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.     

巨大肩袖损伤的手术修复结果

目的 探讨关节镜治疗巨大肩袖损伤的临床效果及影响因素.方法自2007年9月至2009年6月接受手术治疗的巨大肩袖损伤患者16例,男6例,女10例;平均年龄61.5岁.采取关节镜下双排重建对损伤肩袖进行修复.记录术前及最终随访时的疼痛、活动范围、前屈上举的肌肉力量以及功能评分,进行配对t检验;并按不同年龄、病程进行分组,进行统计学分析.结果 所有患者均顺利愈合,术前疼痛视觉模拟评分(visual analogue score,VAS)为5.6,前屈上举为69.1°,外旋为14.7°,内旋达L1水平,Constant-Murley评分为39,加州大学洛杉矾分校评分(UCLA)为10.4,肩关节简单评分(SST)为2.8,前屈上举的肌力相当于健侧的10.7%.术后VAS为1.7,前屈上举为151.2°,外旋为32.2°,内旋达T10水平,Constant-Murley评分为85.6,UCLA为28,SST为8.8,前屈上举的肌力为健侧的65.0%.术后与术前在疼痛、活动范围、肌力及功能方面差异均有统计学意义(P<0.01).不同性别和不同病程在手术前后的差异均无统计学意义.结论通过关节镜手术对损伤的肩袖进行双排重建可获得较为满意的临床治疗结果.

Abstract：

Objective To evaluate the clinical results of arthroscopic repair of massive rotator cuff tear. Methods The study involved 16 patients with massive rotator cuff tears treated arthroscopically from September 2007 to June 2009. There were 6 males and 11 females at average age 61.5 years (45-75 years). The rotator cuff tears was repaired with arthroscopic double-row reconstruction. The range of motion, pain, strength of flexed elevation and function evaluation score were all recorded before operation and at final follow-up. The results were evaluated by t test and compared according to age and course of disease. Results All patients were healed without complications and the outcome was improved significantly ( P < 0.01 ). The mean VAS score was improved from preoperative 5.6 to postoperative 1.7,the average forward flexion from 69. 1°to 151.2°, the average external rotation from 14.7° to 32.2°, and internal rotation from L1 level to T10, the mean Constant-Murle from 39 to 85, the mean UCLA from 10.4 to 28, the mean SST from 2.8 to 8.8 and the strength of flexed elevation from 10.7% of normal side to 65.0%. Compared with preoperation, there was statistical difference in aspects of pain, range of motion, muscle strength and function in postoperation (P < 0.01 ). Conclusion Arthroscopic doublerow fixation can attain satisfactory results in repair of massive rotator cuff tear.     

巨大肩袖损伤的手术修复结果

Objective To evaluate the clinical results of arthroscopic repair of massive rotator cuff tear. Methods The study involved 16 patients with massive rotator cuff tears treated arthroscopically from September 2007 to June 2009. There were 6 males and 11 females at average age 61.5 years (45-75 years). The rotator cuff tears was repaired with arthroscopic double-row reconstruction. The range of motion, pain, strength of flexed elevation and function evaluation score were all recorded before operation and at final follow-up. The results were evaluated by t test and compared according to age and course of disease. Results All patients were healed without complications and the outcome was improved significantly ( P < 0.01 ). The mean VAS score was improved from preoperative 5.6 to postoperative 1.7,the average forward flexion from 69. 1°to 151.2°, the average external rotation from 14.7° to 32.2°, and internal rotation from L1 level to T10, the mean Constant-Murle from 39 to 85, the mean UCLA from 10.4 to 28, the mean SST from 2.8 to 8.8 and the strength of flexed elevation from 10.7% of normal side to 65.0%. Compared with preoperation, there was statistical difference in aspects of pain, range of motion, muscle strength and function in postoperation (P < 0.01 ). Conclusion Arthroscopic doublerow fixation can attain satisfactory results in repair of massive rotator cuff tear.     

Arthroscopic hybrid double-row rotator cuff repair

A Beath pin is drilled on the greater tuberosity under arthroscopy using an anterior cruciate ligament guide. The suture anchor is inserted in the lateral aspect of the footprint. Sutures are then passed through the margins of the rotator cuff tear and tied with sliding knot. One strand of tied suture anchor is passed into the bony trough. One passed strand and the other strand are then tied with a non-sliding knot on the greater tuberosity. The strength of cuff fixation does not only rely on the quality of the bone, it restores the footprint contact area of rotator cuff, and reduces the use of suture anchors to the minimum in this method.     

