median follow-up time of 46 months (12–105), P < 0.001. The majority of the patients (529) achieved good to excellent results. The results were found to be independent of age, workers compensation status, tear size, type of repair performed and concomitant procedures. In conclusion, arthroscopic rotator cuff repair, using metal anchors with dual sutures, in a single row, utilizing margin convergence sutures and performing concomitant procedures when necessary, gave satisfactory results in 87% of patients.