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Russell F Warren - One of the best experts on this subject based on the ideXlab platform.
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Rotator Cuff tear arthropathy evaluation diagnosis and treatment aaos exhibit selection
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Travis G Maak, Bradley S Raphael, Christopher K Kepler, Michael B Cross, Russell F WarrenAbstract:Abstract: Rotator Cuff tear arthropathy encompasses a broad spectrum of pathology, but it involves at least three critical features: Rotator Cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head. Although many patients possess altered biomechanics of the glenohumeral joint secondary to Rotator Cuff pathology, not all patients develop Rotator Cuff tear arthropathy, and thus the exact etiology of Rotator Cuff tear arthropathy remains unclear. The objectives of this manuscript are to (1) review the biomechanical properties of the Rotator Cuff and the glenohumeral joint, (2) discuss the proposed causes of Rotator Cuff tear arthropathy, (3) provide a brief review of the historically used surgical options to treat Rotator Cuff tear arthropathy, and (4) present a treatment algorithm for Rotator Cuff tear arthropathy based on a patient’s clinical presentation, functional goals, and anatomic integrity.
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massive tears of the Rotator Cuff
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Asheesh Bedi, Russell F Warren, Joshua S Dines, David M. DinesAbstract:Repair of massive Rotator Cuff tears is technically difficult but often feasible. Technical and biological challenges to a successful repair include inelastic poor-quality tendon tissue, scarring, muscle atrophy, and fatty infiltration. Fatty infiltration of the involved Rotator Cuff muscles has been identified as an important negative prognostic factor for the outcome after repair of massive Rotator Cuff tears. Tendon transfer is a good option for young patients and manual laborers with an irreparable massive Rotator Cuff tear. Arthroplasty can be considered for the treatment of symptomatic massive Rotator Cuff tears in patients who have glenohumeral arthritis.
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chronic Rotator Cuff injury and repair model in sheep
Journal of Bone and Joint Surgery American Volume, 2003Co-Authors: Struan H Coleman, John D Macgillivray, Stephen Fealy, John R Ehteshami, David W Altchek, Russell F Warren, Simon A TurnerAbstract:Background:Most Rotator Cuff surgery is performed on chronic tears. As there is no animal model in which to examine the physiology of muscle and tendon injury and repair in this setting, we developed a chronic Rotator Cuff injury model in sheep.Methods:The infraspinatus tendon was released in thirty
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Rotator Cuff injury in contact athletes
American Journal of Sports Medicine, 1996Co-Authors: Field T Blevins, William M. Hayes, Russell F WarrenAbstract:The causes and incidence of Rotator Cuff injuries in patients under the age of 40 has not been clearly established. The present study focuses on a group of 10 male contact athletes with Rotator Cuff injuries re lated to trauma sustained during football (ages from 24 to 36 years). Symptoms included pain and dysfunction in all 10 patients and a positive shrug sign in 8 of 10. The diagnoses for these patients were two isolated contusions, five partial-thickness tears, and three full- thickness tears. Surgery was performed on all patients after nonoperative treatment failed. Three partial-thick ness tears were arthroscopically debrided. One full- thickness and two partial-thickness tears were repaired using the arthroscopically assisted miniarthrotomy technique. An open repair was performed in two pa tients. Two isolated Rotator Cuff contusions were arthro scopically debrided. The average followup was 21 months. Nine of 10 athletes returned to active partici pation in football, 7 of these at their preinjury l...
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hemiarthroplasty of the shoulder for Rotator Cuff arthropathy
Journal of Shoulder and Elbow Surgery, 1996Co-Authors: Larry D. Field, Stephen J Zabinski, David M. Dines, Russell F WarrenAbstract:Abstract Sixteen patients underwent hemiarthroplasty for Rotator Cuff arthropathy between June 1989 and March 1992, and evaluations obtained before and after surgery in all patients were compared. A modular head large enough to articulate with the coracoacromial arch but not so large as to prevent approximately 50% of humeral head translation on the glenoid was used in these cases. Each patient was evaluated with Neer's limited goals rating scale after an average follow-up of 33 months (24 to 55 months). Ten patients were rated as successful and six as unsuccessful. Four of the six unsuccessful patients had undergone at least one attempt at Rotator Cuff repair with acromioplasty before the index procedure, and two of these four patients had deficient deltoid function after this Rotator Cuff surgery as a result of postoperative deltoid detachment. Also, three of these four patients who had previously undergone acromioplasty subsequently had anterosuperior subluxation after hemiarthroplasty. Hemiarthroplasty did not provide for a successful outcome in all patients with Rotator Cuff arthropathy. However, 10 of the 12 patients in this series with good deltoid function and an adequate coracoacromial arch were rated as successful by Neer's limited goals criteria. In addition, this study illustrates that formal acromioplasty carried out during attempts at Rotator Cuff repair in such patients may jeopardize the subsequent success of hemiarthroplasty. (J Shoulder Elbow Surg 1997;6:18-23.)
