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 establish a model of chronic rotator cuff injury by inducing subacromial impingement syndrome in rats, so as to lay a foundation for further study on the mechanism and treatment of chronic rotator cuff injury. MethodsThe polyether-ether-ketone implants were designed and made with three-dimensional printing technique. In 48 male Sprague Dawley rats[weighing, (277.25±22.03) g], one shoulder joint was selected randomly as the experimental group; in the experimental group, the implant was pierced into shoulder joint close tothe acromion medial side and was pierced out under acromion close to the deltoid trailing edge; the penetratingpartof implant was cut off after the implanting part was fixed with 4# braided silk suture. No any treatment was performed on the contralateral shoulder of 24 rats as control group; and the implants were immediately removed after they were pierced into the contralateral shoulder joint of the other 24 rats as sham-operation group. All the rats were exposed to 30 minutes of downhill running at 17 m/minute (-13.5°) every day at 4 days after operation and the general condition of rats was observed. At 2, 4, 6, and 8 weeks after operation, 12 rats were sacrificed to collect shoulder joint samples. The hardtissueslices was used for VanGieson staining and histological observation of the supraspinatus tendon. ResultsAll ratssurvived to the end of experiment, without infection.The rats suffered limp at 2-3 daysafter operation, and the gait of most rats returned to normal at 4 days after operation.The histological results showed that the supraspinatus tendon had smooth edge, without split layers or breakage in the control group and sham-operation group. In the experimental group, the implants were positioned accurately without dislocation; 4 kinds of typical pathological changes were observed. Partial-thickness tear on bursal side appeared at 2 weeks (5 rats) and 4 weeks (2 rats), showing no significant difference between at 2 and 4 weeks (P > 0.05); intratendinous gap formed mainly at 4 weeks (10 rats) and 6 weeks (11 rats), showing significant differences when compared with that at 2 weeks (2 rats) (P < 0.05) and 8 weeks (2 rats) (P < 0.05); partial-thickness tear on articular side mainly appeared at 6 weeks (8 rats), showing significant difference when compared with that at other time points (P < 0.05); full-thickness tear was found mainly at 8 weeks (10 rats), showing significant differences when compared with that at other time points (P < 0.05). ConclusionA model of chronic rotator cuff injury is successfully established in rats through microinvasive implantation of subacromial impingement syndrome inducing implants and the pathological changes in this model are highly similar to the clinical pathological progress.
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 explore the effectiveness of the arthroscopic separate double-layer suture bridge technique in treatment of the delaminated rotator cuff tear. Methods Between May 2013 and May 2015, 54 patients with the delaminated rotator cuff tears were recruited in the study. They were randomly allocated into 2 groups to receive repair either using arthroscopic separate double-layer suture bridge technique (trial group, n=28) or using arthroscopic whole-layer suture bridge technique (control group, n=26). There was no significant difference in gender, age, injured side, tear type, and preoperative visual analogue scale (VAS) score, Constants score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) score, and the range of motion of shoulder joint between 2 groups (P>0.05). Postoperative functional scores, range of motion, and recurrence rate of tear in 2 groups were observed and compared. Results The operation time was significant longer in trial group than in control group (t=8.383, P=0.000). All incisions healed at stage Ⅰ without postoperative complication. All the patients were followed up 12 months. At 12 months postoperatively, the UCLA score, ASES score, VAS score, Constant score, and the range of motion were significantly improved when compared with the preoperative values in 2 groups (P<0.05). However there was no significant difference in above indexes between 2 groups (P>0.05). Four cases (14.3%) of rotator cuff tear recurred in trial group while 5 cases (19.2%) in control group, showing no significant difference (χ2=0.237, P=0.626). Conclusion Compared with the arthroscopic whole-layer suture bridge technique, arthroscopic separate double-layer suture bridge technique presents no significant difference in the shoulder function score, the range of motion, and recurrence of rotator cuff tear, while having a longer operation time.
