• Clinics in Shoulder and Elbow
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• v.17 no.4
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• pp.166-174
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• 2014

Background: Our study was to determine the effect on shoulder isokinetic muscle strength and muscle endurance in isolated full-thickness supraspinatus tendon tear and combined other rotator cuff tear. Methods: Total of 81 male patients (mean age $57.8{\pm}7.4$ years) who were diagnosed as a full-thickness supraspinatus tendon tear were included. They were classified into isolated or combined tear. The isokinetic muscle strength and muscle endurance were measured using the Biodex multi-joint system $PRO^{(R)}$ (Biodex Medical Systems, Shirley, NY, USA) in following movements: shoulder abduction, adduction, flexion, extension, external rotation, and internal rotation. Then, the difference in muscle function according to the type of tears were assessed. Fifty-seven patients had isolated supraspinatus tendon (mean age $56.9{\pm}7.3$ years). They were classified into either anteroposterior tear or modified mediolateral tear. The size were measured using T2-weighted magnetic resonance imaging scans in sagittal plane. Results: Between subjects categorized into the type of tear, we found significant inter-categorical differences in isokinetic muscle strength during abduction, adduction, flexion, extension, and internal rotation, and in muscle endurance during flexion, extension, and internal rotation. Anteroposterior diameter tear, we did not show significant differences in either isokinetic muscle strength or muscle endurance during any movements. However, with modified mediolateral diameter, we found significant differences with isokinetic muscle strength during adduction, and in muscle endurance the external rotation and internal rotation. Conclusions: We found that a supraspinatus tendon tear associated with more numbers of rotator cuff tears has lower isokinetic muscle strength and muscle endurance than a tear found alone.

• Clinics in Shoulder and Elbow
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• v.21 no.1
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• pp.3-14
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• 2018

Background: Platelet-rich plasma (PRP) stimulates cell proliferation and enhances matrix gene expression and synthesis. However, there have been no comparative study of the PRP effect on the normal and degenerative tenocytes. The purpose of this study was to compare the effect of PRP on tenocytes from normal and degenerative tendon. Methods: Tendon tissues were obtained from patients undergoing arthroscopic repair (n=9) and from healthy donors (n=3). Tenocytes were cultured with 10% (vol/vol) platelet-poor plasma, PRP activated with calcium, and PRP activated with calcium and thrombin. The total cell number was assessed at days 7 and 14. The expressions of type I and III collagen, decorin, tenascin-C, and scleraxis were evaluated by quantitative real-time reverse transcriptase polymerase chain reaction. The total collagen and glycosaminoglycan (GAG) synthesis was evaluated at days 7 and 14. Results: No differences were observed between the groups at day 7, but cell proliferation was remarkably increased in tenocytes from the degenerative tendon at day 14. In both tenocyte groups, the gene expressions of type I and III collagen were up-regulated. GAG synthesis was greater in the normal tendon, whereas the expressions of decorin and tenascin-C were increased in tenocytes from the degenerative tendon. Tenocytes from the degenerative tendon had higher fold-change of GAG synthesis and a lower collagen III/I ratio than normal tenocytes. Conclusions: PRP promoted the cell proliferation and enhanced the synthesis of tendon matrix in both groups. PRP has a greater positive effect on cell proliferation, matrix gene expression and synthesis in tenocytes from degenerative tendon.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.90-95
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• 2008

Purpose: We wanted to assess the accuracy of ultrasound for detecting abnormality of the long head of the biceps tendon in patients with rotator cuff disorders. Materials and Methods: Between January 2006 and March 2007, we reviewed the arthroscopic findings of biceps tendons in 67 patients with rotator cuff disorder and who underwent ultrasonography pre-operatively. The patients' average age was 58 years and there were 41 males and 26 females. The statuses of the biceps tendons were described as 'normal', 'dislocation', 'subluxation', 'partial or complete tears', and 'tendinopathy'. We investigated the correspondence between the arthroscopic and ultrasonographic findings. Results: On ultrasonography, the biceps tendons were 'normal' in 37 patients and 'abnormal' in 30 patients. On arthroscopy, 5 biceps tendons turned out to have partial tears, which were 'normal' on ultrasonography. On the other hand, 8 biceps tendons were 'normal' which were 'abnormal' on ultrasonography. Three dislocations and 4 complete tears of biceps tendons were identified on arthroscopy, and all of them were detected by ultrasonography. Of the 20 cases of 'tendinopathy' seen on ultrasonography, 15 patients had partial tears and the remaining 5 patients were normal on arthroscopy. Conclusion: Ultrasonography is accurate for detecting some biceps pathologies, such as dislocation or complete tear, but it is not accurate for the detection of partial tear.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.50-57
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• 2006

