TY - JOUR
AB - The inability to repair a rotator cuff tear is not uncommon, and in practices devoted to the management of shoulder injuries up to 30% of rotator cuff tears may be irreparable. The anterior and posterior components of the rotator cuff are the most important deficient areas. In the case of an irreparable subscapularis tendon tear, pain relief and stability appear to be reliably achieved by a split pectoralis major transfer; however, functional improvement is less certain because the biomechanics associated with this tendon transfer do not appear to be optimal. In the case of an irreparable posterosuperior rotator cuff tear, a latissimus dorsi tendon transfer reliably restores flexion and relieves pain; however, its use after failure of prior rotator cuff surgery makes the outcome less predictable. Both anterior and posterior reconstructions with tendon transfer require precise surgical technique and patient compliance with postoperative rehabilitation.
AU - Warner, J J
KW - Biomechanical Phenomena
KW - Humans
KW - Patient Selection
KW - Rotator Cuff
KW - Rotator Cuff Injuries
KW - Tendon Transfer
PY - 2001
SP - 63
EP - 71
TI - Management of massive irreparable rotator cuff tears: the role of tendon transfer.
T2 - Instructional course lectures
UR - http://www.ncbi.nlm.nih.gov/pubmed/11372361
VL - 50
ER -
TY - JOUR
AB - Suprascapular nerve blockade improves pain, range of motion, and disability in acute and chronic shoulder pain. Pain relief usually lasts several hours with local anesthetic. If steroids are added, the relief lasts several weeks. Since repetitive steroid exposure is associated with several hazards, alternative long-term therapies would be desirable. Pulsed mode radiofrequency is a non-destructive, safe, and repeatable long-term pain control therapy. We report a case, wherein a series of fluoroscopically guided, suprascapular nerve pulsed mode RF treatments were performed. Each provided 4-5 months of pain relief and improvement in shoulder function, without deterioration in muscle strength.
AU - Shah, Rinoo V.
AU - Racz, Gabor B.
IS - 4
KW - Radiofrequency
KW - Shoulder pain
KW - Suprascapular nerve block
PY - 2003
SP - 503
EP - 506
TI - Pulsed mode radiofrequency lesioning of the suprascapular nerve for the treatment of chronic shoulder pain
T2 - Pain Physician
VL - 6
ER -
TY - JOUR
AU - Holschen, Malte
AU - Brand, Florian
AU - Agneskirchner, Jens D.
DO - 10.1007/s11678-016-0386-9
IS - 1
KW - Acromion
KW - Arthroscopic surgery
KW - Cuff, rotator
KW - Debridement
KW - Shoulder
PY - 2017
SP - 38
EP - 45
TI - Implantation eines subakromialen Platzhalters bei Rotatorenmanschettenmassenruptur: Klinisches Ergebnis arthroskopisch versorgter Patienten
T2 - Obere Extremitat
VL - 12
ER -
TY - JOUR
AB - Purpose: There is ongoing debate regarding the optimal surgical treatment of irreparable rotator cuff tears (IRCT). This study aimed to assess within the Italian health care system the cost-effectiveness of subacromial spacer as a treatment modality for patients with IRCT. Methods: An expected-value decision analysis was created comparing costs and outcomes of patients undergoing arthroscopic subacromial spacer implantation, rotator cuff repair (RCR), total shoulder arthroplasty, and conservative treatment for IRCTs. A broad literature search provided input data to extrapolate and inform treatment success and failure rates, costs, and health utility states for these outcomes. The primary outcome assessed was an incremental cost-effectiveness ratio (ICER) of subacromial spacer implantation versus shoulder arthroplasty, RCR, and conservative treatment. Results: Subacromial spacer is favorable over both arthroscopic partial repair and shoulder arthroplasty since it costs less than both options and increases effectiveness by 0.06 and 0.10 quality-adjusted life years (QALYs), respectively. While conservative treatment is the least costly management strategy, subacromial spacer results in a gain of 0.05 QALYs for the additional cost of 522 €, resulting in an ICER of 10,440 €/QALY gain, which is below the standard willingness to pay ratio of $50,000 USD. Strategies with an ICER of less than 50,000 USD are considered to be cost-effective. Conclusions: Based on the available evidence and reasonably conservative assumptions, subacromial spacer is likely to provide a safe, effective, and cost-effective option for patients with massive IRCTs. Furthermore, this cost-effectiveness analysis may ultimately serve as a guide for development of health care system and insurer policy as well as clinical practice.
AU - Castagna, Alessandro
AU - Garofalo, Ruffaele
AU - Maman, Eran
AU - Gray, Alisha
AU - Brooks, Elizabeth
DO - 10.1007/s00264-018-4065-x LK - http://elinks.library.upenn.edu/sfx_local?sid=EMBASE&issn=14325195&id=doi:10.1007%2Fs00264-018-4065-x&atitle=Comparative+cost-effectiveness+analysis+of+the+subacromial+spacer+for+irreparable+and+massive+rotator+cuff+tears&stitle=Int.+Orthop.&title=International+Orthopaedics&volume=43&issue=2&spage=395&epage=403&aulast=Castagna&aufirst=Alessandro&auinit=A.&aufull=Castagna+A.&coden=IORTD&isbn=&pages=395-403&date=2019&auinit1=A&auinitm=
IS - 2
KW - Italy
KW - article
KW - comparative effectiveness
KW - conservative treatment
KW - cost effectiveness analysis
KW - health care system
KW - human
KW - intermethod comparison
KW - orthopedic surgical equipment
KW - outcome assessment
KW - priority journal
KW - quality adjusted life year
KW - rotator cuff rupture
KW - sensitivity analysis
KW - shoulder arthroplasty
KW - shoulder arthroscopy
KW - subacromial spacer
PB - International Orthopaedics
PY - 2019
SP - 395
EP - 403
TI - Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears
T2 - International Orthopaedics
UR - http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L623396634%0Ahttp://dx.doi.org/10.1007/s00264-018-4065-x
VL - 43
ER -
TY - JOUR
AB - Massive, irreparable rotator cuff tears are a source of pain and disability. Although most rotator cuff tears can be completely repaired, a significant number are considered massive and irreparable. Numerous operative techniques have been described for the treatment of these kinds of tears including arthroscopic debridement, biceps tenotomy, tendon transfer, grafting, and reverse arthroplasty. We describe a surgical technique using a biodegradable subacromial balloon spacer (InSpace; OrthoSpace, Kfar Saba, Israel) implanted between the humeral head and acromion that permits smooth, frictionless gliding, restoring the shoulder biomechanics. The technique is easy to perform and is less invasive than the conventional surgical techniques available, and it may potentially serve as a bridging option in patients with massive, irreparable tears who are normally candidates for reverse arthroplasty. © 2012 .
AU - Savarese, Eugenio
AU - Romeo, Rocco
DO - 10.1016/j.eats.2012.02.002
IS - 1
PB - Elsevier Masson SAS
PY - 2012
SP - 69
EP - 74
TI - New Solution for Massive, Irreparable Rotator Cuff Tears: The Subacromial "Biodegradable Spacer"
T2 - Arthroscopy Techniques
VL - 1
ER -
TY - JOUR
AB - Purpose: To compare the subacromial balloon spacer with superior capsular reconstruction (SCR) for the treatment of massive irreparable rotator cuff tears. Methods: Eight male cadaveric shoulders were mounted on a custom shoulder simulator that permitted quasistatic deltoid and rotator cuff muscle loading. Four shoulder conditions were tested: intact, irreparable rotator cuff tear (torn), subacromial balloon spacer, and SCR. The primary outcomes were superior humeral head migration and functional shoulder abduction force, which were measured at 0°, 30°, 60°, and 90° of shoulder abduction. Results: In comparison to the intact condition, the torn condition resulted in a significant increase in superior humeral head migration at 0° (P =.03) and 30° (P =.02) of abduction. Insertion of the subacromial balloon spacer restored the humeral head position such that it was not significantly different from the intact condition (P =.18). Similarly, SCR restored the humeral head position such that it was not significantly different from the intact condition (P =.99). No significant differences were found between the balloon and SCR (P =.99). The functional abduction force was significantly decreased after tear creation (P =.01); however, the subacromial balloon (P =.40) and SCR (P =.99) restored functional abduction force comparable to the intact shoulder state. Conclusions: On the basis of the results, both techniques function to decrease superior humeral head migration and to restore more normal glenohumeral joint position and forces during various abduction positions. No substantial differences were identified between techniques at time zero. Clinical Relevance: The results of this laboratory study indicate that the balloon and SCR both provided mechanical effects that restored the humeral head position from the superiorly migrated location. As such, similar clinical effects can be expected at time zero in patients with massive rotator cuff tears.
AU - Singh, Supriya
AU - Reeves, Jacob
AU - Langohr, G. Daniel G.
AU - Johnson, James A.
AU - Athwal, George S.
