Rotator Cuff Repair in the Pediatric Population Displays Favorable Outcomes: A Systematic Review

Abstract

To systematically review the literature to determine the injury mechanisms, presentation, and timing of diagnosis for pediatric patients with intratendinous rotator cuff tears and to determine the efficacy of surgical intervention for affected patients. Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus were searched. Studies were included if they involved only pediatric patients, soft-tissue rotator cuff injuries managed surgically, and reported outcomes. Patient characteristics, injury mechanisms, physical examination and imaging findings, time to diagnosis, surgical technique, and treatment outcomes were extracted. Findings were descriptively analyzed with weighted means and proportions. Results: Twenty-one studies comprising 78 patients were included. The age range was 8 to 17 years and 57 were male. The supraspinatus (n ¼ 56) was the most injured tendon. American football was the most reported sport played at the time of injury. Most patients were diagnosed within 6 months of injury via magnetic resonance imaging. Arthroscopic management was undertaken in 68 patients. Forty-six of 51 patients for whom data were available returned to sports at a range of 2.5 to 12 months postoperatively. Repair failure occurred in three patients. Conclusion: The extant literature regarding rotator cuff tears in pediatric patients is limited to reports of low methodological quality. Qualitative synthesis of this low-level literature reveals that rotator cuff tears are mostly reported in male collision sport athletes but may also occur in female athletes and/or throwing athletes. These injuries are often successfully managed via arthroscopic repair, and patients and their families can be reassured that the majority of patients return to sports following surgery.

Pediatric Shoulder Arthroscopy is Effective and Most Commonly Indicated for Instability, Obstetric Brachial Plexus Palsy, and Partial Rotator Cuff Tears

“… 39 , 40 Clinical outcomes for surgical repair of rotator cuff tears in pediatric patients have been reported to be excellent, but these studies have not independently reported outcomes for open and arthroscopic repair. 41 , 42 Only one study included in this review, Eisner et al., 26 evaluated clinical outcomes of partial-thickness rotator cuff tears treated with arthroscopic repair but did not obtain preoperative scores and was thus unable to quantify the clinical benefit of arthroscopic repair. Arthroscopy for obstetric brachial plexus birth palsy resulted in improved Mallet, glenoid retroversion, PHHA glenoid deformity score, and external rotation after surgery consistent with previous systematic reviews.…”

Rotator Cuff Repair in Pediatric and Adolescent Athletes: Indications and Outcomes

“…22 Surgery may improve pain and function; the current remaining goal might be developing better rehabilitation programs to help these patients return to play. Condron et al, 13 in a systematic review, report excellent outcomes whether surgery was performed within 1 month of injury or delayed for up to 2 years. This result might contradict the conventional approach suggesting an early surgical management is crucial for traumatic injuries to prevent atrophy and scar tissue formation.…”

“…Nevertheless, radiographs could demonstrate indirect signs of RC tears, such as a halo of calcification superior to the humeral head, in the subacromial space correlated to a long-standing supraspinatus injury. 13 Ultrasound can also be used as a diagnostic tool for RC tears in young patients. It is noninvasive, cost-effective, and readily available.…”

“…Arthroscopic repair has not been shown to lead to significantly better clinical outcomes. 5,13 Vezeridis et al 20 report excellent functional outcomes at a median follow-up of 12 months after open repair for 8 patients. However, arthroscopic treatment has better cosmetic results, allows treatment of any concomitant pathologic conditions, decreases the levels of postoperative pain, might decrease the risk of shoulder stiffness, and is characterized by a shorter recovery time.…”

“…Although x-rays can help in ruling out bone fractures (eg, avulsion fractures), this imaging technique may not directly visualize soft tissue injuries. Nevertheless, radiographs could demonstrate indirect signs of RC tears, such as a halo of calcification superior to the humeral head, in the subacromial space correlated to a long-standing supraspinatus injury 13 …”