Rotator Cuff Degeneration Etiology and Pathogenesis

The Hospital for Special Surgery, 535 East 70th Street, York, NY 10021, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 06/2008; 36(5):987-93. DOI: 10.1177/0363546508317344
Source: PubMed


By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical intervention. How we intervene is governed by our understanding of the pathological mechanisms in cuff disease. These factors can be divided into those extrinsic to the rotator cuff (impingement, demographic factors) and those intrinsic to the cuff (age-related degeneration, hypovascularity, inflammation, and oxidative stress, among others). In an era where biologic interventions are increasingly being investigated, our understanding of these mechanisms is likely to become more important in designing effective new interventions. Here we present a literature review summarizing our current understanding of the pathophysiological mechanisms underlying rotator cuff degeneration.

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Available from: Shane J Nho, Mar 29, 2015
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    • "In case of rotator cuff repair, the orthopedic surgeon has the opportunity to perform open, mini open, or arthroscopic procedures. Reduced surgical exposure, ease of insertion, and decreased morbidity are the main reasons why arthroscopic procedures become more and more popular (Nho et al., 2008). "
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    ABSTRACT: Rotator cuff tears are of increasing clinical impact in the physically active elderly patients. Recent research revealed, that a high percentage of these patients present with significant loss of bone mineral density at the insertion site of the rotator cuff, thereby compromising suture anchorage for operative repair. We therefore hypothesized that augmentation of suture anchors improves biomechanical properties in low bone quality. 28 osteoporotic humeral heads were included in this biomechanical study. Bone quality at the anchor insertion sites (group 1: posterior-medial; group 2: anterior-lateral) within the greater tuberosity was analyzed using HR-pQCT (voxel size: 82μm). Anchor positions of identical quality were then randomized to either conventional screw anchorage or polymethylmethacrylat augmented screw anchorage. All anchors were cyclically ramp-loaded until pullout. Pullout strength accounted for 226N in group I for conventional anchorage and for 332N in augmented technique. In group 2 (anterior-lateral) the pullout strength was 209N (conventional) and 304N (augmented). Pull-out strength of augmented screw anchors was significantly higher in both groups (p<0.05). Compared to conventional insertion techniques, the cement augmentation technique increases the pullout strength of suture anchors in low bone quality significantly. Cement augmentation could therefore be a helpful tool for improved suture anchor stability, especially in locations of low bone quality. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Clinical Biomechanics 02/2015; 30(3). DOI:10.1016/j.clinbiomech.2015.02.002 · 1.97 Impact Factor
    • "Shortening the tendon may have inadvertently created the anterior angulation seen in the plane of elevation with our suture anchor repairs. However, there are also theories that a biochemical mediator may cause a damaged rotator cuff to retract.[37] Similarly, the re-attachment of the tendon most likely imposed the observed increased variability in the internal-external rotation angle of the humerus. "
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    ABSTRACT: Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder. Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs) were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm) tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device. Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen. This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference (P ≥ 0.10) was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs. Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease.
    International Journal of Shoulder Surgery 04/2013; 7(2):46-51. DOI:10.4103/0973-6042.114224 · 0.65 Impact Factor
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    • "Evidence suggests that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears [8]. Nho et al. [9] also found decreased cellualarity, fascicular thinning and disruption, accumulation of granulation tissue, and dystrophic calcification. The causes of PTRCTs may result from intrinsic failure in the articular side of the tendon. "
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    ABSTRACT: Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs.
    The Korean journal of pain 06/2011; 24(2):69-73. DOI:10.3344/kjp.2011.24.2.69
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