Paolo Albino

The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes

BACKGROUND This study was conducted to establish whether hypertension increases the risk of occurrence of rotator cuff tear and influences its size. MATERIALS AND METHODS A case-control design was used. We studied 408 consecutive patients (228 men, 180 women) who underwent arthroscopic rotator cuff repair. Tear size was determined during surgery. The control group included 201 individuals. For the study purpose, participants were divided into 2 groups by presence or absence of hypertension. We applied a logistic regression model to investigate if hypertension affects the risk of cuff tear. A multinomial logistic regression model was applied to explore the association between hypertension and tear size. We used the analysis of covariance method to determine if the duration of hypertension influences the severity of the tear; finally, we compared mean duration of antihypertensive therapy in patients with small, large, and massive tears. All analyses were adjusted for age and sex. RESULTS Hypertension was associated with a 2-fold higher risk of tear occurrence (odds ratio [OR], 2.05; 95% confidence interval [CI], 41-2.98). No association was detected between hypertension and the probability of a small tear (OR, 0.63, 95% CI, 0.33-1.19). Hypertensive individuals were 2 times more likely to experience large tear (OR, 02.09; 95% CI, 1.39-3.16) and 4 times more likely to experience massive tear (OR, 04.30; 95% CI, 2.44-7.58) than normotensive individuals. Mean duration of antihypertensive therapy significantly increased from small tear (1.08 years) to large tear (3.20 years) to massive tear (6.34 years) patients (analysis of covariance: F((2,403)) = 16.357, P = 1.48 × 10(-7)). CONCLUSIONS Our data provide evidence that hypertension is a significant risk factor for the occurrence and severity of rotator cuff tears.

Morphometry of the suprascapular notch: correlation with scapular dimensions and clinical relevance

BackgroundBetter knowledge of the suprascapular notch anatomy may help to prevent and to assess more accurately suprascapular nerve entrapment syndrome. Our purposes were to verify the reliability of the existing data, to assess the differences between the two genders, to verify the correlation between the dimensions of the scapula and the suprascapular notch, and to investigate the relationship between the suprascapular notch and the postero-superior limit of the safe zone for the suprascapular nerve.MethodsWe examined 500 dried scapulae, measuring seven distances related to the scapular body and suprascapular notch; they were also catalogued according to gender, age and side. Suprascapular notch was classified in accordance with Rengachary’s method. For each class, we also took into consideration the width/depth ratio. Furthermore, Pearsons correlation was calculated.ResultsThe frequencies were: Type I 12.4%, Type II 19.8%, Type III 22.8%, Type IV 31.1%, Type V 10.2%, Type VI 3.6%. Width and depth did not demonstrate a statistical significant difference when analyzed according to gender and side; however, a significant difference was found between the depth means elaborated according to median age (73 y.o.). Correlation indexes were weak or not statistically significant. The differences among the postero-superior limits of the safe zone in the six types of notches was not statistically significant.ConclusionsPatient’s characteristics (gender, age and scapular dimensions) are not related to the characteristics of the suprascapular notch (dimensions and Type); our data suggest that the entrapment syndrome is more likely to be associated with a Type III notch because of its specific features.

Modified Margin Convergence: Over-Under Lacing Suture Technique

The principle of margin convergence can be applied to rotator cuff repair to enhance the security of fixation by decreasing the mechanical strain at the margins of the tear. We describe a suture technique, over-under lacing, that reproduces the same margin convergence, with equal tissue tension across the entire surface area of the cuff. A consecutive series of patients affected by massive U-shaped rotator cuff tears were treated by this repair technique. Preoperative diagnosis, tear assessment, and grading of fatty infiltration of the cuff muscles were based on arthro-computed tomography evaluation. The technique passes 2 sutures from the medial to lateral margin of the tear, with a knotless suture anchor for tendon-to-bone fixation. The proposed technique seems to reduce tensile strain on the repaired tendon, can reconstruct the rotator cuff cable, and can attain the balanced pull of the tendon in a medial-to-lateral fashion. The over-under lacing suture technique is both simple and reproducible. This technique may achieve the goals of margin convergence with satisfactory preliminary clinical results for patients with massive rotator cuff tears.

Arterial Blood Hypertension

Multicenter studies in different countries have published data about the higher risk of cardiac disease and stroke in patients affected by hypertension [1]; unfortunately, the possible degenerative effects of hypertension on osteotendinous junctions still have to be brought to light. The genesis of rotator cuff rupture is multifactorial. Intrinsic factors, such as rotator cuff hypovascularity [2], have been taken into consideration. Arterial hypertension is a cause of peripheral hypovascularity; therefore, patients with arterial hypertension could conceivably have a more frequent prevalence of rotator cuff tear.

Operating Room Setting

In order to be able to perform rotator cuff repair correctly, some basic equipment is required in the orthopaedic operating theatre: