Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-03-2015 | Arthroscopy and Sports Medicine

Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique

Authors: T. Stein, J. Buckup, T. Efe, R. von Eisenhart-Rothe, R. Hoffmann, E. Zimmermann, F. Welsch

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 3/2015

Abstract

Introduction

Muscular recovery of structural integrity after arthroscopic Bankart repair using the para- and trans-musculotendinous three-portal technique has not been investigated.

Materials and methods

Twenty-seven athletes [mean age 26.9 years, (group 1; G1)] were prospectively and longitudinally monitored after arthroscopic Bankart repair using the three-portal technique by magnetic resonance imaging (MRI) and specific clinical muscular testing. The muscular integrity was assessed at the subscapularis (SSC) for the para-tendinous anteroinferior portal, the supraspinatus (SSP) for the trans-tendinous suprabicipital portal, and the infraspinatus (ISP) for the trans-tendinous posterior portal. Muscular atrophy was assessed by standardized ratios of transverse and vertical diameters for the SSC and ISP, as defined by cross-sectional area ratios for the SSP. Fatty infiltration was assessed by signal intensity analysis for the upper and lower SSC, SSP, and upper ISP as a ratio with the lower ISP. These parameters were analyzed for pre-operative (T0), 1-year (T1), and 2-year status (T2), and compared to 27 healthy volunteers [mean age 29.4 years, (group 2, G2)].

Results

The structural integrity assessments were performed after 14.8 (T1) and 32.0 months (T2). The SSC analysis revealed no muscular impairments in the upper and lower portions between T0 and T2 or compared to G2. MRI analysis for SSP and ISP showed full muscular recovery without any changes between T0 and T2 or deficits compared to G2. The number of pre-operative dislocations had no influence on the muscular integrity. MR analysis detected signs of overuse syndrome in 15 % at T0, 41 % at T1, and 63 % at T2; 77, 22, and 26 % of patients at T0, T1, and T2, respectively, were symptomatic.

Conclusions

Arthroscopic Bankart repair using the three-portal technique prevents full muscular integrity for para-tendinous anteroinferior portals at the SSC, the trans-tendinous suprabicipital portal through the SSP, and the trans-tendinous portal through the ISP.

Abrams JS (2007) Role of arthroscopy in treating anterior instability of the athlete’s shoulder. Sports Med Arthrosc 15(4):230–238CrossRefPubMed

Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy 19(4):404–420CrossRefPubMed

Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy 19(5):531–539CrossRefPubMed

Burkhart SS, Tehrany AM (2002) Arthroscopic subscapularis tendon repair: technique and preliminary results. Arthroscopy 18(5):454–463CrossRefPubMed

Buteau JL, Eriksrud O, Hasson SM (2007) Rehabilitation of a glenohumeral instability utilizing the body blade. Physiother Theory Pract 23(6):333–349CrossRefPubMed

Chao S, Thomas S, Yucha D, Kelly JD 4th, Driban J, Swanik K (2008) An electromyographic assessment of the “bear hug”: an examination for the evaluation of the subscapularis muscle. Arthroscopy 24(11):1265–1270CrossRefPubMed

Cho NS, Hwang JC, Rhee YG (2006) Arthroscopic stabilization in anterior shoulder instability: collision athletes versus noncollision athletes. Arthroscopy 22(9):947–953CrossRefPubMed

DeBerardino TM, Arciero RA, Taylor DC, Uhorchak JM (2001) Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. Two- to five-year follow-up. Am J Sports Med 29(5):586–592PubMed

Edwards TB, Williams MD, Labriola JE, Elkousy HA, Gartsman GM, O’Connor DP (2009) Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elb Surg 18(6):892–896CrossRef

10.

Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD (2004) Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study. Arthroscopy 20(5):456–462CrossRefPubMed

11.

Fremerey R, Bosch U, Freitag N, Lobenhoffer P, Wippermann B (2006) Proprioception and EMG pattern after capsulolabral reconstruction in shoulder instability: a clinical and experimental study. Knee Surg Sports Traumatol Arthrosc 14(12):1315–1320CrossRefPubMed

12.

Frey E, Regenfelder F, Sussmann P et al (2009) Adipogenic and myogenic gene expression in rotator cuff muscle of the sheep after tendon tear. J orthop Res Off publication Orthop Res Soc 27(4):504–509CrossRef

13.

Gamulin A, Pizzolato G, Stern R, Hoffmeyer P (2002) Anterior shoulder instability: histomorphometric study of the subscapularis and deltoid muscles. Clin Orthop Relat Res 398:121–126CrossRefPubMed

14.

Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint surg Am 82(4):505–515PubMed

15.

Gerber C, Krushell RJ (1991) Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br 73(3):389–394PubMed

16.

Gokeler A, Lehmann M, Knopf E, Freiwald J (2003) Current concepts in the diagnosis and rehabilitation of the shoulder in overhead athletes. Sportverletz Sportschaden 17(1):15–20CrossRefPubMed

17.

Habermeyer P, Gleyze P, Rickert M (1999) Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elb Surg 8(1):66–74CrossRef

18.

Habermeyer P, Magosch P, Lichtenberg S (2004) Shoulder instability. Classification and treatment. Orthopade 33(7):847–872 quiz 873CrossRefPubMed

19.

Hegedus EJ, Goode A, Campbell S et al (2008) Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J sports Med 42(2):80–92 discussion 92CrossRefPubMed

20.

Henry TJ, Lephart SM, Stone D, Giraldo JL, Fu FH (1998) An electromyographic analysis of dynamic stabilization exercises for the shoulder. J Athl Train 1(33):14–20

21.

Hiemstra LA, Sasyniuk TM, Mohtadi NG, Fick GH (2008) Shoulder strength after open versus arthroscopic stabilization. Am J Sports Med 36(5):861–867CrossRefPubMed

22.

Hurschler C, Wulker N, Mendila M (2000) The effect of negative intraarticular pressure and rotator cuff force on glenohumeral translation during simulated active elevation. Clin Biomech (Bristol, Avon) 15(5):306–314CrossRef

23.

Imhoff AB, Ansah P, Tischer T et al (2010) Arthroscopic repair of anterior-inferior glenohumeral instability using a portal at the 5:30-o’clock position: analysis of the effects of age, fixation method, and concomitant shoulder injury on surgical outcomes. Am J Sports Med 38(9):1795–1803CrossRefPubMed

24.

Jobe FW, Moynes DR (1982) Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med 10(6):336–339CrossRefPubMed

25.

Katz LM, Hsu S, Miller SL et al (2009) Poor outcomes after SLAP repair: descriptive analysis and prognosis. Arthroscopy 25(8):849–855CrossRefPubMed

26.

Kelly BT, Kadrmas WR, Speer KP (1996) The manual muscle examination for rotator cuff strength. An electromyographic investigation. Am J Sports Med 24(5):581–588CrossRefPubMed

27.

Kibler WB (1998) The role of the scapula in athletic shoulder function. Am J Sports Med 26(2):325–337PubMed

28.

Kibler WB, McMullen J (2003) Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11(2):142–151PubMed

29.

Kronberg M, Nemeth G, Brostrom LA (1990) Muscle activity and coordination in the normal shoulder. An electromyographic study. Clin Orthop Relat Res 257:76–85PubMed

30.

Labriola JE, Jolly JT, McMahon PJ, Debski RE (2004) Active stability of the glenohumeral joint decreases in the apprehension position. Clin Biomech (Bristol, Avon) 19(8):801–809CrossRef

31.

Labriola JE, Lee TQ, Debski RE, McMahon P (2005) Stability and instability of the glenohumeral joint: the role of shoulder muscles. J Shoulder Elb Surg 14(1 Suppl S):32S–38SCrossRef

32.

