• Clinics in Shoulder and Elbow
• /
• v.19 no.4
• /
• pp.237-240
• /
• 2016

Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.

• Journal of the Korean Orthopaedic Association
• /
• v.54 no.2
• /
• pp.91-99
• /
• 2019

Most patients experience pain relief and functional improvement after arthroscopic rotator cuff repair. In some patients, however, symptoms still remain after surgery. Failed rotator cuff repair is a complex outcome of biological, technical, and traumatic factors. Moreover, re-tears might or might not be the main cause for patients with persistent pain after rotator cuff repair. Therefore, a thorough understanding of the patient's history, physical examination, and appropriate imaging studies will be needed to evaluate and manage these patients. The patient's age, functional requirement, quality of the rotator cuff, preoperative range of motion, quality of the deltoid, and glenohumeral arthritis are factors to consider before performing revisional rotator cuff repair. Preoperative patient education is as important as the surgical technique for successful revisional rotator cuff repair.

• Clinics in Shoulder and Elbow
• /
• v.22 no.3
• /
• pp.159-170
• /
• 2019

Delaminated rotator cuff tear pertains to the horizontal split of the tendon substance. As reported previously, the presence of a delaminated tear and incidence of delaminated rotator cuff tear ranges from 38% to 92%. The different strain intensities applied across the rotator cuff tendon, and the shear stress between the bursal and articular layers seem to play a role in its pathogenesis. In a delaminated rotator cuff tear, the degree and direction of retraction between two layers differ, with accompanying intrasubstance cleavage. A surgeon therefore needs to consider and carefully evaluate the tear characteristics when repairing delaminated rotator cuff tear. Delaminated rotator cuff tear is considered to be a poor prognostic factor after rotator cuff repair, but numerous surgical repair techniques have been introduced and applied to resolve this problem. Recent literature has reported good clinical outcomes after delaminated rotator cuff repair.

• Clinics in Shoulder and Elbow
• /
• v.22 no.4
• /
• pp.183-189
• /
• 2019

Background: Since the establishment of biological augmentation to improve the treatment of rotator cuff tears, it is imperative to explore newer techniques to reduce the retear rate and improve long-term shoulder function after rotator cuff repair. This study was undertaken to determine the consequences of a gel-type atelocollagen injection during arthroscopic rotator cuff repair on clinical outcomes, and evaluate its effect on structural integrity. Methods: Between January 2014 and June 2015, 121 patients with full thickness rotator cuff tears underwent arthroscopic rotator cuff repair. Of these, 61 patients were subjected to arthroscopic rotator cuff repair in combination with an atelocollagen injection (group I), and 60 patients underwent arthroscopic rotator cuff repair alone (group II). The visual analogue scale (VAS) for pain and the Korean Shoulder Society (KSS) scores were evaluated preoperatively and postoperatively. Magnetic resonance imaging (MRI) was performed at 6 months postoperatively, to assess the integrity of the repair. Results: VAS scores were significantly lower in group I than in group II at 3, 7, and 14 days after surgery. KSS scores showed no significant difference between groups in the 24 months period of follow-up. No significant difference was obtained in the healing rate of the rotator cuff tear at 6 months postoperatively (p=0.529). Conclusions: Although a gel-type atelocollagen injection results in reduced pain in patients at 2 weeks after surgery, our study does not substantiate the administration of atelocollagen during rotator cuff repair to improve the clinical outcomes and healing of the rotator cuff.

• Clinics in Shoulder and Elbow
• /
• v.19 no.1
• /
• pp.51-58
• /
• 2016

The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.

