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Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Rotator cuff tears (rct) subsequent to glenohumeral dislocation are relevant concomitant injuries, can lead to impaired shoulder function and increase risk of recurrent dislocation.

Aim

The aim of this study was to determine the functional outcome, recurrent dislocation rate and tendon integrity after rotator cuff repair after primary traumatic shoulder dislocation.

Materials and methods

In this retrospective case series, 23 patients (age 56.4 years ± 6.3) who underwent a rotator cuff reconstruction after primary traumatic shoulder dislocation with confirmed combination of full-thickness RCT and Bankart lesion were enrolled after a minimum follow-up of 2 years. Clinical outcome (age and gender adjusted Constant Murley Score (CMS), DASH, Rowe Score) (n = 23) and sonographic tendon integrity (n = 19) were studied.

Results

After a mean follow-up of 58 ± 32 months, a CMS of 85.1% ± 14.7, DASH of 14.2 ± 20.5, and Rowe Score of 82.4 ± 15.2 indicated good functional outcome. In 4 of 19 patients (21.1%) a re-tear was found during sonographic evaluation. In 3 cases (13%), a revision was performed (2 × stiff shoulder, 1 × postoperative infection). One patient had a single traumatic re-dislocation (4.3%).

Conclusions

Patients undergone reconstruction of the rotator cuff following a primary traumatic shoulder dislocation can achieve good functional results and a low rate of recurrent dislocation. Postoperative tendon integrity is comparable with known data about non traumatic tears.

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References

  1. Itoi E, Tabata S (1992) Rotator cuff tears in anterior dislocation of the shoulder. Int Orthop 16(3):240–244

    Article  CAS  Google Scholar 

  2. Neviaser RJ, Neviaser TJ, Neviaser JS (1993) Anterior dislocation of the shoulder and rotator cuff rupture. Clin Orthop Relat Res 291:103–106

    Google Scholar 

  3. Rockwood CA Jr (1993) Rotator cuff tears concomitant with anterior dislocation of the shoulder. Int Orthop 17(1):64

    Article  Google Scholar 

  4. Mancini GB, Malaspina C, Scalercio AM, Ferranti R (2001) Anterior shoulder dislocation and injuries of the rotator cuff in patients aged over 40 years. Clinical and sonographic study. La Chirurgia degli organi di movimento 86(1):37–44

    CAS  PubMed  Google Scholar 

  5. Porcellini G, Caranzano F, Campi F, Pellegrini A, Paladini P (2011) Glenohumeral instability and rotator cuff tear. Sports Med Arthroscopy Rev 19(4):395–400. https://doi.org/10.1097/JSA.0b013e31820d583b

    Article  Google Scholar 

  6. Shin SJ, Yun YH, Kim DJ, Yoo JD (2012) Treatment of traumatic anterior shoulder dislocation in patients older than 60 years. Am J Sports Med 40(4):822–827. https://doi.org/10.1177/0363546511434522

    Article  PubMed  Google Scholar 

  7. Atef A, El-Tantawy A, Gad H, Hefeda M (2016) Prevalence of associated injuries after anterior shoulder dislocation: a prospective study. Int Orthop 40(3):519–524. https://doi.org/10.1007/s00264-015-2862-z

    Article  PubMed  Google Scholar 

  8. Simank HG, Dauer G, Schneider S, Loew M (2006) Incidence of rotator cuff tears in shoulder dislocations and results of therapy in older patients. Arch Orthop Trauma Surg 126(4):235–240. https://doi.org/10.1007/s00402-005-0034-0

    Article  PubMed  Google Scholar 

  9. Gumina S, Postacchini F (1997) Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br 79(4):540–543

    Article  CAS  Google Scholar 

  10. Porcellini G, Paladini P, Campi F, Paganelli M (2006) Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years. Arthroscopy 22(3):270–276. https://doi.org/10.1016/j.arthro.2005.12.015

    Article  PubMed  Google Scholar 

  11. Gerometta A, Rosso C, Klouche S, Hardy P (2016) Arthroscopic Bankart shoulder stabilization in athletes: return to sports and functional outcomes. Knee Surg Sports Traumatol Arthrosc 24(6):1877–1883. https://doi.org/10.1007/s00167-014-2984-7

    Article  PubMed  Google Scholar 

  12. Flinkkila T, Knape R, Sirnio K, Ohtonen P, Leppilahti J (2018) Long-term results of arthroscopic Bankart repair: Minimum 10 years of follow-up. Knee Surg Sports Traumatol Arthrosc 26(1):94–99. https://doi.org/10.1007/s00167-017-4504-z

    Article  PubMed  Google Scholar 

  13. Gombera MM, Sekiya JK (2014) Rotator cuff tear and glenohumeral instability : a systematic review. Clin Orthop Relat Res 472(8):2448–2456. https://doi.org/10.1007/s11999-013-3290-2