DO - 10.1016/j.arthro.2018.09.016
IS - 2
PB - Arthroscopy Association of North America
PY - 2019
SP - 382
EP - 389
TI - The Subacromial Balloon Spacer Versus Superior Capsular Reconstruction in the Treatment of Irreparable Rotator Cuff Tears: A Biomechanical Assessment
T2 - Arthroscopy - Journal of Arthroscopic and Related Surgery
UR - https://doi.org/10.1016/j.arthro.2018.09.016
VL - 35
ER -
TY - JOUR
AB - We have studied cellular and vascular changes in different stages of full thickness tears of the rotator cuff. We examined biopsies from the supraspinatus tendon in 40 patients with chronic rotator cuff tears who were undergoing surgery and compared them with biopsies from four uninjured subscapularis tendons. Morphological and immunocytochemical methods using monoclonal antibodies directed against leucocytes, macrophages, mast cells, proliferative and vascular markers were used. Histological changes indicative of repair and inflammation were most evident in small sized rotator cuff tears with increased fibroblast cellularity and intimal hyperplasia, together with increased expression of leucocyte and vascular markers. These reparative and inflammatory changes diminished as the size of the rotator cuff tear increased. Marked oedema and degeneration was seen in large and massive tears, which more often showed chondroid metaplasia and amyloid deposition. There was no association between the age of the patient and the duration of symptoms. In contrast, large and massive tears showed no increase in the number of inflammatory cells and blood vessels. Small sized rotator cuff tears retained the greatest potential to heal, showing increased fibroblast cellularity, blood vessel proliferation and the presence of a significant inflammatory component. Tissue from large and massive tears is of such a degenerative nature that it may be a significant cause of re-rupture after surgical repair and could make healing improbable in this group. (copyright) 2006 British Editorial Society of Bone and Joint Surgery.
AU - Matthews, Tim J.W.
AU - Hand, G. C.
AU - Rees, J. L.
AU - Athanasou, N. A.
AU - Carr, A. J.
DO - 10.1302/0301-620X.88B4.16845
IS - 4
PY - 2006
SP - 489
EP - 495
TI - Pathology of the torn rotator cuff tendon
T2 - Journal of Bone and Joint Surgery - Series B
VL - 88
ER -
TY - JOUR
AB - Background Lesions of the long head of the biceps (LHB) tendon are frequently associated with massive rotator cuff tears (RCT) and may be responsible for shoulder pain and disability. Objective This study aimed to evaluate functional outcomes of arthroscopic biodegradable spacer implantation with or without biceps tenotomy as treatment for persistent shoulder dysfunction and pain due to a massive irreparable RCT. Methods A total of 48 patients were implanted with the subacromial spacer using arthroscopic approach with or without biceps tenotomy. All patients were assessed for up to 12 months post-implantation and 18 patients were assessed for at least 24 months (and a maximum of 40 months). Improvement in shoulder function was assessed using Constant score. Results Subacromial spacer implantation was performed arthroscopically in 48 patients. The mean total Constant score increased from 36 at baseline to 67 points at 12 months post implantation. Patients who underwent LHB tenotomy in addition to the subacromial spacer presented similar improvement of their shoulder function and score compared to the group that was treated with the spacer alone. Conclusion Current study demonstrates that spacer implantation in this patient population provides significant improvement in function and decreases the pain. Additional LHB tenotomy did not influence the postoperative results during the follow-up.
AU - Maman, Eran
AU - Safran, Ori
AU - Beyth, Shaul
AU - Mozes, Gavriel
AU - Dekel, Assaf
AU - Michael, Bernstein
AU - Chechik, Ofir
AU - Adar, Eliyahu
DO - 10.2174/1874325001711011577
IS - 1
PY - 2018
SP - 1577
EP - 1584
TI - Biceps Tenotomy Does not Affect the Functional Outcomes of Patients Treated with Spacer Implantation Due to Massive Irreparable Rotator Cuff Tears
T2 - The Open Orthopaedics Journal
VL - 11
ER -
TY - JOUR
AB - Purpose This study aimed to compare the arthroscopic patch graft procedure and partial repair for irreparable large or massive rotator cuff tears (RCTs) in shoulders with low-grade fatty degeneration of the infraspinatus (stage 1 or 2 according to Goutallier et al.) in terms of the functional and structural outcomes. Methods This study included 24 patients who underwent the patch graft procedure (group A) and 24 patients who underwent partial repair (group B) for irreparable large or massive RCTs. Clinical outcomes were evaluated at a mean of 35.5 months postoperatively in group A and 35.7 months in group B. Results The clinical findings were significantly improved at the final follow-up in both groups (P <.001). A significant difference was found between groups A and B in terms of postoperative Constant and American Shoulder and Elbow Surgeons scores (P =.001 and P =.021, respectively). There was a significant difference in the retear rate for the infraspinatus tendon (ISP) between the 2 groups (2 patients [8.3%] in group A v 10 patients [41.7%] in group B, P =.015). At the final follow-up, there was a significant difference in the affected side-versus-unaffected side muscle strength ratios for abduction and external rotation between group A and group B (P <.001 for both). Shoulders with retears of the ISP showed significantly inferior clinical outcomes compared with those without retears (P <.001). Conclusions In arthroscopic surgery for irreparable large or massive RCTs with low-grade fatty degeneration of the infraspinatus, the patch graft procedure showed an 8.3% retear rate for the repaired ISP with both improved clinical scores and recovery of muscle strength, whereas the partial repair had a retear rate of 41.7% (P =.015). Level of Evidence Level Cyrillic capital letter sha, retrospective comparative study. © 2013 by the Arthroscopy Association of North America.
AU - Mori, Daisuke
AU - Funakoshi, Noboru
AU - Yamashita, Fumiharu
DO - 10.1016/j.arthro.2013.08.032
IS - 12
PB - Arthroscopy Association of North America
PY - 2013
SP - 1911
EP - 1921
TI - Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus: Patch autograft procedure versus partial repair procedure
T2 - Arthroscopy - Journal of Arthroscopic and Related Surgery
UR - http://dx.doi.org/10.1016/j.arthro.2013.08.032
VL - 29
ER -
TY - JOUR
AB - Journal of Shoulder and Elbow Surgery, 20 (2011) 20-29. doi:10.1016/j.jse.2010.11.028
AU - Gerber, Christian
AU - Wirth, Stephan H.
AU - Farshad, Mazda
DO - 10.1016/j.jse.2010.11.028
IS - 2 Suppl
PB - Journal of Shoulder and Elbow Surgery Board of Trustees
PY - 2011
SP - S20
EP - S29
TI - Treatment options for massive rotator cuff tears.
T2 - Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
UR - http://dx.doi.org/10.1016/j.jse.2010.11.028
VL - 20
ER -
TY - JOUR
AB - BACKGROUND The management of massive, irreparable rotator cuff tears (RCT) is challenging and associated with high failure rates. There are no current consensus or definitive guidelines concerning the optimal surgical treatment for this devastating condition. This study was designed to confirm the long-term safety and efficacy of the biodegradable inflatable InSpace™ system in patients with massive reparable or irreparable RCTs. METHODS In this open-label, single arm, prospective study, subjects with massive RCT underwent subacromial implantation with the biodegradable spacer. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Total Constant Score (TCS). RESULTS Twenty-four patients were treated and assessed. Four patients had partial tears, and in three of them RC repair was performed. These patients were not included in the efficacy analyses. Of the participating subjects who reached the 5-year follow-up, 84.6% of the patients showed a clinically significant improvement of at least 15 points in their score, while 61.54% showed at least 25 points of improvement. Only 10% of the treated patients showed no improvement or worsening in the shoulder score comparing to their baseline. An overall improvement in the total CS commencing at 3 months and sustained by 6 months through to 5 years of follow-up (P < 0.0001) was demonstrated. CONCLUSIONS We conclude that in this initial cohort, arthroscopic implantation of InSpace™ system represented an effective alternative to the existing arthroscopic procedures in patients with painful massive RCT refractory to conservative management. Further randomized controlled trials comparing the clinical and functional outcomes after implantation of the InSpace™ device are warranted.
AU - Senekovic, Vladimir
AU - Poberaj, Boris
AU - Kovacic, Ladislav
AU - Mikek, Martin
AU - Adar, Eliyahu
AU - Markovitz, Elana
AU - Maman, Eran
AU - Dekel, Assaf
DO - 10.1007/s00402-016-2603-9
IS - 1
KW - Baloon
KW - Functional scores
KW - Inspace
KW - Massive rotator cuff tears
PB - Springer Berlin Heidelberg
PY - 2017
SP - 95
EP - 103
TI - The biodegradable spacer as a novel treatment modality for massive rotator cuff tears: a prospective study with 5-year follow-up
T2 - Archives of Orthopaedic and Trauma Surgery
VL - 137
ER -
TY - JOUR
AB - This prospective study evaluates the results of a procedure for massive rotator cuff tears that we term reversed arthroscopic subacromial decompression (ASD). The procedure includes an arthroscopic debridement of the subacromial space and glenohumeral joint, an arthroscopic tuberoplasty, and depending on the pathologic condition of the long head of the biceps, a biceps tendon tenotomy. Reversed ASD avoids a classic acromioplasty in order to preserve the integrity of the coracoacromial arch. Twenty-three patients with a mean age of 69 years underwent this procedure. After a mean follow-up of 40 months, the age-adjusted Constant score increased significantly, from 65.9% to 90.6% (P < .001), with 14 excellent, 5 good, 2 satisfactory, and 1 poor result. Preexisting osteoarthritic changes increased significantly but had no impact on the final clinical results. The acromiohumeral distance decreased from 5.1 to 4.5 mm (P = .004). There were no complications directly related to the surgical procedure. When compared with classic ASD studies for massive rotator cuff tears, we obtained similar midterm results with regard to pain relief, functional recovery, and patient satisfaction. We, therefore, conclude that reversed ASD with tenotomy of the long head of the biceps tendon offers a less invasive treatment strategy for massive rotator cuff tears while preserving the integrity of the coracoacromial arch.
