Objective To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT). Methods The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared. Results All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation (P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation (P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group (P<0.05). There was no significant difference in other baseline data between the two groups (P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group (P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups (P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B (P>0.05). ConclusionTendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.
Objective To analyze the effect of stump-preserving repair on rotator cuff healing and shoulder function for degenerative total rotator cuff tears. Methods A clinical data of 152 patients with degenerative total rotator cuff tears, who underwent arthroscopic repair between April 2019 and May 2022, was retrospectively analyzed. There were 76 males and 76 females with an average age of 55.4 years (range, 24-78 years). MRI was performed at 6 months postoperatively to evaluate the rotator cuff healing according to the Sugaya classification. Pre- and intra-operative related factors were included for univariate analysis, including age (≥60 years/<60 years), gender (male/female), passive activity disorder (yes/no), disease duration (≤3 months/>3 months), stump-preserving repair (yes/no), use of suture bridge technique (yes/no), shoulder joint abduction angle at knotting (<45°/≥45°), acromioplasty (yes/no), glucocorticoid injection (yes/no), time for patients to start postoperative passive exercise (≤2 weeks/>2 weeks), and time for patients to start postoperative active exercise (≤3 months/>3 months). The influencing factors of tendon healing were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors. Two sets of data were balanced by propensity score matching. The American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score of shoulder joint function at 6 and 12 months postoperatively, as well as rotator cuff healing rate at 6 months postoperatively, were compared between groups based on whether or not stump-preserving repair was used. Results All patients were followed up 12-33 months (mean, 23.8 months). MRI at 25-31 weeks postoperatively showed the 121 cases of rotator cuff healing and 31 cases of non healing. Univariate analysis showed that the disease duration, stump-preserving repair, shoulder joint abduction angle at knotting, and the time for patients to start postoperative active exercise were the influencing factors of rotator cuff healing (P<0.05). Multivariate analysis showed that non-stump-preserving repair, shoulder abduction angle more than 45° at knotting, and the time to start active exercise within 3 months postoperatively were risk factors affecting rotator cuff healing (P<0.05). A total of 51 pairs of cases were matched based on the grouping criteria of whether the disease duration exceeded 3 months, whether the shoulder abduction angle at knotting exceeded 45°, and whether the time to start postoperative active exercise exceeded 3 months. The rotator cuff healing rate, ASES score, and Constant-Murley score of the preserving repair group at 6 months postoperatively were superior to those of the non-preserving repair group, and the differences were significant (P<0.05). There was no significant difference in ASES score and Constant-Murley score between the two groups at 12 months postoperatively (P>0.05). Conclusion For degenerative total rotator cuff tears, the stump-preserving repair can shorten the healing time and promote the shoulder function recovery, but has no significant effect on shoulder function at 1 year postoperatively.
Objective To review the research progress of arthroscopic long head of biceps tendon (LHBT) transposition in treatment of irreparable massive rotator cuff tears. Methods The domestic and foreign related literature in recent years on the treatment of irreparable massive rotator cuff tears with different LHBT transposition methods under arthroscopy was reviewed and analyzed. Results Arthroscopic LHBT transposition is an effective method for irreparable massive rotator cuff tears, which mainly includes “proximal cut”, “both two cuts”, “distal cut”, and “no cut”. Different methods of LHBT transposition can achieve good effectiveness, but its long-term effectiveness needs further follow-up. Conclusion Arthroscopic LHBT transposition in treatment of irreparable massive rotator cuff tears is simple and effective. The patients can recover quickly after operation with less injury. But the technique has higher requirements for surgeons, and the indications must be strictly controlled.
ObjectiveTo review the research progress of treatment for massive rotator cuff tears. MethodsThe domestic and foreign literature about the treatment of massive rotator cuff tears was reviewed. The methods and effectiveness were extensively summarized.ResultsThe treatment of massive rotator cuff tears still needs long-term research to promote its continuous improvement. The main goal of treatment is to relieve the symptoms and improve the shoulder joint function. With the development of arthroscopic technique, arthroscopic repair of rotator cuff tears has become a mature surgical protocol. Among these techniques, superior capsule reconstruction and patch augmentation for massive rotator cuff tears acquire more attention in recent years. As for rotator cuff arthropathy, reverse shoulder arthroplasty is considered to be a final choice. ConclusionSurgical treatment is the main choice for massive rotator cuff tears. Patients’ age and muscle condition should be taken into consideration to decide the surgical technique.