关节镜下肩袖损伤修补术后早期运动和制动对肩关节功能的影响

目的 探讨早期康复被动运动和制动对关节镜下肩袖损伤修补术后肩关节功能的影响.方法 采用回顾性病例对照研究分析2016年1月至2017年12月上海交通大学医学院附属新华医院收治的78例肩袖损伤患者临床资料,其中男36例,女42例;年龄35～78岁[(62.7 ±3.2)岁].中度撕裂(1～3 cm)36例,小撕裂(<1 ...     

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.     

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.     

Identifiable risk factors for thirty-day complications following arthroscopic rotator cuff repair

Objectives: Shoulder arthroscopy has increased in frequency over the past decade, with rotator cuff repair comprising the majority of cases performed. Prior studies have detailed risk factors for 30-day complications and readmission rates after arthroscopic shoulder surgery using the National Surgical Quality Improvement Program (NSQIP) database, but no study has specifically looked at arthroscopic rotator cuff repair. The purpose of the study is to evaluate the risk factors for 30-day complications following arthroscopic rotator cuff repair using the NSQIP database.

Methods: The NSQIP database was queried for all patients undergoing arthroscopic rotator cuff repair from 2006–2015. Demographics and thirty-day outcomes for these patients were analyzed using univariate analyses and multivariate regression analysis to determine the risk factors for complications.

Results: 21,143 patients underwent arthroscopic rotator cuff repair, with 147 patients (0.70%) having a complication within 30-days. Univariate analysis found age >65 (p = 0.0028), male gender (p = 0.0053), elevated BMI (p = 0.0054), ASA class >2 (p < 0.0001), history of chronic obstructive pulmonary disease (p < 0.0001), hypertension (p < 0.0002), dyspnea (p < 0.0001), steroid use (p = 0.0350), and operative time >90 min (p = 0.0316) to be associated with increased risk of complications. Multivariate analysis found female sex to be protective or complication (OR 0.56, p = 0.0017), while American Society of Anesthesiology (ASA) class >2 (OR 1.51, p = 0.0335) and history of COPD (OR 2.41, p = 0.0030) and dyspnea (OR 1.89, p = 0.0359) to be risk factors for complication. The most common complication is venothromboembolic events, accounting for 36.7% of all complications.

Conclusion: Male sex, ASA class > 2, and history of COPD and dyspnea were independent risk factors for thirty-day complications following arthroscopic rotator cuff repair.

Level of evidence: IV     

Open techniques for repair of largeand massive rotator cuff tears

Rotator cuff tears can be a significant source of shoulder pain and weakness. Repair of full-thickness tears canimprove patient satisfaction and functional outcome. Several repair techniques have been described in the literature; these include arthroscopic and open approaches. Although arthroscopic repair has been popularized in the recent literature, it may not be optimal for some cases of large or massive rotator cuff tears. Open approaches allow greater access for mobilization and enable placement of bone tunnels for bone-tendon repair. The surgeon may readily release bursal and articular sided adhesions and mobilize the retracted tendon to its anatomic footprint on the greater tuberosity. This article describes 2 surgical approaches of open repair, the mini-open and formal open approach. Furthermore, useful techniques for tendon mobilization, bone-tendon repair, and postoperative rehabilitation for the management of large and massive rotator cuff tears are described.     

异体骨锚钉双排固定法修复肩袖损伤

目的 探讨异体皮质骨锚钉双排固定法修复肩袖损伤的价值.方法 关节镜监视下,采用同种异体皮质骨锚钉双排同定法修复肩袖损伤16例.其中男10例,女6例;年龄32～58岁,平均44岁.按Bigliani肩袖损伤分类法,小撕裂6例,中度撕裂8例,大撕裂2例.关节镜下肩袖清理和肩峰成形后,采用带线异体骨锚钉植入肱骨大结节肩袖附着处,双根缝线垂直褥式缝合冈上肌腱,分别打结固定后,将缝线交叉牵引到在肱骨大结节预制的骨道处,将缝线穿入另一个骨锚钉孔内并击入骨道内.4根缝线交叉呈网状覆盖撕裂的冈上肌腱由骨锚钉固定.根据撕裂创面大小决定骨锚钉植入数量.结果 所有患者术后得到随访,时间6～23个月,平均14个月.术后疼痛症状均消失,肩关节功能采用美国加州洛杉矶大学(UCLA)功能评分标准评估,术前(20.5±5.6)分,术后(33.4±5.8)分.优10例,良5例,可1例.术后肩关节稳定性良好,无锚钉拔出和损伤复发.结论 异体骨锚钉双排同定法修复肩袖损伤,镜下手术操作方便,骨锚钉嵌入固定牢靠,增加肩袖组织与骨创面的接触面积,有利于肩袖愈合.骨锚钉生物固定,无异物存留,价格低廉.     

