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Alaiti RK, Vallio CS, Assunção JH, de Andrade e Silva FB, Gracitelli MEC, Neto AAF, Malavolta EA. Using Machine Learning to Predict Nonachievement of Clinically Significant Outcomes After Rotator Cuff Repair. Orthop J Sports Med 2023; 11:23259671231206180. [PMID: 37868215 PMCID: PMC10588422 DOI: 10.1177/23259671231206180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 10/24/2023] Open
Abstract
Background Although some evidence suggests that machine learning algorithms may outperform classical statistical methods in prognosis prediction for several orthopaedic surgeries, to our knowledge, no study has yet used machine learning to predict patient-reported outcome measures after rotator cuff repair. Purpose To determine whether machine learning algorithms using preoperative data can predict the nonachievement of the minimal clinically important difference (MCID) of disability at 2 years after rotator cuff surgical repair with a similar performance to that of other machine learning studies in the orthopaedic surgery literature. Study Design Case-control study; Level of evidence, 3. Methods We evaluated 474 patients (n = 500 shoulders) with rotator cuff tears who underwent arthroscopic rotator cuff repair between January 2013 and April 2019. The study outcome was the difference between the preoperative and 24-month postoperative American Shoulder and Elbow Surgeons (ASES) score. A cutoff score was calculated based on the established MCID of 15.2 points to separate success (higher than the cutoff) from failure (lower than the cutoff). Routinely collected imaging, clinical, and demographic data were used to train 8 machine learning algorithms (random forest classifier; light gradient boosting machine [LightGBM]; decision tree classifier; extra trees classifier; logistic regression; extreme gradient boosting [XGBoost]; k-nearest neighbors [KNN] classifier; and CatBoost classifier). We used a random sample of 70% of patients to train the algorithms, and 30% were left for performance assessment, simulating new data. The performance of the models was evaluated with the area under the receiver operating characteristic curve (AUC). Results The AUCs for all algorithms ranged from 0.58 to 0.68. The random forest classifier and LightGBM presented the highest AUC values (0.68 [95% CI, 0.48-0.79] and 0.67 [95% CI, 0.43-0.75], respectively) of the 8 machine learning algorithms. Most of the machine learning algorithms outperformed logistic regression (AUC, 0.59 [95% CI, 0.48-0.81]); nonetheless, their performance was lower than that of other machine learning studies in the orthopaedic surgery literature. Conclusion Machine learning algorithms demonstrated some ability to predict the nonachievement of the MCID on the ASES 2 years after rotator cuff repair surgery.
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Affiliation(s)
- Rafael Krasic Alaiti
- Research, Technology, and Data Science Office, Grupo Superador, São Paulo, Brazil
- Universidade de São Paulo, São Paulo, Brazil
| | - Caio Sain Vallio
- Health Innovation, Data Science, and MLOps, Semantix, São Paulo, Brazil
| | - Jorge Henrique Assunção
- Faculdade de Medicina, Hospital das Clinicas FMUSP, Universidade de São Paulo, São Paulo, Brazil
- DASA, Hospital 9 de Julho, São Paulo, São Paulo, Brazil
| | | | | | | | - Eduardo Angeli Malavolta
- Faculdade de Medicina, Hospital das Clinicas FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Hospital do Coração, São Paulo, Brazil
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Huang Q, Li X, Zhang Y, Jian C, Mou H, Ou Y. Comparison of clinical outcomes of arthroscopic rotator cuff repair utilizing suture-bridge procedures with or without medial knots: a meta-analysis. BMC Surg 2023; 23:158. [PMID: 37312138 DOI: 10.1186/s12893-023-02060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/28/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE This investigation aimed to compare the medical efficacy of the knotted and knotless suture-bridge procedures in rotator cuff repair. METHODS The Pubmed, Embase, and Cochrane Library datasets were searched for all available publications comparing the medical results of arthroscopic rotator cuff repairs utilizing knotted or knotless suture-bridge procedures. Two researchers utilized Newcastle-Ottawa Scale and Cochrane risk-of-bias tool to evaluate the included studies. Employing Revman 5.3 software, meta-analysis was conducted following the PRISMA reporting guideline. RESULTS Eleven investigations with 1083 patients were considered suitable for the final meta-analysis. 522 individuals were assigned to the knotted group, whereas 561 were assigned to the knotless group. No statistical difference was found between the knotted and knotless groups, regarding VAS score (WMD, 0.17; 95% CI, - 0.10 to 0.44; P = 0.21); Constant score (WMD, -1.50; 95% CI, - 3.52 to 0.52; P = 0.14); American Shoulder and Elbow Surgeons Shoulder (WMD, -2.02; 95% CI, - 4.53 to 0.49; P = 0.11); University of California Los Angeles score (WMD, -0.13; 95% CI, - 0.89 to 0.63; P = 0.73); ROM of flexion (WMD, 1.57; 95% CI, - 2.11 to 5.60; P = 0.37), abduction (WMD, 1.08; 95% CI, - 4.53 to 6.70; P = 0.71) and external rotation (WMD, 1.90; 95% CI, - 1.36 to 5.16; P = 0.25); re-tear rate (OR, 0.74; 95% CI, 0.50 to 1.08; P = 0.12), and medical complications (OR, 0.90; 95% CI, 0.37 to 2.20; P = 0.82). CONCLUSION For arthroscopic rotator cuff repairs, there were no statistical differences in medical results among knotted and knotless suture-bridge procedures. Overall, both techniques showed excellent clinical outcomes and could be safely utilized to treat rotator cuff injuries.
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Affiliation(s)
- Qiu Huang
- Department of Orthopedics, People's Hospital of Leshan, Shizhong District, Leshan, Sichuan, China
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoyu Li
- Department of Orthopedics, People's Hospital of Leshan, Shizhong District, Leshan, Sichuan, China
- Humanities and Management college, Southwest Medical University, Longmatan District, Luzhou, Sichuan, China
| | - Ye Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changchun Jian
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Mou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Clinical outcomes in patients with retear after arthroscopic rotator cuff repair: A meta-analysis. J Orthop Sci 2022; 27:1017-1024. [PMID: 34400060 DOI: 10.1016/j.jos.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/25/2021] [Accepted: 07/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rotator cuff retear is a major concern after arthroscopic rotator cuff repair (ARCR); however, the effects of retear remain unclear. Therefore, the purpose of this study was to assess the clinical outcomes of postoperative retear and intact tendons after ARCR. METHODS We searched PubMed, Cochrane Library, Scopus, and PEDro databases for studies performed from January 2000 to June 2020. Clinical outcomes included the Constant score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles shoulder (UCLA) score, pain score, range of motion, and muscle strength. Meta-analysis using random-effects models was performed on the pooled results to determine significance. RESULTS The initial database search yielded 3141 records. After removal of duplicates, 26 of which met the inclusion criteria. Patients in the retear group had significantly lower Constant score [- 8.51 points (95% CI, - 10.29 to - 6.73); P < 0.001], ASES score [- 12.53 points (95% CI, - 16.27 to - 8.79); P < 0.001], UCLA score [- 3.77 points (95% CI, - 4.72 to - 2.82); P < 0.001], and significantly higher pain score [0.56 cm (95% CI, 0.10 to 1.01); P = 0.02] than the intact group. In addition, the retear group had significantly lower flexion [- 10.46° (95% CI, - 19.86 to - 1.07); P = 0.03], abduction [- 14.84° (95% CI, - 28.55 to - 1.14); P = 0.03], and external rotation [- 7.22° (95% CI, - 13.71 to - 0.74); P = 0.03] range of motion, and flexion [- 1.65 kg·f (95% CI, - 2.29 to - 1.01); P < 0.001], abduction [- 1.87 kg·f (95% CI, - 3.02 to - 0.72); P = 0.001], and external rotation [- 1.66 kg·f (95% CI, - 3.25 to - 0.07); P = 0.04] muscle strength. CONCLUSION Our results suggest that retear after ARCR leads to poor clinical outcomes after surgery.
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Uno T, Mura N, Yuki I, Oishi R, Takagi M. Factors correlated with the optimal tension for arthroscopic rotator cuff repair using Grasper Tensioning Attachment. J Shoulder Elbow Surg 2022; 31:e213-e222. [PMID: 34687919 DOI: 10.1016/j.jse.2021.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/17/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the optimal tension in arthroscopic rotator cuff repair (ARCR). This study aimed to identify preoperative, intraoperative, and postoperative factors that correlate with the tension in ARCR and to determine the optimal intraoperative tension using Grasper Tensioning Attachment, a tension meter attached to the common arthroscopic surgical grasper. METHODS This study included 63 patients with a mean age at surgery of 65.3 years (range, 45-83 years) who underwent ARCR. The mean follow-up period was 24.1 months (range, 24-28 months). We investigated the patients' demographic data, Japanese Orthopaedic Association score, DeOrio and Cofield classification, and Goutallier stage of the supraspinatus and infraspinatus muscles. We also evaluated cuff integrity based on the Sugaya classification via magnetic resonance imaging. The free edge of the torn retracted tendon was grasped, and the passive tension to the footprint was then measured with Grasper Tensioning Attachment with the arm at the side. The anteroposterior (AP) and mediolateral (ML) diameters were also measured. RESULTS The preoperative Goutallier stage of the supraspinatus muscle was stage 0 in 7 cases, stage 1 in 34, stage 2 in 20, and stage 3 in 2. The mean intraoperative rotator repair tension was 10.0 ± 2.5 N (range, 7.5-17 N). The mean AP diameter of the rotator cuff tear was 22 ± 10 mm (range, 8-50 mm), and the mean ML diameter was 24 ± 10 mm (range, 10-50 mm). Age, DeOrio and Cofield classification, Goutallier stage, AP diameter, and ML diameter correlated with rotator repair tension. The rotator repair tension in Sugaya classification type III or IV cases (n = 12, 11.4 ± 2.4 N) was significantly larger than that in type I or II cases (n = 51, 9.7 ± 2.4 N; P = .03). Tension ≥ 10 N as a cutoff value from receiver operating characteristic curve analysis was a risk factor for poor cuff integrity (95% confidence interval, 0.53-0.88). CONCLUSIONS Rotator repair tension ≥ 10 N was a risk factor for poor cuff integrity. Thus, care should be taken when performing intraoperative procedures and administering postoperative regimens.
