Thursday, January 5, 2012

rotator cuff tears - articles in the December 2011 Journal of Shoulder and Elbow Surgery

Baring et al conducted a study of the change in distance between the supraspinatus tendon and the greater tuberosity with time after open rotator cuff repair. With implanted metal beads and wires they used stereophotogrammetry to monitor the relative position of the tendon and bone to which it was repaired in 10 patients.

During the first month after surgery, the arm was kept in a brace and the distance between the tendon and bone markers did not change over this time interval. During the next 10 weeks passive, then active motion motion was instituted - during this time the distance increased by an average of 7 mm; more motion was noted in the shoulders where the cuff repair eventually failed (3 of the four cases with tears initially measuring > 4 cm). Interestingly there was no significant relationship between the change in the Constant score and the change in the tendon-bone distance.

This paper is important because it shows the difficulty in defining 'success' after rotator cuff surgery. Is it cuff integrity? Is maintaining the relationship between the tendon and the bone? or Is it improvement in the Constant Score or SST?  For example, two patients were felt to have partial retears by ultra sound and over 10 mm increase in tendon-to-bone distance, yet these patients improved their SST scores from 1 to 10 and from 2 to 10, respectively - the biggest improvement in the series. By contrast three patients had final SST scores of 7 or less, each of which had intact repairs by ultrasound and some of the smallest increases in tendon-to-bone distance (2.1, 5.9. and 6.3).

This paper also brings to the surface the question "when is the repair healed enough to start motion?" The authors conclude that 'cuff repairs are most vulnerable to failure in the second and third months.'

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