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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 [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.

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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 [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)