Objective To investigate effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness. Methods A retrospectively study was performed on the data of 15 patients with rotator cuff tear combined with shoulder stiffness (stiff group) and 24 patients without stiffness (non-stiff group) between January 2014 and December 2015. The patients in the stiff group underwent arthroscopic rotator cuff repair with manipulation release and arthroscopic debridement while the patients in the non-stiff group only received arthroscopic rotator cuff repair. The patients in the stiff group were older than the patients in the non-stiff group, showing significant difference (P<0.05). There was no significant difference in gender, type of rotator cuff tear, side of rotator cuff tear, and combined with diabetes between 2 groups (P>0.05). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were used to evaluate the effectiveness after operation. Results All incisions healed by first intention without any complication after operation. The patients were followed up 13-31 months in the stiff group (mean, 19.2 months) and 13-23 months in the non-stiff group (mean, 20.3 months). There was no significant difference in follow- up time between 2 groups (t=–0.573, P=0.570). The VAS score in the stiff group was higher than that in the non-stiff group before operation (t=–2.166, P=0.037); there was no significant difference between 2 groups at 3, 6, 12 months and last follow-up (P>0.05). The forward flexion and external rotation were significantly lower in the stiff group than those in the non-stiff group before operation and at 3 months after operation (P<0.05); there was no significant difference between 2 groups at 6, 12 months and last follow-up (P>0.05). At last follow-up, the internal rotation was beyond L3 level in 2 groups. The preoperative UCLA score was significant lower in the stiff group than that in the non-stiff group (P=0.037); but there was no significant difference in UCLA score at last follow-up between 2 groups (P=0.786). There was no significant difference in pre- and post-operative ASES scores between 2 groups (P>0.05). Conclusion Satisfactory effectiveness can be achieved in the patients with rotator cuff tear combined with shoulder stiffness after rotator cuff repair with manipulation release and arthroscopic debridement, although the patients with shoulder stiffness had slower postoperative recovery of ROM until 6 months after operation.
ObjectiveElectrospinning technique was used to manufacture polycaprolactone (PCL)/collagen typeⅠ nanofibers orientated patches and to study their physical and chemical characterization, discussing their feasibility as synthetic patches for rotator cuff repairing.MethodsPCL patches were prepared by electrospinning with 10% PCL electrospinning solution (control group) and PCL/collagen typeⅠorientated nanofibers patches were prepared by electrospinning with PCL electrospinning solution with 25% collagen type Ⅰ(experimental group). The morphology and microstructure of the two patches were observed by gross and scanning electron microscopy, and the diameter and porosity of the fibers were measured; the mechanical properties of the patches were tested by uniaxial tensile test; the composition of the patches was analyzed by Fourier transform infrared spectroscopy; and the contact angle of the patch surface was measured. Two kinds of patch extracts were co-cultured with the third generation of rabbit tendon stem cells. Cell counting kit 8 (CCK-8) was used to detect the toxicity and cell proliferation of the materials. Normal cultured cells were used as blank control group. Rabbit tendon stem cells were co-cultured with the two patches and stained with dead/living cells after 3 days of in vitro culture, and laser confocal scanning microscopy was used to observe the cell adhesion and activity on the patch.ResultsGross and scanning electron microscopy showed that the two patch fibers were arranged in orientation. The diameter of patch fibers in the experimental group was significantly smaller than that in the control group (t=26.907, P=0.000), while the porosity in the experimental group was significantly larger than that in the control group (t=2.506, P=0.032). The tensile strength and Young’s modulus of the patch in the experimental group were significantly higher than those in the control group (t=3.705, P=0.029; t=4.064, P=0.034). Infrared spectrum analysis showed that PCL and collagen type Ⅰ were successfully mixed in the experimental group. The surface contact angle of the patch in the experimental group was (73.88±4.97)°, which was hydrophilic, while that in the control group was (128.46±5.10) °, which was hydrophobic. There was a significant difference in the surface contact angle between the two groups (t=21.705, P=0.002). CCK-8 test showed that with the prolongation of culture time, the cell absorbance (A) value increased gradually in each group, and there was no significant difference between the experimental group and the control group at each time point (P>0.05). Laser confocal scanning microscopy showed that rabbit tendon stem cells could adhere and grow on the surface of both patches after 3 days of culture. The number of cells adhered to the surface of the patches in the experimental group was more than that in the control group, and the activity was better.ConclusionPCL/ collagen type Ⅰ nanofibers orientated patch prepared by electrospinning technology has excellent physical and chemical properties, cell adhesion, and no cytotoxicity. It can be used as an ideal scaffold material in tendon tissue engineering for rotator cuff repair in the future.
