Pub Date : 2024-05-02DOI: 10.1097/jsa.0000000000000387
Sophie I Worsfold, Kristyn Carter, Moeed Akbar, Lisa Hackett, Neal L Millar, George A C Murrell
Rotator cuff repair is usually successful, but retear is not uncommon. It has been previously identified that there is a higher incidence of apoptosis in the edges of the torn supraspinatus tendon. A prospective cohort study was conducted with 28 patients-14 rotator cuff tear patients, 5 instability patients, and 9 Anterior cruciate ligament reconstruction patients to determine whether there was any increase in several genes implicated in apoptosis, including Fas receptor (FasR), Fas ligand, Aifm-1, Bcl-2, Fadd, Bax, and caspase-3. There was a significant expression of Bax (P=0.2) and FasR (P=0.005) in the edges of torn supraspinatus tendons, and in intact subscapularis tendons, there was a significant expression of caspase-3 (P=0.02) compared with samples from the torn supraspinatus tendon (P=0.04). The cytochrome c pathway, with its subsequent activation of caspase-3, as well as the TRAIL-receptor signaling pathway involving FasR have both been implicated. The elevated expression of Bax supported the model that the Bax to Bcl-2 expression ratio represents a cell death switch. The elevated expression of Bax in the intact subscapularis tissue from rotator cuff tear patients also may confirm that tendinopathy is an ongoing molecular process.
{"title":"Rotator Cuff Tendinopathy: Pathways of Apoptosis.","authors":"Sophie I Worsfold, Kristyn Carter, Moeed Akbar, Lisa Hackett, Neal L Millar, George A C Murrell","doi":"10.1097/jsa.0000000000000387","DOIUrl":"https://doi.org/10.1097/jsa.0000000000000387","url":null,"abstract":"Rotator cuff repair is usually successful, but retear is not uncommon. It has been previously identified that there is a higher incidence of apoptosis in the edges of the torn supraspinatus tendon. A prospective cohort study was conducted with 28 patients-14 rotator cuff tear patients, 5 instability patients, and 9 Anterior cruciate ligament reconstruction patients to determine whether there was any increase in several genes implicated in apoptosis, including Fas receptor (FasR), Fas ligand, Aifm-1, Bcl-2, Fadd, Bax, and caspase-3. There was a significant expression of Bax (P=0.2) and FasR (P=0.005) in the edges of torn supraspinatus tendons, and in intact subscapularis tendons, there was a significant expression of caspase-3 (P=0.02) compared with samples from the torn supraspinatus tendon (P=0.04). The cytochrome c pathway, with its subsequent activation of caspase-3, as well as the TRAIL-receptor signaling pathway involving FasR have both been implicated. The elevated expression of Bax supported the model that the Bax to Bcl-2 expression ratio represents a cell death switch. The elevated expression of Bax in the intact subscapularis tissue from rotator cuff tear patients also may confirm that tendinopathy is an ongoing molecular process.","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"29 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140828578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2024-05-02DOI: 10.1097/JSA.0000000000000407
Nicola Maffulli, F Alan Barber
{"title":"Rotator Cuff Injuries in the Athlete Part 3.","authors":"Nicola Maffulli, F Alan Barber","doi":"10.1097/JSA.0000000000000407","DOIUrl":"10.1097/JSA.0000000000000407","url":null,"abstract":"","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"32 1","pages":"1"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1097/jsa.0000000000000377
Andres Felipe Cobaleda-Aristizabal, Michell Ruiz-Suarez, F Alan Barber, Antonio Miguel Lara, Mauricio Lopez Ramos, Eduardo Torres Rangel, Rafael Gamba Galeazzi
Rotator cuff tears are potentially a career-ending injury for athletes. The surgeon must identify which patients will benefit from surgical repair. The factors to consider are age, type of sport, time since injury, athlete's level, and the patient's expectations. An essential and independent fact determining the surgical treatment is whether the damage is due to overuse or from a traumatic/collision injury. Some sports are more demanding than others resulting in different return-to-participation (RTP) rates. This RTP return rate can present a real challenge and more so by a desire to reach the pre-injury level of play. The incidence of rotator cuff tearing varies from one sport to another. In football players this can be 12% whereas for tennis players this incidence is 4% to 17%. The RTP rate must be considered when making treatment decisions and is influenced by the level of the athlete: for professional athletes, the rate is 61%, and for recreational 73%. When the surgeon and the patient decide on the surgical treatment, the surgeon must consider whether to perform a double-row or a single-row rotator cuff tendon repair. The decision-making and the surgical technique will be addressed.