Evaluation of BioCorkscrew and Bioknotless RC suture anchor rotator cuff repair fixation: an in vitro biomechanical study

This in vitro biomechanical study used cadaveric specimens to compare the rotator cuff repair fixation provided by BioCorkscrew and Bioknotless RC suture anchors. Three cm wide by 1-cm long full-thickness supraspinatus defects were repaired using either two BioCorkscrew suture anchors with combined vertical and horizontal mattress sutures (n = 7) or three Bioknotless RC suture anchors with simple sutures (n = 7). Therefore, the BioCorkscrew suture anchor group had two sutures per anchor (four total sutures), while the Bioknotless RC suture anchor group had one suture per anchor (three total sutures). Two-phase cyclic (5–100 N, 1,000 cycles and 5–180 N, 2,000 cycles) and load to failure tests (31 mm/s) were performed. Non-parametric statistics were used to compare group differences (P < 0.05). All of the BioCorkscrew group specimens (seven of seven) completed the two phase cyclic test regimen without failure or gapping ≥ 5 mm, compared to only three of seven of the Bioknotless RC group (Fisher’s Exact test = 0.03). Groups did not differ for repair site gapping during the 5–100 N cyclic test phase (Fisher’s Exact test = 0.77), however more of the Bioknotless RC group displayed gapping ≥ 5 mm during the 5–180 N cyclic test phase than the BioCorkscrew group (P = 0.02). The BioCorkscrew group also displayed greater yield load during load to failure testing (492.2 ± 204 N vs. 296.4 ± 155 N, P = 0.03). In this in vitro biomechanical study, the BioCorkscrew group with combined vertical and horizontal mattress sutures displayed greater cyclic test survival, less repair site gapping, and superior yield load compared to the Bioknotless RC group with simple sutures. These results in human cadaveric rotator cuff-humerus specimens suggest better immediate post-operative repair site strength and a reduced need for post-operative restrictions. Clinical studies are needed to determine how these rotator cuff repair modes withstand the forces of early rehabilitation and activities of daily living that potentially influence patient outcomes.     

Limited sensitivity of ultrasound for the detection of rotator cuff tears

Bilateral rotator cuff sonography was performed on 56 patients referred for shoulder arthrography to detect rotator cuff tears. Since one patient had bilateral arthrography there were 57 arthrograms. Twenty-seven shoulders had rotator cuff tears shown on arthrography, 15 of which were detected by sonography. Eleven were false negative by sonography, and one was indeterminate. Of the 30 shoulders with negative arthrograms, 28 had normal sonograms and two were false positive. Sensitivity was 58%, specificity was 93% and overall accuracy was 77%. The positive and negative predictive values were 88% and 72%. These results suggest that sonography has limited value in screening patients for rotator cuff tears and that a positive sonographic reading is more reliable than a negative one. Theories relating to the variable anatomic configuration of a tear are postulated to explain these results, which differ from those previously reported.     

肩袖损伤的影像学及关节镜诊疗价值

目的探讨肩袖损伤的影像学改变及关节镜检查在诊疗中的价值。方法18例肩袖损伤术前行造影和磁共振成像(MRI)。关节镜手术18例，其中关节镜下肩峰成形减压术16例，小切口肩峰成形2例。全层肩袖损伤10例行小切口肩袖缝合，肩袖部分磨损8例行关节镜下刨削清理术。结果肩关节造影13例，其中9例显示肩关节腔与肩峰下滑囊和三角肌下滑囊沟通，4例未见异常。MRI检查18例，其中10例显示肩袖全层损伤，8例冈上肌腱信号异常为部分损伤。根据关节镜检查结果判断其诊断准确率，MRI为100％，肩关节造影69％。术后随访时间3～22个月，平均7个月。根据美国加州洛杉矶大学(UCLA)肩关节评分标准，优9例，良6例，可3例，优良率达83％。结论肩关节造影有助于全层肩袖损伤的诊断；MRI对肩袖部分和全层损伤正确诊断率和敏感性最高；关节镜治疗肩袖损伤具有微创，有利于功能恢复。     

Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery

Purpose

To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears.

Materials and methods

Ninety-six patients with clinically suspected rotator cuff pathology underwent ultrasonography and magnetic resonance imaging of the shoulder. The findings in 88 patients were compared with arthroscopy or open surgery.