Anthony A. Romeo - One of the best experts on this subject based on the ideXlab platform.
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management of the irreparable Rotator Cuff tear
Journal of The American Academy of Orthopaedic Surgeons, 2019Co-Authors: Gregory L Cvetanovich, Nikhil N Verma, Brian R Waterman, Anthony A. RomeoAbstract:When evaluating patients with irreparable Rotator Cuff tears, orthopaedic surgeons have an increasingly wide array of surgical options, including both established techniques and emerging technologies. However, significant variability exists in the clinical evaluation and surgical indications in this subset, and definitions for pseudoparalysis and tear irreparability are inconsistent. In older patients with symptomatic Rotator Cuff arthropathy and relatively sedentary demands, the reverse total shoulder arthroplasty has been established as the preferred treatment option, producing reliable improvements in both pain and function. In younger patients without glenohumeral arthritis or pseudoparalysis, joint-preserving options are preferred, with recent literature highlighting alternative options including partial repair, bridging or interpositional graft placement, tendon transfers (ie, latissimus, trapezius, and pectoralis major), superior capsular reconstruction, and subacromial spacer placement. In this review article, we address the topic of irreparable Rotator Cuff tears, emphasizing the workup, indications for various treatment options, and clinical outcomes.
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performance and return to sport following Rotator Cuff surgery in professional baseball players
Journal of Shoulder and Elbow Surgery, 2019Co-Authors: Brandon J Erickson, Peter N Chalmers, John Dangelo, Anthony A. RomeoAbstract:Background While many injuries to the Rotator Cuff in professional baseball players can be managed nonoperatively, recovery fails to occur with nonoperative treatment in some players and surgery on the Rotator Cuff is performed in an attempt to return to sport (RTS). Methods All professional baseball players who underwent Rotator Cuff surgery between 2010 and 2016 were included by use of the Major League Baseball injury database. Demographic and performance data (before and after surgery) for each player were recorded. Preoperative and postoperative performance metrics were then compared. Results Overall, 151 professional baseball players underwent Rotator Cuff debridement (n = 130) or Rotator Cuff repair (n = 21). In the Rotator Cuff repair group, 6 (28.6%) underwent single-row repair, 5 (23.8%) underwent double-row repair, and 10 (47.6%) underwent side-to-side repair. Among the 11 players who underwent either single- or double-row repair, the average number of anchors used per repair was 2.09 ± 1.1 (range, 1-4). Most performance metrics declined following Rotator Cuff debridement. For players who underwent debridement, the RTS rate was 50.8% (42.3% at the same level or a higher level and 8.5% at a lower level). For players who underwent repair, the RTS rate was 33.3% (14.3% at the same level or a higher level and 19% at a lower level). Most players underwent at least 1 concomitant procedure at the time of Rotator Cuff surgery. Conclusion Rotator Cuff debridement is significantly more common than repair in professional baseball players, with 86% of all Rotator Cuff surgical procedures reported as debridement. RTS rates following debridement and repair are disappointing, at 50.8% and 33.3%, respectively. For players who do return, performance declines after surgery.
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cost effectiveness of reverse total shoulder arthroplasty versus arthroscopic Rotator Cuff repair for symptomatic large and massive Rotator Cuff tears
Arthroscopy, 2016Co-Authors: Eric C Makhni, Anthony A. Romeo, Eric F Swart, Michael E Steinhaus, Richard C Mather, William N Levine, Bernard R Bach, Nikhil N VermaAbstract:Purpose To compare the cost-effectiveness within the United States health care system of arthroscopic Rotator Cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive Rotator Cuff tears without Cuff-tear arthropathy. Methods An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic Rotator Cuff repair and reverse total shoulder arthroplasty for large and massive Rotator Cuff tears (and excluding cases of Cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus Rotator Cuff repair. Results For the base case, both arthroscopic Rotator Cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic Rotator Cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic Rotator Cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage Cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted Rotator Cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. Conclusions Arthroscopic Rotator Cuff repair—despite high rates of tendon retearing—for patients with large and massive Rotator Cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these patients. Level of Evidence Level II, economic decision analysis.
