Evolving Concepts in The Rotator Cuff Footprint

Volume 6 | Issue 1 | January-June 2021 | Page 11-14 | Ajinkya Achalare, Nilesh Kamat, M.P. Ramraju Mudunuri


Author: Ajinkya Achalare [1], Nilesh Kamat [2], M.P. Ramraju Mudunuri [1]

[1] Kamat Clinic, Pune, Maharashtra, India.
[2] Department of Shoulder Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence:
Dr. Ajinkya Achalare,
Clinical Fellow in Arthroscopy, Kamat Clinic,
Pune, Maharashtra, India.
E-mail: ajinkya1401@gmail.com


Abstract

Rotator cuff (RC) tears are a common presentation in day-to-day clinical settings. Majority of the symptomatic patients are treated by a surgical repair. Before considering a surgical intervention, it is vital to understand the anatomy of RC footprint and restore it, in order to achieve an optimal tension-free repair, better healing and subsequently good clinical outcomes. Concepts pertaining to the RC footprint over the greater tuberosity (GT) have been constantly changing in the past two decades with meticulous anatomical studies. Traditional concepts of individual insertions of supraspinatus (SSP) and infraspinatus (ISP), SSP alone playing the vital role in shoulder abduction, now stand obsolete. Similarly, being the largest muscle-tendon unit, subscapularis (SSC) has been studied extensively and is now known to have a three dimensional insertion over lesser tuberosity. This article reviews the evolution of concepts pertaining to RC insertion and their clinical application.
Keywords: Rotator cuff; Footprint; Three-dimensional insertion.


References

1. Clemente CD, editor. Gray’s anatomy of the human body. 30th ed. Philadelphia: Lea & Febiger; 1985. Osteology, and muscles and fasciae of the upper limb. p 233-4.

2. Johnson D, Ellis H, editors. Pectoral girdle, shoulder region, and axilla. In: Standring S, Ellis H, Healy JC, Johnson D, Williams A, Collins P, Wigley C, editors. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. Edinburgh: Elsevier Churchill Livingstone; 2005. p 817-49

3. Clark JM, Harryman DT II. Tendons, ligaments, and capsule of the rotator cuff: Gross and microscopic anatomy. J Bone Joint Surg Am 1992;74:713-725

4. Minagawa H, Itoi E, Konno N, et al. Humeral attachment of the supraspinatus and infraspinatus tendons: An anatomic study. Arthroscopy 1998;14:302-306

5. Ellman H, Gartsman GM, Hengst TC. Arthroscopic shoulder surgery and related procedures. Philadelphia: Lea & Febiger,1993

6. Tierney JJ, Curtis AS, Kowalik DL, Scheller AD. The footprint of the rotator cuff. Arthroscopy 1999;15:556-557

7. Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR. The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy. 2006 Jun;22(6):609.e1. doi: 10.1016/j.arthro.2006.04.001. PMID: 16762697

8. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop 1990;254:64-74

9. Ruotolo C, Fow JE, Nottage WM. The supraspinatus footprint: An anatomic study of the supraspinatus insertion. Arthroscopy 2004;20:246-249

10. Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K, Sekiya I, Muneta T, Akita K. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am. 2008 May;90(5):962-9. doi: 10.2106/JBJS.G.00427. PMID: 18451386

11. Hamada J, Nimura A, Yoshizaki K, Akita K. Anatomic study and electromyographic analysis of the teres minor muscle. J Shoulder Elbow Surg. 2017 May;26(5):870-877. doi: 10.1016/j.jse.2016.09.046. Epub 2017 Jan 10. PMID: 28087164.

12. Richards DP, Burkhart SS, Tehrany AM, Wirth MA. The subscapularis footprint: an anatomic description of its insertion site. Arthroscopy. 2007 Mar;23(3):251-4. doi: 10.1016/j.arthro.2006.11.023. PMID: 17349466.

13. Yoo JC, Rhee YG, Shin SJ, Park YB, McGarry MH, Jun BJ, Lee TQ. Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: a cadaveric and prospective clinical observational study. Arthroscopy. 2015 Jan;31(1):19-28. doi: 10.1016/j.arthro.2014.08.015. Epub 2014 Oct 18. PMID: 25442662.

14. Ide J, Tokiyoshi A, Hirose J, Mizuta H. An anatomic study of the subscapularis insertion to the humerus: the subscapularis footprint. Arthroscopy. 2008 Jul;24(7):749-53. doi: 10.1016/j.arthro.2008.02.009. Epub 2008 Apr 14. PMID: 18589262.

15. Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ. Anatomy and dimensions of rotator cuff insertions. J Shoulder Elbow Surg 2002; 11:498-503. doi:10.1067/mse.2002.126208.


How to Cite this article: Achalare A, Kamat N, Mudunuri MPR | Evolving Concepts  in The Rotator Cuff
Footprint | Asian Journal of Arthroscopy | January- June 2021; 6(1): 11-14.

(Abstract)      (Text HTML)      (Download PDF)


Rotator Cuff Tears: An Everlasting Enigma

Volume 6 | Issue 1 | January-June 2021 | Page 1-2| Anshu Shekhar, Nilesh Kamat, Sachin Tapasvi


Author:  Anshu Shekhar [1], Nilesh Kamat [2], Sachin Tapasvi [1]

[1] Orthopaedic Speciality Clinic, Pune Mahatrahtra, India.
[2] Department of Shoulder Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence
Dr Sachin Tapasvi
The Orthopaedic Speciality Clinic, Pune, Mahatrahtra, India.
Email: stapasvi@gmail.com


Rotator Cuff Tears: An Everlasting Enigma

Rotator Cuff (RC) tear is a common cause of disability and pain for which middle aged and elderly individuals seek orthopaedic consultation. A unique feature of RC tear treatment is that it encompasses an entire spectrum, which ranges from humble conservative methods to complicated tendon transfers. There is a now a fair amount of agreement about which treatment modality must be offered to whom, based on tear type, tendon retraction, tissue quality and patient profile. What must be borne in mind however, is that no bridges be burnt when choosing a treatment method. This would keep the door open for a salvage or revision procedure to help the patient. This issue of the Asian Journal of Arthroscopy is a symposium dedicated to management strategies for Rotator cuff tears.

 

The importance of clinical examination in a patient with shoulder pain and weakness cannot be overemphasized. It is the cornerstone of formulating an individualized treatment plan. Vivek Pandey has discussed the methodology for all the  relevant tests to accurately diagnose a rotator cuff tear, along with their pearls and pitfalls. One of the most important reasons why arthroscopic shoulder surgery in general and rotator cuff surgery is particular has evolved, is the remarkable progress in imaging, especially Magnetic Resonance scans. Anupama Patil has written a detailed descriptive review in this subject. An understanding of the nuances of imaging will help the clinician to clinically co-relate her findings. A sound clinician is one has a grasp of theoretical concepts developed and validated over the years. The ability to a classify rotator cuff tear based on imaging findings and co-relating clinically in the foundation on which every treatment decision is made. Ram Chidambaram has written an exhaustive review detailing all classification systems for rotator cuff tear. Jaap Willems has presented an algorithm for such decision making based primarily on age and tear morphology.

