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      Arthroscopic Debridement for Irreparable Rotator Cuff Tears

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background:

          Arthroscopic debridement represents a salvage procedure for irreparable rotator cuff tears. It is important to accurately diagnose the patient for irreparable rotator cuff tears. The diagnosis and the therapeutic options must be explained to the patient. It is mandatory that the patient understands the primary goal of the arthroscopic debridement being reduction of pain, not improving strength or function.

          Methods:

          The procedure consists of 7 distinct steps to debride the soft tissues and alleviate pain.

          Results:

          Even though there is a lack of evidence that this procedure is superior to other therapeutic options, it has shown good results in patients with the main complaint of pain.

          Conclusion:

          The results reported in some studies should, however, be interpreted with caution, taking into consideration the substantial structural damage in irreparable defects.

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          Most cited references24

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          Cuff-tear arthropathy.

          Lorraine Craig, David Fukuda, Charles Neer (1983)
          In this report we describe the clinical and pathological findings of cuff-tear arthropathy in twenty-six patients and discuss the differential diagnosis and a hypothesis on the pathomechanics that lead to its development. This lesion is thought to be peculiar to the glenohumeral joint because of the unique anatomy of the rotator cuff. Following a massive tear of the rotator cuff there is inactivity and disuse of the shoulder, leaking of the synovial fluid, and instability of the humeral head. These events in turn result in both nutritional and mechanical factors that cause atrophy of the glenohumeral articular cartilage and osteoporosis of the subchondral bone of the humeral head. A massive tear also allows the humeral head to be displaced upward, causing subacromial impingement that in time erodes the anterior portion of the acromion and the acromioclavicular joint. Eventually the soft, atrophic head collapses, producing the complete syndrome of cuff-tear arthropathy. The incongruous head may eventually erode the glenoid so deeply that the coracoid becomes eroded as well. Although treatment of cuff-tear arthropathy is extremely difficult, the preferred method appears to be a resurfacing total shoulder replacement with rotator-cuff reconstruction and special rehabilitation. We think that it is important to recognize cuff-tear arthropathy as a distinct pathological entity, as such recognition enhances our understanding of the more common impingement lesions. Cuff-tear arthropathy is especially difficult to treat, and although many tears of the rotator cuff do not enlarge sufficiently to allow this condition to develop, it is a factor to consider when deciding whether or not a documented tear of the rotator cuff should be surgically repaired.
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            Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears.

            Pascal Boileau, François Baqué, Laure Valerio … (2007)
            Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears and may be responsible for shoulder pain and dysfunction. The purpose of this study was to evaluate the clinical and radiographic outcomes of isolated arthroscopic biceps tenotomy or tenodesis as treatment for persistent shoulder pain and dysfunction due to an irreparable rotator cuff tear associated with a biceps lesion. We conducted a retrospective study of sixty-eight consecutive patients (mean age [and standard deviation], 68 +/- 6 years) in whom a total of seventy-two irreparable rotator cuff tears had been treated arthroscopically with biceps tenotomy or tenodesis. A simple tenotomy was performed in thirty-nine cases, and a tenodesis was performed in thirty-three. No associated acromioplasty was performed. All patients were evaluated clinically and radiographically by an independent observer at a mean of thirty-five months postoperatively. Fifty-three patients (78%) were satisfied with the result. The mean Constant score improved from 46.3 +/- 11.9 points preoperatively to 66.5 +/- 16.3 points postoperatively (p < 0.001). A healthy-appearing teres minor on preoperative imaging was associated with significantly increased postoperative external rotation (40.4 degrees +/- 19.8 degrees compared with 18.1 degrees +/- 18.4 degrees ) and a significantly higher Constant score (p < 0.05 for both) compared with the values for the patients with an absent or atrophic teres minor preoperatively. Three patients with pseudoparalysis of the shoulder did not benefit from the procedure and did not regain active elevation above the horizontal level. In contrast, the fifteen patients with painful loss of active elevation recovered active elevation. The acromiohumeral distance decreased 1.1 +/- 1.9 mm on the average, and glenohumeral osteoarthritis developed in only one patient. The results did not differ between the tenotomy and tenodesis groups (mean Constant score, 61.2 +/- 18 points and 72.8 +/- 12 points, respectively). The "Popeye" sign was clinically apparent in twenty-four (62%) of the shoulders that had been treated with a tenotomy; of the sixteen patients who noticed it, none were bothered by it. Both arthroscopic biceps tenotomy and arthroscopic biceps tenodesis can effectively treat severe pain or dysfunction caused by an irreparable rotator cuff tear associated with a biceps lesion. Shoulder function is significantly inferior if the teres minor is atrophic or absent. Pseudoparalysis of the shoulder and severe rotator cuff arthropathy are contraindications to this procedure. Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
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              Massive tears of the rotator cuff.

              Joshua Dines, Asheesh Bedi, David M Dines … (2010)
              Repair of massive rotator cuff tears is technically difficult but often feasible. Technical and biological challenges to a successful repair include inelastic poor-quality tendon tissue, scarring, muscle atrophy, and fatty infiltration. Fatty infiltration of the involved rotator cuff muscles has been identified as an important negative prognostic factor for the outcome after repair of massive rotator cuff tears. Tendon transfer is a good option for young patients and manual laborers with an irreparable massive rotator cuff tear. Arthroplasty can be considered for the treatment of symptomatic massive rotator cuff tears in patients who have glenohumeral arthritis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Orthop J
                Journal ID (iso-abbrev): Open Orthop J
                Journal ID (publisher-id): TOORTHJ
                Title: The Open Orthopaedics Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-3250
                Publication date (Electronic): 21 July 2016
                Publication date Collection: 2016
                Volume: 10
                Pages: 324-329
                Affiliations
                Trauma Department, Hannover Medical School, Hannover, Germany
                Author notes
                [* ] Address correspondence to this author at the Trauma Department of the Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; E-mails: hawi.nael@ 123456mh-hannover.de
                Article
                Publisher ID: TOORTHJ-10-324
                DOI: 10.2174/1874325001610010324
                PMC ID: 5041203
                SO-VID: af8f2143-7008-4661-b205-7357fd5f8341
                Copyright © © Hawi et al.; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) ( https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 4 April 2015
                Date revision received : 16 May 2015
                Date accepted : 1 February 2016
                Categories
                Subject: Article
                Series title: Suppl 1: M8

                ScienceOpen disciplines: Orthopedics
                Keywords: arthroscopy,debridement,degenerative rotator cuff tear,irreparable rotator cuff tear,massive rotator cuff tear,rotator cuff,salvage procedure
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: arthroscopy, debridement, degenerative rotator cuff tear, irreparable rotator cuff tear, massive rotator cuff tear, rotator cuff, salvage procedure

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