Objective To explore the effectiveness of the arthroscopic separate double-layer suture bridge technique in treatment of the delaminated rotator cuff tear. Methods Between May 2013 and May 2015, 54 patients with the delaminated rotator cuff tears were recruited in the study. They were randomly allocated into 2 groups to receive repair either using arthroscopic separate double-layer suture bridge technique (trial group, n=28) or using arthroscopic whole-layer suture bridge technique (control group, n=26). There was no significant difference in gender, age, injured side, tear type, and preoperative visual analogue scale (VAS) score, Constants score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) score, and the range of motion of shoulder joint between 2 groups (P>0.05). Postoperative functional scores, range of motion, and recurrence rate of tear in 2 groups were observed and compared. Results The operation time was significant longer in trial group than in control group (t=8.383, P=0.000). All incisions healed at stage Ⅰ without postoperative complication. All the patients were followed up 12 months. At 12 months postoperatively, the UCLA score, ASES score, VAS score, Constant score, and the range of motion were significantly improved when compared with the preoperative values in 2 groups (P<0.05). However there was no significant difference in above indexes between 2 groups (P>0.05). Four cases (14.3%) of rotator cuff tear recurred in trial group while 5 cases (19.2%) in control group, showing no significant difference (χ2=0.237, P=0.626). Conclusion Compared with the arthroscopic whole-layer suture bridge technique, arthroscopic separate double-layer suture bridge technique presents no significant difference in the shoulder function score, the range of motion, and recurrence of rotator cuff tear, while having a longer operation time.
Objective To investigate the effectiveness of arthroscopic long head of biceps tendon (LHBT) transposition combined with Swivelock anchor double fixation in treatment of massive and irreparable rotator cuff tears. Methods Between June 2019 and November 2021, 25 patients with massive and irreparable rotator cuff tears were treated by arthroscopic LHBT transposition combined with Swivelock anchor double fixation. There were 12 males and 13 females. The age ranged from 47 to 74 years (mean, 62.4 years). The disease duration ranged from 1 to 62 months (median, 7 months). The rotator cuff tears were classified as Hamada grade 2 in 25 cases and Goutallier grade 1 in 2 cases, grade 2 in 22 cases, and grade 3 in 1 case. Pre- and post-operative shoulder range of motion (ROM), visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, and Constant-Murley score were recorded. Postoperative complications were observed. The reconstructed tissue integrity was confirmed by MRI. Results All operations were successfully completed. The operation time was 120-330 minutes (mean, 189.6 minutes). All incisions healed by first intention. All patients were followed up 10-36 months (mean, 22.0 months). At last follow-up, the ROM in forward flexion, abduction, and external rotation, VAS score, UCLA score, and Constant-Murley score were superior to those before operation, and the differences were significant (P<0.05). According to UCLA scoring standard, shoulder joint function was rated as excellent in 5 cases, good in 18 cases, and poor in 2 cases, with an excellent and good rate of 92.0%. No other complications occurred except shoulder joint adhesion in 2 cases. At last follow-up, MRI examination showed no retear of rotator cuff, and LHBT was intact. Conclusion For massive and irreparable rotator cuff tears, arthroscopic LHBT transposition combined with Swivelock anchor double fixation can increase the force of pressing the humeral head, effectively relieve the pain, improve the ROM of joints, maximize the recovery of shoulder function, and do not increase the number of anchor nails.
