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Mbogori MJ, Ma J, Wong I. Surgical Management of Massive Irreparable Cuff Tears/Management of Rotator Cuff Disease: Interpositional Graft for Irreparable Posterosuperior Rotator Cuff Tears. Curr Rev Musculoskelet Med 2024; 17:235-246. [PMID: 38753092 DOI: 10.1007/s12178-024-09903-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Increasingly, massive irreparable rotator cuff tears present a treatment challenge due to their high re-tear rates. The reparability of such tears depends on factors like tear size, the number of involved tendons, tendon retraction extent, muscular atrophy, fatty infiltration, and the presence or absence of arthritis. There are non-surgical and several surgical treatment options described each with their specific indications, contraindications, pros, and cons. Bridging reconstruction restores the superior rotator cuff tissue and arrests humeral head superior migration. The purpose of his review is to explore the existing literature on interpositional graft mechanics, indications, surgical technique, and clinical outcomes. It aims to understand how these parameters can facilitate the incorporation of bridging reconstruction using interpositional grafts into a surgeon's practice for managing massive irreparable rotator cuff tears. RECENT FINDINGS Interpositional grafts for irreparable massive rotator cuff tears can either be auto-, allo-, xenografts, or synthetic material and are best suited for patients who are relatively younger, no glenohumeral arthritis, and minimal to no fatty infiltration and muscle atrophy. Short to medium term outcome studies available report good functional, clinical, and radiological improvements with bridging reconstruction utilizing acellular dermal matrix allograft. Interpositional grafts for management of irreparable posterosuperior cuff tears provides improved clinical and radiological outcomes with minimal complications and thus a viable and valuable surgical technique for a shoulder surgeon's armamentarium.
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Affiliation(s)
| | - Jie Ma
- Division of Orthopaedic Surgery, Nova Scotia Health, Halifax, NS, Canada
| | - Ivan Wong
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
- Division of Orthopaedic Surgery, Nova Scotia Health, Halifax, NS, Canada.
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Gan K, Bi M, Zhou K, Xia C, Ding W, Ding S, Li J. Bridging repair reinforced with artificial ligament as an internal brace for irreparable massive rotator cuff tears. J Shoulder Elbow Surg 2024; 33:e322-e335. [PMID: 38072033 DOI: 10.1016/j.jse.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND The irreparable massive rotator cuff tear (IMRCT) is challenging to manage. Although various surgical options have been proposed to treat IMRCTs, the optimal surgical technique remains controversial. Arthroscopic bridging patch repair is clinically used for treating IMRCTs, but the healing rate of the patch graft is negatively affected by superior shift of the humeral head. This study aimed to evaluate the clinical efficacy of artificial ligament as an internal brace (IB) reinforcing fascia lata autograft bridging repair (ABR) in the treatment of IMRCTs. METHODS The data of 50 patients with IMRCTs who underwent ABR reinforced with artificial ligament as an IB (ABR + IB) (internal brace group) or ABR alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed based on the shoulder activity, of which the strength was measured using a 0-10 points manual muscle test scale, American Shoulder and Elbow Surgeons score, and visual analog scale for pain. Imaging outcomes were evaluated based on acromiohumeral distance (AHD), Hamada grade, Goutallier grade, and the status of fascia lata grafts as per radiographs or magnetic resonance imaging findings. RESULTS Both groups showed significantly better results in shoulder activity, American Shoulder and Elbow Surgeons score, visual analog scale score, and AHD at 2-year follow-up compared with preoperative levels (P < .001). Compared with the control group (n = 24), the internal brace group (n = 26) had better mean AHD (7.0 ± 1.4 mm vs. 5.9 ± 1.0 mm, P = .002), mean improvement in AHD (3.3 ± 1.5 mm vs. 2.0 ± 0.6 mm, P < .001), healing rate of autografts (92.3% vs. 54.2%, P = .002), and improvement rate of Hamada grade (73.1% vs. 41.7%, P = .025) at 2-year follow-up. No significant differences were found in active elevation, active external rotation, active internal rotation, abduction strength, external rotation strength, internal rotation strength, American Shoulder and Elbow Surgeons score, or visual analog scale between the 2 groups at 2-year follow-up. CONCLUSION Both the ABR + IB and ABR improved the postoperative short-term clinical and imaging outcomes in managing IMRCTs, the ABR + IB is statistically superior to ABR alone in terms of healing rate of the bridging graft, AHD, and Hamada grade at 2-year follow-up, while further clinical investigations with larger sample size and longer follow-ups are required to validate the clinical significance of this novel technique for IMRCTs.
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Affiliation(s)
- Kaifeng Gan
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Mingguang Bi
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Ke Zhou
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Chenjie Xia
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Wei Ding
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Shaohua Ding
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Jin Li
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China.
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Yu C, Feng S, Li Y, Chen J. Application of Nondegradable Synthetic Materials for Tendon and Ligament Injury. Macromol Biosci 2023; 23:e2300259. [PMID: 37440424 DOI: 10.1002/mabi.202300259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
Tendon and ligament injuries, prevalent requiring surgical intervention, significantly impact joint stability and function. Owing to excellent mechanical properties and biochemical stability, Nondegradable synthetic materials, including polyethylene terephthalate (PET) and polytetrafluoroethylene (PTFE), have demonstrated significant potential in the treatment of tendon and ligament injuries. These above materials offer substantial mechanical support, joint mobility, and tissue healing promotion of the shoulder, knee, and ankle joint. This review conclude the latest development and application of nondegradable materials such as artificial patches and ligaments in tendon and ligament injuries including rotator cuff tears (RCTs), anterior cruciate ligament (ACL) injuries, and Achilles tendon ruptures.
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Affiliation(s)
- Chengxuan Yu
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Sijia Feng
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
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Credille KT, Wang ZRC, Horner NS, Regan DP, Gadomski BC, Easley JT, Garrigues GE, Yanke AB. Biphasic Interpositional Allograft for Rotator Cuff Repair Augmentation Is Safe in an Ovine Model. Arthroscopy 2023; 39:1983-1997. [PMID: 37001743 DOI: 10.1016/j.arthro.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To perform a preclinical histologic assessment of a biphasic acellular interpositional cancellous allograft in an ovine model of rotator cuff repair (RCR) designed to better understand its safety profile and effects on tendon healing after RCR. METHODS Thirty skeletally mature sheep with clinically normal shoulders with an artificially created degenerative infraspinatus tendon tear were randomized to control and treatment groups. Animals were euthanized at 3 weeks, 6 weeks, and 12 weeks. After gross dissection, rotator cuff specimens were fixed with formalin and polymerized for sectioning and staining. Blinded histologic scores evaluated inflammatory cell infiltrates, signs of degradation, particulate debris, collagen arrangement, neovascularization, and enthesis qualitative measures. RESULTS There were no treatment specimens that exhibited histologic signs of a significant infection, inflammatory infiltrate, or foreign body reaction such as granuloma or fibrous capsule formation. Histologic scores in all categories were not significantly different at all time points, including the primary end point mean cumulative inflammatory score (control: 3.66 ± 1.21 vs treated: 4.33 ± 1.51, P = .42), when comparing the treatment and control RCR groups. In general, the degree of tendon healing and host tissue response was essentially equivalent between the 2 groups with observation of low overall levels of inflammation and progressive improvements in collagen organization, reduced tenocyte activity, and fibrocartilaginous enthesis reformation. CONCLUSIONS This histologic study demonstrated the use of a biphasic interpositional allograft for RCR augmentation in an ovine model does not generate an inflammatory response or foreign body reaction. Use of the biphasic interpositional allograft resulted in a histological profile that was essentially equivalent to that of a standard RCR at 3-, 6-, and 12-week postoperative timepoints. These findings suggest that a biphasic interpositional allograft is safe for further clinical investigation in humans before broader clinical application. CLINICAL RELEVANCE Patch augmentation of RCR is a popular technique that has shown clinical success in improving the likelihood of a successful repair in patients at elevated risk for retear. Newer augmentation technologies are being developed to address the biology at the interface between the bone and soft tissue where failure typically occurs.
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Affiliation(s)
- Kevin T Credille
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Zachary R C Wang
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Nolan S Horner
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Daniel P Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Grant E Garrigues
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Adam B Yanke
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois.
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Lim WSR, Yew AKS, Lie H, Chou SM, Lie DTT. Rotator cuff repair with an interposition polypropylene mesh: A biomechanical ovine study. World J Orthop 2023; 14:319-327. [PMID: 37304195 PMCID: PMC10251272 DOI: 10.5312/wjo.v14.i5.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair. We propose using a synthetic polypropylene mesh to increase the tensile strength of rotator cuff repairs. We hypothesize that using a polypropylene mesh to bridge the repair of large rotator cuff tears will increase the ultimate failure load of the repair.
AIM To investigate the mechanical properties of rotator cuff tears repaired with a polypropylene interposition graft in an ovine ex-vivo model.
METHODS A 20 mm length of infraspinatus tendon was resected from fifteen fresh sheep shoulders to simulate a large tear. We used a polypropylene mesh as an interposition graft between the ends of the tendon for repair. In seven specimens, the mesh was secured to remnant tendon by continuous stitching while mattress stitches were used for eight specimens. Five specimens with an intact tendon were tested. The specimens underwent cyclic loading to determine the ultimate failure load and gap formation.
RESULTS The mean gap formation after 3000 cycles was 1.67 mm in the continuous group, and 4.16 mm in the mattress group (P = 0.001). The mean ultimate failure load was significantly higher at 549.2 N in the continuous group, 426.4 N in the mattress group and 370 N in the intact group (P = 0.003).
CONCLUSION The use of a polypropylene mesh is biomechanically suitable as an interposition graft for large irreparable rotator cuff tears.
