Partial-Thickness Rotator Cuff Tears (original) (raw)
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Biomechanical analysis of bursal-sided partial thickness rotator cuff tears
Journal of Shoulder and Elbow Surgery, 2009
Background: Treatment of partial thickness supraspinatus tendon tears is controversial with no clearly defined treatment algorithms based on severity of tears. This study aims to evaluate the relationship between depth of partial thickness tears and strain. Methods: Bursal-sided partial thickness tears were created at 1 mm increments in depth at the anterior portion of the supraspinatus tendon to 3/4 tendon width on ten fresh-frozen shoulder specimens. The supraspinatus muscle was dynamically loaded from 0-50N, and strain recorded at both the anterior and posterior portions of the tendon. Results: Strain in the intact posterior portion increased monotonically with tear depth and supraspinatus force. Strain in the torn anterior portion decreased with increasing tear thickness and loading force. At 60% thickness tear, strain was significantly higher (P ΒΌ 0.023) in the intact posterior portion compared to intact tendon. As the tear thickness exceeded 50% tendon thickness, the strain in the intact tendon rapidly increased nonlinearly. Conclusions: Biomechanical results herein suggest increasing potential for tear propagation in the transverse plane with increasing depth of tears, and biomechanically supports repairs of grade III (>50% thickness).
Assessment of the shoulder in rotator cuff tears
1996
The rotator cuff consists of four muscles; the subscapularis, supraspinatus, infraspinatus, and teres minor. The long head of the biceps tendon is another important component of the complex. The subscapularis is a head depressor, and in certain positions an internal rotator. The infraspinatus and teres minor are external rotators. The conjoint tendon of these muscles, attached to the tuberosities, anatomically and functionally, works as a unit, to maintain dynamic glenohumeral stability centering the humeral head onto the glenoid articulation. The long head of the biceps attaches to the supraglenoid tubercle of the glenoid and has a stabilising and depressing action on the humeral head. The rotator cuff gives 50% of the abductor power and 80% of the external rotator power to the gleno-h umeral joint.
RESULTS OF SURGICAL REPAIR OF FULL-THICKNESS TEARS OF THE ROTATOR CUFF
Orthopedic Clinics of North America, 1997
Shoulder pain is often caused by pathologic conditions of the rotator cuff. Disorders associated with the rotator cuff range from simple tendinitis to chronic, massive, full-thickness tears. Although treatment frequently is nonoperative, in certain cases surgical management is recommended. Since Codman14 reported his results with surgical treatment of a rotator cuff tear in 1909, much has been learned about the technique and outcome of this procedure. Many investigators have studied the factors that influence the outcome after rotator cuff repair. This article reviews these different factors as well as the various methods of reporting outcome after shoulder surgery.
Revisiting the anatomy of rotator cuff relevant to rotator cuff injury
National Journal of Clinical Anatomy
The rotator cuff is the prime stabilizer of the glenohumeral or shoulder joint. The last decade saw introduction of three components, namely, rotator cable, rotator crescent, and rotator interval of rotator cuff, which were being studied and published in dozen of literatures belonging to clinical specialties of orthopaedics and radiology. At times when these terms have helped the clinician to understand the biomechanics of the rotator cuff while improving the outcome of its repair, the knowledge of the same remains at large for the anatomists. The preoperative assessment of rotator cuff tear has helped surgeons to identify the structure and its functional deficits thereof. The rotator cable is a thick fibrous band that behaves like a suspension bridge. Tears of rotator cable result in partial loss of function or pseudoparalysis of shoulder joint. The rotator interval is a four-layered protective cover of ligaments and the capsule in the rotator cuff. The current knowledge of the rotator interval revealed that the minor underlying ligaments of the shoulder joint play a crucial role in maintaining the congruency of the rotator cuff. The rotator cuff injury is often misdiagnosed due to a lack of knowledge and identification of its recently reported components. This review intends to sensitize the anatomists to investigate further about rotator cuff anatomy and biomechanics of the shoulder joint.