• Journal of the Korean Arthroscopy Society
• /
• v.16 no.1
• /
• pp.98-103
• /
• 2012

The repair technique of rotator cuff tear has been markedly developed in recent years. When the natural history of rotator cuff tear was followed, the size of rotator cuff tear increased with time. The fatty infiltration which would come at the later period of rotator cuff tear and the rotator cuff tear arthropathy which would be occurred after massive rotator cuff tear may be the important factors in predicting the prognosis of rotator cuff tear or determining the timing of surgery. Because moderate supraspinatus fatty infiltration appeared an average of 3 years after onset of symptoms, the repair of rotator cuff tear was recommended to be performed before that. And if there was massive rotator cuff tear with cuff tear arthropathy, it was recommended that the rotator cuff repair should be performed before the occurrence of the narrowing of acromiohumeral interval. The techniques of arthroscopic rotator cuff repair were mainly the single row repair and the double row repair. The former is good in view of time consuming and cost, but the latter is superior in view of biomechanics. To maintain the benefit in biomechanics of double row technique and reduce the time of surgery, the suture-bridge technique was invented and widely used recently. There are several modified techniques in arthroscopic suture-bridge technique according to the characteristics of rotator cuff tear.

• Clinics in Shoulder and Elbow
• /
• v.17 no.1
• /
• pp.44-47
• /
• 2014

Typically, massive rotator cuff tears have stiff and retracted tendon with poor muscle quality, in such cases orthopaedic surgeons are confronted with big challenging to restore the cuff to its native footprint. Furthermore, even with some restoration of the footprint, it is related with a high re-tear rate due to less tension free repair and less tendon coverage. In this tough circumstance, the partial repair has yielded satisfactory outcomes at relatively short follow-up by re-creating the transverse force couple of the rotator cuff. Through this partial repair, the massive rotator cuff tear can be converted to the "functional rotator cuff tear" and provide improvement in pain and functional outcomes in patient's shoulder.

• Clinics in Shoulder and Elbow
• /
• v.17 no.3
• /
• pp.145-150
• /
• 2014

In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis.

• Clinics in Shoulder and Elbow
• /
• v.5 no.1
• /
• pp.55-62
• /
• 2002

Purpose : To compare and analyze the results of arthroscopic subacromial decompression and rotator cuff repair between partial rotator cuff tear and complete rotator cuff tear. Material and Methods : The authors studied 42 patients of rotator cuff tear with operation and followed over one year at Dankook university hospital from September, 1998 to March, 2001 The patient average age is 53 years and follow up period is 23 months (12-42mon1hs). We obtained 22 cases in the partial rotator cuff tear group and 20 cases in the complete rotator cuff tear group. In all cases, we used ASES methods to evaluated pain scale and function. Result : In the last follow up patients, the pain scale is decreased from 7.2 to 0.9 (ASES method : 34 to 91) in the partial rotator cuff tear group and from 7.6 to 1.2 (ASES method . 29 to 88) in the complete rotator cuff tear group, but there was no evidence of statistical difference between two groups (P>0.05). The range of motion after operation were increased in two groups. Excellent to good results were obtained 93％ and 95％ patients had pain relief and satisfied function. Conclusion : Arthroscopic subacromial decompression and arthroscopic rotator cuff repair showed good results for both of (ult-thickness and partial thickness rotator cuff tear patients in pain relief and improving the function.

• Journal of the Korean Society of Physical Medicine
• /
• v.15 no.1
• /
• pp.55-63
• /
• 2020

PURPOSE: This study examined the effects of handgrip exercise, which was started two weeks after surgery for shoulder rotator cuff repair, on the extent of muscle activation around the shoulder and the cross-sectional area of the supraspinatus muscle. METHODS: Among patients diagnosed with rotator cuff rupture by an orthopedic surgeon and rotator cuff repair was performed using an arthroscope, 28 were selected as subjects. These subjects were allocated randomly to the experimental group and control group with 14 subjects in each group. An electromyogram was measured as a measure of the extent of muscle activation around the shoulder for a total of six times (%RVC). The cross-sectional area of the supraspinatus muscle was measured before and after the rotator cuff repair by magnetic resonance imaging. RESULTS: The extent of muscle activation in accordance with time in both the experimental group and control group displayed significant differences in various muscles including the anterior deltoid, pectoralis major, upper trapezius and infraspinatus muscle(p<.05). A significant difference in the variation of the cross-sectional area of the supraspinatus muscle was observed between the experimental group and the control group(p<.05). CONCLUSION: Handgrip exercise helps rehabilitate the shoulder joint at the acute stage after rotator cuff repair when assertive exercise therapy cannot be applied.