Lajtai G, Pfirrmann CW, Aitzetmuller G, Pirkl C, Gerber C, Jost B (2009) The shoulders of professional beach volleyball players: high prevalence of infraspinatus muscle atrophy. Am Journal Sports Med 37(7):1375–1383CrossRef

33.

Lephart SM, Henry TJ (1995) Functional rehabilitation for the upper and lower extremity. Orthop Clin N Am 26(3):579–592

34.

Martelli G, Ciccarone G, Grazzini G, Signorini M, Urgelli S (2013) Isometric evaluation of rotator cuff muscles in volleyball athletes. J Sports Med Phys Fit 53(3):283–288

35.

Matsui Y, Omachi T (2005) New secure suture relay technique for arthroscopic Bankart repair without making an additional working portal. Arthroscopy 21(1):113–118CrossRefPubMed

36.

May S, Chance-Larsen K, Littlewood C, Lomas D, Saad M (2010) Reliability of physical examination tests used in the assessment of patients with shoulder problems: a systematic review. Physiotherapy 96(3):179–190CrossRefPubMed

37.

Maynou C, Cassagnaud X, Mestdagh H (2005) Function of subscapularis after surgical treatment for recurrent instability of the shoulder using a bone-block procedure. J Bone Joint Surg Br 87(8):1096–1101CrossRefPubMed

38.

Meller R, Krettek C, Gosling T, Wahling K, Jagodzinski M, Zeichen J (2007) Recurrent shoulder instability among athletes: changes in quality of life, sports activity, and muscle function following open repair. Knee Surg Sports Traumatol Arthrosc 15(3):295–304CrossRefPubMed

39.

Merolla G, De Santis E, Campi F, Paladini P, Porcellini G (2010) Supraspinatus and infraspinatus weakness in overhead athletes with scapular dyskinesis: strength assessment before and after restoration of scapular musculature balance. Musculoskelet Surg 94(3):119–125CrossRefPubMed

40.

Meyer DC, Farshad M, Amacker NA, Gerber C, Wieser K (2012) Quantitative analysis of muscle and tendon retraction in chronic rotator cuff tears. Am J Sports Med 40(3):606–610CrossRefPubMed

41.

Murray IR, Goudie EB, Petrigliano FA, Robinson CM (2013) Functional anatomy and biomechanics of shoulder stability in the athlete. Clin Sports Med 32(4):607–624CrossRefPubMed

42.

Myers JB, Lephart SM (2000) The role of the sensorimotor system in the athletic shoulder. J Athl Train 35(3):351–363PubMedCentralPubMed

43.

Myers JB, Lephart SM (2002) Sensorimotor deficits contributing to glenohumeral instability. Clin Orthop Relat Res 400:98–104CrossRefPubMed

44.

Myers JB, Wassinger CA, Lephart SM (2006) Sensorimotor contribution to shoulder stability: effect of injury and rehabilitation. Man Ther 11(3):197–201CrossRefPubMed

45.

Nebelung W, Jaeger A, Wiedemann E (2002) Rationales of arthroscopic shoulder stabilization. Arch Orthop Trauma Surg 122(8):472–487PubMed

46.

Picard F, Saragaglia D, Montbarbon E, Tourne Y, Thony F, Charbel A (1998) Anatomo-clinical consequences of the vertical sectioning of the subscapular muscle in Latarjet intervention. Rev Chir Orthop Reparatrice Appar Mot 84(3):217–223PubMed

47.

Potzl W, Thorwesten L, Gotze C, Garmann S, Steinbeck J (2004) Proprioception of the shoulder joint after surgical repair for instability: a long-term follow-up study. Am J Sports Med 32(2):425–430CrossRefPubMed

48.

Pulavarti RS, Symes TH, Rangan A (2009) Surgical interventions for anterior shoulder instability in adults. Cochrane Database Syst Rev 4:CD005077PubMed

49.

