Objective To investigate the effectiveness of arthroscopic long head of biceps tendon (LHBT) transposition combined with Swivelock anchor double fixation in treatment of massive and irreparable rotator cuff tears. Methods Between June 2019 and November 2021, 25 patients with massive and irreparable rotator cuff tears were treated by arthroscopic LHBT transposition combined with Swivelock anchor double fixation. There were 12 males and 13 females. The age ranged from 47 to 74 years (mean, 62.4 years). The disease duration ranged from 1 to 62 months (median, 7 months). The rotator cuff tears were classified as Hamada grade 2 in 25 cases and Goutallier grade 1 in 2 cases, grade 2 in 22 cases, and grade 3 in 1 case. Pre- and post-operative shoulder range of motion (ROM), visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, and Constant-Murley score were recorded. Postoperative complications were observed. The reconstructed tissue integrity was confirmed by MRI. Results All operations were successfully completed. The operation time was 120-330 minutes (mean, 189.6 minutes). All incisions healed by first intention. All patients were followed up 10-36 months (mean, 22.0 months). At last follow-up, the ROM in forward flexion, abduction, and external rotation, VAS score, UCLA score, and Constant-Murley score were superior to those before operation, and the differences were significant (P<0.05). According to UCLA scoring standard, shoulder joint function was rated as excellent in 5 cases, good in 18 cases, and poor in 2 cases, with an excellent and good rate of 92.0%. No other complications occurred except shoulder joint adhesion in 2 cases. At last follow-up, MRI examination showed no retear of rotator cuff, and LHBT was intact. Conclusion For massive and irreparable rotator cuff tears, arthroscopic LHBT transposition combined with Swivelock anchor double fixation can increase the force of pressing the humeral head, effectively relieve the pain, improve the ROM of joints, maximize the recovery of shoulder function, and do not increase the number of anchor nails.
ObjectiveTo investigate effectiveness of arthroscopic superior capsular reconstruction using a “sandwich” patch combined with platelet-rich plasma (PRP) injection in treating massive irreparable rotator cuff tears. Methods A clinical data of 15 patients (15 sides) with massive irreparable rotator cuff tears, who were admitted between September 2020 and March 2023 and met the selective criteria, was retrospectively analyzed. There were 8 males and 7 females with an average age of 62.1 years (range, 40-80 years). The rotator cuff tears were caused by trauma in 7 cases and other reasons in 8 cases. The disease duration ranged from 5 to 25 months, with an average of 17.7 months. According to the Hamada grading, the rotator cuff tears were rated as grade 1 in 2 cases, grade 2 in 8 cases, and grade 3 in 5 cases. All patients were underwent superior capsular reconstruction using the “sandwich” patches (autologous fascia lata+polypropylene patch+autologous fascia lata) combined with PRP injection on patches. The pre- and post-operative active range of motion (ROM) of the shoulder joint, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California, Los Angeles Shoulder Rating Scale (UCLA) score, and visual analogue scale (VAS) score were recorded. The subacromial space was measured on the imaging and rotator cuff integrity was assessed based on Sugaya grading. Results All incisions healed by first intention after operation without any complications such as infection. All patients were followed up 12-18 months (mean, 14.4 months). At last follow-up, the active ROMs of flexion, abduction, external rotation, internal rotation of the shoulder joint, subacromial space, ASES score, Constant-Murley score, and UCLA score increased, and VAS score decreased, showing significant differences when compared with preoperative values (P<0.05). There was no significant difference in the Sugaya grading between last follow-up and immediately after operation (P>0.05). Conclusion For massive irreparable rotator cuff tears, arthroscopic superior capsular reconstruction using the “sandwich” patches combined with PRP injection can restore stability of the shoulder joint, relieve pain, promote rotator cuff healing, and achieve good short-term effectiveness.
Objective To explore the long-term effectiveness of arthroscopic partial repair in treatment of massive irreparable rotator cuff tears from both the radiological and clinical perspectives. Methods A retrospective analysis was conducted on the clinical data of 24 patients (25 sides) with massive irreparable rotator cuff tears who met the inclusion criteria between May 2006 and September 2014. Among them, there were 17 males (18 sides) and 7 females (7 sides) with an age range of 43-67 years (mean, 55.0 years). There were 23 cases of unilateral injury and 1 case of bilateral injuries. All patients were treated with the arthroscopic partial repair. The active range of motion of forward elevation and abduction, external rotation, and internal rotation, as well as the muscle strength for forward flexion and external rotation, were recorded before operation, at the first postoperative follow-up, and at last follow-up. The American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, and Constant score were used to evaluate shoulder joint function. And the visual analogue scale (VAS) score was used to evaluate shoulder joint pain. MRI examination was performed. The signal-to-noise quotient (SNQ) was measured above the anchor point near the footprint area (m area) and above the glenoid (g area) in the oblique coronal T2 fat suppression sequence. The atrophy of the supraspinatus muscle was evaluated using the tangent sign. The global fatty degeneration index (GFDI) was measured to assess fat infiltration in the supraspinatus muscle, infraspinatus muscle, teres minor muscle, upper and lower parts of the subscapularis muscle. The mean GFDI (GFDI-5) of 5 muscles was calculated. Results The incisions healed by first intention. All patients were followed up with the first follow-up time of 1.0-1.7 years (mean, 1.3 years) and the last follow-up time of 7-11 years (mean, 8.4 years). At last follow-up, the range of motion and muscle strength of forward elevation and abduction, ASES score, Constant score, UCLA score, and VAS score of the patients significantly improved when compared with those before operation (P<0.05). Compared with the first follow-up, except for a significant increase in ASES score (P<0.05), there was no significant difference in the other indicators (P>0.05). Compared with those before operation, the degree of supraspinatus muscle infiltration worsened at last follow-up (P<0.05), GFDI-5 increased significantly (P<0.05), and there was significant difference in the tangent sign (P<0.05); while there was no significant difference in the infiltration degree of infraspinatus muscle, teres minor muscle, and subscapularis muscle, upper and lower parts of the subscapularis muscle (P>0.05). Compared with the first follow-up, the SNQm and SNQg decreased significantly at last follow-up (P<0.05). At the first and last follow-up, there was no correlation between the SNQm and SNQg and the ASES score, Constant score, UCLA score, and VAS score of the shoulder (P>0.05). Conclusion Arthroscopic partial repair is effective in treating massive irreparable rotator cuff tear and significantly improves long-term shoulder joint function. For patients with severe preoperative fat infiltration involving a large number of tendons and poor quality of repairable tendons, it is suggested to consider other treatment methods.
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.