AU - Scheibel, Markus
AU - Lichtenberg, Sven
AU - Habermeyer, Peter
DO - 10.1016/j.jse.2004.01.007
IS - 3
PY - 2004
SP - 272
EP - 278
TI - Reversed arthroscopic subacromial decompression for massive rotator cuff tears
T2 - Journal of Shoulder and Elbow Surgery
VL - 13
ER -
TY - JOUR
AB - Aim: The objective of this prospective non-randomized study was to establish the role of biodegradable sub-acromial spacer (InSpace™) insertion in the management of patients with massive irreparable rotator cuff tear by reporting beneficial effects on the pain relief and functional outcomes in these patients. Methods: This is a prospective non-randomized study of patients treated for irreparable cuff tears during a period between January 2014 and November 2016.14 patients with symptomatic massive irreparable rotator cuff tears were managed with arthroscopic debridement and implantation of a biodegradable subacromial spacer and were followed up for at least one year (8–16 m). Inclusion criteria were patients with irreparable rotator cuff tears that failed the conservative management, with muscle retraction (Patte > stage 2), muscle atrophy, and fatty infiltration (Goutalier type 3). Patients with osteoarthritis grade 3 in the Hamada classification and/or without preserved passive motion were excluded from our study. Outcome measures included pre and postoperative, the range of motion, Constant and Oxford shoulder scores. The decision to perform surgery was made after failure of nonoperative treatment and rehabilitation (massive rotator cuff tear protocol, reading shoulder unit)for at least six months. Results: Fourteen shoulders (14 patients, ten male four female) met the inclusion criteria. The mean age of patients was 76.2 (70–85) years. During the last follow-up (8–16 months mean 12.6 months), the range of motion was significantly increased in all patients with anterior elevation (from 80 to 105°), abduction (from 70 to 110°), and external rotation (from 25 to 35°). The mean Constant score was also significantly (P < 0.001) improved from 22.5 (13–33) preoperatively to 51.4 (30–64) at the last follow-up. The Oxford shoulder score improved from 26 preoperatively (21–28) to 48.2 postoperatively (34–56). No night pain following surgery and ADL increased by 40%, which is significant in these patients. No significant perioperative complications were found except for one patient who had a spacer migration. However, no action was required in that case. Conclusions: Arthroscopic implantation of a subacromial spacer for irreparable rotator cuff tear resulted in a noticeable improvement in pain relief and shoulder function at a mean 12.6 months follow up. It is a quick, safe and a minimally invasive procedure that is suitable for elderly patients with irreparable cuff tears and medical co-morbidities.
AU - Yallapragada, Rahi Kiran
AU - Apostolopoulos, Alex
AU - Katsougrakis, I.
AU - Selvan, T. P.
DO - 10.1016/j.jor.2018.08.004
IS - 3
KW - Balloon
KW - Inspace
KW - Irreparable cuff tear
KW - Shoulder arthroscopy
KW - Subacromial space
PB - Elsevier
PY - 2018
SP - 862
EP - 868
TI - The use of a subacromial spacer-inspace balloon in managing patients with irreparable rotator cuff tears
T2 - Journal of Orthopaedics
UR - https://doi.org/10.1016/j.jor.2018.08.004
VL - 15
ER -
TY - JOUR
AB - It is difficult to determine the size and localization of rotator cuff tears preoperatively. But with the special arthrographic technique, a diagnosis with about 80% accuracy was possible in 65 surgically confirmed rotator cuff tears. With this technique, 22 massive cuff tears were found in conservatively treated patients. In these patients, the plain roentgenograms obtained at the initial examination were also analyzed. The roentgenographic findings included narrowing of the acromiohumeral interval and degenerative changes of the humeral head, the tuberosities, the acromion, the acromioclavicular joint, and the glenohumeral joint. Based om these data, five roentgenographic grades of massive cuff tears were identified. Of seven patients with massive tears, which had been treated conservatively and followed for more than eight years, the roentgenographic grades advanced in five. One shoulder progressed to cuff-tear arthropathy. Based on these observations, it is proposed that the following pathogenetic mechanisms are responsible for the progressive roentgenographic changes: (1) arm elevation in activities of daily living, (2) rupture of the long head of biceps tendon, (3) the abnormal fulcrum of the humeral head against the acromion and the coracoacromial ligament, and (4) the weakness of external rotation. A massive cuff tear will progress to cuff-tear arthropathy, with each step of progression accompanied by characteristic roentgenographic changes.
AU - Hamada, Kazutoshi
AU - Fukuda, Hiroaki
AU - Mikasa, Motohiko
AU - Kobayashi, Yoshinori
IS - 254
KW - *classification
KW - *radiology
KW - *rotator cuff rupture/di [Diagnosis]
KW - *shoulder
KW - conference paper
KW - human
KW - major clinical study
KW - methodology
KW - priority journal
PY - 1990
SN - 0009-921X
SP - 92
EP - 96
TI - Roentgenographic findings in massive rotator cuff tears. A long-term observation
T2 - Clinical Orthopaedics and Related Research
UR - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed2&NEWS=N&AN=1990146234
ER -
TY - JOUR
AB - Rotator cuff tears affect 40% or more of those aged older than 60 years, and repair failure rates of 20% to 70% remain a significant clinical challenge. Hence, there is a need for repair strategies that can augment the repair by mechanically reinforcing it, while at the same time biologically enhancing the intrinsic healing potential of the tendon. Tissue engineering strategies to improve rotator cuff repair healing include the use of scaffolds, growth factors, and cell seeding, or a combination of these approaches. Currently, scaffolds derived from mammalian extracellular matrix, synthetic polymers, and a combination thereof, have been cleared by the U.S. Food and Drug Administration and are marketed as medical devices for rotator cuff repair in humans. Despite the growing clinical use of scaffold devices for rotator cuff repair, there are numerous questions related to their indication, surgical application, safety, mechanism of action, and efficacy that remain to be clarified or addressed. This article reviews the current basic science and clinical understanding of commercially available synthetic and extracellular matrix scaffolds for rotator cuff repair. Our review will emphasize the host response and scaffold remodeling, mechanical and suture-retention properties, and preclinical and clinical studies on the use of these scaffolds for rotator cuff repair. We will discuss the implications of these data on the future directions for use of these scaffolds in tendon repair procedures. © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.
AU - Ricchetti, Eric T.
AU - Aurora, Amit
AU - Iannotti, Joseph P.
AU - Derwin, Kathleen A.
DO - 10.1016/j.jse.2011.10.003
IS - 2
KW - ECM scaffold
KW - Review Article
KW - Rotator cuff repair
KW - Rotator cuff repair augmentation
KW - Scaffold device
KW - Synthetic scaffold
PB - Elsevier Ltd
PY - 2012
SP - 251
EP - 265
TI - Scaffold devices for rotator cuff repair
T2 - Journal of Shoulder and Elbow Surgery
UR - http://dx.doi.org/10.1016/j.jse.2011.10.003
VL - 21
ER -
TY - JOUR
AB - BACKGROUND: There have been many clinical reports of patch graft surgery for irreparable rotator cuff tears. However, the retear rate of the patch graft is relatively high because of the lack of superior stability, causing subacromial abrasions.\n\nPURPOSE: To compare superior stability among 3 types of patch grafting for simulated irreparable rotator cuff tears.\n\nSTUDY DESIGN: Controlled laboratory study.\n\nMETHODS: Eight cadaveric shoulders were tested in a custom shoulder testing system. Superior translation of the humerus, subacromial contact pressure, and glenohumeral joint force were quantified in the following 5 conditions: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the patch graft to reconstruct the supraspinatus tendon, (4) after the patch graft to reconstruct the superior capsule, and (5) after the patch graft to reconstruct both the supraspinatus tendon and superior capsule. While the graft was sutured to the torn tendon in condition 3, the graft was attached to the superior glenoid in condition 4.\n\nRESULTS: Compared with values for intact rotator cuffs, cutting the supraspinatus tendon significantly increased superior translation (P < .05), significantly increased subacromial contact pressure (P < .05), and significantly decreased glenohumeral compression force (P < .05). Superior translation was restored partially after the supraspinatus tendon patch graft and restored fully after the superior capsule patch graft and after both patch grafts. All patch grafts fully restored the subacromial contact pressure (P < .05) but did not alter the glenohumeral joint force.\n\nCONCLUSION: When patch graft surgery is chosen for irreparable rotator cuff tears, the graft should be attached medially to the superior glenoid and laterally to the greater tuberosity to restore superior stability of the humeral head.\n\nCLINICAL RELEVANCE: The superior capsule patch graft completely restored superior stability of the glenohumeral joint, while patch grafting to the supraspinatus tendon partially restored superior translation.
AU - Mihata, Teruhisa
AU - McGarry, Michelle H.
AU - Pirolo, Joseph M.
AU - Kinoshita, Mitsuo
AU - Lee, Thay Q.
DO - 10.1177/0363546512456195
IS - 10
KW - biomechanics
KW - irreparable
KW - patch graft
KW - rotator cuff
KW - superior capsule
PY - 2012
SP - 2248
EP - 2255
TI - Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: A biomechanical cadaveric study
T2 - American Journal of Sports Medicine
VL - 40
ER -
TY - JOUR
AB - Objective: To determine the Quality of Life Related to Health and its related factors in patients diagnosed with rotator cuff lesions in the Municipality of Pereira, Colombia, 2013. Methods: Cross‐sectional study. Simple random sampling of 239 patients over 18 years of age attended at five health care institutions in the urban area of Pereira. Sociodemographic, biological, clinical and self‐perception aspects of the disability were collected regarding the quality of life related to health. Use of measures of frequency, chi‐square and logistic regression for analysis. Results: 72% (173) reported poor Quality of Life Related to Health in the physical health status component and 60% (144) in the mental health status component. Factors associated with poor Quality of Life Related to Health according to physical health status were: schooling, having caregiver, and shoulder disability in manual activities, daily activities and pain and physical limitation. While the factors associated with poor Quality of Life Related to Health in mental health status components were: schooling, having caregiver and shoulder disability due to pain and physical limitation. The greater the perception of shoulder disability, the worse the perception of health status. Conclusion: The introduction of psychometric measures for the evaluation of the health status of patients with shoulder injuries contributes to a treatment adjusted to individual requirements and daily activities of the patient.
