Open reconstruction of the rotator cuff

Abstract

Success rates relating to relief from pain and improved function following open reconstruction of the rotator cuff have been documented in many studies. At least for small to medium-size tears the question currently arises of whether an arthroscopic repair would not also give good treatment results. At present, however, the results of arthroscopic repair are not yet comparable to those yielded by the open techniques, at least in terms of recurrent defects especially in the case of massive tears (affecting more than two tendons). Open surgical repair is currently still recommended for all patients who require maximal postoperative function and strength and for elderly patients. Open repairs have a lower rate of re-rupture than arthroscopic repairs, but arthroscopic repair offers the benefits of lower morbidity. The decision on which technique is indicated should be made by an experienced surgeon with special training in this area and with due consideration for newer aspects in diagnostic imaging techniques, so as to avoid unsatisfactory results. In certain cases of irreparable cuff tears affecting two tendons and with fatty infiltration of the muscle and substantial loss of function muscle transfer can be considered in active patients; this can offer some functional improvement in the medium to long term, but do not lead to full restoration of function.

Characterization of bursa subacromialis-derived mesenchymal stem cells

“…Apparently, the BS is often a site of pathology in impingement of the shoulder [ 1 ]. In this study, all BS cells were obtained from patients undergoing rotator cuff repair surgery as a result of degenerative full-thickness tears.…”

“…With an incidence of about 30 %, degenerative tears of the rotator cuff emerge as one of the most common musculoskeletal diseases in the older population [ 1 , 2 ] with significant socio-economic impact [ 3 – 7 ]. Interestingly, it has been noted in the clinical area that localized reactions of the bursa subacromialis (BS) are evident in cases with rotator cuff tears [ 8 ], and that rotator cuff reconstructions reveal a lower success rate when surgical techniques are used that include radical resection of the BS [ 1 ]. Furthermore, in revision cases we have observed that the BS tissue is restored after complete surgical resection within approximately three to six months, indicating its high regenerative potential.…”

Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair

“…The current management of patients with rotator cuff tears (RCT) includes a wide range of non-pharmacological [3], pharmacological [4] and surgical modalities [5] and depends on the location, size and genesis of the lesion [6–9]. Operative repair of small and medium-sized RCT consistently yields good and satisfactory outcome in a high percentage of patients [10].…”

Biological Augmentation With Subacromial Bursa in Arthroscopic Rotator Cuff Repair

“…The hypothesis of the healing potential of the subacromial bursa for rotator cuff repair has long been known, and a lower success rate for surgical techniques resecting the subacromial bursa radically has been described 6, 7. In contrast, subacromial bursal tissue has been considered a pain-generating tissue regarded as a major pathologic factor for shoulder discomfort, so this tissue is routinely removed during surgery.…”

“…When we look at the current literature, the role of the subacromial bursa regarding the supportive influence on tendon healing of the rotator cuff has been discussed controversially. On the one hand, the bursa is attributed a high regeneration potential 6, 7. On the other hand, the frequently associated inflammation of the bursa alone is considered the primary pain generator of the shoulder 8, 9.…”