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; = .03 and < .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; = .034 and = .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; = .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.
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http://dx.doi.org/10.1177/23259671231175873 | DOI Listing |
Arthrosc Tech
November 2024
The Second Affiliated Hospital, Department of Joint Surgery, Hengyang Medical School, University of South China, Hengyang, China.
At present, suture bridge is a feasible choice in the treatment of massive rotator cuff tears (MRCTs). However, high tension on the repair site and medial tension during suture tightening and after medial knotting are unavoidable problems in MRCT repair with a suture bridge. Arthroscopic V-shaped double-pulley suture-bridge repair is a pragmatic surgical technique for the repair of MRCTs.
View Article and Find Full Text PDFArthrosc Tech
November 2024
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
Rotator cuff tear is a common type of injury. For the treatment of rotator cuff tears, arthroscopic surgery is widely used. However, for massive rotator cuff tears, the rate of recurrent tears after arthroscopic surgical repair is higher.
View Article and Find Full Text PDFOrthop J Sports Med
December 2024
Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
Background: Young athletes who undergo surgery for a rotator cuff tear (RCT) are expected to return to sports (RTS) at the preinjury level.
Purpose: To determine the rate and level of RTS and associated factors after RCT surgery in young athletes.
Study Design: Systematic review; Level of evidence, 4.
Orthop J Sports Med
December 2024
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Background: The effects of the erector spinae plane (ESP) block and interscalene nerve block (ISNB) on arthroscopic rotator cuff repair (RCR) have been investigated separately.
Purpose: To evaluate whether additional catheterization for the ESP block can decrease acute postoperative pain and opioid consumption above the ISNB and multimodal oral analgesics in patients after arthroscopic RCR.
Study Design: Cohort study; Level of evidence, 3.
Orthop J Sports Med
December 2024
Department of Orthopaedics, Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, India.
Background: Atrophy and fatty infiltration of the supraspinatus (SS) muscle are prognostic indicators of poor functional outcomes and higher retear rates after rotator cuff repair. While older patients, female patients, and those with massive and retracted rotator cuff tears are at a higher risk for these indicators, it is unclear whether tear characteristics, acromion morphology, and acromioclavicular (AC) joint arthritis affect SS atrophy in older patients with chronic shoulder pain.
Purpose: To investigate the multifactorial influences associated with SS atrophy in rotator cuff tears.
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