One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress

Background

Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self-assessments of pain and function. In several other areas of orthopaedics, higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery. To our knowledge, the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated.

Questions/purposes

(1) Are higher levels of preoperative psychological distress associated with differences in outcome scores (visual analog scale [VAS] for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) 1 year after arthroscopic rotator cuff repair? (2) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores (VAS for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) 1 year after arthroscopic rotator cuff repair? (3) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair?

Methods

Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled; 70 patients (82%) were assessed at 1-year followup. During the study period, the three participating surgeons performed 269 rotator cuff repairs; in large part, the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire, and patients completed self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair. Fifty of 85 patients (59%) had normal levels of distress, 26 of 85 (31%) had moderate levels of distress, and nine of 85 (11%) had severe levels of distress. Statistical models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function at 1 year after surgery.

Results

With the numbers available, distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain (1.9 [95% confidence interval {CI}, 1.0–2.8] versus 1.0 [95% CI, 0.5–1.4], p = 0.10), Simple Shoulder Test (9 [95% CI, 8.1–10.4] versus 11 [95% CI, 10.0–11.0], p = 0.06), or American Shoulder and Elbow Surgeons scores (80 [95% CI, 72–88] versus 88 [95% CI, 84–92], p = 0.08) 1 year after arthroscopic rotator cuff repair. With the numbers available, distressed patients also were not different from nondistressed patients in terms of the amount of improvement in scores between preoperative assessment and 1-year followup on the VAS for pain (3 [95% CI, 2.2–4.1] versus 2 [95% CI, 1.4–2.9], p = 0.10), Simple Shoulder Test (5.2 [95% CI, 3.7–6.6] versus 5.0 [95% CI, 4.2–5.8], p = 0.86), or American Shoulder and Elbow Surgeons scale (38 [95% CI, 29–47] versus 30 [95% CI, 25–36], p = 0.16). The prevalence of psychological distress in our patient population was lower at 1 year after surgery 14 of 70 (20%) versus 35 of 85 (41%) preoperatively (odds ratio, 0.36; 95% CI, 0.17–0.74; p = 0.005).

Conclusions

Mild to moderate levels of distress did not diminish patient-reported outcomes to a clinically important degree in this small series of patients with rotator cuff tears. This contrasts with reports from other areas of orthopaedic surgery and may be related to a more self-limited course of symptoms in patients with rotator cuff disease or possibly to a beneficial effect of rotator cuff repair on sleep quality or other unrecognized determinants of psychosocial status.

Level of Evidence

Level I, prognostic study.     

Outcomes after arthroscopic rotator cuff repairs

Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopic repair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002. Preoperative and postoperative evaluation consisted of a history, questionnaire, and examination to determine American Shoulder and Elbow Surgeons, Constant, and visual analog pain scores. Complete data were available for a minimum of 12 months (range, 12-45 months) for 71 patients. Increases in range of motion and outcome scores and associated reductions in visual analog scores were all significant. With massive tears, scores and pain were significantly improved. Arthroscopic rotator cuff repair reliably improves functional deficits and pain regardless of tear size. Smaller tears yield significant improvement in American Shoulder and Elbow Surgeons, Constant, and pain scores. Functional improvement was seen with massive tears, but gains in strength and motion were less dramatic.     

Deep infection after rotator cuff repair

Currently, there is little information available concerning the outcome of patients with infection after rotator cuff repair. The purpose of this study was to review retrospectively the incidence, clinical presentation, bacteriology, treatment, and outcomes of patients with rotator cuff repair complicated by deep infection. Between 1975 and 2003, 39 cases of deep infection after rotator cuff repair were identified in 38 patients. At a final follow-up of 8.2 years (range, 30 months to 19.8 years), 7 patients had died and 2 had been lost to follow-up, leaving 29 for outcome evaluation. Propionibacterium acnes was the most common organism isolated, infecting 20 of 39 cases (51%). At final follow-up, mean active elevation was 120 degrees and mean external rotation was 45 degrees . The American Shoulder and Elbow Surgeons score averaged 67 points (range, 5-100 points), and the Simple Shoulder Test score averaged 7.3 points (range, 1-12 points). The results were excellent in 7 shoulders, satisfactory in 9, and unsatisfactory in 11. The data from this study suggest that the eradication of deep infection after rotator cuff repair is possible; however, substantial functional limitations are not unusual. In addition, the treating surgeon should be aware of the high incidence of Propionibacterium and the importance of allowing a minimum of 7 days of culture to identify this organism.     

Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up

The purpose of this study was to assess arthroscopic repair of rotator cuff tears at a minimum of 2 years postoperatively with both patient-derived and objective outcome measures, including the use of magnetic resonance imaging (MRI), to evaluate repair status. Evaluated were 49 shoulders in 47 consecutive patients. The American Shoulder and Elbow Surgeons score, Constant and Murley score, Simple Shoulder Test, Rowe score, Visual Analog Pain Scale, and the Medical Outcomes Study Short Form-12 Mental Component Scale all improved significantly (P < .001) between the preoperative and final follow-up evaluations. MRI found 22% of repairs had recurrent tears. The presence of a recurrent tear correlated significantly with patient age (P < .009) and extension of the tear to the infraspinatus (P < .009). Active forward flexion, abduction, external rotation, and strength in forward flexion correlated inversely with the presence of a recurrent tear (P < .05). At minimum 2-year follow-up, arthroscopic repair of rotator cuff tears produced significant improvements in both patient-derived and objectively measured variables.     

Editorial Commentary: Superior Capsule Reconstruction: Graft Healing for Success

In my experience, after superior capsule reconstruction for irreparable rotator cuff tears, if the graft heals, we can expect a successful outcome, such as an American Shoulder and Elbow Surgeons score of more than 90 points and a visual analog scale score of less than 1.0. To decrease the graft tear rate after surgery, I have found that a thicker, stiffer graft than can be achieved with a dermal allograft alone is required to restore superior stability in the glenohumeral joint. Furthermore, the graft size should be determined precisely from the size of the defect in the rotator cuff tendons.     

Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature

Full-thickness rotator cuff tears are common. When symptomatic, they can affect quality of life. Surgical repair might improve patients' overall health. We systematically reviewed postoperative outcomes in 10 studies comparing mini-open repair and all-arthroscopic repair techniques. Data regarding patient demographics, rotator cuff pathology, postoperative rehabilitation protocols, American Shoulder and Elbow Surgeons (ASES) scores, University of California Los Angeles (UCLA) scores, pain scores, and incidence of recurrent defects were extracted. There were no statistically significant differences between groups within each study in terms of these data points. One study found decreased pain 6 months after surgery in the all-arthroscopic group versus the miniopen repair group. This systematic literature review indicates there is no statistically significant difference in postoperative ASES, UCLA, or pain scores or incidence of recurrent rotator cuff tears in rotator cuffs repaired all-arthroscopically versus using the mini-open technique. However, there might be decreased short-term pain in patients who undergo arthroscopic repairs.     

Repair integrity and clinical outcome after arthroscopic rotator cuff repair using single-row anchor fixation: a prospective study of single-tendon and two-tendon tears

This prospective study determined whether single-row anchor fixation would reliably improve clinical outcome and maintain structural integrity after arthroscopic repair of single-tendon and 2-tendon rotator cuff tears. In 39 patients, 21 shoulders had single-tendon tears and 18 had 2-tendon tears. Mean follow-up was 38 months (minimum, 24 months). A standardized assessment was done preoperatively and postoperatively at yearly intervals. Postoperative magnetic resonance imaging (MRI) was performed at a minimum 1-year follow-up. Mean forward elevation, pain, satisfaction, and American Shoulder and Elbow Surgeons scores significantly improved for both groups (P < .01). Postoperative MRI examinations showed 19 cuffs (90%) were intact for single-tendon tears and 15 (83%) were intact for 2-tendon tears. A recurrent tear on postoperative MRI was significantly correlated with the intraoperative finding of asymmetric retraction. Arthroscopic rotator cuff repair using single-row anchor fixation resulted in significant improvements in clinical outcome and reliable repair integrity for both single-tendon and 2-tendon tears.     