 

The non-operative treatment of RC tears encompasses pharmacologic therapies, injections, biologics, physical rehabilitation and electrophysiological rehabilitation modalities. These have a definite role in management of RC tears and Denny Lie has performed a systematic review of randomized current trials to present the current evidence for the same. Arthroscopic rotator cuff repair for degenerative tears is now a standard of care in those fail a trial of non-operative treatment. It has demonstrated proven health and economic benefits in the mid-term [1, 2]. A lacuna is current literature is the absence of large randomized controlled trial with long-term results which would settle the debate conclusively. The repair technique has also travelled a full circle with new vigor seen for trans-osseous repairs after having seen the fallacies of anchor-based repairs in the last couple of decades. The issue of subacromial decompression is another elephant in the room on which everybody seems to agree to disagree. SAD does have a definite place in RC repair surgery, considering its potential biological and mechanical benefits. However, what constitutes a ‘decompression’ and how much of an impact does it really have on a multifactorial phenomenon like rotator cuff healing is largely unknown. Amol Tambe has written an exhaustive review on this subject which will help tailor the readers approach to this enigma.

 

The aim of this issue is to provide the reader with information and knowledge on rotator cuff tears which can then be used to guide patient management. We hope that the wealth of knowledge shared by our authors will enrich the readers and help them in making better decisions when treating patients.

Anshu Shekhar
Nilesh Kamat
Sachin Tapasvi


References

1. Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2018 Mar;27(3):572-576.

2. Mather RC 3rd, Koenig L, Acevedo D, Dall TM, Gallo P, Romeo A, Tongue J, Williams G Jr. The societal and economic value of rotator cuff repair. J Bone Joint Surg Am. 2013 Nov 20;95(22):1993-2000


How to Cite this article: Shekhar A, Kamat N, Tapasvi S | Rotator Cuff  Tears: An Everlasting Enigma | Asian Journal of Arthroscopy | January- June 2021; 6(1): 01-02.

(Abstract)      (Full Text HTML)      (Download PDF)


 

Acromial Index in Indian Population and its Significance on Rotator Cuff Tears

Volume 6 | Issue 1 | January-June 2021 | Page 08-10 | Sharat Balemane, Kaushik Eswaran, Nishanth Shetty


Author: Sharat Balemane [1], Kaushik Eswaran [1], Nishanth Shetty [1]

[1] Department of Orthopaedics, Yenepoya Medical College,
Mangalore, India.

Address of Correspondence:
Dr. Kaushik Eswaran,
Yenepoya Medical College, Mangalore, India.
E-mail: sbkaushik1993@gmail.com.


Abstract

Background: The etiopathogenesis of rotator cuff tears remains debatable. Among the many causes, abnormal scapular morphology has been found to accelerate the degenerative process of rotator cuff tears. The morphology and lateral extension of the acromion process were assessed indetail by Nyffeler et al. and the Acromion Index (AI) was introduced, which measures the lateral extension of the acromion. It was theorized that a large lateral extension of the acromion increased the chances of the supraspinatus tendon to degenerate because of impingement between the acromion and the deltoid muscle. The AI was compared between patients with rotator cuff tears and patients with an intact rotator cuff.
Methods: 21 Indian patients presenting to the orthopaedics OPD, Yenepoya Medical College, with rotator cuff tears were taken up for this study between August 2020 and February 2021. Another 21 patients with intact rotator cuff and other shoulder diseases such as frozen shoulder were included in this study. Patients with rotator cuff tears were included in group A, and patients with intact rotator cuff were included in group B. Both groups had the AI measured on radiographs, and their values were compared.
Results: The mean Acromial Index (AI) in the rotator cuff tear group was 0.74 and in the intact rotator cuff group it was 0.59, which was statistically significant. There was no statistical difference in AI between male and female patients. The mean age of the patients in the rotator cuff group was 50.8 years, and in non rotator cuff tear group, it was 50.2 years.
Conclusion: Acromial Index is a useful predictive tool for detecting rotator cuff tears in the Indian population. Further studies are required to assess its usefulness in predicting the progression of a rotator cuff tear.
Keywords: Rotator cuff tear; Acromial Index; Shoulder.


References

1. Neer CS., 2nd Impingement lesions. Clin Orthop Relat Res. 1983;(173):70–77.

2. Codman EA. The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston, MA: Thomas Todd; 1934.

3. Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

4. Aoki M, Ishii S, Usui M. The slope of the acromion and rotator cuff impingement. Orthop Trans. 1986;10:228.

5. Banas MP, Miller RJ, Totterman S. Relationship between the lateral acromion angle and rotator cuff disease. J Should Elbow Surg. 1995;4(6):454–461. doi: 10.1016/S1058-2746(05)80038-2.

6. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800–805. doi: 10.2106/JBJS.D.03042.

7. Miyazaki AN, Itoi E, Sano H, et al. Comparison between the acromion index and rotator cuff tears in the Brazilian and Japanese populations. J Shoulder Elbow Surg. 2011;20(7):1082–1086.

8. Kim JR, Ryu KJ, Hong IT, Kim BK, Kim JH. Can a high acromion index predict rotator cuff tears? Int Orthop. 2012;36(5):1019–1024.

9. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg. 2014;23(4):536–541.

10. Torrens C, Lopez JM, Puente I, Caceres E. The influence of the acromial coverage index in rotator cuff tears. J Shoulder Elbow Surg. 2007;16(3):347–351.

11. Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2008;90(11):2423–2431.

12. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg. 2014;23(4):536–541.

13. Balke M, Liem D, Greshake O, Hoeher J, Bouillon B, Banerjee M. Differences in acromial morphology of shoulders in patients with degenerative and traumatic supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2200–2205.


How to Cite this article: Balemane S, Eswaran K, Shetty N | Acromial Index in Indian Population and its
Significance on Rotator Cuff Tears | Asian Journal of Arthroscopy | January- June
2021; 6(1): 08-10.


(Abstract)      (Text HTML)      (Download PDF)


Should We be Routinely Performing Arthroscopic Subacromial Decompression During Rotator Cuff Repair (RCR)?

Volume 6 | Issue 1 | January-June 2021 | Page 48-51 | Sachin Kumar, Rajiv Gogna, Daniel Morris, Amol Tambe


Author: Sachin Kumar [1] , Rajiv Gogna [1] , Daniel Morris [1] , Amol Tambe [1]

[1] Derby Shoulder Unit, Royal Derby Hospital, Derby, UK.

Address of Correspondence:
Dr. Amol Tambe,
Consultant, Upper Limb Surgeon, Derby Shoulder Unit, Royal Derby
Hospital, Derby, UK.
E-mail: amol.tambe1@nhs.net


Abstract

Symptomatic rotator cuff tears cause pain and impaired function. Arthroscopic rotator cuff repair is an established treatment when nonoperative management fails. However, debate exists regarding the requirement of concurrent subacromial decompression. This review aims to answer pertinent questions and outline relevant literature in the role of arthroscopic subacromial decompression in rotator cuff repair.
Keywords: Decompression, Cuff, Arthroscopic, Repair.


