title: Management of disorders of the rotator cuff: proceedings of the ISAKOS upper extremity committee consensus meeting.
abstract: The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff- and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single- versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented.
authors.affiliation: Closed Consensus Meeting of the International Society of Knee Surgery and Orthopaedic Sports Medicine Upper Extremity Committee, Buenos Aires, Argentina, April 2012.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Arce
authors.forename: Klaus
authors.initials: K
authors.lastname: Bak
authors.forename: Gregory
authors.initials: G
authors.lastname: Bain
authors.forename: Emilio
authors.initials: E
authors.lastname: Calvo
authors.forename: Benno
authors.initials: B
authors.lastname: Ejnisman
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Giacomo
authors.forename: Vicente
authors.initials: V
authors.lastname: Gutierrez
authors.forename: Dan
authors.initials: D
authors.lastname: Guttmann
authors.forename: Eiji
authors.initials: E
authors.lastname: Itoi
authors.forename: W
authors.initials: W
authors.lastname: Ben Kibler
authors.forename: Tom
authors.initials: T
authors.lastname: Ludvigsen
authors.forename: Augustus
authors.initials: A
authors.lastname: Mazzocca
authors.forename: Alberto
authors.initials: A
authors.lastname: de Castro Pochini
authors.forename: Felix
authors.initials: F
authors.lastname: Savoie
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugaya
authors.forename: John
authors.initials: J
authors.lastname: Uribe
authors.forename: Francisco
authors.initials: F
authors.lastname: Vergara
authors.forename: Jaap
authors.initials: J
authors.lastname: Willems
authors.forename: Yon Sik
authors.initials: YS
authors.lastname: Yoo
authors.forename: John W
authors.initials: JW
authors.lastname: McNeil
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Provencher
mesh_terms: D000174:Acromion / Q000601:surgery; D001182:Arthroscopy / Q000379:methods*; D001696:Biomechanical Phenomena; D006801:Humans; D007592:Joint Diseases / Q000628:therapy*; D053657:Platelet-Rich Plasma; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000517:prevention & control; D053656:Tenodesis / Q000379:methods; D058971:Tenotomy; D014945:Wound Healing