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ISSN 1561-3100 (Impreso)

2014, Número 2

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Revista Cubana de Ortopedia y Traumatología 2014; 28 (2)


Rupturas parciales del espesor del manguito de los rotadores, diagnóstico y tratamiento artroscópico

García MO, Hernández RAR, Candelario ÁJL, del Sol PR, Buess E

Idioma: Español
Referencias bibliográficas: 53
Paginas: 136-152
Archivo PDF: 308.44 Kb.


RESUMEN

Introducción: las rupturas parciales del espesor del manguito rotador (tendones del supraespinoso, infraespinoso) se consideran dos veces más frecuente que las rupturas completas del espesor. Los estudios utilizan la artroscopia como método de elección para su diagnóstico y la convierten en la regla de oro. Numerosos cirujanos consideran conservar intactas la parte sana de las fibras del tendón y reparar el área de ruptura; principio posible de cumplir con las técnicas de reparación artroscópicas.
Objetivo: evaluar los resultados de la aplicación de la técnica artroscópica para el diagnóstico y la reparación de las rupturas parciales del espesor del manguito de los rotadores, conservando la parte sana del tendón.
Métodos: se repararon rupturas parciales del manguito rotador con técnica artroscópica de sutura y anclaje sin completar la ruptura del tendón del supraespinoso e infraespinoso desde enero 2008 hasta mayo de 2009. El estudio incluyó 47 hombros, 34 rupturas parciales de la superficie articular, 7 rupturas parciales de la superficie bursal y 6 rupturas parciales intratendinosas. Se realizó un seguimiento promedio de 14,5 meses (rango de 12 a 17 meses), la distribución según el sexo 34 masculinos (72,3 %) y 13 femeninos (27,7 %) y un promedio de edad de 47,5 años. El miembro dominante estuvo afectado en 38 pacientes (80,9 %).
Resultados: se obtuvo resultados excelentes y buenos en 91,5 % de los pacientes y 95,8 % resultados excelentes, buenos y regulares evaluados según la escala de Constant-Murley.
Conclusiones: la reparación artroscópica utilizando técnica de sutura y anclaje sin completar la ruptura ofrece ventajas. Se conserva la anatomía, preservando la parte sana del tendón y evitando la progresión a defectos completos del espesor.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;254:64-74.

  2. Gonzalez-Lomas G, Kippe MA, Brown GD. In situ transtendon repair outperforms tear completion and repair for partial articular-sided supraspinatus tendon tears. J Shoulder Elbow Surg. 2008;17:722–8.

  3. Brockmeier SF, Dodson CC, Gamradt SC, Coleman SH, Altchek DW. Arthroscopic Intratendinous Repair of the Delaminated Partial Thickness Rotator Cuff Tear in Overhead Athletes. Arthroscopy. 2008;24:961-5.

  4. Gomoll AH, Katz JN, Warner JJP, Millett PJ. Rotator cuff disorders: recognition and management among patients with shoulder pain. Arthritis and Rheumatism. 2004;50:3751-61.

  5. Codman EA. The shoulder: Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston: Thomas Todd. 1934.

  6. Rathbun JB. The microvascular pattern of the rotator cuff. J Bone Joint Surg. 1970;52:540–53.

  7. Uchiyama Y, Hamada K, Khruekarnchana P, Handa A, Nakajima T, Shimpuku E, et al. Surgical treatment of confirmed intratendinous rotator cuff tears: Retrospective analysis after an average of eight years of follow-up. J Shoulder Elbow Surg. 2010;19:837-46.

  8. Duralde XA, McClelland WB Jr. The Clinical Results of Arthroscopic Transtendinous Repair of Grade III Partial Articular-Sided Supraspinatus Tendon Tears. Arthroscopy. 2012;28:160-8.

  9. Fukuda H, Craig EV, Yamanaka K. Surgical treatment of incomplete thickness tears of the rotator cuff: Long-term follow-up. Orthop Trans. 1987;11:327–8.