References

  1. Luime J, Koes B, Hendriksen I, Burdorf A, Verhagen A, Miedema H, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73–81.
  2. Van der Windt D, Koes B, Boeke A. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pr. 1996;46(410):519–23.
  3. Micallef J, Pandya J, Low AK. Management of rotator cuff tears in the elderly population. Maturitas [Internet]. 2019 May;123:9–14.
  4. Mather RC, Koenig L, Acevedo D, Dall TM, Gallo P, Romeo A, et al. The Societal and Economic Value of Rotator Cuff Repair. J Bone Jt Surg [Internet]. 2013 Nov;95(22):1993–2000.
  5. Codman E. The Shoulder: Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston: Thomas Todd Co.; 1934. 1869–1940 p.
  6. Gartsman GM, O’Connor DP. Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes. J Shoulder Elb Surg [Internet]. 2004 Jul;13(4):424–6.
  7. Neer C, Poppen N. Supraspinatus outlet. Orthop Trans. 1987;(11):234.
  8. Bigliani L, Morrison D, April E. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;(10):228.
  9. Sela Y, Eshed I, Shapira S, Oran A, Vogel G, Herman A, et al. Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings. Acta radiol [Internet]. 2015 Feb;56(2):182–9.
  10. Gotoh M, Hamada K, Yamakawa H, Inoue A, Fukuda H. Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases. J Orthop Res [Internet]. 1998 Sep;16(5):618–21.
  11. Beard DJ, Rees JL, Cook JA, Rombach I, Cooper C, Merritt N, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet [Internet]. 2018 Jan;391(10118):329–38.
  12. Milano G, Grasso A, Salvatore M, Zarelli D, Deriu L, Fabbriciani C. Arthroscopic Rotator Cuff Repair With and Without Subacromial Decompression: A Prospective Randomized Study. Arthrosc J Arthrosc Relat Surg [Internet]. 2007 Jan;23(1):81–8.
  13. Xue G, Chahal K, Lim T, Hu S, Li S, Liu J. Titanium mini locking plate with trans-osseous sutures for the treatment of humeral greater tuberosity fracture osteosynthesis versus PHILOS: a retrospective view. Int Orthop. 2018;42(10):2467–73.
  14. Galliera E, Randelli P, Dogliotti G, Dozio E, Colombini A, Lombardi G, et al. Matrix metalloproteases MMP-2 and MMP-9: Are they early biomarkers of bone remodelling and healing after arthroscopic acromioplasty? Injury [Internet]. 2010 Nov;41(11):1204–7.
  15. Randelli P, Margheritini F, Cabitza P, Dogliotti G, Corsi MM. Release of growth factors after arthroscopic acromioplasty. Knee Surgery, Sport Traumatol Arthrosc [Internet]. 2009 Jan 31;17(1):98–101.
  16. MacDonald P, McRae S, Leiter J, Mascarenhas R, Lapner P. Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears. J Bone Jt Surgery-American Vol [Internet]. 2011 Nov;93(21):1953–60.
  17. Abrams GD, Gupta AK, Hussey KE, Tetteh ES, Karas V, Bach BR, et al. Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty. Am J Sports Med [Internet]. 2014 Jun 14;42(6):1296–303.
  18. Song L, Miao L, Zhang P, Wang W-L. Does concomitant acromioplasty facilitate arthroscopic repair of full-thickness rotator cuff tears? A meta-analysis with trial sequential analysis of randomized controlled trials. Springerplus [Internet]. 2016 Dec 21;5(1):685.
  19. Shin S-J, Oh JH, Chung SW, Song MH. The Efficacy of Acromioplasty in the Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears Without Acromial Spur: Prospective Comparative Study. Arthrosc J Arthrosc Relat Surg [Internet]. 2012 May;28(5):628–35.
  20. Tetteh E, Hussey KE, Abrams GD, Gupta AK, Dhawan A, Karas V, et al. A Prospective Randomized Trial of Functional Outcomes Following Rotator Cuff Repair With and Without Acromioplasty. Orthop J Sport Med [Internet]. 2013 Sep;1(4_suppl):2325967113S0010.
  21. Cheng C, Chen B, Xu H, Zhang Z, Xu W. Efficacy of concomitant acromioplasty in the treatment of rotator cuff tears: A systematic review and meta-analysis. van der Linde JA, editor. PLoS One [Internet]. 2018 Nov 15;13(11):e0207306.

22. Dabija DI, Jain NB. Minimal Clinically Important Difference of Shoulder Outcome Measures and Diagnoses. Am J Phys Med Rehabil [Internet]. 2019 Aug;98(8):671–6.


How to Cite this article: Kumar S, Gogna R, Morris D, Tambe A | Should We be Routinely  Performing
Arthroscopic Subacromial Decompression During Rotator Cuff Repair (RCR)?| Asian
Journal of Arthroscopy | January- June 2021; 6(1): 48-51.

(Abstract)      (Text HTML)      (Download PDF)


Functional Outcome in Arthroscopic ACL Reconstruction with Immediate Full Weight Bearing Mobilization- Retrospective Study

Volume 6 | Issue 1 | January-June 2021 | Page 03-07 | Vijayamohan, Shyam Gopal V, Mohana Chandran, Aleena Antony


Author: Vijayamohan [1], Shyam Gopal V [1], Mohana Chandran [2], Aleena Antony [3]

[1] Department of Orthopaedics, Aster Centre of Excellence in Orthopaedics & Rheumatology, Aster Medcity, Kochi, Kerala, India.
[2] Department of Physiotherapy, Aster Centre of Excellence in Orthopaedics & Rheumatology, Aster Medcity, Kochi, Kerala, India
[3] Counsellor, Aster Centre of Excellence in Orthopaedics &Rheumatology, Aster Medcity, Kochi, Kerala, India.

Address of Correspondence:
Dr. Shyam Gopal V,
Specialist, Aster centre of Excellence in Orthopaedics & Rheumatology,
Aster Medcity, Kochi, Kerala, India.
E-mail: shyamg911@gmail.com


Abstract

Rehabilitation following anterior cruciate ligament surgery continues to evolve, with the current emphasis being on immediate weight bearing
and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills.
In this study we evaluate the functional outcome of Immediate full weight bearing mobilization following arthroscopic ACL (Anterior Cruciate
Ligament) reconstruction with quadrupled hamstring graft using endobutton and bioscrew.
With the advancement of fixation techniques immediate weight bearing mobilization after arthroscopic ACL reconstruction can give better
functional outcome and improved patient satisfaction. Although further large volume multicentric research is needed for establishing a
standardized rehabilitation protocol following arthroscopic ACL reconstruction, immediate weight bearing doesn’t cause any complications
and has better outcome as per our study.
Keywords: Arthroscopic reconstruction; ACL; Immediate weight bearing.


References

1 . John T. Cavanaugh, Matthew PowersACL Rehabilitation Progression: Where Are We Now? Curr Rev Musculoskelet Med. 2017 Sep; 10(3): 289–296. Published online 2017 Aug 8. doi: 10.1007/s12178-017-9426-3

2. Tyler TF, McHugh MP, Gleim GW, Nicholas the effect of immediate weightbearing after anterior cruciate ligament reconstruction. SJClin Orthop Relat Res. 1998 Dec; (357):141-8.

3. Rafael F. Escamilla, PT, PhD, CSCS, FACSM1Toran D. MacLeod, PT, PhD2Kevin E. Wilk, PT, DPT3Lonnie Paulos, MD4James R. Andrews, MD5ACL Strain and Tensile Forces for Weight Bearing and Non—Weight-Bearing Exercises After ACL Reconstruction: A Guide to Exercise SelectionJournal of Orthopaedic & Sports Physical TherapyPublished Online:March 1, 2012Volume42Issue3Pages208-220
https://www.jospt.org/doi/10.2519/jospt.2012.3768

4. Heijne A, Werner S. Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study. Knee Surg Sports Traumatol Arthrosc. 2007;15:402-414. http://dx.doi. org/10.1007/s00167-006-0246-

5.Agarwal AR, Dussa KR, Singhal A, et al. A retrospective analysis of arthroscopic ACL reconstruction with hamstring tendon graft. J. Evid. Based Med. Healthc. 2017; 4(64), 3841-3845. DOI: 10.18410/jebmh/2017/767

6. Jorgensen U, Jensen CM, Scanvenius M, et al. Rehabilitation with or without initial weightbearing: a prospective randomized study. Presented at: Sports Medicine 2000; June 6-8, 1995; Stockholm, Sweden.

