Arthroscopic Transosseous Repair of Rotator Cuff Tear and Greater Tuberosity Cysts

Abstract

Purpose: To evaluate the short-term outcomes of rotator cuff repair in the presence of a greater tuberosity cyst (GTC) using a transosseous repair technique. Methods: This study included patients who underwent arthroscopic rotator cuff tear repair with a transosseous technique and were evaluated clinically and by postoperative magnetic resonance imaging (MRI) after 1 year. The inclusion criteria were based on the results of preoperative MRI and were as follows: patients identified as having a repairable full-thickness rotator cuff tear associated with the presence of cystic changes at the tendon insertion site of the greater tuberosity, defined as a GTC involving the footprint area of the torn tendon (supraspinatus and/or infraspinatus tendons). Results: We evaluated 25 patients. The mean preoperative and postoperative American Shoulder and Elbow Surgeons scores were 39.48 (P ¼ .530) and 84.64 (P ¼ .035), respectively; Constant shoulder scores, 38.96 (P < .005) and 80.28 (P ¼ .425), respectively; and University of CaliforniaeLos Angeles shoulder rating scale scores, 10.6 (P ¼ .045) and 29.04 (P ¼ .315), respectively. The GTC mapping system was easily adopted in all the MRI examinations independently from the quality of the images. The GTCs were mostly located in the superficial anterolateral section of the humeral head and in both the posterolateral sections (superficial and deep). Conclusions: Arthroscopic transosseous rotator cuff repair led to significant mid-term improvement and satisfactory subjective outcomes with low complication and failure rates in this study. The GTC mapping system could be useful to evaluate GTCs and to aid surgeons in the choice of the best surgical technique. Level of Evidence: Level IV, therapeutic case series. G reater tuberosity cysts (GTCs) are often observed in patients with rotator cuff tears (RCTs), with a reported prevalence of 9%. 1 The cysts are occasionally encountered in the anterior (supraspinatus tendon insertion) or posterior (infraspinatus tendon insertion) aspect of the greater tuberosity or in the lesser tuberosity (subscapularis tendon insertion). The anterior location of a cyst is strongly associated with a full-thickness RCT 2 regardless of age. 1 The etiopathogenesis of these cysts is still not completely understood, and several explanations have been reported. They can arise from congenital abnormalities, age-related degeneration, or rotator cuff (RC) pathology. 2-4 The intact tendon insertion may protect against cyst formation by attaching firmly to bone that creates a barrier for the synovial fluid. 5 wIn most cases, the cysts are small and do not interfere with RCT reattachment. 6 In this scenario, placing the tendon stump onto the cyst area or medializing the tendon reattachment allows the problem to be easily overcome. However, when a cyst is large enough and in a critical location, its presence poses a serious challenge during arthroscopic RCT repair. 6 These GTCs may encompass such a large area of the RC footprint that suture anchor fixation can be compr...

Identifying key factors associated with subscapularis tendon tears and developing a risk prediction model to assist diagnosis

“…In this study, the subcoracoid cyst was measured in the axial plane. Mostly, the greater tubercle cysts were considered to be associated with supraspinatus tendon tears [ 34 , 35 ], clinicians speculated that the lesser tuberosity cysts (LTC) maybe be related to SSC tendon tears [ 27 , 32 ]. We evaluated the presence of lesser tuberosity cysts and measured their maximum diameter in the fat-suppressed T2-weighted axial plane.…”

Arthroscopic Compaction Bone Grafting for Uncontained Bone Defects of the Greater Tuberosity Associated With a Rotator Cuff Retear

“…Cystic changes of the greater tuberosity are associated with the presence of rotator cuff tears. 2 Although cyst formation can occur in isolation, they can additionally be found around existing suture anchors thereby making future revision surgery fraught with problems. 3 Several techniques have been described to address this problem.…”

“… 1 Bone cysts of the proximal humerus pose a considerable challenge to conventional rotator cuff repair techniques. 2 The cause of degenerative bone cysts is yet to be determined but they are associated with aging and the presence of existing suture anchors during revision surgery. 3 Suture anchors composed of bioabsorbable materials can induce cystic formation and weaken the surrounding bone.…”

Development and Validation of a Web-Based Dynamic Nomogram to Improve the Diagnostic Performance of Subscapularis Tendon Tear

“…Yoon et al demonstrated that malposition (subluxation/dislocation) of the long head tendon of the biceps (LHB) on MRI was associated with a concurrent SSC full-thickness tear ( 17 ), and we evaluated the LHB malposition on the axial plane ( Figure 1 ). Mostly, the greater tubercle cysts were assessed to be related to supraspinatus tears ( 26 , 27 ); some scholars speculated that the lesser tuberosity cyst (LTC) and subcoracoid effusion may be related to SSC tendon tears ( 18 , 24 , 25 ). This study evaluated LTC on the fat-suppressed T2-weighted axial plane to determine the predictive value.…”