  10. Yamaguchi K, Flatow EL. Arthroscopic evaluation and treatment of the rotator cuff. Orthop Clin North Am. 1995;26:643–59.

  11. Andrews JR, Broussard TS, Carson WG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: A preliminary report. Arthroscopy.1985;1:117–22.

  12. Esch JC, Ozerkis LR, Helgager JA. Arthroscopic subacromial decompression: results according to the degree of rotator cuff tear. Arthroscopy. 1988;4:241–9.

  13. García O, Buess E, Gonzales D. Double Band Double-Pulley Repair for Articular Surface Partial Tears of the Supraspinatus in Throwing Athletes: Improving the Transtendon Technique. Open Journal of Orthopedics. 2012;2:150-4

  14. Ryu RK. Arthroscopic subacromial decompression: A clinical review. Arthroscopy. 1991;7:1–7.

  15. Neviaser TJ, Neviaser RJ, Neviaser JS. Incomplete rotator cuff tears. A technique for diagnosis and treatment. Clin Orthop. 1994;306:12–6.

  16. Paulos LE, Kody MH. Arthroscopically enhanced “miniapproach” to rotator cuff repair. J Sports Med. 1994;22:19–25.

  17. McConville OR, Iannotti JP. Partial-thickness tears of the rotator cuff: Evaluation and management. J Am Acad Orthop Surg. 1999;7:32–43.

  18. Gartsman GM. Arthroscopic treatment of rotator cuff disease. J Shoulder Elbow Surg. 1995;4:228–41.

  19. Gartsman GM, Milne JC. Articular surface partial-thickness rotator cuff tears. J Shoulder Elbow Surg. 1995;4:409–15.

  20. Ruotolo C, Fow JE, Nottage WM. The supraspinatus footprint: An anatomic study of the supraspinatus insertion. Arthroscopy. 2004;20:246-9.

  21. Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR. The Insertional Footprint of the Rotator Cuff: An Anatomic Study. Arthroscopy. 2006;22:603-09.

  22. 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.

  23. Grant LB. Full thickness supraspinatus tendon tears with intact superior glenohumeral capsule. Arthroscopy. 1993;9:186-9.

  24. Wright SA, Cofield RH. Management of partial thickness rotator cuff tears. J Shoulder Elbow Surg. 1996;5:458-66.

  25. Lehman RC, Perry CR. Arthroscopic surgery for partial rotator cuff tears. Arthroscopy. 2003;19:81-4.

  26. Snyder SJ. Arthroscopic treatment of partial articular surface tendon avulsions. Presented at the AAOS/AOSSM Comprehensive Sports Medicine: The Athletic Perspective To Treatment, Controversies and Problem Solving. Lake Tahoe, NV. 2001;February

  27. Wolff AB, Magit DP, Miller SR, Wyman J, Sethi PM. Arthroscopic Fixation of Bursal- Sided Rotator Cuff Tears. Arthroscopy. 2006;22: 1247.e1-1247.e4

  28. Burkhart SS, Lo IKY, Brandy PC, Denard PJ. The Cowboy´s. A trail Guide for the Arthroscopic Shoulder Surgeon. 2nd ed. Philadelphia: Lippincott Williams and Wilkins, a Walters Kluwer; 2012.

  29. Martínez OG, Rodríguez ARH, Álvarez JLC, Hernández DH, Buess E. Reparación artroscópica de las rupturas completas del manguito rotador. Rev Cubana Ortop Traumatol. 2012;26:40-52.

  30. Snyder SJ. Shoulder Arthroscopy. 2nd ed. New York: MGraw-Hill Lippincott Williams and Wilkins; 2003.

  31. Waibl B, Buess E. Partial-thickness articular surface supraspinatus tears: A new transtendon suture technique. Arthroscopy. 2005;21:376-81.

  32. Lo IKY, Gonzalez DM, Burkhart SS. The Bubble Sign: An Arthroscopic Indicator of an Intratendinous Rotator Cuff Tear. Arthroscopy. 2002;18:1029-33.

