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Makale, WOS:000941667500026, PubMed ID: 36945963, Background/aim: Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis.Materials and methods: From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores.Results: The UCLA scores increased from the preoperative value of 19.1 +/- 3.2 to 29.8 +/- 4.8 at the last follow-up and increased by an average of 10.7 +/- 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 +/- 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001).Conclusion: To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate., Department of Public Health, Gazi University Medical Faculty

Uvod: Tetive mišic rotatorne manšete v veliki meri skrbijo za dinamično stabilnost glenohumeralnega sklepa, zato lahko ruptura povzroči nestabilnost in disfunkcijo. Glavni cilj rekonstrukcije rupture rotatorne manšete je obnovitev njene funkcije, na uspeh pa pomembno vpliva pooperativna fizioterapija. V grobem obstajata dva možna pristopa zdravljenja in sicer tradicionalen pristop z omejevanjem gibanja ali bolj agresiven pristop z zgodnjo aktivacijo mišic. V literaturi je možno zaslediti dokaze o negativnih in pozitivnih učinkih zgodnjega aktivnega gibanja. Namen: Namen diplomskega dela je analizirati izsledke raziskav o učinkih zgodnjega aktivnega in aktivno asistiranega gibanja na izide rehabilitacije po rekonstrukciji rupture rotatorne manšete. Metode dela: Iskanje literature je potekalo s pregledom podatkovnih zbirk PubMed, PEDro in CINAHL. V pregled so bile vključeni randomizirani kontrolirani poskusi v angleškem jeziku, ki so bili objavljeni od leta 2000 do vključno decembra 2021. Rezultati: V pregled je bilo vključenih pet raziskav. Zasnove raziskav so paciente razdelile na skupino, ki je izvajala zgodnje aktivno gibanje in skupino, ki je z aktivnim gibanjem začela pozneje. Merjeni izidi so bili bolečina, raven funkcijske aktivnosti, kakovost življenja, zadovoljstvo pacientov, obseg pasivne in aktivne gibljivosti, mišična jakost, stanje rekonstruirane tetive in časovno vezana uspešnost celjenja tetive. Ugotovitve raziskav o učinkovitosti zgodnjega aktivnega gibanja na posamezno mero izida v posameznih časovnih obdobjih niso soglasne. V preiskovalnih skupinah raziskav je bilo prisotno hitrejše pridobivanje obsega gibljivosti, rezultati hkrati kažejo na mogoče pozitivne učinke hitrejšega lajšanja bolečine. Raziskave poročajo o odsotnosti statistično pomembnih razlik med skupinama v številu ponovnih ruptur. Razprava in zaključek: Zgodnje aktivno gibanje pozitivno vpliva na izide zdravljenja po rekonstrukciji rupture RM pri čemer povečano tveganje za ponovno rupturo ni dokazano. Na podlagi rezultatov raziskav lahko trdimo, da zgodnje aktivno gibanje v primerjavi z manj agresivnim pristopom prispeva k hitrejšemu vračanju obsega gibljivosti ramenskega sklepa. O kratkoročnih in dolgoročnih učinkih na bolečino, kakovost življenja in mišično jakost raziskave niso soglasne. Heterogenost raziskav otežuje primerjavo in interpretacijo rezultatov. Na podlagi sistematičnega pregleda ni mogoče nedvomno opredeliti, da sta zgodnje gibanje in mišična aktivnost klinično uspešnejša. Za opredelitev tega so potrebne nadaljnje raziskave na tem področju. Introduction: The rotator cuff muscles with their tendons hold greater responsibility for dynamic stability of the glenohumeral joint, therefore a rupture can cause instability and dysfunction. The main goal of the reconstructive procedure is to restore function. Physiotherapy in the post-operative period has a big impact on the success of the repair. There are two main possible exercise approaches, the first one is traditional, with limitation of movement and the second one, which is more aggressive, with early muscle activation. The evidence about effects of early active movement on outcomes in literature differs. Purpose: The purpose of this diploma work is to analyze findings of researches about effects of early active and actively assisted movement on treatment outcomes after reconstruction of a rotator cuff rupture. Methods: We searched databases PubMed, PEDro in CINAHL and included randomized controlled trials published in English in period from year 2000 till including December 2021. Results: Five studies were included. The study designs divided patients into early motion group and in delayed motion group. Measured outcome were pain, level of function, life quality, patients’ satisfaction, active and passive range of motion, muscle strength, re-tear rates and time course of tendon healing. Studies’ findings relating to the different measured outcomes varied at different points in time. The early motion groups presented faster gain in range of motion at the same time results suggesting the possible positive effect of quicker pain relive. Statistically significant difference of number of re-tears in both groups was not found. Discussion and conclusion: Early active movement has positive effects on treatment outcomes after reconstruction of rotator cuff tears, an increased risk for re-tears is not proven. From the found results we can claim that early active motion can contributes to the faster gain of range of motion. Researches are in conflict about short-term and long-term effects on pain, functional activity and muscle strength. The heterogeneity of the research makes it difficult to compare and interpret the results. Based on this systematic review, it is not possible to clearly determine if early active movement is a better approach to use in clinical practice. Further research in this area is needed for more precise conclusions.

