Functional and MRI Outcomes After In Situ Repair Versus Tear Completion Before Repair of Bursal-Side Partial-Thickness Rotator Cuff Tears

Objective

The optimal repair method for bursal-side partial-thickness rotator cuff tears (PTRCTs) involving >50% of the thickness remains a controversial topic. The study was aimed to compare the functional and magnetic resonance imaging (MRI) outcomes after in situ repair or tear completion before repair of bursal-side PTRCTs.

Methods

A retrospective clinical study was conducted involving 58 patients who underwent in situ repair or tear completion before repair of bursal-side PTRCTs between January 2019 and December 2020. These patients were divided into two groups: the in situ repair group and the tear completion before repair group. Functional assessment consisted of active range of motion (ROM), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant–Murley score. The percentages of patients in each group achieving the minimal clinical important difference (MCID) of the functional scores were determined. The healing status of the rotator cuff was assessed by postoperative MRI.

Results

There were no statistically significant differences between the two groups in terms of demographic data. The mean follow-up period was 14.53 ± 2.64 months in the in situ repair group and 15.40 ± 2.66 months in the tear completion before repair group. At the final follow-up, the forward elevation, external rotation, and internal rotation improved significantly in both groups. The VAS, ASES score, and Constant–Murley score improved significantly in the in situ repair group (5.17 ± 2.00 points to 0.11 ± 0.41 points, p = 0.001; 44.04 ± 17.40 points to 95.47 ± 4.32 points, p = 0.001; 49.50 ± 14.38 points to 93.50 ± 3.49 points, p = 0.001) and in the tear completion before repair group (5.43 ± 3.32 points to 0.03 ± 0.18 points, p = 0.001; 41.50 ± 19.59 points to 95.94 ± 2.68 points, p = 0.001; 47.54 ± 17.13 points to 93.97 ± 2.61 points, p = 0.001). Postoperative MRI revealed that the re-tear rate was 7.1% (2/28) in the in situ repair group and 3.3% (1/30) in the tear completion before repair group. No significant differences were observed in terms of the functional scores, the percentages of patients achieving the MCID of the functional scores, and the re-tear rate between the two groups (p > 0.05).

Conclusions

Both in situ repair and tear completion before repair yielded satisfactory clinical outcomes for patients with bursal-side PTRCTs. No significant differences were observed in the functional and MRI outcomes between the two groups.     

Mini-Open Suture Bridge Repair with Porcine Dermal Patch Augmentation for Massive Rotator Cuff Tear: Surgical Technique and Preliminary Results

Background

The aim of this study was to describe the mini-open suture bridge technique with porcine dermal patch augmentation for massive rotator cuff tear and to assess preliminary clinical and radiological results.

Methods

Five patients with massive rotator cuff tear for which it was not possible to restore the anatomical footprint underwent mini-open suture bridge repair using a porcine dermal patch. The patients'' average age was 53.4 years (range, 45 to 57 years), and the average duration of follow-up was 20.6 months (range, 14 to 26 months). Patients were evaluated with preoperative and postoperative outcome measures, including a visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score. The structural integrity of repaired rotator cuffs was assessed by magnetic resonance imaging 6 months postoperatively.

Results

The average VAS pain score, UCLA score, and ASES score improved from 6.8, 15.4, and 39.4 preoperatively to 0.8, 31.2, and 86.4 postoperatively (p = 0.041, 0.042, and 0.043, respectively). Magnetic resonance images obtained at an average of 8 months after surgery showed that four patients had intact repair integrity with graft incorporation. One patient had a re-tear with partial healing but still had a satisfactory clinical outcome. There was no intraoperative or postoperative complication in any patient.

Conclusions

Mini-open suture bridge repair with porcine dermal patch augmentation can be an option in young patients with high physical demands and massive rotator cuff tears for which it is not possible to restore the anatomical footprint.     

关节镜下治疗肩袖损伤合并肱二头肌长头腱病变的临床随访研究

目的 评估经皮关节内肌腱固定技术在关节镜下肩袖损伤重建患者中,治疗合并肱二头肌长头腱损伤的临床效果.方法 2006年3月-2008年3月,对30例肩袖损伤合并肱二头肌长头腱损伤的患者,采用经皮关节内肌腱固定技术进行肌腱固定治疗.按照肩关节ASKS评分、Constant-Murley评分和YAS疼痛评分,并对肱二头肌肌力、外观进行评估.结果 术后随访时间平均为23个月(12～37个月).30例肩关节ASKS评分术前平均为43.8分,术后平均为94.7分;Constant-Murley评分术前平均为52.8分,术后平均为94.1分;VAS疼痛评分术前平均为5.5分,术后平均为0.6分;三种评分术前和术后差异均有统计学意义(P<0.01).术后均未出现Popeye畸形和二头肌痉挛症状,屈肘肌力测量患侧与健侧基本相同,差异无统计学意义.29例对手术效果满意.结论 经皮关节内肌腱固定技术是治疗肱二头肌长头腱损伤的有效方法,术后肩关节功能和疼痛改善明显,可以较好地维持肱二头肌的肌力并且避免肱二头肌出现肌腹膨隆畸形.     

Mid-Term Outcomes of Arthroscopic Rotator Cuff Repair in Patients with Rheumatoid Arthritis

Objective

The effectiveness of arthroscopic rotator cuff repair (ARCR) on rheumatoid arthritis (RA) patients remains a controversial topic. This study investigates the mid-term outcomes of ARCR in RA patients and identifies the factors influencing clinical efficacy.

Methods

This retrospective study enrolled RA patients with small or medium rotator cuff tears (RCTs) between February 2014 and February 2019. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant–Murley scores were collected at each follow-up time. Ultimately, magnetic resonance imaging (MRI) and X-ray were employed to assess rotator cuff integrity and progression of shoulder bone destruction, respectively. Statistical methods used two-way repeated-measures ANOVA or generalized estimation equations.

Results

A total of 157 patients were identified and divided into ARCR (n = 75) and conservative treatment (n = 82) groups. ARCR group continued to be divided into small tear (n = 35) and medium tear (n = 40) groups. At the final, all scores were better in ARCR group than in the conservative treatment group (p < 0.05). A radiographic evaluation of the final follow-up demonstrated that the progression rate in ARCR group (18.67%) was significantly lower than that of the conservative treatment group (39.02%, p < 0.05). In the comparison of the small tear and medium tear groups, all scores increased significantly after surgery (p < 0.05), and the final follow-up scores were better than preoperative scores (p < 0.05) but worse than those of the 6-month postoperative follow-up (p < 0.05). Comparison between the two groups revealed that all scores of the small tear group were significantly better than those of the medium tear group at 6-month postoperative follow-up (p < 0.05). Although the scores of small tear group remained better than those of the medium group at the final postoperative follow-up, the difference was not statistically significant (p > 0.05). Radiographic assessment of the final follow-up demonstrated that the progression rate in the small tear group (8.57%) was significantly lower than that in the medium group (27.50%, p < 0.05), and the retear rate of small tear group (14.29%) was significantly lower than that of the medium tear group (35.00%, p < 0.05).

Conclusion

ARCR could effectively improve the quality of life for RA patients with small or medium RCTs, at least in the medium term. Despite the progression of joint destruction in some patients, postoperative retear rates were comparable to those in the general population. ARCR is more likely to benefit RA patients than conservative treatment.     

Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study

Purpose

The purpose of this study was to compare arthroscopic rotator cuff repair with single-row and double-row techniques because research has demonstrated the superiority of double-row repair from a biological and mechanical point of view but there is no evidence of clinical superiority.

Methods

A total of 160 patients with a full-thickness rotator cuff tear underwent arthroscopic repair with suture anchors. They were randomised into two groups of 80 patients according to the repair technique: single-row (group 1) and double-row (group 2). Results were evaluated by use of the University of California, Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES) and Constant questionnaires, the Shoulder Strength Index (SSI) and range of motion. Follow-up time was two years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and two years after repair.

Results

One hundred per cent of the patients were followed up. All measurements showed significant improvement compared with the preoperative status. The UCLA score showed significant improvement in group 2. In over 30-mm tears UCLA and ASES showed significant differences. SSI showed significant improvement in group 2. Range of motion showed significant improvements in flexion and abduction in group 2. In under 30-mm tears group 2 showed also significant improvement in internal and external rotation. In MRI studies there were no significant differences.

