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Pasqualini I, Brinkman JC, Tokish JM, Denard PJ. Surgical Management of Massive Irreparable Cuff Tears: Superior Capsule Reconstruction and Rotator Cable Reconstruction. Curr Rev Musculoskelet Med 2024; 17:101-109. [PMID: 38340293 PMCID: PMC10917707 DOI: 10.1007/s12178-024-09887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW Massive irreparable rotator cuff tears (MIRCTs) present treatment challenges. Recently, superior capsule reconstruction (SCR) and anterior cable reconstruction have emerged as surgical options, but no single approach is superior. This review provides an overview of SCR and cable reconstruction techniques, including biomechanical studies, clinical outcomes, and surgical considerations. RECENT FINDINGS Biomechanical studies show SCR with autografts or allografts improves glenohumeral stability and mechanics. Clinical outcomes of SCR demonstrate improved range of motion, function scores, and pain relief in short-term studies. Anterior cable reconstruction reduces superior humeral head translation and subacromial pressures in biomechanical models. Early clinical studies report improved rotator cuff healing and outcomes for cable reconstruction in specific irreparable tear patterns. SCR and cable reconstruction are viable surgical options for MIRCTs based on early encouraging results. However, higher-level comparative studies with long-term follow-up are still needed. Careful consideration of tear pattern, patient factors, and surgical goals is required to optimize treatment of MIRCTs. Further research is necessary to determine the optimal role for these procedures.
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Affiliation(s)
| | | | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
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Yubran AP, Pesquera LC, Juan ELS, Saralegui FI, Canga AC, Camara AC, Valdivieso GM, Pisanti Lopez C. Rotator cuff tear patterns: MRI appearance and its surgical relevance. Insights Imaging 2024; 15:61. [PMID: 38411840 PMCID: PMC10899560 DOI: 10.1186/s13244-024-01607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/17/2023] [Indexed: 02/28/2024] Open
Abstract
A new perspective on rotator cuff anatomy has allowed a better understanding of the patterns of the different rotator cuff tears. It is essential for radiologists to be aware of these different patterns of tears and to understand how they might influence treatment and surgical approach. Our objective is to review the arthroscopy correlated magnetic resonance imaging appearance of the different types of rotator cuff tears based on current anatomical concepts.Critical relevance statement Knowledge of the characteristics of rotator cuff tears improves our communication with the surgeon and can also make it easier for the radiologist to prepare a report that guides therapeutic conduct and serves as a prognosis for the patient.Key points• There is no universally accepted classification for RC tears.• New patterns such as delamination or myotendinous junction tears have been defined.• The most difficult feature to assess in full thickness tears on MRI is the pattern.• Fatty infiltration of the RC tendons is crucial in the prognosis and outcome.• The radiological report is an effective way of communication with the surgeon.
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Affiliation(s)
- Alexeys Perez Yubran
- Department of Radiology, IBERORAD, Carrer Valencia 226, Principal, primera, Barcelona, 08007, Spain.
| | | | | | | | - Alvaro Cerezal Canga
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Cruz Camara
- Department of Arthroscopic Surgery, Hospital Santa Clotilde, Santander, Spain
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Lante E, Jany R. Isolated traumatic full-thickness supraspinatus tear with intact glenohumeral capsule: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:81-85. [PMID: 38323200 PMCID: PMC10840580 DOI: 10.1016/j.xrrt.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Erica Lante
- Department of Orthopedic Surgery and Traumatology, Riviera Chablais Hospital, Rennaz, Switzerland (CH)
| | - Richard Jany
- Department of Orthopedic Surgery, Saint Loup Hospital, Etablissements hospitaliers du Nord Vaudois, Pompaples, Switzerland (CH)
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Gadéa F, Dordain F, Merbah J, Charousset C, Berhouet J. Methods to analyse the long head of the biceps in the management of distal ruptures of the supraspinatus tendon. Part 1: the concept of the "biceps box": dynamic rotator interval approach. Incidence of lesions of the long head of the biceps tendon. Orthop Traumatol Surg Res 2023; 109:103669. [PMID: 37517471 DOI: 10.1016/j.otsr.2023.103669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION The area encompassing the long head of the biceps (LHB) can be represented as a rectangular parallelepiped. This geometric view can be likened to a box, the "biceps box", where the sides are the extrinsic structures and the LHB is the intrinsic structure. Since these structures are mobile in relation to each other, a dynamic "biceps box" model can modify assessments of the LHB, in its healthy or pathological state, and make the therapeutic approach to treating LHB lesions less arbitrary. MATERIAL AND METHOD In order to describe the different sides of the "biceps box", and to understand their possible physiological and pathological consequences, a