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Affiliation(s)
- Winston Shang Rong Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Hannah Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Siaw Meng Chou
- College of Engineering, Nanyang Technical University, Singapore 797101, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
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Zhong Y, Jin W, Gao H, Sun L, Wang P, Zhang J, Ong MTY, Sai Chuen Bruma F, Chen S, Chen J. A Knitted PET Patch Enhances the Maturation of Regenerated Tendons in Bridging Reconstruction of Massive Rotator Cuff Tears in a Rabbit Model. Am J Sports Med 2023; 51:901-911. [PMID: 36802867 DOI: 10.1177/03635465231152186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Although nondegradable synthetic grafts for bridging reconstruction of massive rotator cuff tears (MRCTs) have shown satisfactory clinical outcomes, their function and details on graft-tendon healing and enthesis regeneration have not been fully studied. HYPOTHESIS The knitted polyethylene terephthalate (PET) patch as a nondegradable synthetic graft could provide sustained mechanical support, facilitating enthesis and tendon regeneration in the treatment of MRCTs. STUDY DESIGN Controlled laboratory study. METHODS A knitted PET patch was fabricated for bridging reconstruction (PET group) in a New Zealand White rabbit model of MRCTs (negative control group), and an autologous Achilles tendon was used as a control (autograft group). The animals were sacrificed, and tissue samples were harvested for gross observation as well as histological and biomechanical analyses at 4, 8, and 12 weeks postoperatively. RESULTS Histological analysis showed no significant difference in the graft-bone interface score between the PET and autograft groups at 4, 8, and 12 weeks postoperatively. Interestingly, in the PET group, Sharpey-like fibers were observed at 8 weeks, while fibrocartilage formation and the ingrowth of chondrocytes were recognized at 12 weeks. Meanwhile, the tendon maturing score was significantly higher in the PET group than in the autograft group (19.7 ± 1.5 vs 15.3 ± 1.2, respectively; P = .008) at 12 weeks, with parallel-oriented collagen fibers around the knitted PET patch. Moreover, the ultimate failure load of the PET group was similar to that of a healthy rabbit tendon at 8 weeks (125.6 ± 13.6 vs 130.8 ± 28.6 N, respectively; P > .05) and no different from that of the autograft group at 4, 8, and 12 weeks. CONCLUSION The knitted PET patch could not only immediately reconstruct the mechanical support for the torn tendon postoperatively in the rabbit model of MRCTs but also enhanced maturation of the regenerated tendon by fibrocartilage formation and improved the organization of collagen fibers. Herein, the knitted PET patch could be a promising candidate graft adopted in bridging reconstruction of MRCTs. CLINICAL RELEVANCE A nondegradable knitted PET patch can safely bridge MRCTs with satisfactory mechanical strength and the promotion of tissue regeneration.
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Affiliation(s)
- Yuting Zhong
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhe Jin
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Han Gao
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyi Sun
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Peng Wang
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Zhang
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Michael Tim Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Fu Sai Chuen Bruma
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Shiyi Chen
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Campbell RE, Lee D, Day LM, Dixit A, Freedman KB, Tjoumakaris FP. Management of Massive Rotator Cuff Tears Without Arthropathy. Orthopedics 2023; 46:e1-e12. [PMID: 35876782 DOI: 10.3928/01477447-20220719-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Arthroplasty is not an optimal treatment for massive rotator cuff tears in patients who are active and without glenohumeral arthritis. Several surgical techniques have been developed for these patients, including arthroscopic rotator cuff repair with single-/double-row repair (with or without interval slides, margin convergence, graft augmentation), graft bridging, superior capsular reconstruction, tuberoplasty, and tendon transfers. Complete, tension-free, anatomic repair is ideal; however, tendon atrophy and retraction associated with massive tears often complicate repairs. All surgical treatments significantly increase patient-reported functional outcomes 1 year after intervention, with many treatments demonstrating improved mid-term and long-term outcomes. [Orthopedics. 2023;46(1):e1-e12.].
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Sun K, Li Y. Study of arthroscopic superior capsule reconstruction in the treatment of irreparable rotator cuff tears. Front Surg 2023; 9:895571. [PMID: 36684146 PMCID: PMC9852769 DOI: 10.3389/fsurg.2022.895571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Background The objective of this study was to investigate the clinical outcome and radiographic findings after arthroscopic superior capsule reconstruction (ASCR) with a new augmented autograft technique for irreparable rotator cuff tears. Methods Between 2018 and 2020, 11 patients whose shoulders had irreparable rotator cuff tears underwent ASCR using a fascia lata weaving mesh. Physical examination, radiography, and magnetic resonance imaging (MRI) were performed before surgery and the average follow-up was 20 months (18-24 months) after surgery. Clinical outcome scores were recorded. Results Average clinical outcome scores improved significantly at the final follow-up, with 94.7 points scored on the American Shoulder and Elbow Surgeons scale (range, 85-100 points) and 34.5 points on the University of California, Los Angeles scale (33-35 points) (P < 0.05). Mean active elevation increased significantly from 30.1° to 150° (P < 0.05) and external rotation increased from 30° to 59.2° (P < 0.05). The acromiohumeral distance (AHD) increased from 3.9 ± 0.6 mm preoperatively to 10.1 ± 0.7 mm postoperatively (P < 0.05). No patient had graft tear or tendon retear during follow-up. Conclusions ASCR with a new augmented autograft can restore the function of the shoulder joint with irreparable rotator cuff tears. Our results suggest that this reconstruction technique can help obtain good clinical and radiographic outcomes, which can provide a reliable method for the treatment of irreparable rotator cuff tears. Level of Evidence Level IV, therapeutic case series.
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Frazier LP, Quigley RA, Galvin JW, Waterman BR, Brusalis CM, Cole BJ. Put a Patch on It!: When and How to Perform Soft-Tissue Augmentation in Rotator Cuff Surgery. OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Davies A, Singh P, Reilly P, Sabharwal S, Malhas A. Superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement or balloon spacers for large and massive irreparable rotator cuff tears: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:552. [PMID: 36536436 PMCID: PMC9764484 DOI: 10.1186/s13018-022-03411-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multiple non-arthroplasty surgical techniques are described for the management of large and massive irreparable rotator cuff tears. There is currently no consensus on the best management strategy. Our aim was to compare clinical outcomes following arthroscopic debridement, arthroscopic partial cuff repair, superior capsule reconstruction, balloon spacers or graft interposition for the management of large and massive irreparable rotator cuff tears. METHODS A comprehensive search was performed of the following databases: Medline, Embase, CINAHL and Cochrane Database of Systematic Reviews. Data were extracted from relevant studies published since January 2000 according to the pre-specified inclusion criteria. The primary outcome was the post-operative improvement in shoulder scores. Meta-analysis of the primary outcome was performed. Secondary outcomes included retear rates and complications. RESULTS Eighty-two studies were included reporting the outcomes of 2790 shoulders. Fifty-one studies were included in the meta-analysis of the primary outcome. The definition of an irreparable tear varied. All procedures resulted in improved shoulder scores at early follow-up. Shoulder scores declined after 2 years following balloon spacers, arthroscopic debridement and partial cuff repair. High retear rates were seen with partial cuff repairs (45%), graft interposition (21%) and superior capsule reconstruction (21%). CONCLUSIONS Large initial improvements in shoulder scores were demonstrated for all techniques despite high retear rates for reconstructive procedures. Shoulder scores may decline at mid- to long-term follow-up.
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Affiliation(s)
- Andrew Davies
- grid.7445.20000 0001 2113 8111Cutrale Perioperative and Aging Group, Department of Bioengineering, Imperial College London, 86 Wood Lane, London, W120BZ UK
| | - Prashant Singh
- grid.417895.60000 0001 0693 2181Department of Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Reilly
- grid.417895.60000 0001 0693 2181Department of Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjeeve Sabharwal
- grid.417895.60000 0001 0693 2181Department of Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Amar Malhas
- grid.419297.00000 0000 8487 8355Department of Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, UK
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Shim IK, Kang MS, Lee ES, Choi JH, Lee YN, Koh KH. Decellularized Bovine Pericardial Patch Loaded With Mesenchymal Stromal Cells Enhance the Mechanical Strength and Biological Healing of Large-to-Massive Rotator Cuff Tear in a Rat Model. Arthroscopy 2022; 38:2987-3000. [PMID: 35716989 DOI: 10.1016/j.arthro.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/13/2022] [Accepted: 06/03/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine whether the addition of decellularized bovine pericardial patch loaded with mesenchymal stromal cells enhanced bone-to-tendon healing and improved the biomechanical strength of large-to-massive rotator cuff tears in a small animal model. METHODS Adipose-derived mesenchymal stromal cells (MSCs) from rat inguinal fat were isolated, cultured, and loaded onto decellularized bovine pericardium patches. To simulate large-to-massive tears, rats were managed with free cage activity for 6 weeks after tear creation. A total of 18 rats were randomly allocated to repair-only (control), repair with pericardial patch augmentation (patch), or repair with MSC loaded pericardial patch augmentation (patch-MSC). Each group had 6 rats (one shoulder of each rat was used for histological evaluation and another for biomechanical evaluation). MSCs seeded on the pericardial patches were traced on four shoulders from 2 other rats at 4 weeks after surgery. Histological evaluation for bone-to-tendon healing and biomechanical testing was carried out at 8 weeks after repair. RESULTS MSCs tagged with a green fluorescent protein were observed in the repair site 4 weeks after the repair. One shoulder each in the control and patch groups showed complete discontinuity between the bone and tendon. One shoulder in the control group showed attenuation with only a tenuous connection. Fibrocartilage and tidemark formation at the bone-to-tendon interface (P = .002) and collagen fiber density (P = .040) and orientation (P = .003) were better in the patch-MSC group than in the control or patch group. Load-to-failure in the patch-MSC and patch groups was higher than that in the control group (P = .001 and .009, respectively). CONCLUSION Decellularized bovine pericardial patches loaded with adipose-derived and cultured mesenchymal stromal cells enhanced healing in terms of both histology and mechanical strength at 8 weeks following rotator cuff repair in a rat model. CLINICAL RELEVANCE Large-to-massive rotator tears need a strategy to prevent retear and enhance healing. The addition of decellularized bovine pericardial patch loaded with MSCs can enhance bone-to-tendon healing and improve biomechanical healing of large-to-massive rotator cuff tears following repair.
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Affiliation(s)
- In Kyong Shim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Michael Seungcheol Kang
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eui-Sup Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hee Choi
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Na Lee
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Tokish JM, Shaha JS, Denard PJ, Mercuri JJ, Colbath G. Compressed Biceps Autograft Augmentation of Arthroscopic Rotator Cuff Repair. Arthrosc Tech 2022; 11:e2113-e2118. [PMID: 36457381 PMCID: PMC9706130 DOI: 10.1016/j.eats.2022.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/06/2022] [Accepted: 08/05/2022] [Indexed: 11/07/2022] Open
Abstract
Rotator cuff repair failure rates continue to be a challenging problem. Various methods of biological and structural augmentation of the rotator cuff have been explored to improve tendon healing after repair. We describe a technique in which biceps tendon autograft is harvested after tenodesis. The biceps tendon is then compressed into a patch that is placed over the repaired rotator cuff tendon. Repurposing the portion of the tendon that is otherwise discarded offers several advantages over other augmentations that have been used, including the biological potential of live autograft tenocytes in the patch, lower cost, and no donor-site morbidity.
