RESUMO
OBJECTIVES: To implement the Formal Consensus Method among a group of experts in shoulder surgery in Latin America, in order to establish appropriate indications for the surgical treatment of massive and irreparable rotator cuff injuries. METHODS: The Formal Consensus Method was used to develop surgical treatment recommendations for massive and irreparable rotator cuff tears (MIRCT). Three independent groups of experts in shoulder surgery were confirmed. The steering group conducted a systematic literature review and constructed a voting matrix consisting of 348 clinical scenarios. The rating group, composed of 15 members, rated each scenario on two occasions: first anonymously and then during an in-person discussion meeting. The median and voting ranges were used to classify each scenario as inappropriate, uncertain, or appropriate for each surgical technique. Finally, the reading group, consisting of 10 surgeons, reviewed, evaluated and rated the recommendations derived from the detailed analysis of the voting grids. RESULTS: The main finding of the study reveals a high percentage (70%) of clinical scenarios in which consensus was achieved regarding the appropriateness or inappropriateness of different surgical alternatives for the treatment of massive and irreparable rotator cuff injuries. Through a detailed analysis of the voting grids, a total of 20 recommendations were elaborated concerning the appropriateness of various surgical techniques in addressing irreparable rotator cuff tears. CONCLUSIONS: The indications for the operative treatment of MIRCT were determined based on expert consensus and the best available evidence, they seek to provide guidance on the appropriateness of various surgical techniques for different clinical scenarios. LEVEL OF EVIDENCE: V.
Assuntos
Consenso , Lesões do Manguito Rotador , Humanos , Lesões do Manguito Rotador/cirurgia , América Latina , Manguito Rotador/cirurgiaRESUMO
Sr. Editor: La primera descripción de las lesiones parciales del manguito rotador fue hecha por Codman en 19341. Sin embargo, fue hasta el 2001 que Snyder acuñó el término PASTA (Partial Articular-Side Supraspinatus Avulsion) para referirse a una lesión, tipo avulsión, del lado articular del tendón del supraespinoso, que ocasiona dolor e incapacidad funcional y que en algunos pacientes debía ser intervenida quirúrgicamente para mejorar los síntomas y evitar la progresión de la enfermedad2. Con el advenimiento de la RMN se pudo comprobar que estas lesiones son mucho más frecuentes que las lesiones del lado bursal, debatiendo el concepto estrictamente mecánico de Neer que atribuía el daño a un pinzamiento subacromial3. Se han diseñado numerosas estrategias de tratamiento para las lesiones tipo PASTA, consistentes todas ellas en re-insertar el "tendón" a la tuberosidad mayor por vía transtendón o completándola por vía bursal.
Assuntos
Humanos , Lesões do Manguito RotadorRESUMO
Partial tears of the rotator cuff were initially described by Codman in 1934.1 However, it was not until 2001 that Snyder coined the term PASTA to describe an avulsion-type injury on the articular side of the supraspinatus tendon, causing pain and functional disability, for which some patients had to undergo surgery for symptom relief and for avoidance of disease progression.2 The advent of magnetic resonance imaging allowed confirming that articular side tears are much more frequent than bursal side ones, questioning the strictly mechanical concept by Neer, who said that the rotator cuff damage was because the subacromial impingement.3 Many surgical strategies for PASTA lesions have been designed, all of which consist of re-attachment the tendon in the greater tuberosity either transtendon or completing it through the bursal side. Snyder started from the premise that what he observed in the arthroscopic view of the glenohumeral joint, was the supraspinatus tendon; consequently, any lesion in the crescent area, distal to the rotator cable seen through the articular side was considered as a tendinous lesion.