Purpose: The purpose of this study was to evaluate the tendon healing of arthroscopic repair in full-thickness supraspinatus tears. We evaluate the effectiveness of the arthroscopic repair of full-thickness supraspinatus tears by assessing functional improvement. Materials and Methods: Thirty consecutive full-thickness supraspinatus tears were repaired arthroscopically in 19 patients with a one row of anchor and 11 patients with two rows of anchors. Patients ranged in age from 51 to 79 years (average 63 years). Average follow-up was 16 month (range, 12 to 28 months). To evaluate the effectiveness of the arthroscopic repair of full-thickness supraspinatus tears by assessing functional improvement, we calculate the Constant, ASES, UCLA scores. The 30 patients had either an MR Arthrogram (25 cases) or an MRI (5 cases), performed between 5 months and 20 months (mean 10 months) after surgery. Results: The cuff was healed in 21/30 cases (70%) and partially torn in 3 cases (10%) after the arthroscopic repair of full-thickness supraspinatus tear. Although the supraspinatus tendon was totally torn to the tuberosity in 6 cases(20%) after the arthroscopic repair, the size of the tear was smaller than the initial in 5 cases. The Constant score improved from an average of $55.7{\pm}7.1$ points preoperatively to $77.7{\pm}9.7$ points at the last follow-up (p<0.001), and the average ASES score improved from $39.2{\pm}7.4\;to\;72.4{\pm}12.6$ (p<0.001), and the average UCLA score improved from $17.9{\pm}2.2\;to\;26.8{\pm}5.0$ (p<0.001). Strength of elevation was significantly better $(7.1kgs{\pm}2.4)$ in the shoulders with a healed tendon that in those with an total or partial re-tear tendon $(4.5kgs{\pm}1.0)$ (p<0.05). Factors adversely affecting tendon healing were increasing age, Only 41.7% of the repairs completely healed in patients over 65 years (p<0.05). Conclusion: Arthroscopic repair of isolated full-thickness tear of the supraspinatus leads to completely healing in 70% of the cases. Total or partial re-tear of the repaired rotator cuff is associated with a decreased strength. Older patients had significantly lower healing rates.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.175-179
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• 2010

Purpose: Rotator cuff disease is the most common shoulder disease. Rotator cuff tear, which is related to cuff tendon degeneration, is commonly encountered in clinical practice. Materials and Methods: Knowledge about the biology of the normal rotator cuff is fundamental to understanding the pathophysiology of and degenerative processes in rotator cuff tendon tears. Furthermore, such basic knowledge provides a rationale for and facilitates the development of treatment modalities. Results and Conclusion: Therefore, we reviewed the biology of the normal rotator cuff tendon, theories to explain the pathophysiology of rotator cuff tendon tear, and current research on apoptosis of rotator cuff tenofibroblasts.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.79-85
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• 2010

Purpose: To evaluate the results from arthroscopic repair versus debridement for full-thickness tears of the upper subscapularis tendon. Materials and Methods: Ninety-nine patient outcomes were evaluated and compared prospectively. Sixty-nine patients with full-thickness tears of the upper subscapularis tendon underwent arthroscopic repair (group I) and thirty patients underwent simple debridement (group II) between May 2003 and October 2007. In all patients, the tear was localized to the superior one third of the upper subscapularis tendon. The results of the treatment were assessed by evaluating the UCLA, ASES, and VAS for pain and internal rotation strength scores before and after the operation. Results: In groups I and II, UCLA, ASES, VAS, and internal rotation muscle power (perfect score = 5) scores were improved after surgery. In comparing group I and group II, the UCLA and VAS scores were not significantly different (p>0.05), while the ASES and internal rotation strength scores were significantly different (p<0.05). Conclusion: The arthroscopic repair of full-thickness tears of the upper subscapularis tendon was a better surgical method than simple debridement.

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.169-174
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• 2023

Background: Sleep quality, quantity, and efficiency have all been demonstrated to be adversely affected by rotator cuff pathology. Previous measures of assessing the impact of rotator cuff pathology on sleep have been largely subjective in nature. This study was undertaken to objectively analyze this relationship through the use of activity monitors. Methods: Patients with full-thickness rotator cuff tears at a single institution were prospectively enrolled between 2018 and 2020. Waist-worn accelerometers were provided for the patients to use each night for 14 days. Sleep efficiency was calculated using the ratio of the time spent sleeping to the total amount of time that was spent in bed. Retraction of the rotator cuff tear was classified using the Patte staging system. Results: This study included 36 patients: 18 with Patte stage 1 disease, 14 with Patte stage 2 disease, and 4 patients with Patte stage 3 disease. During the study, 25 participants wore the monitor on multiple nights, and ultimately their data was used for the analysis. No difference in the median sleep efficiency was appreciated amongst these groups (P>0.1), with each cohort of patients demonstrating a generally high sleep efficiency. Conclusions: The severity of retraction of the rotator cuff tear did not appear to correlate with changes in sleep efficiency for patients (P>0.1). These findings can better inform providers on how to counsel their patients who present with complaints of poor sleep in the setting of full-thickness rotator cuff tears.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.161-166
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• 2010

Purpose: Irreparable massive rotator cuff tears pose a distinct clinical challenge for the orthopaedist and non-surgical treatment has had inconsistent results and proven unsuccessful for chronic symptoms, while surgery, including debridement and partial and complete repairs have had varying degrees of success. Materials and Methods: For rotator cuff tears that are deemed irreparable, treatment options are limited. Results and Conclusion: The use of tendon transfers (latissimus dorsi for posterosuperior type cuff defects and pectoralis major for subscapularis defects) in younger patients to reconstruct rotator cuffs and re-establish function and restore shoulder kinematics can be useful in solving this difficult problem.

• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.296-303
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• 2022

Background: A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. Methods: Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, Western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. Results: Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05). Conclusions: We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.137-141
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• 2009

Purpose: We wanted to evaluate the results of arthroscopic management of an isolated rupture of the subscapularis tendon using suture anchors. Materials and Methods: Twenty nine patients with unilateral ruptures of the subscapularis tendon and who underwent arthroscopic repair between February 2001 and October 2007 were reviewed prospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon. In 19 patients the tear was localized to the superior one third, in 7 cases the tear was localized to the upper two thirds and the entire tendon was involved in 3 cases. The mean follow up period was 12.2 months (range: 6-26 months). The results of the treatment were assessed by evaluating the constant shoulder score and the pain score before surgery and after surgery. Results: The constant shoulder score improved from $49.9\pm7.3$ to $73.8\pm3.0$ points compared to before surgery and the pain score improved from $4.3\pm3.2$ to $11.2\pm3.0$ points postoperatively. Conclusion: Arthroscopic repair of isolated ruptures of the subscapularis tendon using suture anchors is a good option for effectively managing these tears.