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the role of acromioplasty for Rotator Cuff problems
Orthopedic Clinics of North America, 2014Co-Authors: Jonathan M Frank, Jaskarndip Chahal, Nikhil N Verma, Brian J. Cole, Rachel M. Frank, Anthony A. RomeoAbstract:Abstract Acromioplasty is a well-described technique used throughout the wide spectrum of treatment options for shoulder impingement and Rotator Cuff pathology. Several randomized prospective studies have described clinical outcomes that are statistically similar when comparing patients undergoing Rotator Cuff repair either with or without concomitant acromioplasty. This article reviews the current evidence for use of acromioplasty in patients with subacromial impingement syndrome and during arthroscopic Rotator Cuff repair. Despite recently published studies, more long-term data, especially with regard to failure rates and return-to-surgery rates over time, are needed to better determine the role of acromioplasty.
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the societal and economic value of Rotator Cuff repair
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Richard C Mather, Anthony A. Romeo, Lane Koenig, Daniel C Acevedo, Timothy M Dall, Paul Gallo, John Tongue, Gerald R WilliamsAbstract:Approximately 4.5 million patient visits related to shoulder pain occur each year in the United States1. Disorders of the Rotator Cuff range from painful Rotator Cuff syndromes to full-thickness tears of varying sizes and functional limitations2. Outcomes for Rotator Cuff tears improve with both surgical and nonsurgical treatment3. With the aging of the U.S. population and increased labor force participation of the elderly, the burden of Rotator Cuff tears in the U.S. is an important issue. Using outpatient data from Colorado, Florida, Maryland, New Jersey, New York, and Wisconsin in the State Ambulatory Surgery Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, we find that more than two-thirds of patients treated with Rotator Cuff repair are of working age4. In addition, the prevalence of Rotator Cuff tears increases with age5. Despite these factors, few studies have examined the burden of Rotator Cuff tears and the economic impact of treatment is largely unknown. Societal costs of a medical condition include direct and indirect costs. Direct costs are those associated with diagnosis and treatment, while indirect costs include lost income due to inability to work or lower wages, missed workdays, and disability payments. The purpose of this study was to determine the value of operative treatment for Rotator Cuff tears, with value determined by reductions in costs to society from Rotator Cuff repair compared with nonoperative treatment. Markov models are commonly used in cost-effectiveness analysis. In assessing the value of Rotator Cuff repair, these models are useful because long-term clinical studies do not exist and the risk of an outcome is continuous over time. By taking a societal perspective, we estimated the costs and benefits of Rotator Cuff repair to patients, employers, and payers.
Ranjan Gupta - One of the best experts on this subject based on the ideXlab platform.
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development of fatty atrophy after neurologic and Rotator Cuff injuries in an animal model of Rotator Cuff pathology
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Kasra Rowshan, Scott Hadley, Khoa Pham, Vince Caiozzo, Ranjan GuptaAbstract:Background: Detachment of a tendon from its osseous insertion, as can be the case with severe Rotator Cuff injuries, leads to atrophy of and increased fat in the corresponding muscle. We sought to validate a Rotator Cuff injury model in the rabbit and to test the hypothesis that tenotomy of a Rotator Cuff tendon would consistently create muscle atrophy and fatty degeneration analogous to the changes that occur after injury to a nerve innervating the same muscle. Methods: New Zealand white rabbits were divided into three groups: (1) partial Rotator Cuff tear without retraction of the muscle, (2) complete Rotator Cuff tear with retraction of the muscle, and (3) nerve transection of the subscapular nerve. Animals were killed at two or six weeks after injury, and the muscles were analyzed for weight, cross-sectional area, myosin fiber-type composition, and fat content. In addition, the subscapular nerve was harvested at two weeks and evaluated for neuronal injury. Results: At six weeks after injury, the rabbit muscles in the complete tenotomy and nerve transection groups had significant decreases in wet mass and increases in fat content relative to the control groups. Fat accumulation had a similar spatial pattern at six weeks in both the nerve transection and complete tenotomy groups. Such changes were not seen in the partial tenotomy group. No change was found in muscle myosin fiber-type composition. At two weeks after injury, subscapular nerves in the complete tenotomy group showed gross evidence of neuronal injury. Conclusions: This study establishes the rabbit subscapularis muscle as a valid model to study the muscular changes associated with Rotator Cuff tears. Our data suggest that the muscular changes associated with complete tenotomy are comparable with those seen with denervation of the muscle and suggest that chronic Rotator Cuff tears may induce a neurologic injury. Clinical Relevance: Chronic Rotator Cuff injuries are associated with neuronal injury of the affected muscle. As such, neuronal injury may explain the histopathologic changes that have been observed following chronic Rotator Cuff tears.
