Patrick J Denard1, Alexandre Lädermann2, Paul C Brady3, Pablo Narbona4, Christopher R Adams5, Paolo Arrigoni6, Dave Huberty7, Michael B Zlatkin8, Timothy G Sanders8, Stephen S Burkhart9. 1. Southern Oregon Orthopedics, Medford, Oregon, USA pjdenard@gmail.com. 2. Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland. 3. Tennessee Orthopaedic Clinics, Knoxville, Tennessee, USA. 4. Department of Shoulder Surgery, Sanatorio Allende, Córdoba, Argentina. 5. Arthrex Inc, Naples, Florida, USA. 6. Policlinico San Donato, Università degli Studi di Milano, Milan, Italy. 7. Oregon Orthopedic and Sports Medicine Clinic LLP, West Linn, Oregon, USA. 8. NationalRad, Deerfield Beach, Florida, USA. 9. The San Antonio Orthopaedic Group, San Antonio, Texas, USA.
Abstract
BACKGROUND: Pseudoparalysis is defined as active forward flexion less than 90° with full passive motion. There is controversy about the ideal surgical management of a massive rotator cuff tear with pseudoparalysis. PURPOSE/HYPOTHESIS: The purpose of this study was to prospectively analyze the ability to reverse pseudoparalysis with an arthroscopic rotator cuff repair (ARCR). The hypothesis was that in the absence of substantial glenohumeral arthritis, preoperative fatty infiltration of grade 3 or higher and an acromiohumeral interval (AHI) of less than 7 mm would not prevent reversal of pseudoparalysis with an ARCR. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A prospective multicenter study of ARCR performed for preoperative pseudoparalysis was conducted. The minimum follow-up was 1 year. The mean patient age was 63 years, and pseudoparalysis was present for a mean of 4.2 months preoperatively. Preoperative radiographic evaluation included plain film evaluation of the AHI and Hamada classification and MRI evaluation of fatty degeneration and rotator cuff retraction. Functional outcome was determined by the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, visual analog scale (VAS), and subjective shoulder value (SSV). RESULTS: Of the 58 patients enrolled, 56 had at least 1 year of follow-up. Mean active forward flexion improved from 47° preoperatively to 159° postoperatively (P < .001). Statistically significant improvements were seen in the SST (from 2.8 preoperatively to 10.1 postoperatively), SSV (from 28 to 83), ASES Shoulder Score (from 37 to 88), and VAS (from 5.7 to 1.1) (P < .001). Pseudoparalysis was reversed in 53 of 56 patients (95%). There was no difference in the rate of reversal of pseudoparalysis between those patients with an AHI of less than 7 mm (88.2%) and those with an AHI of 7 mm or more (96.9%) (P =.289). Pseudoparalysis was reversed in all 8 of the patients with fatty degeneration of grade 3 or higher in 1 or more of the rotator cuff muscles. CONCLUSION: ARCR can lead to reversal of preoperative pseudoparalysis in patients with minimal preoperative glenohumeral arthritis. ARCR is a viable first line of treatment for patients with pseudoparalysis in the absence of advanced glenohumeral arthritis.
BACKGROUND: Pseudoparalysis is defined as active forward flexion less than 90° with full passive motion. There is controversy about the ideal surgical management of a massive rotator cuff tear with pseudoparalysis. PURPOSE/HYPOTHESIS: The purpose of this study was to prospectively analyze the ability to reverse pseudoparalysis with an arthroscopic rotator cuff repair (ARCR). The hypothesis was that in the absence of substantial glenohumeral arthritis, preoperative fatty infiltration of grade 3 or higher and an acromiohumeral interval (AHI) of less than 7 mm would not prevent reversal of pseudoparalysis with an ARCR. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A prospective multicenter study of ARCR performed for preoperative pseudoparalysis was conducted. The minimum follow-up was 1 year. The mean patient age was 63 years, and pseudoparalysis was present for a mean of 4.2 months preoperatively. Preoperative radiographic evaluation included plain film evaluation of the AHI and Hamada classification and MRI evaluation of fatty degeneration and rotator cuff retraction. Functional outcome was determined by the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, visual analog scale (VAS), and subjective shoulder value (SSV). RESULTS: Of the 58 patients enrolled, 56 had at least 1 year of follow-up. Mean active forward flexion improved from 47° preoperatively to 159° postoperatively (P < .001). Statistically significant improvements were seen in the SST (from 2.8 preoperatively to 10.1 postoperatively), SSV (from 28 to 83), ASES Shoulder Score (from 37 to 88), and VAS (from 5.7 to 1.1) (P < .001). Pseudoparalysis was reversed in 53 of 56 patients (95%). There was no difference in the rate of reversal of pseudoparalysis between those patients with an AHI of less than 7 mm (88.2%) and those with an AHI of 7 mm or more (96.9%) (P =.289). Pseudoparalysis was reversed in all 8 of the patients with fatty degeneration of grade 3 or higher in 1 or more of the rotator cuff muscles. CONCLUSION: ARCR can lead to reversal of preoperative pseudoparalysis in patients with minimal preoperative glenohumeral arthritis. ARCR is a viable first line of treatment for patients with pseudoparalysis in the absence of advanced glenohumeral arthritis.
Authors: Benjamin B Rothrauff; Thierry Pauyo; Richard E Debski; Mark W Rodosky; Rocky S Tuan; Volker Musahl Journal: Tissue Eng Part B Rev Date: 2017-02-09 Impact factor: 6.389
Authors: Alexandre Lädermann; Stephen S Burkhart; Pierre Hoffmeyer; Lionel Neyton; Philippe Collin; Evan Yates; Patrick J Denard Journal: EFORT Open Rev Date: 2017-03-13
Authors: Alexandre Lädermann; Philippe Collin; George S Athwal; Markus Scheibel; Matthias A Zumstein; Geoffroy Nourissat Journal: EFORT Open Rev Date: 2018-05-21