Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated fact...Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, costeffective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.展开更多
Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon follow...Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.Methods We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of(54.7±11.4)years from March 2013 to July 2017.Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study.The tears were confirmed via arthroscopy,and a polydioxanone suture was placed to indicate the position of each tear.A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear.The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor.Data were analyzed using a paired Student’s t-test with statistical significance defined as p<0.05.Results At the final follow-up of 2 years,the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery(p<0.001).The postoperative American Shoulder and Elbow Surgeons shoulder score was(90.6±6.2),which was significantly higher than the preoperative score of(47.9±8.3)(p<0.001).The University of California at Los Angeles shoulder rating scale score increased from(14.7±4.1)prior to surgery to(32.6±3.4)points after surgery(p<0.001).No patient had joint stiffness.Conclusion This modified tear completion repair,by conversion to full-thickness tears through a small incision,has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions.This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.展开更多
Background： Partial-thickness rotator cufftears （PTRCTs） are being diagnosed more often because of high-resolution magnetic resonance imaging （MRI）. Compared with articular and bursal side tears, there have been ...Background： Partial-thickness rotator cufftears （PTRCTs） are being diagnosed more often because of high-resolution magnetic resonance imaging （MRI）. Compared with articular and bursal side tears, there have been few studies about evaluating the clinical and structural outcomes after intratendinous tear repair. Methods： From 2008 to 2012, 33 consecutive patients with intratendinous PTRCTs underwent arthroscopic repair. All of them were retrospectively evaluated. The University of California at Los Angeles （UCLA） and constant scores were evaluated before operation and at the final follow-up. Postoperative cuff integrity was determined using MRI according to Sugaya＇s classification. Results： At the 2-year follow-up, the average UCLA score increased from 16.7± 1.9 to 32.5± 3,5, and the constant score increased from 66.2 ± 10.5 to 92.4 ± 6.9 （P 〈 0.001）. Twenty seven patients received follow-up MRI examinations at an average of 15.2 months after surgery. Of these 27 patients, 22 （81.5%） had a healed tendon, and five patients had partial tears. There was no association between functional and anatomic results. Conclusions： For intratendinous PTRCT, clinical outcomes and tendon healing showed good results at a minimum 2-year after arthroscopic repair.展开更多
文摘Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, costeffective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.
基金This paper is supported by Zhejiang Medical and Health Science and Technology Project(2019RC309)Taizhou Science and technology plan project(1701ky49).
文摘Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.Methods We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of(54.7±11.4)years from March 2013 to July 2017.Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study.The tears were confirmed via arthroscopy,and a polydioxanone suture was placed to indicate the position of each tear.A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear.The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor.Data were analyzed using a paired Student’s t-test with statistical significance defined as p<0.05.Results At the final follow-up of 2 years,the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery(p<0.001).The postoperative American Shoulder and Elbow Surgeons shoulder score was(90.6±6.2),which was significantly higher than the preoperative score of(47.9±8.3)(p<0.001).The University of California at Los Angeles shoulder rating scale score increased from(14.7±4.1)prior to surgery to(32.6±3.4)points after surgery(p<0.001).No patient had joint stiffness.Conclusion This modified tear completion repair,by conversion to full-thickness tears through a small incision,has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions.This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.
文摘Background： Partial-thickness rotator cufftears （PTRCTs） are being diagnosed more often because of high-resolution magnetic resonance imaging （MRI）. Compared with articular and bursal side tears, there have been few studies about evaluating the clinical and structural outcomes after intratendinous tear repair. Methods： From 2008 to 2012, 33 consecutive patients with intratendinous PTRCTs underwent arthroscopic repair. All of them were retrospectively evaluated. The University of California at Los Angeles （UCLA） and constant scores were evaluated before operation and at the final follow-up. Postoperative cuff integrity was determined using MRI according to Sugaya＇s classification. Results： At the 2-year follow-up, the average UCLA score increased from 16.7± 1.9 to 32.5± 3,5, and the constant score increased from 66.2 ± 10.5 to 92.4 ± 6.9 （P 〈 0.001）. Twenty seven patients received follow-up MRI examinations at an average of 15.2 months after surgery. Of these 27 patients, 22 （81.5%） had a healed tendon, and five patients had partial tears. There was no association between functional and anatomic results. Conclusions： For intratendinous PTRCT, clinical outcomes and tendon healing showed good results at a minimum 2-year after arthroscopic repair.