Background: Rotator cuff tears are the most common cause of shoulder pain in the elderly. Various techniques have been used in the treatment of rotator cuff tears. This study discusses the clinical and functional outcomes in patients in whom rotator cuff tears have been repaired using double-row transosseous fixation material.Methods: The study is carried out on 37 elderly patients who underwent mini-open arthroscopy-supported transosseous repair between February 2017 - March 2019. Age and gender of the patients as well as the tear development mechanism, tear grade, fatty degeneration grade, acromion type, and the University of California - Los Angeles (UCLA) Shoulder Scale and Constant-Murley functional and clinical scores (CMS) before and six months after the surgery were recorded.Results: Mean patient age was 61.19±6.74 (range: 52-76). 17 (45.9%) were female, and 20 (54.1%) were male. The mean preoperative CMS score was 37.68±8.64, and the mean UCLA score was 14.19±8.64. Mean postoperative CMS and UCLA scores were 76.84±9.57 and 28.14±3.02, respectively. Preoperative and postoperative CMS and UCLA scores were statistically significantly different (p

Treatment of irreparable rotator cuff tears in young active patients is challenging. A variety of therapeutic options are available. Only a few joint-preserving treatment options show reliable improvements over a long-term follow-up period. However, the treatment outcomes of joint preservation procedures are not comparable to those of RTSA, as patients are typically younger and have higher expectations. It is remarkable that most of the joint-preserving therapeutic options for irreparable rotator cuff ruptures lack long-term treatment results. This article highlights the indications, technical aspects, and treatment outcomes of the most commonly performed joint-preserving surgeries for irreparable rotator cuff rupture.