7. Lysholm J, Gillquist J. (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med; 10-3:150-4

8. Tegner Y, Lysolm J. (1985) Rating Systems in the Evaluation of Knee Ligament Injuries. Clinical Orthopedics and Related Research. Vol. 198: 43-49.

9. Tajima T, Yamaguchi N, Nagasawa M, Morita Y, Nakamura Y, Chosa E. Early weight-bearing after anterior cruciate ligament reconstruction with hamstring grafts induce femoral bone tunnel enlargement: a prospective clinical and radiographic study. BMC Musculoskelet Disord. 2019;20(1):274. Published 2019 Jun 4. doi:10.1186/s12891-019-2653-6

10. Rizer M, Foremny GB, Rush A, III, Singer AD, Baraga M, Kaplan LD, Jose J. Anterior cruciate ligament reconstruction tunnel size: causes of tunnel enlargement and implications for single versus two-stage revision reconstruction. Skeletal Radial. 2017;46:161–169. doi: 10.1007/s00256-016-2535-z.


How to Cite this article: Vijayaohan, V Shyam Gopal, Chandran M, Antony A | Functional  Outcome in
Arthroscopic ACL Reconstruction with Immediate Full Weight Bearing Mobilization-Retrospective Study | Asian Journal of Arthroscopy | January- June 2021; 6(1): 03-07.


(Abstract)      (Text HTML)      (Download PDF)


Role And Outcomes of Conservative Treatment in Management of Rotator Cuff Tears: A Systematic Review of Randomised Controlled Trials

Volume 6 | Issue 1 | January-June 2021 | Page 39-47 | Andrew Arjun Sayampanathan, Marcus Wei Ping Tan, Denny Tjiauw Tjoen Lie


Author: Andrew Arjun Sayampanathan [1], Marcus Wei Ping Tan [2], Denny Tjiauw Tjoen Lie [1, 2]

[1] National Preventive Medicine Residency Programme, National University Health System, Singapore.
[2] Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.

Address of Correspondence:
Dr. Denny TT Lie,
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
E-mail: denny.lie.t.t@singhealth.com.sg


Abstract

Rotator cuff tears are known to result in significant societal burden. This review synthesises the evidence regarding the role and outcomes of conservatively managed rotator cuff tears. 17 prospective randomised controlled trials (RCTs) (Level 1 and 2 studies) were included in this systematic review. Modalities which were studied were classified into physical rehabilitative modalities, electrophysiological rehabilitative modalities, biological therapies, and pharmacologic therapies. Outcomes which were evaluated in the included RCTs comprised of clinical outcomes, functional outcomes, pain scores, quality of life scores, imaging based outcomes, and patient satisfaction scores. As the modalities and outcomes studied were varied, no quantitative analysis could be performed based on the primary data available. Nevertheless, most studies do suggest that conservative treatment remains beneficial for the management of rotator cuff tears. Based on these findings, an algorithm which proposes conservative therapy as the central mode of management for rotator cuff tear patients has been described. More high-quality studies are required in this area of study to allow for a quantitative review (meta-analysis and meta-regression) of the various non-surgical treatment
modalities of rotator cuff tears.
Keywords: Rotator Cuff Tears; Conservative; Non-operative; Management; Randomised controlled trials; Review.


References

1. Östör AJK, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology. 2005;44(6):800-805. doi:10.1093/rheumatology/keh598

2. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013;10(1):8-12. doi:10.1016/j.jor.2013.01.008

3. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elb Surg. 1999;8(4):296-299. doi:10.1016/S1058-2746(99)90148-9

4. Milgrom C, Schaffler M, Gilbert S, Van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Jt Surg – Ser B. 1995;77(2):296-298. doi:10.1302/0301-620x.77b2.7706351

5. Mather RC, Koenig L, Acevedo D, et al. The societal and economic value of rotator cuff repair. J Bone Jt Surg – Ser A. 2013;95(22):1993-2000. doi:10.2106/JBJS.L.01495

6. Silverstein BA, Viikari-Juntura E, Fan ZJ, Bonauto DK, Bao S, Smith C. Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population. Scand J Work Environ Heal. 2006;32(2):99-108. doi:10.5271/sjweh.985

7. Seida JC, LeBlanc C, Schouten JR, et al. Systematic review: Nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010;153(4):246-255. doi:10.7326/0003-4819-153-4-201008170-00263

8. Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elb Surg. 2018;27(3):572-576. doi:10.1016/j.jse.2017.09.032

9. Lähteenmäki HE, Virolainen P, Hiltunen A, Heikkilä J, Nelimarkka OI. Results of early operative treatment of rotator cuff tears with acute symptoms. J Shoulder Elb Surg. 2006;15(2):148-153. doi:10.1016/j.jse.2005.07.006

10. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Jt Surg – Ser A. 2000;82(4):505-515. doi:10.2106/00004623-200004000-00006

11. Dunn WR, Schackman BR, Walsh C, et al. Variation in orthopaedic surgeons’ perceptions about the indications for rotator cuff surgery. J Bone Jt Surg – Ser A. 2005;87(9 I):1978-1984. doi:10.2106/JBJS.D.02944

12. Safran O, Schroeder J, Bloom R, Weil Y, Milgrom C. Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger. Am J Sports Med. 2011;39(4):710-714. doi:10.1177/0363546510393944

13. Millett PJ, Horan MP, Maland KE, Hawkins RJ. Long-term survivorship and outcomes after surgical repair of full-thickness rotator cuff tears. J Shoulder Elb Surg. 2011;20(4):591-597. doi:10.1016/j.jse.2010.11.019

14. Gladstone JN, Bishop JY, Lo IKY, Flatow EL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med. 2007;35(5):719-728. doi:10.1177/0363546506297539

15. Inderhaug E, Kollevold KH, Kalsvik M, Hegna J, Solheim E. Preoperative NSAIDs, non-acute onset and long-standing symptoms predict inferior outcome at long-term follow-up after rotator cuff repair. Knee Surgery, Sport Traumatol Arthrosc. 2017;25(7):2067-2072. doi:10.1007/s00167-015-3845-8

16. Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: A multicenter prospective cohort study. J Shoulder Elb Surg. 2013;22(10):1371-1379. doi:10.1016/j.jse.2013.01.026

17. Karjalainen T V., Jain NB, Heikkinen J, Johnston R V., Page CM, Buchbinder R. Surgery for rotator cuff tears. Cochrane Database Syst Rev. 2019;2019(12). doi:10.1002/14651858.CD013502

18. Downie BK, Miller BS. Treatment of rotator cuff tears in older individuals: A systematic review. J Shoulder Elb Surg. 2012;21(9):1255-1261. doi:10.1016/j.jse.2011.11.019

19. Huisstede BMA, Koes BW, Gebremariam L, Keijsers E, Verhaar JAN. Current evidence for effectiveness of interventions to treat rotator cuff tears. Man Ther. 2011;16(3):217-230. doi:10.1016/j.math.2010.10.012

20. Thorpe A, Hurworth M, O’Sullivan P, Mitchell T, Smith A. Rising trends in surgery for rotator cuff disease in Western Australia. ANZ J Surg. 2016;86(10):801-804. doi:10.1111/ans.13691

21. Lin KM, Wang D, Dines JS. Injection Therapies for Rotator Cuff Disease. Orthop Clin North Am. 2018;49(2):231-239. doi:10.1016/j.ocl.2017.11.010

22. Vrouva S, Batistaki C, Paraskevaidou E, et al. Comparative study of pain relief in two non-pharmacological treatments in patients with partial rotator cuff tears: A randomized trial. Anesthesiol Pain Med. 2019;9(2). doi:10.5812/aapm.88327

