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

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Overhead Thrower with a Partial Thickness Symptomatic Cuff Tear

PRO: Complete the Tear and Repair to Bone

John E. Kuhn, MD

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ADAPTIVE PATHOLOGY

To do THIS May Require THIS Which will only happen With THIS

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Arthroscopy 29(1):141-161, 2013.

ADAPTIVE PATHOLOGY

Current Reports Sports Med 12(5):311-315, 2013.

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APPROACH TO TREATMENT

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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

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Repair in Situ

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Patch it

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Partial Tears

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Should we Debride the Partial Thickness Rotator Cuff Tear?

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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

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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

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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

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Debridement of Partial Thickness Tears in Pitchers

• 82 professional pitchers had debridement
• f 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

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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.

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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.

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Complete the Tear and Repair

• Indicated for >50% Partial Tears
• Excise remaining tendon and Repair to bone

like full thickness tear

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Complete the Tear and Repair In the General Population Results are Good

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• 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

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Arthroscopy 2012, Level II

• 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

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• 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

Arthroscopy 2015, Level II

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• 2 Level II Comparative Studies 183 shoulders
• Both Techniques had Improvement
• No differences in outcome

Advances in Ortho 2016 Level II

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What about Recreational Athletes?

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• 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

AJSM 2016

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Full Thickness Tears

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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

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Repair of Full Thickness RCT in Professional Baseball Players

• 16 players-12 pitchers dominant arm, Mini-
• pen 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

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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….

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