Introducción: La prevalencia del dolor de hombro oscila entre el 6,7% y el 66,7%; los trastornos del manguito rotador y especialmente la ruptura pueden alcanzar una prevalencia del 22,1%. Debido a los importantes avances y estudios en la reparación de esta lesión, la cirugía artroscópica ha permitido una mejor identificación, visualización y clasificación, y un mejor manejo de los pacientes. Además, la ruptura del manguito rotador o la fractura de la tuberosidad mayor del húmero incrementan el riesgo de lesión nerviosa (riesgo relativo –1,9), más significativa en pacientes >60 años. Se presenta a un paciente con ruptura postraumática del manguito rotador, quien requirió reparación artroscópica mínimamente invasiva, con evolución posoperatoria estacionaria y diagnóstico de lesión del nervio axilar, sin recuperación autolimitada atribuida a luxación anterior e inestabilidad secundaria altrauma inicial.Conclusiones: La lesión del nervio axilar es más frecuente que lo esperado y, en muchas ocasiones, la identificación temprana se pasa por alto debido a la alta asociación con otras lesiones. Por lo tanto, el diagnóstico y el manejo oportunos requieren mucho cuidado por parte del médico tratante. AbstractIntroduction: The prevalence of shoulder pain varies between 6.7% and 66.7%; whereas rotator cuff disorders–especially rupture–can reach a prevalence of 22.1%. Due to the important advances and studies in the repair of this injury, arthroscopic surgery has allowed a better identification, visualization and classification, as well as a better handling of the patients. In addition, rotator cuff ruptures or greater tuberosity fractures increase the risk of nerve injury (relative risk -1.9), which is more significant in patients >60 years old. We discuss the case of a patient with post-traumatic rotator cuff rupture who required minimally invasive arthroscopic repair. No weight-bearing was allowed during the postoperative period. Patient presented a non-self-limited axillary nerve injury secondary to anterior dislocation and resulting instability after the original trauma.Conclusions: Axillary nerve injuries are more common than expected and, in many cases, early identification is not possible due to its high rate of association with other injuries. Therefore, treating physicians must be very careful in order to achieve a timely diagnosis and management of the patient.

Zusammenfassung. Patienten mit Rotatorenmanschettenrupturen können konservativ oder operativ behandelt werden. Welche Behandlung gewählt wird, hängt einerseits von patientenspezifischen Faktoren wie Leidensdruck, körperliche Einschränkung, Aktivitätsniveau und Funktionsanspruch ab und andererseits von morphologischen/radiologischen Gegebenheiten wie Grösse der Sehnenruptur, Degeneration und Verfettung der Rotatorenmanschettenmuskulatur sowie Begleitverletzungen. Dieser Artikel beleuchtet die Hintergründe der Indikationsstellung für die konservative und operative Behandlung von Patienten mit Rissen der Rotatorenmanschette unter Einbezug klinischer und radiologischer Kriterien.

Background: Acute and chronic shoulder symptoms can be due to calcifications but also to other lesions well detected by Ultrasound (US). Objective: The present study’s objectives were to determine whether, some demographic, clinical and ultrasound features were associated with the presence or absence of calcifications in symptomatic shoulders patients. Methods: As part of this retrospective, transversal, case-control study of 490 patients, the 125 patients with calcifications were compared to 125 patients without calcification randomly extracted from the cohort. Subgroups were defined according to types and durations of symptoms. The frequency and types of associated lesions in the two groups, as well as the different US appearances of the calcifications were compared according to their different clinical presentations. Results: Calcific tendinitis was present in 26% of patients. Demographic characteristics or clinical manifestations, significantly associated with calcifications were: being a woman (p = 0.002), a shorter delay between symptoms and diagnosis (p = 0.007 and have acute symptoms. The presence of calcifications was associated with the absence of associated (42% vs. 6%, p = 0.0001) or less severe associated US lesions, particularly total rotator cuff rupture (5% vs. 18%, p = 0.001). Soft and cystic calcifications without shadowing were found more frequently in patients with hyperalgesic shoulders (p = 0.005) compared to chronic shoulders. Conclusions: Only few demographic and clinical features were significantly more frequent in the presence of calcifications. US revealed fewer additional lesions when calcifications were present and, some US aspects of the calcification suggested the type of symptoms.

Background and purpose — Arthroscopic acromioplasty is still commonly used in the treatment of shoulder impingement syndrome, even though its benefits are questioned; randomized controlled studies have not shown any benefits when compared to non-operative treatment. In this randomized study, we investigated whether operative treatment protects from later rotator cuff rupture and whether it has any effect on the development of rotator cuff muscle volume. Patients and methods — 140 stage-II impingement patients were randomized to a structured exercise group (n = 70) or to an operative group (n = 70). In the operative group, arthroscopic acromioplasty was performed, after which a similar structured exercise program was begun. MRI of the shoulder was done at baseline and at 5 years. Results — There were no statistically significant differences in either the amount of perforating ruptures of the supraspinatus tendon or in the changes in muscle volume at 5 years. The grading of muscle fatty degeneration showed worse results in the operative group, but this difference was not statistically significant. Interpretation — In this study, we found that arthroscopic acromioplasty does not have any long-term benefit based on radiological findings of muscle volumes. Also, the frequency of later rotator cuff rupture was similar irrespective of whether or not surgery was performed. Acromioplasty is not justified as a treatment for dynamic shoulder impingement syndrome.