Rhee YG, Lim CT, Cho NS (2007) Muscle strength after anterior shoulder stabilization: arthroscopic versus open Bankart repair. Am J Sports Med 35(11):1859–1864CrossRefPubMed

50.

Scheibel M, Nikulka C, Dick A, Schroeder RJ, Popp AG, Haas NP (2007) Structural integrity and clinical function of the subscapularis musculotendinous unit after arthroscopic and open shoulder stabilization. Am J Sports Med 35(7):1153–1161CrossRefPubMed

51.

Scheibel M, Tsynman A, Magosch P, Schroeder RJ, Habermeyer P (2006) Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med 34(10):1586–1593CrossRefPubMed

52.

Schroder RJ, Scheibel M, Tsynman A, Magosch P, Habermeyer P (2006) Magnetic resonance analysis of the subscapularis muscle after open anterior shoulder stabilization. Rofo 178(7):706–712CrossRefPubMed

53.

Spatschil A, Landsiedl F, Anderl W et al (2006) Posttraumatic anterior-inferior instability of the shoulder: arthroscopic findings and clinical correlations. Arch Orthop Trauma Surg 126(4):217–222CrossRefPubMed

54.

Stein T, Linke RD, Buckup J et al (2011) Shoulder sport-specific impairments after arthroscopic Bankart repair: a prospective longitudinal assessment. Am J Sports Med 39(11):2404–2414CrossRefPubMed

55.

Stein T, Mehling AP, Reck C et al (2011) MRI assessment of the structural labrum integrity after Bankart repair using knotless bio-anchors. Knee Surg Sports Traumatol Arthrosc 19(10):1771–1779CrossRefPubMed

56.

Steinbacher P, Tauber M, Kogler S, Stoiber W, Resch H, Sanger AM (2010) Effects of rotator cuff ruptures on the cellular and intracellular composition of the human supraspinatus muscle. Tissue Cell 42(1):37–41CrossRefPubMed

57.

Stephenson DR, Hurt JH, Mair SD (2012) Rotator cuff injury as a complication of portal placement for superior labrum anterior-posterior repair. J Shoulder Elb Surg 21(10):1316–1321CrossRef

58.

Swanik CB, Lephart SM, Rubash HE (2004) Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. J Bone Joint Surg Am 86-A(2):328–334PubMed

59.

Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67(3):264–268CrossRefPubMed

60.

Urayama M, Itoi E, Sashi R, Minagawa H, Sato K (2003) Capsular elongation in shoulders with recurrent anterior dislocation. Quantitative assessment with magnetic resonance arthrography. Am J Sports Med 31(1):64–67PubMed

61.

Walch G, Boulahia A, Calderone S, Robinson AH (1998) The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br 80(4):624–628CrossRefPubMed

62.

Warner JJ, Lephart S, Fu FH (1996) Role of proprioception in pathoetiology of shoulder instability. Clin Orthop Relat Res 330:35–39CrossRefPubMed

63.

Yoo JC, Lee YS, Tae SK, Park JH, Park JW, Ha HC (2008) Magnetic resonance imaging appearance of a repaired capsulolabral complex after arthroscopic bankart repair. Am J Sports Med 36(12):2310–2316CrossRefPubMed

Title: Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique
Authors: T. Stein
J. Buckup
T. Efe
R. von Eisenhart-Rothe
R. Hoffmann
E. Zimmermann
F. Welsch
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 3/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2158-1

At a glance: The STEP trials

Springer Medicine

Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2015

What factors influence follow-up in orthopedic trauma surgery?

The application of atlantoaxial screw and rod fixation in revision operations for postoperative re-dislocation in children

Bilateral nonunion of the sacrum in a long-term paraplegic patient treated with trans-sacral bar and spinopelvic fixation

Comparison of Bryan versus ProDisc-C total disk replacement as treatment for single-level cervical symptomatic degenerative disk disease

Does rotational acetabular osteotomy affect subsequent total hip arthroplasty?

Update TFCC: histology and pathology, classification, examination and diagnostics