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Published in: BMC Sports Science, Medicine and Rehabilitation 1/2012

Open Access 01-12-2012 | Review

Management of degenerative rotator cuff tears: a review and treatment strategy

Authors: Nicholas D Clement, Yuan X Nie, Julie M McBirnie

Published in: BMC Sports Science, Medicine and Rehabilitation | Issue 1/2012

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Abstract

The aim of this review was to present an over view of degenerative rotator cuff tears and a suggested management protocol based upon current evidence. Degenerative rotator cuff tears are common and are a major cause of pain and shoulder dysfunction. The management of these tears is controversial, as to whether they should be managed non-operatively or operatively. In addition when operative intervention is undertaken, there is question as to what technique of repair should be used. This review describes the epidemiology and natural history of degenerative rotator cuff tears. The management options, and the evidence to support these, are reviewed. We also present our preferred management protocol and method, if applicable, for surgical fixation of degenerative rotator cuff tears.
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Literature
1.
go back to reference Monro A: A description of all the bursae mucosae of the human body. 1788, London Monro A: A description of all the bursae mucosae of the human body. 1788, London
2.
go back to reference Dunn WR, Schackman BR, Walsh C, Lyman S, Jones EC, Warren RF, Marx RG: Variation in orthopaedic surgeons' perceptions about the indications for rotator cuff surgery. J Bone Joint Surg Am. 2005, 87: 1978-1984. 10.2106/JBJS.D.02944.CrossRefPubMed Dunn WR, Schackman BR, Walsh C, Lyman S, Jones EC, Warren RF, Marx RG: Variation in orthopaedic surgeons' perceptions about the indications for rotator cuff surgery. J Bone Joint Surg Am. 2005, 87: 1978-1984. 10.2106/JBJS.D.02944.CrossRefPubMed
3.
go back to reference Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB: Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995, 77: 10-15.PubMed Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB: Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995, 77: 10-15.PubMed
4.
go back to reference Tempelhof S, Rupp S, Seil R: Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999, 8: 296-299. 10.1016/S1058-2746(99)90148-9.CrossRefPubMed Tempelhof S, Rupp S, Seil R: Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999, 8: 296-299. 10.1016/S1058-2746(99)90148-9.CrossRefPubMed
5.
go back to reference Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD: Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001, 10: 199-203. 10.1067/mse.2001.113086.CrossRefPubMed Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD: Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001, 10: 199-203. 10.1067/mse.2001.113086.CrossRefPubMed
6.
go back to reference Murthi AM: Rotator cuff tears and cuff tear arthropasty. AAOS comprehensive orthopaedic review. Edited by: Lieberman JR. 2009, USA: American Academy of Orthopaedic Surgeons, 817-826. Murthi AM: Rotator cuff tears and cuff tear arthropasty. AAOS comprehensive orthopaedic review. Edited by: Lieberman JR. 2009, USA: American Academy of Orthopaedic Surgeons, 817-826.
7.
go back to reference Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, Cook C: Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008, 42: 80-92.CrossRefPubMed Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, Cook C: Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008, 42: 80-92.CrossRefPubMed
8.
go back to reference Longo UG, Berton A, Ahrens PM, Maffulli N, Denaro V: Clinical tests for the diagnosis of rotator cuff disease. Sports Med Arthrosc. 2011, 19: 266-278. 10.1097/JSA.0b013e3182250c8b.CrossRefPubMed Longo UG, Berton A, Ahrens PM, Maffulli N, Denaro V: Clinical tests for the diagnosis of rotator cuff disease. Sports Med Arthrosc. 2011, 19: 266-278. 10.1097/JSA.0b013e3182250c8b.CrossRefPubMed
9.
go back to reference Hamada K, Fukuda H, Mikasa M, Kobayashi Y: Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990, 254: 92-96.PubMed Hamada K, Fukuda H, Mikasa M, Kobayashi Y: Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990, 254: 92-96.PubMed
10.
go back to reference Gazzola S, Bleakney RR: Current imaging of the rotator cuff. Sports Med Arthrosc. 2011, 19: 300-309. 10.1097/JSA.0b013e3182189468.CrossRefPubMed Gazzola S, Bleakney RR: Current imaging of the rotator cuff. Sports Med Arthrosc. 2011, 19: 300-309. 10.1097/JSA.0b013e3182189468.CrossRefPubMed
11.
