Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon

BACKGROUND

Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial.

PURPOSE

To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects.

RESULTS

From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups.

CONCLUSION

Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.

Concordance of shoulder strength assessments using a spring balance and isometric dynamometer in patients before and after arthroscopic rotator cuff repair

Background

Shoulder strength is an essential assessment to monitor the outcome of treatment interventions. Isometric strength assessment in the Constant Score (CS) was initially measured with a cable tensiometer or spring balance (SB). Some authors have questioned the validity of this strength assessment and the resulting CS. The purpose of this study was to investigate the concordance of strength measurements using an unsecured SB vs. isometric dynamometer and outline the impact of these methods on the CS.

Methods

In the context of routine clinical examination as well as participation in a Swiss national cohort study, shoulder strength was measured to calculate baseline (before surgery) and 6-month postoperative CS in adult rotator cuff tear patients who had undergone primary arthroscopic rotator cuff repair. Measurements of each of the operated and contralateral shoulders were made per patient routinely using an unsecured SB and study-specific using an isometric dynamometer in patients with the shoulder at 90° abduction in the scapular plane. Absolute and change values of strength and CS data were presented in scatter plots and assessed using concordance correlation coefficients (CCCs) and Bland-Altman plots.

Results

Between June 2020 and October 2021, baseline strength measurements from the operated shoulder of 78 patients ranged from 0.0 to 13.6 kg with a CCC of 0.64 (P < .001) and a mean difference of 0.81 kg between the SB and dynamometer methods. There were 89 measurements of the contralateral healthy shoulder that ranged from 3.6 to 15.6 kg; CCC and mean strength difference were 0.76 (P < .001) and 0.70 kg, respectively. At 6 months postsurgery, strength measurements of the operated shoulder ranged from 1.4 to 12.0 kg with a CCC of 0.66 (P < .001) and mean strength difference of 0.9 kg (n = 68). Respective 6-month measurements of the contralateral side (n = 52) ranged from 2.0 to 15.9 kg with a CCC of 0.73 (P < .001) and mean strength difference of 0.03 kg.

Conclusion

Absolute and change values in shoulder strength assessments using an unsecured SB and isometric dynamometer are fairly concordant with mean differences of less than 1 kg between methods. With the variability of strength differences among patients, interpretation of these values for individual patients may be challenging. Nonetheless, unsecured SB and dynamometer methods share only slight and clinically unimportant differences that can provide similar group mean values for use in research along with the calculation of the CS.

Biceps Smash Technique: Biceps Tendon Autograft Augmentation for Arthroscopic Rotator Cuff Reconstruction

The proportion of postoperative retears after arthroscopic rotator cuff reconstruction remains constant despite advancement of suture techniques and improved anchor implants. The commonly degenerative nature of rotator cuff tears can carry the risk of compromised tissue. Several techniques have been developed to biologically enhance rotator cuff repair, and a considerable number of autologous, allogeneic, and xenogenous augmentation methods have been described. This article introduces the biceps smash technique, an arthroscopic augmentation procedure for posterosuperior rotator cuff reconstruction using an autograft patch of the long head of the biceps tendon.

[Treatment of subscapularis tendon lesions]

The further development of minimally invasive techniques in recent years, enables adequate intraoperative visualization, mobilization and stable reconstruction even of larger subscapularis tears resulting in good to excellent clinical and structural results. Chronic tears of the subscapularis tendon with high grade muscle atrophy and advanced fatty infiltration can be treated with a muscle tendon transfer (e.g. pectoralis major or latissimus dorsi transfer). If pseudoparalysis and/or signs of anterosuperior decentration of the humeral head or defect arthropathy are present, in most cases a reverse shoulder arthroplasty represents the only surgical option.

[Anatomy and diagnostics of subscapularis tendon lesions]

Among lesions of the rotator cuff, subscapularis tendon tears are one of the less common injuries and mostly occur in combination with additional lesions of the posterosuperior rotator cuff and the long biceps tendon. If a subscapularis tendon rupture is suspected in the initial clinical testing, the primary diagnostics should include modern cross-sectional magnetic resonance imaging to assess the tendon lesion and to detect concomitant pathologies. Nevertheless, subscapularis tendon lesions are often initially overlooked and first correctly diagnosed during shoulder arthroscopy.

Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures-A Retrospective Cohort Study

Head-split fractures are proximal humerus fractures (PHF) that result from fracture lines traversing the articular surface. While head-split fractures are rare, surgical treatment of these complex injuries can be extremely challenging and is associated with high rates of complications. Treatment using primary reverse shoulder arthroplasty (RSA) has been associated with moderate complication rates and reproducible clinical results. The aim of this study was to evaluate clinical and radiographic outcomes, and complication rates of RSA for head-split PHF. Twenty-six patients were evaluated based on Constant Score (CS) and range of motion of both shoulders and Subjective Shoulder Value (SSV). Radiographic analysis evaluated tuberosity healing, prosthetic loosening and scapular notching. Patients achieved good clinical results with a CS of 73.7 points and SSV of 82% after a mean follow-up of 50 months. The relative CS comparing operated versus the unaffected shoulder was 92%. Greater tuberosity healing was achieved in 61%. Patients who suffered a high-energy trauma reached a significantly greater functional outcome. Patients who suffered multifragmentation to the humeral head performed the worst. There were no cases of loosening; scapular notching was visible in two cases. The complication rate was 8%. RSA is an adequate treatment option with for head-split PHF in elderly patients.

Lateralized vs. classic Grammont-style reverse shoulder arthroplasty for cuff deficiency Hamada stage 1-3: does the design make a difference?

BACKGROUND

Reverse shoulder arthroplasty (RSA) with a lateralized design is thought to improve outcomes. Our aim was to compare RSA with the classic Grammont prosthesis against a prosthesis with 135° inclination and a lateralized glenosphere for cuff-deficient shoulders.

METHODS

Patients with irreparable massive posterosuperior rotator cuff tear Hamada grade 1-3 underwent RSA and were documented prospectively up to 24 months postsurgery. Comparative RSA groups were "lateralized" (L), with 135° humeral inclination and 36+4-mm lateralized glenosphere (n = 44), and "Grammont" (G), with 155° humeral inclination and 36+2-mm eccentric glenosphere (n = 23). Range of motion including the Apley scratch test, abduction strength, Constant-Murley score (CS), and Shoulder Pain and Disability Index (SPADI) were assessed. Anteroposterior and axial radiographs were evaluated at 24 months, and additional measurements of scapular neck and glenoid anatomy, baseplate and glenosphere position, center of rotation, humeral offset, and lateralization and distalization shoulder angles were made. Linear regression and mixed models adjusted for sex differences and preoperative values were applied.

RESULTS

Overall CS and SPADI outcomes were not significantly different between groups (P ≥ .654). For group L, external rotation remained stable up to the 2-year follow-up and was higher than for group G (P = .012 ); a greater proportion of group L patients could reach the lumbar vertebra 3 (L3) (70% vs. 48% in group G) (P = .26). Group G had a higher inferior glenosphere overhang (P = .020) and center of rotation (COR) medialization (P < .001), whereas group L had higher humeral offset (P < .001) and lateralization shoulder angle (P < .001) with a trend toward higher baseplate positioning (P = .045). The rate of scapular notching was 2.9 times higher for group G than group L (P = .001).

CONCLUSION

RSA with 135° humeral inclination and a lateralized glenosphere shows similar outcome scores as the classic Grammont design but enables better preservation of external rotation and reduces the rate of scapular notching compared with the classic Grammont design in Hamada 1-3 patients with irreparable posterosuperior tears.