Indications for High Tibial Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 3-7 | Clement Joseph, Yugal Varandani

DOI: 10.13107/aja.2021.v06i02.027

Author: Clement Joseph [1], Yugal Varandani [1]

[1] Department of Arthroscopy & Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, Tamil Nadu, India.

Address of Correspondence:
Dr. Clement Joseph,
Senior Consultant & Head, Arthroscopy & Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, Tamil Nadu, India.
E-mail: clementorth@yahoo.co.in

Abstract

There is a resurgence of interest in HTO to treat young to middle aged patients with varus alignment and isolated medial joint osteoarthritis. With improvements in implant design and preoperative planning methods, good outcomes are reported in multiple studies. But the most important factor for a successful outcome is patient selection. The ideal patient would be a middle-aged patient with isolated medial joint arthritis with good range of movements, non-smoker and with reasonable functional status of knee. The indications of HTO are evolving to include patients in higher age groups, with minimal to moderate patellofemoral symptoms and varying amounts of flexion deformities. It is also increasingly being performed as a joint protective surgery following meniscus repairs and cartilage repair procedures and to correct abnormal joint alignment following neglected ligamentous injuries.

References

1. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br. 1961 Nov;43-B:746-51. doi: 10.1302/0301-620X.43B4.746. https://doi.org/10.1302/0301-620x.43b4.746
2. Coventry, M B. “Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report” J Bone Joint Surg Am. 1965; 47:984-990. PMID: 14318636
3. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332-354. PMID: 3818700.
4. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res. 1999;(367):18-27. PMID: 10546594.
5. Capella M, Gennari E, Dolfin M, Saccia F. Indications and results of high tibial osteotomy. Ann Joint 2017:2;33. doi: 10.21037/aoj.2017.06.06 https://aoj.amegroups.com/article/view/3720/4378
6. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. Arch Bone Jt Surg. 2016;4(3):204-212. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4969364/
7. Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J. 2014;96-B (11):1491-1497. doi:10.1302/0301-620X.96B11.33617 https://doi.org/10.1302/0301-620x.96b11.33617
8. Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):149-152. doi:10.1007/s00167-005-0638-5 https://doi.org/10.1007/s00167-005-0638-5
9. Bonasia DE, Dettoni F, Sito G, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med. 2014;42(3):690-698. doi:10.1177/0363546513516577 https://doi.org/10.1177/0363546513516577
10. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br. 2008;90(5):592-596. doi:10.1302/0301-620X.90B5.20386 https://doi.org/10.1302/0301-620x.90b5.20386
11. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91-96. doi:10.1097/01.blo.0000229362.12244.f6 https://doi.org/10.1097/01.blo.0000229362.12244.f6
12. Herbst M, Ahrend MD, Grünwald L, Fischer C, Schröter S, Ihle C. Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results [published online ahead of print, 2021 Feb 11]. Knee Surg Sports Traumatol Arthrosc. 2021;10.1007/s00167-021-06457-3. doi:10.1007/s00167-021-06457-3 https://doi.org/10.1007/s00167-021-06457-3