literature review using PRISMA methodology was used. RESULTS The supraspinatus (SSP) has expansions on its anterior aspect that project anteriorly and cross the coracohumeral ligament (CHL). The most functionally important expansion is the fasciculus obliquus, which extends perpendicular to the axis of the tendon fibers of the SSP, divides the CHL into a deep and a superficial layer, and terminates on the superficial aspect of the subscapularis. The humeral insertion of the SSP may be binary, making a bridge over the LHB, with a posterior branch inserting on the greater tuberosity and an anterior branch on the lesser tuberosity. The superior glenohumeral ligament (SGHL) has a twisted course, downward and forward, and ends at the proximal opening of the bicipital groove with a flap on which the LHB rests. The bicipital pulley is not an independent structure but an arciform structure resulting from the fusion of several tissues. DISCUSSION The presence of structures linked together by common expansions in the 3 planes of space validates the relevance of a "biceps box" as a functional geometric model. The structure that acts as a crossroads through which all expansions pass is the CHL. An extrinsic SSP lesion can be compensated for by other "biceps box" structures, whereas an extrinsic SGHL lesion rarely exists without the presence of an intrinsic LHB lesion. The CHL constitutes a connective tissue crossed by a vasculonervous pedicle from the lateral pectoral nerve, which may explain some anterior shoulder pain attributed to the biceps. CONCLUSION The LHB can be likened to an intrinsic structure contained in a box whose sides are made up of different interconnected stabilizing structures defining the extrinsic structures. The concept of a dynamic "biceps box" allows LHB lesions to be accurately classified, separating extrinsic and intrinsic lesions, and thus potentially modifying therapeutic approaches to the LHB. LEVEL OF EVIDENCE IV; systematic review.
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Affiliation(s)
- François Gadéa
- Centre Ortho-Globe, place du Globe, 83000 Toulon, France.
| | - Franck Dordain
- Hôpital privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - Johan Merbah
- Centre Ortho-Globe, place du Globe, 83000 Toulon, France
| | | | - Julien Berhouet
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, faculté de médecine, université de Tours Centre-Val de Loire, Tours, France
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Ju J, Ma M, Zhang Y, Ding Z, Fu Z, Chen J. Fracture Line Morphology of Greater Tuberosity Fragments of Neer Three- and Four-Part Proximal Humerus Fractures. Orthop Surg 2023; 15:1959-1966. [PMID: 36274213 PMCID: PMC10432440 DOI: 10.1111/os.13523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/21/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE In complicated Neer three- and four-part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking plate may not fix GT fragments effectively. A further understanding of morphological characteristics of the GT fragments may help explore new fixation devices. This study aimed to determine the fracture line morphology of the GT fragment of Neer three- or four-part PHF and analyze the location relationship between the locking plate and the GT fragment. METHODS Seventy-one three-dimensional computed tomography scans of Neer three- and four-part PHF were retrospectively reviewed between January 2014 and June 2019. Fracture fragments were reconstructed and virtually reduced in the Mimics software, and fracture lines of GT fragments were depicted on a humerus template in the 3-matic software and then were superimposed altogether. The common sites of the GT fracture were identified, and the location relationship between the locking plate and GT fragments was analyzed in a computer-simulated scenario. RESULTS The fracture line morphology of GT fragments was similar between Neer three- and four-part PHF. The overall morphology of GT fragments was in a fan shape, which could be summarized as anterior, superior, posterior, and middle lines. Of these, we identified 51 split and 29 avulsion type GT fragments based on the Mutch classification, and they could occur simultaneously in a PHF. The overall morphology of split type fragments was in a fan shape, and avulsion type fragments showed a quite distinguishable distribution pattern. A GT fragment could be classified as anterior-split, posterior-split, complete-split, anterior -avulsion, and posterior-avulsion type based on its morphology and location. The median percentage of fragment area covered by the plate was 32.3% in all of the fragments, and it was 69.4%, 23.0%, 37.2%, 21.8%, 0.0% in anterior-split, posterior-split, complete-split, anterior-avulsion, and posterior-avulsion type GT fragments. We defined the posterior-split, anterior-avulsion, and posterior-avulsion type GT fragments as the risky GT fragments, and they occurred in 43 (60.6%) Neer three- and four-part PHFs. CONCLUSION The fracture line morphology of GT fragments of Neer three- and four-part PHF was in a fan shape. GT fragments could be classified based on their location and morphology. The extent of GT fragment coverage provided by the locking plate differed in various fragment types, and we identified the anterior-avulsion, posterior-avulsion, and posterior-split type fragments as the risky GT fragments with a high incidence rate in Neer three- and four-part PHFs.
