Background: Tuberoplasty is a therapeutic option for irreparable massive rotator cuff tear (RCT). However, no study has reported long-term outcomes after arthroscopic tuberoplasty.
Methods: We evaluated 16 patients who underwent arthroscopic tuberoplasty for symptomatic irreparable massive RCT without pseudoparalysis. Patients were a mean age of 64 years (range, 43-80 years) at the time of the operation, and the mean duration of follow-up was 98 months (range, 84-126 months).
Results: At the last follow-up, the visual analog scale score for pain during motion had decreased to 2.3 from a preoperative mean of 6.9 (P < .001). The mean University of California at Los Angeles and Constant scores improved from 10.3 and 37.9 preoperatively to 27.2 and 59.2, respectively, at the last follow-up (P < .001 for both). The best University of California at Los Angeles (UCLA) and Constant scores during the follow-up duration were 28.3 and 60.3, respectively, at 5 years. The mean acromiohumeral interval changed from 5 mm preoperatively to 4 mm at the last follow-up. The rate of continuity in the inferior scapulohumeral line decreased significantly from 69% (11 shoulders) preoperatively to 19% (3 shoulders) at the last follow-up (P = .011). Only 1 patient underwent revision surgery.
Conclusions: Arthroscopic tuberoplasty yielded satisfactory outcomes during a mean 8-year follow-up period. Although superior migration of the humeral head progressed with time, the clinical outcomes were not affected. Arthroscopic tuberoplasty is a good option for relieving pain and improving functionality in nonpseudoparalytic patients with painful irreparable massive RCT.
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http://dx.doi.org/10.1016/j.jse.2015.07.025 | DOI Listing |
Am J Sports Med
January 2025
Sports Medicine Center, Department of Orthopaedic Surgery/Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Background: Traditional superior capsular reconstruction (SCR) with biceps tendon transposition (TB) alone for irreparable massive rotator cuff tears (IMRCTs) has demonstrated a high retear rate, highlighting the need for alternative approaches. Therefore, SCR using a peroneus longus tendon graft (PLG) combined with TB (PLG-TB) should be clinically studied.
Purpose: To compare the clinical and radiological outcomes of SCR using the PLG-TB technique versus the TB technique alone for IMRCT.
The management of massive irreparable rotator cuff tears is commonly debated without consensus. With reverse shoulder arthroplasty often reserved for the older patient (older than 60 years) with rotator cuff arthropathy, treatment of the younger patient population (younger than 60 years) without arthritis is more complex. When determining a surgical approach, the clinical presentation including history and physical examination plays a vital role in the decision tree.
View Article and Find Full Text PDFKnee Surg Sports Traumatol Arthrosc
December 2024
Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Purpose: To explore if recentering the humeral head could improve shoulder abduction in shoulders with irreparable massive rotator cuff tears (IMRCTs).
Methods: Nine fresh-frozen cadaveric shoulders were used to simulate the intact condition and IMRCTs as controls. Four 'recenter' interventions were then sequentially applied: subacromial interposition (SI) using 4- and 8-mm spacers and superior capsule reconstruction (SCR) using two- and four-layer fascia lata grafts.
Arthroscopy
December 2024
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
Purpose: To evaluate the minimum 12-month clinical and radiological outcomes of combined superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) for posterosuperior irreparable massive rotator cuff tears (IMRCTs).
Methods: Patients with posterosuperior IMRCTs and severe fatty infiltration (Goutallier grades 3 or more) in the infraspinatus who underwent SCR +LTT were retrospectively reviewed. A double-folded fascia lata autograft with one layer of polypropylene mesh inside was used for SCR and an Achilles tendon allograft was used to connect the tendon of lower trapezius to the greater tuberosity.
Orthop J Sports Med
December 2024
Oregon Shoulder Institute, Medford, Oregon, USA.
Background: Despite the effectiveness of reverse total shoulder arthroplasty (RSA) and arthroscopic rotator cuff repair (ARCR) for treating massive rotator cuff tears (MRCTs), controversies remain in patients without glenohumeral osteoarthritis (GHOA).
Purpose: To compare clinical outcomes of ARCR or RSA in patients with MRCT with high-grade fatty atrophy without GHOA.
Study Design: Cohort study; Level of evidence, 3.
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