13. Noyes, Frank & Barber-Westin, Sue. (2010). Primary, Double, and Triple Varus Knee Syndromes. In book: Noyes’ Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes (pp.821-895). 10.1016/B978-1-4160-5474-0.00031-X
14. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):170-180. doi:10.1007/s00167-012-2087-2 https://doi.org/10.1007/s00167-012-2087-2
15. Schuster P, Geßlein M, Schlumberger M, et al. Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment. Am J Sports Med. 2018;46(6):1362-1370. doi:10.1177/0363546518758016 https://doi.org/10.1177/0363546518758016
16. Hohloch L, Kim S, Eberbach H, et al. Improved clinical outcome after medial open-wedge osteotomy despite cartilage lesions in the lateral compartment. PLoS One. 2019;14(10):e0224080. Published 2019 Oct 24. doi:10.1371/journal.pone.0224080 https://doi.org/10.1371/journal.pone.0224080
17. Bin SI, Kim HJ, Ahn HS, Rim DS, Lee DH. Changes in Patellar Height After Opening Wedge and Closing Wedge High Tibial Osteotomy: A Meta-analysis. Arthroscopy. 2016;32(11):2393-2400. doi:10.1016/j.arthro.2016.06.012 https://doi.org/10.1016/j.arthro.2016.06.012
18. Kloos, F., Becher, C., Fleischer, B. et al. High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. Knee Surg Sports Traumatol Arthrosc 27, 2334–2344 (2019). https://doi.org/10.1007/s00167-018-5194-x
19. Javidan P, Adamson GJ, Miller JR, et al. The effect of medial opening wedge proximal tibial osteotomy on patellofemoral contact. Am J Sports Med. 2013;41(1):80-86. doi:10.1177/0363546512462810 https://doi.org/10.1177/0363546512462810
20. Krause M, Drenck TC, Korthaus A, Preiss A, Frosch KH, Akoto R. Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1859-1866. doi:10.1007/s00167-017-4548-0 https://doi.org/10.1007/s00167-017-4548-0
21. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med. 2000;28(3):282-296. doi:10.1177/03635465000280030201 https://doi.org/10.1177/03635465000280030201
22. Arthur A, LaPrade RF, Agel J. Proximal tibial opening wedge osteotomy as the initial treatment for chronic posterolateral corner deficiency in the varus knee: a prospective clinical study. Am J Sports Med. 2007;35(11):1844-1850. doi:10.1177/0363546507304717 https://doi.org/10.1177/0363546507304717
23. Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J. 2010;30:131-140. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2958284/
24. Kanamiya T, Naito M, Hara M, Yoshimura I. The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations. Arthroscopy. 2002;18(7):725-729. doi:10.1053/jars.2002.35258 https://doi.org/10.1053/jars.2002.35258
25. Thambiah MD, Tan MKL, Hui JHP. Role of High Tibial Osteotomy in Cartilage Regeneration – Is Correction of Malalignment Mandatory for Success?. Indian J Orthop. 2017;51(5):588-599. doi:10.4103/ortho.IJOrtho_260_17 https://doi.org/10.4103/ortho.ijortho_260_17
26. Nha KW, Lee YS, Hwang DH, et al. Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus [published correction appears in Arthroscopy. 2019 Feb;35(2):691] [published correction appears in Arthroscopy. 2020 Mar;36(3):923]. Arthroscopy. 2013;29(2):226-231. doi:10.1016/j.arthro.2012.08.027 https://doi.org/10.1016/j.arthro.2012.08.027
27. Lee DW, Lee SH, Kim JG. Outcomes of Medial Meniscal Posterior Root Repair During Proximal Tibial Osteotomy: Is Root Repair Beneficial?. Arthroscopy. 2020;36(9):2466-2475. doi:10.1016/j.arthro.2020.04.038 https://doi.org/10.1016/j.arthro.2020.04.038