AU - Rincón‐Hurtado, Ángela Maria
AU - Rocha‐Buelvas, Anderson
AU - López‐Cardona, Alejandro
AU - Martínez, José William
DO - 10.1016/j.rbo.2017.05.020
IS - 3
KW - Colombia
KW - Musculoskeletal system
KW - Quality of life
KW - Rotator cuff
KW - Shoulder
KW - Shoulder pain
PB - Sociedade Brasileira de Ortopedia e Traumatologia
PY - 2018
SP - 364
EP - 372
TI - Health‐related quality of life of patients with rotator cuff injuries, Cofee Triangle, Colombia, 2013
T2 - Revista Brasileira de Ortopedia
UR - https://doi.org/10.1016/j.rboe.2018.03.018
VL - 53
ER -
TY - JOUR
AB - History Infiltration of the rotator cuff musculature with fatty tissue is a well-known feature of tears in the rotator cuff tendon. In a rabbit model, sectioning of the supraspinatus tendon resulted in increased adipose tissue in the muscle belly on histologic examination after 4 weeks [2]. The following year, Goutallier et al. [12] reported results of CT scans of the shoulder in patients undergoing repair of the rotator cuff. The injured shoulders showed greater fatty infiltration than normal, asymptomatic shoulders, which the authors classified in a spectrum of five stages [13]. With the advent of MRI to evaluate the rotator cuff, Fuchs et al. [7] compared CT and MRI assessment of fatty infiltra-tion. Although interobserver agreement was good to excellent between musculoskeletal radiologists for CT and MRI eval-uation individually, the correlation between CT and MRI grading of infiltration was only moderate. Fuchs et al. [7] attributed this to the improved ability of MRI to distinguish between healthy muscle and fibrous tissue. Despite imperfect correlation with CT, the adaptation by Fuchs et al. for MRI is widely used [8, 10, 11] owing to the shift to MRI as the pre-dominant imaging study for rotator cuff injuries. Purpose The Goutallier classification serves primarily as a prog-nostic tool, which may help clinicians anticipate the potential benefits of various interventions. Fatty infiltration has been shown to be a poor prognostic factor for repair of the cuff tendons [4–6, 10, 14–17, 30]. Goutallier et al. [15] reported functional Constant and Murley score and radio-graphic (MRI and/or CT scans) outcomes for 220 shoulders undergoing rotator cuff repair; the rate of recurrent tear was greater in patients with fatty infiltration of the muscle. A longer-term study by Goutallier et al. [17] showed a strong correlation between the Constant and Murley score (a functional outcome score for the shoulder) at latest fol-lowup and preoperative fatty infiltration. In another study [10], preoperative fatty infiltration and muscle atrophy were found to be independent predictors for final American Shoulder and Elbow Surgeons and Constant and Murley scores after rotator cuff repair. Interestingly, fatty infiltra-tion was a better predictor of outcome than either tear size or recurrence in that series. A meta-analysis investigating outcomes of rotator cuff repair showed a strong correlation between fatty infiltration and rate of retear, but available published data were too heterogeneous to determine whether clinical outcomes were affected [24]. Owing to its prognostic importance, surgeons have used the Goutallier classification to guide treatment options for rotator cuff tears [1]. The classification also has been used to define conditions for inclusion or exclusion in studies [3]. In addition,
AU - Somerson, Jeremy S.
AU - Hsu, Jason E.
AU - Gorbaty, Jacob D.
AU - Gee, Albert O.
DO - 10.1007/s11999-015-4630-1
IS - 5
PB - Springer US
PY - 2016
SP - 1328
EP - 1332
TI - Classifications in Brief: Goutallier Classification of Fatty Infiltration of the Rotator Cuff Musculature
T2 - Clinical Orthopaedics and Related Research
VL - 474
ER -
TY - JOUR
AB - Background: The number of systematic reviews and meta-analyses published on the rotator cuff (RC) has increased markedly. Purpose: To quantify the number of systematic reviews and meta-analyses published on the RC and to provide a qualitative summary of the literature. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search for all systematic reviews and meta-analyses pertaining to the RC published between January 2007 and September 2017 was performed with PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews. Narrative reviews and non–English language articles were excluded. Results: A total of 1078 articles were found, of which 196 met the inclusion criteria. Included articles were summarized and divided into 15 topics: anatomy and function, histology and genetics, diagnosis, epidemiology, athletes, nonoperative versus operative treatment, surgical repair methods, concomitant conditions and surgical procedures, RC tears after total shoulder arthroplasty, biological augmentation, postoperative rehabilitation, outcomes and complications, patient-reported outcome measures, cost-effectiveness of RC repair, and quality of randomized controlled trials. Conclusion: A qualitative summary of the systematic reviews and meta-analyses published on the RC can provide surgeons with a single source of the most current literature.
AU - Jancuska, Jeffrey
AU - Matthews, John
AU - Miller, Tyler
AU - Kluczynski, Melissa A.
AU - Bisson, Leslie J.
DO - 10.1177/2325967118797891
IS - 9
KW - meta-analysis
KW - repair
KW - rotator cuff
KW - systematic review
PY - 2018
SP - 1
EP - 21
TI - A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff
T2 - Orthopaedic Journal of Sports Medicine
VL - 6
ER -
TY - JOUR
AB - Cytogenetic findings contribute not only to a detailed classification of malignant lymphomas, but also to better prediction of prognosis. Therefore cytogenetic findings gain increasing importance in lymphoma diagnosis. Here, the characteristic chromosome abnormalities t(8;14)(q24;q32), t(2;8)(p12;q24), t(8;22)(q24;q11), t(14;18)(q32;q21), t(11;14)(q13;q32), + 12, + 3 and t(2;5)(p23;q35) and their molecular consequences are described.
AU - Mitchell, Caroline
AU - Adebajo, Ade
AU - Hay, Elaine
AU - Carr, Andrew
DO - 10.1136/bmj.331.7525.1124
IS - 7525
PY - 2005
SP - 1124
EP - 1128
TI - Shoulder pain: Diagnosis and management in primary care
T2 - British Medical Journal
VL - 331
ER -
TY - JOUR
AB - Despite the popularity of surgical repair of rotator cuff tears, literature regarding the indications for and timing of surgery are sparse. We performed a systematic review of the literature to investigate factors influencing the decision to surgically repair symptomatic, full-thickness rotator cuff tears. Specifically, how do demographic variables, duration of symptoms, timing of surgery, physical examination findings, and size of tear affect treatment outcome and indications for surgery? We reviewed the best available evidence, which offers some guidelines for surgical decision making. Variables suggest earlier surgical intervention may be needed in the setting of weakness and substantial functional disability. With regard to demographic variables, the evidence is unclear regarding their association with treatment outcome. However, older chronological age does not seem to portend a worse outcome. Pending worker's compensation claims does seem to negatively affect treatment results. Further research is required to define the indications for surgery for full thickness rotator cuff tears. However, the design and conduct of an ethical study to obtain Level I evidence on this issue will be a major challenge.
AU - Oh, Luke S
AU - Wolf, Brian R
AU - Hall, Michael P
AU - Levy, Bruce A
AU - Marx, Robert G
DA - 2007/2//
DO - 10.1097/BLO.0b013e31802fc175
KW - Age Factors
KW - Female
KW - Humans
KW - Male
KW - Prognosis
KW - Range of Motion, Articular
KW - Rotator Cuff
KW - Rotator Cuff Injuries
KW - Rupture
KW - Sex Factors
KW - Shoulder Joint
KW - Time Factors
KW - Treatment Outcome
KW - Workers' Compensation
KW - physiopathology
KW - surgery
PY - 2007
SP - 52
EP - 63
TI - Indications for rotator cuff repair: a systematic review.
T2 - Clinical orthopaedics and related research
VL - 455
ER -
TY - JOUR
AB - BACKGROUND: Whereas physical examination tests for shoulder disorders have numeric values that describe the utility of the test and its effect on the probability of having a diagnosis, this information is lacking for elements of the history. The purpose of this study was to conduct a systematic review of the literature to determine numeric data (sensitivity, specificity, predictive values, and likelihood or odds ratios) for elements of the history with regard to diagnoses in patients with chronic atraumatic shoulder pain. METHODS: We performed a systematic review to extract information from the existing literature regarding the numeric utility of different features of the patient history as they pertain to chronic atraumatic shoulder pain. Data sources were MEDLINE through PubMed (1946-January 2012) and EMBASE through Ovid (1980-January 2012). RESULTS: Twenty-one studies met inclusion criteria. A diagnosis of rotator cuff tear was more likely with a history of hypercholesterolemia, having a relative with rotator cuff disease, excessive lifting, above-shoulder work, hand-held vibration work, or age older than 60 years. Acromioclavicular arthritis was more likely in weightlifters. Glenohumeral arthritis was more likely if the patient has a history of prior dislocation, age >75 years, or a diagnosis of knee osteoarthritis. Adhesive capsulitis was more likely with a history of diabetes or thyroid disorder. Posterior labral tear was more likely in football players. CONCLUSIONS: The numeric values for the utility of these history features will help establish numeric probabilities for diagnoses in patients with shoulder pain.