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Affiliation(s)
- John M. Tokish
- Mayo Clinic Arizona, Phoenix, Arizona, USA,Address correspondence to John M. Tokish, M.D., Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | | | | | - Jeremy J. Mercuri
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
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Zhang X, Wang D, Wang Z, Ling SKK, Yung PSH, Tuan RS, Ker DFE. Clinical perspectives for repairing rotator cuff injuries with multi-tissue regenerative approaches. J Orthop Translat 2022; 36:91-108. [PMID: 36090820 PMCID: PMC9428729 DOI: 10.1016/j.jot.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background In the musculoskeletal system, bone, tendon, and muscle form highly integrated multi-tissue units such as the rotator cuff complex, which facilitates functional and dynamic movement of the shoulder joint. Understanding the intricate interplay among these tissues within clinical, biological, and engineering contexts is vital for addressing challenging issues in treatment of musculoskeletal disorders and injuries. Methods A wide-ranging literature search was performed, and findings related to the socioeconomic impact of rotator cuff tears, the structure-function relationship of rotator cuff bone-tendon-muscle units, pathophysiology of injury, current clinical treatments, recent state-of-the-art advances (stem cells, growth factors, and exosomes) as well as their regulatory approval, and future strategies aimed at engineering bone-tendon-muscle musculoskeletal units are outlined. Results Rotator cuff injuries are a significant socioeconomic burden on numerous healthcare systems that may be addressed by treating the rotator cuff as a single complex, given its highly integrated structure-function relationship as well as degenerative pathophysiology and limited healing in bone-tendon-muscle musculoskeletal tissues. Current clinical practices for treating rotator cuff injuries, including the use of commercially available devices and evolving trends in surgical management have benefited patients while advances in application of stem/progenitor cells, growth factors, and exosomes hold clinical potential. However, such efforts do not emphasize targeted regeneration of bone-tendon-muscle units. Strategies aimed at regenerating bone-tendon-muscle units are thus expected to address challenging issues in rotator cuff repair. Conclusions The rotator cuff is a highly integrated complex of bone-tendon-muscle units that when injured, has severe consequences for patients and healthcare systems. State-of-the-art clinical treatment as well as recent advances have resulted in improved patient outcome and may be further enhanced by engineering bone-tendon-muscle multi-tissue grafts as a potential strategy for rotator cuff injuries. Translational Potential of this Article This review aims to bridge clinical, tissue engineering, and biological aspects of rotator cuff repair and propose a novel therapeutic strategy by targeted regeneration of multi-tissue units. The presentation of these wide-ranging and multi-disciplinary concepts are broadly applicable to regenerative medicine applications for musculoskeletal and non-musculoskeletal tissues.
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Affiliation(s)
- Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine, Hong Kong
- School of Biomedical Sciences, Hong Kong
| | - Dan Wang
- Institute for Tissue Engineering and Regenerative Medicine, Hong Kong
- School of Biomedical Sciences, Hong Kong
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Hong Kong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
| | - Zuyong Wang
- College of Materials Science and Engineering, Hunan University, Changsha, China
| | - Samuel Ka-kin Ling
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
| | - Patrick Shu-hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
| | - Rocky S. Tuan
- Institute for Tissue Engineering and Regenerative Medicine, Hong Kong
- School of Biomedical Sciences, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
| | - Dai Fei Elmer Ker
- Institute for Tissue Engineering and Regenerative Medicine, Hong Kong
- School of Biomedical Sciences, Hong Kong
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Hong Kong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
- Corresponding author. Institute for Tissue Engineering and Regenerative Medicine School of Biomedical Sciences, Faculty of Medicine The Chinese University of Hong Kong, Shatin, Hong Kong.
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Wang Y, Ding W, Xu J, Ruan D, Heng BC, Ding Q, Shen L, Ding S, Shen W. Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Results in Significant Improvements in Patient Reported Outcomes and Range of Motion: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1523-e1537. [PMID: 36033196 PMCID: PMC9402467 DOI: 10.1016/j.asmr.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purposes of this study were to evaluate the clinical outcomes (with the minimum mean follow-up period of 2 years) of arthroscopic superior capsular reconstruction (ASCR) using different grafts for massive irreparable rotator cuff tears (MIRCTs) and to explore whether margin convergence in ASCR affects range of motion (ROM) outcomes. Methods This systematic review was registered in PROSPERO and was then conducted following PRISMA guidelines by searching the databases: MEDLINE, EMBASE, Web of Science, and Cochrane Library database before April 2021. These literature searches investigating the clinical outcomes of ASCR were included. The methodological quality of included studies was assessed using the MINORS criteria. The data, including margin convergence, patient-reported outcome scores, range of motion, and complications, were extracted and analyzed. The minimal clinically important differences (MCID) criteria was used to define clinical significance. Results 15 studies met the inclusion criteria. All studies reported statistically significant improvements in visual analog scale scores (range: 2.07 to 7.1) and American Shoulder and Elbow Surgeons scores (range: 18.1 to 58). Significant improvements of Constant scores were noted in 4 of 5 reporting studies (mean improvement ranged from 14.64 to 50.79). Active forward flexion/elevation (11 studies), active abduction (4 studies), and active external rotation (8 studies) displayed improvements in all reporting studies, with mean changes ranging from 12 to 73.68, 19 to 89.21, and 1 to 24.74, respectively. The mean change of postoperative acromiohumeral distance ranged from −0.86 mm to 3.2 mm in 9 studies. The postoperative complication rate of ASCR ranged from 4.5% to 47.6%. The anterior margin convergence in SCR was associated with a relatively poor improvement in active external rotation. Conclusions ASCR contributes to significant improvements in patient-reported clinical outcomes and ROM at follow-up after a mean of more than two years, emerging as a viable option for patients with MIRCTs. The anterior margin convergence should be prudently chosen, especially in ASCR using fascia lata autograft, on account of the probable restriction on postoperative active external rotation. Level of Evidence Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Yongjian Wang
- Department of Orthopedics, First People’s Hospital of Wenling, Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, hejiang, PR China
| | - Wei Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
| | - Jungang Xu
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dengfeng Ruan
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Boon Chin Heng
- Peking University School of Stomatology, Beijing, PR China
| | - Qianhai Ding
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingfang Shen
- Air Force Health Care Center for Special Services, Hangzhou, PR China
| | - Shaohua Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
- Shaohua Ding, M.D., Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, PR China.
| | - Weiliang Shen
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Orthopaedics Research Institute of Zhejiang University, Zhejiang, PR China; China Orthopaedic Regenerative Medicine (CORMed), Hangzhou, PR China; Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Zhejiang, PR China; Department of Sports Medicine, School of Medicine, Zhejiang University, Zhejiang, PR China; Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, PR China
- Address correspondence to Weiliang Shen, M.D., Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou 310009, China.
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15
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Park MC, Detoc E, Lee TQ. Anterior Cable Reconstruction: Prioritize Rotator Cable and Tendon Cord When Considering Superior Capsular Reconstruction. Arthroscopy 2022; 38:1705-1713. [PMID: 35314273 DOI: 10.1016/j.arthro.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
Although distinct in name, the anterior cable of the superior capsule and tendon cord of the supraspinatus are structurally one in the same at the attachment on the greater tuberosity footprint. Force transmission through both structures where they converge and interdigitate at this location is disproportionately high, which has implications on functional impact. Superior capsule reconstruction, and, specifically, the anterior cable of the superior capsule, has been shown to assist in maintaining superior stability and a functional fulcrum of the glenohumeral joint, without overconstraining range of motion. Anterior cable reconstructions have been described for specific indications, including full-thickness tears of the supraspinatus and anterior one-half of the infraspinatus. Cord-like grafts, including long head biceps tendon autografts and semitendinosus allografts, can provide relative technical ease during surgery compared to sheet-like grafts for this indication. Side-to-side sutures between anterior cable reconstruction graft and posterosuperior capsule retension the native capsule to optimize its natural functional role. Accounting for abduction and rotation at the time of fixation and employing "loop-around" fixation sutures (no sutures through the graft), are critical concepts to consider in terms of kinematics and limiting graft failure. With both the biomechanically and clinically based literature demonstrating functionality with maintenance of the superior capsule (and specifically the anterior cable of the capsule), despite rotator cuff tendon insufficiency or irreparability, the anterior cable of the superior capsule should be prioritized when considering full-thickness rotator cuff tears that naturally involve both the capsular cable and the supraspinatus tendon cord. LEVEL OF EVIDENCE: Level V (expert opinion).
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Affiliation(s)
- Maxwell C Park
- Southern California Permanente Medical Group, Woodland Hills, California; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California.