How to Cite this article: Joseph C, Varandani Y | Indications for High Tibial Osteotomy | Asian Journal of Arthroscopy | July-December 2021; 6(2): 03-07

(Abstract Text HTML)      (Download PDF)

Short Term Clinical Outcomes of Fixed Length Loop Devices and Adjustable Length Loop Devices for Femoral Fixation of Hamstring Graft for Arthroscopic Anterior Cruciate Ligament Reconstruction: A Non-Randomized Comparative Trial

Volume 6 | Issue 2 | July-December 2021 | Page 58-62 | Samir C. Dwidmuthe, Kaustubh Patil, Vikram Sapre, Sushil Mankar

DOI: 10.13107/aja.2021.v06i02.036

Author: Samir C. Dwidmuthe [1], Kaustubh Patil [2], Vikram Sapre [2], Sushil Mankar [2]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
[2] Department Of Orthopaedics, NKPSIMS & RC, Nagpur, Maharashtra, India.

Address of Correspondence:
Dr. Samir C. Dwidmuthe
Associate professor, Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
E-mail: samirdwidmuthe@aiimsnagpur.edu.in

Abstract

Background: In anterior cruciate ligament (ACL) reconstruction, cortical suspension devices are used widely. The two most commonly used cortical suspension devices for ACL reconstruction are fixed fixed-length loop devices (FLDs) and adjustable length loop devices ALDs.
Aim: This study is aimed to compare the clinical outcomes between ALDs and FLDs in the femoral fixation component of ACL reconstruction using a hamstring graft. Methods: It was a non-randomized trial which that was conducted at department of orthopaedics tertiary care teaching hospital. The total sample size of the study was calculated as 34, in which 17 patients were placed in FLDs and the rest of 17 patients were placed in ALDs. Functional outcomes were measured by Lysholm score at preoperatively and then postoperatively at one month, two months, and six months. Knee laxity was tested were assessed by the Lachman test and Pivot shift test at preoperatively and postoperatively at 6 months.
Results: The mean Lysholm score increased from at preoperatively was 51.53±6.39 and postoperative score at last, at last, follow up was to 97.94±1.95 in FLD group and from 50.24.±12.36 to 98.29±1.86 in ALD group at 6-month follow-up. No significant difference was found in between the groups for Lysholm score at preoperatively and postoperative follow follow-ups(p>0.05). Lachman and Pivot shift test also showed no significant difference in between the groups (p>0.05).
Conclusion: The clinical effectiveness of FLDs and ALDs were found to be similar in ACL reconstruction.
Keywords: Anterior cruciate ligament reconstruction, Fixed length loop devices, Adjustable length loop devices, Lysholm score, Lachman test, Pivot shift test

