An Evidenced-Based Examination of the Epidemiology and Outcomes of Traumatic Rotator Cuff Tears

Sports Medicine Program, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 01/2013; 29(2). DOI: 10.1016/j.arthro.2012.06.024
Source: PubMed


PURPOSE: The purpose of this study was to systematically review the literature to better define the epidemiology, mechanism of injury, tear characteristics, outcomes, and healing of traumatic rotator cuff tears. A secondary goal was to determine if sufficient evidence exists to recommend early surgical repair in traumatic rotator cuff tears. METHODS: An independent systematic review was conducted of evidence Levels I to IV. A literature search of PubMed, Medline, Embase, and Cochrane Collaboration of Systematic Reviews was conducted, with 3 reviewers assessing studies for inclusion, methodology of individual study, and extracted data. RESULTS: Nine studies met the inclusion and exclusion criteria. Average patient age was 54.7 (34 to 61) years, and reported mean time to surgical intervention, 66 days (3 to 48 weeks) from the time of injury. The most common mechanism of injury was fall onto an outstretched arm. Supraspinatus was involved in 84% of tears, and infraspinatus was torn in 39% of shoulders. Subscapularis tears were present in 78% of injuries. Tear size was <3 cm in 22%, 3 to 5 cm in 36%, and >5 cm in 42%. Average active forward elevation improved from 81° to 150° postoperatively. The weighted mean postoperative UCLA score was 30, and the Constant score was 77. CONCLUSIONS: Traumatic rotator cuff tears are more likely to occur in relatively young (age 54.7), largely male patients who suffer a fall or trauma to an abducted, externally rotated arm. These tears are typically large and involve the subscapularis, and repair results in acceptable results. However, insufficient data prevent a firm recommendation for early surgical repair. LEVEL OF EVIDENCE: Level IV, systematic review Levels III and IV studies.

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Available from: Seth L Sherman, Feb 09, 2015
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    • "Since 14–63% of anterior dislocations are associated with rotator cuff tears [12], MRI should be performed when the patient has persistent pain or muscle weakness after reduction of the shoulder. Although Mall et al. reported that there was no indication that acute repair in traumatic injuries produced better outcomes [13], Simonich and Wright recommend proceeding with rotator cuff repair as soon as the diagnosis has been made in order to obtain the optimal results for terrible triad of injuries [14]. The tears of tendons of the rotator cuff cause atrophy and fatty degeneration of the rotator cuff muscles. "
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    ABSTRACT: We present a case of concurrent rotator cuff tear and axillary nerve palsy resulting from anterior dislocation of the shoulder and a large glenoid rim fracture-a "terrible tetrad." A 61-year-old woman fell on her right shoulder. Radiographs showed anterior dislocation of the shoulder with a glenoid rim fracture, and an MRI two months after injury revealed a rotator cuff tear. Upon referral to our hospital, physical and electrophysiological examinations revealed axillary nerve palsy. The axillary nerve palsy was incomplete and recovering, and displacement of the glenoid rim fracture was minimal and already united; therefore, we surgically repaired only the rotator cuff tear three months after injury. The patient recovered satisfactorily following the operation. In patients whose axillary nerve palsy is recovering, surgeons should consider operating on rotator cuff tears in an attempt to prevent rotator cuff degeneration.
    06/2014; 2014:312968. DOI:10.1155/2014/312968

  • Arthroscopy The Journal of Arthroscopic and Related Surgery 02/2013; 29(2):191-192. DOI:10.1016/j.arthro.2012.11.012 · 3.21 Impact Factor
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    ABSTRACT: The present article aims to give an overview of the current surgical techniques for arthro- scopic rotator cuff repair. Depending on the affected tendons and the size of the tear sev- eral methods of refixation are available. In articular sided partial tears of the supraspina- tus tendon a transtendinous repair of the ten- don can be performed with good clinical out- comes. In complete tears of the superior and posterosuperior cuff single and double-row techniques are available. Despite the promis- ing biomechanical properties of double-row techniques the respective clinical results are not superior to a single-row technique with a modified suture configuration. Whereas tears of the subscapularis tendon have long been thought to be only repairable in an open sur- gery the results of arthroscopic refixation es- pecially of the cranial part of the tendon are promising. Biological augmentation of rotator cuff repairs with platelet-rich plasma was not able to increase the healing rate so far.
    Minerva Ortopedica e Traumatologica 12/2013; 64(6):535-546.
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