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Affiliation(s)
- Jiabao Ju
- Department of Trauma & OrthopaedicsPeking University People's HospitalBeijingChina
| | - Mingtai Ma
- Department of Trauma & OrthopaedicsPeking University People's HospitalBeijingChina
| | - Yichong Zhang
- Department of Trauma & OrthopaedicsPeking University People's HospitalBeijingChina
| | - Zhentao Ding
- Department of Trauma & OrthopaedicsPeking University People's HospitalBeijingChina
| | - Zhongguo Fu
- Department of Trauma & OrthopaedicsPeking University People's HospitalBeijingChina
| | - Jianhai Chen
- Department of Trauma & OrthopaedicsPeking University People's HospitalBeijingChina
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Surgery and Rotator Cuff Disease. Clin Sports Med 2023; 42:1-24. [DOI: 10.1016/j.csm.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim G, Kim S, Lee Y, Jang I, Kim JH. Prognostic Factors Leading to Good or Poor Outcomes Based on Functional and Radiological Findings After a Rotator Cuff Retear. Am J Sports Med 2022; 50:3924-3933. [PMID: 36300545 DOI: 10.1177/03635465221128232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A retear after rotator cuff repair is a common problem; however, there is little information related to the prognosis after a retear. In addition, some patients with retears have satisfactory outcomes, which raises the question of whether a retear leads to a poor prognosis. PURPOSE To identify radiological factors that influence the prognosis after a retear. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 51 patients with retears confirmed by magnetic resonance imaging at 1 year after arthroscopic rotator cuff repair with a minimum follow-up of 24 months were enrolled in this study. Patients were divided into 2 groups according to whether they achieved the minimal clinically important difference for clinical outcome measures. Range of motion and radiological variables, including preoperative and postoperative anteroposterior (AP) and mediolateral (ML) tear sizes, sagittal extent of the retear, acromiohumeral distance (AHD), and degree of fatty degeneration, were analyzed using magnetic resonance imaging. RESULTS Overall, 36 patients were allocated to the good prognosis (GP) group and 15 to the poor prognosis (PP) group. The 2 groups had no significant differences in baseline demographics and preoperative radiological parameters. Postoperative range of motion was decreased in the PP group at the last follow-up. The AP and ML retear sizes decreased in both groups after arthroscopic rotator cuff repair, but the retear size was significantly larger in the PP group (both P < .05). The AHD increased in the GP group (P < .001) but decreased in the PP group (P = .230) postoperatively. Logistic regression analysis revealed that postoperative AHD (P = .003), fatty degeneration of the infraspinatus tendon (P = .001), posterior (P = .007) and anterior (P = .025) sagittal extent of the retear, and change in the AP tear size (P = .017) were related to poor outcomes after a retear. However, change in the ML tear size (P = .105) and middle sagittal extent of the retear (P = .878) were not related to a poor prognosis. Also, further analysis showed that posterior (P = .006) and anterior (P = .003) sagittal extent of the retear were related to rotator cable involvement. CONCLUSION An increased AP retear size and decreased AHD were radiological parameters that were associated with poor clinical outcomes after a retear. In particular, patients who had posterior and anterior sagittal extent of the retear, possibly with rotator cable involvement and more severe fatty degeneration of the infraspinatus tendon, showed worse outcomes.
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Affiliation(s)
- Gotak Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Segi Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Younghun Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Inseok Jang
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jae Hwa Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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A Technique for a Suture-Based Cable Reconstruction of an Irreparable Posterosuperior Rotator Cuff Tear. Arthrosc Tech 2022; 11:e2055-e2060. [PMID: 36457380 PMCID: PMC9705767 DOI: 10.1016/j.eats.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/03/2022] [Indexed: 11/05/2022] Open
Abstract
The management of irreparable rotator cuff tears remains challenging. In patients in whom a complete repair cannot be obtained, a partial repair remains an option. The goal of a partial rotator cuff repair is to obtain a stable glenohumeral joint fulcrum by restoring the rotator cable complex. Traditionally, partial repair has been performed with independent reattachment(s) of the rotator cable complex with or without margin convergence medially. This Technical Note describes an alternative approach to a partial rotator cuff repair with a suture-based cable reconstruction.