Conclusions

At two years follow-up the double-row repair technique showed a significant difference in clinical outcome compared with single-row repair and this was even more significative in over 30-mm tears. No MRI differences were observed.     

肩袖撕裂合并冻结肩行手法松解后的关节镜下表现及影响因素分析

目的 观察肩袖撕裂合并冻结肩行手法松解后的关节镜下表现,并分析其影响因素。方法 回顾性分析2017年9月至2019年9月收治的68例肩袖撕裂合并冻结肩病人的病例资料,其中,男35例,女33例,年龄为（52.68±6.54）岁,均行一期麻醉后手法松解联合关节镜检查并肩袖修复术,观察手法松解后的关节镜下表现,比较松解损伤病人和未损伤病人之间的性别、患侧、肩袖撕裂程度差异,分析患肩关节疼痛时间、肩关节活动受限病程和实施手法松解时间与手法松解损伤的相关性。收集病人的数字分级法（numerical rating scale, NRS）疼痛评分、美国肩肘外科医师学会（American Shoulder and Elbow Surgeons, ASES）评分、Constant-Murley评分及丹麦健康与医疗管理局（Danish Health and Medicine Authority）满意度评分。结果 共16例（23.53%）发生手法松解损伤,其中单一损伤者12例,两种及以上损伤者4例,损伤类型为前关节囊撕裂（3例,18.75%）、下关节囊撕裂（6例,37.50%）、盂肱中韧带撕裂（7例,43.75%）、盂肱下韧带肱骨端撕裂（humeral avulsion of the glenohumeral ligament, HAGL）（3例,18.75%）、前盂唇撕裂（2例,12.50%）。松解损伤病人和未损伤病人之间的年龄（P=0.431）、性别（P=0.893）、患侧（P=0.673）、肩袖撕裂程度（P=0.723）、患肩关节疼痛时间（P=0.813）、肩关节活动受限病程（P=0.250）、实施手法松解时间（P=0.125）均未见显著差异。松解损伤组和松解无损伤组术后NRS评分均较术前明显降低,肩关节功能评分较术前明显改善（P均＜0.05）;手术前后的NRS评分、肩关节功能ASES评分、Constant-Murley评分、病人满意度评分比较,差异均无统计学意义（P均＞0.05）。结论 肩袖撕裂合并冻结肩行麻醉后肩关节手法松解联合关节镜下肩袖修复术可能导致单一或合并的镜下损伤表现,年龄、性别、患侧、肩袖撕裂程度、患肩关节疼痛时间、肩关节活动受限病程、实施手法松解时间等因素与发生手法松解损伤无明确相关性。     

Is there a difference in clinical outcomes and repair integrity between arthroscopic single-row versus transosseous (anchorless) fixation? A retrospective comparative study

Background

Few studies have investigated clinical and structural outcomes after transosseous (TO) repair. The purpose of this study was to compare structural and clinical outcomes of rotator cuff tear, repaired arthroscopically, with a single row (SR) or transossoeus (TO) anchorless technique.

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...     