ObjectiveTo investigate early effectiveness of arthroscopic superior fulcrum reconstruction in the treatment of irreparable massive rotator cuff tear (IMRCT). Methods A retrospective analysis was conducted on the clinical data of 24 patients with IMRCT who met the inclusion criteria between January 2020 and April 2022. Among them, there were 11 males and 13 females with an average age of 56.2 years (range, 42-68 years). There were 12 cases of falling injuries, 3 cases of traction injuries, and the other 9 cases had no obvious causes. The disease duration ranged from 1 to 25 months (median, 6 months). The rotator cuff tears were classified as Hamada grade 2 in 18 cases and grade 3 in 6 cases, and Goutallier grade 1 in 3 cases, grade 2 in 20 cases, and grade 3 in 1 case. All patients were treated with arthroscopic superior fulcrum reconstruction. Visual analogue scale (VAS) score, Constant-Murley score, the University of California at Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score were recorded before operation and at 1, 3, 6, and 12 months after operation. Results The operations were all successfully completed. The incisions healed by first intention and no related complications occurred. All patients were followed up 12-33 months (mean, 24.6 months). The VAS, Constant-Murley, UCLA, and ASES scores at different time points after operation were superior to those before operation (P<0.05). All of the above indicators further improved with time. Except for no significant difference in VAS and Constant-Murley scores between 6 and 12 months (P>0.05), the differences between the other time points were significant (P<0.05). At 12 months after operation, according to UCLA scoring standard, shoulder joint function was rated as excellent in 4 cases, good in 19 cases, and poor in 1 case, with an excellent and good rate of 96.0%. MRI showed that there was no graft re-tear and the transplanted tendon and bone tunnel healed. Conclusion The arthroscopic superior fulcrum reconstruction for IMRCT can effectively relieve the pain, improve the shoulder range of motion, and restore good shoulder function.
Objective To observe and evaluate the short-term effectiveness of superior capsular reconstruction using autologous fascia lata graft for irreparable massive rotator cuff tears. Methods The clinical data of 9 patients with irreparable massive rotator cuff tears treated with arthroscopic superior capsular reconstruction by using autologous fascia lata graft between September 2019 and April 2020 were retrospectively analysed. There were 4 males and 5 females with a median age of 66 years (range, 55-70 years). The disease duration was 6-60 months with an average of 19.1 months. According to Hamada classification, the patients were classified as grade 1 in 2 cases, grade 2 in 2 cases, grade 3 in 2 cases, and grade 4 in 3 cases. Before and after operation, the visual analogue scale (VAS) score was used to evaluate the improvement of shoulder joint pain, the American Shoulder and Elbow Surgeons (ASES) score, Constant score, and the University of California Los Angeles (UCLA) shoulder function score were used to evaluate the improvement of shoulder joint function. The active range of motion of shoulder joint was recorded, including forward flexion, abduction, lateral external rotation, and internal rotation. The changes of subacromial space were recorded by anteroposterior X-ray film of shoulder joint. Sugaya classification was used to judge the integrity of rotator cuff immediately after operation and at last follow-up. ResultsThe operation time was 210-380 minutes, with an average of 302.3 minutes. All incisions healed by first intention after operation, and there was no complication such as infection and nonunion of incisions. Two patients had numbness of the upper limbs on the surgical side after operation, and the numbness completely relieved at 6 weeks after operation; 5 cases with preoperative pseudoparalysis symptoms recovered after operation. Nine patients were followed up 12-17 months, with an average of 14.1 months. At last follow-up, the patient’s active range of motion of shoulder joint (forward flexion, abduction, lateral external rotation, and internal rotation), subacromial space distance, VAS score, ASES score, Constant score, and UCLA score significantly improved when compared with preoperative ones (P<0.05). There was no significant difference in the Sugaya classification between at last follow-up and immediately after operation (Z=−1.633, P=0.102). ConclusionSuperior capsular reconstruction using autologous fascia lata graft can restore the superior stability and achieve a good short-term effectiveness for irreparable massive rotator cuff tears.
Objective To investigate the effectiveness of arthroscopic long head of biceps tendon (LHBT) transposition combined with Swivelock anchor double fixation in treatment of massive and irreparable rotator cuff tears. Methods Between June 2019 and November 2021, 25 patients with massive and irreparable rotator cuff tears were treated by arthroscopic LHBT transposition combined with Swivelock anchor double fixation. There were 12 males and 13 females. The age ranged from 47 to 74 years (mean, 62.4 years). The disease duration ranged from 1 to 62 months (median, 7 months). The rotator cuff tears were classified as Hamada grade 2 in 25 cases and Goutallier grade 1 in 2 cases, grade 2 in 22 cases, and grade 3 in 1 case. Pre- and post-operative shoulder range of motion (ROM), visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, and Constant-Murley score were recorded. Postoperative complications were observed. The reconstructed tissue integrity was confirmed by MRI. Results All operations were successfully completed. The operation time was 120-330 minutes (mean, 189.6 minutes). All incisions healed by first intention. All patients were followed up 10-36 months (mean, 22.0 months). At last follow-up, the ROM in forward flexion, abduction, and external rotation, VAS score, UCLA score, and Constant-Murley score were superior to those before operation, and the differences were significant (P<0.05). According to UCLA scoring standard, shoulder joint function was rated as excellent in 5 cases, good in 18 cases, and poor in 2 cases, with an excellent and good rate of 92.0%. No other complications occurred except shoulder joint adhesion in 2 cases. At last follow-up, MRI examination showed no retear of rotator cuff, and LHBT was intact. Conclusion For massive and irreparable rotator cuff tears, arthroscopic LHBT transposition combined with Swivelock anchor double fixation can increase the force of pressing the humeral head, effectively relieve the pain, improve the ROM of joints, maximize the recovery of shoulder function, and do not increase the number of anchor nails.
