ObjectiveTo explorethe method and effectivenessofarthroscopically assisted treatmentof rotator cuff injury. MethodsBetween November 2009 and March 2011, 27 patients with rotator cuff injury were treated. There were 17 males and 10 females with a mean age of 43.6 years (range, 29-66 years). The disease duration was1 to 36 months (mean, 27months). The location was theleft shoulder in 11 cases and theright shoulder in 16 cases. Of them, 12 cases had a history of trauma and 15 caseshad no obvious predisposing causes. All patients had limitation of shoulder flexionandabduction. Anteroposterior and lateral X-ray films of the shoulder and the out-let X-ray films of the supraspinous muscle were taken. According to the acromion classification of Bigliani, there were 5 cases of type I, 13 cases of type II, and 9 cases of type III. MRI images showed all patients had rupture of the rotator cuff. The examination of shoulder arthroscope showed complete rupture of the supraspinatus muscle in 27 cases and acromion impingement in 23 cases. The patients without impingement underwent tear debridement, and the patients with impingement underwent acromioplasty and resection of subacromial bursa after tear debridement. The 3-4 cm incision was made with arthroscopically assisted positioning, and the metal suture anchorwas placed on the greater tubercle of humerus to repair rotator cuff. ResultsAll incisions healed primarily. All patients were followed up 13-27 months (mean, 19 months). No infection, loosening of internal fixation, and rotator cuffre-tearoccurred. Pain was relieved and the results was satisfactory after operation. The shoulder range of motion (ROM) at last follow-up was significantly improved when compared with preoperative ROM (P lt; 0.05). The visual analogue scale (VAS) score was significantly improved from 8.0 ± 1.8 at preoperation to 1.6 ± 0.7 at 2 weeks after operation and 0.8 ± 0.7 at last follow-up (Plt; 0.05); the University of California Los Angeles (UCLA) score of shoulder was significantly increased from 18.8 ± 6.6 at preoperation to 32.2 ± 3.3at 3months after operation and 33.6 ± 2.1 at last follow-up (P lt; 0.05). Conclusion The effectivenessofarthroscopically assisted treatmentof rotator cuff injury is satisfactory. However, long-termeffectiveness needs furtherfollow-up observation.
Objective?To analyze the effect of different surgery techniques on the tendon-bone healing of rotator cuff insertion.?Methods?Forty-two adult Japanese rabbits, weighing 2.0-2.5 kg and male or female, were selected. Thirty-six rabbits were given a sharply left-lateral tenotomy of the supraspinatus tendon with subsequent re-attachment of the tendon. According to the depth of re-attachment, 36 rabbits were equally randomized into the cancellous-fixation group (a cancellous bed was prepared with a dental burr) and the cortical-fixation group (the same treatment was performed except the preparation of the bone bed). Six rabbits served as the controls without treatment (control group). At 4 and 8 weeks after operation, the general observation, HE staining, and the biomechanical test were performed.?Results?At 4 weeks after operation, the supraspinatus-humerus specimens morphologically showed atrophy and vague between tendon and new bone in the cancellous-fixation group and the cortical-fixation group; at 8 weeks, no obvious difference was observed between 2 groups and the control group. The histological results of the cortical-fixation group at 4 weeks revealed the interface between tendon and new bone became smooth. The interface became transitional at 8 weeks, and the shape of bone tissue was nearly normal. The interface obtained from the cancellous-fixation group at 4 weeks became sclerotic, and collagen fibers formed in disorder. With ingrowth of new bone and re-establishment of collagen-fiber continuity at 8 weeks, thickness of interface became thin, and bone tissue was remodeling. The ultimate load were significantly higher in the cortical-fixation group than in the cancellous-fixation group at both 4 and 8 weeks, and the results gained at 8 weeks is significantly higher than that at 4 weeks in each group (P lt; 0.05). Except rupture strength at 4 weeks between 2 groups and all tensile strength (P gt; 0.05), there were significant differences in the results of others (P lt; 0.05).?Conclusion?In this model, the tendon-bone healing process and the biomechanical properties of cortical-fixation is superior to those of cancellous-fixation.