{"title":"Single-row or Double-row Rotator Cuff Repair.","authors":"Andres Felipe Cobaleda-Aristizabal, Michell Ruiz-Suarez, F Alan Barber, Antonio Miguel Lara, Mauricio Lopez Ramos, Eduardo Torres Rangel, Rafael Gamba Galeazzi","doi":"10.1097/jsa.0000000000000377","DOIUrl":"https://doi.org/10.1097/jsa.0000000000000377","url":null,"abstract":"Rotator cuff tears are potentially a career-ending injury for athletes. The surgeon must identify which patients will benefit from surgical repair. The factors to consider are age, type of sport, time since injury, athlete's level, and the patient's expectations. An essential and independent fact determining the surgical treatment is whether the damage is due to overuse or from a traumatic/collision injury. Some sports are more demanding than others resulting in different return-to-participation (RTP) rates. This RTP return rate can present a real challenge and more so by a desire to reach the pre-injury level of play. The incidence of rotator cuff tearing varies from one sport to another. In football players this can be 12% whereas for tennis players this incidence is 4% to 17%. The RTP rate must be considered when making treatment decisions and is influenced by the level of the athlete: for professional athletes, the rate is 61%, and for recreational 73%. When the surgeon and the patient decide on the surgical treatment, the surgeon must consider whether to perform a double-row or a single-row rotator cuff tendon repair. The decision-making and the surgical technique will be addressed.","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"3 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138743825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1097/jsa.0000000000000375
William J Ciccone, Brent Geers, Bodrie Jensen, Shariff K Bishai
Rotator cuff tears are a common source of pain and impairment in the shoulder. Healing of the rotator cuff tendons following repair has been associated with improved patient outcomes. While there have been many technical improvements in surgical techniques for rotator cuff repair, failure rates are still surprisingly high. Augmentation of these repairs has been shown to help with fixation biomechanics as well as healing rates. The described types of augments include autograft, allograft, xenograft, and synthetic options. This report reviews the commonly available types of augments and some of the outcomes associated with their use.
{"title":"Rotator Cuff Augmentation: Its Role and Best Practices.","authors":"William J Ciccone, Brent Geers, Bodrie Jensen, Shariff K Bishai","doi":"10.1097/jsa.0000000000000375","DOIUrl":"https://doi.org/10.1097/jsa.0000000000000375","url":null,"abstract":"Rotator cuff tears are a common source of pain and impairment in the shoulder. Healing of the rotator cuff tendons following repair has been associated with improved patient outcomes. While there have been many technical improvements in surgical techniques for rotator cuff repair, failure rates are still surprisingly high. Augmentation of these repairs has been shown to help with fixation biomechanics as well as healing rates. The described types of augments include autograft, allograft, xenograft, and synthetic options. This report reviews the commonly available types of augments and some of the outcomes associated with their use.","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"24 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138743823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1097/jsa.0000000000000370
Emily Chan, Sarah Remedios, Ivan Wong
Failed rotator cuff repairs pose several challenges due to the high incidence rate, complexity, and range of symptoms. We propose an overview for assessing and treating failed rotator cuff repairs. For active young patients, attempt revision repair with patch augmentation if possible. When anatomic revision is not viable, but muscle is retained, consider partial repair with interposition bridging. Isolated, irreparable supraspinatus tears may benefit from superior capsule reconstruction. Tendon transfer is suitable for patients with significant atrophy and multiple irreparable cuff tears. Low-demand elderly patients or those with substantial glenohumeral arthritis may consider reverse total shoulder arthroplasty if conservative management fails. There are a variety of reported outcomes in the literature but long-term studies with larger cohorts are needed to improve the management of failed rotator cuff repair.