Objective To explore the long-term effectiveness of arthroscopic partial repair in treatment of massive irreparable rotator cuff tears from both the radiological and clinical perspectives. Methods A retrospective analysis was conducted on the clinical data of 24 patients (25 sides) with massive irreparable rotator cuff tears who met the inclusion criteria between May 2006 and September 2014. Among them, there were 17 males (18 sides) and 7 females (7 sides) with an age range of 43-67 years (mean, 55.0 years). There were 23 cases of unilateral injury and 1 case of bilateral injuries. All patients were treated with the arthroscopic partial repair. The active range of motion of forward elevation and abduction, external rotation, and internal rotation, as well as the muscle strength for forward flexion and external rotation, were recorded before operation, at the first postoperative follow-up, and at last follow-up. The American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, and Constant score were used to evaluate shoulder joint function. And the visual analogue scale (VAS) score was used to evaluate shoulder joint pain. MRI examination was performed. The signal-to-noise quotient (SNQ) was measured above the anchor point near the footprint area (m area) and above the glenoid (g area) in the oblique coronal T2 fat suppression sequence. The atrophy of the supraspinatus muscle was evaluated using the tangent sign. The global fatty degeneration index (GFDI) was measured to assess fat infiltration in the supraspinatus muscle, infraspinatus muscle, teres minor muscle, upper and lower parts of the subscapularis muscle. The mean GFDI (GFDI-5) of 5 muscles was calculated. Results The incisions healed by first intention. All patients were followed up with the first follow-up time of 1.0-1.7 years (mean, 1.3 years) and the last follow-up time of 7-11 years (mean, 8.4 years). At last follow-up, the range of motion and muscle strength of forward elevation and abduction, ASES score, Constant score, UCLA score, and VAS score of the patients significantly improved when compared with those before operation (P<0.05). Compared with the first follow-up, except for a significant increase in ASES score (P<0.05), there was no significant difference in the other indicators (P>0.05). Compared with those before operation, the degree of supraspinatus muscle infiltration worsened at last follow-up (P<0.05), GFDI-5 increased significantly (P<0.05), and there was significant difference in the tangent sign (P<0.05); while there was no significant difference in the infiltration degree of infraspinatus muscle, teres minor muscle, and subscapularis muscle, upper and lower parts of the subscapularis muscle (P>0.05). Compared with the first follow-up, the SNQm and SNQg decreased significantly at last follow-up (P<0.05). At the first and last follow-up, there was no correlation between the SNQm and SNQg and the ASES score, Constant score, UCLA score, and VAS score of the shoulder (P>0.05). Conclusion Arthroscopic partial repair is effective in treating massive irreparable rotator cuff tear and significantly improves long-term shoulder joint function. For patients with severe preoperative fat infiltration involving a large number of tendons and poor quality of repairable tendons, it is suggested to consider other treatment methods.
Objective To observe and evaluate the short-term effectiveness of superior capsular reconstruction using autologous fascia lata graft for irreparable massive rotator cuff tears. Methods The clinical data of 9 patients with irreparable massive rotator cuff tears treated with arthroscopic superior capsular reconstruction by using autologous fascia lata graft between September 2019 and April 2020 were retrospectively analysed. There were 4 males and 5 females with a median age of 66 years (range, 55-70 years). The disease duration was 6-60 months with an average of 19.1 months. According to Hamada classification, the patients were classified as grade 1 in 2 cases, grade 2 in 2 cases, grade 3 in 2 cases, and grade 4 in 3 cases. Before and after operation, the visual analogue scale (VAS) score was used to evaluate the improvement of shoulder joint pain, the American Shoulder and Elbow Surgeons (ASES) score, Constant score, and the University of California Los Angeles (UCLA) shoulder function score were used to evaluate the improvement of shoulder joint function. The active range of motion of shoulder joint was recorded, including forward flexion, abduction, lateral external rotation, and internal rotation. The changes of subacromial space were recorded by anteroposterior X-ray film of shoulder joint. Sugaya classification was used to judge the integrity of rotator cuff immediately after operation and at last follow-up. ResultsThe operation time was 210-380 minutes, with an average of 302.3 minutes. All incisions healed by first intention after operation, and there was no complication such as infection and nonunion of incisions. Two patients had numbness of the upper limbs on the surgical side after operation, and the numbness completely relieved at 6 weeks after operation; 5 cases with preoperative pseudoparalysis symptoms recovered after operation. Nine patients were followed up 12-17 months, with an average of 14.1 months. At last follow-up, the patient’s active range of motion of shoulder joint (forward flexion, abduction, lateral external rotation, and internal rotation), subacromial space distance, VAS score, ASES score, Constant score, and UCLA score significantly improved when compared with preoperative ones (P<0.05). There was no significant difference in the Sugaya classification between at last follow-up and immediately after operation (Z=−1.633, P=0.102). ConclusionSuperior capsular reconstruction using autologous fascia lata graft can restore the superior stability and achieve a good short-term effectiveness for irreparable massive rotator cuff tears.
Objective To review the progress in the treatment and research of massive rotator cuff tears. Methods Recent l iteratures about the treatment and research of massive rotator cuff tears were reviewed. Results Treatment options of massive rotator cuff tears include nonoperative treatment, debridement, direct repair, tendon transfer, and repair with various substitutes, but the outcome is unpredictable. Recently, many experimental studies on the treatment of massive rotator cuff tears, such as gene therapy, cell therapy, and tissue engineering techniques, can provide cl inicians with new treatment strategies. Conclusion The treatment of massive rotator cuff tears pose a distinct cl inical challenge for the orthopaedist, depending on the overall presentation. The effect of traditional operation method to repair massive rotator cuff tears is limited. The treatment and research of massive rotator cuff tears still need to be studied.
