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 , Nilesh Kamat , M.P. Ramraju Mudunuri 
 Kamat Clinic, Pune, Maharashtra, India.
 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.
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.
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|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.
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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 , Nilesh Kamat , Sachin Tapasvi 
 Orthopaedic Speciality Clinic, Pune Mahatrahtra, India.
 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.
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.
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.|
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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 , Kaushik Eswaran , Nishanth Shetty 
 Department of Orthopaedics, Yenepoya Medical College,
Address of Correspondence:
Dr. Kaushik Eswaran,
Yenepoya Medical College, Mangalore, India.
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.
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|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.
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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  , Rajiv Gogna  , Daniel Morris  , Amol Tambe 
 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.
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.
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|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.
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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 , Shyam Gopal V , Mohana Chandran , Aleena Antony 
 Department of Orthopaedics, Aster Centre of Excellence in Orthopaedics & Rheumatology, Aster Medcity, Kochi, Kerala, India.
 Department of Physiotherapy, Aster Centre of Excellence in Orthopaedics & Rheumatology, Aster Medcity, Kochi, Kerala, India
 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.
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.
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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.
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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 , Marcus Wei Ping Tan , Denny Tjiauw Tjoen Lie [1, 2]
 National Preventive Medicine Residency Programme, National University Health System, Singapore.
 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Address of Correspondence:
Dr. Denny TT Lie,
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
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.
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|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.
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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]
 Lairesse Kliniek, Amsterdam, The Netherlands.
 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.
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.
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|How to Cite this article: Willems WJ | Natural History of Rotator Cuff Tears | Asian Journal of Arthroscopy | January-June 2021; 6(1): 36-38.|
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Classification Systems in Rotator Cuff Tears
Volume 6 | Issue 1 | January-June 2021 | Page 31-35 | Ram Chidambaram, Reet Mukhopadhyay
Author: Ram Chidambaram , Reet Mukhopadhyay 
 Department of Shoulder, Elbow, Hand and Sports Injuries, MGM Healthcare, Aminjikarai, Chennai, Tamil Nadu, India.
 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.
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.
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|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.|
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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 
 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.
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.
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|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..
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