Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes

Greenspoon, Joshua A.; Petri, Maximilian; Warth, Ryan J.; Millett, Peter J.

doi:10.1016/j.jse.2015.04.005

Cited by 156 publications

(169 citation statements)

References 128 publications

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“…These injections have been shown to be of benefit for early and late osteoarthritis of the shoulder [39,40]. A series of infiltrations with hyaluronic acid (once a week for 3 weeks) followed by rehabilitative treatment yielded significant pain reduction, improvement of range of motion, and autonomy in daily life activities [41] in a cohort of 22 patients (mean age 78y) with rotator cuff tears.…”

Section: Conservative Treatmentmentioning

confidence: 99%

“…The ideal candidate for this type of procedure is a young, active patient with an irreparable rotator cuff tendon tear and minimal glenohumeral arthritis whose primary complaint is weakness [10]. Various tendons transfer techniques has been described for patients with massive irreparable tears, with the most common being latissimus dorsi with or without the teres major, pectoralis major, and trapezius [10,41].…”

Section: Tendon Transfersmentioning

confidence: 99%

“…It seems that pectoralis major transfers are a reasonable surgical option for the management of irreparable anterosuperior rotator cuff tears, particularly when the patient is experiencing anterior instability as a result of subscapularis insufficiency [41].…”

Section: Tendon Transfersmentioning

confidence: 99%

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Options Before Reverse Total Shoulder Replacement

Hackney¹,

Lesniewski²,

Cowling³

2018

Advances in Shoulder Surgery

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Management of massive tears of the rotator cuff tears is one of the most difficult problems an upper limb surgeon encounters. Patients with similar tears can present with minimal discomfort through to a flail shoulder. There are a bewildering number of options available, many with published outcomes not always borne out in clinical practise. These range from rehabilitation, simple arthroscopic surgery, attempts at repair, complex tendon transfers and ultimately a reverse total shoulder replacement. More recently further options of patch augmentation and balloon arthroplasty have been added. This paper attempts to provide a critical assessment of the evidence available.

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Section: Conservative Treatmentmentioning

confidence: 99%

Section: Tendon Transfersmentioning

confidence: 99%

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Options Before Reverse Total Shoulder Replacement

Hackney¹,

Lesniewski²,

Cowling³

2018

Advances in Shoulder Surgery

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“…About 10% to 40% of all rotator cuff tears are massive rotator cuff tears that present a formidable clinical challenge to the orthopedic surgeon, and which often require implantable devices for therapy [3]. Tissue grafts, particularly allograft is the current gold standard in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Alignment of collagen fiber in knitted silk scaffold for functional massive rotator cuff repair

Zheng¹,

Ran

Chen

et al. 2017

Acta Biomaterialia

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a b s t r a c tRotator cuff tear is one of the most common types of shoulder injuries, often resulting in pain and physical debilitation. Allogeneic tendon-derived decellularized matrices do not have appropriate pore size and porosity to facilitate cell infiltration, while commercially-available synthetic scaffolds are often inadequate at inducing tenogenic differentiation. The aim of this study is to develop an advanced 3D aligned collagen/silk scaffold (ACS) and investigate its efficacy in a rabbit massive rotator cuff tear model. ACS has similar 3D alignment of collagen fibers as natural tendon with superior mechanical characteristics. Based on ectopic transplantation studies, the optimal collagen concentration (10 mg/ml), pore diameter (108.43 ± 7.25 lm) and porosity (97.94 ± 0.08%) required for sustaining a stable macro-structure conducive for cellular infiltration was determined. Within in vitro culture, tendon stem/progenitor cells (TSPCs) displayed spindle-shaped morphology, and were well-aligned on ACS as early as 24 h. TSPCs formed intercellular contacts and deposited extracellular matrix after 7 days. With the in vivo rotator cuff repair model, the regenerative tendon of the ACS group displayed more conspicuous native microstructures with larger diameter collagen fibrils (48.72 ± 3.75 vs. 44.26 ± 5.03 nm) that had better alignment and mechanical properties (139.85 ± 49.36 vs. 99.09 ± 33.98 N) at 12 weeks post-implantation. In conclusion, these findings demonstrate the positive efficacy of the macroporous 3D aligned scaffold in facilitating rotator cuff tendon regeneration, and its practical applications for rotator cuff tendon tissue engineering. Statement of SignificanceMassive rotator cuff tear is one of the most common shoulder injuries, and poses a formidable clinical challenge to the orthopedic surgeon. Tissue engineering of tendon can potentially overcome the problem. However, more efficacious scaffolds with good biocompatibility, appropriate pore size, favorable inductivity and sufficient mechanical strength for repairing massive rotator cuff tendon injuries need to be developed. In this study, we developed a novel macroporous 3D aligned collagen/silk scaffold, and demonstrated that this novel scaffold enhanced the efficacy of rotator cuff tendon regeneration by inducing aligned supracellular structures similar to natural tendon, which in turn enhanced http://dx

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“…The prevalence of massive rotator cuff tears has been reported to be as high as 40% of all rotator cuff tears, and failure rates are higher when compared with smaller tears. [1][2][3] Many surgical treatment options exist including debridement with biceps tenodesis, complete repair, partial repair, repair with patch augmentation, superior capsule reconstruction, tendon transfer, and reverse total shoulder arthroplasty. However, concerns regarding longevity of arthroplasty implants and morbidity associated with tendon transfers lend these treatment options to be less desirable in younger and more active patients.…”

mentioning

confidence: 99%

Arthroscopic Knotless, Double-Row, Extended Linked Repair for Massive Rotator Cuff Tears

Greenspoon

Petri

Millett

2016

Arthroscopy Techniques

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The management of massive rotator cuff tears remains a challenge for physicians, with failure rates being higher when compared with smaller tears. Many surgical treatment options exist including debridement with biceps tenodesis, complete repair, partial repair, repair with augmentation devices, superior capsule reconstruction, tendon transfer, and reverse total shoulder arthroplasty. The purpose of this article is to describe our preferred surgical technique for a complete arthroscopic repair using an extended linked, knotless, double-row construct.

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Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes

Cited by 156 publications

References 128 publications

Options Before Reverse Total Shoulder Replacement

Options Before Reverse Total Shoulder Replacement

Alignment of collagen fiber in knitted silk scaffold for functional massive rotator cuff repair

Arthroscopic Knotless, Double-Row, Extended Linked Repair for Massive Rotator Cuff Tears

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