Rotator cuff disease. An arthroscopic view

An arthroscopic technique for full-thickness rotator cuff repair by transposition of the long head of biceps

Arthroscopic rotator cuff (RC) repair is now considered as an effective treatment for patients with symptomatic rotator cuff tears. We reported a new method for repairing a full-thickness RC tear by using the double-row technique with transposition of the long head of biceps (LHB). The novelty of this technique is using the long head of the biceps as an augmentation. The indication of this technique consists of two aspects including LHB lesions and RC tears. Three patients were enrolled. An ideal reconstruction of the anatomic footprint of the tendon and stabilization of glenohumeral joint was achieved after the double-row technique with the transposition of the long head of biceps. At 6-month postoperation, the mean VAS score was 1.23±0.15 and the mean Constant score was 88.00±9.17. Transposition of the long head of biceps is a choice for full-thickness RC tear. LEVEL OF EVIDENCE: IV, case series.

Outcomes of combined arthroscopic rotator cuff and labral repair

BACKGROUND

Rotator cuff tears, Bankart lesions, and superior labral anterior posterior lesions commonly occur in isolation, but there is a subgroup of patients who experience combined injuries. Prior studies have excluded such patients as confounding groups.

HYPOTHESIS

In patients with combined lesions of the labrum and rotator cuff, arthroscopic repair of both lesions will restore range of motion and stability and provide good clinical results.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

We retrospectively evaluated the clinical outcomes of a series of patients with combined rotator cuff and labral (Bankart or superior labral anterior posterior) lesions treated arthroscopically.

RESULTS

Thirty patients (average age, 47.8 years) with combined rotator cuff and labral lesions were evaluated at a mean follow-up of 2.7 years (range, 24-54 months). Sixteen patients had Bankart lesions and 14 patients had SLAP lesions. Significant improvements in forward flexion (20.5 degrees, P = .005), external rotation (9.0 degrees, P = .008), and internal rotation (2 vertebral levels, P = .016) were observed. The mean L'Insalata and American Society of Shoulder and Elbow Surgeons scores for all patients were 92.9 and 94.3, respectively. Twenty-seven (90%) patients reported satisfaction as good to excellent, and 23 of 30 (77%) returned to their preinjury level of athletics. Two patients suffered recurrent rotator cuff tears.

CONCLUSION

In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction.

Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results

PURPOSE

The purpose of this study is to describe the technique and review the preliminary results of arthroscopic repair of massive, contracted, immobile rotator cuff tears using an interval slide technique.

TYPE OF STUDY

Case series.

METHODS

From January 1999 to December 2000, the senior author (S.S.B.) performed arthroscopic rotator cuff repair on 94 massive rotator cuff tears. Of these, 9 (9.6%) were massive, severely contracted rotator cuff tears and required repair using an interval slide technique. A single interval slide was used in 6 patients, and a double interval slide was used in 3 patients. All patients were evaluated preoperatively and postoperatively using a modified University of California Los Angeles (UCLA) scoring system.

RESULTS

At a mean follow-up time of 17.9 months (range, 10-24 months), 8 of 9 patients were satisfied with the procedure. The mean UCLA score increased from 10.0 preoperatively to 28.3 postoperatively (P <.00001). All patients showed some improvement in active motion, strength, or function. Active forward flexion improved significantly, from a preoperative mean of 108 degrees to a postoperative mean of 146.1 degrees (P =.025). Active external rotation increased significantly from a preoperative mean of 24.4 degrees to a postoperative mean of 35.0 degrees (P =.04). A significant increase in strength grade (2.2 to 3.6; P <.005) and function (2.5 to 7.1; P <.0005) were also seen. We encountered no significant complications to the procedure.

CONCLUSIONS

The interval slide technique provides a method of mobilization of massive, severely contracted, immobile rotator cuff tears allowing repair of previously irreparable tears. This technique, in conjunction with arthroscopic rotator cuff repair, may provide patients with improvements in pain, motion, strength, and overall shoulder function.

LEVEL OF EVIDENCE

Level IV.