| | - Emma Detoc
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
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16
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Awad MA, Sparavalo S, Ma J, King JP, Wong I. Interposition Graft Bridging Reconstruction of Irreparable Rotator Cuff Tears Using Acellular Dermal Matrix: Medium-Term Results. Arthroscopy 2022; 38:692-698. [PMID: 34384854 DOI: 10.1016/j.arthro.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE In this study, we aimed to evaluate the medium-term clinical outcomes for patients who underwent bridging reconstruction. METHODS A retrospective chart review was conducted for all patients who underwent bridging reconstruction between 2010 and 2018. Patients who were missing either pre- or postoperative outcome scores were excluded. All included patients completed self-reported questionnaires (Western Ontario Rotator Cuff [WORC] and Disabilities of the Arm, Shoulder and Hand [DASH]) pre- and postoperatively at 6 months, 1 year, and annually thereafter. All scores were reported out of 100. RESULTS Ninety-one patients initially met our inclusion criteria, and 33 were excluded owing to lack of either pre- or postoperative outcome scores. Nine patients were lost to follow-up; therefore, 49 patients were finally evaluated, including 30 males (61.2%) and 19 females (38.8%) with an age of 59.6 ± 10.4 years (mean ± standard deviation) and mean follow-up of 5.3 years (range 2 to 9). Both WORC and DASH scores significantly improved from pre- to postoperatively (WORC: 69.6 ± 12.2 to 27.9 ± 23.7, P < .001; DASH: 51.5 ± 17.5 to 24.5 ± 23.0, P = .001). For WORC and DASH, 92% and 74% of patients, respectively, met the minimal clinical importance difference. CONCLUSION Our results showed that patients' clinical outcome scores significantly improved with an average of 5-year follow-up, which demonstrates that bridging reconstruction is a safe procedure with promising midterm clinical outcomes. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Moayd Abdullah Awad
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Sparavalo
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jie Ma
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John-Paul King
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Abstract
AIMS Long-term outcomes following the use of human dermal allografts in the treatment of symptomatic irreparable rotator cuff tears are not known. The aim of this study was to evaluate these outcomes, and to investigate whether this would be a good form of treatment in young patients in whom a reverse shoulder arthroplasty should ideally be avoided. METHODS This prospective study included 47 shoulders in 45 patients who underwent an open reconstruction of the rotator cuff using an interposition GraftJacket allograft to bridge irreparable cuff tears, between January 2007 and November 2011. The Oxford Shoulder Score (OSS), pain score, and range of motion (ROM) were recorded preoperatively and at one year and a mean of 9.1 years (7.0 to 12.5) postoperatively. RESULTS There was significant improvement in the mean OSS from 24.7 (SD 5.4) preoperatively to 42.0 (SD 6.3) at one year, and this improvement was maintained at 9.1 years (p < 0.001), with a score of 42.8 (SD 6.8). Similar significant improvements in the pain score were seen and maintained at the final follow-up from 6.1 (SD 1.6) to 2.1 (SD 2.3) (p < 0.001). There were also significant improvements in the ROM of the shoulder, and patient satisfaction was high. CONCLUSION The use of an interposition human dermal allograft in patients with an irreparable rotator cuff tear leads to good outcomes that are maintained at a mean of nine years postoperatively. Cite this article: Bone Joint J 2022;104-B(1):91-96.
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Affiliation(s)
- Amit Modi
- University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Aziz Haque
- University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Vijay Deore
- University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Harvinder Pal Singh
- University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Radhakant Pandey
- University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
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18
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Zafra M, Uceda P. Arthroscopic superior capsule reconstruction using semitendinosus tendon autograft for irreparable rotator cuff tears: Preliminary results. J Orthop 2021; 28:107-111. [PMID: 34924725 DOI: 10.1016/j.jor.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/05/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background To examine prospectively the functional and structural results of arthroscopic superior capsule reconstruction using semitendinosus tendon autograft for irreparable superior rotator cuff tears. Methods 5 patients (40.8 months average follow-up) were evaluated clinical preoperatively and at the end of the follow-up. Magnetic resonance imaging (MRI) was used preoperatively and at 12 months. Results The mean ASES and the Constant scores increased from 56.2 to 92 and 46.8 to 82.8. The MRI showed continuity of the ligamentoplasty. Conclusions Given the small number of cases, few conclusions can be drawn. Nonetheless, the results regarding this technique may be considered promising. Level of evidence Level IV; Case series; Treatment Study.
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Affiliation(s)
- Manuel Zafra
- Instituto de Traumatología, Hospital Quirón, Airport Avenue, 14005, Córdoba, Spain
| | - Pilar Uceda
- Instituto de Traumatología, Hospital Quirón, Airport Avenue, 14005, Córdoba, Spain
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19
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Yang J, Kang Y, Zhao W, Jiang J, Jiang Y, Zhao B, Jiao M, Yuan B, Zhao J, Ma B. Evaluation of patches for rotator cuff repair: A systematic review and meta-analysis based on animal studies. Bioact Mater 2021; 10:474-491. [PMID: 34901561 PMCID: PMC8633530 DOI: 10.1016/j.bioactmat.2021.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
Based on the published animal studies, we systematically evaluated the outcomes of various materials for rotator cuff repair in animal models and the potentials of their clinical translation. 74 animal studies were finally included, of which naturally derived biomaterials were applied the most widely (50.0%), rats were the most commonly used animal model (47.0%), and autologous tissue demonstrated the best outcomes in all animal models. The biomechanical properties of naturally derived biomaterials (maximum failure load: WMD 18.68 [95%CI 7.71–29.66]; P = 0.001, and stiffness: WMD 1.30 [95%CI 0.01–2.60]; P = 0.048) was statistically significant in the rabbit model. The rabbit model showed better outcomes even though the injury was severer compared with the rat model. The first systematic review & meta-analysis on rotator cuff patch materials. The quality of evidence for repair of rotator cuff injury with patch materials is very low. Evidence-based research is an effective way to study patch materials.
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Affiliation(s)
- Jinwei Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.,Reproductive Medicine Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, 730050, China
| | - Yuhao Kang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Wanlu Zhao
- College of Biomedical Engineering, Sichuan University, Chengdu, 610064, China.,National Engineering Research Center for Biomaterials, Chengdu, 610064, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yanbiao Jiang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Bing Zhao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Mingyue Jiao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Bo Yuan
- College of Biomedical Engineering, Sichuan University, Chengdu, 610064, China.,National Engineering Research Center for Biomaterials, Chengdu, 610064, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
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20
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Baek S, Shin MH, Kim TM, Im JM, Oh KS, Chung SW. Clinical Outcomes of Interposition Graft Versus Superior Capsular Reconstruction in Patients With Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211022241. [PMID: 34527751 PMCID: PMC8435932 DOI: 10.1177/23259671211022241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Interposition grafting (IG), also called bridging grafting, and superior capsular reconstruction (SCR) are the most commonly used joint-preserving surgical methods for irreparable rotator cuff tears (RCTs). Purpose: To compare the effectiveness of IG versus SCR to treat patients with irreparable RCTs. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed in MEDLINE, Embase, and Scopus. Included in this review were clinical studies evaluating the effect of IG or SCR in patients with irreparable RCTs with a minimum follow-up of 1 year. Various clinical results from the studies were extracted and compared between IG and SCR, and among them, the results of the American Shoulder and Elbow Surgeons score, graft retear rate, and complication rate were included in the meta-analysis. Results: Of 1638 identified articles, 17 (10 studies of IG involving 321 patients and 7 studies of SCR involving 357 patients) were selected. Both surgical methods showed significantly improved clinical outcomes in all but 1 study; however, the IG group had lower pain visual analog scale score, higher Constant score, and bigger active forward flexion and internal rotation compared with the SCR group (all P < .001). The meta-analysis showed no difference in the American Shoulder and Elbow Surgeons score between groups (P = .44), but showed a significantly lower complication rate in the IG group compared with the SCR group (1.12% vs 8.37%, respectively; P < .001). The graft retear rate was not significantly different between groups (IG = 10.64% vs SCR = 12.67%; P = .79). The meta-analysis of graft type indicated no difference between groups in retear rate (autograft: 95% CI, 0.045-0.601; I2 = 93.28 [IG], 91.27 [SCR]; P = .22; allograft: 95% CI, 0.041-0.216; I2 = 80.39 [IG], 69.12 [SCR]; P = .64) or complication rate (autograft: 95% CI, 0.009-0.150; I2 = 0 [IG], 65.89 [SCR]; P = .25; allograft: 95% CI, 0.012-0.081; I2 = 0 [IG], 30.62 [SCR]; P = .09). Conclusion: Both IG and SCR techniques resulted in improvement in patients with irreparable RCTs. Meta-analysis showed a lower complication rate in the IG group; however, the lack of randomized studies limited our conclusions.
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Affiliation(s)
- Samuel Baek
- Department of Orthopaedic Surgery, Seoul Red Cross Hospital, Seoul, Republic of Korea
| | - Myung Ho Shin
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Je Min Im
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
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21
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Kim D, Um J, Lee J, Kim J. Improved Clinical and Radiologic Outcomes Seen after Superior Capsule Reconstruction using Long Head Biceps Tendon Autograft. Arthroscopy 2021; 37:2756-2767. [PMID: 33892071 DOI: 10.1016/j.arthro.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to investigate the clinical and radiologic outcomes after superior capsule reconstruction (SCR) with biceps tendon (BT) for irreparable rotator cuff tears. METHODS The retrospective study period was May 2015 through February 2018. The average follow-up was 32 months (24-48 months) after surgery. Study inclusion criteria included an arthroscopic SCR performed using only our technique and minimum 2-year clinical follow-up by office visit and survey. Exclusion criteria included irreparable subscapularis tear and those patients lost to follow-up. This method enabled SCR by using the extraarticular portion and the intraarticular portion and making it 2 to 3 bundles by moving back and forth in the intraarticular area. Physical examination and functional scoring procedures were performed before surgery and at 3, 6, 12, and 24 months after surgery. Radiography and magnetic resonance imaging (MRI) were performed before surgery, after surgery (only radiography), and at 6 and 24 months after surgery. RESULTS Fifty-three shoulders involving 45 consecutive patients underwent BT technique for irreparable massive rotator cuff tears. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and constant score (CS) showed statistically significant improvement (VAS, 4.1-1.0; ASES, 60.9-82.7; and CS, 64.9-80.0; P < .0001). The shoulder active range of motion improved significantly by 23 for forward elevation (125.3-148.4; P < .0001) and by 12 for external rotation (38.0-50.9, P < .0001). The acromiohumeral distance (AHD) was significantly increased by 2.7 mm (4.4 ± 1.4 mm -> 7.1 ± 1.3 mm). No graft tear was detected in 39 patients (86.7%) during follow-up (24-48 months). CONCLUSIONS SCR via our technique improved clinical and radiologic outcomes. Thirty-five (77.7%) patients achieved 17-point improvement (the minimally clinically important difference) in the last follow-up of ASES score. Clinical scores and AHD had significantly increased, and good healed rate (86.7%) was observed in MRI. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Doosup Kim
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea; Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Wonju, Republic of Korea
| | - Jaewoong Um
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Junhyeok Lee
- Department of biostatistics, College of Medicine, Yonsei University, Republic of Korea
| | - Jaehyeon Kim
- Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Wonju, Republic of Korea.