Background: Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia. Materials and Methods: 24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2. Results: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P < 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively. Conclusion: These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients' satisfaction could be improved.

To analyse the current scientific evidence regarding the natural history of the clinical and anatomical progression of rotator cuff tears. A broad systematic review of the literature (PubMed database through January 2014) which was guided, conducted and reported according to PRISMA criteria. This article focuses on the rotator cuff tears. Articles had to meet an inclusion criteria. The methodological quality of each study was individually assessed using a recently developed general assessment tool AMQPP (assessing the methodological quality of published papers). Seven articles dealing with rotator cuff tears were included, one of them was a high-quality study. Three papers assessed the natural history and the natural course of rotator cuff rupture directly. The other studies indirectly assessed the natural history with reports on non-operative and operative therapy trends. All of these articles had been published in four different top medical journals according to 2013 ranking. We found no articles which clearly referred to the role of regression to the mean of rotator cuff tears. The development of symptoms and anatomical deterioration are often directly correlated. Spontaneous recovery to normal levels of function has been successfully achieved, and standardised non-operative treatment programmes are an effective alternative to surgery for many patients. Follow-up is necessary to avoid irreparable stage. However, surgery is still favoured by young active people and highly professional persons who need to get fit in a short period of time. Further research is still necessary. The AMQPP score system is simple and reliable. It works as a quick quality-checking tool which helps researchers to identify the key points in each paper and reach a decision regarding the eligibility of the paper more easily.

Aim The aim of this study is to prospectively evaluate the functional outcome after repair of PTRCT, moreconcisely partial-thickness articular surface tear, through converting it into complete tear and repairing in a routine manner using a spinal needle as a guideline for localization of the tear. Objectives Repair of PTRCT, through converting it into complete tear and repairing in a routine manner using a spinal needle. Background Partial-thickness rotator cuff tears (PTRCTs) involve all tears that do not connect the subacromial space with the glenohumeral joint but the fibers are disrupted. They may be articular-side tear, intertendinous tears, or bursal-side tears. The histopathological changes leading to rotator cuff rupture are gradual and progressive. The exact location and extent of incomplete tear can be shown by shoulder arthroscopy. Methods A total of 50 patients who underwent arthroscopic repair for a partial-thickness articular-sided rotator cuff tear between March 2013 and July 2015 were included in this study. Results Range of motion of the shoulder preoperatively was forward elevation of 135 5.6, mean external rotation of 44 3.5, and mean internal rotation of L3 level. Postoperatively, the range finally improved significantly to forward elevation of 165 4, external rotation of 60 5, and internal rotation of L1 level. Conclusions The use of spinal needle in arthroscopic repair of PTRCT facilitates the site of tear and as a guide for the healthy bursal side of the cuff. The limitations of our study included patient were highly selected regarding PTRCT and there was no postoperative imaging study.