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Affiliation(s)
- Tomohiro Uno
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan; Department of Orthopaedic Surgery, Yoshioka Hospital, Yamagata, Japan.
| | - Nariyuki Mura
- Department of Orthopaedic Surgery, Yoshioka Hospital, Yamagata, Japan; Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Issei Yuki
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan; Department of Orthopaedic Surgery, Yoshioka Hospital, Yamagata, Japan
| | - Ryuta Oishi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan; Department of Orthopaedic Surgery, Yoshioka Hospital, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Hu G, Li Z, Li H, Guan H. Clinical Observation on the Treatment of Rotator Cuff Injury with Modified Buyang Huanwu Decoction and Rotator Cuff Repair. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:3088160. [PMID: 34733453 PMCID: PMC8560238 DOI: 10.1155/2021/3088160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
In this paper, we have evaluated the clinical efficacy of rotator cuff surgery combined with Chinese medicine Buyang Huanwu Decoction (adding medicine) in the treatment of patients with rotator cuff injury. For this purpose, sixty patients with rotator cuff injury and shoulder arthroscopic surgery were selected in this hospital (where 57 cases were finally screened). The patients were divided into a control group (28 cases) and a study group (29 cases) by the envelope method. The control group received conventional treatment after the operation, whereas the study group was combined with Buyang Huanwu Decoction after the operation. The clinical efficacy of the two groups, particularly after treatment, was compared in terms of self-care ability and Constant-Murley scores before and after treatment, that is, 4 w, 8 w, and 12 w. The total effective rate of treatment in the study group was significantly higher than that of the control group after 4 weeks of treatment (P < 0.05). There was no significant difference in the FIM self-care scores of the two groups before treatment (P > 0.05). In the study group patients, after treatment for 4 w and 8 w, the FIM self-care score was significantly improved (P < 0.05). The FIM self-care score of the patients in the study group, after 12 w of treatment, had no significant difference compared with the control group (P > 0.05). The Constant-Murley scores of the two groups were compared before treatment where no significant difference is observed (P > 0.05) and the Constant-Murley score of the study group patients was significantly higher than that of the control group, after 4 w and 8 w treatment (P < 0.05). Additionally, Constant-Murley score of the study group was not significantly higher than that of the control group after 12 w of treatment difference (P > 0.05). The proposed combined treatment program has value of promotion and implementation in the clinical treatment of patients with rotator cuff injury.
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Affiliation(s)
- Gangfeng Hu
- The First People's Hospital of Xiaoshan District, Xiaoshan District, Hangzhou 311200, China
| | - Zhennan Li
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou 310053, China
| | - Haonan Li
- The First Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou 310053, China
| | - Hong Guan
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou 310053, China
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Hackl M, Nacov J, Kammerlohr S, Staat M, Buess E, Leschinger T, Müller LP, Wegmann K. Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure. Am J Sports Med 2021; 49:1847-1853. [PMID: 33872064 DOI: 10.1177/03635465211006138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-row (DR) and transosseous-equivalent (TOE) techniques for rotator cuff repair offer more stability and promote better tendon healing compared with single-row (SR) repairs and are preferred by many surgeons. However, they can lead to more disastrous retear patterns with failure at the medial anchor row or the musculotendinous junction. The biomechanics of medial cuff failure have not been thoroughly investigated thus far. PURPOSE To investigate the intratendinous strain distribution within the supraspinatus tendon depending on repair technique. STUDY DESIGN Controlled laboratory study. METHODS Twelve fresh-frozen cadaveric shoulders were used. The intratendinous strain within the supraspinatus tendon was analyzed in 2 regions-(1) at the footprint at the greater tuberosity and (2) medial to the footprint up to the musculotendinous junction-using a high-resolution 3-dimensional camera system. Testing was performed at submaximal loads of 40 N, 60 N, and 80 N for intact tendons, after SR repair, after DR repair, and after TOE repair. RESULTS The tendon strain of the SR group differed significantly in both regions from that of the intact tendons and the TOE group at 40 N (P≤ .043) and from the intact tendons, the DR group, and the TOE group at 60 N and 80 N (P≤ .048). SR repairs showed more tendon elongation at the footprint and less elongation medial to the footprint. DR and TOE repairs did not provide significant differences in tendon strain when compared with the intact tendons. However, the increase in tendon strain medial to the footprint from 40 N to 80 N was significantly more pronounced in the DR and TOE group (P≤ .029). CONCLUSION While DR and TOE repair techniques more closely reproduced the strains of the supraspinatus tendon than did SR repair in a cadaveric model, they showed a significantly increased tendon strain at the musculotendinous junction with higher loads in comparison with the intact tendon. CLINICAL RELEVANCE DR and TOE rotator cuff reconstructions lead to a more anatomic tendon repair. However, their use has to be carefully evaluated whenever tendon quality is diminished, as they lead to a more drastic increase in tendon strain medial to the footprint, putting these repairs at risk of medial cuff failure.
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Affiliation(s)
- Michael Hackl
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Julia Nacov
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Sandra Kammerlohr
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Manfred Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Jülich, Germany
| | | | - Tim Leschinger
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Lars P Müller
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Kilian Wegmann
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
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Prospective study of tendon healing and functional gain after arthroscopic repair of isolated supraspinatus tear. Orthop Traumatol Surg Res 2020; 106:S201-S206. [PMID: 32948500 DOI: 10.1016/j.otsr.2020.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In case of failure of non-operative treatment of isolated supraspinatus tear, tendon surgery can improve shoulder function and alleviate pain. The present study hypothesis was that isolated supraspinatus repair shows good healing, with improved clinical results. MATERIALS AND METHODS A prospective multicentre study followed up 199 patients (mean age, 57 years) for one year. Inclusion criteria comprised: isolated full-thickness supraspinatus tear, retraction grade<3, with the same double-row arthroscopic technique. Clinical assessment used Constant score at 6 weeks and 3, 6 and 12 months. Ultrasound control checked tendon repair quality on the Sugaya criteria, types I-II-III being considered as healed. RESULTS At one year, mean Constant score had increased by 26 points (p<0.001). Healing rate was 94% (n=187): Sugaya type I, 46% (n=92); type II, 41% (n=81); type III, 7% (n=14). Mean Constant score was significantly higher in case of healing: 81 vs. 70 points (p=0.002). Constant score progression was identical in both healing groups throughout follow-up. Univariate analysis showed no correlation between epidemiological or tear-related factors and tendon healing. CONCLUSION Arthroscopic repair of isolated small supraspinatus tear provided 94% healing. Clinical results were better when healing was achieved. LEVEL OF EVIDENCE I, prospective cohort study.
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Guo S, Zhu Y, Song G, Jiang C. Assessment of Tendon Retraction in Large to Massive Rotator Cuff Tears: A Modified Patte Classification Based on 2 Coronal Sections on Preoperative Magnetic Resonance Imaging With Higher Specificity on Predicting Reparability. Arthroscopy 2020; 36:2822-2830. [PMID: 32622802 DOI: 10.1016/j.arthro.2020.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To propose a modified Patte classification (evaluating tendon retraction on 2 coronal sections) and analyze whether this classification was better at predicting irreparability and retear of large to massive rotator cuff tears (RCTs). METHODS A retrospective study was performed. Imaging evaluation including tendon retraction, fatty infiltration, the acromiohumeral distance (AHD), and the tangent sign was performed using magnetic resonance imaging. The modified Patte classification was used to assess tendon retraction. Intraobserver and interobserver reliability was analyzed by calculating intraclass correlation coefficients. Factors affecting irreparability and retear were analyzed using both univariate and multivariate analyses. Sensitivity and specificity of tendon retraction to predict irreparability and retear were calculated. RESULTS A total of 121 shoulders with large to massive RCTs underwent arthroscopic rotator cuff repairs. The modified Patte classification system had excellent interobserver and intraobserver reliability. Several factors were associated with reparability and retear in the univariate analysis. However, in binary logistic regression analysis, the only factors affecting reparability were AHD less than 0.4 cm (P = .007) and modified Patte stage III tendon retraction (P = .023). Low-grade repair quality (P = .001) and modified Patte stage III tendon retraction (P = .031) were independent factors for retear. Modified Patte stage III had a high specificity for predicting irreparability (93.58%) and retear (98.78%), whereas the specificity of original Patte stage III was 76.15% and 84.15%, respectively. CONCLUSIONS For large to massive RCT repairs, modified Patte stage III tendon retraction with evaluation of 2 coronal cuts reveals higher specificity on predicting tendon irreparability and postoperative retear. An AHD less than 0.4 cm on magnetic resonance imaging and modified Patte stage III tendon retraction were independent risk factors for irreparability. Low-grade repair quality and modified Patte stage III tendon retraction were independent risk factors for postoperative retear. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Siyi Guo
- Sports Medicine Department, Beijing Ji Shui Tan Hospital, Peking University School of Medicine, Beijing, China
| | - Yiming Zhu
- Sports Medicine Department, Beijing Ji Shui Tan Hospital, Peking University School of Medicine, Beijing, China
| | - Guanyang Song
- Sports Medicine Department, Beijing Ji Shui Tan Hospital, Peking University School of Medicine, Beijing, China
| | - Chunyan Jiang
- Sports Medicine Department, Beijing Ji Shui Tan Hospital, Peking University School of Medicine, Beijing, China.