{"title":"My Approach to Failed Rotator Cuff Repair.","authors":"Emily Chan, Sarah Remedios, Ivan Wong","doi":"10.1097/jsa.0000000000000370","DOIUrl":"https://doi.org/10.1097/jsa.0000000000000370","url":null,"abstract":"Failed rotator cuff repairs pose several challenges due to the high incidence rate, complexity, and range of symptoms. We propose an overview for assessing and treating failed rotator cuff repairs. For active young patients, attempt revision repair with patch augmentation if possible. When anatomic revision is not viable, but muscle is retained, consider partial repair with interposition bridging. Isolated, irreparable supraspinatus tears may benefit from superior capsule reconstruction. Tendon transfer is suitable for patients with significant atrophy and multiple irreparable cuff tears. Low-demand elderly patients or those with substantial glenohumeral arthritis may consider reverse total shoulder arthroplasty if conservative management fails. There are a variety of reported outcomes in the literature but long-term studies with larger cohorts are needed to improve the management of failed rotator cuff repair.","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"142 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138743954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1097/jsa.0000000000000376
Justin A Magnuson, Christian J Coulson, Luke S Oh, Kevin F Bonner
Subscapularis tears, either in combination with more extensive rotator cuff pathology or in isolation, are a relatively common cause of shoulder pain and dysfunction which often requires surgical intervention. Similar to the general treatment of most rotator cuff tears, patients may respond to conservative treatment and not require surgical intervention, especially in the elderly or those with partial tears. However, many subscapularis tears require intervention to address complaints of pain, dysfunction, or both. The spectrum of subscapularis tears ranges from low-grade partial requiring simple debridement to full-thickness tears which have become retracted and irreparable necessitating complex repair. Although open repair had been performed with success, most subscapularis repairs can be accomplished with arthroscopic techniques.
{"title":"Subscapularis Tendon Tears: How Best to Approach This Issue.","authors":"Justin A Magnuson, Christian J Coulson, Luke S Oh, Kevin F Bonner","doi":"10.1097/jsa.0000000000000376","DOIUrl":"https://doi.org/10.1097/jsa.0000000000000376","url":null,"abstract":"Subscapularis tears, either in combination with more extensive rotator cuff pathology or in isolation, are a relatively common cause of shoulder pain and dysfunction which often requires surgical intervention. Similar to the general treatment of most rotator cuff tears, patients may respond to conservative treatment and not require surgical intervention, especially in the elderly or those with partial tears. However, many subscapularis tears require intervention to address complaints of pain, dysfunction, or both. The spectrum of subscapularis tears ranges from low-grade partial requiring simple debridement to full-thickness tears which have become retracted and irreparable necessitating complex repair. Although open repair had been performed with success, most subscapularis repairs can be accomplished with arthroscopic techniques.","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"2 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138743957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1097/jsa.0000000000000374
Mohamad Y Fares, Peter Boufadel, Joseph A Abboud
The subacromial balloon spacer is a novel treatment option for the management of massive irreparable rotator cuff tears. This device is introduced into the glenohumeral joint and acts to alleviate the acromiohumeral impingement, caused by the massive irreparable rotator cuff tear. The device also redistributes the tension around the adjacent muscles in the joint, allowing them to compensate for the torn rotator cuff tendons. By doing so, the balloon can act as a "rehabilitation accelerator", ultimately resulting in improved shoulder pain and function. Adherence to balloon indications when selecting the appropriate patient is necessary, and these include an irreparable posterosuperior rotator cuff tear, with preserved subscapularis function, minimal to no osteoarthritis, and the ability to forward flex to 90 degrees. Clinical studies have demonstrated promising potential regarding the benefit of the balloon, with numerous studies demonstrating great outcomes after its implantation. Nevertheless, future research remains necessary to render the evidence behind its utility unequivocal.