ObjectiveTo investigate early effectiveness of arthroscopic superior fulcrum reconstruction in the treatment of irreparable massive rotator cuff tear (IMRCT). Methods A retrospective analysis was conducted on the clinical data of 24 patients with IMRCT who met the inclusion criteria between January 2020 and April 2022. Among them, there were 11 males and 13 females with an average age of 56.2 years (range, 42-68 years). There were 12 cases of falling injuries, 3 cases of traction injuries, and the other 9 cases had no obvious causes. The disease duration ranged from 1 to 25 months (median, 6 months). The rotator cuff tears were classified as Hamada grade 2 in 18 cases and grade 3 in 6 cases, and Goutallier grade 1 in 3 cases, grade 2 in 20 cases, and grade 3 in 1 case. All patients were treated with arthroscopic superior fulcrum reconstruction. Visual analogue scale (VAS) score, Constant-Murley score, the University of California at Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score were recorded before operation and at 1, 3, 6, and 12 months after operation. Results The operations were all successfully completed. The incisions healed by first intention and no related complications occurred. All patients were followed up 12-33 months (mean, 24.6 months). The VAS, Constant-Murley, UCLA, and ASES scores at different time points after operation were superior to those before operation (P<0.05). All of the above indicators further improved with time. Except for no significant difference in VAS and Constant-Murley scores between 6 and 12 months (P>0.05), the differences between the other time points were significant (P<0.05). At 12 months after operation, according to UCLA scoring standard, shoulder joint function was rated as excellent in 4 cases, good in 19 cases, and poor in 1 case, with an excellent and good rate of 96.0%. MRI showed that there was no graft re-tear and the transplanted tendon and bone tunnel healed. Conclusion The arthroscopic superior fulcrum reconstruction for IMRCT can effectively relieve the pain, improve the shoulder range of motion, and restore good shoulder function.
ObjectiveTo evaluate the effectiveness of the combined tenodesis for proximal lesions of biceps tendon with massive rotator cuff tear by arthroscopy. MethodsBetween January 2011 and June 2013, 48 patients with massive rotator cuff tear and proximal lesions of biceps tendon underwent combined tenodesis under arthroscopy, and the clinical data were retrospectively analyzed. Of 48 cases, 22 were male and 26 were female with an average age of 46 years (range, 35-59 years); 12 cases had clear history of trauma. The disease duration ranged from 1 to 57 months (mean, 4.6 months). All cases suffered from moderate to severe shoulder pain, the strength and the range of motion (ROM) declined when compared with those of the other side. According to Goutallier classification standard, 3 cases were rated as grade 0, 18 cases as grade 1, and 27 cases as grade 2. The operation time and complication were recorded. The visual analogue scale (VAS) score, ROM, the strength of flexed elevation and elbow flexion, Constant-Murley score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Mayo elbow performance score (MEPS) were used to evaluate the effectiveness. ResultsThe operations were performed successfully, and incisions healed primarily. The operation time was 120-160 minutes (mean, 135 minutes). One case had shoulder joint swelling with wound bleeding, which was cured after proper treatment. All 48 patients were followed up 12-18 months (mean, 13.9 months). The results of MRI showed good healing of tendon at 6 months after operation. When compared with preoperative values, VAS score was significantly decreased (P<0.05); the ROM in forward flexion, external rotation, and internal rotation, and the strength of flexed elevation were significantly increased (P<0.05); and ASES score, Constant-Murley score, and UCLA score were significantly improved at 12 months after operation (P<0.05). No significant difference was observed in MEPS score and elbow flexion strength (P>0.05). ConclusionThe technique of combined tenodesis under arthroscopy can obtain satisfactory clinical outcomes in treating proximal lesions of biceps tendon with massive rotator cuff tear.