Die Standzeit und Uberlebensrate von Schulterprothesen werden von zahlreichen Komplikationsmoglichkeiten beeinflusst. Die Auswertung der aktuellen Literatur und Prothesenregister zeigt aber insgesamt eine geringe Revisions- (1,39 Revisionen/100 Beobachtungsjahre) und Lockerungsrate (implantatbezogene 10-Jahres-Uberlebensrate bis zu 99 %), die mit derjenigen aus der Huft- und Knieendoprothetik vergleichbar ist. Hervorzuheben ist, dass zementfreie Schafte haufiger Probleme bereiten als zementierte Komponenten (4,34 vs. 0,77 Revisionen/100 Beobachtungsjahre) sowie dass sekundare Rotatorenmanschettenrupturen (4,6 %; Funktionsdefizit bis zu 30 %) haufiger sind als allgemein angenommen und oftmals nur inkonsequent diagnostiziert und behandelt werden. Die Infektionsrate liegt bei ca. 1 %, die Luxationsrate ist in der neueren Literatur rucklaufig und wird mit ca. 5 % angegeben. Die niedrige Komplikations- und Revisionsrate rechtfertigt die Verdrangung der Schaftprothesen durch schaftfreie Implantate und Kurzschaftprothesen nicht, sondern die Bevorzugung der neuen Implantate ist auf die besseren Revisionsmoglichkeiten und die leichtere Konvertierbarkeit in eine inverse Prothese zuruckzufuhren.

Backround Operative treatment of traumatic rotator cuff ruptures, i.e. ruptures with a predisposing traumatic event, is reported to yield superior results compared to operative treatment of non-traumatic, degenerative ruptures. Aim The purpose of this study was to evaluate the difference of outcome, peroperative findings, and demographics after operative treatment of traumatic versus non-traumatic rotator cuff rupture. Methods A total of 306 consecutive shoulders with an operated rotator cuff rupture (124 traumatic and 182 non-traumatic) were followed up. Constant and Murley score, size of the rupture, and age of the patients were used as an outcome measure. Results A total of 112 traumatic and 167 non-traumatic rotator cuff rupture shoulders were available for 1-year follow-up (91%). Mean Constant and Murley score was preoperatively lower in the traumatic group (46 versus 52, P = 0.01). At 3 months postoperatively, Constant and Murley scores were 61 and 60 (P = 0.72) and at 1 year 73 and 77 (P = 0.03), respectively. Altogether 91% of the patients in the traumatic and 93% in the non-traumatic group were satisfied with the final outcome (P = 0.45). In 94% of traumatic and 95% of a non-traumatic cases the rupture involved the supraspinatus tendon. In the traumatic group the rupture was larger and involved more frequently the whole supraspinatus insertion area (41% versus 17%, P < 0.0001). Mean age of patients was 58 and 57 years, respectively. Conclusion Operative treatment of both traumatic and non-traumatic rotator cuff ruptures gives essentially good results. In our cohort, patients' recollection of predisposing trauma reflects the size of the rotator cuff rupture, but does not reflect the age of the patients.

Aim: This study aims to evaluate the effect of tenotomy on clinical and radiological outcomes in the treatment of biceps long head tendon pathologies associated with rotator cuff tears.Material and Methods: The study was conducted with 66 patients who met the inclusion criteria and were available (Group 1: Tenotomy, n = 40; Group 2: Non-tenotomy, n = 26). Clinical evaluation of the patients was performed with Modified Constant-Murley Scoring, radiological evaluation with ultrasonography, functional evaluation with dynamometer and visual evaluation with the detection of Popeye Sign finding. Results: The mean age of the patients in group 1 was 58.17 ± 7.95, the follow-up period was 28.87 months, the mean age of the patients in group 2 was 60.61 ± 4.66, and the follow-up period was 35.28 months; there was no statistically significant difference between two groups (p> 0.05). The mean score of the patients in group 1 was 89.83 ± 7.87, whereas the mean score of the patients in group 2 was 86.19 ± 7.07 (p> 0.05). In the ultrasonographic examination, the tendon cut in 24 (60%) of the 40 patients who underwent tenotomy was seen in the bicipital groove, but not in the groove in 16 (40%) patients, but only 3 of these patients had “Popeye Sign” findings.Conclusion: Tenotomy for the treatment of biceps tendon pathologies associated with rotator cuff tear may be an effective treatment method in terms of cost, pain relief and postoperative rehabilitation in the appropriate patient group.Keywords: Rotator cuff, long head of biceps, tenotomy, popeye sign.