ObjectiveTo compare the difference of rotator cuff healing between different types of injury and between different repair methods, and to explore the animal model to accurately simulate the restorative process after repair of rotator cuff injury. MethodTwelve adult male beagle dogs (weighing, 10-15 kg) were divided into 3 groups (n=4) according to different processing methods:acute rotator cuff injury+Mason-Allen suture repair (group A), huge rotator cuff injury+Mason-Allen suture repair (group B), and huge rotator cuff injury+Mason-Allen combined with autogenous semitendinosus expansion suture repair (group C). The external fixation was used for immobilization after repair. After operation, the general situation of the animals was observed, and the infraspinatus tendon was harvested for gross observation at 6 weeks after operation. The biomechanical test of limit load and histological observation of tendon fibers were carried out. ResultsAll the animals survived to the end of the experiment. All incisions healed well and no infection occurred. Gross observation showed more scar tissues at the end of infraspinatus muscle tendon than normal tendon in group A; no obvious tendon tissue was observed at the end of infraspinatus muscle tendon in group B; the infraspinatus muscle tendon was covered with some white scar tissue, but the tendon and the general direction could be observed in group C. The limit load of groups A, B, and C were (223.75±24.28) , (159.25±34.87) , and (233.25±14.24) N respectively, group B was significantly lower than groups A and C (P<0.05) , and no significant differnce was found between group A and group C (P>0.05) . Histological observation showed normal arrangement of tendon fibers in group A; tendon fibers arranged disorderly in group B and tendon cells were significantly less than those of group A; tendon fibers arranged in neat in group C and tendon cells were more than those of group B. ConclusionsCanine autologous semitendinosus expansion repair of massive rotator cuff injury immobilization model can better simulate the clinical rotator cuff injury healing process, so it can be used as an ideal animal model for related research.
Objective To compare the analgesic efficiency and safety of subacromial bursa continued ropivacaine analgesia with patient-controlled intravenous analgesia for arthroscopic rotator cuff repair. Methods A total of 64 patients undergoing rotator cuff repair surgery between October 2013 and February 2015 were randomly divided into the subacromial bursa group (JFX group, 32 cases) and the patient-controlled intravenous analgesia group (JM group, 32 cases). At the end of surgery, a catheter was inserted into the subacromial bursa of the patients in JFX group under arthroscopic visualisation and fixed properly, and analgesia pump was connected after surgery; in JM group, analgesia pump was connected to the vein channel after surgery. The pain Visual Analogue Scale (VAS) (motion and rest) scores 1 hour and 12, 24, 48, 72 hours after surgery, adverse reactions, use of analgesic pump, number of additional analgesia and patients satisfaction were recorded. Results There were no differences between the two groups in the number of additional analgesia, patients satisfaction, additional use of antiemetic drugs, motion and rest VAS scores 1 hour and 12, 72 hours after surgery, and the incidence of moderate-severe pain (VAS≥4) at each time point (P>0.05). The motion and rest VAS scores 24, 48 hours after surgery in JFX group were lower than those in JM group, the analgesia times and the incidence of nausea and vomiting in JFX group were lower than those in JM group, and the differences were statistically significant (P<0.05). Conclusion Efficiency of subacromial bursa infiltration of ropivacaine sustained analgesic is slightly better than that of patient-controlled intravenous analgesia, with lower incidence of adverse reactions.