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Rotator Cuff tear arthropathy
Journal of The American Academy of Orthopaedic Surgeons, 2007Co-Authors: Kier J Ecklund, James E Tibone, Ranjan GuptaAbstract:: Rotator Cuff tear arthropathy represents a spectrum of shoulder pathology characterized by Rotator Cuff insufficiency, diminished acromiohumeral distance with impingement syndromes, and arthritic changes of the glenohumeral joint. Additional features may include subdeltoid effusion, humeral head erosion, and acetabularization of the acromion. Although the progression of Rotator Cuff tears seems to play a role in the development of Cuff tear arthropathy, information is lacking regarding the natural progression of Rotator Cuff tears to Cuff tear arthropathy. Controversy remains about the role of basic calcium phosphate crystals in the development of Cuff tear arthropathy. Nonsurgical management is the first line of treatment in most patients. Traditionally, surgical management of Rotator Cuff tear arthropathy has been disappointing because of the development of complications long-term and poor patient satisfaction with functional outcomes. Recent studies, however, report promising experience with reverse ball-and-socket arthroplasty.
David M. Dines - One of the best experts on this subject based on the ideXlab platform.
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massive tears of the Rotator Cuff
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Asheesh Bedi, Russell F Warren, Joshua S Dines, David M. DinesAbstract:Repair of massive Rotator Cuff tears is technically difficult but often feasible. Technical and biological challenges to a successful repair include inelastic poor-quality tendon tissue, scarring, muscle atrophy, and fatty infiltration. Fatty infiltration of the involved Rotator Cuff muscles has been identified as an important negative prognostic factor for the outcome after repair of massive Rotator Cuff tears. Tendon transfer is a good option for young patients and manual laborers with an irreparable massive Rotator Cuff tear. Arthroplasty can be considered for the treatment of symptomatic massive Rotator Cuff tears in patients who have glenohumeral arthritis.
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hemiarthroplasty of the shoulder for Rotator Cuff arthropathy
Journal of Shoulder and Elbow Surgery, 1996Co-Authors: Larry D. Field, Stephen J Zabinski, David M. Dines, Russell F WarrenAbstract:Abstract Sixteen patients underwent hemiarthroplasty for Rotator Cuff arthropathy between June 1989 and March 1992, and evaluations obtained before and after surgery in all patients were compared. A modular head large enough to articulate with the coracoacromial arch but not so large as to prevent approximately 50% of humeral head translation on the glenoid was used in these cases. Each patient was evaluated with Neer's limited goals rating scale after an average follow-up of 33 months (24 to 55 months). Ten patients were rated as successful and six as unsuccessful. Four of the six unsuccessful patients had undergone at least one attempt at Rotator Cuff repair with acromioplasty before the index procedure, and two of these four patients had deficient deltoid function after this Rotator Cuff surgery as a result of postoperative deltoid detachment. Also, three of these four patients who had previously undergone acromioplasty subsequently had anterosuperior subluxation after hemiarthroplasty. Hemiarthroplasty did not provide for a successful outcome in all patients with Rotator Cuff arthropathy. However, 10 of the 12 patients in this series with good deltoid function and an adequate coracoacromial arch were rated as successful by Neer's limited goals criteria. In addition, this study illustrates that formal acromioplasty carried out during attempts at Rotator Cuff repair in such patients may jeopardize the subsequent success of hemiarthroplasty. (J Shoulder Elbow Surg 1997;6:18-23.)
Umile Giuseppe Longo - One of the best experts on this subject based on the ideXlab platform.
