Massive Rotator Cuff Tears, Rotator Cuff Injuries, Shoulder Pain Chronic
Conditions
Keywords
Massive rotator cuff, Partial repair, biceps augmentation, shoulder arthroscopy
Brief summary
Management of massive rotator cuff tears (MRCT) is associated with high rates of failure. The long head of the biceps tendon augmentation (LHBTA) by reinforcement of the reconstruction and additional blood supply may improve healing and provide better outcome than partial repair only.
Detailed description
Patients with irreparable supraspinatus muscle (SSP) tear, and complete infraspinatus muscle (ISP) tear are including in the prospective, comparative study. Excluding criteria consist of: problems or previous surgery of contralateral shoulder, subscapularis muscle tear larger than stage 2 by Lafosse classification, uncontrolled diabetes and previous surgery. First group consisting of patients treated by partial cuff repair with LHBTA. Second group is comparative group consisting of patients treated by only partial cuff repair without LHBTA. Group stratification depends on quality of the biceps tendon. In case of good tendon quality - its used for biological augmentation, if it's degenerated- tenotomy of the tendon and only partial repair is performing. Irreparability is defined as SSP ≥ 3 in Goutallier classification and stage 3 in Patte classification what is preoperatively assessed by MRI. Assessment tools consisting of range of motion (ROM), strength measurements in position adequate to assess reconstructing tendons and muscles force, Acromio-humeral index (AHI), Constant, SST, Hamada, and Sugaya scores. Goutallier classification for SSP and ISP and diameter of the teres minor muscle (TMn). Radiological and clinical assessment is performing one year after the surgery
Interventions
PROCEDUREArthroscopic partial repair of massive rotator cuff tear
Surgery relies on arthroscopic reconstruction of the rotator cuff tendons. Because of irreparability of Supraspinatus tendon ( always) and infraspinatus tendon ( sometimes) surgeon performed partial repair to cover humeral head by the tendons
PROCEDUREArthroscopic partial repair of rotator cuff with biceps augmentation
Surgery relies on arthroscopic reconstruction of the rotator cuff tendons. Because of irreparability of Supraspinatus tendon ( always) and infraspinatus tendon ( sometimes) surgeon performed partial repair to cover humeral head by the tendons and because of good quality of the long head of the biceps tendon, its uses as biological reinforcement of the reconstruction to achieve better clinical and radiological outcome
Sponsors
Saint Lucas Hospital, Poland
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
2 different groups. Differences in type of surgery Comparison of two ways of treatment
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
Massive and irreparable rotator cuff tear: * chronic supraspinatus tear with retraction grade 3 and muscle fatty infiltration ( measured in MRI ) \> 3\* * Infraspinatus tear with retraction and fatty muscle degeneration
Exclusion criteria
* Previosus surgery * Imposibility to performed MRI * Diabetes * no compliance
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of improvement in shoulder strength | Through study completion, an average of 2.5 years | Strength will be measured by dynamometer in Kilograms \[Kg\] by main investigator in external rotation position, flexion, abduction and Jobe test position for every patient at the end of the study. Comparison of two methods will be perform to assess better method for shoulder strength improvement |
| Comparison of shoulder function measured in Constant-Murley Score | Through study completion, an average of 2.5 years | Function of the shoulder will be assess by Constant Murlay score which describes shoulder function in daily routines: In this score range is 0-100 when 100 is the best result. |
| Comparison of shoulder function measured in SST Score | Through study completion, an average of 2.5 years | Function of the shoulder will be assess by SST score which describes shoulder function in daily routines: In this score range is 0-100% when 100% is the best result. |
| Comparison of improvement in shoulder range of motion | Through study completion, an average of 2.5 years | Range of motion ( ROM) of every patient is measured preoperatively and postoperatively using goniometer and the result is presented in degrees. Comparision of two methods will be perform to assess better method for ROM improvement |
| Comparison of improvement in shoulder pain in VAS score | Through study completion, an average of 2.5 years | Pain is assessed preoperatively and postoperatively using VAS score ( from 0 to 10, when 0 is no pain and 10 is the higher possible pain). Comparison of two methods will be perform to assess better method for shoulder pain reduce. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of radiological outcome in Sugaya score | Through study completion, an average of 2.5 years | Radiological outcome will be assessed by Sugaya score. This score is used to measure quality of tendon reconstruction in MRI view. Range of points in this score is 1-5 when 1 is the best result. For every patient this score will be calculated through study completion and comparison of two methods will be performed. |
| Comparison of radiological outcome in Hamada score | Through study completion, an average of 2.5 years | Radiological outcome will be assessed by Hamada score. This score measure shoulder cuff arthropathy ( stage 1-5 when 1 is the best result). For every patient this score will be calculated through study completion and comparison of two methods will be performed. |
Countries
Poland
Contacts
Primary ContactHubert Laprus, MD
Outcome results
None listed