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. 2021 Feb;56(1):83-90.
doi: 10.1055/s-0040-1702963. Epub 2020 Jul 17.

Captured Rotator Cuff: A Poor Prognostic Factor in Rotator Cuff Repair

Flavio Oliveira de França  1   2 , José Márcio Alves Freitas  1   2   3 , Ricardo Palombini Medeiros  1   2   3 , Romero Ruan Cartaxo de Queiroga  1   2   3 , Tiago Prause Nunes  1   2   3 , Glaydson Gomes Godinho  1   2   3
Affiliations

Captured Rotator Cuff: A Poor Prognostic Factor in Rotator Cuff Repair

Flavio Oliveira de França et al. Rev Bras Ortop (Sao Paulo). 2021 Feb.

Abstract

Objective To describe a new presentation of tears and retears of the rotator cuff, which we denominate captured rotator cuff (CRC). We also aim to evaluate it clinically and through images. Methods We assessed retrospectively 16 patients with intraoperative diagnosis of CRC between March 2005 and September 2017; by means of imaging (radiography and magnetic resonance imaging [MRI]) and functional scores (UCLA and Constant & Murley). In images we analyzed the evolution for rotator cuff arthropathy and presence of retears. Functionally, we compared the affected side with the contralateral side and extensive lesions with nonextensive. Results Five (31.25%) patients presented with rotator cuff arthropathy, and 10 (62.5%) with retears. Three (75%) patients with nonextensive lesions had good/excellent UCLA and Constant & Murley scores. In patients with extensive lesions, when the Constant & Murley score was evaluated, 6 (50%) presented good/excellent results, and in the UCLA score, 7 (58.3%). Comparing the affected side (Constant 74.72 points; UCLA 20 points) with the contralateral side (Constant 96.96 points; UCLA 25.63 points), there were worse functional results with statistical significance. Conclusion The diagnosis of CRC is suspected by characteristic findings on MRI and confirmed in arthroscopy. The affected shoulders present worse functional postoperative scores.

Keywords: rotator cuff; rupture; shoulder; subacromial adhesions.

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Conflict of interest statement

Conflito de Interesses Os autores declaram não haver conflito de interesses.

Figures

Fig. 1
Fig. 1
( A ) Continuity between the tendon stump and the subacromial bursa (black arrow). ( B ) Orientation/superior dislocation of the tendon stump (white arrow) and fluid sheet between it and the superomedial surface of the humeral head (3.92mm).
Fig. 2
Fig. 2
"Empty shoulder" sign. G: glenoid. Ac: acromion; RC: rotator cuff; Hu: humerus.
Fig. 3
Fig. 3
Adhesions between tendons of the RC and the acromion. Ac: acromion; RC: rotator cuff; Hu: humerus.
Fig. 4
Fig. 4
Creating cleavage plane between the acromion (Ac) and the rotator cuff (RC). Hu: humerus; SB: synovial shaver blade.
Fig. 5
Fig. 5
Rotator cuff released from the acromion and evaluation of tendon flexibility with Grasper instruments (G). Hu: humerus; GT: Greater tubercle.
Fig. 6
Fig. 6
Tendon sutured in its footprint using metal anchors (black arrows). Ac: acromion; RC: rotator cuff; GT: Greater tuber.
Fig. 1
Fig. 1
( A ) Continuidade entre o coto tendíneo e a bolsa subacromial (seta preta). ( B ) Orientação/ deslocamento superior do coto tendíneo (seta branca) e lâmina de líquido entre este e superfície súpero-medial da cabeça umeral (3,92mm).
Fig. 2
Fig. 2
Sinal do “ombro vazio“. G: glenóide. Ac: acrômio; MR: manguito rotador; U: úmero.
Fig. 3
Fig. 3
Aderências entre tendões do MR e acrômio. Ac: acrômio; MR: manguito rotador; U: úmero.
Fig. 4
Fig. 4
Criando plano de clivagem entre acrômio (Ac) e manguito rotador (MR). U: úmero; LS: lâmina de shaver sinovial.
Fig. 5
Fig. 5
Manguito rotador (MR) liberado do acrômio e avaliado flexibilidade do tendão com instrumental Grasper (G). U: úmero; TM: tubérculo maior.
Fig. 6
Fig. 6
Tendão suturado em seu footprint com uso de âncoras metálicas (setas pretas). Ac: acrômio; MR: manguito rotator; TM: tubérculo maior.
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