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Zhou Y, Xie S, Tang Y, Li X, Cao Y, Hu J, Lu H. Effect of book-shaped acellular tendon scaffold with bone marrow mesenchymal stem cells sheets on bone-tendon interface healing. J Orthop Translat 2020; 26:162-170. [PMID: 33437635 PMCID: PMC7773951 DOI: 10.1016/j.jot.2020.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background Tissue engineering has exhibited great effect on treatment for bone-tendon interface (BTI) injury. The aim of this study was to evaluate the effect of a book-shaped acellular tendon scaffold (ATS) with bone marrow mesenchymal stem cells sheets (MSCS) for BTI injury repair. Methods ATS was designed based on the shape of "book", decellularization effect was evaluated by Hematoxylin and eosin (H&E), 4', 6-diamidino-2-phenylindole (DAPI) and scanning electron microscopy (SEM), then bone marrow mesenchymal stem cells (MSCs) were cultured on ATS to assess the differentiation inductivity of ATS. A rabbit right partial patellotomy model was established, and MSCS seeded on ATS were implanted into the lesion site. The patella-patellar tendon (PPT) at 2, 4, 8 or 16 weeks post-operation were obtained for histological, biomechanical and immunofluorescence analysis. Results H&E, DAPI and SEM results confirmed the efficiency of decellularization of ATS, and their in vitro tenogenic and chondrogenic ability were successfully identified. In vivo results showed increased macrophage polarization toward the M2 phenotype, IL-10 expression, regenerated bone and fibrocartilage at the patella-patellar tendon interface of animals received MSCS modified ATS implantation. In addition, the level of tensile strength was also the highest in MSCS modified ATS implantation group. Conclusion This study suggests that ATS combined with MSCS performed therapeutic effects on promoting the regeneration of cartilage layer and enhancing the healing quality of patella-patellar tendon interface. The translational potential of this article This study showed the good biocompatibility of the ATS, as well as the great efficacy of ATS with MSCS on tendon to bone healing. The results meant that the novel book-shaped ATS with MSCS may have a great potential for clinical application.
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Affiliation(s)
- Yongchun Zhou
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710000, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Shanshan Xie
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Yifu Tang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Xiaoning Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
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10
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Patient-Reported Outcomes After Use of a Bioabsorbable Collagen Implant to Treat Partial and Full-Thickness Rotator Cuff Tears. Arthroscopy 2019; 35:2262-2271. [PMID: 31350082 DOI: 10.1016/j.arthro.2019.02.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/31/2019] [Accepted: 02/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To collect outcomes data on patients treated with a bioinductive collagen implant designed to induce rotator cuff healing in partial- and full-thickness cuff tears and to assess the safety and efficacy of the device. METHODS Fifteen surgeons in 15 centers in the United States enrolled patients between April 2016 and August 2017 and collected standardized outcomes data. Patients 21 years of age and older, able to read and speak English, and with partial- or full-thickness tears of the rotator cuff documented by magnetic resonance imaging were included in the study. Patients were assessed preoperatively with visual analogue scale (VAS), single-assessment numeric evaluation (SANE), Veterans RAND 12-Item (VR-12), American Shoulder and Elbow Surgeons (ASES), and Western Ontario Rotator Cuff (WORC) outcomes measures. Postoperative assessment was made at 2, 6, and 12 weeks, 6 months, and 1 year. Patients underwent a standardized operative procedure with the implant. Patient demographics, comorbidities, tear types, and concomitant operative procedures were recorded. RESULTS Patients in both groups experienced statistically significant improvement in VAS, SANE, VR-12 PCS, ASES, and WORC scores (mean values 1.1, P < .001; 86.0, P < .001; 49.7, P < .001; 85.6, P < .001; and 84.4, P < .001 for partial tears and 1.2, P < .001; 80.7, P < .001; 45.7, P < .001; 83.8, P < .0001; and 80.1, P < .001 for full-thickness tears, respectively). For the partial tear group, average times for return to driving, work, and nonoverhead athletic activity were 14.6, 37.3, and 65.6 days, and for the full-thickness group, 24.5, 50.7, and 119.2 days, respectively. In the partial-thickness group, 84% and 83% of patients reported improvement in their VAS pain and ASES scores, respectively, that met or exceeded each measure's minimal clinically important difference. In the full-thickness group, 72% and 77% of the patients met or exceeded the minimal clinically important differences for VAS pain and ASES, respectively. CONCLUSION Outcomes after repair of partial- and full-thickness rotator cuff tears using a bioinductive implant show safety and efficacy at 1-year follow-up. LEVEL OF EVIDENCE Retrospective case series, level IV evidence.
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Aagaard KE, Lunsjö K, Frobell R. Early repair of trauma-related full-thickness rotator cuff tears does not eliminate the problem of healing failure. Bone Joint J 2019; 101-B:603-609. [PMID: 31038994 DOI: 10.1302/0301-620x.101b5.bjj-2018-0867.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS Failure of healing is a well-known problem after repair of the rotator cuff. This study aimed to investigate if early repair of trauma-related full-thickness rotator cuff tears (FTRCTs) could prevent this failure. PATIENTS AND METHODS In this prospective trial, 62 consecutive patients (14 women (23%), 48 men (77%); median age 61 years (interquartile range (IQR) 54 to 65)) with trauma-related FTRCT underwent arthroscopic single-row repair within six weeks of trauma. Tendon integrity was assessed one year after surgery using the Sugaya score on MR images. Patients were followed up with Western Ontario Rotator Cuff (WORC) index, EuroQol visual analogue scale (EQ VAS), and the Constant-Murley score (CS) two years after repair. RESULTS A total of 57 patients (92%) had MR images available at one year; 59 patients (95%) had CS (one year), WORC (two years), and EQ VAS scores (two years). Intact repair was found on MRI in 36 patients (63%); 13 patients (23%) displayed healing failure of at least one repaired tendon and eight patients (14%) displayed total healing failure. Median WORC index and relative CS improved from 30.8 points (IQR 20.1 to 38.6) at baseline to 85.0 points (IQR 60.6 to 95.7) at two years and 26.5 points (IQR 21.2 to 37.4) to 83.2 points (IQR 71.9 to 97.5) at one year, respectively. The relative CS at one year was significantly better among those with intact repairs compared with those with healing failure (91.6 vs 78.1 points; p = 0.031). CONCLUSION Although early repair of trauma-related FTRCT improved patient relevant outcomes over two years for the entire cohort, only two out of three repaired rotator cuffs displayed intact structural integrity on MRI after one year. Consequently, early repair did not seem to prevent healing failure after trauma-related FTRCT. Cite this article: Bone Joint J 2019;101-B:603-609.
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Affiliation(s)
- K E Aagaard
- Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
| | - K Lunsjö
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.,Clinical Sciences Helsingborg, Lund University, Helsingborg, Sweden
| | - R Frobell
- Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
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12
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Qian S, Wang Z, Zheng Z, Ran J, Zhu J, Chen W. A Collagen and Silk Scaffold for Improved Healing of the Tendon and Bone Interface in a Rabbit Model. Med Sci Monit 2019; 25:269-278. [PMID: 30622234 PMCID: PMC6338012 DOI: 10.12659/msm.912038] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The study aimed to develop a novel orthopedic surgical scaffold made of collagen and silk to repair the tendon and bone interface, and to investigate its influence on tendon and bone healing in a rabbit model. Material/Methods Four types of surgical scaffold were prepared, including a random collagen scaffold (RCS), an aligned collagen scaffold (ACS), a random collagen scaffold combined with knitted silk (RCSS), and an aligned collagen scaffold combined with knitted silk (ACSS). Rabbit bone marrow stem cells (BMSCs) were cultured and seeded onto the RCS and ACS scaffold. The animal model included four-month-old female New Zealand White rabbits (N=20) that underwent drilling into the rotator cuff of the left supraspinatus muscle tendon, randomized into the ACSS and RCSS groups. Results Rabbit BMSCs adhered to and proliferated on the RCS and ACS in vitro. Transcription levels of the COL I, COL III, and tenascin (TCN) genes were significantly increased in the ACS group compared with the RCS group. Transcription levels of COL I, runt-related transcription factor-2 (RUNX-2) and bone morphogenetic protein-2 (BMP-2) were significantly increased in the RCS group compared with the ACS group. RCSS and ACSS implanted in the rabbit models for eight weeks resulted in more regenerative tissue in the RCSS group compared with the ACSS group, with new cartilage at the tendon and bone interface at 12 weeks. Conclusions A collagen and silk scaffold improved healing of the tendon and bone interface in a rabbit model.