ObjectiveTo investigate effectiveness of arthroscopic superior capsular reconstruction using a “sandwich” patch combined with platelet-rich plasma (PRP) injection in treating massive irreparable rotator cuff tears. Methods A clinical data of 15 patients (15 sides) with massive irreparable rotator cuff tears, who were admitted between September 2020 and March 2023 and met the selective criteria, was retrospectively analyzed. There were 8 males and 7 females with an average age of 62.1 years (range, 40-80 years). The rotator cuff tears were caused by trauma in 7 cases and other reasons in 8 cases. The disease duration ranged from 5 to 25 months, with an average of 17.7 months. According to the Hamada grading, the rotator cuff tears were rated as grade 1 in 2 cases, grade 2 in 8 cases, and grade 3 in 5 cases. All patients were underwent superior capsular reconstruction using the “sandwich” patches (autologous fascia lata+polypropylene patch+autologous fascia lata) combined with PRP injection on patches. The pre- and post-operative active range of motion (ROM) of the shoulder joint, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California, Los Angeles Shoulder Rating Scale (UCLA) score, and visual analogue scale (VAS) score were recorded. The subacromial space was measured on the imaging and rotator cuff integrity was assessed based on Sugaya grading. Results All incisions healed by first intention after operation without any complications such as infection. All patients were followed up 12-18 months (mean, 14.4 months). At last follow-up, the active ROMs of flexion, abduction, external rotation, internal rotation of the shoulder joint, subacromial space, ASES score, Constant-Murley score, and UCLA score increased, and VAS score decreased, showing significant differences when compared with preoperative values (P<0.05). There was no significant difference in the Sugaya grading between last follow-up and immediately after operation (P>0.05). Conclusion For massive irreparable rotator cuff tears, arthroscopic superior capsular reconstruction using the “sandwich” patches combined with PRP injection can restore stability of the shoulder joint, relieve pain, promote rotator cuff healing, and achieve good short-term effectiveness.
Objective To review the research progress of arthroscopic long head of biceps tendon (LHBT) transposition in treatment of irreparable massive rotator cuff tears. Methods The domestic and foreign related literature in recent years on the treatment of irreparable massive rotator cuff tears with different LHBT transposition methods under arthroscopy was reviewed and analyzed. Results Arthroscopic LHBT transposition is an effective method for irreparable massive rotator cuff tears, which mainly includes “proximal cut”, “both two cuts”, “distal cut”, and “no cut”. Different methods of LHBT transposition can achieve good effectiveness, but its long-term effectiveness needs further follow-up. Conclusion Arthroscopic LHBT transposition in treatment of irreparable massive rotator cuff tears is simple and effective. The patients can recover quickly after operation with less injury. But the technique has higher requirements for surgeons, and the indications must be strictly controlled.
ObjectiveTo establish a model of chronic rotator cuff injury by inducing subacromial impingement syndrome in rats, so as to lay a foundation for further study on the mechanism and treatment of chronic rotator cuff injury. MethodsThe polyether-ether-ketone implants were designed and made with three-dimensional printing technique. In 48 male Sprague Dawley rats[weighing, (277.25±22.03) g], one shoulder joint was selected randomly as the experimental group; in the experimental group, the implant was pierced into shoulder joint close tothe acromion medial side and was pierced out under acromion close to the deltoid trailing edge; the penetratingpartof implant was cut off after the implanting part was fixed with 4# braided silk suture. No any treatment was performed on the contralateral shoulder of 24 rats as control group; and the implants were immediately removed after they were pierced into the contralateral shoulder joint of the other 24 rats as sham-operation group. All the rats were exposed to 30 minutes of downhill running at 17 m/minute (-13.5°) every day at 4 days after operation and the general condition of rats was observed. At 2, 4, 6, and 8 weeks after operation, 12 rats were sacrificed to collect shoulder joint samples. The hardtissueslices was used for VanGieson staining and histological observation of the supraspinatus tendon. ResultsAll ratssurvived to the end of experiment, without infection.The rats suffered limp at 2-3 daysafter operation, and the gait of most rats returned to normal at 4 days after operation.The histological results showed that the supraspinatus tendon had smooth edge, without split layers or breakage in the control group and sham-operation group. In the experimental group, the implants were positioned accurately without dislocation; 4 kinds of typical pathological changes were observed. Partial-thickness tear on bursal side appeared at 2 weeks (5 rats) and 4 weeks (2 rats), showing no significant difference between at 2 and 4 weeks (P > 0.05); intratendinous gap formed mainly at 4 weeks (10 rats) and 6 weeks (11 rats), showing significant differences when compared with that at 2 weeks (2 rats) (P < 0.05) and 8 weeks (2 rats) (P < 0.05); partial-thickness tear on articular side mainly appeared at 6 weeks (8 rats), showing significant difference when compared with that at other time points (P < 0.05); full-thickness tear was found mainly at 8 weeks (10 rats), showing significant differences when compared with that at other time points (P < 0.05). ConclusionA model of chronic rotator cuff injury is successfully established in rats through microinvasive implantation of subacromial impingement syndrome inducing implants and the pathological changes in this model are highly similar to the clinical pathological progress.