The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients

BACKGROUND: Patients who have pain and dysfunction from glenohumeral arthritis associated with severe rotator cuff deficiency have few treatment options. The goal of this study was to retrospectively evaluate the short-term results of arthroplasty with use of the Reverse Shoulder Prosthesis in the management of this problem. METHODS: We report the results for sixty patients (sixty shoulders) with a rotator cuff deficiency and glenohumeral arthritis who were followed for a minimum of two years. Thirty-five patients had no previous shoulder surgery, whereas twenty-three had had either an open or arthroscopic rotator cuff repair, one had had a subacromial decompression, and one had had a biceps tendon repair. All patients were assessed preoperatively and postoperatively with the American Shoulder and Elbow Surgeons scoring system for pain and function and with visual analog scales for pain and function. They were also asked to rate their satisfaction with the outcome. The shoulder range of motion was measured preoperatively and postoperatively. RESULTS: The average age of the patients was seventy-one years. The average duration of follow-up was thirty-three months. All measures improved significantly (p < 0.0001). The mean total score on the American Shoulder and Elbow Surgeons system improved from 34.3 to 68.2; the mean function score, from 16.1 to 29.4; and the mean pain score, from 18.2 to 38.7. The score for function on the visual analog scale improved from 2.7 to 6.0, and the score for pain on the visual analog scale improved from 6.3 to 2.2. Forward flexion increased from 55.0 degrees to 105.1 degrees, and abduction increased from 41.4 degrees to 101.8 degrees. Forty-one of the sixty patients rated the outcome as good or excellent; sixteen were satisfied, and three were dissatisfied. There were a total of thirteen complications in ten patients (17%). Seven patients (12%) had eight failures, requiring revision surgery to another Reverse Shoulder Prosthesis in five patients (one shoulder had two revisions) and revision to a hemiarthroplasty in two patients because of deep infection. CONCLUSIONS: The data from this study suggest that arthroplasty with the Reverse Shoulder Prosthesis may be a viable treatment for patients with glenohumeral arthritis and a massive rotator cuff tear. However, future studies will be necessary to determine the longevity of the implant and whether it will provide continued improvement in function.     

Mini-open rotator cuff repair does not result in intractable stiffness

We conducted a study to determine whether intractable postoperative stiffness or deltoid damage results from primary arthroscopic anterior acromioplasty and mini-open repair of full-thickness tears of the superior rotator cuff. Eighty-three repairs (80 patients) were available for follow-up at a mean (range) of 57.2 (12-98) months. Range of motion at presentation and motion in contralateral shoulder at final follow-up were used for comparison. Significant improvements were seen in active forward elevation, passive forward elevation, and active external rotation at 90° abduction. Final motion in the operative and contralateral shoulders was similar. American Shoulder and Elbow Surgeons shoulder index improved significantly (P<.0001) from 50.0 before surgery to 88.3 after surgery. Although 1 patient had a symptomatic retear that required revision surgery, there were no cases of intractable stiffness, and there were no cases of deltoid damage.     

Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes

We performed a prospective, randomized study to determine whether arthroscopic subacromial decompression changes the outcome of rotator cuff repair. We performed a power analysis to ensure statistical validity. Patients scheduled for arthroscopic rotator cuff repair were randomized to cuff repair with arthroscopic subacromial decompression (group 1) or without it (group 2). All other aspects of the surgical and postsurgical treatment were identical. We included patients with full-thickness tears limited to the supraspinatus tendon and a type 2 acromion. We excluded patients with prior surgery, those with larger tears involving two or more tendons, those with a type 1 or 3 acromion, those with workers' compensation claims, and those who had concomitant procedures (labral repair, acromioclavicular joint resection) There were 47 patients in group 1 and 46 in group 2. Minimum follow-up was 1 year (mean, 15.6 +/- 3.3 months). We recorded the American Shoulder and Elbow Surgeons (ASES) shoulder scores preoperatively and postoperatively. There was no statistical difference in postoperative ASES scores between group 1 (91.5 +/- 10.3) and group 2 (89.2 +/- 15.1) (P =.392). The change in ASES score over time did not differ between the two groups (61.1 vs 60.2, P =.363). In conclusion, within the parameters described above, arthroscopic subacromial decompression does not appear to change the functional outcome after arthroscopic repair of the rotator cuff.     

Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa

Small intestinal submucosa (SIS) has been used for reinforcement of other tissues in the body with success and has been shown to act as a bioabsorbable tissue scaffold that promotes and assists healing. The effectiveness of using porcine SIS as a tissue scaffold for reinforcement of rotator cuff repair is unclear. This study evaluates both clinical and magnetic resonance imaging (MRI) follow-up at 6 months in patients with large and massive rotator cuff tears treated with open repair and SIS reinforcement or interpositional grafting. Eleven consecutive patients who underwent open rotator cuff repair with SIS augmentation for large or massive tears were selected retrospectively, and their charts were reviewed. Magnetic resonance images were then obtained at least 6 months after the index procedure. Patients were evaluated clinically and with a questionnaire, and an American Shoulder and Elbow Surgeons shoulder score was calculated. Results showed retear on MRI in 10 of 11 patients with recurrence of large, retracted tears. One repair remained intact by MRI evaluation at 10 months. Clinically, there was no statistically significant difference between preoperative and postoperative shoulder scores by use of a paired t test analysis (P =.70). Five patients had worse scores postoperatively. We concluded that, though SIS xenografting may be effective in other areas of the body for tendon healing, its use in reinforcement of large and massive rotator cuff repairs seems to be ineffective and does not improve clinical outcome.     

Clinical and Anatomical Outcomes of Arthroscopic Repair of Large Rotator Cuff Tears with Allograft Patch Augmentation: A Prospective,Single-Blinded,Randomized Controlled Trial with a Long-term Follow-up

BackgroundArthroscopic rotator cuff repair using human dermal matrix allograft augmentation has been widely used. We assessed the effect of acellular human dermal matrix augmentation after arthroscopic repair of large rotator cuff tears through a prospective, single-blinded, randomized controlled trial with a long-term follow-up.MethodsSixty patients with large-sized rotator cuff tears were randomly assigned to two groups. Patients in the control group underwent arthroscopic rotator cuff repair. Allograft patch augmentation was additionally performed in the allograft group. All patients were subdivided into a complete coverage (CC) group or an incomplete coverage (IC) group according to footprint coverage after cuff repair. Constant and American Shoulder and Elbow Surgeons (ASES) scores were assessed preoperatively and at final follow-up. Magnetic resonance imaging was also performed at the same time to evaluate the anatomical results.ResultsForty-three patients were followed up for an average of 5.7 years. Clinical scores (Constant and ASES) increased significantly at the last follow-up in both groups. The increase in ASES score in the allograft group was statistically significantly greater than that in the control group. The degree of Constant score improvement did not differ significantly between the two groups. The retear rate was 9.1% in the allograft group, which was significantly lower than that in the control group (38.1%). In the control group, the CC subgroup had a statistically significantly lower retear rate (16.7%) than did the IC subgroup. There were no retear cases in the CC subgroup of the allograft group.ConclusionsLong-term follow-up of arthroscopic repair of large rotator cuff tears with allograft patch augmentation showed better clinical and anatomical results. Footprint coverage after rotator cuff repair was an important factor affecting the retear rate. If the footprint was not completely covered after rotator cuff repair, allograft patch augmentation may reduce the retear rate.     