go back to reference Neer CS: Impingement lesions. Clin Orthop Relat Res. 1983, 173: 70-77.PubMed Neer CS: Impingement lesions. Clin Orthop Relat Res. 1983, 173: 70-77.PubMed
12.
go back to reference Yamanaka K, Matsumoto T: The joint side tear of the rotator cuff. A followup study by arthrography. Clin Orthop Relat Res. 1994, 304: 68-73.PubMed Yamanaka K, Matsumoto T: The joint side tear of the rotator cuff. A followup study by arthrography. Clin Orthop Relat Res. 1994, 304: 68-73.PubMed
13.
go back to reference Weber SC: Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears. Arthroscopy. 1999, 15: 126-131. 10.1053/ar.1999.v15.0150121.CrossRefPubMed Weber SC: Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears. Arthroscopy. 1999, 15: 126-131. 10.1053/ar.1999.v15.0150121.CrossRefPubMed
14.
go back to reference Fukuda H, Hamada K, Nakajima T, Tomonaga A: Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc Histologic sections. Clin Orthop Relat Res. 1994, 304: 60-67.PubMed Fukuda H, Hamada K, Nakajima T, Tomonaga A: Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc Histologic sections. Clin Orthop Relat Res. 1994, 304: 60-67.PubMed
15.
go back to reference Hamada K, Tomonaga A, Gotoh M, Yamakawa H, Fukuda H: Intrinsic healing capacity and tearing process of torn supraspinatus tendons: in situ hybridization study of alpha 1 (I) procollagen mRNA. J Orthop Res. 1997, 15: 24-32. 10.1002/jor.1100150105.CrossRefPubMed Hamada K, Tomonaga A, Gotoh M, Yamakawa H, Fukuda H: Intrinsic healing capacity and tearing process of torn supraspinatus tendons: in situ hybridization study of alpha 1 (I) procollagen mRNA. J Orthop Res. 1997, 15: 24-32. 10.1002/jor.1100150105.CrossRefPubMed
16.
go back to reference Lohr JF, Uhthoff HK: The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. 1990, 254: 35-38.PubMed Lohr JF, Uhthoff HK: The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. 1990, 254: 35-38.PubMed
17.
go back to reference Rathbun JB, Macnab I: The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970, 52: 540-553.PubMed Rathbun JB, Macnab I: The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970, 52: 540-553.PubMed
18.
go back to reference Rothman RH, Parke WW: The vascular anatomy of the rotator cuff. Clin Orthop Relat Res. 1965, 41: 176-186.CrossRefPubMed Rothman RH, Parke WW: The vascular anatomy of the rotator cuff. Clin Orthop Relat Res. 1965, 41: 176-186.CrossRefPubMed
19.
go back to reference Ecklund KJ, Lee TQ, Tibone J, Gupta R: Rotator cuff tear arthropathy. J Am Acad Orthop Surg. 2007, 15: 340-349.CrossRefPubMed Ecklund KJ, Lee TQ, Tibone J, Gupta R: Rotator cuff tear arthropathy. J Am Acad Orthop Surg. 2007, 15: 340-349.CrossRefPubMed
20.
go back to reference Neer CS, Craig EV, Fukuda H: Cuff-tear arthropathy. J Bone Joint Surg Am. 1983, 65: 1232-1244.PubMed Neer CS, Craig EV, Fukuda H: Cuff-tear arthropathy. J Bone Joint Surg Am. 1983, 65: 1232-1244.PubMed
21.
go back to reference Hamada K, Yamanaka K, Uchiyama Y, Mikasa T, Mikasa M: A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res. 2011, 469: 2452-2460. 10.1007/s11999-011-1896-9.CrossRefPubMedPubMedCentral Hamada K, Yamanaka K, Uchiyama Y, Mikasa T, Mikasa M: A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res. 2011, 469: 2452-2460. 10.1007/s11999-011-1896-9.CrossRefPubMedPubMedCentral
22.
go back to reference Shibata Y, Midorikawa K, Emoto G, Naito M: Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg. 2001, 10: 209-216. 10.1067/mse.2001.113501.CrossRefPubMed Shibata Y, Midorikawa K, Emoto G, Naito M: Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg. 2001, 10: 209-216. 10.1067/mse.2001.113501.CrossRefPubMed
23.
go back to reference Chou WY, Ko JY, Wang FS, Huang CC, Wong T, Wang CJ, Chang HE: Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study. J Shoulder Elbow Surg. 2010, 19: 557-563. 10.1016/j.jse.2009.08.006.CrossRefPubMed Chou WY, Ko JY, Wang FS, Huang CC, Wong T, Wang CJ, Chang HE: Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study. J Shoulder Elbow Surg. 2010, 19: 557-563. 10.1016/j.jse.2009.08.006.CrossRefPubMed
24.
go back to reference Ejnisman B, Andreoli CV, Soares BG, Fallopa F, Peccin MS, Abdalla RJ, Cohen M: Interventions for tears of the rotator cuff in adults. Cochrane Database Syst Rev. 2004, 1: CD002758.PubMed Ejnisman B, Andreoli CV, Soares BG, Fallopa F, Peccin MS, Abdalla RJ, Cohen M: Interventions for tears of the rotator cuff in adults. Cochrane Database Syst Rev. 2004, 1: CD002758.PubMed
25.
go back to reference Bartolozzi A, Andreychik D, Ahmad S: Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994, 308: 90-97.PubMed Bartolozzi A, Andreychik D, Ahmad S: Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994, 308: 90-97.PubMed