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Affiliation(s)
- Shengjun Qian
- Centre for Orthopedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Zhan Wang
- Centre for Orthopedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Zefeng Zheng
- Centre for Orthopedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jisheng Ran
- Centre for Orthopedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Junfeng Zhu
- Department of Orthopedics, Suichang Peoples' Hospital, Lishui, Zhejiang, China (mainland)
| | - Weishan Chen
- Centre for Orthopedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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13
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Effect of Platelet-Rich Plasma and Amniotic Membrane in Patients with Rotator Cuff Repair. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2018. [DOI: 10.4028/www.scientific.net/jbbbe.39.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rotator cuff disorders are the most common source of shoulder problems, ranging from mild strain to massive tears. Platelet-rich plasma (PRP), an autologous blood with platelets concentration above baseline values represents a source of multiple growth factors that promotes tissue repair. This review examines the potential of using PRP to augment rotator cuff repair. Reporting 4 patients with impingement syndrome and supraspinatus tear who underwent decompression acromioplasty and supraspinatus repair augmented with platelet-rich plasma and amniotic membrane. An evaluation was made 3-24 months postoperative using Shoulder Pain and Disability Index (SPADI). Average preoperative pain score is 64%, disability score 54.58%, and total score 58.19%. Average postoperative pain score is 0%, disability score 0.42%, and total score 0.26% (Minimum Detectable Change at 90% confidence for pain score is 18%, disability score 13%, and total score 11%). This result is consequent with research by Luoay Fallouh, stating that improvement is caused by growth factor effects in platelet-rich plasma which promotes soft tissue healing. It can be concluded that platelet-rich plasma and amniotic membrane have promising effects to enhance soft tissue healing in patients with rotator cuff syndrome. Shoulder function is restored with no limitation on daily activity and pain is no longer present.
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Willinger L, Lacheta L, Beitzel K, Buchmann S, Woertler K, Imhoff AB, Scheiderer B. Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years' Follow-up. Am J Sports Med 2018; 46:2700-2706. [PMID: 30084649 DOI: 10.1177/0363546518786006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The retear rate after primary rotator cuff (RC) reconstruction is high and commonly leads to poorer clinical outcomes and shoulder function. In the case of primary failure, revision RC reconstruction (RCR) has become increasingly important to re-create RC integrity and improve outcomes. To date, clinical and structural outcomes after RCR have not been sufficiently investigated and described at midterm follow-up. Hypothesis/Purpose: The purpose was to evaluate the clinical and radiological outcomes after revision RCR. It was hypothesized that revision RCR significantly improves clinical outcomes and that the outcomes positively correlate with tendon integrity on magnetic resonance imaging (MRI). STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent revision RCR between 2008 and 2014 were retrospectively evaluated with a minimum follow-up of 2 years. Outcomes were assessed by a clinical examination, a visual analog scale for pain (VAS), the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Tendon integrity was determined using 3-T MRI and graded according to the Sugaya classification. RESULTS Thirty-one of 40 patients (77.5%) were available for the final assessment at a mean follow-up of 50.3 ± 20.4 months. Clinical outcome scores significantly improved from preoperatively to postoperatively for the CS (39.7 ± 16.7 to 65.1 ± 19.7; P < .001), ASES (44.2 ± 17.7 to 75.2 ± 24.8; P < .001), and DASH (68.6 ± 15.1 to 21.5 ± 19.1; P < .001). The VAS score decreased from 6.1 ± 1.8 preoperatively to 1.3 ± 1.8 at final follow-up ( P < .001). MRI demonstrated a retear rate of 55.5%. No differences in CS, ASES, and DASH scores were detected between patients with an intact repair and failure. Abduction strength was not significantly different in patients with an intact repair and retears (55.5 N vs 44.0 N, respectively, P = .52). CONCLUSION Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. The clinical outcome scores were comparable in patients with an intact repair and those with failed RC healing. Therefore, tendon integrity was not correlated with better clinical outcomes after revision RCR at final follow-up.
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Affiliation(s)
- Lukas Willinger
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lucca Lacheta
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Orthopaedisches Fachzentrum Weilheim-Garmisch-Starnberg-Penzberg, Weilheim, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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15
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Hirakawa Y, Manaka T, Orita K, Ito Y, Ichikawa K, Nakamura H. The accelerated effect of recombinant human bone morphogenetic protein 2 delivered by β-tricalcium phosphate on tendon-to-bone repair process in rabbit models. J Shoulder Elbow Surg 2018; 27:894-902. [PMID: 29396102 DOI: 10.1016/j.jse.2017.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bone morphogenetic protein 2 (BMP-2) plays an important role in the tendon-to-bone repair process. However, there is no previous literature on acceleration of the tendon-to-bone repair process by BMP-2 delivered by β-tricalcium phosphate (β-TCP). The aim of this study was to investigate the accelerated effect of recombinant human BMP-2 (rhBMP-2) delivered by β-TCP on the tendon-to-bone repair process. METHODS The infraspinatus tendon of elderly female Japanese white rabbits was detached from its insertion site on the humerus. A bone tunnel (4.2 mm) was created at the original insertion site of the tendon, which was repaired using the McLaughlin procedure after filling in β-TCP (porosity 75%) without BMP-2 (control group) or with 10 µg rhBMP-2 (BMP group). The rabbits were sacrificed at the second, fourth, and eighth weeks after surgery for histologic analysis and biomechanical testing. We also evaluated the maturity of the tendon-to-bone junction using the tendon-to-bone maturity score. RESULTS Histologic analysis revealed no significant difference between the groups at 2 and 8 weeks but a more abundant organized fibrocartilage at the tendon-to-bone junction in the BMP group at 4 weeks. The tendon-to-bone maturity score improved sequentially. The interface of the BMP group at 4 weeks had significantly improved biomechanical properties than that of the control group. CONCLUSION The tendon-to-bone repair process was facilitated by the use of rhBMP-2 delivered by β-TCP at 4 weeks.
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Affiliation(s)
- Yoshihiro Hirakawa
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Kumi Orita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoichi Ito
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan; Osaka Shoulder Center, Ito Clinic, Osaka, Japan
| | - Koichi Ichikawa
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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16
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Porcine Dermis Patch Augmentation of Supraspinatus Tendon Repairs: A Pilot Study Assessing Tendon Integrity and Shoulder Function 2 Years After Arthroscopic Repair in Patients Aged 60 Years or Older. Arthroscopy 2018; 34:24-37. [PMID: 28822637 DOI: 10.1016/j.arthro.2017.06.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the 2-year postoperative clinical and subjective outcomes after arthroscopic rotator cuff repair (ARCR) with xenologous porcine dermal patch augmentation compared with ARCR alone. METHODS Patients aged 60 years or older with a complete supraspinatus (SSP) tendon tear underwent primary ARCR with a transosseous-equivalent technique. By use of a matched-pair comparative trial design, a consecutive series of 20 patients receiving additional xenologous porcine dermal patch augmentation (patch group) was matched by tear location with 20 patients who received ARCR only (control group). Prior conservative treatment failed in all patients. Patients with concomitant pathologies precluding accurate repair assessment, partial or open reconstruction, or a latissimus dorsi and/or pectoralis major muscle transfer were excluded. Patients reported daily pain levels for 10 days after surgery. Clinical parameters and various patient-reported outcome scores were documented preoperatively and at 3, 6, and 24 months after surgery. Repair integrity was determined by magnetic resonance imaging or ultrasound at 24 months. Adverse events were recorded. Group outcome differences were analyzed with t tests, Fisher exact tests, and mixed models. RESULTS Patients in both groups were aged 67 years on average (range, 60-74 years), and 70% of patients were men. Patients in the patch group had slightly more SSP fatty infiltration preoperatively. Patch surgical procedures were on average 22 minutes longer than control interventions (P = .003). At 24 months, 4 patients and 9 patients were diagnosed with a recurrent SSP tendon defect in the control group (n = 20) and patch group (n = 19), respectively (relative risk, 2.4; P = .096). Of 11 defects (85%) identified as medial cuff failure, 8 occurred in the patch group. Pain rated by all patients decreased from postoperative day 1 to day 10 without any significant group difference (P = .348). No significant group differences were noted for other outcome parameters, and recurrent defects had no relevant effect on functional outcomes. Local complications (including recurrent defects) occurred in 8 patients in the control group and 12 in the patch group (P = .343). CONCLUSIONS Our pilot study supports the view that an SSP tear repair with porcine dermal xenograft augmentation does not benefit patients in terms of reducing the risk of a recurrent tendon defect or improving shoulder function up to 24 months after surgical repair. LEVEL OF EVIDENCE Level III, therapeutic study, retrospective comparative trial.
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17
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Chona DV, Lakomkin N, Lott A, Workman AD, Henry AC, Kuntz AF, Huffman GR, Glaser DL. The timing of retears after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2017; 26:2054-2059. [PMID: 28918111 DOI: 10.1016/j.jse.2017.07.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/07/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the time dependence of the failure rate of surgically repaired rotator cuffs. Retears are significant, as they are common and may lead to less satisfactory outcomes and additional operations. Their timing is critical foundational information for understanding failure mechanisms. However, this remains unclear. Currently, there exist a number of studies that have reported retear rates at specific time points. Combining data from these publications can reveal when cuffs retear, which will help inform expectations and guidelines for progression of activity after surgery. METHODS PubMed, Medline, and Embase were searched for studies relating to rotator cuff repair. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Data were extracted from those publications that satisfied all requirements, and regression analysis was performed. RESULTS Thirteen articles were included in the final meta-analysis. Retear rates for medium tears increased for approximately 15 months and leveled off at approximately 20%. Retear rates for large tears progressed steadily for about 12 months and approached an upper limit of approximately 40%. Retear rates for massive tears ranged from 20% to 60%, but the distribution of retear rate over time for these cuff tears is not clear from these data. CONCLUSION Retear rates for medium and large tears generally increase until at least 10-15 months after surgery, after which they are likely to level off. Retear rates for massive tears are variable and may follow a time course different from that of other tear sizes. Retear rates depend on size of the original tear.
