Alteration of coracoacromial ligament thickness at the acromial undersurface in patients with rotator cuff tears

Does the Timing of the Initiation of Physical Therapy Post-Rotator Cuff Repair Impact Shoulder Function?

Background

Rehabilitation typically restores shoulder function after a common rotator cuff repair; however, it is unclear when to initiate physical therapy (PT) post-surgery. To understand effective start times, this study analyzed PT start times and their effect on shoulder function. The most effective shoulder outcomes were hypothesized to occur when PT started 0-4 weeks post-surgery.

Methods

Data from 1002 patients who underwent rotator cuff repair were analyzed retrospectively from 52 outpatient clinics in the years of 2016-2021. The primary data of timings between surgery and the start of PT (0-2 weeks [0-14 days], 2-4 weeks [15-28 days], 4-6 weeks [29-42 days], and 6-14 weeks [43-100 days]), change in functional shoulder scores, number of PT visits utilized, and functional scores changed per visit were analyzed. Regression analyses of the impact of age, sex, payor source, and tear size were completed.

Results

The change in functional scores and functional scores changed per visit are not affected by the initiation timing of PT post- rotator cuff surgery, when controlling for baseline functional scores. This result is revealed despite initial functional scores being significantly different. Functional scores change per visit may have been affected by payor source (R 2 = 0.004, p ≤ 0.010). PT start times may have been impacted by age (R 2 = 0.010, p = 0.007), payor source (R 2 = 0.016, p = 0.001), and tear size (R 2 = 0.007, p = 0.026). Payor source may have influenced the number of PT visits (R 2 = 0.060, p < 0.001).

Conclusions

After rotator cuff surgery, patients should choose to complete rehabilitation to optimize shoulder function. However, the initiation timing of PT may not affect functional shoulder outcomes.

Association Between Rotator Cuff Tears and Shoulder MRI Parameters: Importance of Arthroscopic Validation in Coronal Acromiohumeral Interval Measurement

Background

Magnetic resonance imaging (MRI) measurement parameters-the standard noninvasive diagnostic method for rotator cuff tears (RCTs)-have been used to compare groups with and without RCTs. Arthroscopy is used in definitive diagnosis and treatment.

Purposes

To evaluate the association between RCT and shoulder angles and distances on MRI in patients with and without arthroscopically validated RCT and to determine whether the degree of rotator cuff fatty degeneration affects the MRI measurements.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Shoulder measurements on MRI were compared between patients with and without RCT as confirmed by shoulder arthroscopy performed by a single surgeon between 2019 and 2024, and non-RCT patients without arthroscopic confirmation. Interobserver reliability (Fleiss kappa coefficient) was calculated for the measurements. The groups were compared using the independent t test or the Mann-Whitney U test. The RCT group was further divided according to the level of fatty degeneration (Goutallier types 0-1-2 vs types 3-4) for subanalysis.

Results

In addition to the 368 RCT and 55 non-RCT patients with arthroscopic confirmation, there were 92 non-RCT patients without arthroscopic confirmation. The sagittal acromiohumeral interval (AHI) (8.32 vs 9.24 mm), coronal AHI (7.87 vs 8.96 mm), and coronal AHI/glenoid height ratio (22.63% vs 24.88%) were significantly lower in the patients with RCT (P < .001, P < .001, and P = .001, respectively). In contrast, the critical shoulder angle (CSA) (33.17° vs 31.92°) and the glenoid width/humeral head coverage ratio (57.52% vs 55.7%) were significantly higher in the patients with RCT (P = .037 and P = .017, respectively). Higher rotator cuff fatty degeneration levels (Goutallier types 3-4) further increased these differences within the patients with RCT (P < .001 for all). When the arthroscopically validated and nonvalidated non-RCT patients were compared, coronal AHI and AHI/glenoid height ratio values were found to be significantly lower in the nonvalidated group (P = .034 and P = .047, respectively).

Conclusion

In this study, RCT was associated with decreased sagittal AHI, coronal AHI, and coronal AHI/glenoid height ratios and increased CSA and glenoid width/humeral head coverage ratios.

Can coracoacromial ligament degeneration be evaluated with preoperative MRI?

BACKGROUND

Subacromial impingement syndrome is one of the most common causes of painful shoulder in the middle-aged and elderly population. Coracoacromial ligament (CAL) degeneration is a well-known indicator for subacromial impingement.

PURPOSE

To examine the relationship between CAL thickness on preoperative magnetic resonance imaging (MRI), arthroscopic CAL degeneration and types of rotator cuff tears.

MATERIAL AND METHODS

Video records of patients who underwent arthroscopic shoulder surgery between 2015 and 2021 were retrospectively scanned through the hospital information record system. In total, 560 patients were included in this study. Video records of the surgery were used to evaluate the grade of coracoacromial ligament degeneration and the type of cuff tear. Preoperative MRI was used to measure CAL thickness, acromiohumeral distance, critical shoulder angle, acromial index, and acromion angulation.

RESULTS

Significant differences were observed between grades of CAL degeneration in terms of CAL thickness (P < 0.001). As CAL degeneration increases, the mean of CAL thickness decreases. According to the results of post-hoc analysis, the mean CAL thickness of normal patients was significantly higher than those of patients with full-thickness tears (P = 0.024) and massive tears (P <0.001). Patients with articular-side, bursal-side, and full-thickness tears had significantly higher CAL thickness averages than patients with massive tears.