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Duijn EAHD, Roy van S, Karel YHJM, Provyn S, Pouliart N. An interexaminer agreement and reliability study on cadavers with musculoskeletal ultrasound of the shoulder performed by physiotherapists and radiologists compared with dissection. Musculoskelet Sci Pract 2022; 60:102569. [PMID: 35533597 DOI: 10.1016/j.msksp.2022.102569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A cross-sectional inter-examiner agreement and reliability study on fresh frozen cadaver shoulders. BACKGROUND Musculoskeletal ultrasound (MSU) is frequently used by physical therapists and radiologists to improve specific diagnosis in rotator cuff related pathology. The evaluation of the rotator cable seems to be important as stabilizing structure when cuff tears occur. OBJECTIVES To evaluate the inter-examiner agreement and reliability of MSU of the shoulder to detect rotator cuff-pathology and the involvement of the rotator cable in comparison to "dissection". METHODS Physical therapists, a radiologist and an orthopedic surgeon (dissection) investigated 40 fresh frozen cadaver shoulders in order to detect shoulder pathology including rotator cable involvement. Examiners were blinded to each other's findings. RESULTS We found a strong and significant agreement between the raters: PTs, the radiologist and the dissector in this cadaver study for all rotator cuff, the long head of the biceps pathologies and in detecting abnormalities of the rotator cable. The kappa value was substantial to (almost) perfect agreement for all diagnostic outcome categories. CONCLUSIONS This study shows that among a limited group of physical therapists, one radiologist and a dissector a strong level of agreement with kappa values from substantial to (almost) perfect in finding subacromial pathology.
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Affiliation(s)
- E A H D Duijn
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium.
| | - S Roy van
- Vrije Universiteit van Brussel, Brussels, Belgium
| | - Y H J M Karel
- Research Group Life in Motion, Avans University of Applied Sciences, Breda, the Netherlands
| | - S Provyn
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium; Anatomical Research and Clinical Studies (ARCS) Vrije Universiteit Brussel, Brussels, Belgium
| | - N Pouliart
- Basic (bio) Medical Sciences (BMWE), Vrije Universiteit Brussel, Brussels, Belgium; Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel) Brussels, Belgium
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Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice. Dis Mon 2022; 68:101314. [PMID: 34996610 DOI: 10.1016/j.disamonth.2021.101314] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.
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Yin L, Zhang H, Kong Y, Zhang X, Yan W, Zhang J. Distance between the supraspinatus and long head of the biceps tendon on sagittal MRI: a new tool to identify anterior supraspinatus insertion injury. J Exp Orthop 2021; 8:108. [PMID: 34821972 PMCID: PMC8617234 DOI: 10.1186/s40634-021-00410-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Anterior insertion of the supraspinatus muscle plays an essential role in rotator cuff tissue. We aimed to determine whether the distance between the midpoints of the supraspinatus central tendon and long head of the biceps tendon on a sagittal shoulder magnetic resonance imaging scan can help to preoperatively diagnose an injury of the anterior insertion of the supraspinatus. METHOD This retrospective study reviewed 103 patients with a full-thickness supraspinatus tendon tear: 50 patients with (injured group) and 53 patients without (intact group) anterior supraspinatus insertion tear. The inter-tendon distance was measured based on an oblique sagittal magnetic resonance imaging scan. SPSS was used for statistical analyses. Two independent samples t-test and receiver operating curve analysis were also performed. RESULTS The measurements of inter-tendon distance revealed good intra- and inter-observer reliabilities with intra-class correlation coefficients of 0.92 and 0.97, respectively. The inter-tendon distance of the injured group was significantly greater than that of the intact group (10.1 ± 2.7 vs 8.0 ± 2.3 mm, P < 0.001). The diagnostic ability of the inter-tendon distance was fair (area under the curve = 0.745), and a threshold of 9 mm had a specificity of 73% and sensitivity of 74%. CONCLUSION The distance between the supraspinatus central tendon and long head of the biceps tendon on magnetic resonance imaging was greater in patients with anterior supraspinatus insertion injury than those without the injury. A distance of 9 mm may be the cut-off value and a good diagnosis marker for anterior supraspinatus insertion injury. LEVEL OF EVIDENCE Level III, diagnostic case-control study.
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Affiliation(s)
- Lifeng Yin
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Hua Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Yangang Kong
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Xinyu Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Wenlong Yan
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Jian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China.