Objective To evaluate the influencing factors that affect early pain after arthroscopic rotator cuff repair. MethodsA clinical data of 592 patients who met the selection criteria and underwent arthroscopic rotator cuff repair between June 2018 and October 2020 were retrospectively analyzed. There were 239 males and 353 females, with an average age of 58.1 years (range, 32-81 years). Before operation and at 3 days, 6 weeks, and 3 months after operation, the pain degree of patients was evaluated by visual analogue scale (VAS) score; and the patients were divided into no pain or mild pain group and moderate to severe pain group according to the postoperative VAS score. Preoperative and intraoperative related factors were included for univariate analysis, including age, gender, body mass index, preoperative VAS score, history of frozen shoulder, history of hypertension, history of diabetes, history of smoking, affected tendons (supraspinatus, infraspinatus, or subscapularis tendon injury), supraspinatus muscle atrophy, fatty infiltration, operation time, degree of rotator cuff tear, number of anchors, and whether to perform acromioplasty. The influencing factors of postoperative pain were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors. Results Moderate to severe pain occurred in 440 patients (74.3%) at 3 days after operation, 382 patients (66.2%) at 6 weeks, and 141 patients (23.8%) at 3 months. Multivariate analysis showed that the women, partial-thickness rotator cuff tear, and acromioplasty were risk factors for pain at 3 days after operation (P<0.05); the women, combined with fatty infiltration, partial-thickness rotator cuff tear, and acromioplasty were the risk factors at 6 weeks (P<0.05); and the women, combined with fatty infiltration, and partial-thickness rotator cuff tear were risk factors at 3 months (P<0.05). Conclusion Among patients undergoing arthroscopic rotator cuff repair, women, those with smaller rotator cuff tears, combined with fatty infiltration, and acromioplasty have more severe pain within 3 months after operation, and attention should be paid to postoperative analgesia in these patients management, providing an individualized approach to rehabilitation, and closer follow-up.
Objective To review the progress in the treatment and research of massive rotator cuff tears. Methods Recent l iteratures about the treatment and research of massive rotator cuff tears were reviewed. Results Treatment options of massive rotator cuff tears include nonoperative treatment, debridement, direct repair, tendon transfer, and repair with various substitutes, but the outcome is unpredictable. Recently, many experimental studies on the treatment of massive rotator cuff tears, such as gene therapy, cell therapy, and tissue engineering techniques, can provide cl inicians with new treatment strategies. Conclusion The treatment of massive rotator cuff tears pose a distinct cl inical challenge for the orthopaedist, depending on the overall presentation. The effect of traditional operation method to repair massive rotator cuff tears is limited. The treatment and research of massive rotator cuff tears still need to be studied.
Objective To explore the effectiveness of the arthroscopic separate double-layer suture bridge technique in treatment of the delaminated rotator cuff tear. Methods Between May 2013 and May 2015, 54 patients with the delaminated rotator cuff tears were recruited in the study. They were randomly allocated into 2 groups to receive repair either using arthroscopic separate double-layer suture bridge technique (trial group, n=28) or using arthroscopic whole-layer suture bridge technique (control group, n=26). There was no significant difference in gender, age, injured side, tear type, and preoperative visual analogue scale (VAS) score, Constants score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) score, and the range of motion of shoulder joint between 2 groups (P>0.05). Postoperative functional scores, range of motion, and recurrence rate of tear in 2 groups were observed and compared. Results The operation time was significant longer in trial group than in control group (t=8.383, P=0.000). All incisions healed at stage Ⅰ without postoperative complication. All the patients were followed up 12 months. At 12 months postoperatively, the UCLA score, ASES score, VAS score, Constant score, and the range of motion were significantly improved when compared with the preoperative values in 2 groups (P<0.05). However there was no significant difference in above indexes between 2 groups (P>0.05). Four cases (14.3%) of rotator cuff tear recurred in trial group while 5 cases (19.2%) in control group, showing no significant difference (χ2=0.237, P=0.626). Conclusion Compared with the arthroscopic whole-layer suture bridge technique, arthroscopic separate double-layer suture bridge technique presents no significant difference in the shoulder function score, the range of motion, and recurrence of rotator cuff tear, while having a longer operation time.