AU - Raynor, Martin B
AU - Kuhn, John E
DA - 2016/4//
DO - 10.1016/j.jse.2015.09.023
IS - 4
KW - Humans
KW - Joint Diseases
KW - Medical History Taking
KW - Physical Examination
KW - Shoulder Joint
KW - Shoulder Pain
KW - complications
KW - diagnosis
KW - etiology
PY - 2016
SP - 688
EP - 694
TI - Utility of features of the patient's history in the diagnosis of atraumatic shoulder pain: a systematic review.
T2 - Journal of shoulder and elbow surgery
VL - 25
ER -
TY - JOUR
AB - PURPOSE: To evaluate the clinical and radiographic outcome of a biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tear. METHODS: Between January 2011 and December 2014, all shoulders with symptomatic massive irreparable rotator cuff tears treated at our institution with arthroscopic implantation of a biodegradable subacromial spacer followed for at least 1 year were included in our series. Patients with osteoarthritis >/= grade 3 in the Hamada classification were excluded. Outcome measures included pre- and postoperative, range of motion, Constant score, acromiohumeral distance, and Hamada classification on anteroposterior and lateral radiographs. RESULTS: Thirty-nine consecutive shoulders (37 patients) met the inclusion criteria. The mean age of patients was 69.8 (53-84) years. At the last follow-up (mean 32.8 +/- 12.4 months), range of motion was significantly increased for all patients in anterior elevation (from 130 degrees to 160 degrees , P = .02), abduction (from 100 degrees to 160 degrees , P = .01), and external rotation (from 30 degrees to 45 degrees , P = .0001). The mean Constant score was also significantly (P < .001) improved from 44.8 (+/-15.2) preoperatively to 76.0 (+/-17.1) at the last follow-up. The mean acromiohumeral distance significantly (P = .002) decreased from 8.2 mm (+/-3.4) to 6.2 mm (+/-3.1) at the last follow-up. The Hamada score progressed of 1 radiographic stage in 4 shoulders (15%) and progressed of 3 stages in 2 (4%), whereas the other 32 shoulders remained stable. No intra- or postoperative complications were found except for 1 patient who required a revision for spacer migration. CONCLUSIONS: Arthroscopic implantation of a subacromial spacer for irreparable rotator cuff tear leads to significant improvement in shoulder function at a minimum of 1 year postoperatively. LEVEL OF EVIDENCE: Level IV, therapeutic case series; treatment study.
AU - Deranlot, Julien
AU - Herisson, Olivier
AU - Nourissat, Geoffroy
AU - Zbili, David
AU - Werthel, Jean David
AU - Vigan, Marie
AU - Bruchou, Francois
DA - 2017/9//
DO - 10.1016/j.arthro.2017.03.029
IS - 9
KW - Absorbable Implants
KW - Aged
KW - Aged, 80 and over
KW - Arthroscopy
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Radiography
KW - Range of Motion, Articular
KW - Retrospective Studies
KW - Rotation
KW - Rotator Cuff
KW - Rotator Cuff Injuries
KW - Shoulder Joint
KW - Shoulder Pain
KW - Treatment Outcome
KW - diagnostic imaging
KW - methods
KW - physiopathology
KW - surgery
PY - 2017
SP - 1639
EP - 1644
TI - Arthroscopic Subacromial Spacer Implantation in Patients With Massive Irreparable Rotator Cuff Tears: Clinical and Radiographic Results of 39 Retrospectives Cases.
T2 - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
VL - 33
ER -
TY - JOUR
AB - The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), patient self-report section. Patients with shoulder dysfunction (n = 63) completed the ASES, The University of Pennsylvania Shoulder Score, and the Short Form-36 during the initial evaluation, 24 to 72 hours after the initial visit, and after 3 to 4 weeks of physical therapy. The test-retest reliability (intraclass correlation coefficient[1-way random-effects], 0.84; 95% CI lower limit, 0.75) and internal consistency (Cronbach alpha, 0.86) values were acceptable. The standard error of the measure was 6.7 ASES points (90% CI, 11.0). Construct and discriminant validity was demonstrated. Responsiveness was demonstrated with a standardized response mean of 1.5 and an effect size of 1.4. The minimal detectable change was 9.7 ASES points (90% CI, 16), and the minimal clinically important difference was 6.4 ASES points. The results indicate that the ASES is a reliable, valid, and responsive outcome tool.
AU - Michener, Lori A
AU - McClure, Philip W
AU - Sennett, Brian J
DO - 10.1067/mse.2002.127096
IS - 6
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Cohort Studies
KW - Data Collection
KW - Female
KW - Health Status Indicators
KW - Humans
KW - Male
KW - Middle Aged
KW - Orthopedics
KW - Pain Measurement
KW - Patient Participation
KW - Physical Therapy Modalities
KW - Range of Motion, Articular
KW - Reproducibility of Results
KW - Self-Assessment
KW - Sensitivity and Specificity
KW - Shoulder Pain
KW - Societies, Medical
KW - Surveys and Questionnaires
KW - Treatment Outcome
KW - methods
KW - physiology
KW - physiopathology
KW - rehabilitation
KW - standards
PY - 2002
SP - 587
EP - 594
TI - American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness.
T2 - Journal of shoulder and elbow surgery
VL - 11
ER -
TY - JOUR
AB - Purpose: To evaluate the 2-year results of an absorbable subacromial spacer in patients with irreparable posterosuperior rotator cuff tears. Methods: Prospective longitudinal study of a consecutive case series of 16 subjects with irreparable tears of the posterosuperior rotator cuff in which the InSpace® subacromial spacer was arthroscopically implanted. A full clinical evaluation that included the Constant test, Simple Shoulder Test (SST) and the QuickDash questionnaire was performed preoperatively and at 12 and 24 months follow-up. The primary outcome for assessing the success of the procedure was a variable composed of a clinically relevant variation of the Constant (established in an improvement greater than 10 points) and the absence of surgical reintervention. Results: Fifteen subjects (11 women/4 men, median age = 69.4 years [interquartile range 7.50], range 60–80 years) completed the 2-year of follow-up. According to the main evaluation criteria, only 6 patients (40%) had a successful outcome. Five subjects required reconversion to a reverse shoulder arthroplasty (at a median of 9.8 months postoperatively) due to absence of clinical improvement or worsening of symptoms. Of the ten remaining subjects, only 6 had improvements greater than 10 points in the Constant score. Despite of this, these 10 subjects had, on average, some improvement in the Constant test (preoperative Constant: median 35.0 [27.0–52.5] vs Constant at 24 months: 53.5 [55.0–84.0], significant differences p = 0.02), in the SST (3.0 [2.0–4.0] vs 6.0 [3.25–7.75], p = 0.039) and in the QuickDASH test (37.0 [33.25–40.0] vs 27.5 [20.5–32.75], p = 0.012). Conclusions: The outcomes of the implantation of the subacromial biodegradable spacer at 2-year follow-up are not satisfactory. In this small case series only 40% of patients seem to clearly benefit from surgery. One in three required revision to a reverse shoulder arthroplasty. The described technique does not seem a reasonable alternative for the management of the majority of patients with irreparable ruptures of the rotator cuff. The indications of this device should be more clearly defined. Level of evidence: IV.
AU - Ruiz Ibán, Miguel Angel
AU - Lorente Moreno, Rafael
AU - Ruiz Díaz, Raquel
AU - Álvarez Sciamanna, Roselyn
AU - Paniagua Gonzalez, Andrea
AU - Lorente Gómez, Alejandro
AU - Díaz Heredia, Jorge
DA - 2018/12//
DO - 10.1007/s00167-018-5083-3
IS - 12
KW - Irreparable cuff tear
KW - Massive rotator cuff tear
KW - Shoulder
KW - Subacromial spacer
PB - Springer Verlag
PY - 2018
SP - 3848
EP - 3854
TI - The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results
T2 - Knee Surgery, Sports Traumatology, Arthroscopy
VL - 26
ER -
TY - JOUR
AB - Summary
Background
New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears.
Methods
We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590.
Findings
Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design –4·2 [95% CI –8·2 to –0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups.
Interpretation
In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears.