Our understanding of the spectrum of rotator cuff disease continues to improve as imaging modalities and treatment techniques become more refined. The original ideas and contributions provided by Codman and Neer continue to inform our understanding. Unfortunately, high-quality data on the management of partial-thickness rotator cuff tears are relatively lacking in the literature when compared with those available on full-thickness tears. This is particularly important because the estimated prevalence of partialthickness rotator cuff tears is significant and can be expected to increase in light of our aging population and the association between increasing age and rotator cuff pathology. There remains a lack of long-term outcome studies; however, short-term follow-up studies provide us with important information regarding the difference between bursaland articular-sided partial-thickness tears. Our overall understanding of the anatomy, biomechanics, and potential etiologies of partial-thickness tears continues to improve.

Resume Depuis pres de 15 ans, l’arthro-IRM est devenue la methode d’imagerie de reference de l’epaule. Les publications la concernant sont nettement plus nombreuses que celles portant sur l’IRM ou surtout l’arthroscanner. Pourtant, sa superiorite diagnostique varie en fonction du cadre nosologique et un bilan radioclinique precis est necessaire avant d’en poser l’indication. Chez le patient jeune et sportif ou les lesions sont en general de petite taille, l’arthro-IRM est plus precise que l’IRM et plus exhaustive que l’arthroscanner. De plus, son caractere non irradiant est indiscutablement un avantage, en particulier chez les femmes. Chez les patients âges chez qui l’on suspecte une rupture de coiffe, la valeur diagnostique ajoutee n’est pas significative et l’absence d’irradiation un bien faible avantage au vu de ses inconvenients : cout eleve, contraintes logistiques, penibilite superieure a l’arthroscanner. L’arthro-IRM est donc loin d’etre justifiee dans tous les cas. Le but de cet article est de rappeler l’interet de cette methode d’imagerie, expliciter ses differents aspects techniques, discuter sa valeur diagnostique par rapports aux autres methodes et preciser ses indications.

An arthroscopic modified margin convergence technique using suture anchors may be effective in achieving footprint reconstruction of the rotator cuff by avoiding undue tension in patients with mobile or partially mobile massive rotator cuff tears.

Resume Notre objectif a ete de determiner le devenir fonctionnel et le retentissement sur la qualite de vie a long terme des ruptures de la coiffe des rotateurs ayant beneficie d’un traitement conservateur et d’etudier les correlations entre l’amelioration algofonctionnelle et celle de la qualite de vie. Materiel et methodes Il s’agit d’une etude prospective portant sur les patients ayant consulte notre service, durant la periode allant de janvier 1995 a decembre 2004 pour rupture de la coiffe des rotateurs confirmee radiologiquement et ayant beneficie d’un traitement medical associe a des exercices de reeducation. L’evaluation realisee avant traitement et au recul final de l’etude a comporte une evaluation de la douleur, de la mobilite articulaire, de la force musculaire, de la fonction par l’indice de Constant et de la qualite de vie par l’echelle SF-36. Resultats Il s’agit de 38 femmes et 21 hommes, d’âge moyen 61ans (46–75 ans). L’evaluation finale a ete realisee avec un recul moyen sept ans (quatre a 12 ans). L’EVA douleur moyenne est passe de 68,3 ± 31 a 28,3 ± 12 ( p −3 ) au repos et de 82,5 ± 36 a 40,3 ± 15 a l’effort. Toutes les amplitudes articulaires actives ont ete ameliorees a l’evaluation finale ( p −3 ). Le score de « Constant modifie » est passe de 28,8 ± 14,2 a 51,6 ± 21,8. Le score de qualite de vie SF36 a ete ameliore de 16 %. A l’evaluation finale de l’etude, 62,7 % des patients etaient satisfaits et tres satisfaits. L’evolution a ete jugee bonne a tres bonne pour 42 patients (71,8 %). L’amelioration de la qualite de vie parait bien correlee a la diminution de la douleur au repos ( r = 0,62) et a l’effort ( r = 0,59) et a l’amelioration du score de Constant. Conclusion Nos resultats soulignent l’interet d’un programme individualise de reeducation associe a un traitement medical aussi bien sur la douleur, la fonction et sur qualite de vie dans les ruptures de la coiffe des rotateurs a court et a long terme.

