Rotator Cuff Repair in Adolescent Athletes
Bibliographic record
Abstract
Objectives: Rotator cuff tears are rare injuries in adolescents, but can be a cause of significant morbidity if unrecognized. Previous literature on rotator cuff repairs in adolescents is limited to small case series, with little data to guide treatment. The purpose of this study was to investigate the clinical information, demographics, and results of surgical treatment of a consecutive series of adolescent athletes who underwent rotator cuff repair with a minimum 2-year follow-up. We hypothesized that adolescent patients would have excellent functional outcome scores and return to the same level of sports participation after rotator cuff repair, but would have some difficulty returning to the same position in overhead sports. Methods: A retrospective search of the practice’s billing records identified all patients with high-grade (>50%) partial-thickness or rotator cuff tears that underwent rotator cuff repair between 2006 and 2014 with an age of less than 18 years at the time of surgery and a minimum of two years of follow-up. Clinical records were evaluated for demographic information, and telephone follow-up was obtained for return to play, performance, other surgeries and complications, a numeric pain rating scale (0-10) for current shoulder pain, American Shoulder and Elbow Surgeons (ASES) Shoulder Assessment Form, and the Western Ontario Rotator Cuff Index (WORC). Statistical analysis was performed with JMP 10 (SAS Institute, Cary, NC) with p < 0.05 for significance. Descriptive statistics were prepared for all variables, and outcomes were compared according to affected tendon and concomitant procedures using two-sided Fisher’s exact tests and Student’s t-tests. Results: Thirty-two consecutive adolescent athletes (28 boys and 4 girls) with a mean age of 16.1 years (range 13.2-17.9 years, SD=1.3) met inclusion criteria. Twenty-nine patients (91%) had a traumatic event associated with the onset of their shoulder pain, and 27 of these patients (93%) had no symptoms prior to the trauma. The most common tendon affected was the supraspinatus (21 patients, 66%). All seven subscapularis injuries were repaired in open fashion, while all other tears were repaired arthroscopically with either a single-row or double-row configuration depending on tear size and anatomy. Of the 18 partial-thickness tears, eight (44%) were measured intraoperatively to be 50-75% of the footprint, and the remaining ten tears (56%) encompassed greater than 75% of the footprint from medial to lateral. Twenty-seven patients (84%) d the outcome questionnaires at a mean of 6.2 years after surgery (range 2-10 years, SD=2.6 years). The mean ASES score was 93 (range 65-100, SD=9), mean WORC was 89% (range 60%-100%, SD=13%), and mean numeric pain rating was 0.3 (range 0-3, SD=0.8). Table 1 Overall, 25 patients (93%) were able to return to the same level of play or higher. In overhead athletes, 13 patients (93%) were able to return to the same level of play, but 8 patients (57%) were forced to switch positions due to difficulty with throwing. There were no surgical complications, but two patients did undergo a second operation during the study period. Conclusion: Surgical repair of high-grade partial-thickness and rotator cuff tears yielded successful outcomes in adolescents, with excellent functional outcomes at mid-term follow-up. However, overhead athletes may have difficulty playing the same position after surgery due to difficulty throwing. [Table: see text]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".