Funding
Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership
AU - Metcalfe, Andrew
AU - Parsons, Helen
AU - Parsons, Nicholas
AU - Brown, Jaclyn
AU - Fox, Josephine
AU - Gemperlé Mannion, Elke
AU - Haque, Aminul
AU - Hutchinson, Charles
AU - Kearney, Rebecca
AU - Khan, Iftekhar
AU - Lawrence, Tom
AU - Mason, James
AU - Stallard, Nigel
AU - Underwood, Martin
AU - Drew, Stephen
AU - Metcalfe, Andrew
AU - Parsons, Helen
AU - Parsons, Nicholas
AU - Arif, Azra
AU - Arnold, Susanne
AU - Bhabra, Gev
AU - Brown, Jaclyn
AU - Bora, Sunayna
AU - Bush, Howard
AU - Drew, Stephen
AU - Fox, Jo
AU - Gemperlé Mannion, Elke
AU - Haque, Aminul
AU - Hutchinson, Charles
AU - Jones, Ceri
AU - Kearney, Rebecca
AU - Khan, Iftekhar
AU - Lawrence, Thomas
AU - Mason, James
AU - McGowan, Kerri
AU - Modi, Chetan
AU - Rahman, Bushra
AU - Rahman, Usama
AU - Ramirez, Maria
AU - Spocinska, Marta
AU - Stallard, Nigel
AU - Teuke, Joanna
AU - Thayalan, Varjithan
AU - Ul-Rahman, Sumayyah
AU - Viswanath, Aparna
AU - Underwood, Martin
AU - Haque, Aminul
AU - Khan, Iftekhar
AU - Mason, James
AU - Parsons, Helen
AU - Parsons, Nicholas
AU - Stallard, Nigel
AU - Packham, Iain
AU - Barnett, Elizabeth
AU - Witham, Rian
AU - Crowther, Mark
AU - Murphy, Richard
AU - Coates, Katherine
AU - Morley, Josephine
AU - Barnfield, Stephen
AU - Gill, Sukhdeep
AU - Jones, Alistair
AU - Halliday, Ruth
AU - Dunn, Sarah
AU - Fagg, James
AU - Dacombe, Peter
AU - Nanda, Rajesh
AU - Wilson, Deborah
AU - Boulton, Lesley
AU - Liow, Raymond
AU - Jeavons, Richard
AU - Meddes, Andrea
AU - Kang, Niel
AU - Dehghani, Leila
AU - Nacorda, Aileen
AU - Punnoose, Anuj
AU - Ferran, Nicholas
AU - Adewetan, Gbadebo
AU - Adedoyin, Temi
AU - Pall, Arun
AU - Sala, Matthew
AU - Zaman, Tariq
AU - Hartley, Richard
AU - a-Sayyad, Charif
AU - Vamplew, Luke
AU - Howe, Elizabeth
AU - Bokor, Norbert
AU - Corbett, Steve
AU - Moverley, Robert
AU - Cox, Elise
AU - Donaldson, Oliver
AU - Jones, Michael
AU - Wood, Diane
AU - Perry, Jess
AU - Lewis, Alison
AU - Howard, Linda
AU - Beesley, Kate
AU - Harries, Luke
AU - Elmorsy, Ahmed
AU - Wilcocks, Katherine
AU - Shean, Kate
AU - Diment, Sarah
AU - Pidgeon, Helen
AU - King, Victoria
AU - Sjolin, Soren
AU - Williams, Angharad
AU - Kellett, Joanne
AU - Young, Lora
AU - Dunne, Michael
AU - Lockwood, Tom
AU - Curtis, Mark
AU - Siddiqui,, Nashat
AU - Mckenley, India
AU - Morrison, Sarah
AU - Morrison, Charlotte
AU - O'Brien, Tracey
AU - Bradley, Isabel
AU - Lambatan, Kenneth
AU - Kelly, Cormac
AU - Perkins, Charlotte
AU - Jones, Teresa
AU - Rowlands, Tessa
AU - Collins, Dawn
AU - Nicholas, Claire
AU - Birch, Claire
AU - Lloyd -Evans, Julie
AU - Akhbari, Pouya
AU - Edakalathu, Jefin Jose
AU - Hand, Campbell
AU - Cole, Andy
AU - Prince, Debbie
AU - Thorpe, Kerry
AU - Rooke, Louise
AU - Baggot, Maria
AU - Morris, Matt
AU - Ivanova, Dima
AU - Baker, David
AU - Matthews, Tim
AU - Falatoori, Jessica
AU - Jarvis, Heather
AU - Jones, Debbie
AU - Williams, Matthew
AU - Evans, Richard
AU - Pullen, Huw
AU - Hodkinson, Gemma
AU - Vannet, Nicola
AU - Davey, Alison
AU - Poyser, Emma
AU - Hall, Angela
AU - Mehta, Hemang
AU - Prakash Tokola, Devi
AU - Connor, Clare
AU - Jordan, Caroline
AU - Ennis, Owain
AU - Omar, Zohra
AU - Lewis, Tracy
AU - Owen, Angharad Lisa
AU - Morgan, Andrew
AU - Ponnada, Ravi
AU - Al-Azzani, Waheeb
AU - Williams, Carolyn
AU - Knox, Liam
AU - Singh, Harvinder
AU - Lee, Tracy
AU - Robinson, Kathryn
AU - Kumar, Dileep
AU - Armstrong, Alison
AU - Majed, Addie
AU - Falworth, Mark
AU - Butt, David
AU - Higgs, Deborah
AU - Rudge, Will
AU - Hughes, Ben
AU - Hanison, Esther
AU - Brooking, Deirdre
AU - Patel, Amit
AU - Symonds, Andrew
AU - Gibson, Jenifer
AU - Santiago, Rodney
AU - Barlow, David
AU - Lennon, Joanne
AU - Smith, Christopher
AU - Hall, Jane
AU - Griffin, Emily
AU - Lear, Rebecca
AU - Thomas, William
AU - Rose, David
AU - Edkins, Janet
AU - Samuel, Helen
AU - Jahnich, Hagen
AU - Geoghegan, John
AU - Gooding, Ben
AU - Hudson, Siobhan
AU - Nightingale, Jess
AU - Papanna, Madhavan
AU - Briggs, Tom
AU - Pugh, Rebecca
AU - Neal, Amy
AU - Warrem, Lisa
AU - Maxwell, Veronica
AU - Chadwick, Robert
AU - Jaki, Thomas
AU - Davies, Loretta
AU - Gwilym, Stephen
AU - Taylor, Rod
AU - Abel, Geoffrey
AU - Graham, John
AU - Littlewood, Christopher
AU - Wallace, Angus
AU - Howard, Anthony
DA - 2022/5//
DO - 10.1016/s0140-6736(22)00652-3
IS - 10339
PB - Elsevier BV
PY - 2022
SP - 1954
EP - 1963
TI - Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS): a group-sequential, double-blind, multicentre randomised controlled trial
T2 - The Lancet
VL - 399
ER -
TY - JOUR
AB - Purpose: The purposes of this prospective non-randomized study were to confirm the feasibility of the biodegradable sub-acromial spacer (InSpace™) implantation in patients with massive irreparable rotator cuff tear and to determine the safety profile and functional results 3 years post-implantation. Methods: Twenty patients were implanted with the InSpace™ device and assessed up to 3 years of post-implantation. Improvement in shoulder function was assessed using Constant score, while ease of use of the system was recorded by surgeons as were device-related adverse events. Results: Twenty patients were available for assessment. Implantation was performed arthroscopically in all patients, and a range of deployment time was 2-20 min. The mean total Constant score increased from 33.4 to 65.4 points at 3 years. There was an improvement of 6.4 points in subjective pain score which commenced at 1 week post-operatively and was sustained until 3 years of follow-up. Also activities of daily living and motions commenced improvement by 9.4 and 7.7 points, respectively. Improvement in power was only evident at 18 months of follow-up but was sustained at 3 years. Conclusions: Arthroscopic deployment of a co-polymer biodegradable spacer (balloon) into the sub-acromial space for an irreparable rotator cuff tear was found to be low-risk and simple procedure associated with improvement in shoulder function and low rate of complications. Level of evidence: IV; therapeutic case series © 2012 Springer-Verlag.
AU - Senekovic, Vladimir
AU - Poberaj, Boris
AU - Kovacic, Ladislav
AU - Mikek, Martin
AU - Adar, Eliyahu
AU - Dekel, Assaf
DA - 2013/4//
DO - 10.1007/s00590-012-0981-4
IS - 3
KW - Arthroscopy
KW - Constant score
KW - Massive irreparable rotator cuff tears
KW - Sub-acromial spacer
PY - 2013
SP - 311
EP - 316
TI - Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears
T2 - European Journal of Orthopaedic Surgery and Traumatology
VL - 23
ER -
TY - JOUR
AB - Background: The management of massive rotator cuff tears (MRCTs) is challenging and associated with a high failure rates. Studies have shown that advanced age, lower American Society of Anesthesiologists physical status score and concomitant comorbidities are associated with higher risks of death and postoperative complications. This study was designed to assess the safety and efficacy of fluoroscopy-guided biodegradable spacer implantation under local anesthesia, in patients with MRCT and comorbidities completely or partially contraindicating surgeries under general anesthesia. Methods: In this open-label, single arm, prospective study, subjects with MRCTs underwent subacromial fluoroscopy-guided implantation with a biodegradable spacer (InSpace™ system) under local anesthesia. Fifteen patients were treated and assessed. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Constant (CS) and American Shoulder and Elbow Society (ASES) scores. Results: All patients demonstrated an overall improvement in the total CS and ASES beginning at 6 weeks and sustained by at least 12 months postoperatively. Of the 15 patients who reached the 1-year follow-up, 85% showed a clinically significant improvement of at least 15 points in their Constant score starting at 6 weeks postoperation and maintained throughout the entire follow-up period. Conclusions: We conclude that in this initial patient’s cohort, fluoroscopy-guided implantation of InSpace™ system under local anesthesia, represented an effective alternative to the existing procedures. This procedure may be considered as a treatment option for elderly patients or for patients with multiple comorbidities complicating or contraindicating surgery under general anesthesia. Technically easy, this technique can be an effective tool in the armamentarium of most orthopedic surgeons. Level of proof: single-arm prospective study, Level II.
AU - Gervasi, E.
AU - Maman, E.
AU - Dekel, A.
AU - Cautero, E.
DA - 2016/12//
DO - 10.1007/s12306-016-0433-0
KW - Biodegradable spacer
KW - Fluoroscopy-guided subacromial implantation
KW - Local anesthesia
KW - Massive rotator cuff tears
PB - Springer-Verlag Italia s.r.l.
PY - 2016
SP - 19
EP - 24
TI - Fluoroscopy-guided biodegradable spacer implantation using local anesthesia: safety and efficacy study in patients with massive rotator cuff tears
T2 - Musculoskeletal Surgery
VL - 100
ER -
TY - JOUR
AB - Background. The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. Material and methods. Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. Results. Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). Conclusions. 1. Irreparable rotator cuff tears have maintained their importance as a challenging subject for the orthopedic surgeon. 2. In the present case series including a limited number of patients, the clinical and radiographic results of subacromial balloon spacer insertion in irreparable rotator cuff tears were unsatisfactory. 3. The indications for performing subacromial balloon spacer in patients with irreparable rotator cuff tears should be more clearly defined.