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Affiliation(s)
- Deepak V Chona
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Nikita Lakomkin
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariana Lott
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Alan D Workman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Aneel C Henry
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew F Kuntz
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - G Russell Huffman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - David L Glaser
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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18
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Rashid MS, Cooper C, Cook J, Cooper D, Dakin SG, Snelling S, Carr AJ. Increasing age and tear size reduce rotator cuff repair healing rate at 1 year. Acta Orthop 2017; 88:606-611. [PMID: 28880113 PMCID: PMC5694804 DOI: 10.1080/17453674.2017.1370844] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There is a need to understand the reasons why a high proportion of rotator cuff repairs fail to heal. Using data from a large randomized clinical trial, we evaluated age and tear size as risk factors for failure of rotator cuff repair. Patients and methods - Between 2007 and 2014, 65 surgeons from 47 hospitals in the National Health Service (NHS) recruited 447 patients with atraumatic rotator cuff tendon tears to the United Kingdom Rotator Cuff Trial (UKUFF) and 256 underwent rotator cuff repair. Cuff integrity was assessed by imaging in 217 patients, at 12 months post-operation. Logistic regression analysis was used to determine the influence of age and intra-operative tear size on healing. Hand dominance, sex, and previous steroid injections were controlled for. Results - The overall healing rate was 122/217 (56%) at 12 months. Healing rate decreased with increasing tear size (small tears 66%, medium tears 68%, large tears 47%, and massive tears 27% healed). The mean age of patients with a healed repair was 61 years compared with 64 years for those with a non-healed repair. Mean age increased with larger tear sizes (small tears 59 years, medium tears 62 years, large tears 64 years, and massive tears 66 years). Increasing age was an independent factor that negatively influenced healing, even after controlling for tear size. Only massive tears were an independent predictor of non-healing, after controlling for age. Interpretation - Although increasing age and larger tear size are both risks for failure of rotator cuff repair healing, age is the dominant risk factor.
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Affiliation(s)
- Mustafa S Rashid
- Botnar Research Centre, Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,National Institute for Health Research, Oxford Musculoskeletal Biomedical Research Unit, Oxford, UK,Correspondence:
| | - Cushla Cooper
- Botnar Research Centre, Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,National Institute for Health Research, Oxford Musculoskeletal Biomedical Research Unit, Oxford, UK
| | - Jonathan Cook
- Botnar Research Centre, Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Cooper
- Health Services Research Unit (HSRU), University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK
| | - Stephanie G Dakin
- Botnar Research Centre, Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,National Institute for Health Research, Oxford Musculoskeletal Biomedical Research Unit, Oxford, UK
| | - Sarah Snelling
- Botnar Research Centre, Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,National Institute for Health Research, Oxford Musculoskeletal Biomedical Research Unit, Oxford, UK
| | - Andrew J Carr
- Botnar Research Centre, Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,National Institute for Health Research, Oxford Musculoskeletal Biomedical Research Unit, Oxford, UK
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19
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Kim JO, Lee JH, Kim KS, Ji JH, Koh SJ, Lee JH. Rotator cuff bridging repair using acellular dermal matrix in large to massive rotator cuff tears: histologic and clinical analysis. J Shoulder Elbow Surg 2017; 26:1897-1907. [PMID: 28705694 DOI: 10.1016/j.jse.2017.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 03/28/2017] [Accepted: 04/16/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study investigated the efficacy of the bridging repair using an acellular dermal matrix (ADM) and an ADM with stem cells in rabbits. Also investigated were clinical outcomes of ADM bridging repair for large to massive rotator cuff tears. MATERIALS AND METHODS ADM, with and without stem cells, was used to cover a 5- × 5-mm-sized cuff defect in 17 rabbits, and biomechanical, histologic, and immunohistochemical analyses were conducted. Also evaluated were 24 patients with large to massive rotator cuff tears after ADM bridging repair. RESULTS In the biomechanical test, the normal rotator cuff, cuff with ADM plus stem cells, and cuff with ADM in the rabbit model showed a maximum load (N) of 287.3, 217.5, and 170.3 and ultimate tensile strength (N/mm2) of 11.1, 8.0, and 5.2, respectively. Histologically, the cuff tendons with the ADM or ADM plus stem cells showed characteristically mature tendons as time passed. In the clinical study, the mean American Shoulder and Elbow Surgeons score improved from preoperative 50 to postoperative 83, the University of California Los Angeles Shoulder Rating Scale from 17 to 30, and the Simple Shoulder Test from 4 to 8, respectively. No further fatty deteriorations or muscle atrophy were observed on follow-up magnetic resonance imaging. A retear was found in 5 of 24 patients (21%). CONCLUSIONS Bridging repair with ADM or stem cells in the rabbit model showed cellular infiltration into the graft and some evidence of neotendon formation. Clinically, ADM repair was a safe alternative that did not show any further fatty deterioration nor muscle atrophy in large to massive rotator cuff tears.
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Affiliation(s)
- Jong Ok Kim
- Department of Pathology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jong-Ho Lee
- Department of Thoracic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Kwang-Sup Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
| | - Sung-Jun Koh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jae-Ho Lee
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
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20
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Saltzman BM, Zuke WA, Go B, Mascarenhas R, Verma NN, Cole BJ, Romeo AA, Forsythe B. Does early motion lead to a higher failure rate or better outcomes after arthroscopic rotator cuff repair? A systematic review of overlapping meta-analyses. J Shoulder Elbow Surg 2017; 26:1681-1691. [PMID: 28619382 DOI: 10.1016/j.jse.2017.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/14/2017] [Accepted: 04/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aims of the study were as follows: to perform a systematic review of meta-analyses comparing "early motion" and "delayed motion" after arthroscopic rotator cuff repair; to provide a framework to analyze the best available evidence to develop recommendations; and to identify gaps where suggestions could be made for future investigations. METHODS Literature searches were performed to identify meta-analyses examining arthroscopic rotator cuff repair with early-motion vs. delayed-motion rehabilitation protocols. Clinical data were extracted, and meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses and Oxman-Guyatt scales. RESULTS Nine meta-analyses met inclusion criteria. No clear superiority was noted in clinical outcome scores for early-motion or delayed-motion rehabilitation. Results of tendon healing were found to be either no different or in favor of delayed motion, but no differences were noted in rotator cuff tear recurrence rates postoperatively. The majority of meta-analyses found significantly better range of motion with early motion up to a year postoperatively for forward elevation and up to 6 months for external rotation, but significant differences were not reported for functional improvements and strength at 12 months postoperatively. Subgroup analyses suggested that larger preoperative tear sizes have significantly greater retear rates with early-motion rehabilitation. CONCLUSIONS The current highest level of evidence suggests that early-motion rehabilitation after rotator cuff repair results in superior postoperative range of motion up to 1 year. Whereas early motion and delayed motion after cuff repair may lead to comparable functional outcomes and retear rates, concern exists that early motion may result in greater retear rates, particularly with larger tear sizes.
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Affiliation(s)
- Bryan M Saltzman
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - William A Zuke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Beatrice Go
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Randy Mascarenhas
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Randelli P, Stoppani CA, Zaolino C, Menon A, Randelli F, Cabitza P. Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial. Am J Sports Med 2017; 45:2000-2009. [PMID: 28339286 DOI: 10.1177/0363546517695789] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. PURPOSE To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. RESULTS Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). CONCLUSION No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical repair of the rotator cuff. Registration: NCT01815177 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Pietro Randelli
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Carlo Zaolino
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Paolo Cabitza
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Lee YS, Jeong JY, Park CD, Kang SG, Yoo JC. Evaluation of the Risk Factors for a Rotator Cuff Retear After Repair Surgery. Am J Sports Med 2017; 45:1755-1761. [PMID: 28319431 DOI: 10.1177/0363546517695234] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A retear is a significant clinical problem after rotator cuff repair. However, no study has evaluated the retear rate with regard to the extent of footprint coverage. PURPOSE To evaluate the preoperative and intraoperative factors for a retear after rotator cuff repair, and to confirm the relationship with the extent of footprint coverage. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were retrospectively collected from 693 patients who underwent arthroscopic rotator cuff repair between January 2006 and December 2014. All repairs were classified into 4 types of completeness of repair according to the amount of footprint coverage at the end of surgery. All patients underwent magnetic resonance imaging (MRI) after a mean postoperative duration of 5.4 months. Preoperative demographic data, functional scores, range of motion, and global fatty degeneration on preoperative MRI and intraoperative variables including the tear size, completeness of rotator cuff repair, concomitant subscapularis repair, number of suture anchors used, repair technique (single-row or transosseous-equivalent double-row repair), and surgical duration were evaluated. Furthermore, the factors associated with failure using the single-row technique and transosseous-equivalent double-row technique were analyzed separately. RESULTS The retear rate was 7.22%. Univariate analysis revealed that rotator cuff retears were affected by age; the presence of inflammatory arthritis; the completeness of rotator cuff repair; the initial tear size; the number of suture anchors; mean operative time; functional visual analog scale scores; Simple Shoulder Test findings; American Shoulder and Elbow Surgeons scores; and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis. Multivariate logistic regression analysis revealed patient age, initial tear size, and fatty degeneration of the supraspinatus as independent risk factors for a rotator cuff retear. Multivariate logistic regression analysis of the single-row group revealed patient age and fatty degeneration of the supraspinatus as independent risk factors for a rotator cuff retear. Multivariate logistic regression analysis of the transosseous-equivalent double-row group revealed a frozen shoulder as an independent risk factor for a rotator cuff retear. CONCLUSION Our results suggest that patient age, initial tear size, and fatty degeneration of the supraspinatus are independent risk factors for a rotator cuff retear, whereas the completeness of rotator cuff repair based on the extent of footprint coverage and repair technique are not.
