Link Between Findings and Reparability of Rotator Cuff Tears
There are many factors that affect recovery following rotator cuff repair. Among those are the patient's demographics, pre-operative level of disability, clinical presentation, imaging such as humeral head position, fatty infiltration and tear size and surgical findings such as tear size and shape and tendon quality and retraction. The relationship between size of the rotator cuff tear and recovery based on patient oriented outcomes remains controversial. While some authors point out that tear size is not an important contributor to outcomes or overall satisfaction with surgery, others report that larger tears have a less predictable recovery of strength and function and are associated with more residual disability.
The relationship between tear reparability and recovery is also a subject of debate. The limited literature has shown that partial repairs, sometimes referred to as functional repairs, provide surprisingly good results despite incomplete closure of the defect of the cuff. The concept of functional repair was first introduced by Burkhart and colleagues in the early 1990's. The authors proposed that partial repairs would restore the force couple of the humeral head and increase acromion-humeral distance, resulting in dramatic changes in pain and function. Consistent reports of successful results of partial repairs is promising but the failure to demonstrate superiority of complete repair over partial repair in the limited literature might be due to lack of statistical power in studies that have used small sample sizes of patients. Improved life style of the aging population over the past decades demands better function in these individuals, which increases the need for managing larger and more disabling rotator cuff tears. Therefore, investigating factors that affect reparability of a cuff tear and their interaction with disability can help clinicians to choose surgical candidates more accurately.
The purpose of this study was therefore twofold, 1) to examine clinical outcomes following complete or partial repair of large or massive full-thickness rotator cuff tear, and 2) to explore the value of clinical and surgical factors in predicting reparability. We hypothesized significant improvement in pain and function in both partial and complete repair groups. The second hypothesis was that pre-operative active external rotation, strength, and intra operative findings such as size, shape and tendon quality would affect reparability.
Background
There are many factors that affect recovery following rotator cuff repair. Among those are the patient's demographics, pre-operative level of disability, clinical presentation, imaging such as humeral head position, fatty infiltration and tear size and surgical findings such as tear size and shape and tendon quality and retraction. The relationship between size of the rotator cuff tear and recovery based on patient oriented outcomes remains controversial. While some authors point out that tear size is not an important contributor to outcomes or overall satisfaction with surgery, others report that larger tears have a less predictable recovery of strength and function and are associated with more residual disability.
The relationship between tear reparability and recovery is also a subject of debate. The limited literature has shown that partial repairs, sometimes referred to as functional repairs, provide surprisingly good results despite incomplete closure of the defect of the cuff. The concept of functional repair was first introduced by Burkhart and colleagues in the early 1990's. The authors proposed that partial repairs would restore the force couple of the humeral head and increase acromion-humeral distance, resulting in dramatic changes in pain and function. Consistent reports of successful results of partial repairs is promising but the failure to demonstrate superiority of complete repair over partial repair in the limited literature might be due to lack of statistical power in studies that have used small sample sizes of patients. Improved life style of the aging population over the past decades demands better function in these individuals, which increases the need for managing larger and more disabling rotator cuff tears. Therefore, investigating factors that affect reparability of a cuff tear and their interaction with disability can help clinicians to choose surgical candidates more accurately.
The purpose of this study was therefore twofold, 1) to examine clinical outcomes following complete or partial repair of large or massive full-thickness rotator cuff tear, and 2) to explore the value of clinical and surgical factors in predicting reparability. We hypothesized significant improvement in pain and function in both partial and complete repair groups. The second hypothesis was that pre-operative active external rotation, strength, and intra operative findings such as size, shape and tendon quality would affect reparability.
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