Tear patterns and outcomes of surgery for rotator cuff tears in rugby. Presented at FISIC 2015.

1. Mr Amol Tambe
Upper Limb Fellow, Wrightington
Mr Ravi Badge
Clinical Fellow, RAEI, Wigan
Mr Lennard Funk
Consultant, Shoulder & Upper Limb Surgeon
Honorary Professor, Salford University
ARTHROSCOPIC ROTATOR CUFF REPAIR
IN
ELITE RUGBY PLAYERS

2. ABER Direct
Bankart Soft tissue 79 % 33%
Bony 26% 11%
SLAP 7% 35%
Cuff Lesions 32% 12%
Significant Cuff Injury can occur in the athlete in the absence
of a frank dislocation
Background:

3. Methods:
Subject Selection:
• Elite rugby professionals
• Had arthroscopic rotator cuff repair
• January 2005 – December 2006
Data Collection:
• Pre-operative scores and injury mechanisms
• Operative records
• Post-operative outcome scores – Constant & Oxford
• Patients recalled for outcome scoring and ultrasound scans.

4. Pre-operative:
Cuff pain and weakness
Suboptimal performance
Pain on eccentric / weight training
Loss of confidence
None were able to return to rugby after injury
1 player - true dislocation
9 players - ABER impact, no dislocation
1 player - not known

5. Beach chair position
Standard portals
Assessment of cuff tear, dimensions, mobility of tear
Assess associated injuries
Debridement of bursa and cuff edge
Foot print preparation
Variety of anchors(5mm Mitek, Fastin, Spiralok)
Suture material: Ultrabraid or Orthocord.
Cuff repaired to the footprint in all but one case
Operative:
Post-op protocol: supervised accelerated rehab

6. Operative:
Total Shoulder
Arthroscopic Procedures
1054
Athletes 164 (15.6%)
Rugby Players 120 (11.4% of total; 74% of athletes)
ARCRs Total 167
ARCRs Rugby 11 (6.5%)
Of the procedures on the
rugby players:
9.1% required ARCR (11/120).
The rest were mostly labral repairs.

7. 11 elite rugby players
7 Rugby league and 4 rugby union players
Including 6 internationals
Mean age was 25.7 years (range= 19 to 31 years)
Results:

8. Small (<1 cm) 3
Moderate (1-3 cm) 5
Large (3-5 cm) 2
Massive (>5 cm) 1
Cuff tear sizes:
Mean =1.8 cm
Range: 1cm to > 5cm
Bateman Classification
Small (<1cm) Moderate (1-3cm) Large (3-5cm)
3 5 2

9. Associated Injury:
2
360 deg Labral lesion = 2
3
1

10. No post-operative complications
Mean follow-up = 18 months (3-28)
All but one player had CS and OS at FU
Results:
Pre-op 3m Final
CS 44 95 101
OS 34 18 12

11. Mean time of return to full match play = 4.8 months (3-8)
Results:
10 players went back to play at the same level of sport
1 retired for personal reasons , went to heavy manual job

12. Ultrasound:
Post-operative scans in 9 cases (81%)
All were intact

13. Update
2015
54 Athletes (14%)
14 Non-rugby 38 Rugby (70%)
16 League (42%) 22 Union (58%)
382 cuff repairs
betw. 2005-2015

14. Tendon Involvement:

15. Conclusions:
1. Cuff tears not uncommon in rugby
2. Posterior Cuff involvement
3. Good results with arthroscopic repair

16. Thank you !