Objective To compare the effectiveness of simultaneous and delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Methods Between January 2015 and January 2017, 44 patients with proximal humerus fractures complicated with full-thickness rotator cuff injuries were included. Twenty-four patients underwent open reduction and internal fixation (ORIF) and rotator cuff repair simultaneously (simultaneous operation group), and 20 patients underwent delayed arthroscopic rotator cuff repair more than 90 days after ORIF (delayed operation group). There was no significant difference in gender, age, cause of injury, and side of injury between the two groups (P>0.05). The fracture healing was observed by X-ray films. The shoulder function was assessed at 3, 6, and 12 months after operation by using the University of California at Los Angeles (UCLA) score. Results All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17 months). Fractures all healed at 3 months after operation in simultaneous operation group. According to UCLA score, the patients had achieved significantly better outcomes in function, active forward flexion, strength of forward flexion, and subjective satisfaction in simultaneous operation group than in delayed operation group at 3, 6, and 12 months after operation (P<0.05). However, there was no significant difference in pain between the two groups (P>0.05). Conclusion For patients with proximal humerus fracture complicated with full-thickness rotator cuff rupture, performing ORIF and simultaneous repair of rotator cuff can improve shoulder function and achieve better effectiveness when compared with delayed repair of rotator cuff.
ObjectiveTo study the surgical treatments of scapula fracture through the muscle space of rotator cuff approach and the Judet approach, and to evaluate and compare the clinical results.MethodsBetween January 2014 and December 2015, 50 patients with scapula fractures were treated with open reduction and internal fixation of reconstruction plate. Twenty-four patients were treated through the muscle space of rotator cuff approach (group A), and 26 patients were treated through the Judet approach (group B). There was no significant difference in gender, age, cause of injury, type of fracture, and the interval between injury and operation (P>0.05). The operation time, intraoperative blood loss, and incision length were recorded, and the shoulder functions after fracture healing confirmed by X-ray films were evaluated according to the Hardegger’s scoring system.ResultsThe operation time, intraoperative blood loss, and incision length in group A were significantly lower than those in group B (P < 0.05). The incisions of the two groups healed by first intention. All patients were followed up 6-13 months (mean, 11.6 months) in group A and 7-15 months (mean, 12.1 months) in group B. According to Hardegger standard, the effectiveness was rated as excellent in 19 cases, good in 4 cases, and fair in 1 case, with the excellent and good rate of 95.8% in group A, and as excellent in 15 cases, good in 4 cases, fair in 5 cases, and poor in 2 cases with the excellent and good rate of 73.1% in group B. The difference in effectiveness between 2 groups was significant (χ2=4.81, P=0.03). X-ray films showed that the reduction and internal fixation were satisfied and the fractures healed in 2 groups. The fracture healing time were (29.86±8.38) weeks in group A and (30.05±7.99) weeks in group B, showing no significant difference between 2 groups (t=0.16, P=0.87). ConclusionCompared with the Judet approach, the muscle space of rotator cuff approach has advantages of clearly exposure, less muscular dissection, less intraoperative blood loss, less operation time, easier operation, and satisfied shoulder function can be obtained.
ObjectiveTo summarize the research progress of the greater tubercle fixation and the rotator cuff repair in humeral head replacement.MethodsThe literature about proximal humerus fracture and humeral head replacement in recent years was extensively consulted and analyzed.ResultsThe greater tubercle fixation and the attached rotator cuff repair have great influence on the function of shoulder joint after humeral head replacement. It is difficult to make an objective comparison because of lack of direct comparison between various methods, unified standards of grading, and limited number of cases.ConclusionIt is an important factor of reduction and fixation of greater tubercle to obtain better effectiveness in humeral head replacement. However, one-stage repair of rotator cuff is more important than greater tubercle fixation for functional recovery of shoulder joint.
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.