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Affiliation(s)
- Yeong Seok Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeung Yeol Jeong
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan-Deok Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Gyoon Kang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Galanopoulos I, Ilias A, Karliaftis K, Papadopoulos D, Ashwood N. The Impact of Re-tear on the Clinical Outcome after Rotator Cuff Repair Using Open or Arthroscopic Techniques - A Systematic Review. Open Orthop J 2017; 11:95-107. [PMID: 28400878 PMCID: PMC5366380 DOI: 10.2174/1874325001711010095] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 12/20/2022] Open
Abstract
Background: It is generally accepted that rotator cuff repair gives satisfactory results in the long term, although most studies have so far shown a fairly high rate of structural failure or re-tear. The purpose of this review study is to assess whether failure of the repaired cuff to heal could negatively affect the functional outcome. Methods: This article includes an extensive Internet PubMed based research in the current English-language literature including level I to level V studies as well as systematic reviews. Results: According to this extended study research, the results are mixed; certain reports show that patients with a healed rotator cuff repair have improved function and strength compared to those with structural failure, whereas other studies support the generally perceived concept that tendon re-tear does not lead to inferior clinical outcome. Conclusion: Further high-level prospective studies with larger numbers of patients and longer follow up are needed to overcome the current debate over function between healed and failed rotator cuff repairs.
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Affiliation(s)
- Ilias Galanopoulos
- Department of Orthopedics, 401 General Military Hospital of Athens, Athens, Greece
| | - Aslanidis Ilias
- Department of Orthopedics, 401 General Military Hospital of Athens, Athens, Greece
| | | | | | - Neil Ashwood
- Department of Orthopedics, Queen's Hospital, Burton-on-Trent, United Kingdom
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D'Ambrosi R, Palumbo F, Paronzini A, Ragone V, Facchini RM. Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial. Musculoskelet Surg 2016; 100:25-32. [PMID: 27900700 DOI: 10.1007/s12306-016-0415-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Results on the effectiveness of PRP supplementation in arthroscopic rotator cuff repair are conflicting, making it difficult to draw definitive conclusions. METHODS This was a prospective, randomized, and double-blind study with two groups of 20 patients each (PRP group and control group). Degenerative supraspinatus full-thickness tears grade C2-C3 were subjected to arthroscopic repair; PRP supplementation was given to patients in the PRP group. The outcomes were assessed by DASH, Constant scales, and ultrasound before and 6 months after surgery. Pain measured by VAS was evaluated preoperatively and 7 and 30 days after surgery. RESULTS The two groups did not differ significantly by age, sex, and dominance of the affected side. In all surgical procedures, a long head of the biceps tenotomy and single-row repair were performed. The preoperative VAS was 5.6 ± 2.4 in PRP group and 6.4 ± 1.5 in the control group (p > 0.05). The group supplemented with PRP reported a VAS significantly better in the first week (2.5 ± 1.9 vs 5.3 ± 2.1, p < 0.05) and during the first month after surgery (1.5 ± 1.0 vs 3.2 ± 1.7, p < 0.05) compared to the control group. The preoperative Constant and DASH scores were 39.95 ± 12 and 51 ± 15.2, respectively, in the PRP group and 41 ± 11 (p > 0.05) and 45 ± 12.6 (p > 0.05) in the control group. The average Constant score improved significantly after 6 months to 81 ± 11.2 (p < 0.05) in the PRP group and 78.5 ± 9 (p < 0.05) in the control group. No differences were noted between the two groups (p > 0.05). The DASH score after 6 months was 17.4 ± 8 (p < 0.05) for the treatment group (the PRP group) and 21 ± 8.4 (p < 0.05) for the control group. No statistically significant differences were found as regards the DASH score in the two groups after 6 months (p > 0.05). The two groups showed no differences in the ultrasound evaluation after 6 months either. No re-ruptures occurred in either group. CONCLUSIONS PRP leads to a reduction in pain during a short-term follow-up. Pain reduction allows for a more rapid recovery of mobilization and improvement in functionality. LEVEL OF EVIDENCE Randomized controlled trial, Level of evidence, 1.
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Affiliation(s)
- R D'Ambrosi
- U.O. Clinica Ortopedica e Traumatologica, Centro Traumatologico Ortopedico, Università degli Studi di Milano, Milan, Italy.
| | - F Palumbo
- U.O. Clinica Ortopedica e Traumatologica, Centro Traumatologico Ortopedico, Università degli Studi di Milano, Milan, Italy
| | - A Paronzini
- U.O. Clinica Ortopedica e Traumatologica, Centro Traumatologico Ortopedico, Università degli Studi di Milano, Milan, Italy
| | - V Ragone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - R M Facchini
- U.O. Clinica Ortopedica e Traumatologica, Centro Traumatologico Ortopedico, Università degli Studi di Milano, Milan, Italy
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Saccomanno MF, Sircana G, Cazzato G, Donati F, Randelli P, Milano G. Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016. [PMID: 26197937 DOI: 10.1007/s00167-015-3700-y] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To identify prognostic factors significantly associated with rotator cuff repair outcome and define the strength of these associations. METHODS Search was performed using electronic databases. Studies reporting prognostic factors affecting rotator cuff repair outcome were included. Primary outcomes were: structural integrity, Disabilities of the Arm, Shoulder and Hand score, American Shoulder and Elbow Surgeons score, and Constant score. Each other outcome was considered as secondary outcome. Descriptive statistics was used. When possible, meta-analyses were performed. Methodological quality was assessed using the Quality In Prognosis Studies Tool. A best evidence synthesis was performed using the Grading of Recommendations Assessment, Development and Evaluation framework adapted to prognostic studies. RESULTS Sixty-four studies were included. Methodological quality was high only for twelve studies. The overall quality of evidence was low to very low. Meta-analyses were possible only for seven studies. Older age and larger tears size were found to affect retear risk. Results were controversial for fatty infiltration, acromioclavicular joint or biceps procedures, acromiohumeral distance, delamination of tendon edges, musculotendinous junction position, number of tendons involved, and tendon length, quality and retraction. Baseline scores and workers compensation claim predicted functional outcomes. Subjective outcome was also affected by patient's expectations. CONCLUSIONS Despite the large number of outcomes and prognostic factors evaluated by a relative small number of studies, almost not prognostic in design, it was not possible to reach any definitive conclusion regarding the most relevant predictors of outcome of rotator cuff repair. Moreover, the low methodological quality of the included studies and, subsequently, the low quality of evidence, seriously affected the strength of recommendation of the present review. Based on data available, retear risk is mainly affected by older age and larger tears size. Baseline scores and work compensation claim are the most significant predictors for functional outcomes. LEVEL OF EVIDENCE Systematic review of level I-IV prognostic studies, Level IV.
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Affiliation(s)
- Maristella F Saccomanno
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Giuseppe Sircana
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Gianpiero Cazzato
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Fabrizio Donati
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Pietro Randelli
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppe Milano
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy.
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Mook WR, Greenspoon JA, Millett PJ. Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique. Open Orthop J 2016; 10:286-295. [PMID: 27733881 PMCID: PMC5043448 DOI: 10.2174/1874325001610010286] [Citation(s) in RCA: 13] [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: 04/18/2015] [Revised: 04/28/2015] [Accepted: 02/01/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. METHODS The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. RESULTS The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. CONCLUSION Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears.
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Affiliation(s)
- William R Mook
- The Steadman Philippon Research Institute (W.R.M, J.A.G., P.J.M.) and The Steadman Clinic (W.R.M., P.J.M.), Vail, Colorado, U.S.A
| | - Joshua A Greenspoon
- The Steadman Philippon Research Institute (W.R.M, J.A.G., P.J.M.) and The Steadman Clinic (W.R.M., P.J.M.), Vail, Colorado, U.S.A
| | - Peter J Millett
- The Steadman Philippon Research Institute (W.R.M, J.A.G., P.J.M.) and The Steadman Clinic (W.R.M., P.J.M.), Vail, Colorado, U.S.A
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Predictors of Early Complications After Rotator Cuff Repair. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2016. [DOI: 10.1097/bte.0000000000000082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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30
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Tan M, Lam PH, Le BTN, Murrell GAC. Trauma versus no trauma: an analysis of the effect of tear mechanism on tendon healing in 1300 consecutive patients after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2016; 25:12-21. [PMID: 26264504 DOI: 10.1016/j.jse.2015.06.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with rotator cuff tears often recall a specific initiating event (traumatic), whereas many cannot (nontraumatic). It is unclear how important a history of trauma is to the outcomes of rotator cuff repair. METHODS This question was addressed in a study cohort of 1300 consecutive patients who completed a preoperative questionnaire regarding their shoulder injury and had a systematic evaluation of shoulder range of motion and strength, a primary arthroscopic rotator cuff repair performed by a single surgeon, an ultrasound scan, and the same subjective and objective measurements made of their shoulder 6 months after surgery. Post hoc, this cohort was separated into 2 groups: those who reported no history of trauma on presentation (n = 489) and those with a history of traumatic injury (n = 811). RESULTS The retear rate in the group with no history of trauma was 12%, whereas that of the group with a history of trauma was 14% (P = .36). Those patients with a history of shoulder trauma who waited longer than 24 months had higher retear rates (20%) than those who had their surgery earlier (13%) (P = .040). CONCLUSION Recollection of a traumatic initiating event had little effect on the outcome of arthroscopic rotator cuff repair. Duration of symptoms was important in predicting retears if patients recalled a specific initiating event but not in patients who did not recall any specific initiating event. Patients with a history of trauma should be encouraged to have their rotator cuff tear repaired within 2 years.
