0
Scientific Articles   |    
Tendon Integrity and Functional Outcome After Arthroscopic Repair of High-Grade Partial-Thickness Supraspinatus Tears
Ganesh Kamath, MD1; Leesa M. Galatz, MD1; Jay D. Keener, MD1; Sharlene Teefey, MD2; William Middleton, MD2; Ken Yamaguchi, MD1
1 Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for L.M. Galatz: galatzl@wustl.edu
2 Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, St. Louis, MO 63110
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Arthrex). Also, a commercial entity (Arthrex) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).
Investigation performed at the Shoulder and Elbow Service, Washington University Orthopaedics, Barnes-Jewish Hospital, St. Louis, Missouri

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 May 01;91(5):1055-1062. doi: 10.2106/JBJS.G.00118
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Partial-thickness rotator cuff tears are a common cause of shoulder pain, yet the appropriate surgical treatment is controversial. In particular, very little information is available regarding rotator cuff integrity after operative repair. The purpose of this study was to evaluate the functional outcome and anatomic healing rate after arthroscopic repair of high-grade partial (>50%) thickness tears of the supraspinatus tendon.

Methods: Forty-one consecutive patients (forty-two shoulders) who had undergone arthroscopic conversion of a partial-thickness rotator cuff tear to a full-thickness tear and subsequent repair were evaluated with ultrasound for evidence of rotator cuff healing. Clinical outcomes were assessed with use of validated outcomes measures, and all patients were reexamined by an independent observer.

Results: The average patient age was fifty-three years. Thirty-seven (88%) of the forty-two shoulders had an intact rotator cuff repair seen on ultrasound at an average of eleven months postoperatively. The remaining five patients had a full-thickness defect in the tendon. The mean American Shoulder and Elbow Surgeons (ASES) score improved from 46.1 points preoperatively to 82.1 points at the time of follow-up. The overall rate of patient satisfaction was 93%. The average age of the patients with an intact rotator cuff was 51.8 years compared with 62.6 years for those with a persistent defect (p = 0.02).

Conclusions: Arthroscopic repair of high-grade partial-thickness rotator cuff tears results in a high rate of tendon healing. Patient age is an important factor in tendon healing.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Leesa M. Galatz, MD
    Posted on June 08, 2009
    Dr. Galatz and colleagues respond to Dr. Bernstein
    Washington Universtiy in St. Louis School of Medicine

    We agree with Dr. Bernstein’s statement that not all partial thickness rotator cuff tears are painful. It should be emphasized that our article applies to partial thickness rotator cuff tears in patients who have failed non-operative treatment, and thus came to surgery. The results and recommendations from our study are specific to symptomatic tears and should not be generalized to asymptomatic ones or those that respond to conservative treatment. As noted by Dr. Bernstein, it is widely accepted that many individuals have asymptomatic partial thickness rotator cuff tears and/or tendinosis which may be evident on MRI. The natural history and potential for full-thickness progression of these tears is unknown. We agree with Dr. Bernstein’s concerns given that we are currently studying the natural history of asymptomatic partial thickness tears as part of our ongoing NIH R01 investigation. We appreciate Dr. Bernstein’s comments and reiterate that our results do not apply for partial rotator cuff tears that can be treated non-operatively.

    Joseph Bernstein
    Posted on May 28, 2009
    Association of Partial Thickness Tears of the Rotator Cuff and Shoulder Pain
    University of Pennsylvania, Philadelphia, Pennsylvania

    To the Editor:

    The opening sentence of the paper, “Tendon Integrity and Functional Outcome After Arthroscopic Repair of High-Grade Partial-Thickness Supraspinatus Tears” by Kamath et al. (1) is extremely troubling. The authors assert, without citation, that, “Partial-thickness tears of the rotator cuff are a common source of shoulder pain”.

    Forgetting for a moment whether designating the condition of tendinosis as a, “partial tear”, and thereby implying that this lesion is one in need of “repair”, it is the case that partial-thickness tears of the rotator cuff are also found in asymptomatic individuals. At best then, we can say that, “partial-thickness tears of the rotator cuff are associated with shoulder pain”. I believe that the relationship of partial-thickness rotator cuff tears and shoulder pain must be deemed incidental, not causal.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

    Reference

    1. Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K. Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am. 2009;91:1055-62.

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    02/05/2014
    OR - The Center - Orthopedic and Neurosurgical Care and Research
    04/16/2014
    CT - Yale University School of Medicine
    12/31/2013
    SC - Department of Orthopaedic Surgery Medical Univerity of South Carlonina