快速康复外科理念在关节镜下治疗肩袖损伤中的应用

目的探讨快速康复外科理念在关节镜下治疗肩袖损伤中的应用效果。 方法回顾性分析自2015年2月至2016年8月咸宁市中心医院关节外科收治的肩袖损伤患者37例,所有患者术前诊断为单纯肩袖损伤并在关节镜下行肩袖缝合修补术。随机将37例无合并严重内科疾患的单纯肩袖损伤患者分为快速康复组(FTS)和传统康复组(TRG),其中FTS组19例,男10例,女9例,平均年龄(43±9)岁(22～60岁);TRG组18例,男11例,女7例,平均年龄(42±8)岁(19～63岁)。术后1周、1、3个月随访时比较两组Constant-Murley评分、美国肩与肘协会评分系统(ASES)、加州大学肩关节评分系统(UCLA)、患者满意度及术后住院时间。FTS组与TRG组均数比较采用t检验,切口愈合不良发生率比较采用Fisher检验,性别及肩袖损伤分类应用χ²检验。 结果术后1周Constant-Murley评分、ASES评分、UCLA评分、患者满意度FTS组均明显高于TRG组(t＝2.217,t＝2.255,t＝2.457,t＝2.537,P<0. 05),术后1个月Constant-Murley评分、ASES评分、UCLA评分、患者满意度FTS组均明显高于TRG组(t＝2.395,t＝2.693,t＝2.204,t＝2.183,P<0. 05)。术后住院时间、住院总费用FTS组均低于TRG组(t＝2.695,t＝2.179,P<0. 05);切口愈合不良发生率FTS组与TRG组差异无统计学意义(F＝0.717,P>0. 05)。FTS术后3个月的Constant-Murley评分、ASES评分UCLA评分及患者满意度与TRG比较无明显差异(t＝1.873,t＝1.737,t＝1.984,t＝1.483,P>0. 05)。 结论快速康复外科理念在关节镜下治疗肩袖损伤中的应用可有效促进术后患者的早期康复,改善肩关节评分,缩短住院时间,提高患者满意度等优点。     

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.     

Arthroscopic Percutaneous Repair of Anterosuperior Rotator Cuff Tear Including Biceps Long Head: A 2-Year Follow-up

Background

To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion.

Methods

The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed.

Results

The mean (± standard deviation) age of the 20 enrolled patients was 56.0 ± 7.7 years. The forward flexion strength increased from 26.3 ± 6.7 Nm preoperatively to 38.9 ± 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 ± 1.7 to 19.1 ± 3.03 Nm, 12.3 ± 3.2 to 18.1 ± 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months, 1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%).

Conclusions

The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction.     

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Purpose

To compare two groups of patients who underwent two different arthroscopic procedures for repair of articular-sided partial-thickness rotator cuff tears (PTRCTs).

Materials this is a comparative prospective study of two methods for repair of partial cuff tears

Thirty-two patients underwent arthroscopic rotator cuff repair with a transtendon technique (group 1); 28 underwent arthroscopic full-thickness conversion and repair of the lesion (group 2). ROM measures, clinical findings, MRI features (tendon healing and re-tear), Constant–Murley and ASES scores were assessed pre- and postoperatively and compared. Patients were also asked about return to sport and level of activity.

Results

At the last appointment, patients of both the groups were significantly improved for clinical findings, ROM measures, imaging features, Constant–Murley and ASES scores than at baseline, without any significant inter-group difference. In group 1, 15 of 20 patients (75 %) who practiced recreational sport activities had returned to sport at the same level as before the onset of symptoms, without any discomfort. In group 2, 12 of 18 patients (67 %) had returned to the same level of sport activity they practiced before symptoms. At the last follow up, MRI showed rotator cuff healing in 31 patients of Group 1 and 27 patients of Group 2 (p = 0.83).

Conclusions

The two procedures are safe, effective, and comparable.     

全关节镜下肩袖修补术对老年肩袖损伤患者术后72 h内疼痛程度和并发症的影响

目的:分析全关节镜下肩袖修补术与小切口肩袖修补术对老年肩袖损伤患者的临床效果。方法:选取2017年1月至2018年11月收治的60例老年肩袖损伤患者作为研究对象,男37例,女23例;年龄61~77(63.45±12.34)岁;病程6~12(5.32±1.02)个月;左侧29例,右侧31例。其中,行全关节镜下肩袖修补术者30例,为观察组;行小切口肩袖修补术者30例,为对照组。观察并记录两组患者术前术后美国加州大学肩关节评分系统(University of California,Los Angeles,UCLA)评分,美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分,Constant-Murley评分,肩关节前屈活动度、外旋活动度、外展活动度,术后72 h内视觉模拟疼痛评分(visual analogue scale,VAS)及并发症发生情况,然后进行对比分析。结果:两组患者术后UCLA评分、ASES评分、Constant-Murley评分较术前均显著提高(P<0.05),两组术后UCLA、ASES、Constant-Murley评分相比差异无统计学意义(P>0.05)。两组患者术后肩关节前屈活动度、外旋活动度、外展活动度较术前均显著增加(P<0.05),术后两组间比较差异无统计学意义(P>0.05);观察组术后24、48、72 h VAS低于对照组(P<0.05);观察组并发症总发生率13.33%(4/30)低于对照组33.33%(10/30)(P<0.05)。结论:全关节镜下肩袖修补术和小切口肩袖修补术均可以改善老年肩袖损伤后的肩部功能,但全关节镜下肩袖修补术后72 h内疼痛程度和并发症均明显优于小切口肩袖修补术,可根据患者临床实际情况与需求进行选择。     