23. Türkmen E, Analay Akbaba Y, Altun S. Effectiveness of video-based rehabilitation program on pain, functionality, and quality of life in the treatment of rotator cuff tears: A randomized controlled trial. J Hand Ther. Published online 2020. doi:10.1016/j.jht.2019.08.004

24. Hurd JL, Facile TR, Weiss J, et al. Safety and efficacy of treating symptomatic, partial-thickness rotator cuff tears with fresh, uncultured, unmodified, autologous adipose-derived regenerative cells (UA-ADRCs) isolated at the point of care: A prospective, randomized, controlled first-in-human pilot study. J Orthop Surg Res. 2020;15(1). doi:10.1186/s13018-020-01631-8

25. Lambers Heerspink FO, van Raay JJAM, Koorevaar RCT, et al. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: Arandomized controlled trial. J Shoulder Elb Surg. 2015;24(8):1274-1281. doi:10.1016/j.jse.2015.05.040

26. Gialanella B, Comini L, Gaiani M, Olivares A, Scalvini S. Conservative treatment of rotator cuff tear in older patients: A role for the cycloergometer? A randomized study. Eur J Phys Rehabil Med. 2018;54(6):900-910. doi:10.23736/S1973-9087.18.05038-4

27. Gialanella B, Bertolinelli M. Corticosteroids injection in rotator cuff tears in elderly patient: Pain outcome prediction. Geriatr Gerontol Int. 2013;13(4):993-1001. doi:10.1111/ggi.12046

28. Cai Y, Sun Z, Liao B, Song Z, Xiao T, Zhu P. Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator Cuff Tears. Med Sci Sports Exerc. 2019;51(2):227-233. doi:10.1249/MSS.0000000000001781

29. Akan O, Mete BD, Kocyigit H, Bayram KB, Yilmaz HE, Tosun A. Efficacy of ultrasound guided platelet-rich plasma in the repair of partial and full-thickness supraspinatus tears. Int J Clin Exp Med. 2019;12(9):11918-11929.

30. Shams A, El-Sayed M, Gamal O, Ewes W. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol. 2016;26(8):837-842. doi:10.1007/s00590-016-1826-3

31. Schwitzguebel AJ, Kolo FC, Tirefort J, et al. Efficacy of Platelet-Rich Plasma for the Treatment of Interstitial Supraspinatus Tears: A Double-Blinded, Randomized Controlled Trial. Am J Sports Med. 2019;47(8):1885-1892. doi:10.1177/0363546519851097

32. Ranebo MC, Björnsson Hallgren HC, Holmgren T, Adolfsson LE. Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial. J Shoulder Elb Surg. 2020;29(3):459-470. doi:10.1016/j.jse.2019.10.013

33. Moosmayer S, Lund G, Seljom US, et al. At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears. J Bone Jt Surg – Am Vol. 2019;101(12):1050-1060. doi:10.2106/JBJS.18.01373

34. Liu CT, Yang TF. Intra-substance steroid injection for full-thickness supraspinatus tendon rupture. BMC Musculoskelet Disord. 2019;20(1). doi:10.1186/s12891-019-2952-y

35. Kukkonen J, Joukainen A, Lehtinen J, et al. Treatment of nontraumatic rotator cuff tears: A randomized controlled trial with two years of clinical and imaging follow-up. J Bone Jt Surg – Am Vol. 2014;97(21):1729-1737. doi:10.2106/JBJS.N.01051

36. Krischak G, Gebhard F, Reichel H, et al. A prospective randomized controlled trial comparing occupational therapy with home-based exercises in conservative treatment of rotator cuff tears. J Shoulder Elb Surg. 2013;22(9):1173-1179. doi:10.1016/j.jse.2013.01.008

37. Kim JH, Kim DJ, Lee HJ, Kim BK, Kim YS. Atelocollagen Injection Improves Tendon Integrity in Partial-Thickness Rotator Cuff Tears: A Prospective Comparative Study. Orthop J Sport Med. 2020;8(2). doi:10.1177/2325967120904012

38. Rong Lim WS, Tjoen Lie DT, Mitra AK, Cheng Chang PC. What is the optimal surgical intervention for patients with frozen shoulder and a concomitant partial thickness rotator cuff tear? JSES Int. Published online 2020. doi:10.1016/j.jseint.2020.06.010

39. Mak WK, Punn K, Lie DTT. Morphology, and a classification of massive cuff tears. Unpubl Data. Published online 2020.

40. Van Der Windt DAWM, Van Der Heijden GJMG, Scholten RJPM, Koes BW, Bouter LM. The efficacy of non-steroidal anti-inflammatory drugs (NSAIDS) for shoulder complaints. A systematic review. J Clin Epidemiol. 1995;48(5):691-704. doi:10.1016/0895-4356(94)00170-U

41. Daniels S, Robbins J, West CR, Nemeth MA. Celecoxib in the treatment of primary dysmenorrhea: Results from two randomized, double-blind, active- and placebo-controlled, crossover studies. Clin Ther. 2009;31(6):1192-1208. doi:10.1016/j.clinthera.2009.06.003

42. Chechik O, Dolkart O, Mozes G, Rak O, Alhajajra F, Maman E. Timing matters: NSAIDs interfere with the late proliferation stage of a repaired rotator cuff tendon healing in rats. Arch Orthop Trauma Surg. 2014;134(4):515-520. doi:10.1007/s00402-014-1928-5

43. Cohen DB, Kawamura S, Ehteshami JR, Rodeo SA. Indomethacin and celecoxib impair rotator cuff tendon-to-bone healing. Am J Sports Med. 2006;34(3):362-369. doi:10.1177/0363546505280428

44. Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B. Exercise for rotator cuff tendinopathy: A systematic review. Physiotherapy. 2012;98(2):101-109. doi:10.1016/j.physio.2011.08.002

45. Longo UG, Franceschi F, Berton A, Maffulli N, Droena V. Conservative treatment and rotator cuff tear progression. Med Sport Sci. 2012;57:90-99. doi:10.1159/000328910

46. Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. Exercise Rehabilitation in the Non-Operative Management of Rotator Cuff Tears: a Review of the Literature. Int J Sports Phys Ther. 2016;11(2):279-301. http://www.ncbi.nlm.nih.gov/pubmed/27104061%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4827371

47. Goldberg BA, Nowinski RJ, Matsen FA. Outcome of nonoperative management of full-thickness rotator cuff tears. Clin Orthop Relat Res. 2001;(382):99-107. doi:10.1097/00003086-200101000-00015

48. Kuhn JE. Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elb Surg. 2009;18(1):138-160. doi:10.1016/j.jse.2008.06.004

49. Moosmayer S, Tariq R, Stiris M, Smith HJ. The natural history of asymptomatic rotator cuff tears: A three-year follow-up of fifty cases. J Bone Jt Surg – Ser A. 2013;95(14):1249-1255. doi:10.2106/JBJS.L.00185

50. Abdul-Wahab TA, Betancourt JP, Hassan F, et al. Initial treatment of complete rotator cuff tear and transition to surgical treatment: Systematic review of the evidence. Muscles Ligaments Tendons J. 2016;6(1):35-47. doi:10.11138/mltj/2016.6.1.035

51. Ryösä A, Laimi K, Äärimaa V, Lehtimäki K, Kukkonen J, Saltychev M. Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil. 2017;39(14):1357-1363. doi:10.1080/09638288.2016.1198431