    Article  PubMed  Google Scholar 

  14. Robinson CM, Kelly M, Wakefield AE (2002) Redislocation of the shoulder during the first 6 weeks after a primary anterior dislocation: risk factors and results of treatment. J Bone Joint Surg Am. 84(9):1552–1559

    Article  CAS  Google Scholar 

  15. Shields E, Mirabelli M, Amsdell S, Thorsness R, Goldblatt J, Maloney M, Voloshin I (2014) Functional and imaging outcomes of arthroscopic simultaneous rotator cuff repair and bankart repair after shoulder dislocations. Am J Sports Med 42(11):2614–2620. https://doi.org/10.1177/0363546514550993

    Article  PubMed  Google Scholar 

  16. Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF, Cordasco FA, Allen AA (2010) Prospective evaluation of arthroscopic bankart repairs for anterior instability. Am J Sports Med 38(2):302–307. https://doi.org/10.1177/0363546509348049

    Article  PubMed  Google Scholar 

  17. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  18. Yian EH, Ramappa AJ, Arneberg O, Gerber C (2005) The constant score in normal shoulders. J Shoulder Elbow Surg 14(2):128–133. https://doi.org/10.1016/j.jse.2004.07.003

    Article  PubMed  Google Scholar 

  19. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The upper extremity collaborative group (UECG). Am J Ind Med. 29(6):602–608

    Article  CAS  Google Scholar 

  20. Rowe CR, Zarins B (1982) Chronic unreduced dislocations of the shoulder. J Bone Joint Surg Am 64(4):494–505

    Article  CAS  Google Scholar 

  21. Jensen K-U, Bongaerts G, Schneider S, Bruhn R (2009) Selbsteinschätzungsbogen auf Grundlage des Rowe-Scores von 1982. Obere Extremität 4(3):178–183. https://doi.org/10.1007/s11678-009-0039-3

    Article  Google Scholar 

  22. Collin P, Yoshida M, Delarue A, Lucas C, Jossaume T, Ladermann A (2015) Evaluating postoperative rotator cuff healing: prospective comparison of MRI and ultrasound. Orthop Traumatol Surg Res 101(6 Suppl):S265–268. https://doi.org/10.1016/j.otsr.2015.06.006

    Article  CAS  PubMed  Google Scholar 

  23. 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 Joint Surg Am 89(5):953–960. https://doi.org/10.2106/jbjs.f.00512

    Article  PubMed  Google Scholar 

  24. Kim YK, Jung KH, Kim JW, Kim US, Hwang DH (2018) Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study. J Shoulder Elbow Surg 27(6):1012–1020. https://doi.org/10.1016/j.jse.2017.11.016

    Article  PubMed  Google Scholar 

  25. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87(6):1229–1240. https://doi.org/10.2106/jbjs.d.02035

    Article  PubMed  Google Scholar 

  26. Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ (2014) Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elbow Surg 23(4):586–597. https://doi.org/10.1016/j.jse.2013.10.006

    Article  PubMed  Google Scholar 

  27. Neviaser RJ, Neviaser TJ, Neviaser JS (1988) Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient. J Bone Joint Surg Am 70(9):1308–1311

    Article  CAS  Google Scholar 

  28. Hawkins RJ, Morin WD, Bonutti PM (1999) Surgical treatment of full-thickness rotator cuff tears in patients 40 years of age or younger. J Shoulder Elbow Surg 8(3):259–265

    Article  CAS  Google Scholar 

  29. Pouliart N, Gagey O (2006) Concomitant rotator cuff and capsuloligamentous lesions of the shoulder: a cadaver study. Arthroscopy 22(7):728–735. https://doi.org/10.1016/j.arthro.2006.03.015

    Article  PubMed  Google Scholar 

  30. Adam M, Attia AK, Alhammoud A, Aldahamsheh O, Al Dosari MA, Ahmed G (2018) Arthroscopic Bankart repair for the acute anterior shoulder dislocation: systematic review and meta-analysis. Int Orthop. https://doi.org/10.1007/s00264-018-4046-0

    Article  PubMed  Google Scholar 

  31. Brown L, Rothermel S, Joshi R, Dhawan A (2017) Recurrent instability after arthroscopic bankart reconstruction: a systematic review of surgical technical factors. Arthroscopy 33(11):2081–2092. https://doi.org/10.1016/j.arthro.2017.06.038

    Article  PubMed  Google Scholar 

  32. Hohmann E, Tetsworth K, Glatt V (2017) Open versus arthroscopic surgical treatment for anterior shoulder dislocation: a comparative systematic review and meta-analysis over the past 20 years. J Shoulder Elbow Surg 26(10):1873–1880. https://doi.org/10.1016/j.jse.2017.04.009

