• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.257-264
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• 2022

Background: Chronic subscapularis tendon tear (SBT) is a degenerative disease and a common pathologic cause of shoulder pain. Several potential risk factors for chronic SBT have been reported. Although metabolic abnormalities are common risk factors for degenerative disease, their potential etiological roles in chronic SBT remains unclear. The purpose of this study was to investigate potential risk factors for chronic SBT, with particular attention to metabolic factors. Methods: This study evaluated single shoulders of 939 rural residents. Each subject undertook a questionnaire, physical examinations, blood tests, and simple radiographs and magnetic resonance imaging (MRI) evaluations of bilateral shoulders. Subscapularis tendon integrity was determined by MRI findings based on the thickness of the involved tendons. The association strengths of demographic, physical, social, and radiologic factors, comorbidities, severity of rotator cuff tear (RCT), and serologic parameters for SBT were evaluated using logistic regression analyses. The significance of those analyses was set at p<0.05. Results: The prevalence of SBT was 32.2% (302/939). The prevalence of partial- and full-thickness tears was 23.5% (221/939) and 8.6% (81/939), respectively. The prevalence of isolated SBT was 20.2% (190/939), SBT combined with supraspinatus or infraspinatus tendon tear was 11.9% (112/939). In multivariable logistic regression analysis, dominant side involvement (p<0.001), manual labor (p=0.002), diabetes (p<0.001), metabolic syndrome (p<0.001), retraction degree of Patte tendon (p<0.001), posterosuperior RCT (p=0.010), and biceps tendon injury (p<0.001) were significantly associated with SBT. Conclusions: Metabolic syndrome is a potential risk factor for SBT, as are these factors: overuse activity, diabetes, posterosuperior RCT, increased retraction of posterosuperior rotator cuff tendon, and biceps tendon injury.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.366-372
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• 2023

Background: There is minimal literature on the morphology of partial distal biceps tendon (DBT) tears. We sought to investigate tear morphology by retrospectively reviewing 3-Tesla magnetic resonance imaging (3T MRI) scans of elbows with partial DBT tears and to propose a basic classification system. Methods: 3T MRI scans of elbows with partial DBT tears were retrospectively reviewed by two experienced observers. Basic demographic data were collected. Tear morphology was recorded including type, presence of retraction (>5 mm), and presence of discrete long-head and short-head tendons at the DBT insertion. Results: For analysis, 44 3T MRI scans of 44 elbows with partial DBT tears were included. There were 9 isolated long-head tears (20%), 13 isolated short-head tears (30%), 2 complete long-head tears with a partial short-head tear (5%), 5 complete short-head tears with a partial long-head tear (11%), and 15 peel-off tears (34%). Retraction was seen in 5 or 44 partial tears (11%), and 13 of the 44 DBTs were bifid tendons at the insertion (30%). Conclusions: Partial DBT tears can be classified into five sub-types: long-head isolated tears, short-head isolated tears, complete long-head tears with partial short-head involvement, complete short-head tears with partial long-head involvement, and peel-off tears. Classification of tears may have implications for operative and non-operative management. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.8 no.1
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• pp.9-13
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• 2005

An isolated tear of the subscapularis is uncommon, and there are a few literatures regarding the treatment of this problem. But, the incidence has increased with development of the arthroscopic techniques. An all-arthroscopic rotator cuff repair is a challenging procedure that can be effectively performed for treatment of subscapularis tendon tears. Often, tears of the subscapularis tendon do not involve entire tendon, and retraction of the torn edge is within to 2 cm of its attachment site. Occasionally, the entire tendon is torn and retracted medially to the glenoid. This article outlines the examination, preoperative planning and details the steps necessary to perform this procedure on upper third of subscapularis tears.

• Journal of Korean Foot and Ankle Society
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• v.25 no.2
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• pp.80-88
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• 2021

Chronic Achilles tendon rupture is likely to result in functional impairment in gait and sports activity. The presence of a large defect secondary to retraction of the tendon ends, atrophy of the calf muscles, and vulnerable vascularity of the soft tissue envelope make it a challenging problem to treat. Surgical reconstruction aims to restore the length and tension of the gastrocnemius-soleus complex. Various surgical treatment options have been described, depending on several factors, including residual gap size after scar tissue removal, remaining tissue quality, and vascularity. Despite good results being reported, there is a lack of high-level, evidence-based clinical guidelines available to select the first-line surgical procedure. This paper overviews the current available surgical options for patients with chronic Achilles tendon rupture.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.516-518
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• 2009

Purpose: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal - incision tenorrhaphy using 1 cm - length incision and minimal dissection. Methods: Transverse incision about 1 cm - length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. Catheter is sutured to proximal tendon in end - to - end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. Results: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. Conclusion: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.169-174
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• 2023

Background: Sleep quality, quantity, and efficiency have all been demonstrated to be adversely affected by rotator cuff pathology. Previous measures of assessing the impact of rotator cuff pathology on sleep have been largely subjective in nature. This study was undertaken to objectively analyze this relationship through the use of activity monitors. Methods: Patients with full-thickness rotator cuff tears at a single institution were prospectively enrolled between 2018 and 2020. Waist-worn accelerometers were provided for the patients to use each night for 14 days. Sleep efficiency was calculated using the ratio of the time spent sleeping to the total amount of time that was spent in bed. Retraction of the rotator cuff tear was classified using the Patte staging system. Results: This study included 36 patients: 18 with Patte stage 1 disease, 14 with Patte stage 2 disease, and 4 patients with Patte stage 3 disease. During the study, 25 participants wore the monitor on multiple nights, and ultimately their data was used for the analysis. No difference in the median sleep efficiency was appreciated amongst these groups (P>0.1), with each cohort of patients demonstrating a generally high sleep efficiency. Conclusions: The severity of retraction of the rotator cuff tear did not appear to correlate with changes in sleep efficiency for patients (P>0.1). These findings can better inform providers on how to counsel their patients who present with complaints of poor sleep in the setting of full-thickness rotator cuff tears.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.119-125
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• 2009