References

1. Grassi A, Roberti di Sarsina T, Di Paolo S, Signorelli C, Bonanzinga T, Raggi F, Mosca M, Zaffagnini S. Increased Rotatory Laxity after Anterolateral Ligament Lesion in Anterior Cruciate Ligament- (ACL-) Deficient Knees: A Cadaveric Study with Noninvasive Inertial Sensors. Bini F, editor. Biomed Res Int 2021;1–7.
2. Kiapour AM, Murray MM. Basic science of anterior cruciate ligament injury and repair. Bone Jt Res 2014 ;3(2):20–31.
3. Eggerding V, Reijman M, Meuffels DE, Es E van, Arkel E van, Brand I van den, Linge J van, Zijl J, Bierma-Zeinstra SM, Koopmanschap M. ACL reconstruction for all is not cost-effective after acute ACL rupture. Br J Sports Med 2021;1–5.
4. Canale ST (S. T, Azar FM, Beaty JH, Campbell WC (Willis C. Campbell’s operative orthopaedics. THIRTEEN. Elsevier Inc.; 2017. p. 2123–2237.
5. Houck DA, Kraeutler MJ, McCarty EC, Bravman JT. Fixed- Versus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Studies 2018;6(10).
6. Zeng C, Lei G, Gao S, Luo W. Methods and devices for graft fixation in anterior cruciate ligament reconstruction. Cochrane Database Syst Rev 2013;(9).
7. Hapa O, Barber FA. ACL fixation devices. Sports Med Arthrosc 2009 ;17(4):217–23.
8. Barrow AE, Pilia M, Guda T, Kadrmas WR, Burns TC. Femoral Suspension Devices for Anterior Cruciate Ligament Reconstruction: Do Adjustable Loops Lengthen? 2013;42(2):343–9.
9. Eguchi A, Ochi M, Adachi N, Deie M, Nakamae A, Usman MA. Mechanical properties of suspensory fixation devices for anterior cruciate ligament reconstruction: Comparison of the fixed-length loop device versus the adjustable-length loop device. Knee 2014;21(3):743–8.
10. Johnson JS, Smith SD, LaPrade CM, Turnbull TL, LaPrade RF, Wijdicks CA. A Biomechanical Comparison of Femoral Cortical Suspension Devices for Soft Tissue Anterior Cruciate Ligament Reconstruction Under High Loads 2014;43(1):154–60.
11. Ahn JH, Ko TS, Lee YS, Jeong HJ, Park JK. Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- and Adjustable-Length Loop Cortical Fixation. Clin Orthop Surg 2018;10(2):157–66.
12. Lee, Dae-Hee & Son, Dong-Wook & Seo, Yi-Rak & Lee, In-Gyu. (2020). Comparison of femoral tunnel widening after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral cross-pin fixation: a systematic review and meta-analysis. Knee Surgery & Related Research. 32. 10.1186/s43019-020-0028-9.
13. Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR. Age, Graft Size, and Tegner Activity Level as Predictors of Failure in Anterior Cruciate Ligament Reconstruction With Hamstring Autograft 2013;41(8):1808–12.
14. Watson J. suspension device vs . adjustable-loop fixation designs : Review of mechanical data 2014;04(04):1–9.
15. BC N, JS D, AA A, DW A, A B. Biomechanical Evaluation of an Adjustable Loop Suspensory Anterior Cruciate Ligament Reconstruction Fixation Device: The Value of Retensioning and Knot Tying. Arthroscopy 2016 ;32(10):2050–9.
16. Singh S, Shaunak S, Shaw SCK, Anderson JL, Mandalia V. Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Indian Journal of Orthopaedics 2020;54: 426–43.
17. Firat A, Catma F, Tunc B, Hacihafizoglu C, Altay M, Bozkurt M, Kapicioglu MİS. The attic of the femoral tunnel in anterior cruciate ligament reconstruction: a comparison of outcomes of two suspensory femoral fixation systems. Knee Surgery, Sport Traumatology Arthroscopy 2013 ;22(5):1097–105.
18. Sheth H, Salunke AA, Barve R, Nirkhe R. Arthroscopic ACL reconstruction using fixed suspensory device versus adjustable suspensory device for femoral side graft fixation: What are the outcomes? J Clin Orthop Trauma 2019;10(1):138–42.
19. Ahn HW, Seon JK, Song EK, Park CJ, Lim HA. Comparison of Clinical and Radiologic Outcomes and Second-Look Arthroscopic Findings After Anterior Cruciate Ligament Reconstruction Using Fixed and Adjustable Loop Cortical Suspension Devices. Arthrosc J Arthrosc Relat Surg 2019 ;35(6):1736–42.
20. Lanzetti RM, Monaco E, De Carli A, Grasso A, Ciompi A, Sigillo R, Argento G, Ferretti A. Can an adjustable-loop length suspensory fixation device reduce femoral tunnel enlargement in anterior cruciate ligament reconstruction? A prospective computer tomography study. Knee 2016 ;23(5):837–41.
21. Ahn JH, Ko TS, Lee YS, Jeong HJ, Park JK. Magnetic Resonance Imaging and Clinical Results of Outside-in Anterior Cruciate Ligament Reconstruction: A Comparison of Fixed- and Adjustable-Length Loop Cortical Fixation. Clin Orthop Surg 2018;10(2):157–66.
22. Sharma, Parmar RS. Early outcome analysis of arthroscopic anterior cruciate ligament reconstruction using fixed closed loop and adjustable loop techniques: A prospective case series. J Orthop Allied Sci 2018 ;6(2):74.
23. Choi N-H, Yang B-S, Victoroff BN. Clinical and Radiological Outcomes After Hamstring Anterior Cruciate Ligament Reconstructions: Comparison Between Fixed-Loop and Adjustable-Loop Cortical Suspension Devices.Am J Sports Med 2016;45(4):826–31.
24. Wise BT, Patel NN, Wier G, Labib SA. Outcomes of acl reconstruction with fixed versus variable loop button fixation. Orthopedics 2017 ;40(2):e275–80.
25. Pokharel B, Bhalodia M, Raut A. Comparative study on fixed versus adjustable-length loop device for femoral fixation of graft in anterior cruciate ligament reconstruction. Int. J. Orthop.Sci 2018 ;4(1):889–92.

How to Cite this article: Dwidmuthe S C, Patil K, Sapre V, Mankar S | Short Term Clinical Outcomes of Fixed Length Loop Devices and Adjustable Length Loop Devices for Femoral Fixation of Hamstring Graft for Arthroscopic Anterior Cruciate Ligament Reconstruction: A Non-Randomized Comparative Trial | Asian Journal of Arthroscopy | July-December 2021; 6(2): 58-62.

(Abstract Text HTML)      (Download PDF)

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 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)