e16
ABSTRACTS
Introduction: The purpose of this article was to report on
the long-term outcomes of revision arthroscopic rotator
cuff repairs and analyze variables associated with poorer
long-term outcomes.
Methods: A retrospective review was performed on 32
shoulders in 30 patients that over a 12 year period had
undergone arthroscopic revision rotator cuff repair. A
thorough shoulder examination was performed, as well as
functional outcomes assessments including the University
of California Los Angeles (UCLA) score, American
Shoulder & Elbow Society (ASES) score and visual analog
scale (VAS) pain score and was compared to the patient’s
preoperative data. Analysis of variables including patient
demographics, previous surgical history, and functional
outcomes was performed to determine if there was any
association with a poorer outcome.
Results: At final follow-up there were 20 males and 10
females with a mean age of 69.3 years (range 55.1-84.1) at
a mean final follow-up of 70.3 months after last revision
surgery. A statistically significant improvement was seen in
the mean UCLA scores, mean “modified ASES” scores, and
mean VAS pain scores postoperatively (P < .001). A poorer
functional outcome as defined by a UCLA score < 28 was
associated with female gender (P¼ .005), >70 years of age
at time of last revision (P¼ .012), surgical side being the
dominant arm (P¼ .038), and preoperative AROM
external rotation < 35 (P¼ .047). Preoperative AROM FF
< 140 (P¼ .039) and AROM ER <35 (P¼ .025) were
associated with an ASES score < 65.
Conclusion: The results of the current study compare
favorably to the current literature and support the relatively few published series on this subject. Our current
study has demonstrated that patients can maintain these
outcomes at an average of at least 70 months (5.8 years)
after the revision procedure. This suggests that a successful
procedure may be subjectively and functionally durable
over time.
Influence Of Preoperative Musculotendinous Junction (MTJ) Position On Rotator Cuff Healing
SS-30
Friday, May 2, 9:50 AM
ROBERT TASHJIAN, M.D., PRESENTING AUTHOR
MAN HUNG, PH.D.
ROBERT BURKS, M.D.
PATRICK GREIS, M.D.
Introduction: Various factors have been identified that
affect healing after rotator cuff repair including age, tear
size, muscle quality and repair construct. Limited data
exists on muscle retraction after rotator cuff tear and
effects of retraction on healing. The purpose of this study
was to determine the effect of the preoperative position of
the musculotendinous junction (MTJ) on rotator cuff
repair healing. Factors influencing postoperative changes
in tendon length and MTJ position were also examined.
Methods: Preoperative and postoperative MRIs were
reviewed of 51 patients undergoing arthroscopic single
row rotator cuff repair. Preoperative MRIs were evaluated
for anteroposterior tear size, tendon retraction, tendon
length, muscle quality and MTJ position with respect to
the glenoid. The position of the MTJ was also referenced
off the glenoid face as either lateral or medial. Postoperative MRIs were evaluated for healing, tendon length,
and MTJ position.
Results: Seventy-six percent of tears healed with 87% of
small/medium tears and 62% of large/massive tears
healing. Greater tendon retraction, worse preoperative
muscle quality and a more medialized MTJ all associated
with worse tendon healing (p<0.05). Ninety-three percent
of tears that had a preoperative MTJ lateral to the face of
the glenoid healed while only 55% of tears that had
a preoperative MTJ medial to the face of the glenoid
healed (p<0.05). The tendon lengthening averaged 13.68
mm in patients who healed compared to shortening 3.62
mm in patients that did not heal (p<0.05). The MTJ lateralized an average of 6 mm in patients who healed
compared to medializing 0.3 mm in patients who did not
heal (p¼0.07). Results from univariate regression analysis
indicated larger preoperative tear size, increased tendon
retraction, smaller preoperative tendon length, poorer
preoperative muscle quality and a more medialized
preoperative position of the MTJ all had a positive effect on
tendon lengthening after repair. (p<0.05).
Conclusion: Preoperative MTJ position is predictive of
postoperative tendon healing. The glenoid face can be used
as a simple marker to reference MTJ position and thereby
predict postoperative healing. Small tears with minimal
retraction and good muscle routinely heal anatomically
with little change in postoperative tendon length or MTJ
position. Larger tears, if they heal, often heal with
apparent tendon lengthening with or without some
restoration of muscle length.
Sleep Disturbance Associated with Rotator Cuff
Tear; Correction with Arthroscopic Rotator Cuff
Repair
SS-31
Friday, May 2, 9:55 AM
LUKE AUSTIN, B.S., M.D., PRESENTING AUTHOR
FOTIOS TJOUMAKARIS, M.D.
BRADFORD TUCKER, M.D.
ALVIN ONG, B.A., M.D.
BRANDON ECK, B.S.
MATTHEW PEPE, M.D.
Introduction: Sleep disturbance is a common complaint
of patients with a rotator cuff tear (RCT). Poor or inadequate sleep, along with pain, are often the driving symptoms for patients to proceed with rotator cuff repair (RCR).
To date, no studies examine sleep disturbance in patients
undergoing RCR, and there is no evidence that RCR
improves sleep disturbance. Since adequate sleep plays
a role in postoperative healing and also in patient satisfaction, it is necessary to investigate and characterize sleep
disturbances in patients undergoing RCR.
Methods: With IRB approval, fifty-six consecutive
patients undergoing arthroscopic RCR for full thickness
RCT were enrolled in this prospective study. Irreparable
tears, revision repairs, arthritis, and workers compensation