Arthroscopic superior labrum anterior-posterior repair in military patients

The purpose of this retrospective study was to determine the efficacy of arthroscopic superior labrum anterior-posterior (SLAP) repair in a military population. In this study, 27 patients (of 30 consecutive patients) who had suture anchor repair of a type II SLAP lesion were evaluated at a mean of 30.5 months postoperatively. Fifteen patients had isolated tears, whereas twelve also had a concomitant diagnosis. At follow-up, the overall mean American Shoulder and Elbow Surgeons score was 86.9 points and the mean University of California, Los Angeles score was 30.4 points. The results were excellent in 4 patients, good in 20, and fair in 3. Of the patients, 96% returned to full duty (mean, 4.4 months). Patients treated for concomitant diagnoses and a SLAP tear had significantly higher American Shoulder and Elbow Surgeons scores and tended to have higher University of California, Los Angeles scores than those treated for an isolated SLAP tear. The findings indicate that arthroscopic SLAP repair in military patients results in a high rate of return to duty. The results suggest that concomitant shoulder pathology should be treated at the time of SLAP repair.     

Arthroscopic repair of medium to large full-thickness rotator cuff tears: outcome at 2- to 6-year follow-up

Medium-term follow-up of arthroscopic rotator cuff repair was evaluated in 48 consecutive arthroscopic repairs of medium to large rotator cuff tears. Mean rotator cuff tear size was 2.4 cm (range, 2-4 cm), mean age at surgery was 57.6 years (range, 38-80 years), and mean follow-up was 39 months (range, 24-66 months). Mean University of California at Los Angeles End-Result Scores were 17.2 preoperatively and 33.7 postoperatively (P <.001). American Shoulder and Elbow Surgeons mean scores were 42.2 and 94.9, respectively. There were no complications requiring reoperation. There were 35 excellent, 11 good, 2 fair, and no poor results; however, 1 patient had clinical evidence of a failed repair. Forty-four of 45 patients (47/48 repairs) were satisfied with their results.     

Rotator cuff repair tension as a determinant of functional outcome

This study evaluated the effect of rotator cuff repair tension on surgical outcome. A total of 67 consecutive rotator cuff repairs for full-thickness tendon tears were prospectively evaluated. Rotator cuff repair tension was quantified by means of an intraoperative calibrated tensiometer after cyclic loading. The point of maximum repair tension was measured. Patients were evaluated for pain and improvement before and after surgery through use of Constant scores, American Shoulder and Elbow Surgeons' functional criteria, isokinetic strength-testing, and visual analog scale scores. Increased repair tension correlated with lesser gains in postoperative Constant score, a decrease in perceived improvement, decreased isokinetic strength measurements, and increased pain. Tension on repaired rotator cuff tendons should be minimized. High-tension repairs--those greater than 8 lb--are associated with poor subjective and objective outcomes and are not recommended.     

Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcomes and patient satisfaction

This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates.     

Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis

BACKGROUND: Outcomes assessment after the treatment of shoulder disorders has involved the use of various condition-specific outcome instruments. The purpose of this study was to determine the psychometric properties of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. METHODS: Test-retest reliability, internal consistency, content validity, criterion validity, construct validity, and responsiveness to change were determined for the American Shoulder and Elbow Surgeons shoulder scale within subsets of an overall study population of 455 patients with shoulder instability, 474 patients with rotator cuff disease, and 137 patients with glenohumeral arthritis. RESULTS: There was acceptable test-retest reliability for the overall American Shoulder and Elbow Surgeons shoulder scale (intraclass correlation coefficient = 0.94) and ten of eleven domains. There was acceptable internal consistency for patients with instability (Cronbach alpha = 0.61), rotator cuff disease (0.64), and arthritis (0.62). There were acceptable floor and ceiling effects for patients with instability (0% and 1.3%, respectively), rotator cuff disease (0% for both), and arthritis (0% for both). There was acceptable and appropriate criterion validity, with significant correlations (p < 0.05) between the overall American Shoulder and Elbow Surgeons scale and the physical functioning, role-physical, and bodily pain domains of the Short Form-12 scale, and nonsignificant correlations (p > 0.05) with the role-emotional, mental health, vitality, and social function domains. There was acceptable construct validity, with all twenty-three hypotheses demonstrating significance (p < 0.05), and acceptable responsiveness to change for patients with instability (standardized response mean, 0.93), rotator cuff disease (1.16), and arthritis (1.11). CONCLUSIONS: The use of outcome instruments with psychometric properties that have been vigorously established is essential. The American Shoulder and Elbow Surgeons subjective shoulder scale demonstrated overall acceptable psychometric performance for outcomes assessment in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis.     