52. Lin MT, Chiang CF, Wu CH, Huang YT, Tu YK, Wang TG. Comparative Effectiveness of Injection Therapies in Rotator Cuff Tendinopathy: A Systematic Review, Pairwise and Network Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2019;100(2):336-349.e15. doi:10.1016/j.apmr.2018.06.028

53. Koester MC, Dunn WR, Kuhn JE, Spindler KP. The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: A systematic review. J Am Acad Orthop Surg. 2007;15(1):3-11. doi:10.5435/00124635-200701000-00002

54. Akgün K, Birtane M, Akarirmak Ü. Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome? Clin Rheumatol. 2004;23(6):496-500. doi:10.1007/s10067-004-0930-7

55. Wei AS, Callaci JJ, Juknelis D, et al. The effect of corticosteroid on collagen expression in injured rotator cuff tendon. J Bone Jt Surg – Ser A. 2006;88(6):1331-1338. doi:10.2106/JBJS.E.00806

56. Yamaguchi T, Ochiai N, Sasaki YY, et al. Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury. J Orthop Res. 2015;33(12):1861-1867. doi:10.1002/jor.22976

57. Halici M, Karaoglu S, Canoz O, Kabak S, Baktir A. Sodium hyaluronate regulating angiogenesis during Achilles tendon healing. In: Knee Surgery, Sports Traumatology, Arthroscopy. Vol 12. Knee Surg Sports Traumatol Arthrosc; 2004:562-567. doi:10.1007/s00167-004-0536-2

58. Osti L, Buda M, del Buono A, Osti R, Massari L. Clinical evidence in the treatment of rotator cuff tears with hyaluronic acid. Muscles Ligaments Tendons J. 2015;5(4):270-275. doi:10.11138/mltj/2015.5.4.270

59. Nourissat G, Ornetti P, Berenbaum F, Sellam J, Richette P, Chevalier X. Does platelet-rich plasma deserve a role in the treatment of tendinopathy? Jt Bone Spine. 2015;82(4):230-234. doi:10.1016/j.jbspin.2015.02.004

60. Mazzocca AD, McCarthy MBR, Chowaniec DM, et al. Platelet-rich plasma differs according to preparation method and human variability. J Bone Jt Surg – Ser A. 2012;94(4):308-316. doi:10.2106/JBJS.K.00430

61. Kim SJ, Kim EK, Song DH. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cufftendon. J Orthop Surg Res. 2018;13(1). doi:10.1186/s13018-017-0693-x.


How to Cite this article: Sayampanathan AA, Tan MWP, Lie DTT | Role And Outcomes of Conservative Treatment in Management of Rotator Cuff Tears: A Systematic Review of Randomised Controlled Trial |
Asian Journal of Arthroscopy | January- June 2021; 6(1): 39-47.

(Abstract)      (Text HTML)      (Download PDF)


Natural History of Rotator Cuff Tears

Volume 6 | Issue 1 | January-June 2021 | Page 36-38 | W. Jaap Willems


Author: W. Jaap Willems [1, 2]

[1] Lairesse Kliniek, Amsterdam, The Netherlands.
[2] International Knee and Joint Centre, Abu Dhabi, UAE.

Address of Correspondence:
Dr. W. Jaap Willems,
Shoulder Unit, Lairesse Kliniek, Amsterdam, The Netherlands.
International Knee and Joint Centre, Abu Dhabi, UAE.
E-mail: w.j.willems@xs4all.nl


Abstract

Rotator cuff tears are a frequent phenomenon with an increasing incidence when the patient gets older. A considerable number of tears remain asymptomatic during a lifetime. However, still, a substantial number of asymptomatic tears become symptomatic. There is, at present evolving evidence that surgical treatment of small to medium-sized tears does better than conservative treatment, even after a long term follow-up. A treatment algorithm is suggested to help the clinician in decision making, where tear size and age are important factors in the prognosis of surgical treatment.
Keywords: Rotator cuff; Ruptures; Natural historyf tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.


References

1. Codman EA. Complete rupture of the supraspinatus tendon. Operative treatment with report of two successful cases. 1911. Boston Med Surg J.1911;164:708-710.

2. Neer 2nd CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am.1972;54:41-50.

3. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elb Surg. 2014;23(12):1913–21.

4. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br. 1995;77(2):296–8.

5. Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elb Surg 2010; 19(1), 116-120

6. Codman EA. The pathology associated with the rupture of the supraspinatus tendon. Ann Surg. 1931;93:348-359.

7. Kim HM, Dahiya N, Teefey SA, MiddletonWD, Stobbs G, Steger-May K, et al. location and initiation of degenerative rotator cuff tears: an analysis of three hundred and sixty shoulders. J Bone Joint Surg Am. 2010;92(5):1088–96.

8. Kim HM, Dahiya N, Teefey SA, Keener JD, Galatz LM,Yamaguchi K. Relationship of tear size and location to fatty degeneration of the rotator cuff. J Bone Joint Surg Am. 2010;92(4):829–39.

9. Keener JD, Wei AS, Kim HM, Steger-May K, Yamaguchi K. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. J Bone Joint Surg Am.2009;91(6):1405–13.

10) Keener JD, Skelley NW, Stobbs-Cucchi G, Steger-May K,Chamberlain AM, Aleem AW, et al. Shoulder activity level and progression of degenerative cuff disease. J Shoulder Elb Surg.2017;26(9):1500–1507.

11. Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, BishopJY, et al. Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am.2014;96(10):793–800.

12. Hebert-Davies J, Teefey SA, Steger-May K, Chamberlain AM,Middleton W, Robinson K, et al. progression of fatty muscle degeneration in atraumatic rotator cuff tears. J Bone Joint Surg Am. 2017;99(10):832–839.

13. Chalmers PN, Salazar DH, Steger-May K, Chamberlain AM,Stobbs-Cucchi G, Yamaguchi K, et al. Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears. J Shoulder Elb Surg. 2016;25(11):1749–55.

14. Moosmayer S, Gärtner AV, Tariq R. The natural course of nonoperatively treated rotator cuff tears: an 8.8-year follow-up of tear anatomy and clinical outcome in 49 patients. J Shoulder Elb Surg. 2017;26(4):627–634.

15. Moosmayer S, Lund G, SeljomUS, Haldorsen B, Svege IC, Hennig T, et al. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. J Bone Joint Surg Am.2014;96(18):1504–1514.

16. Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, et al. At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears. J Bone Joint Surg m.2019;101(12):1050-1060.

17. Bassett RW, Cofield RH. Acute tears of the rotator cuff. The timing of surgical repair. Clin Orthop 1983;175:18-24.

18. Mall NA,Lee AS, B.S, Chahal J,Sherman SL,Romeo AA, Verma NN, Cole BJ. An Evidenced-Based Examination of the Epidemiology and Outcomes of Traumatic Rotator Cuff Tears. Arthroscopy 2012 Feb:29(2):366-76

19. Loew M, Magosch P, Lichtenberg S, Habermeyer P, Porschke F. How to discriminate between acute traumatic and chronic degenerative rotator cuff lesions: an analysis of specific criteria on radiography and magnetic resonance imaging. J Shoulder Elb Surg.2015;24(11):1685–93.

20. Tan M, Lam PH, Le BTN, Murrell GAC. Trauma versus no trauma: an analysis of the effect of tear mechanism on tendon healing in 1300 consecutive patients after arthroscopic rotator cuff repair. J Shoulder Elb Surg. 2016;25(1):12–21.

21. Petersen SA, Murphy TP. The timing of rotator cuff repair for the restoration of function. J Shoulder Elb Surg. 2011;20(1):62–8.