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22
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Rohman ML, Snow M. Use of biologics in rotator cuff disorders: Current concept review. J Clin Orthop Trauma 2021; 19:81-88. [PMID: 34099971 PMCID: PMC8165426 DOI: 10.1016/j.jcot.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Poor tendon to bone healing following rotator cuff repair has led to the continued interest and investigation into biological augmentation. The biology of tendinopathy is not fully understood and consequently the availability of disease modifying therapeutic targets is limited. A ceiling of benefit has been reached by mechanical optimisation of rotator cuff repair and thus, in order to improve healing rates, a biological solution is required. This review focuses on the strategies to biologically augment rotator cuff disorders with an emphasis on rotator cuff repair. Leucocyte rich platelet rich plasma has been shown to improve healing rates without clinically relevant improvements in outcome scores. Similarly, improved healing rates have also been reported with bone marrow stimulation and in long-term follow-up with bone marrow concentrate. Extracellular matrix (ECM) and synthetic scaffolds can increase healing through mechanical and or biological augmentation. A potential third category of scaffold is bio-inductive and has no mechanical support. Studies involving various scaffolds have shown promising results for augmentation of large to massive tears and is likely to be most beneficial when tendon quality is poor, however level I evidence is limited.
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Affiliation(s)
| | - Martyn Snow
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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23
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Haque A, Modi A. Interposition grafting for irreparable rotator cuff tears: Systematic review and specialist practice report. J Clin Orthop Trauma 2021; 17:218-222. [PMID: 33868918 PMCID: PMC8047223 DOI: 10.1016/j.jcot.2021.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 02/06/2023] Open
Abstract
The treatment of symptomatic irreparable rotator cuff tears poses significant challenges to both patients and shoulder surgeons. Although reverse shoulder arthroplasty provides reliably good outcomes in the elderly, it is not a good option in younger patients. Various surgical techniques have been proposed for the treatment of irreparable rotator cuff tears; however, no gold standard currently exists. Interposition grafting is used when the rotator cuff cannot be fully repaired onto its footprint, and the remaining defect is bridged with either an allograft, autograft, xenograft or a synthetic graft. This review aims to present the literature on the use of various interposition grafts and techniques to treat large or massive irreparable rotator cuff tears and provide a specialist practice report.
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Affiliation(s)
- Aziz Haque
- Leicester Shoulder & Elbow Unit, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Amit Modi
- Leicester Shoulder & Elbow Unit, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
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Augmentation der Rotatorenmanschette mittels Patch. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00447-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cook JA, Baldwin M, Cooper C, Nagra NS, Crocker JC, Glaze M, Greenall G, Rangan A, Kottam L, Rees JL, Farrar-Hockley D, Merritt N, Hopewell S, Beard D, Thomas M, Dritsaki M, Carr AJ. Patch augmentation surgery for rotator cuff repair: the PARCS mixed-methods feasibility study. Health Technol Assess 2021; 25:1-138. [PMID: 33646096 PMCID: PMC7958078 DOI: 10.3310/hta25130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A rotator cuff tear is a common, disabling shoulder problem. Symptoms may include pain, weakness, lack of shoulder mobility and sleep disturbance. Many patients require surgery to repair the tear; however, there is a high failure rate. There is a need to improve the outcome of rotator cuff surgery, and the use of patch augmentation (on-lay or bridging) to provide support to the healing process and improve patient outcomes holds promise. Patches have been made using different materials (e.g. human/animal skin or tissue and synthetic materials) and processes (e.g. woven or mesh). OBJECTIVES The aim of the Patch Augmented Rotator Cuff Surgery (PARCS) feasibility study was to determine the design of a definitive randomised controlled trial assessing the clinical effectiveness and cost-effectiveness of a patch to augment surgical repair of the rotator cuff that is both acceptable to stakeholders and feasible. DESIGN A mixed-methods feasibility study of a randomised controlled trial. DATA SOURCES MEDLINE, EMBASE and the Cochrane Library databases were searched between April 2006 and August 2018. METHODS The project involved six stages: a systematic review of clinical evidence, a survey of the British Elbow and Shoulder Society's surgical membership, a survey of surgeon triallists, focus groups and interviews with stakeholders, a two-round Delphi study administered via online questionnaires and a 2-day consensus meeting. The various stakeholders (including patients, surgeons and industry representatives) were involved in stages 2-6. RESULTS The systematic review comprised 52 studies; only 15 were comparative and, of these, 11 were observational (search conducted in August 2018). These studies were typically small (median number of participants 26, range 5-152 participants). There was some evidence to support the use of patches, although most comparative studies were at a serious risk of bias. Little to no published clinical evidence was available for a number of patches in clinical use. The membership survey of British Elbow and Shoulder surgeons [105 (21%) responses received] identified a variety of patches in use. Twenty-four surgeons (77%) completed the triallist survey relating to trial design. Four focus groups were conducted, involving 24 stakeholders. Differing views were held on a number of aspects of trial design, including the appropriate patient population (e.g. patient age) to participate. Agreement on the key research questions and the outline of two potential randomised controlled trials were achieved through the Delphi study [29 (67%)] and the consensus meeting that 22 participants attended. LIMITATIONS The main limitation was that the findings were influenced by the participants, who are not necessarily representative of the views of the relevant stakeholder groups. CONCLUSION The need for further clinical studies was clear, particularly given the range and number of different patches available. FUTURE WORK Randomised comparisons of on-lay patch use for completed rotator cuff repairs and bridging patch use for partial rotator cuff repairs were identified as areas for further research. The value of an observational study to assess safety concerns of patch use was also highlighted. These elements are included in the trial designs proposed in this study. STUDY REGISTRATION The systematic review is registered as PROSPERO CRD42017057908. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mathew Baldwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cushla Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Navraj S Nagra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joanna C Crocker
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, UK
| | - Molly Glaze
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gemma Greenall
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amar Rangan
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Lucksy Kottam
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Dair Farrar-Hockley
- Patient representative, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Naomi Merritt
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Melina Dritsaki
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Micheloni GM, Salmaso G, Zecchinato G, Giaretta S, Barison E, Momoli A. Bio-inductive implant for rotator cuff repair: our experience and technical notes. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020004. [PMID: 33559620 PMCID: PMC7944686 DOI: 10.23750/abm.v91i14-s.10824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
The treatment of chonic large and partial rotator cuff tears represents a common challenge for orthopedic surgeons. Numerous treatments were suggested but the best is still controversial. Into this field the use of an augment for rotator cuff repair aims to protect the tension of the suture in the postoperative phase and to facilitate the biological healing process. In our institution we treated 4 patients (3 males and 1 female) with rotator cuff tear with bio-inductive implant. All patients presented with a postero-superior rotator cuff tear: 3 patients with a type C-III tear according to Snyder classification and 1 patient with partial articular tear with significant degeneration and poor tendon quality (type A-III tear according to Snyder classification). The final outcome is highly satisfying intraoperatively and the postoperative protocol reflects our normal postoperative protocol following to rotator cuff repair. No complications occurred at 6 months follow-up. The use of the bio-inductive implant in the arthroscopic rotator cuff repair resulted easy, rapid and reproducible. Although no current scientific evidences regarding such implants exist, in selected cases and with the correct indications, the use of bio-inductive implant could represent an effective aid and an option in case of complex rotator cuff tears. (www.actabiomedica.it)
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Baldwin M, Nagra NS, Greenall G, Carr AJ, Beard D, Rees JL, Rangan A, Merritt N, Dritsaki M, Hopewell S, Cook JA. Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis. BMJ Open 2020; 10:e039552. [PMID: 33293307 PMCID: PMC7722806 DOI: 10.1136/bmjopen-2020-039552] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/03/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To appraise studies reporting on clinical effectiveness and safety of surgical meshes used to augment rotator cuff repairs (RCRs). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase and Cochrane databases were searched between April 2006 and April 2020. ELIGIBILITY CRITERIA All studies evaluating adults (≥18 years) undergoing RCR were considered. There were no language restrictions. DATA EXTRACTION AND SYNTHESIS Screening, data extraction and quality appraisal were conducted by two independent reviewers. Meta-analysis was conducted using a random-effects models if ≥2 comparative studies reported the same outcome measure. Risk of bias assessment was undertaken for randomised (RoB2, Cochrane) and comparative studies (ROBINS-I, Cochrane). RESULTS We included 60 studies, consisting of 7 randomised controlled trials, 13 observational comparative studies and 40 observational case series. All comparative studies reported on shoulder-specific functional outcome scores, 18 on the radiographic occurrence of re-tear and 14 on pain score metrics. All studies contained some risk of bias.Compared with non-augmented repair, a small improvement in shoulder-specific function or pain scores was observed for synthetic patches with a mean improvement of 6.7 points on the University of California Los Angles (UCLA) shoulder score (95% CI 0.1 to 13.4) and 0.46 point reduction on the Visual Analogue Scale (95% CI -0.74 to -0.17), respectively. A reduced likelihood of radiologically observed re-tear was observed for synthetic (risk ratio (RR) 0.41, 95% CI 0.27 to 0.61) and allograft (RR 0.34, 95% CI 0.18 to 0.65) patches. A total of 49 studies reported on the occurrence of complications. Slightly higher crude complication rates were observed following patch-augmented repair (2.1%) than standard repair (1.6%). CONCLUSIONS While several studies suggest a decreased failure rate and small improvements in shoulder function and pain following augmented RCR, a paucity of rigorous clinical evaluation, for both effectiveness and safety, prevents firm recommendations. PROSPERO REGISTRATION NUMBER CRD42017057908.
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Affiliation(s)
- Mathew Baldwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - N S Nagra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Gemma Greenall
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - J L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
- Department of Orthopaedics, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Naomi Merritt
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Melina Dritsaki
- Centre for Statistics in Medicine, Oxford University, Oxford, Oxfordshire, UK
| | - Sally Hopewell
- Centre for Statistics in Medicine, Oxford University, Oxford, Oxfordshire, UK
| | - Jonathan Alistair Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
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Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg 2020; 29:2459-2475. [PMID: 32763381 PMCID: PMC7669555 DOI: 10.1016/j.jse.2020.07.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies. METHODS The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds. RESULTS No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate. CONCLUSION There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.