26.
go back to reference Bokor DJ, Hawkins RJ, Huckell GH, Angelo RL, Schickendantz MS: Results of nonoperative management of full-thickness tears of the rotator cuff. Clin Orthop Relat Res. 1993, 294: 103-110.PubMed Bokor DJ, Hawkins RJ, Huckell GH, Angelo RL, Schickendantz MS: Results of nonoperative management of full-thickness tears of the rotator cuff. Clin Orthop Relat Res. 1993, 294: 103-110.PubMed
27.
go back to reference Itoi E, Tabata S: Conservative treatment of rotator cuff tears. Clin Orthop Relat Res. 1992, 275: 165-173.PubMed Itoi E, Tabata S: Conservative treatment of rotator cuff tears. Clin Orthop Relat Res. 1992, 275: 165-173.PubMed
28.
go back to reference Prasad N, Odumala A, Elias F, Jenkins T: Outcome of open rotator cuff repair. An analysis of risk factors. Acta Orthop Belg. 2005, 71: 662-666.PubMed Prasad N, Odumala A, Elias F, Jenkins T: Outcome of open rotator cuff repair. An analysis of risk factors. Acta Orthop Belg. 2005, 71: 662-666.PubMed
29.
go back to reference Ellman H, Hanker G, Bayer M: Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986, 68: 1136-1144.PubMed Ellman H, Hanker G, Bayer M: Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986, 68: 1136-1144.PubMed
30.
go back to reference Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van DS: Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003, 12: 550-554. 10.1016/S1058-2746(03)00211-8.CrossRefPubMed Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van DS: Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003, 12: 550-554. 10.1016/S1058-2746(03)00211-8.CrossRefPubMed
31.
go back to reference Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC: Fatty infiltration of disrupted rotator cuff muscles. Rev Rhum Engl Ed. 1995, 62: 415-422.PubMed Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC: Fatty infiltration of disrupted rotator cuff muscles. Rev Rhum Engl Ed. 1995, 62: 415-422.PubMed
32.
go back to reference Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F: Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand. 1996, 67: 264-268. 10.3109/17453679608994685.CrossRefPubMed Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F: Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand. 1996, 67: 264-268. 10.3109/17453679608994685.CrossRefPubMed
33.
go back to reference Samilson RL, Binder WF: Symptomatic full thickness tears of rotator cuff: an analysis of 292 shoulders in 276 patients. Orthop Clin North Am. 1975, 6: 449-466.PubMed Samilson RL, Binder WF: Symptomatic full thickness tears of rotator cuff: an analysis of 292 shoulders in 276 patients. Orthop Clin North Am. 1975, 6: 449-466.PubMed
34.
go back to reference Hawkins RH, Dunlop R: Nonoperative treatment of rotator cuff tears. Clin Orthop Relat Res. 1995, 321: 178-188.PubMed Hawkins RH, Dunlop R: Nonoperative treatment of rotator cuff tears. Clin Orthop Relat Res. 1995, 321: 178-188.PubMed
35.
go back to reference Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG: Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res. 2007, 455: 52-63.CrossRefPubMed Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG: Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res. 2007, 455: 52-63.CrossRefPubMed
36.
go back to reference Mansat P, Cofield RH, Kersten TE, Rowland CM: Complications of rotator cuff repair. Orthop Clin North Am. 1997, 28: 205-213. 10.1016/S0030-5898(05)70280-7.CrossRefPubMed Mansat P, Cofield RH, Kersten TE, Rowland CM: Complications of rotator cuff repair. Orthop Clin North Am. 1997, 28: 205-213. 10.1016/S0030-5898(05)70280-7.CrossRefPubMed
37.
go back to reference Bellumore Y, Mansat M, Assoun J: Results of the surgical repair of the rotator cuff. Radio-clinical correlation. Rev Chir Orthop Reparatrice Appar Mot. 1994, 80: 582-594.PubMed Bellumore Y, Mansat M, Assoun J: Results of the surgical repair of the rotator cuff. Radio-clinical correlation. Rev Chir Orthop Reparatrice Appar Mot. 1994, 80: 582-594.PubMed
38.
go back to reference Harryman DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA: Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991, 73: 982-989.PubMed Harryman DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA: Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991, 73: 982-989.PubMed
39.
go back to reference Jost B, Zumstein M, Pfirrmann CW, Gerber C: Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2006, 88: 472-479.CrossRefPubMed Jost B, Zumstein M, Pfirrmann CW, Gerber C: Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2006, 88: 472-479.CrossRefPubMed
