Rotator Cuff Surgery

Contents

Foreword ix

Mark D. Miller

Preface xi

Stephen F. Brockmeier

Epidemiology, Natural History, and Indications for Treatment of Rotator Cuff Tears 589

Robert Z. Tashjian

Rotator cuff disease is the most common shoulder disorder treated byorthopedic surgeons. Little information exits regarding its prevalenceand natural history. The prevalence of rotator cuff tearing increases withage as well as several other factors including smoking and family history.Knowledge regarding the natural history of nonoperatively treated tears aswell as the healing potential after repair can be used to aid in refining sur-gical and nonsurgical indications for the treatment rotator cuff tears. Analgorithmic approach to the treatment of rotator cuff tears is reviewed.

Imaging Evaluation of the Rotator Cuff 605

Mark W. Anderson, Christopher Brennan, and Amit Mittal

The rotator cuff is a complex network of interwoven tendons that playsa key role in glenohumeral movement and stability. Cuff abnormality isa common source of shoulder pain, but the clinical presentation is oftennonspecific and, as a result, diagnostic imaging, especially magnetic res-onance imaging, plays a key role in evaluating these patients. This articlereviews imaging modalities available for evaluating the cuff, normal cuffanatomy, and common pathologic conditions that affect it.

Arthroscopic Rotator Cuff Repair: Techniques in 2012 633

James E. Voos, Cris D. Barnthouse, and Andrew R. Scott

Rotator cuff repairs have evolved from open to arthroscopic techniques.The fundamentals of recognizing rotator cuff tear patterns, tissue mobiliza-tion, footprint restoration, and stable repair construct remain largelyunchanged. Recent clinical studies have raised concern regarding highretear rate for rotator cuff repairs, despite good clinical outcomes, with sin-gle-row repair techniques. As a result, double-row and transosseous-equivalent techniques have been developed. Biomechanical data favorthese newer techniques whereas clinical data have not definitivelyconcluded which technique is superior. The most up-to-date arthroscopicrotator cuff repair techniques are presented for partial-thickness and full-thickness rotator cuff tears.

Biologics in the Management of Rotator Cuff Surgery 645

Michael E. Angeline and Scott A. Rodeo

Surgical repair of rotator cuff tears is a relatively common orthopedic pro-cedure. Although the procedure is clinically successful, the repair site

Contentsvi

frequently has incomplete healing and gap formation, owing to a fibrovas-cular scar—mediated healing response at the tendon-bone interface. Byaugmenting the repair site with biological agents, the ultimate goal is tostimulate a regenerative healing pathway. Challenges remain, however,regarding the ideal factor(s), timing, and vehicle of delivery.

Outcomes of Rotator Cuff Surgery: What Does the Evidence Tell Us? 665

Alexander W. Aleem and Robert H. Brophy

Rotator cuff tears are a common clinical problem that increases with agefrom an incidence of 4% in those aged 40 to 60 years to more than 54%in those older than 60 years. The purpose of this article is to review thecurrent evidence regarding outcomes of surgical techniques in rotatorcuff surgery. Future research should be aimed at identifying whether andin whom rotator cuff healing is appropriate to better identify surgicalcandidates as well as to determine the best surgical repair strategy.

Rotator Cuff Tears in Overhead Athletes 675

Kostas J. Economopoulos and Stephen F. Brockmeier

Rotator cuff tears in overhead athletes can take on several different forms.Identification of symptomatic rotator cuff disease can be challenging in theoverhead athlete as abnormalities of the rotator cuff can be seen com-monly in asymptomatic throwers and rotator cuff pathologic conditions of-ten occur in conjunction with other injuries. Partial-thickness tears treatedwith arthroscopic debridement and management of concomitant patho-logic conditions appear to have fairly good outcomes in the literaturewith most athletes able to return to activity at their preinjury level. Full-thickness tears, however, have fared much more poorly in the overheadathlete with largely dismal outcomes after surgical repair.

Failed Rotator Cuff Surgery, Evaluation and Decision Making 693

Scott R. Montgomery, Frank A. Petrigliano, and Seth C. Gamradt

Rotator cuff repair is performed commonly to address pain and shoulderdysfunction after a rotator cuff tear. Recurrent or persistent tears are com-mon after rotator cuff repair. The causes of failed rotator cuff surgeryinclude biologic factors, technical errors, and traumatic failure. A thoroughhistory, physical examination, and appropriate imaging are required todetermine if a patient is an appropriate candidate for revision rotator cuffrepair. Ideal candidates for revision rotator cuff repair are younger, haveminimal muscle atrophy, minimal tendon retraction, preoperative forwardelevation of greater than 90�, a functioning deltoid, and no evidence ofcuff tear arthropathy.

Revision Rotator Cuff Repair 713

Jay D. Keener

Rotator cuff repair is one of the most common procedures performed inthe shoulder. Predictable pain relief and functional improvements areseen across all age groups. However, anatomic healing of the surgically re-paired tendon is not as consistent and has varied widely in the literature.

Contents vii

The purpose of this article is to review the appropriate evaluation and man-agement of patients with a failed rotator cuff repair, with specific emphasison identifying proper surgical candidates for revision rotator cuff repair.This article also reviews the relevant surgical techniques, appropriaterehabilitation, and expected outcomes of revision rotator cuff repairsurgery.

Nonarthroplasty Options for the Management of Massive and IrreparableRotator Cuff Tears 727

Ruth A. Delaney, Albert Lin, and Jon J.P. Warner

Massive, irreparable rotator cuff tears remain a clinical challenge. In low-demand patients, debridement of the tear may relieve pain. Partial repairusing the technique of margin convergence decreases the size of thetear gap and reduces strain. Biceps tenotomy or tenodesis has a role inproviding pain relief in massive rotator cuff tears. Tendon transfers offergood results in patients with massive, irreparable rotator cuff tears. Thetreatment modality specifically chosen for the massive, irreparable rotatorcuff tear must be tailored to the individual patient, their needs and expec-tations, and their ability to comply with intensive rehabilitation.

Reverse Total ShoulderArthroplasty for Irreparable Rotator Cuff Tears andCuff TearArthropathy 749

Miguel A. Ramirez, Jose Ramirez, and Anand M. Murthi

Reverse shoulder arthroplasty (RSA) was pioneered by Grammont in the1980s as a potential treatment for cuff tear arthropathy and irreparablecuff tears. RSA was designed to use the deltoid as the primary elevatorof the shoulder, negating the need for the rotator cuff. Early short-termresults show improvements in pain and function scores for both cuff teararthropathy and irreparable cuff tears. Long-term studies are still neededto evaluate the long-term benefits of these devices in this patientpopulation.

Index 761