The Correlation between Variation of Labral Attachment and Lesions of the Long Head of the Biceps Tendon in Patients with Rotator Cuff Tears

Objective

There was no universally accepted classification system that describes LHBT lesions as a type of its' pathology in patients with shoulder pain. This study aimed to determine the correlation of anatomic variants of glenoid labrum attachment of long head of biceps tendon (LHBT) and to assess their association, if any, with its lesions in rotator cuff tear (RCT) patients.

Methods

All RCT patients from January 2016 to December 2019 were assessed arthroscopically to classify the LHBT labrum attachment according to its' anatomical location. A simplified classification was created to describe the LHBT as normal, tendinitis, subluxation or dislocation, partial tear and superior labral tear from anterior to posterior (SLAP) lesion beyond type II The RCT were classified as three types as partial, small to medium and large to massive. The correlation of variants of LHBT labral attachment with type of LHBT lesions in different RCT groups was evaluated.

Results

In total, 669 patients were included for evaluation. The attachment of the LHBT was entirely posterior in 23 shoulders (3.4%), posterior-dominant in 81 shoulders (12.1%), and equal in 565 shoulders (84.4%). In equal distribution LHBT attachment group, age > 60 (odds ratio: 2.928, P < 0.001) and size of RCT (P < 0.001) were significant risk factors of LHBT lesions. In the analysis of all patients, comparing with the partial thickness rotator cuff tear (PTRCT), the odds ratio of small to medium RCT and large to massive RCT was 2.398 and 6.606 respectively. In addition, age > 60 (odds ratio: 2.854, P < 0.001) and size of RCT (P < 0.001) were significant risk factors of LHBT lesions. In posterior dominant group, size of RCT was a significant risk factor of LHBT lesions but not any others (P < 0.001). In entirely posterior group, no risk factor of LHBT lesions was found. It showed that the variation of LHBT attachment was not a significant risk factor of LHBT lesions in rotator cuff repaired patients (p = 0.075).

Conclusions

There are three types of LHBT labrum attachment in RCT patients on arthroscopic observation. 84.4% were equal distribution of LHBT attachment on glenoid labrum, followed by posterior-dominant (12.1%) and entirely posterior type (3.4%) in present study. Although the variation of LHBT attachment was not a significant risk factor of LHBT lesion in rotator cuff repaired(RCR) patients, there were different risk factors among three LHBT labral attachment types. In RCR patients, age > 60 and RCT size were significant risk factors of LHBT lesions.     

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.     

Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review

BackgroundThe benefits of acromioplasty in treating rotator cuff disease have been debated. We systematically reviewed the literature regarding whether acromioplasty with concomitant coracoacromial(CA) release is necessary for the successful treatment of full-thickness rotator cuff tears.ResultsFour studies fulfilled the inclusion criteria. They reported on 354 patients (mean age, 59 years; range 3–81 years) with a mean follow-up of 22 months (range 12–24 months). There were two level-I and two level-II studies. Two studies compared rotator cuff repair with versus without acromioplasty, and two studies compared rotator cuff repair with versus without subacromial decompression (acromioplasty, CA ligament resection, and bursectomy). The procedures were performed arthroscopically, and the CA ligament was released in all four studies. There were no statistically significant differences in clinical outcomes between patients treated with acromioplasty compared with those treated without acromioplasty.ConclusionsThis systematic review of the literature does not support the routine use of partial acromioplasty or CA ligament release in the surgical treatment of rotator cuff disease. In some instances, partial acromioplasty and release of the CA ligament can result in anterior escape and worsening symptoms. Further research is needed to determine the optimum method for the operative treatment of full-thickness rotator cuff tears.