40.
go back to reference Sperling JW, Cofield RH, Schleck C: Rotator cuff repair in patients fifty years of age and younger. J Bone Joint Surg Am. 2004, 86-A: 2212-2215.PubMed Sperling JW, Cofield RH, Schleck C: Rotator cuff repair in patients fifty years of age and younger. J Bone Joint Surg Am. 2004, 86-A: 2212-2215.PubMed
41.
go back to reference Knudsen HB, Gelineck J, Sojbjerg JO, Olsen BS, Johannsen HV, Sneppen O: Functional and magnetic rsonance imaging evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg. 1999, 8: 242-246. 10.1016/S1058-2746(99)90136-2.CrossRefPubMed Knudsen HB, Gelineck J, Sojbjerg JO, Olsen BS, Johannsen HV, Sneppen O: Functional and magnetic rsonance imaging evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg. 1999, 8: 242-246. 10.1016/S1058-2746(99)90136-2.CrossRefPubMed
42.
go back to reference Zanetti M, Jost B, Hodler J, Gerber C: MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatice subjects. Skeletal Radiol. 2000, 29: 314-319. 10.1007/s002560000203.CrossRefPubMed Zanetti M, Jost B, Hodler J, Gerber C: MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatice subjects. Skeletal Radiol. 2000, 29: 314-319. 10.1007/s002560000203.CrossRefPubMed
43.
go back to reference Galatz LM, Ball CM, Teefey SA, Middleton WD: The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004, 86: 219-224.PubMed Galatz LM, Ball CM, Teefey SA, Middleton WD: The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004, 86: 219-224.PubMed
44.
go back to reference Gerber C, Fuchs B, Hodler J: The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000, 82: 505-515.PubMed Gerber C, Fuchs B, Hodler J: The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000, 82: 505-515.PubMed
45.
go back to reference Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F: Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997, 344: 275-283.CrossRefPubMed Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F: Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997, 344: 275-283.CrossRefPubMed
46.
go back to reference Djurasovic M, Marra G, Arroyo JS, Pollock RG, Flatlow EL, Bigliani LU: Revision rotator cuff repair: factors influencing results. J Bone Joint Surg Am. 2001, 83: 1849-1855.PubMed Djurasovic M, Marra G, Arroyo JS, Pollock RG, Flatlow EL, Bigliani LU: Revision rotator cuff repair: factors influencing results. J Bone Joint Surg Am. 2001, 83: 1849-1855.PubMed
47.
go back to reference Jost B, Pfirrmann CW, Gerber C, Switzerland Z: Clinical outcome after structural failure of rotator cuff tears. J Bone Joint Surg Am. 2000, 82: 304-314.CrossRefPubMed Jost B, Pfirrmann CW, Gerber C, Switzerland Z: Clinical outcome after structural failure of rotator cuff tears. J Bone Joint Surg Am. 2000, 82: 304-314.CrossRefPubMed
48.
go back to reference Lindley K, Jones GL: Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature. Am J Orthop (Belle Mead NJ). 2010, 39: 592-600. Lindley K, Jones GL: Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature. Am J Orthop (Belle Mead NJ). 2010, 39: 592-600.
49.
go back to reference Trappey GJ, Gartsman GM: A systematic review of the clinical outcomes of single row versus double row rotator cuff repairs. J Shoulder Elbow Surg. 2011, 20: S14-S19. 10.1016/j.jse.2010.12.001.CrossRefPubMed Trappey GJ, Gartsman GM: A systematic review of the clinical outcomes of single row versus double row rotator cuff repairs. J Shoulder Elbow Surg. 2011, 20: S14-S19. 10.1016/j.jse.2010.12.001.CrossRefPubMed
50.
go back to reference Gartsman GM, Drake GN, Edwards TB, Elkousy HA, Hammerman SM, O'Connor DP: Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single row versus double row suture bridge (transosseous equivalent) fixation. Results of a randomized prospective study. American society of shoulder and elbow surgeons 2010 speciality day. 2010, LA: New Orleans Gartsman GM, Drake GN, Edwards TB, Elkousy HA, Hammerman SM, O'Connor DP: Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single row versus double row suture bridge (transosseous equivalent) fixation. Results of a randomized prospective study. American society of shoulder and elbow surgeons 2010 speciality day. 2010, LA: New Orleans
Metadata
Title
Management of degenerative rotator cuff tears: a review and treatment strategy
Authors
Nicholas D Clement
Yuan X Nie
Julie M McBirnie
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Sports Science, Medicine and Rehabilitation / Issue 1/2012
Electronic ISSN: 2052-1847
DOI
https://doi.org/10.1186/1758-2555-4-48

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