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Editorial Commentary: If the Massive Rotator Cuff Tear is Irreparable, Just Fix the Rotator Cable. Arthroscopy 2021; 37:1411-1413. [PMID: 33896496 DOI: 10.1016/j.arthro.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 02/02/2023]
Abstract
Large and massive rotator cuff tears are not always reparable and present a difficult clinical problem. If surgery is warranted surgical options range from arthroscopic debridement, partial repairs, degradable spacers, tendon transfers, and more superior capsular reconstruction. The rotator cable is formed by the deep layer of the coracohumeral ligament and the crescent structure running from the anterior insertion site of the supraspinatus to the inferior border of the infraspinatus. The role of the rotator cable is not clear but seems to play a role in reducing tendon stress and influence glenohumeral kinematics. In this laboratory-based cadaver study the anterior cable was reconstructed with semitendinosus allograft treating large "irreparable" rotator cuff defects. Reconstruction resulted in reduced superior migration and subacromial contact forces without inhibiting range of motion.
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Yoon TH, Kim SJ, Choi YR, Shin JC, Alruwaili SH, Chun YM. Anterior rotator cable disruption does not affect outcomes in rotator cuff tear with subscapularis involvement. Knee Surg Sports Traumatol Arthrosc 2021; 29:154-161. [PMID: 32055877 DOI: 10.1007/s00167-020-05891-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/29/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this study was to compare clinical and radiological outcomes after arthroscopic repair of two different rotator cuff tear configurations: anterosuperior rotator cuff tear and rotator cuff tears with subscapularis involvement. It was hypothesized that, although both tear configurations would show significant improvement in clinical outcomes after arthroscopic repair, the rotator cuff tears with subscapularis involvement where the anterior rotator cable maintains its integrity would have better clinical outcomes and structural integrity. METHODS This study included 226 patients who underwent arthroscopic repair of anterosuperior rotator cuff tears (n = 107, group A) and rotator cuff tears with subscapularis involvement (n = 119, group B). The visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder score, and active range of motion (ROM) were assessed. Modified belly press test was performed to assess the strength of the subscapularis muscle. Cuff integrity was evaluated using magnetic resonance arthrography or computed tomographic arthrography at 6 months after operation. RESULTS At 3-year follow-up, the VAS score, SSVs, ASES scores, UCLA shoulder scores, active ROM, and modified belly press test showed significant improvement in both groups (p < 0.001). However, these improvements showed no statistical significance between the two groups. On follow-up radiologic evaluations, no significant difference in re-tear rates between group A (25 of 107, 23.4%) and group B (23 of 119, 19.3%) was observed. CONCLUSIONS The presence of anterior cable involvement of the anterosuperior rotator cuff tear did not affect postoperative clinical outcomes and re-tear rate compared to rotator cuff tears with subscapularis involvement where the anterior cable integrity was maintained, although the anterosuperior rotator cuff tear was associated with more significant preoperative supraspinatus fatty infiltration. Therefore, the present study determined that it would not be necessary to differentiate treatment protocols between these patterns. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Korea
| | - Ju-Cheol Shin
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Korea
| | - Sager-Holyl Alruwaili
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Korea.
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Abstract
The aim of this article is to review the use of magnetic resonance imaging (MRI) for the evaluation of shoulder pain, which is a common clinical complaint of the musculoskeletal system. MRI is an essential auxiliary tool to evaluate these patients because of its high resolution and high sensitivity in depicting the soft tissues. This article will review the imaging technique, normal imaging anatomy, and most common imaging findings of disorders of tendons, labrum, and ligaments of the shoulder. It will also discuss common systemic diseases that manifest in the shoulder as well as disorders of the acromioclavicular joint and bursae. New advances and research in MRI have provided additional potential uses for evaluating shoulder derangements.
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Goetti P, Denard PJ, Collin P, Ibrahim M, Hoffmeyer P, Lädermann A. Shoulder biomechanics in normal and selected pathological conditions. EFORT Open Rev 2020; 5:508-518. [PMID: 32953136 PMCID: PMC7484714 DOI: 10.1302/2058-5241.5.200006] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing.
Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006
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Affiliation(s)
- Patrick Goetti
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick J Denard
- Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Mohamed Ibrahim
- Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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16
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Ricci V, Çalışkan A, Nalbant E, Özçakar L. Suspension Bridge of the Shoulder: Sonoanatomy of the Rotator Cable Revisited. PM R 2019; 12:101-103. [PMID: 31207091 DOI: 10.1002/pmrj.12203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Vincenzo Ricci
- IRCCS Rizzoli Orthopaedic Institute, Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, Bologna, Italy
| | - Aslı Çalışkan
- Department of Physical and Rehabilitation Medicine, 29 Mayıs State Hospital, Ankara, Turkey
| | - Emre Nalbant
- Department of Radiology, 29 Mayıs State Hospital, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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