Repair of massive rotator cuff tears using interval slide technique and progressive rehabilitation exercises

doi:10.3877/cma.j.issn.2095-5790.2021.01.005

Abstract

Abstract:

Background

Rotator cuff injury is a common disease of sports medicine, affecting the quality of work and life, and the incidence increases with age. Many factors impact the treatment of massive rotator cuff tears, including huge damage range, shortening of rotator cuffs, degeneration and adhesion of surrounding tissues. Although there are lots of rotator cuff surgical procedures and postoperative rehabilitation methods, few studies reported on slide repair and systematic rehabilitation exercises. Objective To investigate the curative effect of interval slide technique under the optimal rotator cuff tension and adjustable abduction brace assisted postoperative progressive rehabilitation with mechanical stimulation in the treatment of massive rotator cuff injury.

Methods

From January 2012 to October 2016, 24 patients (17 males and 7 females) with massive rotator cuff injuries were admitted into our hospital. The ages ranged from 43 to 69 years, with an average age of 57.9 years. After acromioplasty, rotator interval release and slide, the rotator cuff were repaired in the abduction position under the optimal tension. The progressive rehabilitation exercises were conducted under the protection of the adjustable abduction brace. The range of motion, shoulder function scores (Constant score, ASES score) , retear and stiffness were evaluated in the 6th and 24th month. The mechanics analysis was performed based on the geometric model of the shoulder joint.

Results

Compared with the preoperative range of motion (120.4°±23.6° of forward elevation, 102.5°±14.9° of abduction, and 35.6°±9.1°of external rotation) , Constant-Murley score [ (48.9±13.3) points] , and ASES score [ (47.5±10.8) points] , the postoperative range of motion (150.6°±12.1° of forward elevation, 151.7°±19.9° of abduction, and 55.6°±10.8° of external rotation) , Constant-Murley score [ (72.7±9.1) points] and ASES score [ (75.7±11.0) points ] were significantly improved in the 6th months, and the pain was less severe than before surgery (P<0.001) . In the 24th month, the above indexes (ROM: 157.3°±13.6° of forward elevation, 155.4°±20.5° of abduction and 62.1°±9.0° of external rotation; Constant-Murley score: (80.6±8.5) points; ASES score: (82.0±8.8) points were further improved compared with those in the 6th month postoperatively (P<0.01) . At the last follow-up, 3 patients were found rotator cuff retear (retear rate 12.5%) , and 1 patient suffered from shoulder stiffness. A negative correlation formula between the abduction angle and the extended length of rotator cuff was derived from the shoulder joint model.

Conclusion

Optimal tension repair of massive rotator cuff tears using interval slide technique and adjustable brace assisted postoperative progressive rehabilitation exercises with mechanical stimulation significantly improved the range of motion, shoulder function, pain relief, and kept lower stiffness rate and retear rate with high patient satisfaction, which was consistent with the results of mechanics analysis based on shoulder joint geometric model.

Key words: Shoulder joint, Massive rotator cuff tear, Shoulder impingement syndrome, Rehabilitation

Zezheng Yang, Yuanjing Xu, Yihao Liu, Tao Li, Zhiyuan Liu, Chuan Jiang, Jinwu Wang, Kerong Dai. Repair of massive rotator cuff tears using interval slide technique and progressive rehabilitation exercises[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2021, 09(01): 30-37.

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URL: https://zhjzwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5790.2021.01.005

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References 33

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时间	前举（°）	外展（°）	外旋（°）	Constant评分（分）	ASES评分（分）
术前	120.4±23.6	102.5±14.9	35.6±9.1	48.9±13.3	47.5±10.8
术后6个月	150.6±12.1^a	151.7±19.9^a	55.6±10.8^a	72.7±9.1^a	75.7±11.0^a
术后24个月	157.3±13.6^b	155.4±20.5^b	62.1±9.0^b	80.6±8.5^b	82.0±8.8^b
F值	-6.905	-10.170	-10.398	-12.556	-14.288
P值	<0.001	<0.001	<0.001	<0.001	<0.001

时间	前举（°）	外展（°）	外旋（°）	Constant评分（分）	ASES评分（分）
术前	120.4±23.6	102.5±14.9	35.6±9.1	48.9±13.3	47.5±10.8
术后6个月	150.6±12.1^a	151.7±19.9^a	55.6±10.8^a	72.7±9.1^a	75.7±11.0^a
术后24个月	157.3±13.6^b	155.4±20.5^b	62.1±9.0^b	80.6±8.5^b	82.0±8.8^b
F值	-6.905	-10.170	-10.398	-12.556	-14.288
P值	<0.001	<0.001	<0.001	<0.001	<0.001

时间	疼痛	日常活动	主动活动	肌力
术前	5.2±5.2	11.2±5.0	18.2±3.1	14.4±5.8
术后6个月	11.3±4.0^a	12.2±5.2^a	28.1±2.7^a	19.2±4.1^a
术后24个月	11.5±4.3	14.6±4.7	32.7±2.7^b	21.9±3.2
F值	-4.861	-3.000	-16.663	-5.874
P值	<0.001	<0.01	<0.001	<0.001

时间	疼痛	日常活动	主动活动	肌力
术前	5.2±5.2	11.2±5.0	18.2±3.1	14.4±5.8
术后6个月	11.3±4.0^a	12.2±5.2^a	28.1±2.7^a	19.2±4.1^a
术后24个月	11.5±4.3	14.6±4.7	32.7±2.7^b	21.9±3.2
F值	-4.861	-3.000	-16.663	-5.874
P值	<0.001	<0.01	<0.001	<0.001

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