The primary purposes of revision repair for a failed rotator cuff repair are a relief of pain and functional improvement. Therefore, revision repair is most proper in patients with the functional deficit accompanied with the shoulder weakness as well as the persistent pain. The important factor that is considered in revision repair is a quality of torn cuff. Especially, Care must be taken to ensure that the revision repair is possible, considering the size of tendon defect, atrophy of the muscle, fatty infiltration and extent of the retraction of tendon. Revision repair of a failed rotator cuff repair is more difficult, and the functional results are less satisfactory than those of primary repair, because excessive bursal scarring and tendon retraction may be exhibited, a large or massive tear is often detected, tear has usually been present for a long time, and a quality of muscle-tendon may be poor. So, we discuss our experiences related to revision repair after a failed cuff repair that has been recently introduced through the articles.

• Clinics in Shoulder and Elbow
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• v.22 no.3
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• pp.159-170
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• 2019

Delaminated rotator cuff tear pertains to the horizontal split of the tendon substance. As reported previously, the presence of a delaminated tear and incidence of delaminated rotator cuff tear ranges from 38% to 92%. The different strain intensities applied across the rotator cuff tendon, and the shear stress between the bursal and articular layers seem to play a role in its pathogenesis. In a delaminated rotator cuff tear, the degree and direction of retraction between two layers differ, with accompanying intrasubstance cleavage. A surgeon therefore needs to consider and carefully evaluate the tear characteristics when repairing delaminated rotator cuff tear. Delaminated rotator cuff tear is considered to be a poor prognostic factor after rotator cuff repair, but numerous surgical repair techniques have been introduced and applied to resolve this problem. Recent literature has reported good clinical outcomes after delaminated rotator cuff repair.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.10-19
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• 2023

Background: Tendon degeneration contributes to rotator cuff tears; however, its role in postoperative structural integrity is poorly understood. The purpose of this study was to investigate the factors associated with postoperative structural integrity after rotator cuff repair, particularly focusing on the histology of tendons harvested intraoperatively. Methods: A total of 56 patients who underwent primary arthroscopic rotator cuff repair between 2009 and 2011 were analyzed. A 3-mm-diameter sample of supraspinatus tendons was harvested en bloc from each patient after minimal debridement of the torn ends. Tendon degeneration was assessed using seven histological parameters on a semi-quantitative grading scale, and the total degeneration score was calculated. One-year postoperative magnetic resonance imaging was used to classify the patients based on retear. Results: The total degeneration scores in the healed and retear groups were 13.93±2.03 and 14.08±2.23 (P=0.960), respectively. Arthroscopically measured anteroposterior (AP) tear sizes in the healed and retear groups were 24.30±12.35 mm and 36.42±25.23 mm (P=0.026), respectively. Preoperative visual analog scale pain scores at rest in the healed and retear groups were 3.54±2.37 and 5.16±2.16 (P=0.046), respectively. Retraction sizes in the healed and retear groups were 16.02±7.587 mm and 22.33±13.364 mm (P=0.037), respectively. The odds of retear rose by 4.2% for every 1-mm increase in AP tear size (P=0.032). Conclusions: The postoperative structural integrity of the rotator cuff tendon was not affected by tendon degeneration, whereas the arthroscopically measured AP tear size of the rotator cuff tendon was an independent predictor of retear. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.22 no.2
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• pp.70-78
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• 2019

Background: This study evaluated postoperative changes in the supraspinatus from time-zero to 6 months, using magnetic resonance imaging (MRI). We hypothesized that restoration of the musculotendinous unit of the rotator cuff by tendon repair immediately improves the rotator cuff muscle status, and maintains it months after surgery. Methods: Totally, 76 patients (29 men, 47 women) with rotator cuff tears involving the supraspinatus tendon who underwent arthroscopic rotator cuff repairs were examined. MRI evaluation showed complete repair with intact integrity of the torn tendon at both time-zero and at 6 months follow-up. All patients underwent standardized MRI at our institution preoperatively, at 1 or 2 days postoperative, and at 6 months after surgery. Supraspinatus muscular (SSP) atrophy (Thomazeau grade) and fatty infiltrations (Goutallier stage) were evaluated by MRI. The cross-sectional area of SSP in the fossa was also measured. Results: As determined by MRI, the cross-sectional area of SSP significantly decreased 11.41% from time-zero (immediate repair) to 6 months post-surgery, whereas the Goutallier stage and Thomazeau grade showed no significant changes (p<0.01). Furthermore, compared to the preoperative MRI, the postoperative MRI at 6 months showed a no statistically significant increase of 8.03% in the cross-sectional area. In addition, morphological improvements were observed in patients with high grade Goutallier and Thomazeau at time-zero, whereas morphology of patients with low grade factors were almost similar to before surgery. Conclusions: Our results indicate that cross-sectional area of the initial repair appears to decrease after a few months postoperatively, possibly due to medial retraction or strained muscle.