Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3797–3803 | Cite as

Arthroscopic treatment for intratendinous rotator cuff tear results in satisfactory clinical outcomes and structural integrity

  • Sang Jin CheonEmail author
  • Hyo Yeol Lee
  • Woong Ki Jeon
Shoulder
  • 164 Downloads

Abstract

Purpose

This study aimed to evaluate the clinical outcomes and structural integrity of arthroscopic repair of intratendinous rotator cuff tear.

Methods

Patients who were diagnosed with an intratendinous tear but in whom conservative treatment failed were selected and underwent arthroscopic repair. Between 2008 and 2014, a total of 30 patients (6 men, 24 women; mean age, 59 ± 3.7 years) met the inclusion criteria and were followed up. The mean follow-up period was 26.3 ± 0.7 months. The results were evaluated using the University of California at Los Angeles (UCLA) score, the Society of the American Shoulder and Elbow Surgeons rating scale (ASES) questionnaire, and the visual analog scale (VAS) and range of motion (ROM) were measured preoperatively and at final follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 6.7 ± 0.2 months postoperatively. Postoperative MRI was performed on 27 out of 30 patients and analysed using the Sugaya classification.

Results

Corresponding to the preoperative MRI findings, arthroscopic findings of intratendinous tears were observed in all 30 patients. The mean active forward elevation ROM was 137.3° ± 15.4° before surgery and 168.8° ± 15.2° at the final follow-up. The internal and external rotations at abduction were 31.7° ± 5.1° and 63.0° ± 11.6° before surgery, respectively, and 60.5° ± 8.0° and 75.2° ± 10.8° after surgery, respectively. The UCLA score improved from of 20.1 ± 7.4 points preoperative to 28.4 ± 5.5 points at the final follow-up. The ASES score improved from 55.7 ± 15.3 points preoperative to 82.6 ± 9.7 points postoperatively. The VAS for pain score decreased from 6.4 ± 1.2 points preoperative to 1.6 ± 0.9 points postoperative. Satisfactory outcomes (excellent/good) in terms of UCLA and ASES scores were observed in 29 of 30 patients. Based on Sugaya classification, grades I, II, and III structural integrities were observed in 9, 14, and 4 patients, respectively.

Conclusions

Successful clinical outcomes and structural integrity can be achieved with arthroscopic repair of intratendinous rotator cuff tears involving more than half thickness (> 50%). Therefore, arthroscopic repair is a practical next treatment option for patients with intratendinous rotator cuff tears in whom conservative treatment fails.

Level of evidence

IV.

Keywords

Rotator cuff Intratendinous tear Arthroscopic repair Clinical outcome Structural integrity 

Notes

Acknowledgements

This study was supported by (Bio)Medical Research Institute Grant 2006-47 from Pusan National University.

Compliance with ethical standards

Conflict of interest

The authors, their immediate families, and research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Ethical approval

This study received ethical approval from the institutional review board (PNUH-IRB No. E-2016073).