Level of evidence

Level I, systematic review of level I and II studies.     

关节镜下缝线桥技术治疗巨大肩袖撕裂的临床研究

目的探讨关节镜下缝线桥技术缝合巨大肩袖撕裂的临床疗效。 方法回顾分析2014年6月至2016年6月在广州市正骨医院收治并取得完整随访的38例采用关节镜下缝线桥技术修复的巨大肩袖撕裂患者的临床资料,排除无法取得随访、依从性差的患者,分析术前X线片、MRI检查,了解肩袖撕裂口大小、肩袖回缩程度、肌肉萎缩及脂肪浸润情况,应用SPSS 17.0统计学软件配对t检验对术前与术后半年随访时视觉模拟评分系统(VAS)评分和美国加州大学肩关节评分系统(UCLA)评分进行比较。 结果本组患者38例,男23例,女15例,平均年龄(66±6)岁,所有患者均获半年以上的随访,随访时间(12±5)月。所有患者在关节镜下均发现有2条或以上的肌腱撕裂,关节镜下见15例患者冈上肌腱和冈下肌腱撕裂,8例冈上肌、冈下肌和小圆肌腱撕裂,10例冈上肌腱、冈下肌腱撕裂和肩胛下肌腱撕裂,5例冈上肌腱和肩胛下肌腱撕裂。术前VAS评分为(6.7±1.6)分,术后6月随访时为(2.4±1.7)分,术前与术后6月随访的VAS评分差异均有统计学意义(t ＝10.123,P<0.01);术前UCLA评分为(7.9±1.2)分,术后6月随访时为(23.4±5.1)分,术前与术后6月随访的UCLA评分差异均有统计学意义(t ＝－18.979,P<0.01);术后的UCLA、VAS评分均明显升高。术后半年MR检查结果,5例患者出现小型再撕裂,裂口均<3 cm,术后再撕裂患者与无再撕裂患者的VAS评分和UCLA肩关节评分无明显统计学差异(P>0.05)。 结论关节镜下缝线桥技术修复巨大肩袖撕裂取得较好的短期疗效,是1种合理、有效的治疗方法。     

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.     

The Prevalence of Os Acromiale in Korean Patients Visiting Shoulder Clinic

Background

The prevalence of os acromiale has been documented to be between 1% and 15% and is known to be clinically associated with subacromial impingement or rotator cuff tear. However, the prevalence of os acromiale in Korea has not yet been determined. The purpose of this study is to evaluate the prevalence of os acromiale in Korean patients who visited shoulder clinics and to investigate the correlations with rotator cuff tear.

Methods

We retrospectively reviewed the X-rays of patients visiting a shoulder clinic at a tertiary hospital in Korea from January 2011 to January 2012 to determine the frequency of os acromiale. X-ray findings were confirmed with magnetic resonance imaging (MRI) for patients who had these images available. MRI was also used to assess the status of the rotator cuff. The correlation between the presence of os acromiale either with gender, hand dominance or rotator cuff tear was analyzed statistically.

Results

A total of 2,946 shoulders from 1,568 patients were analyzed with X-rays. Thirteen cases out of 1,568 patients had an os acromiale; and there were five and eight cases of pre-acromiale and meso-acromiale, respectively. Thus, the prevalence of os acromiale in this study population was found to be 0.7 (7 cases per 1,000 patients). Bilaterality was found in two cases. Os acromiale was not more frequent according to gender (five males versus eight females, p = 0.525) and hand dominance was not associated with frequency of os acromiale (seven dominant arms versus six non-dominant arms, p = 0.631). A sub-analysis of shoulders with available MRIs (1,074 shoulders) revealed that there were two rotator cuff tears (40%) out of five cases of os acromiale, whereas 607 rotator cuff tears were observed (57%) among 1069 cases without os acromiale. This difference was not statistically significant (p = 0.656).

Conclusions

The identified prevalence of os acromiale in Korean patients who visited shoulder clinics is 0.7%, which is much lower as compared with the prevalence of general population from other ethnic groups. No correlation was observed between rotator cuff tears and os acromiale in this study population.