  33. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-64.

  34. Andrews JR, Broussard TS, Carson WG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: A preliminary report. Arthroscopy. 1985;1:117–22.

  35. Esch JC, Ozerkis LR, Helgager Ja. Arthroscopic subacromial decompression: results according to the degree of rotator cuff tear. Arthroscopy. 1988;4:241-9.

  36. Olsewski JM, Depew AD. Arthroscopic subacromial decompression and rotator cuff debridement of stage II and stage III impingement. Arthroscopy. 1994;1:61-8.

  37. Warren RF, Altcheck DW, Skyhar MJ. Arthroscopic acromioplasty: A prospective analysis of 43 patients. Orthop Trans. 1989;13:560.

  38. Ryu RK. Arthroscopic subacromial decompression: A clinical review. Arthroscopy. 1991;7:1-7.

  39. Oglivie-Harris DJ. Arthroscopic surgery of the shoulder: A general appraisal. J Bone Joint Surg (Br). 1986;68:201–07.

  40. Weber SC. Arthroscopic Debridement and Acromioplasty Versus Mini-Open Repair in the Treatment of Significant Partial-Thickness Rotator Cuff Tears. Arthroscopy. 1999;15:126-31.

  41. Lyons TR, Savoie FS III, Field LD. Arthroscopic repair of partial-thickness tears of the rotator cuff. Arthroscopic. The Journal of Arthroscopic & Related Surgery. 2001;17(2):219-23

  42. Strauss EJ, Salata MJ, KercherJ, Barker JU, McGill K, Bach BR, et al. Affiliations The Arthroscopic Management of Partial-Thickness Rotator Cuff Tears: A Systematic Review of the Literature. Arthroscopy. 2011;27:568-80.

  43. YamanakaK, Matsumoto T. The joint side tear of the rotator cuff: A followup study by arthrography. Clin Orthop Relat Res. 1994;68-73.

  44. Iyengar JJ, Porat S, Burnett KR, Perez LM, Hernandez VH, Nottage WM. Magnetic resonanceimaging tendon integrity assessment after arthroscopic Partial-Thickness Rotator Cuff Repair. Arthroscopy. 2011;27:306-13.

  45. Shin SJ. A Comparison of 2 Repair Techniques for Partial-Thickness Articular- Sided Rotator Cuff Tears. Arthroscopy. 2012;28:25-33.

  46. Porat S, Nottage WM, Fouse MN. Repair of partial thickness rotator cuff tears: A retrospective review with minimum twoyear follow-up. J Shoulder Elbow Surg. 2008;17:729-31.

  47. Lo IKY, Burkhart SS. Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff. Arthroscopy. 2004;20:214-20.

  48. Yamakado K. Histopathology of Residual Tendon in High-Grade Articular-Sided Partial-Thickness Rotator Cuff Tears (PASTA Lesions). Arthroscopy. 2012;28:474-80.

  49. Cordasco FA, Backer M, Craig EV, Klein D, Warren RF. The partial-thickness rotator cuff tear: Is acromioplasty without repair sufficient? Am J Sports Med. 2002;30:257-60.

  50. Wolff AB, Magit DP, Miller SR, Wyman J, Sethi PM. Arthroscopic Fixation of Bursal- Sided Rotator Cuff Tears. Arthroscopy. 2006;22:1247.e1-1247.e4.

  51. Yoo JC, Ahn JH, Lee SH, Kim JH. Arthroscopic Full-Layer Repair of Bursal-Side Partial-Thickness Rotator Cuff Tears: A Small-Window Technique. Arthroscopy. 2007;23:903.e1-903.e4.

  52. 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. 1994;304:60-7.

  53. Stetson WB, Phillips T, Deutsch A. The use of magnetic resonance arthrography to 162 detect partial-thickness rotator cuff tears. J Bone Joint Surg Am. 2005;87:81-8.




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