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Affiliation(s)
- Martin Tan
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Brian T N Le
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
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Miyazaki AN, Fregoneze M, Santos PD, da Silva LA, do Val Sella G, Santos RMM, de Souza A, Estelles JRD, Checchia SL. EVALUATION OF THE RESULTS FROM REOPERATIONS ON PATIENTS WITH ROTATOR CUFF LESIONS. Rev Bras Ortop 2015; 46:45-50. [PMID: 27026985 PMCID: PMC4799201 DOI: 10.1016/s2255-4971(15)30175-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 08/20/2010] [Indexed: 11/29/2022] Open
Abstract
Objectives: To assess the results from open or arthroscopic surgical treatment on patients with symptomatic recurrence of rotator cuff injuries. Methods: Between December 1990 and July 2007, 30 patients were assessed and underwent reoperation performed by the Shoulder and Elbow Surgery Group of the Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, Santa Casa de São Paulo, because of dehiscence of the rotator cuff suture. The study included patients with symptomatic recurrence of the injury and with at least 24 months of postoperative follow-up. Results: According to the UCLA evaluation criteria, 21 patients (70%) showed excellent or good outcomes; and nine patients (30%) showed fair or poor outcomes. Conclusion: Open or arthroscopic surgical treatment of recurrent rotator cuff injuries tended to present worse results than from the primary repair. In this study, we found that 70% of the results were excellent and good. The presence of extensive injuries in the reoperation tended to evolve with larger numbers of unsatisfactory results. In our study, we obtained better results from arthroscopic surgery than from open surgery.
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Affiliation(s)
- Alberto Naoki Miyazaki
- Assistant Professor and Head of the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Fregoneze
- Assistant Professor and Attending Physician in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Pedro Doneux Santos
- Attending Physician in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Luciana Andrade da Silva
- Attending Physician in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Guilherme do Val Sella
- Attending Physician in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Ruy Mesquita Maranhão Santos
- Trainee in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Adriano de Souza
- Trainee in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Sérgio Luiz Checchia
- Adjunct Professor, Academic Consultant and Member of the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
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Retear Rates After Arthroscopic Single-Row, Double-Row, and Suture Bridge Rotator Cuff Repair at a Minimum of 1 Year of Imaging Follow-up: A Systematic Review. Arthroscopy 2015; 31:2274-81. [PMID: 26188783 DOI: 10.1016/j.arthro.2015.06.004] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/11/2015] [Accepted: 06/04/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether there are differences in retear rates among arthroscopic single-row, double-row, and suture bridge rotator cuff repair. METHODS The literature was systematically reviewed for clinical outcome studies assessing arthroscopic single-row, double-row, or suture bridge rotator cuff repair. All included studies indicated the imaging-diagnosed retear rate stratified by preoperative tear size at a minimum of 1 year of follow-up, and retears were diagnosed with either magnetic resonance imaging, ultrasound, or arthrogram. Only studies with comprehensive surgical methods were included, and the repair type was confirmed by the number of rows of fixation and suture configuration. Studies from journals with an impact factor below 1.5 were excluded. Retear rates were grouped and statistically compared using χ(2) tests. RESULTS Thirty-two studies met the inclusion criteria, yielding a total of 2,048 repairs. Double-row repair (DR) and suture bridge repair (SB) both had significantly lower retear rates than single-row repair (SR) for tears sized 1 to 3 cm (DR, P < .001; SB, P < .001), less than 3 cm (DR, P < .001; SB, P = .004), greater than 3 cm (DR, P = .016; SB, P = .003), and greater than 5 cm (DR, P = .003; SB, P = .003), as well as total retear rates (DR, P = .024; SB, P = .022). DR and SB did not differ significantly from each other in any tear size category. CONCLUSIONS Both DR and SB have lower retear rates than SR in most tear size categories. No differences in retear rates were found between DR and SB. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Kluczynski MA, Nayyar S, Marzo JM, Bisson LJ. Early Versus Delayed Passive Range of Motion After Rotator Cuff Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2015; 43:2057-63. [PMID: 25296646 DOI: 10.1177/0363546514552802] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative rehabilitation has been shown to affect healing of the rotator cuff after surgical repair. However, it is unknown whether an early or delayed rehabilitation protocol is most beneficial for healing. PURPOSE To determine whether early versus delayed passive range of motion (PROM) affects rotator cuff (RC) retear rates after surgery. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review of the literature published between January 2003 and February 2014 was conducted. Retear rates were compared for early (within 1 week after surgery) versus delayed (3-6 weeks after surgery) PROM using χ(2) or Fisher exact tests as well as relative risks (RR) and 95% CIs. In the first analysis, data from evidence level 1 studies that directly compared early versus delayed PROM were pooled; and in the second analysis, data from level 1 to 4 studies that did not directly compare early versus delayed PROM were pooled. The second analysis was stratified by tear size and repair method. RESULTS Twenty-eight studies (1729 repairs) were included. The first analysis of level 1 studies did not reveal a significant difference in retear rates for early (13.7%) versus delayed (10.5%) PROM (P = .36; RR = 1.30 [95% CI, 0.74-2.30]). The second analysis revealed that for ≤3 cm tears, the risk of retear was lower for early versus delayed PROM for transosseous (TO) plus single-row anchor (SA) repairs (18.7% vs 28.2%, P = .02; RR = 0.66 [95% CI, 0.47-0.95]). For >5 cm tears, the risk of retear was greater for early versus delayed PROM for double-row anchor (DA) repairs (56.4% vs 20%, P = .002; RR = 2.82 [95% CI, 1.31-6.07]) and for all repair methods combined (52.2% vs 22.6%, P = .01; RR = 2.31 [95% CI, 1.16-4.61]). There were no statistically significant associations for tears measuring <1 cm, 1 to 3 cm, 3 to 5 cm, and >3 cm. CONCLUSION Evidence is lacking with regard to the optimal timing of PROM after RC repair; however, this study suggests that tear size may be influential.
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Affiliation(s)
- Melissa A Kluczynski
- Department of Orthopaedics, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
| | - Samir Nayyar
- Department of Orthopaedics, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
| | - John M Marzo
- Department of Orthopaedics, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
| | - Leslie J Bisson
- Department of Orthopaedics, School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
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Shin SJ, Kook SH, Rao N, Seo MJ. Clinical Outcomes of Modified Mason-Allen Single-Row Repair for Bursal-Sided Partial-Thickness Rotator Cuff Tears: Comparison With the Double-Row Suture-Bridge Technique. Am J Sports Med 2015; 43:1976-82. [PMID: 26055919 DOI: 10.1177/0363546515587718] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various repair techniques have been reported for the operative treatment of bursal-sided partial-thickness rotator cuff tears. Recently, arthroscopic single-row repair using a modified Mason-Allen technique has been introduced. HYPOTHESIS The arthroscopic, modified Mason-Allen single-row technique with preservation of the articular-sided tendon provides satisfactory clinical outcomes and similar results to the double-row suture-bridge technique after conversion of a partial-thickness tear to a full-thickness tear. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective study was conducted on 84 consecutive patients with symptomatic, bursal-sided partial-thickness rotator cuff tears involving more than 50% thickness of the tendon. A total of 47 patients were treated by the modified Mason-Allen single-row repair technique, preserving the articular-sided tendon, and 37 patients were treated by the double-row suture-bridge repair technique after conversion to a full-thickness tear. The clinical and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores and a visual analog scale (VAS) for pain and satisfaction of patients. Magnetic resonance imaging (MRI) was used to analyze the integrity of tendons at 6-month follow-up. Patients were followed up for a mean of 32.5 months. RESULTS In the 47 patients treated with the modified Mason-Allen suture technique, the VAS score decreased from a preoperative mean of 5.3 ± 0.3 to 0.9 ± 0.5 at the time of final follow-up. There was a statistically significant increase in the mean ASES score (from 45.4 ± 2.9 to 88.6 ± 4.5) and mean Constant score (from 66.9 ± 2.6 to 88.1 ± 2.4) (P < .001). Four of 47 patients (8.5%) demonstrated retears at 6-month postoperative MRI. There was no statistical difference in terms of functional outcomes and the retear rate compared with those of patients with the suture-bridge repair technique (3 patients, 8.1%). However, the mean number of suture anchors used in the patients with modified Mason-Allen suture repair (1.2 ± 0.4) was significantly fewer than that in the patients with suture-bridge repair (3.2 ± 0.4) (P < .01). CONCLUSION The modified Mason-Allen single-row repair technique that preserved the articular-sided tendon provided satisfactory clinical outcomes in patients with symptomatic, bursal-sided partial-thickness rotator cuff tears. Despite a fewer number of suture anchors, the shoulder functional outcomes and retear rate in patients after modified Mason-Allen repair were comparable with those of patients who underwent double-row suture-bridge repair. Therefore, the modified Mason-Allen single-row repair technique using a triple-loaded suture anchor can be considered as an effective treatment in patients with bursal-sided partial-thickness rotator cuff tears.
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Affiliation(s)
- Sang-Jin Shin
- Global Top 5 Research Program, Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Seung-Hwan Kook
- Global Top 5 Research Program, Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Nandan Rao
- Global Top 5 Research Program, Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Myeong-Jae Seo
- Global Top 5 Research Program, Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
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Saccomanno MF, Cazzato G, Fodale M, Sircana G, Milano G. Magnetic resonance imaging criteria for the assessment of the rotator cuff after repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2015; 23:423-42. [PMID: 25557222 DOI: 10.1007/s00167-014-3486-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/11/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this systematic review was to detect the reliability of the currently available magnetic resonance imaging measurements used in the evaluation of repaired rotator cuff. METHODS Search was performed using major electronic databases from their inception to February 2014. All studies reporting post-operative magnetic resonance assessment after rotator cuff repair were included. After the identification of available magnetic resonance criteria, reliability studies were further analysed. Descriptive statistics were used to summarize findings. Methodological quality was assessed using the Quality Appraisal of Reliability Studies checklist. RESULTS One hundred and twenty studies were included in the review. Twenty-six different criteria were identified. Ten studies reported inter-observer reliability, and only two assessed intra-observer reliability of some of the identified criteria. Structural integrity was the most investigated criterion. The dichotomized Sugaya's classification showed the highest reliability (k = 0.80-0.91). All other criteria showed moderate to low inter-observer reliability. Tendon signal intensity and footprint coverage showed a complete discordance. Intra-observer reliability was high for the presence of structural integrity, and moderate to low for all other criteria. Methodological quality was high only for one study and moderate for three studies. CONCLUSIONS Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff after repair. Reliability of most of them has not been analysed yet. With the data available, only the presence of structural integrity showed good intra- and inter-observer agreement. LEVEL OF EVIDENCE Systematic review of descriptive and qualitative studies, Level IV.