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genetic basis of Rotator Cuff injury a systematic review
BMC Medical Genetics, 2019Co-Authors: Umile Giuseppe Longo, Alessandra Berton, Giuseppe Salvatore, Andrea Guarnieri, Joseph P. Deangelis, Ara Nazarian, Vincenzo Candela, Vincenzo DenaroAbstract:Rotator Cuff disease is a widespread musculoskeletal pathology and a major cause of shoulder pain. Studies on familial predisposition suggest that genetic plays a role in the pathogenesis of Rotator Cuff disease. Several genes are responsible for Rotator Cuff disease. The aim of this study was to perform a systematic review on genetic association between Rotator Cuff disease and genes variations. A systematic review of the literature was performed, in accordance with the PRISMA guidelines. PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases were searched comprehensively using the keywords: “Rotator Cuff”, “Gene”, “Genetic”, “Predisposition”, “Single-nucleotide polymorphism” and “Genome-wide association”. 8 studies investigating genes variations associated with Rotator Cuff tears were included in this review. 6 studies were case-control studies on candidate genes and 2 studies were GWASs. A significant association between SNPs and Rotator Cuff disease was found for DEFB1, FGFR1, FGFR3, ESRRB, FGF10, MMP-1, TNC, FCRL3, SASH1, SAP30BP, rs71404070 located next to cadherin8. Contradictory results were reported for MMP-3. Further investigations are warranted to identify complete genetic profiles of Rotator Cuff disease and to clarify the complex interaction between genes, encoded proteins and environment. This may lead to individualized strategies for prevention and treatment of Rotator Cuff disease. Level IV, Systematic Review.
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a systematic review of the reverse shoulder replacement in Rotator Cuff arthropathy Rotator Cuff tears and rheumatoid arthritis
Sports Medicine and Arthroscopy Review, 2011Co-Authors: Wasim S Khan, Vincenzo Denaro, Umile Giuseppe Longo, Philip Michael Ahrens, Nicola MaffulliAbstract:The reverse shoulder arthroplasty prosthesis was originally designed for Rotator Cuff arthropathy, and provided good results. Over time, the indications have expanded to include, among others, irreparable Rotator Cuff tears and rheumatoid arthritis, and the results have become more variable. There are also fundamental differences in the designs of the original Delta III prostheses and the later developed reverse shoulder prosthesis, and many studies that provide the results in reverse shoulder arthroplasties do not consider these 2 prostheses separately. In this systematic review, we analyze the clinical outcomes of the reverse shoulder arthroplasty in Rotator Cuff arthropathy, Rotator Cuff tears without arthropathy, and rheumatoid arthritis. We also analyze the results of the 2 prostheses separately to provide a more accurate comparison.
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a systematic review of the reverse shoulder replacement in Rotator Cuff arthropathy Rotator Cuff tears and rheumatoid arthritis
Sports Medicine and Arthroscopy Review, 2011Co-Authors: Wasim S Khan, Vincenzo Denaro, Umile Giuseppe Longo, Philip Michael Ahrens, Nicola MaffulliAbstract:The reverse shoulder arthroplasty prosthesis was originally designed for Rotator Cuff arthropathy, and provided good results. Over time, the indications have expanded to include, among others, irreparable Rotator Cuff tears and rheumatoid arthritis, and the results have become more variable. There a
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Conservative treatment and Rotator Cuff tear progression.
Medicine and sport science, 2011Co-Authors: Umile Giuseppe Longo, Francesco Franceschi, Alessandar Berton, Nicola Maffulli, Vincenzo DroenaAbstract:There is no definite consensus on the best management for patients with Rotator Cuff tears. No randomized controlled studies have compared the outcome of surgical versus conservative treatment. The described successful rate of conservative treatment varies widely, from 33 to 92%. Even though current evidence is not sufficient to allow definitive conclusions on conservative treatment of Rotator Cuff tears, non-operative management is often recommended in such patients. Prognostic factors seem to be clinical presentation, duration of symptoms and tear size. The best programme for conservative treatment is not defined. Physical therapy consists of stretching and strengthening exercises. The characteristics of exercise programmes are not standardized. In clinical practice, intra-articular injections are commonly used for treatment of shoulder pain. Systemic pharmacotherapy for patients with shoulder pain consists of non-steroidal anti-inflammatory drugs. Recently, cyclo-oxygenase-2-selective inhibitors have been introduced for management of shoulder pain. To date, few randomized controlled trials are available on conservative management of Rotator Cuff tears, and therefore further studies are required to clarify its role in such patients.