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D'Ambrosio MM, Klein DS, Feldman JJ. Superior capsular reconstruction-Where we are now? Musculoskeletal Care 2020; 19:375-379. [PMID: 33225625 DOI: 10.1002/msc.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew M D'Ambrosio
- Jersey City Medical Center, Robert Wood Johnson Barnabas Health, Jersey CIty, New Jersey, USA
| | - David S Klein
- Jersey City Medical Center, Robert Wood Johnson Barnabas Health, Jersey CIty, New Jersey, USA
| | - John J Feldman
- Jersey City Medical Center, Robert Wood Johnson Barnabas Health, Jersey CIty, New Jersey, USA
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Interposition Graft Repair of Irreparable Rotator Cuff Tears: A Review of Biomechanics and Clinical Outcomes. J Am Acad Orthop Surg 2020; 28:e829-e838. [PMID: 32649438 DOI: 10.5435/jaaos-d-19-00500] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Managing massive irreparable rotator cuff tears is a challenge. Interposition graft repairs to bridge the torn defect are a promising solution. Many graft materials are available for interposition repairs including the following: allografts, autografts, extracellular matrix, and synthetic grafts. Currently, it is unknown how these materials compare biomechanically or in their clinical outcomes when used for interposition graft repairs of massive irreparable rotator cuff tears. Most allografts and autografts are similar, in maximal load and stiffness, to intact rotator cuff tendons. Synthetic grafts have similar maximal load but lower stiffness, whereas extracellular matrix grafts are lower in maximal load and stiffness compared with intact rotator cuff tendons. Overall interposition graft repairs have shown some promising 2-year outcomes in patient and physician-reported functional outcomes, regardless of graft type. Few reported complications or repair failure associated with interposition graft repairs of massive irreparable rotator cuff tears at 2 years postsurgery have been noted.
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Lin J, Sun Y, Chen Q, Liu S, Ding Z, Chen J. Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction for Large to Massive Rotator Cuff Tears: A Systematic Review. Am J Sports Med 2020; 48:2828-2838. [PMID: 31766858 DOI: 10.1177/0363546519889040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences between GB and SCR remain unclear. PURPOSE To systematically review and compare the outcomes of GB and SCR for large to massive RCT. STUDY DESIGN Systematic review. METHODS A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of GB or SCR were included according to the inclusion and exclusion criteria. The primary outcome was Constant-Murley score at the final follow-up. Secondary outcomes included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, active shoulder range of motion, and graft healing rate. Complication rate was the safety outcome measure. Outcomes were summarized into group SCR and group GB, and the results were compared statistically (P < .05). RESULTS A total of 23 studies were included in this review: 238 repairs from the 5 studies in group SCR and 593 repairs from the 18 studies in group GB. For group SCR and group GB, the mean age was 61.6 and 63.3 years, and the mean follow-up was 18.0 and 40.1 months, respectively. Overall, both procedures demonstrated improvement of clinical outcomes. When compared with group SCR, group GB had significantly higher mean differences of the Constant-Murley score (41.9 vs 19.8), American Shoulder and Elbow Surgeons score (39.3 vs 33.8), visual analog scale score for pain (4.4 vs 3.4), and active external rotation at side (15.3 vs 9.3). No statistically significant difference was detected in the mean difference of active forward flexion, internal rotation, abduction, and graft healing rate between the groups. The complication rates were 0.84% (2 of 238) in group SCR and 0.67% (4 of 593) in group GB. CONCLUSION In general, GB showed significantly better clinical and functional outcomes postoperatively than SCR, with a similar complication rate. The available fair-quality evidence suggested that GB might be a better choice for large to massive RCT. More high-quality randomized controlled studies are required to further evaluate the relative benefits of the 2 procedures.
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Affiliation(s)
- Jinrong Lin
- Fudan University Huashan Hospital, Shanghai, China
| | - Yaying Sun
- Fudan University Huashan Hospital, Shanghai, China
| | - Qingyan Chen
- Department of Biology, Boston University, Boston, Massachusetts, USA
| | - Shaohua Liu
- Fudan University Huashan Hospital, Shanghai, China
| | - Zheci Ding
- Fudan University Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Fudan University Huashan Hospital, Shanghai, China
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Abstract
PURPOSE OF THE REVIEW Rotator cuff repair has excellent outcomes for many patients but continues to be suboptimal for large, retracted tears, and revision procedures. In these situations, patch augmentation may be considered in order to improve healing. The purpose of this article is to review the history, graft options, indications, surgical technique, outcomes, and complications associated with arthroscopic patch augmentation for rotator cuff repair. RECENT FINDINGS Patch augmentation has been shown in several studies to improve healing rates. After multiple investigations into different materials available for patch augmentation, acellular dermal allograft seems to be the graft with the best scientific support. While multiple techniques have been presented, few studies have compared their performance. While the arthroscopic technique for patch augmentation can be challenging, we present a systematic approach to this procedure with the potential to reliably and predictably perform patch augmentation. This technique is a valuable tool for surgeons that treat rotator cuff pathology.
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Affiliation(s)
- Peter N Chalmers
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Robert Z Tashjian
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Roth TS, Welsh ML, Osbahr DC, Varma A. Arthroscopic Single-Row Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Arthrosc Tech 2020; 9:e675-e681. [PMID: 32489844 PMCID: PMC7253793 DOI: 10.1016/j.eats.2020.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/25/2020] [Indexed: 02/03/2023] Open
Abstract
Massive, irreparable rotator cuff tears are challenging to manage. Often, these tears are not amenable to primary repair and necessitate additional treatment options. This is especially true in patients with absent glenohumeral arthritis in the setting of a massive, irreparable rotator cuff tear. Superior capsular reconstruction (SCR), originally described by Mihata using a fascia lata autograft, has grown in popularity for the treatment of irreparable rotator cuff tears as a salvage option with good clinical outcomes. More recently, SCR techniques have been described using dermal allograft. Biomechanical studies and reported clinical series show promising results, with favorable postoperative clinical outcomes. The procedure, however, may be technically challenging, especially when performed using an all-arthroscopic technique. This article describes an all-arthroscopic technique using a predetermined graft size, unique medial fixation to ease graft passage, and knotless single-row lateral fixation to optimize suture management and efficiency.
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Affiliation(s)
- Travis S. Roth
- American Sports Medicine Institute, Birmingham, Alabama, U.S.A.,Address correspondence to Travis S. Roth, M.D., M.S., American Sports Medicine Institute, 805 St. Vincent’s Dr, Birmingham, AL 35205, U.S.A.
| | - Matthew L. Welsh
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Daryl C. Osbahr
- Orlando Health Orthopedic Institute, Orlando, Florida, U.S.A
| | - Amit Varma
- Florida Sports Injury & Orthopaedic Institute, Clermont, Florida, U.S.A
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Application of a new polyester patch in arthroscopic massive rotator cuff repair-a prospective cohort study. J Shoulder Elbow Surg 2020; 29:e11-e21. [PMID: 31405714 DOI: 10.1016/j.jse.2019.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Massive rotator cuff (RC) tears still present a clinically challenging problem, with reported rerupture rates in up to 94%. The study objective was to determine the impact of synthetic patch augmentation for massive RC tears. METHODS Between June 2012 and 2014, we performed 50 arthroscopic RC reconstructions augmented with a synthetic polyester patch. Pre- and postoperative imaging methods included arthrographic magnetic resonance imaging, arthrographic computed tomography, and ultrasound examination to determine tendon integrity or rerupture. Clinical outcome was evaluated using the Constant-Murley score and the subjective shoulder value. Mean clinical midterm and final follow-up was 22 months (9-35 months) and 52 months (25-74 months), respectively. RESULTS The mean Constant-Murley score increased significantly from 36.5 (±16.4 standard deviation [SD]) preoperatively to a midterm value of 81.2 (±9.6 SD; P < .0001) and further improved to a mean of 83.4 (±10.8 SD) at final follow-up. The mean subjective shoulder value increased from 40.3 (±24.3 SD) to 89.2 (±12.9 SD; P < .0001) at midterm and to 89.6 (±15.2 SD) at final follow-up. We observed 7 complete reruptures (14%). However, reruptures did not correlate with revision surgery, which was performed in 8 patients. The main reason for revision was frozen shoulder or arthrofibrosis with an intact reconstruction and patch, which was performed in 6 cases. CONCLUSIONS The retear rate of 14% compared favorably with nonaugmented RC repairs in the literature. Therefore, we conclude that patch augmentation in massive RC tears is feasible to reduce retears and to improve clinical outcome.
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Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear. Arch Orthop Trauma Surg 2020; 140:1319-1325. [PMID: 31807850 PMCID: PMC7505825 DOI: 10.1007/s00402-019-03316-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Superior capsule reconstruction (SCR) has been used for the tendon grafting of massive rotator cuff tears when primary repair is difficult. We examined the postoperative outcomes of SCR for massive rotator cuff tears and the risk factors for postoperative retear. MATERIALS AND METHODS Through this retrospective comparative study, we evaluated 35 patients with an average age of 75.3 (57-90) years who underwent SCR using the technique developed by Mihata et al. Clinical outcomes were evaluated 1 year postoperatively using the Japan Orthopedic Association (JOA) score, University of California Los Angeles (UCLA) shoulder score, elevation angle and the Sugaya classification, which uses a 5-point scale evaluation on magnetic resonance imaging in which types 4 and 5 are considered retears. We also investigated the progression of fatty degeneration before and after surgery and the rupture site of the graft. Acromio-humeral distance (AHD), before and after surgery was measured through X-rays. Rotator cuff tear-related shoulder arthritis was evaluated on plain X-rays using the Hamada stage. Risks of retear were identified using multiple regression analyses for sex, age, Hamada stage and JOA score. RESULTS The JOA score improved from 62.3 ± 9.49 (SD) preoperatively to 84.6 ± 5.66 (SD) postoperatively (P < 0.001). The UCLA score improved from 15.3 ± 3.77 (SD) preoperatively to 30.1 ± 3.11 (SD) postoperatively (P < 0.001). AHD increased from 4.03 mm preoperatively to 6.23 mm postoperatively (P < 0.001). Postoperative retear was observed in seven of the 35 patients. Moreover, retear was observed in five of nine patients with a Hamada stage ≥ 4. Multiple regression analysis revealed that age ≥ 80 years, male sex and Hamada stage ≥ 4 were risk factors for retear. CONCLUSIONS While the postoperative outcomes of SCR are favorable, age, sex and degree of arthropathic change should be considered for surgical indications of SCR.
