A differential approach to surgical treatment of post-traumatic injuries of the rotator cuff

Abstract

Background. Retracted ruptures of the rotator cuff are difficult to reconstruct. A large number of repeated ruptures due to the inability of standard refixation to restore the integrity of the rotators, emphasize the importance of finding alternative methods of reconstruction. The purpose of this study is to evaluate the improved techniques and to develop new reconstructive and restorative techniques for rotator cuff ruptures. Methods and materials. A retrospective analysis of the outcomes of 219 patients with long-standing rotator cuff injury was performed. 126 of these patients underwent damage reconstruction using generally accepted methods (control groups). The experimental subgroups included 93 patients who received treatment using modified methods. The disease has a duration of 24.3 14.1 months. The duration of the study is 31.25.4 months. The VAS, ASES, UCLA, CSS scales, and MRI data were used to evaluate the results. Results. Standard refixation of nonfragmented rotator cuff ruptures resulted in a 9.1 % pain syndrome frequency, 81.8% positive outcomes, and the absence of repeated ruptures. A comparison of refixation with a modified suture and standard refixation with moderately retracted ruptures revealed the presence of pain syndrome in 3.1 % and 9.7 % of positive outcomes, 87.5 % and 64.5 % of repeated ruptures, respectively. The frequency of pain syndrome was found to be 6.1 percent and 12.5 %, 69.7 % and 59.4 % of positive outcomes, and 9.1 % and 43.8 % of repeated ruptures, respectively, when the reconstruction technique using biceps tendon and reconstruction with medialization of the fixation site were compared with an irreparable rupture of the supraspinatus tendon. A comparison of the author’s reconstruction technique with the use of autosuscular plasty and partial reconstruction of rotators with an irreparable rupture of the supraspinatus and subcostal tendons revealed the frequency of pain syndrome in 7.1 % and 23.3 % of positive outcomes, 53.6 % and 26.7 % of repeated ruptures, respectively. Conclusions. The use of modified techniques reduces the incidence of pain and repeated ruptures compared to classical methods.

Keywords

• rupture
• rotator cuff
• refixation