The management of partial thicknessrotator cuff tears in throwers

Clinical outcomes after arthroscopic trans-tendon suture-bridge technique in partial-thickness articular-side rotator cuff tear

PURPOSE

We evaluated the functional and radiological outcomes of arthroscopic trans-tendon suture-bridge repair for partial-thickness articular-side rotator cuff tears.

METHODS

From December 2008 to May 2010, 32 consecutive patients with partial-thickness articular-side rotator cuff tears prospectively underwent arthroscopic trans-tendon suture-bridge repair. We included patients with articular-side partial-thickness supraspinatus tears involving more than half the normal thickness. Patients underwent ultrasonography or magnetic resonance imaging postoperatively. The functional outcomes of patients were evaluated at a minimum 1 year postoperatively. The mean age and follow-up period for the patients were 51.8 ± 13.7 years and 17.4 ± 4.2 months, respectively. Five outcome measures were used before surgery and at the final follow-up: a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant-Murley score and range of motion (ROM).

RESULTS

The radiological follow-up rate was 87.5%, and the follow-up rate for clinical evaluation was 96.9%. Mean UCLA, ASES and Constant-Murley scores improved from 19.1 ± 5.4, 45.2 ± 16.0 and 58.0 ± 19.6 preoperatively to 35.7 ± 8.5, 79.0 ± 15.8 and 78.1 ± 12.9 at final follow-up, respectively (all p ≤ 0.001). Mean VAS score and ROM (forward flexion) improved from 6.1 ± 1.9 and 140 ± 36.6 preoperatively to 2.6 ± 1.9 and 163 ± 25.2 at the final follow-up, respectively (p ≤ 0.001). Additionally, the postoperative radiological examination showed cuff integrity without retear in all patients.

CONCLUSIONS

Arthroscopic trans-tendon suture-bridge repair for partial-thickness articular-side rotator cuff tears resulted in significant improvement in function compared with that before the operation.

Predictive factors of subtle residual shoulder symptoms after transtendinous arthroscopic cuff repair: a clinical study

BACKGROUND

Transtendinous repair is a well-known technique for the arthroscopic management of partial rotator cuff tear. However, there are not a lot of clinical follow-up studies in the literature reporting data on this approach, and, moreover, potential factors responsible to influence the outcomes have not been investigated.

PURPOSE

To evaluate clinical outcomes after arthroscopic transtendinous repair and to identify predictive factors of residual shoulder symptoms.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Fifty-four patients with a mean age of 56.7 +/- 8.8 years (range, 31-71 years) who had undergone an arthroscopic transtendon repair for a painful articular-sided rotator cuff tear with a minimum of 2 years of follow-up were contacted. Clinical outcomes using a patient-based questionnaire, the Constant score, University of California at Los Angeles score, Simple Shoulder Test, and visual analog scale were evaluated. The influence of patient age, presence or absence of a trauma responsible for the cuff tear, presence of associated shoulder lesions, millimeters of exposed footprint, and millimeters of torn tendon retraction on the outcomes were assessed.

RESULTS

The mean cuff tear exposure footprint was 5.2 mm, and the mean retraction of the torn part of the tendon was 8 mm. Only one patient reported dissatisfaction with surgery because of persistence of pain during overhead activities. After arthroscopic repair, University of California at Los Angeles, Constant, and Simple Shoulder Test scores were significantly improved from 14.1, 45.3, and 9.8 to 32.9, 90.6, and 0.8, respectively (P < .001). Twenty-two patients (41%) reported occasional shoulder discomfort at the extremes of range of motion (particularly at extremes of abduction and internal rotation) occurring during some daily living and sports activities. The best multivariate model showed that residual shoulder discomfort is strongly linked with a partial thickness supraspinatus tendon avulsion-type articular-sided rotator cuff lesion consisting of a large tendon retraction and/or a relatively small exposure footprint area in an older patient in the absence of a specific trauma (P < .001).

CONCLUSION

Arthroscopic transtendon partial articular supraspinatus tendon avulsion-type rotator cuff repair was a reliable procedure that resulted in a good outcome in terms of pain relief and shoulder scores in 98% of the 54 patients. Better results could be expected in patients with less tendon retraction, a larger footprint exposure, of younger age, and with a clinical history of trauma.

MRI of the postoperative shoulder

Pain in the postoperative shoulder is difficult for all individuals involved. The patient has already undergone a surgical procedure and is presenting now with pain possibly relating to a complication of the procedure or reinjury. In addition, the patient typically has undergone a series of maneuvers, from physical therapy to cortisone injection, without relief of the symptoms. For the orthopaedic surgeon the possibility of a complication of the procedure is disheartening. Finally, for the radiologist the postoperative shoulder usually is more difficult to interpret because of a change in the normal anatomy, not knowing exactly what was accomplished at surgery or what techniques or types of equipment were used, and, more typically, the presence of artifact.