Resume Les ruptures transfixiantes de la coiffe des rotateurs associees a une luxation recidivante anterieure posent un probleme therapeutique. Faut-il traiter l’instabilite et la rupture de coiffe dans le meme temps ou l’une des deux seulement ? A partir d’une serie retrospective, le but de ce travail etait d’apporter des elements de reponse. La serie comportait 27 patients et 28 epaules. L’âge moyen lors de la premiere luxation etait de 47 ans [16–65]. Le nombre moyen de luxations preoperatoires etait de 2,6 (1–20). Le delai moyen entre le premier episode et l’intervention chirurgicale etait de 6,1 annees. Une encoche de Malgaigne etait presente dans 96 % des cas, une fracture du bord antero-inferieur de la glene dans 53,5 % des cas et une arthrose glenohumerale stade 1 ou 2 dans 37,5 %. Tous les patients presentaient une rupture transfixiante de la coiffe : rupture isolee du supraepineux dans 43 % des cas, rupture supra- plus infraepineux dans 35 %, rupture supraepineux plus subscapulaire 4 % et une rupture des trois tendons dans 18 % des cas. En preoperatoire, le bilan clinique comportait un score de Constant ainsi qu’un bilan radiographique standard et un arthroscanner ou une IRM permettant d’evaluer le statut tendinomusculaire de la coiffe. Deux types d’interventions ont ete realisees ; soit traitement isole de l’instabilite par une butee de Trillat lorsque la coiffe n’etait pas reparable (19 cas), soit reparation tendineuse associee a une butee coracoidienne selon Latarjet-Patte modifiee (neuf cas). L’âge moyen des patients operes d’un Trillat etait de 59,3 ans alors qu’il etait de 40 ans pour les patients operes d’un Latarjet avec reparation de la coiffe. A la revision, les resultats sur l’instabilite et la coiffe etaient evalues avec les scores de Duplay et de Constant et un bilan radiographique standard etait realise. Les patients ont ete revus avec un recul moyen de 73,5 mois [24–178]. L’âge moyen au moment de la revision etait de 59,1 ans [30–74]. Le score de Duplay etait en moyenne de 88 [10–100] et le score de Constant de 78,1 points [35–99]. Subjectivement, 96 % des patients etaient satisfaits. Trois patients operes d’une butee de Trillat ont presente une recidive d’instabilite (16 %). Le bilan radiographique postoperatoire montrait une arthrose glenohumerale dans 64,3 % des cas. La difference d’âge a la revision entre les deux groupes de patients et les deux types d’intervention empechait toute comparaison valable concernant les resultats cliniques et radiologiques. L’absence de reparation de la coiffe etait justifie par l’etat de la coiffe tendinomusculaire et/ou la motivation et l’âge des patients. Cette attitude a conduit a un resultat fonctionnel moins bon et a un taux de recidive d’instabilite superieur. Nous n’avons jamais realise de reparation isolee de la coiffe sans traiter les lesions d’instabilite, cette option nous parait risquee, car tous nos patients presentaient des lesions capsulolabrales ou osseuses du bord antero-inferieur de la glene ; une recidive de luxation compromettrait la reparation de la coiffe. En cas de rupture de la coiffe des rotateurs associee a une instabilite anterieure chronique, les lesions d’instabilite anterieures sont presentes dans 92,5 % des cas. L’operation de Trillat, malgre un taux de recidive de 16 %, apporte des resultats fonctionnels satisfaisants en l’absence de reparation de coiffe. Lorsqu’elle est possible, la reparation associee de la coiffe est souhaitable.

