Info: Call 624-3800 for more info on Kaweah Delta’s orthopedics program.

Injuries to the rotator cuff can cause debilitating pain, weakness, loss of function, sleep disturbance and, if left untreated, can lead to significant degeneration of the shoulder joint. �e end stage of these injuries is a debilitating disease called rotator cuff tear arthropathy. �e diagnosis and treatment of this common problem has seen significant advancements and is now one of the most commonly treated shoulder injuries by orthopedic surgeons across the country.

Rotator cuff disease is a common problem not just in young and active individuals, but in the aging population as well. Research has shown that as we age, the probability of rotator cuff tears increases[1]. For those over the age of 70 who have maintained an active lifestyle, rotator cuff injury can cause significant loss of function and ability to resume daily and recreational activities, including simple hygiene. �e expectation of a functional and active lifestyle in this population warrants surgical management of rotator cuff tears that have failed conservative management. Recent research has demonstrated that arthroscopic repair reduces pain and

allows those over the age of 70 to resume pre-injury levels of recreational activity.[2]

In the last 15 years there has been a shift in the orthopedic community amongst surgeons who perform rotator cuff repairs. A 2003 survey of the Arthroscopy Association of American Orthopedic Society members found 23% of surgeons performing rotator cuff repair arthroscopically. Just two years later, a survey from the American Academy of Orthopedic Surgeons found this number rose to 62%.[3] Today, the majority of these procedures are being performed arthroscopically. Historically, rotator cuff repair was often done via biomechanically unsound procedures. As a result of advances in rotator cuff repair techniques, patients experience significant pain relief, restoration of normal sleep pattern, and return to previous levels of activity[34]. Research has demonstrated not only a functional improvement in patients treated with arthroscopic rotator cuff repair but also that rotator cuff repair is cost-effective and produces net societal cost savings compared to non-operative treatment.[5]

�e question many orthopaedic surgeons have, however, is if arthroscopic repair is truly more effective in healing the rotator cuff? �is is because previous studies have demonstrated that improved clinical outcomes do not always correlate with radiographic evidence of cuff healing.[6] A prospective study performed at the Hospital for Special Surgery demonstrated a surprising ability of the rotator cuff to heal, despite early imaging studies identifying a defect at the repaired cuff. �ey found one year ultrasound results of repaired rotator cuffs demonstrating a 64.3 percent healing rate. �is increased to an 81.2 percent healing rate at 5 years[7]. �is study confirms that even up to 5 years following surgery, arthroscopically repaired rotator cuff tears have the ability to heal and that arthroscopic rotator cuff repair is a highly effective surgery producing long lasting effects.

K A W E A H D E L T A O R T H O P E D I C S P R E S E N T S :A R T H R O S C O P I C R O T A T O R C U F F R E P A I R :

By Bruce Le, D.O., M.S. DR. LE IS THE ORTHOPEDIC SERVICE LINE CHAIR AT KAWEAH DELTA MEDICAL CENTER

KAWEAH DELTA ORTHOPEDICS: PROVIDING A COMPREHENSIVE ORTHOPEDIC PROGRAM TO THE CENTRAL VALLEY.

�ere are significant advantages to arthroscopic repair since the advent of arthroscopic instruments and devices. �ese advantages include no violation to the origin of the deltoid muscle, small puncture wounds, and better visualization of pathology.

�e orthopaedic surgeons at Kaweah Delta use the latest in sports medicine technology to diagnose and treat disorders of the rotator cuff in patients of all ages and activity levels. �ey work with each individual to develop the best treatment plan. Using advanced arthroscopic procedures they are able to return patients of all levels back to the activities they love. �ey strive to provide the highest quality of orthopedic care to the Central Valley communities. Bruce Le, D.O., M.S., an orthopedic surgeon with 17 years experience, sees patients at Orthopaedic Associates Medical Clinic Inc., located at 820 S. Akers, Ste. 200, Visalia, CA 93277. He can be reached at 733-3346.

References:

1. Sher JS, Uribe JW, Posada A, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. �e Journal of bone and joint surgery American volume 1995;77(1):10-5 2. Bhatia S, Greenspoon JA, Horan MP, et al. Two-Year Outcomes After Arthroscopic Rotator Cuff Repair in Recreational Athletes Older �an 70 Years. �e American journal of sports medicine 2015 doi: 10.1177/0363546515577623[published Online First: Epub Date]|.3. Burkhart SS, Lo IK. Arthroscopic rotator cuff repair. �e Journal of the American Academy of Orthopaedic Surgeons 2006;14(6):333-46 4. Austin L, Pepe M, Tucker B, et al. Sleep disturbance associated with rotator cuff tear: correction with arthroscopic rotator cuff repair. �e American journal of sports medicine 2015;43(6):1455-9 doi: 10.1177/0363546515572769[published Online First: Epub Date]|.5. Mather RC, 3rd, Koenig L, Acevedo D, et al. �e societal and economic value of rotator cuff repair. �e Journal of bone and joint surgery American volume 2013;95(22):1993-2000 doi: 10.2106/JBJS.L.01495[published Online First: Epub Date]|.6. Kim KC, Shin HD, Lee WY. Repair Integrity and Functional Outcomes After Arthroscopic Suture-Bridge Rotator Cuff Repair. JBJS-A. 2012;94(8).7. Gulotta, L, Nho, S, Dodson, C, Alder, R, Altcheck, D. Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: Part I - functional outcomes and radiographic healing rates. J Shoulder Elbow Surg. 2011; 20(6): 934-40.

Physicians: Physicians collaboration with Kaweah Delta Health Care District’s orthopedics program: Ian C. Duncan, M.D.Frank L. Feng, D.O.Bruce N. Le, D.O.Donald R. Schengel, M.D.James R. Guadagni, M.D.Burton L. Redd, M.D.David Surdyka, M.D.