References

  1. 1.
    Boileau P, Brassart N, Watkinson DJ, Michel C et al (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Jt Surg Am 87:1229–1240Google Scholar
  2. 2.
    Budoff JE, Nirschl RP, Guidi EJ (1998) Débridement of partial-thickness tears of the rotator cuff without acromioplasty. Long-term follow-up and review of the literature. J Bone Jt Surg Am 80:733–748CrossRefGoogle Scholar
  3. 3.
    Donohue NK, Nickel BT, Grindel SI (2016) High-grade articular, bursal, and intratendinous partial-thickness rotator cuff tears: a retrospective study comparing functional outcomes after completion and repair. Am J Orthop Belle Mead NJ 45:E254-260Google Scholar
  4. 4.
    Duralde XA, McClelland WB (2012) The clinical results of arthroscopic transtendinous repair of grade III partial articular-sided supraspinatus tendon tears. Arthroscopy 28:160–168CrossRefGoogle Scholar
  5. 5.
    Ellman H (1990) Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res 254:64–74Google Scholar
  6. 6.
    Farley TE, Neumann CH, Steinbach LS, Jahnke AJ, Petersen SS (1992) Full-thickness tears of the rotator cuff of the shoulder: diagnosis with MR imaging. Am J Roentgenol 158:347–351CrossRefGoogle Scholar
  7. 7.
    Franceschi F, Papalia R, Del Buono A, Maffulli N, Denaro V (2011) Repair of partial tears of the rotator cuff. Sports Med Arthrosc 19(4):401–408CrossRefGoogle Scholar
  8. 8.
    Fukuda H (2003) The management of partial-thickness tears of the rotator cuff. J Bone Jt Surg Br 85:3–11CrossRefGoogle Scholar
  9. 9.
    Gartsman GM, Milne JC (1995) Articular surface partial-thickness rotator cuff tears. J Shoulder Elbow Surg 4:409–415CrossRefGoogle Scholar
  10. 10.
    Iannotti JP, Deutsch A, Green A, Rudicel S, Christensen J, Marraffino S, Rodeo S (2013) Time to failure after rotator cuff repair: a prospective imaging study. J Bone Jt Surg Am 95:965–971CrossRefGoogle Scholar
  11. 11.
    Jeon YS, Kim RG, Shin S-J (2017) What influence does progression of a nonhealing rotator cuff tear have on shoulder pain and function? Clin Orthop Relat Res 475:1596–1604CrossRefGoogle Scholar
  12. 12.
    Koh KH, Laddha MS, Lim TK, Park JH, Yoo JC (2012) Serial structural and functional assessments of rotator cuff repairs: do they differ at 6 and 19 months postoperatively? J Shoulder Elbow Surg 21:859–866CrossRefGoogle Scholar
  13. 13.
    Lo IK, Gonzalez DM, Burkhart SS (2002) The bubble sign: an arthroscopic indicator of an intratendinous rotator cuff tear. Arthroscopy 18:1029–1033CrossRefGoogle Scholar
  14. 14.
    Malavolta EA, Assunção JH, Ramos FF, Ferreira TC, Gracitelli MEC, Bordalo-Rodrigues M, Ferreira Neto AA (2016) Serial structural MRI evaluation of arthroscopy rotator cuff repair: does Sugaya’s classification correlate with the postoperative clinical outcomes? Arch Orthop Trauma Surg 136:791–797CrossRefGoogle Scholar
  15. 15.
    McConville OR, Iannotti JP (1999) Partial-thickness tears of the rotator cuff: evaluation and management. J Am Acad Orthop Surg 7:32–43CrossRefGoogle Scholar
  16. 16.
    McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA (2015) Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med 43:491–500CrossRefGoogle Scholar
  17. 17.
    Park S-E, Panchal K, Jeong J-J, Kim Y-Y, Kim J-H, Lee J-Y, Ji J-H (2015) Intratendinous rotator cuff tears: prevalence and clinical and radiological outcomes of arthroscopically confirmed intratendinous tears at midterm follow-up. Am J Sports Med 43:415–422CrossRefGoogle Scholar
  18. 18.
    Rafii M, Firooznia H, Sherman O, Minkoff J, Weinreb J, Golimbu C, Gidumal R, Schinella R, Zaslav K (1990) Rotator cuff lesions: signal patterns at MR imaging. Radiology 177:817–823CrossRefGoogle Scholar
  19. 19.
    Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJ (2006) Dead men and radiologists don’t lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl 88:116–121CrossRefGoogle Scholar
  20. 20.
    Rudzki JR, Shaffer B (2008) New approaches to diagnosis and arthroscopic management of partial-thickness cuff tears. Clin Sports Med 27:691–717CrossRefGoogle Scholar
  21. 21.
    Schaeffeler C, Mueller D, Kirchhoff C, Wolf P, Rummeny EJ, Woertler K (2011) Tears at the rotator cuff footprint: prevalence and imaging characteristics in 305 MR arthrograms of the shoulder. Eur Radiol 21:1477–1484CrossRefGoogle Scholar
  22. 22.
    Shin S-J (2012) A comparison of 2 repair techniques for partial-thickness articular-sided rotator cuff tears. Arthroscopy 28:25–33CrossRefGoogle Scholar
  23. 23.
    Stoppino LP, Ciuffreda P, Rossi M, Lelario M, Bristogiannis C, Vinci R, Genovese EA, Macarini L (2013) Lesions of the rotator cuff footprint: diagnostic performance of MR arthrography compared with arthroscopy. Musculoskelet Surg 97(Suppl 2):S197–S202CrossRefGoogle Scholar
  24. 24.
    Strauss EJ, Salata MJ, Kercher J, Barker JU, McGill K, Bach BR, Romeo AA, Verma NN (2011) Multimedia article. The arthroscopic management of partial-thickness rotator cuff tears: a systematic review of the literature. Arthroscopy 27:568–580CrossRefGoogle Scholar
  25. 25.
    Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Jt Surg Am 89:953–960CrossRefGoogle Scholar
  26. 26.
    Uchiyama Y, Hamada K, Khruekarnchana P, Handa A, Nakajima T, Shimpuku E, Fukuda H (2010) Surgical treatment of confirmed intratendinous rotator cuff tears: retrospective analysis after an average of eight years of follow-up. J Shoulder Elbow Surg 19:837–846CrossRefGoogle Scholar
  27. 27.
    Weber SC (1997) Arthroscopic debridement and acromioplasty versus mini-open repair in the management of significant partial-thickness tears of the rotator cuff. Orthop Clin North Am 28:79–82CrossRefGoogle Scholar
  28. 28.
    Weber SC (1999) Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears. Arthroscopy 15:126–131CrossRefGoogle Scholar
  29. 29.
    Wolff AB, Sethi P, Sutton KM, Covey AS, Magit DP, Medvecky M (2006) Partial-thickness rotator cuff tears. J Am Acad Orthop Surg 14:715–725CrossRefGoogle Scholar
  30. 30.
    Yamanaka K (1988) [Pathological study of the supraspinatus tendon]. Nippon Seikeigeka Gakkai Zasshi 62:1121–1138PubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Sang Jin Cheon
    • 1
    Email author
  • Hyo Yeol Lee
    • 1
  • Woong Ki Jeon
    • 1
  1. 1.Department of Orthopedic Surgery, School of MedicinePusan National UniversityPusanSouth Korea

Personalised recommendations