BackgroundNumerous operative techniques have been described for the treatment of massive rotator cuff tears with severe retraction where anatomical repair is impossible.PurposeTo evaluate the outcome of massive rotator cuff tears repaired using the biceps interposition technique.Study DesignCase series; Level of evidence, 4.MethodsBetween April 2000 and April 2004, 31 shoulders with irreparable massive rotator cuff tears and associated degenerative lesions of the biceps tendon were included for analysis. Open procedures were performed in 15 cases (open group), while 16 patients underwent arthroscopic procedures (arthroscopic group). The mean follow-up period was 32 months (range, 24-67 months).ResultsThe overall University of California at Los Angeles score at the last follow-up was 31.1 points (range, 21-35). The clinical outcome was excellent in 15 (48.4%) and good in 13 (41.9%) cases. Three patients (9.7%) had poor outcome. There was 1 case of reoperation in the open group for a retear. The mean preoperative Constant score, which was 44.6 points (range, 8-70) in the open group and 51.8 points (range, 24-70) in the arthroscopic group, improved to 80.7 points (range, 37-88) in the former and 83.5 points (range, 57-96) in the latter. The University of California at Los Angeles score improved from preoperative means of 11.3 points (range, 6-16) and 13.6 points (range, 6-19) to 29.5 points (range, 9-33) and 32.6 points (range, 21-35), respectively. However, the differences between the scores in both the categories were not statistically significant ( P = .412 and .198, respectively). According to the postoperative repair integrity analyzed with use of magnetic resonance imaging in 14 of 16 cases with arthroscopic augmentation, 9 (64.3%) presented complete healing.ConclusionThe biceps tendon interposition technique for massive rotator cuff tears offers a possible improvement in the clinical outcomes and is comparable to that of conventional repair. As well, the augmentation technique using the tenotomized biceps as potential graft for rotator cuff tears is particularly useful in bridging the gap in immobile massive rotator cuff tears with posterior defects and retraction.

Ruptures of the rotator cuff are more frequent than generally assumed. Out of 25 patients with ruptures of the rotator cuff treated surgically, 17 were seen at follow-up investigations at least 6 months later. The procedure was successful in most cases. Should severe pains persist despite regular conservative treatment for 6--8 weeks, disturbing night rest of sports and working performance, and has the rupture been demonstrated by arthrography, surgical reconstruction should not be delayed as partial shoulder immobility diminishes postoperative results considerably. Long-term follow-up physiotherapy is a prerequisite for a lasting success.

This paper presents the results of surgery in a total of 43 cases of rupture of rotator muscle sheaths which were followed up. Surgery was carried out from a saber-cut incision (n = 24) and from a transacromial approach (n = 19). The follow-up period for the first group was 42.2 months, for the second 14.3 months. The procedures employed were, almost without exception, the Schuhnestel or continuous suture and transosseous fixation after McLaughlin. In Group I the results were very good and good in 22 patients (91.6%); results in two shoulders were poor. In Group II the results were somewhat poorer, with 76.5% very good and good results; this is attributable principally to the much shorter follow-up period. The poor results are analyzed. The coraco-acromial ligament was severed or resected in 22 cases. Neer acromioplasty is now performed routinely. The surgical approach appears to have no decisive influence on the result. Advantages and disadvantages of the various approaches are described. A particularly important factor is the small therapeutic team (surgeon and physiotherapist).

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 8 avril 2016

When primary repair of a massive rotator cuff tear is impossible, the lesion is called an irreparable rotator cuff tear. Treating irreparable rotator cuff tears is difficult as a result of the less satisfactory results and a higher retear rate. In addition, if massive rotator cuff rupture is left untreated, this complication frequently leads to cuff tear arthroplasty. Therefore, is would be helpful to change the concept of treatment from tissue repair and/or reconstruction to tissue regeneration. For tissue regeneration, the use of a scaffold is necessary. Based on the results of this experimental study, we concluded that the PGA sheet scaffold material allows for the regeneration of the tendon-to-tendon as well as tendon-to-bone interface in an animal model.