22. Collin P, Kempf J-F,Molé D, Meyer N, Agout C, Saffarini M, et al.Ten-year multicenter clinical and MRI evaluation of isolated supraspinatus repairs. J Bone Joint Surg Am. 2017;99(16):1355–1364.


How to Cite this article: Willems WJ | Natural History of Rotator Cuff Tears | Asian Journal of Arthroscopy | January-June 2021; 6(1): 36-38.

(Abstract)      (Text HTML)      (Download PDF)


Classification Systems in Rotator Cuff Tears

Volume 6 | Issue 1 | January-June 2021 | Page 31-35 | Ram Chidambaram, Reet Mukhopadhyay


Author: Ram Chidambaram [1], Reet Mukhopadhyay [2]

[1] Department of Shoulder, Elbow, Hand and Sports Injuries, MGM Healthcare, Aminjikarai, Chennai, Tamil Nadu, India.
[2] Department of Orthopaedics, R.G.Kar Medical College & Hospital, Kolkata, West Bengal, India.

Address of Correspondence:
Dr. Reet Mukhopadhyay,
Department of Orthopaedics, R.G.Kar Medical College & Hospital, Kolkata, West Bengal, India.
E-mail: reetm.2008@gmail.com


Abstract

Rotator cuff pathology is one of the most common conditions affecting the shoulder joint. Several classification systems have been used to describe rotator cuff tears in orthopedic literature. However, no comprehensive classification inclusive of all types and characteristics currently exists. Rotator cuff tears are classified based on various parameters. These include: 1. Tear depth 2. Tear Size/Extent 3. Tear Retraction 4. Tendon Quality 5. Tear Progression 6. Arthroscopic Classification. This review article aims to establish an algorithm based on the various existing classification systems so as to arrive at the best surgical or non-surgical solution as well as prognosticate the patient regarding the outcome. Special consideration needs to be made for massive tears which are irreparable.
Keywords: Rotator cuff tears; Rotator cuff tear classification; Massive irreparable rotator cuff tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.


References

1. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;(254):64–74.

2. Davidson J, Burkhart SS. The Geometric Classification of Rotator Cuff Tears: A System Linking Tear Pattern to Treatment and Prognosis. Arthrosc – J Arthrosc Relat Surg [Internet]. 2010;26(3):417–24. Available from: http://dx.doi.org/10.1016/j.arthro.2009.07.009.

3. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;(254):81–6.

4. Collin P, Matsumura N, Lädermann A, Denard PJ, Walch G. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elb Surg. 2014;23(8):1195–202.

5. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Jt Surg – Ser A. 2007;89(6):1184–93.

6. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;(304):78–83.

7. Fuchs B, Weishaupt D, Gerber C, Hodler J. Scheduled Tomography for. :599–605.

8. Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol. 1998;33(3):163–70.

9. Thomazeau H, Rolland Y, Lucas C, Duval J, Langlais F. Atrophy of the supraspinatus belly. Acta Orthop. 1996;67(3):264–8.

10. Brolin TJ, Updegrove GF, Horneff JG. Classifications in Brief: Hamada Classification of Massive Rotator Cuff Tears. Clin Orthop Relat Res. 2017;475(11):2819–23.

11. Spencer EE, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E, et al. Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med. 2008;36(1):99–103.

12. Habermeyer P, Magosch P, Lichtenberg S. Classifications and scores of the shoulder. Classifications and Scores of the Shoulder. 2006. 1–297.

13. Lädermann A, Burkhart SS, Hoffmeyer P, Neyton L, Collin P, Yates E, et al. Classification of full-thickness rotator cuff lesions: A review. EFORT Open Rev. 2016;1(12):420–30.

14. Brolin TJ, Updegrove GF, Horneff JG. Classifications in Brief: Hamada Classification of Massive Rotator Cuff Tears. Clin Orthop Relat Res. 2017;475(11):2819–23.

15. Juhan T, Stone M, Jalali O, Curtis W, Prodromo J, Weber AE, et al. Irreparable rotator cuff tears: Current treatment options. Orthop Rev (Pavia). 2019;11(3):123–8.

16. Neri BR, Chan KW, Kwon YW. Management of massive and irreparable rotator cuff tears. J Shoulder Elb Surg [Internet]. 2009;18(5):808–18. Available from: http://dx.doi.org/10.1016/j.jse.2009.03.013.

17. Oh JH, Park MS, Rhee SM. Treatment strategy for irreparable rotator cuff tears. CiOS Clin Orthop Surg. 2018;10(2):119–34.

18. DeOrio JK, Cofield RH: Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 1984;66(4):563-567.

19. Kissenberth MJ, Rulewicz GJ, Hamilton SC, Bruch HE, Hawkins RJ. A positive tangent sign predicts the repairability of rotator cuff tears. J Shoulder Elbow Surg 2014;23:1023-1027.

20. Neer CS 2nd, Cruess RL, Sledge CS, Wilde AH. Total glenohumeral replacement: a preliminary report. Orthop Trans. 1977;1:244–245.

21. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears: a long-term observation. Clin Orthop Relat Res. 1990;254:92–96.

22. Walch G, Edwards B, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14:238–246.

23. Burkhart SS: Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears: A suspension bridge model. Clin Orthop Relat Res 1992;284:144-152.

24. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg [Am] 2000;82-A:505-515.

25. Neviaser TJ, Neviaser RJ, Neviaser JS, Neviaser JS. The four-in-one arthroplasty for the painful arc syndrome. Clin Orthop Relat Res. 1982;(163):107-112.

26. APA Nho, Shane J. MD, MS; Strauss, Eric J. MD; Lenart, Brett A. MD; Provencher, Matthew T. MD, MC, USN; Mazzocca, Augustus D. MD, MS; Verma, Nikhil N. MD; Romeo, Anthony A. MD Long Head of the Biceps Tendinopathy: Diagnosis and Management, American Academy of Orthopaedic Surgeon: November 2010 – Volume 18 – Issue 11 – p 645-656.

27. Pedowitz RA, Higashigawa K, Nguyen V: The “50% rule” in arthroscopic and orthopaedic surgery. Arthroscopy 2011;27 (11):1584-1587.


How to Cite this article: Chidambaram R, Mukhopadhyay R | Classification Systems in Rotator Cuff Tears | Asian Journal of Arthroscopy | January- June 2021; 6(1): 31-35.

(Abstract)      (Text HTML)      (Download PDF)


Diagnostic Clinical Tests in Rotator Cuff Tear: Which and Why?

Volume 6 | Issue 1 | January-June 2021 | Page 24-30 | Vivek Pandey


Author: Vivek Pandey [1]

[1] Sports Medicine and Arthroscopy Division, Orthopaedic Surgery, Kasturba Medical College, Manipal, Udupi, Karnataka, India.

Address of Correspondence:
Dr. Vivek Pandey
Sports Medicine and Arthroscopy Division, Orthopaedic Surgery,
Kasturba Medical College, Manipal, Karnataka, Manipal Academy of
Higher Education, Udupi, Karnataka, India.
E-mail: vivekortho@gmail.com


Abstract

Rotator cuff tear is a leading cause of shoulder pain resulting in varying degree of disability to perform activities of daily living. A methodical history taking and focussed clinical examination helps in establishing the clinical diagnosis. A number of tests are mentioned in the literature to test the integrity of rotator cuff. This narrative review will focus upon methodology of each test, and their diagnostic accuracy.
Keywords: Rotator cuff tear; Impingement; Clinical tests; Diagnosis.