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Catapano M, Zhang K, Mittal N, Sangha H, Onishi K, de Sa D. Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review. PM R 2019; 12:288-300. [PMID: 31642203 DOI: 10.1002/pmrj.12268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 10/04/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To systematically review and evaluate the efficacy and complication profile of prolotherapy using hyperosmolar dextrose solution injection for rotator cuff tendinopathy. LITERATURE SURVEY MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (from inception to 1 July, 2019). METHODOLOGY A comprehensive search was completed to identify randomized controlled trials addressing prolotherapy using hyperosmolar dextrose solution for rotator cuff tendinopathy. Two reviewers independently screened the titles, abstracts, and full texts, and then extracted data from eligible studies. All reported outcome measures and complications were analyzed descriptively. SYNTHESIS Five studies satisfied inclusion criteria. Included studies analyzed a total of 272 participants with a final follow-up ranging from 6 weeks to 12 months. Prolotherapy differed greatly among studies. Two studies used a multisite enthesis injection protocol while the other three used ultrasound-guided protocols. Two of the studies used an intrasubstance supraspinatus injection and three used a supraspinatus enthesis injection. Control groups consisted of nonoperative rehabilitation including physical therapy and medical management in three studies, supraspinatus saline enthesis injection in one study, and corticosteroid injection in one study. There was statistically significant improvement in pain intensity with multisite injection protocols compared to physical therapy and medical management in both studies. Ultrasound-guided supraspinatus injection trials did not find any statistically significant difference in pain intensity, range of motion, strength, function, or ultrasound characteristics compared to controls of enthesis saline injection or corticosteroid. The complication rate was low, with only 6/272 participants experiencing adverse events consisting of transient increase in pain for 1 to 2 days postintervention. CONCLUSIONS Prolotherapy with hyperosmolar dextrose solution is a potentially effective adjuvant intervention to physical therapy for patients with rotator cuff tendinopathy ranging from tendinosis to partial-thickness and small full-thickness tears. Further studies are necessary to determine effects in subpopulations as well as optimal technique including dextrose concentration, volume, and location.
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Affiliation(s)
- Michael Catapano
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kailia Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nimish Mittal
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Harpreet Sangha
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Karuppaiah K, Sinha J. Scaffolds in the management of massive rotator cuff tears: current concepts and literature review. EFORT Open Rev 2019; 4:557-566. [PMID: 31598334 PMCID: PMC6771075 DOI: 10.1302/2058-5241.4.180040] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Injuries to the rotator cuff (RC) are common and could alter shoulder kinematics leading to arthritis. Synthetic and biological scaffolds are increasingly being used to bridge gaps, augment RC repair and enhance healing potential. Our review evaluates the clinical applications, safety and outcome following the use of scaffolds in massive RC repair. A search was performed using EBSCO-Hosted Medline, CINAHL, Cochrane and PubMed using various combinations of the keywords ‘rotator cuff’, ‘scaffold’, ‘biological scaffold’, ‘massive rotator cuff tear’ ‘superior capsular reconstruction’ and ‘synthetic scaffold’ between 1966 and April 2018. The studies that were most relevant to the research question were selected. All articles relevant to the subject were retrieved, and their bibliographies hand searched. Synthetic, biosynthetic and biological scaffolds are increasingly being used for the repair/reconstruction of the rotator cuff. Allografts and synthetic grafts have revealed more promising biomechanical and early clinical results than xenografts. The retear rates and local inflammatory reactions were alarmingly high in earlier xenografts. However, this trend has reduced considerably with newer versions. Synthetic patches have shown lower retear rates and better functional outcome than xenografts and control groups. The use of scaffolds in the treatment of rotator cuff tear continues to progress. Analysis of the current literature supports the use of allografts and synthetic grafts in the repair of massive cuff tears in reducing the retear rate and to provide good functional outcome. Though earlier xenografts have been fraught with complications, results from newer ones are promising. Prospective randomized controlled trials from independent centres are needed before widespread use can be recommended.
Cite this article: EFORT Open Rev 2019;4:557-566. DOI: 10.1302/2058-5241.4.180040
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Affiliation(s)
- Karthik Karuppaiah
- Upper Limb Unit, Department of Orthopaedic Surgery, King's College Hospital, London, UK
| | - Joydeep Sinha
- Upper Limb Unit, Department of Orthopaedic Surgery, King's College Hospital, London, UK
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Ingrassia T, Lombardo B, Nigrelli V, Ricotta V, Nalbone L, D'Arienzo A, D'Arienzo M, Porcellini G. Influence of sutures configuration on the strength of tendon-patch joints for rotator cuff tears treatment. Injury 2019; 50 Suppl 2:S18-S23. [PMID: 30739762 DOI: 10.1016/j.injury.2019.01.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Massive rotator cuff tears are common in the aging population. The incidence of failed rotator cuff repairs is still quite high, especially in the treatment of full-thickness tears or revision repairs. In this context, natural and synthetic meshes can be used as augmentation scaffolds or as devices to close the gap between a retracted tendon and the bone. The purpose of this work is to evaluate the ultimate tensile strength of different tendon-patch joints in order to consider their use in the treatment of massive cuff tears. MATERIALS AND METHODS Porcine tendons and a synthetic low-density polypropylene mesh have been used. A preliminary study on the tensile strength of tendons and patches has been performed. Different patch-tendon joints have been studied by modifying the number and the layout of the sutures. For every joint, the tensile test, performed through an electromechanical machine, has been repeated at least twice to obtain reliable data. RESULTS Experimental tensile tests on tendons and patches have given good results with very low dispersion data. Mean values of the calculated ultimate tensile stresses are, respectively, about 34 MPa and 16 MPa for tendons and patches. As regards the sutures arrangement, the staggered layout gave, for all joints, a higher tensile strength than the regular (aligned) one. Different ultimate tensile stress values, depending on the sutures number and layout, have been calculated for the joints. CONCLUSION Synthetic patches could be an interesting option to repair massive cuff tears and to improve, in a significant way, pain, range of motion and strength at time 0, so reducing the rehabilitation time. Obtained results demonstrated that joints with a suitable number and layout of sutures could ensure very good mechanical performances. The failure load of the tendon-patch joint, in fact, is higher than the working load on a healthy tendon.
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Affiliation(s)
- Tommaso Ingrassia
- Dipartimento di Ingegneria - Università degli Studi di Palermo, Palermo, Italy.
| | - Benedetto Lombardo
- Dipartimento di Ingegneria - Università degli Studi di Palermo, Palermo, Italy
| | - Vincenzo Nigrelli
- Dipartimento di Ingegneria - Università degli Studi di Palermo, Palermo, Italy
| | - Vito Ricotta
- Dipartimento di Ingegneria - Università degli Studi di Palermo, Palermo, Italy
| | - Lorenzo Nalbone
- Clinica Ortopedica e Traumatologica del Policlinico 'Paolo Giaccone' - Università degli Studi di Palermo, Palermo, Italy
| | | | - Michele D'Arienzo
- Clinica Ortopedica e Traumatologica del Policlinico 'Paolo Giaccone' - Università degli Studi di Palermo, Palermo, Italy
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Gouk CJC, Shulman RM, Buchan C, Thomas MJE, Taylor FJ. Failure of Dermal Allograft Repair of Massive Rotator Cuff Tears in Magnetic Resonance Imaging and Clinical Assessment. Clin Orthop Surg 2019; 11:200-207. [PMID: 31156773 PMCID: PMC6526136 DOI: 10.4055/cios.2019.11.2.200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/14/2019] [Indexed: 01/08/2023] Open
Abstract
Background Massive retracted rotator cuff tears represent a therapeutic dilemma, particularly in the young and middle-aged patients who are not appropriate for a reverse total shoulder replacement. Interposition grafting using human dermal allograft offers an alternative treatment. Methods A retrospective review of all patients who underwent interposition grafting using human dermal allograft between December 2013 and May 2015 for massive rotator cuff tears at our tertiary referral center was performed. Preoperative and 6 month postoperative magnetic resonance imaging (MRI) assessments were performed in all patients, with postoperative graft integrity being the primary outcome measure. Clinical evaluation was performed using the Oxford shoulder score, Constant score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results The mean age at the time of follow-up was 54 years. On MRI, 84% of grafts were seen to have failed at 6 months. Strength was grossly reduced on the operative side when supraspinatus and subscapularis were tested; despite this, Constant score (mean, 48.2) was comparable to that in the previous reports. DASH and Oxford scores were a mean of 24.94 and 37.16, respectively. Conclusions Based on these results, in particular the MRI findings, we cannot advocate the use of dermal allograft as an interposition graft for the repair of massive rotator cuff tears.
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Affiliation(s)
| | - Ryan Mark Shulman
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, Australia
| | - Craig Buchan
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, Australia
| | | | - Fraser James Taylor
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, Australia
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Bailey JR, Kim C, Alentorn-Geli E, Kirkendall DT, Ledbetter L, Taylor DC, Toth AP, Garrigues GE. Rotator Cuff Matrix Augmentation and Interposition: A Systematic Review and Meta-analysis. Am J Sports Med 2019; 47:1496-1506. [PMID: 29906191 DOI: 10.1177/0363546518774762] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical management of rotator cuff tears is controversial and complex, ranging from nonoperative management to reverse shoulder arthroplasty. PURPOSE To systematically review and evaluate the outcomes of graft augmentation or interposition versus rotator cuff repair (RCR) alone and evaluate via meta-analysis whether the use of a graft leads to superior outcomes versus RCR alone. STUDY DESIGN Systematic review and meta-analysis. METHODS An electronic literature search (Medline, Embase, CINAHL) was conducted. Studies with a minimum follow-up of 1 year and minimum sample size of 10 that provided clinical results of RCR or rotator cuff reconstruction using any type of augmentation tissue or matrix were included. Methodological quality was evaluated by assessment of the risk of bias in the included studies. Studies comparing outcomes of RCR with graft augmentation or interposition versus repair alone (control group) were subjected to meta-analysis. RESULTS The authors identified 774 articles and included 36 in the systematic review; 5 of the 36 studies underwent meta-analysis. Except for one outcome measure in a single study, all surgical interventions (RCR alone, RCR with augmentation, and RCR with interposition) improved clinical scores and outcome measures. Because of variability in study outcomes, no graft option was found to be superior. Compared with RCR alone, graft augmentation or interposition provided significantly lower retear rates ( P = .05) and higher American Shoulder and Elbow Surgeons (ASES) scores ( P = .005), but improvements in UCLA (University of California, Los Angeles) scores ( P = .29) and pain scores ( P = .1) did not reach statistical significance. CONCLUSION In the meta-analysis, graft augmentation or interposition appeared to provide a lower retear rate and improved ASES scores when compared with RCR alone. Future prospective, randomized, controlled, and appropriately powered trials are needed for more definitive recommendations.