{"title":"Subacromial Balloon Spacer: When to Use This?","authors":"Mohamad Y Fares, Peter Boufadel, Joseph A Abboud","doi":"10.1097/jsa.0000000000000374","DOIUrl":"https://doi.org/10.1097/jsa.0000000000000374","url":null,"abstract":"The subacromial balloon spacer is a novel treatment option for the management of massive irreparable rotator cuff tears. This device is introduced into the glenohumeral joint and acts to alleviate the acromiohumeral impingement, caused by the massive irreparable rotator cuff tear. The device also redistributes the tension around the adjacent muscles in the joint, allowing them to compensate for the torn rotator cuff tendons. By doing so, the balloon can act as a \"rehabilitation accelerator\", ultimately resulting in improved shoulder pain and function. Adherence to balloon indications when selecting the appropriate patient is necessary, and these include an irreparable posterosuperior rotator cuff tear, with preserved subscapularis function, minimal to no osteoarthritis, and the ability to forward flex to 90 degrees. Clinical studies have demonstrated promising potential regarding the benefit of the balloon, with numerous studies demonstrating great outcomes after its implantation. Nevertheless, future research remains necessary to render the evidence behind its utility unequivocal.","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"79 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138743894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-12-18DOI: 10.1097/01.jsa.0001004712.79405.c3
{"title":"Index.","authors":"","doi":"10.1097/01.jsa.0001004712.79405.c3","DOIUrl":"https://doi.org/10.1097/01.jsa.0001004712.79405.c3","url":null,"abstract":"","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"31 4","pages":"129-131"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-12-18DOI: 10.1097/JSA.0000000000000381
Nicola Maffulli
{"title":"Rotator Cuff Injuries in the Athlete Part 2: Editorial.","authors":"Nicola Maffulli","doi":"10.1097/JSA.0000000000000381","DOIUrl":"https://doi.org/10.1097/JSA.0000000000000381","url":null,"abstract":"","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"31 4","pages":"89"},"PeriodicalIF":1.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-11-17DOI: 10.1097/JSA.0000000000000373
Antonio Caldaria, Edoardo Giovannetti de Sanctis, Alessio Palumbo, Francesco Franceschi, Nicola Maffulli
Rotator cuff (RC) tears in pediatric and adolescent athletes are rare events. In these patients, RC tears are more likely to be traumatic or related to overuse among overhead. Repeated movements of abduction and external rotation are frequent mechanisms of injury. The supraspinatus is the most commonly involved tendon and the articular-sided tears are more common than the bursal side. Magnetic resonance imaging is considered the gold standard for diagnosing RC tears. Conservative treatment, arthroscopic, and open repair are all effective treatment methods depending on the type of injury. The risk of growth plate injury in these patients should be always considered when planning surgical interventions. Return to sport for competitive-level throwing athletes represents the greatest challenge in the treatment of these injuries.
{"title":"Rotator Cuff Repair in Pediatric and Adolescent Athletes: Indications and Outcomes.","authors":"Antonio Caldaria, Edoardo Giovannetti de Sanctis, Alessio Palumbo, Francesco Franceschi, Nicola Maffulli","doi":"10.1097/JSA.0000000000000373","DOIUrl":"10.1097/JSA.0000000000000373","url":null,"abstract":"<p><p>Rotator cuff (RC) tears in pediatric and adolescent athletes are rare events. In these patients, RC tears are more likely to be traumatic or related to overuse among overhead. Repeated movements of abduction and external rotation are frequent mechanisms of injury. The supraspinatus is the most commonly involved tendon and the articular-sided tears are more common than the bursal side. Magnetic resonance imaging is considered the gold standard for diagnosing RC tears. Conservative treatment, arthroscopic, and open repair are all effective treatment methods depending on the type of injury. The risk of growth plate injury in these patients should be always considered when planning surgical interventions. Return to sport for competitive-level throwing athletes represents the greatest challenge in the treatment of these injuries.</p>","PeriodicalId":49481,"journal":{"name":"Sports Medicine and Arthroscopy Review","volume":"31 3","pages":"62-66"},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136400012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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