ObjectiveTo evaluate the effectiveness of the combined tenodesis for proximal lesions of biceps tendon with massive rotator cuff tear by arthroscopy. MethodsBetween January 2011 and June 2013, 48 patients with massive rotator cuff tear and proximal lesions of biceps tendon underwent combined tenodesis under arthroscopy, and the clinical data were retrospectively analyzed. Of 48 cases, 22 were male and 26 were female with an average age of 46 years (range, 35-59 years); 12 cases had clear history of trauma. The disease duration ranged from 1 to 57 months (mean, 4.6 months). All cases suffered from moderate to severe shoulder pain, the strength and the range of motion (ROM) declined when compared with those of the other side. According to Goutallier classification standard, 3 cases were rated as grade 0, 18 cases as grade 1, and 27 cases as grade 2. The operation time and complication were recorded. The visual analogue scale (VAS) score, ROM, the strength of flexed elevation and elbow flexion, Constant-Murley score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Mayo elbow performance score (MEPS) were used to evaluate the effectiveness. ResultsThe operations were performed successfully, and incisions healed primarily. The operation time was 120-160 minutes (mean, 135 minutes). One case had shoulder joint swelling with wound bleeding, which was cured after proper treatment. All 48 patients were followed up 12-18 months (mean, 13.9 months). The results of MRI showed good healing of tendon at 6 months after operation. When compared with preoperative values, VAS score was significantly decreased (P<0.05); the ROM in forward flexion, external rotation, and internal rotation, and the strength of flexed elevation were significantly increased (P<0.05); and ASES score, Constant-Murley score, and UCLA score were significantly improved at 12 months after operation (P<0.05). No significant difference was observed in MEPS score and elbow flexion strength (P>0.05). ConclusionThe technique of combined tenodesis under arthroscopy can obtain satisfactory clinical outcomes in treating proximal lesions of biceps tendon with massive rotator cuff tear.
Objective To review the progress in the treatment and research of massive rotator cuff tears. Methods Recent l iteratures about the treatment and research of massive rotator cuff tears were reviewed. Results Treatment options of massive rotator cuff tears include nonoperative treatment, debridement, direct repair, tendon transfer, and repair with various substitutes, but the outcome is unpredictable. Recently, many experimental studies on the treatment of massive rotator cuff tears, such as gene therapy, cell therapy, and tissue engineering techniques, can provide cl inicians with new treatment strategies. Conclusion The treatment of massive rotator cuff tears pose a distinct cl inical challenge for the orthopaedist, depending on the overall presentation. The effect of traditional operation method to repair massive rotator cuff tears is limited. The treatment and research of massive rotator cuff tears still need to be studied.
ObjectiveTo review the research progress of treatment for massive rotator cuff tears. MethodsThe domestic and foreign literature about the treatment of massive rotator cuff tears was reviewed. The methods and effectiveness were extensively summarized.ResultsThe treatment of massive rotator cuff tears still needs long-term research to promote its continuous improvement. The main goal of treatment is to relieve the symptoms and improve the shoulder joint function. With the development of arthroscopic technique, arthroscopic repair of rotator cuff tears has become a mature surgical protocol. Among these techniques, superior capsule reconstruction and patch augmentation for massive rotator cuff tears acquire more attention in recent years. As for rotator cuff arthropathy, reverse shoulder arthroplasty is considered to be a final choice. ConclusionSurgical treatment is the main choice for massive rotator cuff tears. Patients’ age and muscle condition should be taken into consideration to decide the surgical technique.
Irreparable posterosuperior massive rotator cuff tears represent a common and challenging condition in shoulder surgery. Reconstruction procedures can effectively restore the anatomical structure and function of the shoulder joint and, as an important joint-preserving treatment option for irreparable posterosuperior massive rotator cuff tears, have garnered increasing attention and application among shoulder surgeons. However, a lack of consensus currently exists regarding its definition, diagnostic criteria, and treatment strategies, leading to inconveniences in clinical decision-making and academic communication. To standardize the indications, surgical option selection, and postoperative rehabilitation strategies for the reconstruction of irreparable posterosuperior massive rotator cuff tears, the Shoulder Joint Study Group of the Fifth Committee of the Chinese Society of Sports Medicine of Chinese Medical Association organized experts in the relevant field to develop a consensus using a modified Delphi method, which involved two rounds of questionnaire surveys and one online expert meeting. After reviewing domestic and foreign literature, the consensus drafting group compiled the initial draft and questionnaire items. Suitable topics were selected via the first round of expert voting, and the recognition level of responses to each consensus question was determined in the second round. Online expert discussions were subsequently held to refine wording and reconcile divergent views, yielding the final consensus. A consensus is confirmed with an approval rate of no less than 85%. It is classified into three tiers: high consensus (95.0%-100%), general consensus (90.0%-94.9%), and basic consensus (85.0%-89.9%). This consensus ultimately formulated 10 recommendations focusing on core issues, including the definition and diagnosis of irreparable posterosuperior massive rotator cuff tears, the indications and timing of reconstruction surgery, the selection and application principles of commonly used reconstruction techniques, perioperative management and phased rehabilitation protocols, and the prevention and treatment of postoperative complications. This consensus aims to provide a clinical decision-making reference for orthopedic surgeons, sports medicine physicians, and rehabilitation specialists, thereby promoting the standardization and individualization of reconstruction treatment for irreparable massive rotator cuff tears and improving patient functional outcomes.