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Affiliation(s)
- James R Bailey
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher Kim
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Eduard Alentorn-Geli
- Fundación García-Cugat, Artroscopia GC, Hospital Quirón, and Mutualidad Catalana de Futbolistas, Barcelona, Spain
| | - Donald T Kirkendall
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Leila Ledbetter
- Duke University Medical Center Library, Duke University Medical Center, Durham, North Carolina, USA
| | - Dean C Taylor
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Alison P Toth
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Grant E Garrigues
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Catapano M, de Sa D, Ekhtiari S, Lin A, Bedi A, Lesniak BP. Arthroscopic Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review of Modern Literature. Arthroscopy 2019; 35:1243-1253. [PMID: 30878327 DOI: 10.1016/j.arthro.2018.09.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To systematically review and evaluate the efficacy and complication profile of superior capsular reconstruction (SCR) as a technique to address massive, irreparable rotator cuff tears (MIRCTs). METHODS Searches of the Cochrane Database of Systematic Reviews, Embase, MEDLINE, PubMed, and conference abstracts of 4 major conferences identified clinical studies addressing SCR for MIRCTs. Two reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. Reported outcome measures and complications were descriptively analyzed. RESULTS A total of 10 studies, 7 full texts and 3 conference abstracts, satisfied the inclusion criteria. The included studies examined a total of 350 shoulders with a mean patient age of 60.6 years and mean follow-up period of 20.6 months postoperatively. Only 4 studies had a minimum of 24-month follow-up data. Statistically significant improvements in pain and function were noted in all studies reporting results, with mean improvement ranging from 29.4 to 68.5 and from 2.5 to 5.9 points across the American Shoulder and Elbow Surgeons score and visual analog scale score, respectively. Mean improvement in range of motion ranged from 21.7° to 64.0° in elevation and from 9.0° to 15.0° in external rotation. Statistically significant improvements in the postoperative acromiohumeral distance were noted in 4 of 5 reporting studies, with a mean increase ranging from 2.2 to 5.0 mm. The combined clinical and radiographic failure and/or retear rate ranged from 3.4% to 36.1%. Complications for all studies included deep infection (0%-2%), symptomatic suture anchor loosening (0%-4%), and severe shoulder contracture (0%-2%). CONCLUSIONS Arthroscopic SCR represents an accepted surgical option for patients with MIRCTs, with short-term improvements shown in pain, range of motion, and function. Although early results are promising, further studies are necessary to determine the long-term success of this technique and to better delineate the clinical indications, survivorship, and risk factors for failure in this population. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Michael Catapano
- Physical Medicine & Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Darren de Sa
- University of Pittsburgh Medical Center Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Albert Lin
- University of Pittsburgh Medical Center Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Asheesh Bedi
- MedSport, Department of Orthopaedic Surgery, University of MichiganAnn Arbor, Michigan, U.S.A
| | - Bryson P Lesniak
- University of Pittsburgh Medical Center Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A..
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Yildiz F, Bilsel K, Pulatkan A, Kapicioglu M, Uzer G, Çetindamar T, Sonmez C, Bozdag E, Sünbüloglu E. Comparison of two different superior capsule reconstruction methods in the treatment of chronic irreparable rotator cuff tears: a biomechanical and histologic study in rabbit models. J Shoulder Elbow Surg 2019; 28:530-538. [PMID: 30466819 DOI: 10.1016/j.jse.2018.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the treatment of irreparable rotary cuff (RC) tears, the superior capsule of the shoulder is reconstructed using tensor fascia lata (TFL) or several allografts to prevent progressive joint degeneration. This study compared the healing qualities of acellular human dermal graft (HDG) and the TFL autograft in superior capsule reconstruction (SCR) from biomechanical and histologic perspectives. METHODS Chronic retracted RC tear models were created bilaterally in 9 rabbits, and 7 rabbits with intact RC were used as a control group. SCR was performed 8 weeks after the tear using HDG in right shoulders and TFL in left shoulders. At 12 weeks after SCR, 2 shoulders from each experimental group were investigated for histologic healing, and 7 samples from the experimental and control groups were biomechanically tested. RESULTS Complete healing was observed macroscopically in the glenoid and humeral sides of both groups. No difference was observed in the enthesis maturation scores between the experimental groups. Collagen fiber density was higher and the orientation was better in TFL group. Inflammatory cell infiltration was not seen in the TFL group, but inflammatory cell infiltration was pronounced in the HDG group. The mean pullout strengths of the TFL group, HDG group, and intact RC group were 139.7 ± 40.5 N, 123.9 ± 47.9 N, and 105.1 ± 11.8 N (P = .187), respectively. The mean stiffness values (P = .711), yield forces (P = .404), and displacements (P = .135) were also statistically not different between the groups. CONCLUSION In SCR, the healing qualities of HDG and TFL were similar in rabbit models.
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Affiliation(s)
- Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey.
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Gokcer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Tolga Çetindamar
- Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Cavide Sonmez
- Department of Pathology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
| | - Emin Sünbüloglu
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
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Techniques for Interpositional Graft Reconstruction for Massive Irreparable Rotator Cuff Tears. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2019. [DOI: 10.1097/bte.0000000000000149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rosales-Varo A, Zafra M, García-Espona M, Flores-Ruiz M, Roda O. Superior capsular reconstruction of irreparable rotator cuff tear using autologous hamstring graft. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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45
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Reconstrucción de la cápsula superior en las roturas irreparables del manguito mediante injerto autógeno de isquiotibiales. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:1-6. [DOI: 10.1016/j.recot.2018.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/05/2018] [Accepted: 08/19/2018] [Indexed: 11/21/2022] Open
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Carver TJ, Kraeutler MJ, Smith JR, Bravman JT, McCarty EC. Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears. Orthop J Sports Med 2018; 6:2325967118805385. [PMID: 30480007 PMCID: PMC6240971 DOI: 10.1177/2325967118805385] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Massive, irreparable rotator cuff tears (MIRCTs) provide a significant dilemma for orthopaedic surgeons. One treatment option for MIRCTs is reverse total shoulder arthroplasty. However, other methods of treating these massive tears have been developed. A search of the current literature on nonoperative management, arthroscopic debridement, partial repair, superior capsular reconstruction (SCR), graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer for MIRCTs was performed. Studies that described each surgical technique and reported on clinical outcomes were included in this review. Arthroscopic debridement may provide pain relief by removing damaged rotator cuff tissue, but no functional repair is performed. Partial repair has been suggested as a technique to restore shoulder functionality by repairing as much of the rotator cuff tendon as possible. This technique has demonstrated improved clinical outcomes but also fails at a significantly high rate. SCR has recently gained interest as a method to prohibit superior humeral head translation and has been met with encouraging early clinical outcomes. Graft interposition bridges the gap between the retracted tendon and humerus. Balloon spacer arthroplasty has also been recently proposed and acts to prohibit humeral head migration by placing a biodegradable saline-filled spacer between the humeral head and acromion; it has been shown to provide good clinical outcomes. Both trapezius and latissimus dorsi transfer techniques involve transferring the tendon of these respective muscles to the greater tuberosity of the humerus; these 2 techniques have shown promising restoration in shoulder function, especially in a younger, active population. Arthroscopic debridement, partial repair, SCR, graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer have all been shown to improve clinical outcomes for patients presenting with MIRCTs. Randomized controlled trials are necessary for confirming the efficacy of these procedures and to determine when each is indicated based on specific patient and anatomic factors.
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Affiliation(s)
- Trevor J Carver
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew J Kraeutler
- Department of Orthopedics, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - John R Smith
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Seker V, Hackett L, Lam PH, Murrell GAC. Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up. Am J Sports Med 2018; 46:3155-3164. [PMID: 30307743 DOI: 10.1177/0363546518801014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. PURPOSE To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. STUDY DESIGN Case series; Level of evidence, 4. METHODS This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. RESULTS At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). CONCLUSION At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.
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Affiliation(s)
- Vasanth Seker
- Orthopaedic Research Institute, Saint George Hospital, University of New South Wales, Sydney, Australia
| | - Lisa Hackett
- Orthopaedic Research Institute, Saint George Hospital, University of New South Wales, Sydney, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, Saint George Hospital, University of New South Wales, Sydney, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, Saint George Hospital, University of New South Wales, Sydney, Australia
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Ranebo MC, Björnsson Hallgren HC, Norlin R, Adolfsson LE. Long-term clinical and radiographic outcome of rotator cuff repair with a synthetic interposition graft: a consecutive case series with 17 to 20 years of follow-up. J Shoulder Elbow Surg 2018; 27:1622-1628. [PMID: 29731397 DOI: 10.1016/j.jse.2018.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment options for irreparable cuff tears include synthetic interposition grafts, but whether such grafts can maintain acceptable shoulder function and prevent cuff tear arthropathy in the long-term is unknown. METHOD This was a retrospective case series of 13 consecutive patients treated with a synthetic interposition graft made of Dacron (DuPont, Wilmington, DE, USA). Patients were examined with bilateral ultrasonography, bilateral x-ray imaging, Constant-Murley score, and Western Ontario Rotator Cuff score. RESULTS After a mean of 18 years (range, 17-20 years), 1 patient had died, and 12 were available for x-ray imaging and 10 also for ultrasonography and clinical scores. Cuff tear arthropathy (Hamada grade ≥2) had developed in 9 of 12 (75%; 95% confidence interval, 43%-95%), including 3 patients operated on with arthroplasty in the follow-up period. The mean absolute Constant-Murley score was 46 (standard deviation, 26), and the mean Western Ontario Rotator Cuff score was 59 (standard deviation, 20). In 7 of 10 patients (70%) with available ultrasonography, the graft was interpreted as not intact. All patients had a contralateral full-thickness tear, and 7 of 12 patients (58 %; 95% confidence interval, 28%-85%) had contralateral cuff tear arthropathy. The number of patients with cuff tear arthropathy was not significantly different between the shoulder repaired with a Dacron graft and the contralateral shoulder (P = .667). CONCLUSION These results indicate that a synthetic interposition graft with screw fixation could not prevent cuff tear arthropathy and preserve cuff integrity in a long-term perspective.
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Affiliation(s)
- Mats C Ranebo
- Department of Orthopedics, Kalmar County Hospital, Kalmar, Sweden; Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | | | - Rolf Norlin
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Lars E Adolfsson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Orthopedics, Linköping University Hospital, Linköping, Sweden
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A Novel Surgical Technique for Interpositional ePTFE Patch Repair of Massive Irreparable Rotator Cuff Tears. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2018. [DOI: 10.1097/bte.0000000000000141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Galvin JW, Waterman BR, Cole BJ. Patch Augmentation and Patch Extension for Complex Rotator Cuff Tears. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2017.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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