Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Siyi , ZHU Yiming , LU Yi , ZHENG TONG , ZHANG Pu , QIN Qihuang ,  JIANG Chunyan

Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;

Corresponding author：

JIANG Chunyan, Email: chunyanj@hotmail.com

Keywords：

Tendon insertion medialization; large rotator cuff tears; massive rotator cuff tears; clinical function; radiologic outcomes

DOI：

10.7507/1002-1892.202212019

Video：

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Objective To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT). Methods The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared. Results All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation (P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation (P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group (P<0.05). There was no significant difference in other baseline data between the two groups (P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group (P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups (P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B (P>0.05). Conclusion Tendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.

Citation： GUO Siyi, ZHU Yiming, LU Yi, ZHENG TONG, ZHANG Pu, QIN Qihuang, JIANG Chunyan. Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 391-397. doi: 10.7507/1002-1892.202212019 Copy

1.	Bedi A, Dines J, Warren RF, et al. Massive tears of the rotator cuff. J Bone Joint Surg (Am), 2010, 92(9): 1894-1908.
2.	Henry P, Wasserstein D, Park S, et al. Arthroscopic repair for chronic massive rotator cuff tears: A systematic review. Arthroscopy, 2015, 31(12): 2472-2480.
3.	Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 2003, 12(6): 550-554.
4.	Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2000, 82(4): 505-515.
5.	Guo S, Zhu Y, Song G, et al. Assessment of tendon retraction in large to massive rotator cuff tears: A modified patte classification based on 2 coronal sections on preoperative magnetic resonance imaging with higher specificity on predicting reparability. Arthroscopy, 2020, 36(11): 2822-2830.
6.	Bigliani LU, Cordasco FA, McLlveen SJ, et al. Operative repair of massive rotator cuff tears: Long-term results. J Shoulder Elbow Surg, 1992, 1(3): 120-130.
7.	Harryman 2nd DT, Mack LA, Wang KY, et al. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg (Am), 1991, 73(7): 982-989.
8.	DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg (Am), 1984, 66(4): 563-567.
9.	Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg (Am), 1986, 68(8): 1136-1144.
10.	Yamamoto N, Itoi E, Tuoheti Y, et al. Glenohumeral joint motion after medial shift of the attachment site of the supraspinatus tendon: a cadaveric study. J Shoulder Elbow Surg, 2007, 16(3): 373-378.
11.	史文骥, 毛宾尧, 朱迎春. 关节镜下止点内移缝合修复巨大肩袖撕裂. 中国骨伤, 2020, 33(12): 1092-1095.
12.	沈海良, 周骁栋, 叶秋杰. 关节镜下肩袖肱骨止点内移技术与传统技术治疗巨大肩袖撕裂的疗效比较. 中国骨伤, 2020, 33(4): 312-316.
13.	王进, 宁仁德, 陈光, 等. 关节镜下肩袖肱骨止点内移技术修复巨大肩袖撕裂. 临床骨科杂志, 2020, 23(5): 673-676.
14.	Lee KW, Lee GS, Yang DS, et al. Clinical outcome of arthroscopic partial repair of large to massive posterosuperior rotator cuff tears: Medialization of the attachment site of the rotator cuff tendon. Clin Orthop Surg, 2020, 12(3): 353-363.
15.	Lee KW, Moon KH, Ma CH, et al. Clinical and radiologic outcomes after medializing and not medializing rotator cuff tendon attachment site on chronic retracted rotator cuff tears. Arthros-copy, 2018, 34(8): 2298-2307.
16.	Kim YK, Jung KH, Won JS, et al. Medialized repair for retracted rotator cuff tears. J Shoulder Elbow Surg, 2017, 26(8): 1432-1440.
17.	Cofield RH. Rotator cuff disease of the shoulder. J Bone Joint Surg (Am), 1985, 67(6): 974-979.
18.	Goutallier D, Postel JM, Van Driessche S, et al. Tension-free cuff repairs with excision of macroscopic tendon lesions and muscular advancement: results in a prospective series with limited fatty muscular degeneration. J Shoulder Elbow Surg, 2006, 15(2): 164-172.
19.	Fuchs B, Weishaupt D, Zanetti M, et al. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg, 1999, 8(6): 599-605.
20.	Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Investigative Radiology, 1998, 33(3): 163-170.
21.	Richards RR, An KN, Bigliani LU, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg, 1994, 3(6): 347-352.
22.	Sugaya H, Maeda K, Matsuki K, et al. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy, 2005, 21(11): 1307-1316.
23.	Davidson PA, Rivenburgh DW. Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elbow Surg, 2000, 9(6): 502-506.
24.	Park SG, Shim BJ, Seok HG. How much will high tension adversely affect rotator cuff repair integrity? Arthroscopy, 2019, 35(11): 2992-3000.
25.	Takeda H, Urata S, Matsuura M, et al. The influence of medial reattachment of the torn cuff tendon for retracted rotator cuff tears. J Shoulder Elbow Surg, 2007, 16(3): 316-320.
26.	Kim JY, Park JS, Rhee YG. Can preoperative magnetic resonance imaging predict the reparability of massiverotator cuff tears? Am J Sports Med, 2017, 45(7): 1654-1663.
27.	Cho NS, Rhee YG. The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder. Clin Orthop Surg, 2009, 1(2): 96-104.
28.	Liu J, Hughes RE, O’Driscoll SW, et al. Biomechanical effect of medial advancement of the supraspinatus tendon. A study in cadavera. J Bone Joint Surg (Am), 1998, 80(6): 853-859.