ObjectiveTo investigate the effect of ultrasound-guided anterior injection of platelet-rich plasma (PRP) combined with routine physiotherapy on pain and functional improvement in patients with rotator cuff injury.MethodsThe patients with rotator cuff injury treated in the Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University from August 2017 to June 2018 were randomly divided into control group and PRP group. The control group was treated with routine physiotherapy for 4 weeks, and the PRP group was treated with PRP injection guided by musculoskeletal ultrasound (once a week, two injections) combined with routine physiotherapy for 4 weeks. The Shoulder Pain and Disability Index (SPADI) and the European Shoulder Association Constant-Murley Score (CMS) were used to evaluate the changes of pain and function before intervention, 12 weeks after intervention and 24 weeks after intervention.ResultsFinally, 65 patients were included, with 33 in the control group and 32 in the PRP group. Compared with the control group, there were significant differences in the CMS and SAPDI scores between the PRP group and the control group at 12 and 24 weeks after intervention (P<0.05), except before intervention (P>0.05). Twelve and 24 weeks after intervention, the CMS scores of the two groups were higher than those before intervention, while the SPADI scores were lower than those before intervention (P<0.05). The results of repeated measures analysis of variances showed that there was no statistical significance in group effect of CMS or SAPDI scores (F=2.753, P=0.102; F=2.724, P=0.104), but the time effects of CMS and SAPDI scores were statistically significant (F=251.002, P<0.001; F= 1 846.753, P<0.001), and there was interaction between group and time (F=4.931, P=0.020; F=36.405, P<0.001).ConclusionAnterior injection of PRP guided by musculoskeletal ultrasound combined with conventional physiotherapy is more effective than conventional physiotherapy in relieving shoulder pain and improving shoulder joint function.
Objective To compare the effectiveness of the long head of the biceps tendon (LHBT) with or without proximal amputation after arthroscopic rotator cuff repair in the treatment of repairable rotator cuff tear with LHBT injury. Methods The clinical data of 68 patients with LHBT injury combined with supraspinatus tendon tear who met the selection criteria between January 2016 and June 2020 were retrospectively analyzed. According to whether the proximal end of LHBT was cut off or not after arthroscopic rotator cuff repair, they were divided into LHBT fixation without cutting group (group A, 32 cases) and LHBT fixation with cutting group (group B, 36 cases). There was no significant difference in gender, age, operating side, preoperative supraspinatus tear width, Constant-Murley shoulder function scale, University of California Los Angeles (UCLA) score, and visual analogue scale (VAS) score between the two groups (P>0.05). The operation time, elbow flexion muscle strength, and postoperative complications were compared between the two groups. The Constant-Murley shoulder function scale, UCLA score, and VAS score were used to evaluate the recovery of shoulder function before operation and at 3, 6, 12 months after operation. The acromion-humeral distance (AHD) was measured by Y-view X-ray film of the shoulder joint immediately after operation and at last follow-up. AHD and acromion-greater tubercle distance (AGT) were measured by musculoskeletal ultrasound at 0°, 30°, 60°, and 90° of abduction. Results There was no significant difference in operation time between the two groups (t=–0.740, P=0.463). Patients in both groups were followed up (13.0±0.7) months in group A and (13.1±0.8) months in group B, with no significant difference (t=0.127, P=0.899). At last follow-up, the elbow flexor muscle strength of the two groups reached grade Ⅴ. Complications (including shoulder pain, deltoid atrophy, and rotator cuff re-tear) occurred in 6 patients (18.75%) in group A and 9 patients (25.00%) in group B, without neurovascular injury, surgical site infection, joint stiffness, LHBT spasmodic pain, and Popeye deformity. There was no significant difference in the incidence of complications between the two groups (χ2=0.385, P=0.535). The Constant-Murley shoulder function scale, UCLA score, and VAS score significantly improved in both groups at 3, 6, and 12 months after operation (P>0.05). The above scores in group B were significantly better than those in group A at 3 and 6 months after operation (P<0.05), and there was no significant difference between the two groups at 12 months after operation (P>0.05). Y-view X-ray film measurement of the shoulder joint showed that the AHD of the two groups at last follow-up was less than that at immediate after operation, but the difference was not significant (Z=−1.247, P=0.212); the AHD of group A was significantly greater than that of group B at last follow-up (t=−2.291, P=0.025). During musculoskeletal ultrasound detection of abduction and shoulder lift, there was no significant difference in the reduction degree of AHD and AGT in group A with abduction of 0°-30° compared with group B (P>0.05). The reduction degree of AHD and AGT in group A with abduction of 30°-60°, and the reduction degree of AGT in group A with abduction of 60°-90° were significantly smaller than those in group B (P<0.05). Conclusion In arthroscopic rotator cuff repair, whether the proximal structure of LHBT is cut off or not after LHBT fixation can effectively improve the symptoms of patients and promote the recovery of shoulder joint function. Compared with preserving the proximal structure of LHBT, cutting the proximal structure of LHBT after LHBT fixation has more obvious pain relief within 6 months, and the latter had better stability above the shoulder joint.
