Débridement of degenerative, irreparable lesions of the rotator cuff.

Rockwood, Charles A.; Williams, Gerald R.; Burkhead, Wayne Z.

doi:10.2106/00004623-199506000-00006

Cited by 392 publications

(210 citation statements)

References 48 publications

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“…Clinically, our findings support phased postoperative rehabilitation programs to match the progressive restoration of anatomy and tensile strength of a new enthesis [5,23,29,30]. Since the duration of rehabilitation has so far been based on clinical judgment and rarely extended to 24 weeks [5,30], our results caution against too short a rehabilitation period.…”

Section: Discussionsupporting

confidence: 68%

Formation of a new enthesis after attachment of the supraspinatus tendon: A quantitative histologic study in rabbits

2005

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Purpose. To quantify in a longitudinal study non-chondrocytic cells and chondrocytes, tissular architecture as well as extracellular matrix restoration during the formation of an enthesis following supraspinatus tendon attachment to the humerus. Methods. In 89 rabbits, one supraspinatus fibrocartilaginous enthesis was resected and the tendon either attached to the greater tuberosity (n = 75) or not attached ( n = 14). The animals were sacrificed after 2, 6, 8, 12 or 24 weeks. The operated and contralateral shoulders were processed for histologic sections. Number of non-chondrocytes, chondrocytes and alignment of chondrocytes in rows were assessed histologically. Extracellular matrix restoration was measured based on ( 1 ) area of toluidine blue metachromasia indicating proteoglycan content and (2) on area of diffracted polarized light indicating spatial collagen fiber alignment. Results. In the attached tendon, the number of non-chondrocytic cells sharply increased at 2 weeks, progressively decreased thereafter but remained higher than controls at all time points. Chondrocytes appeared at 2 weeks and their number reached control levels by 6 weeks (136 f 14 vs 144 5 15 controls, p .05). The percentage of chondrocytes aligned in rows increased from 19 k 4% at 2 weeks to reach near normal values at 24 weeks (71 f 3% vs 78 5 2% controls, p > .05). Area of metachromasia increased from 0.1 f 0.1 mm2 at 2 weeks to 3.8 k 0.3 mm2 at 24 weeks, still below contralateral enthesis levels (4.6 f 0.1 mm2, p < .05). Area of diffracted polarized light enlarged from 12 5 2 x lo3 pm2 at 2 weeks to 151 k 19 x lo3 pm2 at 24 weeks, still significantly smaller than contralateral levels (177 k 13 x lo3 pm', p < .05). Neither chondrocytes nor metachromasia were observed in the non-attached tendons. Conclusion. A new enthesis was formed after attachment of the supraspinatus tendon into bony trough. Histomorphometry allowed to document extensive non-chondrocytic proliferation that was followed by appearance of chondrocytes and their spatial organization, a process was complete by 24 weeks. Extracellular matrix formation as well as spatial alignment of collagen fibers were delayed and not complete by 24 weeks. This first longitudinal investigation on the formation of the supraspinatus enthesis using quantitative outcome measures cautions against too early and too aggressive a rehabilitation program.

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Section: Discussionsupporting

confidence: 68%

Formation of a new enthesis after attachment of the supraspinatus tendon: A quantitative histologic study in rabbits

2005

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“…Chronic tears may give rise to tendon retraction, atrophy and fatty degeneration of the affected muscle [13], leading to impaired muscle quality and, often, to defective contraction, which renders bone reattachment ineffective. In such cases, the therapeutic options include arthroscopic debridement [10], acromioplasty [17], biceps tenodesis [20], cuff fixation to avoid progression [5], tuberoplasty [9], tendon transfer [1-3, 6, 11, 12, 15, 19, 21, 22] and tendon graft.…”

Section: Introductionmentioning

confidence: 99%

Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff

Zafra

Carpintero

Carrasco

2008

International Orthopaedics (SICOT)

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The objective of this paper was to determine the outcome of the transfer of the latissimus dorsi tendon in patients with massive irreparable rotator cuff tears. Eighteen patients of mean age 54 years (range 37-72 years) with massive irreparable rotator cuff tears were studied. The mean follow-up was 28 months (range 12-58 months). The postoperative Constant score was higher by an average of 21.15 points compared to the preoperative score (P=0.002); 88.8% of patients reported significant pain relief and improved mobility, particularly on external rotation. Postoperative resting antero-posterior radiography in neutral rotation revealed a mean 3.2-mm depression of the humeral head, due to the tenodesis effect of tendon transfer, thus, increasing the deltoid lever arm. These clinical results suggest that latissimus dorsi transfer is a useful surgical technique for treating massive irreparable postero-superior tears of the rotator cuff in young and/or active patients, providing significant pain relief and improved shoulder strength.

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“…Furthermore, recurrent and chronic rotator cuff tears may not be repairable. Treatment of symptomatic irreparable tears is extremely challenging and limited to nonsurgical management, débridement with partial repair [18][19][20][21] , or major reconstructive procedures such as muscle transfers 22 .…”

mentioning

confidence: 99%

Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device

Derwin

Codsi

Milks

et al. 2009

The Journal of Bone and Joint Surgery-American Volume

142

129

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Débridement of degenerative, irreparable lesions of the rotator cuff.

Cited by 392 publications

References 48 publications

Formation of a new enthesis after attachment of the supraspinatus tendon: A quantitative histologic study in rabbits

Formation of a new enthesis after attachment of the supraspinatus tendon: A quantitative histologic study in rabbits

Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff

Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device

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