1. Bedi A, Dines J, Warren RF, et al. Massive tears of the rotator cuff. J Bone Joint Surg (Am), 2010, 92(9): 1894-1908.
2. Henry P, Wasserstein D, Park S, et al. Arthroscopic repair for chronic massive rotator cuff tears: A systematic review. Arthroscopy, 2015, 31(12): 2472-2480.
3. Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 2003, 12(6): 550-554.
4. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2000, 82(4): 505-515.
5. Guo S, Zhu Y, Song G, et al. Assessment of tendon retraction in large to massive rotator cuff tears: A modified patte classification based on 2 coronal sections on preoperative magnetic resonance imaging with higher specificity on predicting reparability. Arthroscopy, 2020, 36(11): 2822-2830.
6. Bigliani LU, Cordasco FA, McLlveen SJ, et al. Operative repair of massive rotator cuff tears: Long-term results. J Shoulder Elbow Surg, 1992, 1(3): 120-130.
7. Harryman 2nd DT, Mack LA, Wang KY, et al. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg (Am), 1991, 73(7): 982-989.
8. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg (Am), 1984, 66(4): 563-567.
9. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg (Am), 1986, 68(8): 1136-1144.
10. Yamamoto N, Itoi E, Tuoheti Y, et al. Glenohumeral joint motion after medial shift of the attachment site of the supraspinatus tendon: a cadaveric study. J Shoulder Elbow Surg, 2007, 16(3): 373-378.
11. 史文骥, 毛宾尧, 朱迎春. 关节镜下止点内移缝合修复巨大肩袖撕裂. 中国骨伤, 2020, 33(12): 1092-1095.
12. 沈海良, 周骁栋, 叶秋杰. 关节镜下肩袖肱骨止点内移技术与传统技术治疗巨大肩袖撕裂的疗效比较. 中国骨伤, 2020, 33(4): 312-316.
13. 王进, 宁仁德, 陈光, 等. 关节镜下肩袖肱骨止点内移技术修复巨大肩袖撕裂. 临床骨科杂志, 2020, 23(5): 673-676.
14. Lee KW, Lee GS, Yang DS, et al. Clinical outcome of arthroscopic partial repair of large to massive posterosuperior rotator cuff tears: Medialization of the attachment site of the rotator cuff tendon. Clin Orthop Surg, 2020, 12(3): 353-363.
15. Lee KW, Moon KH, Ma CH, et al. Clinical and radiologic outcomes after medializing and not medializing rotator cuff tendon attachment site on chronic retracted rotator cuff tears. Arthros-copy, 2018, 34(8): 2298-2307.
16. Kim YK, Jung KH, Won JS, et al. Medialized repair for retracted rotator cuff tears. J Shoulder Elbow Surg, 2017, 26(8): 1432-1440.
17. Cofield RH. Rotator cuff disease of the shoulder. J Bone Joint Surg (Am), 1985, 67(6): 974-979.
18. Goutallier D, Postel JM, Van Driessche S, et al. Tension-free cuff repairs with excision of macroscopic tendon lesions and muscular advancement: results in a prospective series with limited fatty muscular degeneration. J Shoulder Elbow Surg, 2006, 15(2): 164-172.
19. Fuchs B, Weishaupt D, Zanetti M, et al. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg, 1999, 8(6): 599-605.
20. Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Investigative Radiology, 1998, 33(3): 163-170.
21. Richards RR, An KN, Bigliani LU, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg, 1994, 3(6): 347-352.
22. Sugaya H, Maeda K, Matsuki K, et al. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy, 2005, 21(11): 1307-1316.
23. Davidson PA, Rivenburgh DW. Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elbow Surg, 2000, 9(6): 502-506.
24. Park SG, Shim BJ, Seok HG. How much will high tension adversely affect rotator cuff repair integrity? Arthroscopy, 2019, 35(11): 2992-3000.
25. Takeda H, Urata S, Matsuura M, et al. The influence of medial reattachment of the torn cuff tendon for retracted rotator cuff tears. J Shoulder Elbow Surg, 2007, 16(3): 316-320.
26. Kim JY, Park JS, Rhee YG. Can preoperative magnetic resonance imaging predict the reparability of massiverotator cuff tears? Am J Sports Med, 2017, 45(7): 1654-1663.
27. Cho NS, Rhee YG. The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder. Clin Orthop Surg, 2009, 1(2): 96-104.
28. Liu J, Hughes RE, O’Driscoll SW, et al. Biomechanical effect of medial advancement of the supraspinatus tendon. A study in cadavera. J Bone Joint Surg (Am), 1998, 80(6): 853-859.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears

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