Rotator cuff injuries are often associated with long head of biceps tendon (LHBT) lesions, which are more common in middle-aged and older adults. With the continuous updating of diagnosis and treatment techniques and treatment concepts in recent years, many patients can receive effective diagnosis and treatment. This article starts from the anatomy, etiology, diagnosis and treatment progress of rotator cuff and LHBT, and details the related research progress of rotator cuff injury combined with LHBT at home and abroad. This paper focuses on the significance of paying attention to LHBT lesions while dealing with rotator cuff injuries, aiming to improve clinicians’ understanding of rotator cuff injuries combined with LHBT lesions, explore accurate and effective diagnosis and treatment systems, so as to choose the best treatment method.
ObjectiveTo investigate the feasibility and effectiveness of “tail compression fixation+suture bridge” technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff. Methods The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with “tail compression fixation+suture bridge” technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system. Results All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation (P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation (P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).Conclusion For the patients with primary tear in medial enthesis of rotator cuff, the “tail compression fixation+suture bridge” technology under shoulder arthroscopy is simple and effective.
Objective To explore the mid-term effectiveness of arthroscopic “mini incision” transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesion. Methods A clinical data of 39 patients with PASTA lesions, who underwent the arthroscopic “mini incision” transtendon repair and met the selected criteria between May 2017 and April 2021, was retrospectively analyzed. There were 13 males and 26 females, with an average age of 63.7 years (range, 43-76 years). Nine patients underwent trauma history, and no obvious inducement was found in the other 30 patients. The main clinical symptom was shoulder pain with positive hug resistance test. The interval from symptom onset to operation was 3-21 months (mean, 8.3 months). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, American Association of Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up. Results All incisions healed by first intention with no complications such as incision infection or nerve injury. All patients were followed up 24-71 months (mean, 46.9 months). The VAS, UCLA, and ASES scores significantly improved at 24 months after operation when compared with preoperative ones (P<0.05). The ROMs of forward flexion and external rotation of the shoulder joint significantly increased at 3 and 24 months, and further increased at 24 months compared to 3 months, with significant differences (P<0.05). However, the ROM of abduction of the shoulder joint at 3 months did not significantly improve compared with that before operation (P>0.05), and it was significantly greater at 24 months than before operation and at 3 months after operation (P<0.05). At last follow-up, the patients were very satisfied with the effectiveness in 30 cases (76.9%), satisfied in 5 cases (12.8%), and dissatisfied in 4 cases (10.3%). At 6 months after operation, 31 patients underwent reviews of MRI scans, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing, and 3 patients underwent tendon re-tear. ConclusionArthroscopic “mini incision” transtendon repair in treatment of PASTA lesion could obtain satisfying mid-term effectiveness with low risk of tendon re-tear.
ObjectiveTo review the research progress in biotherapy of rotator cuff injury in recent years, in order to provide help for clinical decision-making of rotator cuff injury treatment. MethodsThe literature related to biotherapy of rotator cuff injury at home and abroad in recent years was widely reviewed, and the mechanism and efficacy of biotherapy for rotator cuff injury were summarized from the aspects of platelet-rich plasma (PRP), growth factors, stem cells, and exosomes. ResultsIn order to relieve patients’ pain, improve upper limb function, and improve quality of life, the treatment of rotator cuff injury experienced an important change from conservative treatment to open surgery to arthroscopic rotator cuff repair. Arthroscopic rotator cuff repair plus a variety of biotherapy methods have become the mainstream of clinical treatment. All kinds of biotherapy methods have ideal mid- and long-term effectiveness in the repair of rotator cuff injury. The biotherapy method to promote the healing of rotator cuff injury is controversial and needs to be further studied. ConclusionAll kinds of biotherapy methods show a good effect on the repair of rotator cuff injury. It will be an important research direction to further develop new biotherapy technology and verify its effectiveness.