Surgical Treatment Options for Partial Rotator Cuff Tears: A Review of the Literature
International Journal of Orthopaedics
Partial-thickness rotator cuff tears (PTRCT) can be articularsided, bursal-sided or intratendinous. New research suggests that a considerable proportion (up to 30%) of cuff thickness on the articular side is taken up histologically by the superior joint capsule conjoined to the rotator cuff tissue. This means that newer reviews of the surgical options may be required to complement the Ellman classification which grades lesions as grade 1 (less than 25% of tendon thickness involved), grade 2 (25-50%) or grade 3 (greater than 50% of tendon thickness). If primary non-operative treatment fails, many surgical options can be considered. The surgical technique chosen has been based on depth of the tear and the tear location. Surgical treatment can be distinguished between debridement and repair of PTRCT's, as well as biologically active experimental techniques showing some promise. Debridement can be successfully performed for bursal-sided Ellman grade 1 tears and articular-sided grade 1 and 2 tears. All other techniques show better results with a repair technique, which can be either performed with an in-situ or trans-cuff repair technique (leaving the intact rotator cuff portion intact) or with tear conversion to a full-thickness cuff tear and subsequent repair. Successful functional and structural outcome after repair of Ellman grade 3 tears can be shown with both repair techniques. The current literature also suggests evidence for inferior outcomes and higher failure rates after arthroscopic debridement of bursal-sided partial-thickness rotator cuff tears compared to articularsided lesions, which may reflect the contribution of capsule to the tear. Articular-sided partial cuff tears are frequently seen in overhead athletes and should be treated non-operatively whenever possible. If conservative treatment fails, debridement seems to be a better surgical choice in most cases, as only a half of professional athletes return to the same level of play after repair of partial-thickness rotator cuff tears.
Basic Science in Rotator Cuff Tears
MOJ Orthopedics & Rheumatology, 2017
Rotator cuff (RC) tears are the most common soft tissue injuries of the shoulder. Despite the surgical improvement with new techniques in the repair site of the tears, the clinical results remain with high rate of failure. Deferent experimental studies in many animal models try to evaluate the complexity of the clinical problem. In this review article we summarize the knowledge from studies regarding the tendon to bone repair and healing, the early inflammatory reaction, the bone, tendon and muscle condition and the diversity of scaffolds that have been used in order to bridge a gap between RC tendon and the recipient site on bone. To answer the spectrum of questions regarding the treatment of RC tears further specific knowledge using the aforementioned animal models is compulsory.
American Journal of Sports Medicine, 2020
Background: Tear completion followed by repair (TCR) and in situ repair (ISR) have been widely used for bursal-side partialthickness rotator cuff tears (PTRCTs). Both techniques have shown favorable results; however, controversy continues in terms of the best management. Purpose: To compare the histological and biomechanical outcomes of these 2 techniques for 50% partial-thickness bursal-side rotator cuff tear repair in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 27 rabbits were used in this experimental study. Seven rabbits were sacrificed at the beginning of the study to form an intact tendon control group. A chronic 50% partial-thickness bursal-side tear model was created in 20 rabbits, and 5 rabbits were sacrificed for biomechanical testing of chronic partial-thickness tears (control group) without repair. In 15 rabbits, partial-thickness tears were repaired after 8 weeks. Partial-thickness tears in the right shoulders were completed to full thickness and repaired; in contrast, left shoulders were repaired in situ. All rabbits were euthanized 8 weeks after the repair. The tendons were tested biomechanically for ultimate failure, linear stiffness, and displacement. Histological evaluations of tendon-to-bone healing were performed via the modified Watkins score. Results: Macroscopically, all repaired tendons were attached to the greater tuberosity. The TCR group had a higher failure load than the ISR group, with mean values of 140.4 6 13.8 N and 108.1 6 16.6 N, respectively (P = .001). The modified Watkins score was significantly higher in the TCR group (23.5; range, 22-27) than in the ISR group (19.5; range, 16-22) (P = .009). Conclusion: Both repair techniques are effective for 50% partial-thickness bursal-side rotator cuff tears; however, TCR yields significantly superior biomechanical and histological characteristics compared with ISR. Clinical Relevance: Tear completion and repair technique may increase tendon-to-bone healing and thereby reduce re-rupture rate in the partial thickness bursal side rotator cuff tears.