References

1. Bot SD, van der Waal JM, Terwee CB, van der Windt DA, Schellevis FG, Bouter LM et al. (2005) Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis 64 (1):118-23. doi:10.1136/ard.2003.019349

2. Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG (2007) Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res 455:52-63. doi:10.1097/BLO.0b013e31802fc175

3. Saha AK (1971) Dynamic stability of the glenohumeral joint. Acta Orthop Scand 42 (6):491-505. doi:10.3109/17453677108989066

4. Hess SA (2000) Functional stability of the glenohumeral joint. Man Ther 5 (2):63-71. doi:10.1054/math.2000.0241

5. Jain NB, Wilcox RB, 3rd, Katz JN, Higgins LD (2013) Clinical examination of the rotator cuff. PM R 5 (1):45-56. doi:10.1016/j.pmrj.2012.08.019

6. Lädermann A, Meynard T, Denard PJ, Ibrahim M, Saffarini M, Collin P (2020) Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-020-06136-9

7. Neer CS, 2nd (1983) Impingement lesions. Clin Orthop Relat Res (173):70-7

8. Hawkins RJ, Kennedy JC (1980) Impingement syndrome in athletes. Am J Sports Med 8 (3):151-8. doi:10.1177/036354658000800302

9. Jobe FW, Jobe CM (1983) Painful athletic injuries of the shoulder. Clin Orthop Relat Res (173):117-24

10. Jobe FW, Moynes DR (1982) Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med 10 (6):336-9. doi:10.1177/036354658201000602

11. Kelly BT, Kadrmas WR, Speer KP (1996) The manual muscle examination for rotator cuff strength. An electromyographic investigation. Am J Sports Med 24 (5):581-8. doi:10.1177/036354659602400504

12. Itoi E, Kido T, Sano A, Urayama M, Sato K (1999) Which is more useful, the “full can test” or the “empty can test,” in detecting the torn supraspinatus tendon? Am J Sports Med 27 (1):65-8. doi:10.1177/03635465990270011901

13. Chew K PY, Chin J, ClarkeM,Wong YS. (2010) Clinical predictors for the diagnosis of supraspinatus pathology. Physiother Singap 13 (2):12-18

14. Sgroi M, Loitsch T, Reichel H, Kappe T (2018) Diagnostic Value of Clinical Tests for Supraspinatus Tendon Tears. Arthroscopy 34 (8):2326-33. doi:10.1016/j.arthro.2018.03.030

15. EA C (1934) The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. In. G Miller & Co Medi Publishers, Brooklyn, New York, USA

16. Kurokawa D, Sano H, Nagamoto H, Omi R, Shinozaki N, Watanuki S et al. (2014) Muscle activity pattern of the shoulder external rotators differs in adduction and abduction: an analysis using positron emission tomography. J Shoulder Elbow Surg 23 (5):658-64. doi:10.1016/j.jse.2013.12.021

17. Gerber C, Blumenthal S, Curt A, Werner CM (2007) Effect of selective experimental suprascapular nerve block on abduction and external rotation strength of the shoulder. J Shoulder Elbow Surg 16 (6):815-20. doi:10.1016/j.jse.2007.02.120

18. Sgroi M, Loitsch T, Reichel H, Kappe T (2019) Diagnostic Value of Clinical Tests for Infraspinatus Tendon Tears. Arthroscopy 35 (5):1339-47. doi:10.1016/j.arthro.2018.12.003

19. Hertel R, Ballmer FT, Lombert SM, Gerber C (1996) Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 5 (4):307-13. doi:10.1016/s1058-2746(96)80058-9

20. Walch G, Boulahia A, Calderone S, Robinson AH (1998) The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br 80 (4):624-8. doi:10.1302/0301-620x.80b4.8651

21. Patte D, Goutallier D (1988) [Extensive anterior release in the painful shoulder caused by anterior impingement]. Rev Chir Orthop Reparatrice Appar Mot 74 (4):306-11

22. Collin P, Treseder T, Denard PJ, Neyton L, Walch G, Lädermann A (2015) What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears? Clin Orthop Relat Res 473 (9):2959-66. doi:10.1007/s11999-015-4392-9

23. Arthuis M (1972) [Obstetrical paralysis of the brachial plexus. I. Diagnosis. Clinical study of the initial period]. Rev Chir Orthop Reparatrice Appar Mot 58:Suppl 1:124-6

24. Gerber C, Krushell RJ (1991) Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br 73 (3):389-94

25. Gerber C, Hersche O, Farron A (1996) Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 78 (7):1015-23. doi:10.2106/00004623-199607000-00005

26. Burkhart SS, Tehrany AM (2002) Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy 18 (5):454-63. doi:10.1053/jars.2002.30648

27. Scheibel M, Tsynman A, Magosch P, Schroeder RJ, Habermeyer P (2006) Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med 34 (10):1586-93. doi:10.1177/0363546506288852

28. Scheibel M, Magosch P, Pritsch M, Lichtenberg S, Habermeyer P (2005) The belly-off sign: a new clinical diagnostic sign for subscapularis lesions. Arthroscopy 21 (10):1229-35. doi:10.1016/j.arthro.2005.06.021

29. Barth JR, Burkhart SS, De Beer JF (2006) The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 22 (10):1076-84. doi:10.1016/j.arthro.2006.05.005

30. Ardic F, Kahraman Y, Kacar M, Kahraman MC, Findikoglu G, Yorgancioglu ZR (2006) Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil 85 (1):53-60. doi:10.1097/01.phm.0000179518.85484.53

31. Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma-Zeinstra SM (2013) Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA 310 (8):837-47. doi:10.1001/jama.2013.276187

32. Salaffi F, Ciapetti A, Carotti M, Gasparini S, Filippucci E, Grassi W (2010) Clinical value of single versus composite provocative clinical tests in the assessment of painful shoulder. J Clin Rheumatol 16 (3):105-8. doi:10.1097/RHU.0b013e3181cf8392

33. Silva L, Andréu JL, Muñoz P, Pastrana M, Millán I, Sanz J et al. (2008) Accuracy of physical examination in subacromial impingement syndrome. Rheumatology (Oxford) 47 (5):679-83. doi:10.1093/rheumatology/ken101

34. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, 3rd et al. (2008) Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med 42 (2):80-92; discussion 92. doi:10.1136/bjsm.2007.038406

35. Holtby R, Razmjou H (2004) Validity of the supraspinatus test as a single clinical test in diagnosing patients with rotator cuff pathology. J Orthop Sports Phys Ther 34 (4):194-200. doi:10.2519/jospt.2004.34.4.194

36. Murrell GA, Walton JR (2001) Diagnosis of rotator cuff tears. Lancet 357 (9258):769-70. doi:10.1016/s0140-6736(00)04161-1

37. Hippensteel KJ, Brophy R, Smith MV, Wright RW (2019) A Comprehensive Review of Physical Examination Tests of the Cervical Spine, Scapula, and Rotator Cuff. J Am Acad Orthop Surg 27 (11):385-94. doi:10.5435/jaaos-d-17-00090

38. Miller CA, Forrester GA, Lewis JS (2008) The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Med Rehabil 89 (6):1162-8. doi:10.1016/j.apmr.2007.10.046

39. Bartsch M, Greiner S, Haas NP, Scheibel M (2010) Diagnostic values of clinical tests for subscapularis lesions. Knee Surg Sports Traumatol Arthrosc 18 (12):1712-7. doi:10.1007/s00167-010-1109-1

40. Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM et al. (2012) Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med 46 (14):964-78. doi:10.1136/bjsports-2012-091066.


How to Cite this article: Pandey V | Diagnostic Clinical Tests in | Rotator Cuff Tear: Which and Why? | Asian
Journal of Arthroscopy | January- June 2021; 6(1): 24-30..

(Abstract)      (Text HTML)      (Download PDF)