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      OUTCOME OF ROTATOR CUFF REPAIR IN SNYDER TYPE Cl AND C2 LESIONS, CONSIDERING SMOKERS AND NONSMOKERS

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          Abstract

          Objective: To evaluate the influence of smoking on the results from surgical repair of Snyder type C1 and C2 complete lesions of the rotator cuff. Methods: We evaluated 166 patients who had undergone surgical treatment for Snyder type C1 and C2 complete lesions of the rotator cuff, between June 2002 and December 2006. The inclusion criteria were a minimum follow-up period of 24 months and the absence of previous surgery on the affected shoulder. Patients with other associated injuries were excluded. We evaluated smoking and nonsmoking patients in accordance with the criteria of the World Health Organization (WHO). Female patients (119) predominated over male patients (47), and the mean age was 57 years (38 to 78). Out of the 166 patients evaluated, 21 were classified as smokers and 145 as nonsmokers. The final results were evaluated using the UCLA (University of California at Los Angeles) criteria and statistical analysis was performed using the Epi Info ® software. Results: According to the UCLA criteria, smokers had a final average of 32.6 points, while non-smokers had 33.8. Postoperative statistical analysis revealed a difference between the two groups, such that non-smoking patients had a better outcome. Conclusion: Smoking interferes with the final results from repairs of small and medium-sized lesions of the rotator cuff.

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          Repair of the rotator cuff. End-result study of factors influencing reconstruction.

          H. Ellman, G Hanker, M. Bayer (1986)
          In fifty patients who had fifty tears of the rotator cuff that had been repaired, we correlated the preoperative findings by history, physical examination, and radiography with the operative findings, the difficulty of the repair, and the results after an average follow-up of 3.5 years. The results, which were rated on the basis of pain, function, range of motion, strength, and satisfaction of the patient, were satisfactory in 84 per cent and unsatisfactory in 16 per cent. The correlations of the preoperative findings with the results showed that pain and functional impairment, the primary indications for repair, were significantly relieved. The longer the duration of pain was preoperatively, the larger the cuff tear and the more difficult the repair were. The strength of abduction and of external rotation before repair was of prognostic value: the greater the weakness, the poorer the result. The poorest results were in patients with strength ratings of grade 3 or less. Limitation of active motion preoperatively was also of prognostic value: in patients who were unable to abduct the shoulder beyond 100 degrees preoperatively, there was an increased risk of a poor result. An acromiohumeral distance of seven millimeters or less (measured on the anteroposterior radiograph) suggested a larger tear and the likelihood that after repair there would be less strength in flexion, less active motion, and lower scores. Single or double-contrast arthrography was not consistently accurate in estimating the size of the tear. After so-called watertight repair and anterior acromioplasty, successful results can be anticipated in a high percentage of patients.
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            SLAP lesions of the shoulder.

            S. Snyder, R P Karzel, R Ferkel … (1989)
            A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twenty-seven patients included in a retrospective review of more than 700 shoulder arthroscopies performed at our institution. The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the "anchor" of the biceps tendon to the labrum. We have labeled this injury a "SLAP lesion" (Superior Labrum Anterior and Posterior). There were 23 males and four females with an average age of 37.5 years. Time from injury to surgery averaged 29.3 months. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The most common clinical complaints were pain, greater with overhead activity, and a painful "catching" or "popping" in the shoulder. No imaging test accurately defined the superior labral pathology preoperatively. We divided the superior labrum pathology into four distinct types. Treatment was performed arthroscopically based on the type of SLAP lesion noted at the time of surgery. The SLAP lesion, which has not been previously described, can be diagnosed only arthroscopically and may be treated successfully by arthroscopic techniques alone in many patients.
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              Cigarette smoking increases the risk for rotator cuff tears.

              Ken Yamaguchi, Gary Middleton, David Gerlach … (2010)
              There is little available evidence regarding risk factors for rotator cuff tears. Cigarette smoking may be an important risk factor for rotator cuff disease. The purpose of this study was to determine if cigarette smoking correlates with an increased risk for rotator cuff tears in patients who present with shoulder pain. A questionnaire was administered to 586 consecutive patients 18 years of age or older who had a diagnostic shoulder ultrasound for unilateral, atraumatic shoulder pain with no history of shoulder surgery. Three hundred seventy-five patients had a rotator cuff tear and 211 patients did not. Data regarding cigarette smoking were obtained for 584 of 586 patients. A history of smoking (61.9% versus 48.3%), smoking within the last 10 years (35.2% versus 30.1%), mean duration of smoking (23.4 versus 20.2 years), mean packs per day of smoking (1.25 versus 1.10 packs per day), and mean pack-years of smoking (30.1 versus 22.0) correlated with an increased risk for rotator cuff tear. We observed a dose-dependent and time-dependent relationship between smoking and rotator cuff tears. We observed a strong association between smoking and rotator cuff disease. This may indicate smoking is an important risk factor for the development of rotator cuff tears. Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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                Author and article information

                Contributors
                Sérgio Correa Pinto Júnior: Role: Orthopedist
                Crischiman Dal Zotto: Role: Orthopedist
                Airton Rodrigues: Role: Orthopedist
                Journal
                Journal ID (nlm-ta): Rev Bras Ortop
                Journal ID (iso-abbrev): Rev Bras Ortop
                Title: Revista Brasileira de Ortopedia
                Publisher: Elsevier
                ISSN (Electronic): 2255-4971
                Publication date PMC-release: 16 November 2015
                Publication date Collection: Nov-Dec 2010
                Publication date (Electronic): 16 November 2015
                Volume: 45
                Issue: 6
                Pages: 554-556
                Affiliations
                [1 ]Orthopedist in The Shoulder Clinic, Florianópolis, SC, Brazil.
                [2 ]Orthopedist in the Institute of Orthopedics and Traumatology (IOT), Blumenau, SC, Brazil.
                [3 ]Orthopedist in the Orthopedic Study Center of Passo Fundo (CEOP), Passo Fundo, RS, Brazil.
                Author notes
                [* ]Correspondence: Clínica do Ombro, Rua Presidente Coutinho 579, Sala 603, Centro, 88015-230 Florianópolis, SC, BrazilCorrespondence: Clínica do OmbroRua Presidente Coutinho 579Sala 603, CentroFlorianópolisSC88015-230Brazil sergiopintojr@ 123456gmail.com
                Article
                Publisher ID: S2255-4971(15)30302-5
                DOI: 10.1016/S2255-4971(15)30302-5
                PMC ID: 4799158
                PubMed ID: 27026963
                SO-VID: 5381d2e3-5ee4-4e5c-991a-c6b58b7f4e81
                Copyright © © 2010 Sociedade Brasileira de Ortopedia e Traumatologia
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 22 September 2009
                Date accepted : 9 March 2010
                Categories
                Subject: Original Article

                Keywords: arthroscopy,shoulder/injuries,shoulder/surgery,shoulder pain
                Data availability:
                Keywords: arthroscopy, shoulder/injuries, shoulder/surgery, shoulder pain

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