Rotator cuff tendon ruptures (literature review)

Abstract

Rotator cuff injury is a common pathology: up to 20 % of the population over 45 years of age has ruptures of varying severity, and up to 40 % of these ruptures are large and massive. The gradual development of tendon degeneration and fatty degeneration of muscle tissue and the asymptomatic course of the disease often lead to late medical attention when secondary arthropathy of the shoulder joint develops. With age, the probability of having a rupture increases, reaching 51 % in people over  80  years of age. The main diagnostic tools are radiography and  magnetic resonance imaging of the shoulder joint combined with clinical examination. Conservative treatment for massive injuries is ineffective, and the risk of worsening rotator cuff tendinopathy to rupture reaches 54 %. There are three main directions in the surgery of rotator cuff injuries: tendon reconstruction or replacement of their defect with grafts; muscle transfer; shoulder arthroplasty. Subacromial balloon spacer and tenogenic patches are also used. Each of these methods has a number of disadvantages and limitations. The frequency of repeated ruptures of reconstructed tendons reaches 45 %. Muscle transfer is extremely demanding on the skill of the surgeon and is associated with high risks of neurological complications. Arthroplasty imposes a number of significant restrictions on the patient, reducing the  quality of life, and prosthesis components wear increases the risk of complications, especially during revision interventions. The use of the subacromial spacer is limited by its high cost and lack of  long-term follow-up of treatment outcomes. Tenogenic patches have not undergone clinical trials, being an experimental technique. There is no single approach to the treatment of massive rotator cuff ruptures. The results are contradictory, the advantages of each of the methods are balanced by their disadvantages, which provides a wide window of opportunity in the studying, optimizing classical and introducing new methods of treatment of this pathology