Shoulder Instability and Related Rotator Cuff Tears:
Arthroscopic Findings and Treatment in Patients
Aged 40 to 60 Years
Giuseppe Porcellini, M.D., Paolo Paladini, M.D., Fabrizio Campi, M.D., and
Massimo Paganelli, M.D.
Purpose: To report our experience with the arthroscopic treatment of patients aged 40 to 60 years
with rotator cuff lesions, shoulder instability, or both, and to seek a relationship among capsular-
labral complex lesions, cuff tears, number of dislocations, and patient age. Type of Study: Case
series. Methods: From January 2000, all patients aged between 40 and 60 years undergoing an
arthroscopic procedure for rotator cuff lesions, shoulder instability, or both were divided into 3
cohorts: shoulder instability (group I), complete cuff tear (group C), and instability and complete cuff
tear (group IC). In May 2002 there were 50 patients per group. Arthroscopic findings were analyzed
using the Pearson correlation coefficient and the
2
test to seek correlations between the lesions. The
Student t test was used to highlight significant differences between preoperative and postoperative
scores. Results: There was a strong correlation between the rising number of dislocations and
associated lesions of the supraspinatus and infraspinatus (P .001); this correlation became stronger
after 7 episodes of dislocation (P .0001). There was no correlation between capsular or Bankart
lesion and presence or absence of rotator cuff tears (P .5). Two cases of recurrence of instability
were recorded in group IC. Postoperatively, the Constant and Rowe scores rose significantly and
consistently in all patients (P .001). Conclusions: Rotator cuff tears and glenohumeral instability
appear to be closely related. Patient age and number of dislocations do not appear to correlate with
Bankart or capsular lesions, whereas posterosuperior cuff tears seem to be influenced by number of
dislocations. Although data do not permit us to conclude whether repair of the sole cuff tear can
achieve shoulder stability nor whether shoulder stabilization alone can resolve the instability,
treatment of both lesions should be performed arthroscopically. Level of Evidence: Level IV, case
series. Key Words: Shoulder—Instability—Rotator cuff tear—Outcomes.
G
lenohumeral dislocation may cause a rotator cuff
tear, less frequently in patients under 40 years of
age
1-3
but more commonly in older patients because of
the changes that collagen undergoes with age.
4-7
It is
still unclear whether the shoulder instability can cause
a cuff tear during trauma,
8
or whether a partial or
complete lesion of the rotator cuff involving 1 or more
tendons
9-11
may induce abnormal, uncoordinated
shoulder movement, and related instability also in
cases of less severe traumas. The rotator cuff is an
important stabilizer of the glenohumeral joint.
12
Pre-
mature degeneration and tears of the cuff pose special
clinical problems by disturbing the delicate balance of
rotator cuff, deltoid muscle, and glenohumeral liga-
ments.
13
A rotator cuff tear may also be caused by a
repeated movement, such as those made by overhead
throwing athletes, who, because of contracture of the
posterior capsule, may even sustain associated articu-
lar lesions, such as SLAP.
14
Operative treatment is
indicated in shoulders with recurrent dislocation and
in those with associated lesions such as glenoid frac-
From the Unit of Shoulder and Elbow Surgery, “D. Cervesi”
Hospital (G.P., P.P., F.C.), Cattolica; and the Department of
Orthopaedics, University of Ferrara (M.P.), Ferrara, Italy.
Address correspondence and reprint requests to Giuseppe Por-
cellini, M.D., Via Miller 8, 47100 Forlì, Italy. E-mail:
gporcellini@tin.it
© 2006 by the Arthroscopy Association of North America
0749-8063/06/2203-4600$32.00/0
doi:10.1016/j.arthro.2005.12.015
270 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 22, No 3 (March), 2006: pp 270-276