    Article  PubMed  Google Scholar 

  33. Voos JE, Pearle AD, Mattern CJ, Cordasco FA, Allen AA, Warren RF (2007) Outcomes of combined arthroscopic rotator cuff and labral repair. Am J Sports Med 35(7):1174–1179. https://doi.org/10.1177/0363546507300062

    Article  PubMed  Google Scholar 

  34. Domb BG, Glousman RE, Brooks A, Hansen M, Lee TQ, ElAttrache NS (2008) High-tension double-row footprint repair compared with reduced-tension single-row repair for massive rotator cuff tears. J Bone Joint Surg Am 90(Suppl 4):35–39. https://doi.org/10.2106/jbjs.h.00650

    Article  PubMed  Google Scholar 

  35. Kim YK, Moon SH, Cho SH (2013) Treatment outcomes of single- versus double-row repair for larger than medium-sized rotator cuff tears: the effect of preoperative remnant tendon length. Am J Sports Med 41(10):2270–2277. https://doi.org/10.1177/0363546513499000

    Article  PubMed  Google Scholar 

  36. Lee KW, Moon KH, Ma CH, Lee GS, Yang DS, Choy WS (2018) Clinical and radiologic outcomes after medializing and not medializing rotator cuff tendon attachment site on chronic retracted rotator cuff tears. Arthroscopy 34(8):2298–2307. https://doi.org/10.1016/j.arthro.2018.03.015

    Article  PubMed  Google Scholar 

  37. Tashjian RZ, Erickson GA, Robins RJ, Zhang Y, Burks RT, Greis PE (2017) Influence of preoperative musculotendinous junction position on rotator cuff healing after double-row repair. Arthroscopy 33(6):1159–1166. https://doi.org/10.1016/j.arthro.2016.12.010

    Article  PubMed  Google Scholar 

  38. Gimbel JA, Mehta S, Van Kleunen JP, Williams GR, Soslowsky LJ (2004) The tension required at repair to reappose the supraspinatus tendon to bone rapidly increases after injury. Clin Orthop Relat Res 426:258–265

    Article  Google Scholar 

  39. Davidson PA, Rivenburgh DW (2000) Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elbow Surg 9(6):502–506. https://doi.org/10.1067/mse.2000.109385

    Article  CAS  PubMed  Google Scholar 

  40. Liem D, Lichtenberg S, Magosch P, Habermeyer P (2007) Magnetic resonance imaging of arthroscopic supraspinatus tendon repair. J Bone Joint Surg Am 89(8):1770–1776. https://doi.org/10.2106/jbjs.F.00749

    Article  PubMed  Google Scholar 

  41. Kang RW, Frank RM, Nho SJ, Ghodadra NS, Verma NN, Romeo AA, Provencher MT (2009) Complications associated with anterior shoulder instability repair. Arthroscopy 25(8):909–920. https://doi.org/10.1016/j.arthro.2009.03.009

    Article  PubMed  Google Scholar 

  42. Cucchi D, Marmotti A, De Giorgi S, Costa A, D'Apolito R, Conca M, Russo A, Saccomanno MF, de Girolamo L (2017) Risk factors for shoulder stiffness: current concepts. Joints 5(4):217–223. https://doi.org/10.1055/s-0037-1608951

    Article  PubMed  PubMed Central  Google Scholar 

  43. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS (2009) Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy 25(8):880–890. https://doi.org/10.1016/j.arthro.2009.01.018

    Article  PubMed  Google Scholar 

  44. Ji X, Bi C, Wang F, Wang Q (2015) Arthroscopic versus mini-open rotator cuff repair: an up-to-date meta-analysis of randomized controlled trials. Arthroscopy 31(1):118–124. https://doi.org/10.1016/j.arthro.2014.08.017

    Article  PubMed  Google Scholar 

  45. Taylor DC, Arciero RA (1997) Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 25(3):306–311. https://doi.org/10.1177/036354659702500306

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We acknowledge Tom Bruckner (Institute for Medical Biometry and Informatics, University of Heidelberg) for statistical advisory.

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Authors and Affiliations

  1. BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Germany

    Felix Porschke, Sebastian Manuel Schlee, Marc Schnetzke, Stefan Studier-Fischer & Paul A. Gruetzner

  2. ATOS Clinic Heidelberg, German Joint Center Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany

    Marc Schnetzke

  3. Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany

    Thorsten Guehring

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  1. Felix Porschke
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Porschke, F., Schlee, S.M., Schnetzke, M. et al. Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation. Arch Orthop Trauma Surg 140, 1073–1079 (2020). https://doi.org/10.1007/s00402-020-03416-4

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