AU - Yamak, Kamil
AU - Karahan, Hüseyin Gökhan
AU - Altay, Taşkın
AU - Kayalı, Cemil
AU - Ozan, Fırat
DO - 10.5604/01.3001.0013.7399
IS - 6
KW - Irreparable rotator cuff tear
KW - Shoulder arthroscopy
KW - Subacromial balloon spacer
PB - Agencja Wydawnicza Medsportpress
PY - 2019
SP - 421
EP - 426
TI - Is subacromial balloon spacer appropriate for treatment of irreparable rotator cuff tears in elderly patients?
T2 - Ortopedia Traumatologia Rehabilitacja
VL - 21
ER -
TY - GEN
AB - Purpose: To synthesize and report the early clinical and radiographic outcomes associated with subacromial spacer use in patients with massive irreparable rotator cuff tears. Methods: A systematic search on MEDLINE, Embase, and Cochrane Library databases was performed during February 2018. Included studies were evaluated regarding the level of evidence and quality using the methodological index for nonrandomized studies. Patient demographics, intraoperative findings, clinical and radiographic outcomes, and complications were recorded for each of the included studies. Results: Seven eligible studies including 204 shoulders from 200 patients with subacromial spacer implantation were identified (6 Level IV studies and 1 Level III study). The mean methodological index for nonrandomized studies score for noncomparative studies was 11, whereas that of comparative studies was 15. The mean age of patients was 67.6 years, and the mean reported follow-up time was 19.4 months. All patients had Goutallier stage 3 and 4 fatty infiltration on magnetic resonance imaging. All studies reported consistent improvement in the total Constant score or American Shoulder and Elbow Surgeons score over the duration of follow-up. A total of 6 (3%) complications were reported in the included studies. Two studies detailed radiographic outcomes, with discrepant changes in the acromiohumeral interval. Conclusions: Patients undergoing subacromial spacer implantation for the treatment of massive irreparable rotator cuff tears have satisfactory outcomes at the 2- to 3-year follow-up with a low rate of complications. Level of Evidence: Level IV, systematic review of 1 Level III and 6 Level IV studies.
AU - Moon, Andrew S.
AU - Patel, Harshadkumar A.
AU - Ithurburn, Matthew P.
AU - Brabston, Eugene W.
AU - Ponce, Brent A.
AU - Momaya, Amit M.
DA - 2019/2//
DO - 10.1016/j.arthro.2018.08.006
IS - 2
PB - W.B. Saunders
PY - 2019
SP - 607
EP - 614
TI - Subacromial Spacer Implantation for the Treatment of Massive Irreparable Rotator Cuff Tears: A Systematic Review
T2 - Arthroscopy - Journal of Arthroscopic and Related Surgery
VL - 35
ER -
TY - JOUR
AB - The use of biodegradable materials is gaining popularity in medicine, especially in orthopedic applications. However, preclinical evaluation of biodegradable materials can be challenging, since they are located in close contact with host tissues and might be implanted for a long period of time. Evaluation of these compounds requires biodegradability and biocompatibility studies and meticulous pathology examination. We describe 2 pre-clinical studies performed on Sprague-Dawley rats for 52 weeks, to evaluate clinical pathology, biocompatibility, biodegradability, and systemic toxicity after implantation of 2-layered films or saline-inflated balloon-shaped implants of downsized InSpace™ devices (termed ''test device''). The test devices are made from a copolymer of poly-L-lactide-co-e-caprolactone in a 70:30 ratio, identical to the device used in humans, intended for the treatment of rotator cuff tears. Intra-articular film implantation and subcutaneous implantation of the downsized device showed favorable local and systemic tolerability. Although the implanted materials have no inherent toxic or tumorigenic properties, one animal developed a fibrosarcoma at the implantation site, an event that is associated with a rodent-predilection response where solid materials cause mesenchymal neoplasms. This effect is discussed in the context of biodegradable materials along with a detailed description of expected pathology for biodegradable materials in long-term rodent studies.
AU - Ramot, Yuval
AU - Nyska, Abraham
AU - Markovitz, Elana
AU - Dekel, Assaf
AU - Klaiman, Guy
AU - Zada, Haim
AU - Domb, Abraham J
AU - Maronpot, Robert R
DO - 10.1177/0192623315600275
KW - biocompatibility
KW - biodegradability
KW - biodegradable materials
KW - rotator cuff syndrome
KW - safety studies
TI - Long-term Local and Systemic Safety of Poly(L-lactide-co-epsilon-caprolactone) after Subcutaneous and Intra-articular Implantation in Rats
ER -
TY - JOUR
AB - Background:A subacromial balloon spacer is an option to treat irreparable rotator cuff tears. We hypothesized that the balloon would restore glenohumeral contact pressure, the acromion-humeral interval, and deltoid load to intact values after a simulated irreparable supraspinatus tear in a cadaveric model.Methods:Fourteen cadaveric shoulders (mean age at the time of death, 67.9 years) were tested using a custom test frame. In this frame, glenohumeral contact pressure, the acromion-humeral interval, and deltoid load were measured using a digital sensor, a MicroScribe, and a spring scale, respectively. Test conditions included the intact shoulder, a small supraspinatus tear, supraspinatus repair, repair plus balloon, an irreparable supraspinatus tear (rotator cable-insufficient), and an irreparable tear plus balloon. Load was applied in a simulated neutral arm position (balanced) and active shoulder abduction (unbalanced).Results:When the balloon was inflated over the irreparable supraspinatus tear in the balanced condition, glenohumeral contact pressure increased by 122% (p = 0.006) compared with that for the irreparable tear at 0° of abduction and by 94% (p = 0.046) at 60°. In the unbalanced condition, pressure decreased in the irreparable tear condition after the balloon was inflated, restoring pressure to close to that in the intact state. The balloon did not restore glenohumeral contact area to that in the intact shoulder in either the balanced or the unbalanced condition. The irreparable tear displaced the humeral head superiorly in the unbalanced condition, decreasing the acromion-humeral interval. The balloon moved the head inferiorly by a mean (and standard error of the mean) of 6.2 ± 1.3 mm (p < 0.001) at 0° of abduction, 4.4 ± 1.3 mm (p < 0.001) at 30°, and 3.0 ± 0.8 mm (p < 0.001) at 60°. The balloon increased the deltoid load after an irreparable tear by 8.2% (p = 0.022) at 0°, 12.6% (p = 0.002) at 30°, and 11.1% (p = 0.008) at 60°.Conclusions:In a cadaveric model of an irreparable supraspinatus tear, a balloon spacer restored intact-state glenohumeral contact pressures at most abduction angles, lowered the humeral head, and increased deltoid load at postoperative time 0.Clinical Relevance:This study supports further investigation of the balloon spacer in comparative clinical studies of surgical options for irreparable rotator cuff tears, with clinically relevant evaluation measures and observation periods.
AU - Lobao, Mario H.
AU - Canham, R. Bruce
AU - Melvani, Roshan T.
AU - Abboud, Joseph A.
AU - Parks, Brent G.
AU - Murthi, Anand M.
DA - 2019/6//
DO - 10.2106/JBJS.18.00850
IS - 11
PB - Lippincott Williams and Wilkins
PY - 2019
TI - Biomechanics of Biodegradable Subacromial Balloon Spacer for Irreparable Superior Rotator Cuff Tears: Study of a Cadaveric Model
T2 - Journal of Bone and Joint Surgery - American Volume
VL - 101
ER -
TY - JOUR
AB - Purpose: This meta-analysis was performed systematically to evaluate the efficacy of subacromial balloon spacers for patients with massive, irreparable rotator cuff tears. Methods: Electronic databases, including Medline/PubMed, Embase and Cochrane Library, were systematically searched to identify studies evaluating the efficacy of subacromial spacers for patients with irreparable or massive rotator cuff tears. Meta-analyses were performed to pool the outcome estimates of interest, such as the total constant score (TCS) and its sub-score (pain, activities of daily living [ADL], range of motion [ROM], and strength), Oxford shoulder score (OSS), American Shoulder and Elbow Society scores (ASES) and numeric rating scale (NRS), as well as different outcomes at different time points in the follow-up period. Results: Ten studies with a total of 261 patients involving 270 shoulders were deemed viable for inclusion in the meta-analysis. The combined results demonstrated significant improvements in the TCS at the final follow-up (pooled mean difference = 26.4, 95% confidence intervals [CIs] 23.3 to 29.5). A sensitivity analysis and subgroup analysis, which were implemented based on two factors, different follow-up points and sub-scores (pain, ADL, ROM, and strength), revealed a consistent trend. The combined shoulder motion results demonstrated significant improvements in the forward flexion and external rotation (0° abduction) variables rather than in the abduction and external rotation (90° abduction) variables. Additionally, significant improvements in the OSS and ASES and a decrease in the NRS were observed in the middle of the follow-up period. Conclusion: This meta-analysis indicated that subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears may achieve satisfactory outcomes between 3 months and 3 years of follow-ups. Although the short- and middle- term effect is significant, the long-term effect needs to be confirmed by large-sample randomized controlled trial. Level of evidence: IV.
AU - Liu, Fanxiao
AU - Dong, Jinlei
AU - Kang, Qinglin
AU - Zhou, Dongsheng
AU - Xiong, Fei
DA - 2021/1//
DO - 10.1007/s00167-019-05834-3
IS - 1
KW - Meta-analysis
KW - Rotator cuff tear
KW - Subacromial balloon spacer
PB - Springer Science and Business Media Deutschland GmbH
PY - 2021
SP - 143
EP - 153
TI - Subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears achieves satisfactory clinical outcomes in the short and middle of follow-up period: a meta-analysis
T2 - Knee Surgery, Sports Traumatology, Arthroscopy
VL - 29
ER -
TY - JOUR
AU - Kucirek, Natalie K.