CONCLUSION

This study showed that the CAL thickness decreases on MRI as arthroscopic CAL degeneration increases. High-grade CAL degeneration and therefore subacromial impingement syndrome can be predicted by looking at the CAL thickness in MRI, which is a non-invasive method.

Association of Coracoacromial Ligament Degeneration With Rotator Cuff Tear Patterns and Retear Rate

Background

Coracoacromial ligament (CAL) degeneration is thought to be a factor in external impingement in bursal-sided rotator cuff tears, but CAL release is associated with adverse effects.

Purpose

To investigate the association between CAL degeneration and the patterns of massive rotator cuff tears using multiple modalities and to assess the effect of CAL degeneration on supraspinatus tendon retear rates.

Study Design

Cohort study; Level of evidence, 2.

Methods

The authors prospectively recruited 44 patients who had undergone arthroscopic rotator cuff repair without acromioplasty or CAL release. Preoperative radiographs and magnetic resonance imaging (MRI) scans were reviewed to determine acromial morphology and CAL thickness, respectively. Rotator cuff tears were categorized as isolated supraspinatus or massive (involvement of ≥2 tendons), with massive tears categorized using the Collin classification. Acromial degeneration was analyzed using the Copeland-Levy classification. The CAL was biopsied intraoperatively and histologically analyzed using the Bonar score. At 6-month follow-up, the integrity of the repaired supraspinatus tendon was analyzed on MRI using the Sugaya classification. Finally, the associations among CAL degeneration, rotator cuff tear pattern, and arthroscopic grading were investigated.

Results

Patients with Collin type B rotator cuff tear had significantly higher CAL Bonar scores than those with Collin type A or isolated supraspinatus tears (10.0 vs 6.8 and 3.4; P = .03 and P < .001, respectively). Patients with a degenerative acromial undersurface of Copeland-Levy stage 2 or 3 had CALs with significantly higher Bonar scores than those with an intact acromial undersurface (8.4 and 8.2 vs 3.5; P = .034 and P = .027, respectively). The CAL Bonar scores of patients with different stages of the 6-month postoperative Sugaya classification were comparable (6.5, 7.2, 8.0, and 7.8 for stages 1, 2, 3, and 4, respectively; P = .751).

Conclusion

CAL degeneration was more severe in anterosuperior-type massive rotator cuff tears. Interestingly, even without acromioplasty, the severity of CAL degeneration did not affect the retear rate of the supraspinatus tendon.

[Short-term safety and effectiveness of domestic polyether-ether-ketone suture anchors for rotator cuff repair: A multicenter, randomized, single-blind, parallel-controlled noninferiority study]

OBJECTIVE

A multicenter, randomized, single-blind, parallel-controlled noninferiority study was used to evaluate the short-term safety and effectiveness of domestic polyether-ether-ketone (PEEK) suture anchor for rotator cuff repair by comparing with the imported PEEK suture anchor commonly used in clinical practice.

METHODS

A total of 59 patients with rotator cuff tears who were admitted between May 2019 and October 2019 were selected as the research objects. Among them, 3 patients were excluded because they did not meet the selection criteria, and 1 patient withdrew from the study because of serious adverse events. A total of 55 patients were included in the study. They were randomly divided into trial group ( n=27) and control group ( n=28). The trial group used PEEK suture anchors produced from REJOIN Company, and the control group used PEEK suture anchors from American Arthrex Company. Two patients in control group were lost to follow-up. Twenty-seven patients in trial group and 26 patients in control group were included in the final quantitative analysis. There was no significant difference ( P>0.05) in gender, age, disease duration, side and sizes of rotator cuff tears, composition ratio of patients with type 2 diabetes, and preoperative American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California at Los Angeles (UCLA) score, and visual analogue scale (VAS) score. The patients were followed up regularly after operation. The postoperative follow-up included safety evaluation (complications, anchor position, and anchor bone reaction) and effectiveness evaluation (shoulder joint function and pain scores, rotator cuff integrity based on Sugaya classification criteria).

RESULTS

The operations in both groups were successfully completed, and there was no complication related to the operation and suture anchor. All incisions healed by first intention. There was no significant difference in follow-up time between trial group [(5.85±0.77) months] and control group [(5.96±0.72) months] ( t=0.535, P=0.595). MRI examination indicated that the repaired tendons were fixed and the anchors did not get loose or torn. At 1 day, 3 months, and 6 months after operation, there was no patient with grade 3-4 anchor bone reaction in the two groups, and there was no significant difference in the bone reaction grading between groups ( P>0.05). After operation, the VAS scores of the two groups gradually decreased, and the ASES scores, Constant-Murley scores, and UCLA scores gradually increased, and there were significant differences between groups at each time point ( P<0.05). There was no significant difference between groups at different time points ( P>0.05). There was no significant difference in Sugaya classification of rotator cuff integrity at 1 day, 3 months, and 6 months after operation between groups ( P>0.05).

CONCLUSION

The short-term safety and effectiveness of domestic PEEK suture anchors in rotator cuff tear repair are not significant different from those of imported PEEK suture anchors commonly used in clinical practice.