Overhead Thrower with a Partial Thickness Symptomatic Cuff Tear - PowerPoint PPT Presentation

Overhead Thrower with a Partial Thickness Symptomatic Cuff Tear PRO: Complete the Tear and Repair to Bone John E. Kuhn, MD V A N D E R B I L T S P O R T S M E D I C I N E

ADAPTIVE PATHOLOGY May Require THIS Which will only happen To do THIS With THIS V A N D E R B I L T S P O R T S M E D I C I N E

ADAPTIVE PATHOLOGY Current Reports Sports Med 12(5):311-315, 2013. Arthroscopy 29(1):141-161, 2013. V A N D E R B I L T S P O R T S M E D I C I N E

APPROACH TO TREATMENT V A N D E R B I L T S P O R T S M E D I C I N E

Surgical Treatment of Rotator Cuff Tears in Throwers • Debridement • Repair to Bone in Situ • Repair Delamination in Situ • Complete the Tear if >50% and Repair to Bone • Patch the Tendon V A N D E R B I L T S P O R T S M E D I C I N E

Repair in Situ V A N D E R B I L T S P O R T S M E D I C I N E

Patch it V A N D E R B I L T S P O R T S M E D I C I N E

Partial Tears V A N D E R B I L T S P O R T S M E D I C I N E

Should we Debride the Partial Thickness Rotator Cuff Tear? V A N D E R B I L T S P O R T S M E D I C I N E

Debridement of Partial Thickness Tears in Athletes • 43 Athletes under 40 years • Follow-up 24 mos • Debride and SAD • 14 Acute Injuries, 9 (64%) Returned to Sports • 29 Overhead Athletes, 13 (45%) Returned to Sports Payne. Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report. AJSM 1997;25(3):299-305. Level 4 V A N D E R B I L T S P O R T S M E D I C I N E

Debridement of Partial Thickness Tears in Athletes • 36 patients all athletes, 23 pitchers, age 22 years, 12 months of sx • F/ U on 34 • Debride partial rct, (also debride labrum and biceps lesions) • 7 6 % excellent , 9% good, 15% poor • 85% returned to play Andrews JR, Broussard TS, Carson WG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: a preliminary report. Arthroscopy 1985;1(2):117-122 Level 4-case series V A N D E R B I L T S P O R T S M E D I C I N E

Debridement of Partial Thickness Tears in Athletes • 67 ptrct debrided in 75 throwing athletes, surgery delayed 22 months, follow up at 2 years • 8 (10% ) very satisfied, 22 (29% ) satisfied, 45 (60% ) disappointed • 1 2 ( 1 6 % ) resum ed sports at form er level Riand N, Boulahia A, Walch G. (Posterosuperior impingement of the shoulder in the athlete: results of arthroscopic debridement in 75 patients. Rev Chir Orthop Reparatrice Appar Mod 2002;88(1):19-27. Level 4- case series V A N D E R B I L T S P O R T S M E D I C I N E

Debridement of Partial Thickness Tears in Pitchers • 82 professional pitchers had debridement of ptRCT • Retrospective Review of 67 (82% ) – 51 (76% ) returned to competitive pitching at professional level – 3 7 ( 5 5 % ) w ere able to return at sam e or higher level Reynolds SB. Debridement of small partial-thickness rotator cuff tears in elite Overhead throwers. CORR 466:614-21, 2008 LOE-4 V A N D E R B I L T S P O R T S M E D I C I N E

Should we Repair Articular Surface Partial Thickness Rotator Cuff Tears to Bone? Ide. Arthroscopic transtendon repair of partial thickness articular side tears of the rotator cuff. AJSM 2005;33:1672-1680. V A N D E R B I L T S P O R T S M E D I C I N E

Repair Articular Surface Partial Thickness Rotator Cuff Tears to Bone • Ide 2005 (Level IV) – 17 patients, 42 years, 39 month FU – 94% Good to Excellent – OF 6 THROWING ATHLETES: • 2 ( 3 3 % ) RETURNED TO SAME LEVEL • 3 ( 5 0 % ) RETURNED AT LOW ER LEVEL • 1 DI D NOT RETURN Ide. Arthroscopic transtendon repair of partial thickness articular side tears of the rotator cuff. AJSM 2005;33:1672-1680. V A N D E R B I L T S P O R T S M E D I C I N E

Complete the Tear and Repair • Indicated for >50% Partial Tears • Excise remaining tendon and Repair to bone like full thickness tear V A N D E R B I L T S P O R T S M E D I C I N E

Complete the Tear and Repair In the General Population Results are Good V A N D E R B I L T S P O R T S M E D I C I N E

• 16 Studies • Tears <50% do well with debridement, but progression to full thickness noted in up to 34% • High Grade Lesions are successfully treated with takedown and repair, in situ repair, and transosseous repair Arthroscopy 2011, Level IV V A N D E R B I L T S P O R T S M E D I C I N E

• 48 patients with >50% ptrct • 24 Transtendon vs 24 completion and repair • Completion and Repair Group had – Less Pain and Quicker Recovery – But Re-tear developed 2 patients V A N D E R B I L T S P O R T S M E D I C I N E Arthroscopy 2012, Level II

• 100 patients with >50% ptrct • 50 Trans-tendon vs 50 completion and repair • Results – No difference in outcomes – Completion and Repair-if bursal tear-had higher re- tear rates V A N D E R B I L T S P O R T S M E D I C I N E Arthroscopy 2015, Level II

• 2 Level II Comparative Studies 183 shoulders • Both Techniques had Improvement • No differences in outcome V A N D E R B I L T S P O R T S M E D I C I N E Advances in Ortho 2016 Level II

What about Recreational Athletes? V A N D E R B I L T S P O R T S M E D I C I N E

• 25 studies, 683 Athletes • Conclusions: – No differences for surgical treatment of partial or full thickness tears – Most recreational athletes retuned at the same level of play – Only half of competitive/professional athletes returned to same level of play V A N D E R B I L T S P O R T S M E D I C I N E AJSM 2016

Full Thickness Tears V A N D E R B I L T S P O R T S M E D I C I N E

Repair of FTRCT to Bone in Amateur Throwing Athletes • Retrospective Review 21 Throwing Athletes with FTRCT Arthroscopic Repair • Age 58.9 years, 25.7 month Follow-up • Constant Score Improved 54.9 to 84.3 • Re-Tear Rate 23.8% • All patients returned to overhead activity at 6.3 months (3- 12) • Pre-injury and Post-op Participation Levels were no different Liem. Arthroscopic Rotator Cuff Repair in Overhead-throwing Athletes. AJSM 2008;36:1317-1322 LOE 3-Retrospective Review V A N D E R B I L T S P O R T S M E D I C I N E

Repair of Full Thickness RCT in Professional Baseball Players • 16 players-12 pitchers dominant arm, Mini- open repairs of FTRCT, 66.6 month F/ U – 2 of 2 position player with non-dominant arm involvement returned – 1 of 2 position players w ith dom inant arm involvem ent returned – Only one pitcher returned Mazoue CG, Andrews JR. Repair of full-thickness rotator cuff tears in professional baseball players. Am J Sports Med 2006;34(2):182-9. Level-4 Case Series V A N D E R B I L T S P O R T S M E D I C I N E

SUMMARY • Rotator Cuff-Partial Tears – If >50% can repair in situ or Excise and Repair and expect good results in recreational athletes – NOT a good prognosis for professional athletes • Rotator Cuff-Full Thickness Tears – Repair to Bone may be ok in amateurs – Repair to Bone 12.5% RTP in professionals…. V A N D E R B I L T S P O R T S M E D I C I N E

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