AU - Hung, Nicole J.
AU - Wong, Stephanie E.
DA - 2021/10//
DO - 10.1007/s12178-021-09714-7
IS - 5
PY - 2021
SP - 304
EP - 315
TI - Treatment Options for Massive Irreparable Rotator Cuff Tears
T2 - Current Reviews in Musculoskeletal Medicine
VL - 14
ER -
TY - JOUR
AB - This narrative review is intended to provide hand and upper extremity therapists, who occasionally treat patients with shoulder diagnoses, with several current concepts related to normal shoulder anatomy and function. It is hoped that this review will be useful for 1) appreciating patho-anatomy and pathophysiology, 2) planning treatment approaches, and 3) stimulating research aimed at improved understanding of the shoulder. © 2009 Hanley & Belfus.
AU - Hurov, Jack
DA - 2009/10//
DO - 10.1016/j.jht.2009.05.002
IS - 4
PY - 2009
SP - 328
EP - 343
TI - Anatomy and Mechanics of the Shoulder: Review of Current Concepts
T2 - Journal of Hand Therapy
VL - 22
ER -
TY - JOUR
AB - Shoulder pain and instability are common complaints in primary care and orthopaedic sports medicine clinics. Diagnoses and treatment can prove to be a challenge for practitioners, especially if the underlying normal and pathologic anatomy is not well understood. The glenohumeral joint is a multiaxial synovial ball and socket joint that permits a wide range of motion at the cost of inherent stability. To provide support to the joint, osseous and capsuloligamentous static stabilizers function in concert with dynamic muscular stabilizers. This article will review these critical structures and provide an anatomic guide to restore function and stability in the clinical setting.
AU - Gasbarro, Gregory
AU - Bondow, Benjamin
AU - Debski, Richard
DA - 2017/11//
DO - 10.21037/aoj.2017.10.03
PB - AME Publishing Company
PY - 2017
SP - 58
EP - 58
TI - Clinical anatomy and stabilizers of the glenohumeral joint
T2 - Annals of Joint
VL - 2
ER -
TY - GEN
AB - OBJECTIVE. The purpose of this article is to review the biomechanical properties of the rotator cuff and glenohumeral joint and the pathophysiology, imaging characteristics, and treatment options of rotator cuff tear arthropathy (RCTA). CONCLUSION. Although multiple pathways have been proposed as causes of RCTA, the exact cause remains unclear. Increasing knowledge about the clinical diagnosis, imaging features, and indicators of severity improves recognition and treatment of this pathologic condition.
AU - Eajazi, Alireza
AU - Kussman, Steve
AU - Lebedis, Christina
AU - Guermazi, Ali
AU - Kompel, Andrew
AU - Jawa, Andrew
AU - Murakami, Akira M.
DA - 2015/11//
DO - 10.2214/AJR.14.13815
IS - 5
KW - Arthropathy
KW - Biomechanics
KW - Imaging
KW - MRI
KW - Rotator cuff tear
KW - Shoulder
PB - American Roentgen Ray Society
PY - 2015
SP - W502
EP - W511
TI - Rotator cuff tear arthropathy: Pathophysiology, imaging characteristics, and treatment options
T2 - American Journal of Roentgenology
VL - 205
ER -
TY - JOUR
AB - Rotator cuff tears represent one of common shoulder pathologies presenting over a wide spectrum of age groups and varying presentation. Typically, rotator cuff tears occur more frequently in elderly than in younger patients, following a chronic or acute-on-chronic course and usually secondary to due to tendon degeneration. Though there has been a considerable debate in the literature of the terms “acute” and “traumatic” used in the classification of rotator cuff tears, there appears to be consensus about the need for early diagnosis to facilitate prompt surgical treatment and the improve patient outcome. Significant differences in rotator cuff tears between those occurring in younger and older patients could be due to mechanism of injury, presentation, severity of the tear, biological healing potential and rehabilitation. Acute traumatic rotator cuff tears especially in younger age group represent a distinct entity from other patterns of rotator cuff tears. Consequently, a high index of suspicion, focused clinical examination, complementary imaging is a pre-requisite for an early diagnosis and effective management. We analyze the biomechanical consequences of acute rotator cuff tears along with characteristic mechanism of injury and spectrum of tendon involvement. The evolving concepts in the diagnosis and management of these distinct injuries are discussed with review of current literature.
AU - Abdelwahab, Ali
AU - Ahuja, Neeraj
AU - Iyengar, Karthikeyan P.
AU - Jain, Vijay Kumar
AU - Bakti, Nik
AU - Singh, Bijayendra
DA - 2021/7//
DO - 10.1016/j.jcot.2021.04.013
KW - Physiotherapy
KW - Rehabilitation
KW - Rotator cuff
KW - Rotator cuff injuries
KW - Rupture
KW - Shoulder
KW - Surgery
PB - Elsevier B.V.
PY - 2021
SP - 51
EP - 55
TI - Traumatic rotator cuff tears - Current concepts in diagnosis and management
T2 - Journal of Clinical Orthopaedics and Trauma
VL - 18
ER -
TY - JOUR
AU - Cvetanovich, Gregory L.
AU - Waterman, Brian R.
AU - Verma, Nikhil N.
AU - Romeo, Anthony A.
DA - 2019/12//
DO - 10.5435/JAAOS-D-18-00199
IS - 24
PY - 2019
SP - 909
EP - 917
TI - Management of the Irreparable Rotator Cuff Tear
T2 - Journal of the American Academy of Orthopaedic Surgeons
VL - 27
ER -
TY - JOUR
AB - Background The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain." Methods One hundred consecutive patients aged ≥18 years who presented with a chief complaint of pain were asked to record pain scores via a paper VAS and digitally via both the laptop computer and mobile phone. Ninety-eight subjects, 51 men (age, 44 ± 16 years) and 47 women (age, 46 ± 15 years), were included. A mixed-model analysis of covariance with the Bonferroni post hoc test was used to detect differences between the paper and digital VAS scores. A Bland-Altman analysis was used to test for instrument agreement between the platforms. The minimal clinically important difference was set at 1.4 cm (14% of total scale length) for detecting clinical relevance between the three VAS platforms. A paired one-tailed Student t-test was used to determine whether differences between the digital and paper measurement platforms exceeded 14% (P < 0.05). Results A significant difference in scores was found between the mobile phone-based (32.9% ± 0.4%) and both the laptop computer- and paper-based platforms (31.0% ± 0.4%, P < 0.01 for both). These differences were not clinically relevant (minimal clinically important difference <1.4 cm). No statistically significant difference was observed between the paper and laptop computer platforms. Measurement agreement was found between the paper- and laptop computer-based platforms (mean difference, 0.0% ± 0.5%; no proportional bias detected) but not between the paper- and mobile phone-based platforms (mean difference, 1.9% ± 0.5%; proportional bias detected). Conclusion No clinically relevant difference exists between the traditional paper-based VAS assessment and VAS scores obtained from laptop computer- and mobile phone-based platforms.
AU - Delgado, Domenica A.
AU - Lambert, Bradley S.
AU - Boutris, Nickolas
AU - McCulloch, Patrick C.
AU - Robbins, Andrew B.
AU - Moreno, Michael R.
AU - Harris, Joshua D.
DA - 2018/3//
DO - 10.5435/jaaosglobal-d-17-00088
IS - 3
PB - Ovid Technologies (Wolters Kluwer Health)
PY - 2018
SP - e088
EP - e088
TI - Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults
T2 - JAAOS: Global Research and Reviews
VL - 2
ER -
TY - CONF
AB - Background In 1990, Hamada et al. radiographically classified massive rotator cuff tears into five grades. Walch et al. subsequently subdivided Grade 4 to reflect the presence/ absence of subacromial arthritis and emphasize glenohumeral arthritis as a characteristic of Grade 4. Questions/purposes We therefore determined (1) whether patient characteristics and MRI findings differed between the grades at initial examination and final followup; (2) which factors affected progression to a higher grade; (3) whether the retear rate of repaired tendons differed among the grades; and (4) whether the radiographic grades at final followup differed from those at initial examination among patients treated operatively. Patients and Methods We retrospectively reviewed 75 patients with massive rotator cuff tears. Thirty-four patients were treated nonoperatively and 41 operatively. Results Patients with Grade 3, 4, or 5 tears had a higher incidence of fatty muscle degeneration of the subscapularis muscle than patients with Grade 1 or 2 tears. In 26 patients with Grade 1 or 2 tears at initial examination, duration of followup was longer in patients who remained at Grade 1 or 2 than in those who progressed to Grade 3, 4, or 5 at final followup. The retear rate of repaired supraspinatus tendon was more frequent in Grade 2 than Grade 1 tears. In operated cases, radiographic grades at final followup did not develop to Grades 3 to 5. Conclusions We believe cuff repair should be performed before acromiohumeral interval narrowing. Our observations are consistent with the temporal concepts of massive cuff tear pathomechanics proposed by Burkhart and Hansen et al. Level of Evidence Level III, Therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2011 The Association of Bone and Joint Surgeons.
AU - Hamada, Kazutoshi
AU - Yamanaka, Kaoru
AU - Uchiyama, Yoshiyasu
AU - Mikasa, Takahiko
AU - Mikasa, Motohiko
DO - 10.1007/s11999-011-1896-9
IS - 9
PB - Springer New York LLC
PY - 2011
SP - 2452
EP - 2460
TI - A radiographic classification of massive rotator cuff tear arthritis
T2 - Clinical Orthopaedics and Related Research
VL - 469
ER -