The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture

BACKGROUND: Humeral hemiarthroplasty is an established treatment for patients with selected fractures of the proximal part of the humerus. However, a subset of patients have development of glenoid arthritis and rotator cuff deficiency due to tuberosity failure. To date, there has been no reliable salvage procedure for this problem. METHODS: Over a period of five years, twenty-nine patients (twenty-five women and four men) with a mean age of sixty-nine years (range, forty-two to eighty years) were managed with removal of a hemiarthroplasty prosthesis and revision with a Reverse Shoulder Prosthesis alone or in combination with a proximal humeral allograft. Patients were followed clinically and radiographically for an average of thirty-five months. All patients were evaluated with use of the American Shoulder and Elbow Surgeons score; the Simple Shoulder Test; range-of-motion measurements, including abduction, forward flexion, and external rotation; and a rating scale for overall satisfaction with the outcome of the surgery. Patients were assessed preoperatively and at all follow-up points beginning at three months postoperatively. RESULTS: The average total American Shoulder and Elbow Surgeons score improved from 22.3 preoperatively to 52.1 at the time of the last follow-up (p < 0.001). The average American Shoulder and Elbow Surgeons pain score improved from 12.2 to 34.4 (p < 0.001), and the average American Shoulder and Elbow Surgeons function score improved from 10.1 to 17.7 (p = 0.058). The average Simple Shoulder Test score improved from 0.9 to 2.6 (p = 0.004). Forward flexion improved from 38.1 degrees to 72.7 degrees (p < 0.001), and abduction improved from 34.1 degrees to 70.4 degrees (p < 0.001). The overall complication rate was 28% (eight of twenty-nine). At the time of the latest follow-up, sixteen patients rated the outcome as good or excellent, seven rated it as satisfactory, and six were dissatisfied. Four of the six patients who were dissatisfied had been managed with a Reverse Shoulder Prosthesis alone. CONCLUSIONS: The Reverse Shoulder Prosthesis offers a salvage-type solution to the problem of failed hemiarthroplasty due to glenoid arthritis and rotator cuff deficiency following tuberosity failure. The early results reported here are promising. In cases of severe proximal humeral bone deficiency, augmentation of the Reverse Shoulder Prosthesis with a proximal humeral allograft may improve patient satisfaction.     

关节镜下改良Mason-Allen与缝线桥缝合治疗中型肩袖撕裂的疗效对比

目的:观察并比较关节镜下改良Mason-Allen与缝线桥缝合治疗中型肩袖撕裂的术后疗效.方法:自2017年1月至2018年1月,采用关节镜下改良Mason-Allen缝合治疗中型肩袖撕裂患者22例,年龄40～81(57.14±10.26)岁;男9例,女13例.2018年2月至2019年1月,采用缝线桥缝合治疗中型肩袖...     

Infection after mini-open rotator cuff repair

A consecutive case series from 2 institutions of patients with postoperative wound infections after mini-open rotator cuff repair was reviewed. Between 1991 and 2000, 360 patients underwent mini-open rotator cuff repair after arthroscopic subacromial decompression. Seven patients had postoperative infection develop (1.9%). All patients were men, with a mean age of 55 years (range, 40-64 years). Treatment included serial irrigation and debridement, long-term intravenous antibiotics, and revision rotator cuff repair. Mean follow-up after definitive treatment was 32 months (range, 12-57 months). Propionibacter acnes was present in 6 of 7 patients (86%) with infections. The initial rotator cuff repair was disrupted in 4 shoulders and intact in 3. A revision rotator cuff repair was performed at the final irrigation and debridement in all 4 shoulders. Results were 100% satisfactory. The mean American Shoulder and Elbow Surgeons pain score improved from 7 (range, 6-9) preoperatively to 1 (range, 0-2). The mean final score was 95. Because these infections were noted to occur only in arthroscopically assisted rotator cuff repairs, a second preparation and draping were introduced as routine protocol. No postoperative infections have occurred in the ensuing 200 mini-open rotator cuff repairs.