Results

Full-thickness tear was confirmed in 57 cases, partial-thickness tear in 30 cases and degenerative changes without tear in 1. In all 57 cases of full-thickness tear and in 28 out of 30 cases of partial-thickness tear the supraspinatus tendon was involved. The accuracy in the detection of full-thickness tears was 98 and 100% for ultrasonography and magnetic resonance imaging, respectively. The accuracy in the detection of bursal or articular partial-thickness tears was 87 and 90% for ultrasonography and magnetic resonance imaging, respectively.

Conclusions

In experienced hands ultrasonography should be considered as an accurate modality for the initial investigation of rotator cuff, especially supraspinatus, tears.     

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.     

Pullout strength of suture anchors in comparison with transosseous sutures for rotator cuff repair

Suture anchors are increasingly gaining importance in rotator cuff surgery. This means they will be gradually replacing transosseous sutures. The purpose of this study was to compare the stability of transosseous sutures with different suture anchors with regard to their pullout strength depending on bone density. By means of bone densitometry (CT scans), two groups of human humeral head specimens were determined: a healthy and a osteopenic bone group. Following anchor systems were being tested: SPIRALOK™ 5.0 mm (resorbable, DePuy Mitek), Super Revo 5 mm (titanium, Linvatec), UltraSorb (resorbable, Linvatec) and the double U-sutures with Orthocord™ USP 2 (partly resorbable, DePuy Mitek) and Ethibond Excel 2 (non-resorbable, Ethicon). The suture anchors/double U-sutures were inserted in the greater tuberosity 12 times. An electromechanical testing machine was used for cyclic loading with power increasing in stages. We recorded the ultimate failure loads, the system displacements and the modes of failure. The suture anchors tended to bring about higher ultimate failure loads than the transosseous double U-sutures. This difference was significant in the comparison of the Ethibond suture and the SPIRALOK 5.0 mm—both in healthy and osteopenic bone. Both the suture materials and the SPIRALOK 5.0 mm showed a significant difference in pullout strength on either healthy or osteopenic bone; the titanium anchor SuperRevo 5 mm and the tilting anchor UltraSorb did not show any significant difference in healthy or osteopenic bone. There was no significant difference concerning system displacement (healthy and osteopenic bone) between the five anchor systems tested. The pullout strength of transosseous sutures is neither on healthy nor on osteopenic bone higher than that of suture anchors. Therefore, even osteopenic bone does not constitute a valid reason for the surgeon to perform open surgery by means of transosseous sutures. The choice of sutures in osteopenic bone is of little consequence anyway since it is mostly the bone itself which is the limiting factor.     

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.     

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。     

Arthroscopic repair of rotator cuff tear with a modified Mason–Allen stitch: mid-term clinical and ultrasound outcomes

One of the most discussed point about arthroscopic full-thickness rotator cuff (RTC) repair is the strength of tendon–stitch interface. In the period between November 2003 and September 2004, in a series of 29 patients with primary isolated supraspinatus tear measuring >2 cm a reconstruction using one titanium anchor and a modified Mason–Allen (MMA) stitch was done. These patients were prospectively collected in this study and then retrospectively evaluated. There were 21 men and 8 women with a mean age of 59.3 years. Patients were examined pre-operatively by a single sport medicine doctor, very experienced on shoulder pathology problem. Constant score, University of California at Los Angeles (UCLA) scale and Simple Shoulder Test (SST) were administered. After a minimum follow-up of 24 months patients were revaluated clinically by the same independent examiner. At the same time patients underwent an ultrasound shoulder examination to evaluate rotator cuff integrity. Clinically there was a significant improvement of Constant score, SST score and UCLA scale at follow-up. Twenty-five patients (86.2%) were satisfied, whether the other four patients (13.8%) stated that they would decline procedure. Recurrent rotator cuff tear was found in 11 patients (38%), who were all older than 60. All the patients but one with a pre-operative MRI grade III tendon tissue fatty infiltration, had a cuff re-tear. Arthroscopic supraspinatus tendon repair with one single anchor and MMA stitch is a reliable technique leading to a re-tear of 38% that is comparable with results reported in literature.     

Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study

A prospective evaluation of the coexistence of calcific tendinitis and tear of the rotator cuff demonstrated by arthrography was made in patients presenting with shoulder pain. Patients were X-rayed using conventional views and impingement views. Eighty-one patients (mean age 61.2 years) with calcific tendinitis underwent arthrography. Arthrography showed 22 partial or complete tears of the rotator cuff. A small rather than a large amount of calcification was more likely to be associated with a rotator cuff tear (p = 0.005). The coexistence of calcific tendinitis with rotator cuff tear is not uncommon, especially in older age groups.