Transosseous Physeal-Sparing Rotator Cuff Repair in an Adolescent Football Player

Abstract

Rotator cuff injuries in the pediatric and adolescent population are rare. These injuries are normally caused by an acute event or by repeated microtrauma as a result of poor mechanics during overhead sporting activities. Overall, these injuries account for fewer than 1% of all rotator cuff tears. Physeal injuries, tuberosity avulsions ("rotator cuff equivalents"), and proximal humeral fractures commonly occur in the pediatric population. Traumatic full-thickness rotator cuff ruptures that occur in this age group during contact sports are an extremely uncommon cause of shoulder pain. The rarity of this type of injury in the pediatric and adolescent population may be the result of the excellent tensile properties of rotator tendons in childhood that often resist mechanical forces better than the growth plate or the apophyses. This report describes a full-thickness rotator cuff tear and a posterior labral tear in a 12-year-old boy who had a direct injury to the shoulder while playing football. The authors' goal in reporting this case is to increase orthopedic surgeons' awareness of this type of injury. Early use of magnetic resonance imaging for persistent shoulder pain after direct injury during contact sports may avoid undue delay in diagnosis. This report also describes the mini-open transosseous extraphyseal technique of cuff repair and reviews the literature on this infrequent injury. Overall, excellent clinical outcomes and return to sports can be expected after surgical repair of torn and often retracted tendons.

Physeal-Sparing Transosseous-Equivalent Arthroscopic Rotator Cuff Repair

“…Pediatric rotator cuff repair should be approached using a physeal-sparing technique to avoid potential growth disturbances. Although the literature is sparse, previously described techniques underemphasize physeal-sparing techniques and use an open approach 2, 6. Our technique highlights an arthroscopic approach with fluoroscopic confirmation of preservation of the physis.…”

“…Contusions to the rotator cuff are reported in contact athletes and can present with a short-term loss of muscle strength and function 3 . Fortunately, traumatic rotator cuff tears in this population are rare, and the literature contains predominantly case reports and small series without attention to physeal-sparing repair techniques 2, 4, 5, 6, 7…”

“…Contact sports such as football have been documented to carry a high risk of rotator cuff tears in the pediatric population 1 . Adolescent athletes in overhead sports also have a higher incidence of rotator cuff tears, and throwing has been implicated in overuse tears resulting from the significant forces to the developing shoulder 2 . Repetitive microtrauma is thought to precipitate undersurface tears of the supraspinatus, which may progress to full-thickness tears.…”

Rotator cuff tears in the pediatric population: Comparing findings on arthroscopic evaluation to pre-operative magnetic resonance imaging

“…Rotator cuff (RC) tears are common injuries sustained by competitive overhead athletes resulting from acute trauma or more commonly, chronic degenerative changes from overuse. 1,2 These injuries have been frequently documented in both collegiate and professional level athletes in which a repetitive overhead throwing motion is used. [3][4][5] When RC tears occur in athletes and younger populations, they tend to result from trauma, multiple subluxations, or repetitive overhead motions where large rotational torques are observed, often occurring in athletes participating in sports such as baseball, tennis, or swimming.…”

“…7 Although RC injuries are a common etiology for shoulder pain in adults, evidence suggests RC lesions occur less often in the pediatric population, and account for less than 1% of all total RC tears. 2,14 Current literature reports shoulder injuries comprise nearly 11% of all high school athlete injuries 15 . However, few studies have reported the incidence of RC tears in the pediatric population, with current evidence limited to case reports and small retrospective reviews.…”