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Affiliation(s)
- Maristella F Saccomanno
- Division of Orthopaedic Surgery, Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
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Wlk MV, Abdelkafy A, Hexel M, Krasny C, Aigner N, Meizer R, Landsiedl F. Biomechanical evaluation of suture-tendon interface and tissue holding of three suture configurations in torn and degenerated versus intact human rotator cuffs. Knee Surg Sports Traumatol Arthrosc 2015; 23:386-92. [PMID: 24744172 DOI: 10.1007/s00167-014-2988-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 04/02/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to biomechanically evaluate suture-tendon interface and tissue holding of three sutures in torn and degenerated versus intact human rotator cuffs. METHODS Sixty-three human rotator cuff tendons were divided into torn degenerated group (TDG), n = 21 and intact group (IG), n = 42. Ultimate tension load (UTL) and cyclic loading were tested for three arthroscopic sutures: simple, horizontal, and massive cuff sutures (MCS). RESULTS Ultimate tension load was significantly higher (p < 0.05) for the MCS (194 ± 68 N) in comparison with the simple (105 ± 48 N) and horizontal sutures (141 ± 49 N) in IG. In TDG, UTL was not significantly higher (n.s.) for MCS (118 ± 49 N), simple (79 ± 30 N), and horizontal sutures (107 ± 28 N) in comparison with IG. MCS (118 ± 49 N) showed no significantly superior UTL in comparison with the simple and horizontal sutures in the TDG. MCA elongation was 0.6 ± 0.7 mm in the IG and 1.3 ± 0.7 mm in the TDG, while horizontal suture elongation was 0.7 ± 0.4 mm in the IG and 1.3 ± 0.5 mm in the TDG. Simple suture elongation was 1.1 ± 0.5 mm in the IG and 1.6 ± 0.7 mm in the TDG. CONCLUSION Human torn and degenerated rotator cuffs have poor tissue quality, significantly lower UTL and higher cyclic elongation in comparison with intact cuffs regardless of the type of suture used for repair, which invites the need for repair techniques that grasps greater tissue volume in addition to augmentation techniques. CLINICAL RELEVANCE Clinicians better use repair techniques that grasp greater tissue volume (e.g. MCS, modified Mason-Allen cross bridge, double-row cross bridge, etc.) when repairing the torn and degenerated rotator cuffs.
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Affiliation(s)
- Matthias V Wlk
- Orthopaedic Department, Herz-Jesu Hospital, Baumgasse 20A, 1030, Vienna, Austria
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Abstract
Several studies have noted that increasing age is a significant factor for diminished rotator cuff healing, while biomechanical studies have suggested the reason for this may be an inferior healing environment in older patients. Larger tears and fatty infiltration or atrophy negatively affect rotator cuff healing. Arthroscopic rotator cuff repair, double-row repairs, performing a concomitant acromioplasty, and the use of platelet-rich plasma (PRP) do not demonstrate an improvement in structural healing over mini-open rotator cuff repairs, single-row repairs, not performing an acromioplasty, or not using PRP. There is conflicting evidence to support postoperative rehabilitation protocols using early motion over immobilization following rotator cuff repair.
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Affiliation(s)
- Nathan A Mall
- Regeneration Orthopedics, 6 McBride and Son Center Drive, Suite 204, St. Louis, MO 63005. E-mail address for N.A. Mall: . E-mail address for L.S. Choi: . E-mail address for G.A. Paletta Jr.:
| | - Miho J Tanaka
- Regeneration Orthopedics, 6 McBride and Son Center Drive, Suite 204, St. Louis, MO 63005. E-mail address for N.A. Mall: . E-mail address for L.S. Choi: . E-mail address for G.A. Paletta Jr.:
| | - Luke S Choi
- Regeneration Orthopedics, 6 McBride and Son Center Drive, Suite 204, St. Louis, MO 63005. E-mail address for N.A. Mall: . E-mail address for L.S. Choi: . E-mail address for G.A. Paletta Jr.:
| | - George A Paletta
- Regeneration Orthopedics, 6 McBride and Son Center Drive, Suite 204, St. Louis, MO 63005. E-mail address for N.A. Mall: . E-mail address for L.S. Choi: . E-mail address for G.A. Paletta Jr.:
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Le BTN, Wu XL, Lam PH, Murrell GAC. Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs. Am J Sports Med 2014; 42:1134-42. [PMID: 24748610 DOI: 10.1177/0363546514525336] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rate of retears after rotator cuff repair varies from 11% to 94%. A retear is associated with poorer subjective and objective clinical outcomes than intact repair. PURPOSE This study was designed to determine which preoperative and/or intraoperative factors held the greatest association with retears after arthroscopic rotator cuff repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study retrospectively evaluated 1000 consecutive patients who had undergone a primary rotator cuff repair by a single surgeon using an arthroscopic inverted-mattress knotless technique and who had undergone an ultrasound evaluation 6 months after surgery to assess repair integrity. Exclusion criteria included previous rotator cuff repair on the same shoulder, incomplete repair, and repair using a synthetic polytetrafluoroethylene patch. All patients had completed the modified L'Insalata Questionnaire and underwent a clinical examination before surgery. Measurements of tear size, tear thickness, associated shoulder injury, tissue quality, and tendon mobility were recorded intraoperatively. RESULTS The overall retear rate at 6 months after surgery was 17%. Retears occurred in 27% of full-thickness tears and 5% of partial-thickness tears (P < .0001). The best independent predictors of retears were anteroposterior tear length (correlation coefficient r = 0.41, P < .0001), tear size area (r = 0.40, P < .0001), mediolateral tear length (r = 0.34, P < .0001), tear thickness (r = 0.29, P < .0001), age at surgery (r = 0.27, P < .0001), and operative time (r = 0.18, P < .0001). These factors produced a predictive model for retears: logit P = (0.039 × age at surgery in years) + (0.027 × tear thickness in %) + (1 × anteroposterior tear length in cm) + (0.76 × mediolateral tear length in cm) - (0.17 × tear size area in cm(2)) + (0.018 × operative time in minutes) -9.7. Logit P can be transformed into P, which is the chance of retears at 6 months after surgery. CONCLUSION A rotator cuff retear is a multifactorial process with no single preoperative or intraoperative factor being overwhelmingly predictive of it. Nevertheless, rotator cuff tear size (tear dimensions, tear size area, and tear thickness) showed stronger associations with retears at 6 months after surgery than did measures of tissue quality and concomitant shoulder injuries.
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Affiliation(s)
- Brian T N Le
- George A.C. Murrell, MBBS, DPhil, Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, 4-10 South Street, Level 2, Kogarah, NSW 2217, Australia.
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Prognostic factors for successful recovery after arthroscopic rotator cuff repair: a systematic literature review. J Orthop Sports Phys Ther 2014; 44:153-63. [PMID: 24450368 DOI: 10.2519/jospt.2014.4832] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES To perform a systematic review of the literature on prognostic factors for successful recovery after arthroscopic rotator cuff repair. BACKGROUND Rotator cuff lesion is a common shoulder disorder, with a prevalence ranging from 13% in people over 50 years of age to more than 50% in people over 80 years of age. Several factors can affect the extent to which a person will recover after the surgical repair of a rotator cuff tear. More knowledge about these prognostic factors may lead to a better understanding of why the recovery process is successful in some patients but not in others. METHODS A systematic literature search from 1995 to November 2013 was performed to identify studies reporting prognostic factors for successful recovery after arthroscopic rotator cuff repair. RESULTS A total of 455 studies were initially identified, 10 of which were included in the review. For all included studies, the percentage of patients with complete tendon healing at final assessment ranged from 60% to 88%. Twelve prognostic factors, which could be divided into 4 categories, were identified as being associated with better recovery: demographic factors (younger age, male gender), clinical factors (higher bone mineral density, absence of diabetes mellitus, higher level of sports activity, greater preoperative range of motion, absence of obesity), factors related to cuff integrity (smaller sagittal size of the cuff lesion, less retraction of the cuff, less fatty infiltration, no multiple tendon involvement), and factors related to the surgical procedure (no concomitant biceps or acromioclavicular joint procedures). CONCLUSION Knowledge and understanding of prognostic factors should be used in the decision-making process concerning arthroscopic rotator cuff repair to offer better care to patients. LEVEL OF EVIDENCE Prognosis, level 2a-.
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Chen M, Xu W, Dong Q, Huang Q, Xie Z, Mao Y. Outcomes of single-row versus double-row arthroscopic rotator cuff repair: a systematic review and meta-analysis of current evidence. Arthroscopy 2013; 29:1437-49. [PMID: 23711754 DOI: 10.1016/j.arthro.2013.03.076] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 03/14/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Our purpose was to perform a systematic review and meta-analysis of the clinical outcomes of single-row versus double-row repair. METHODS An electronic search was performed using PubMed, EMBASE, and the Cochrane Library up to September 30, 2012. Studies that met the inclusion and exclusion criteria were assessed for quality of methodology. The primary analysis included Level I evidence from studies examining single-row versus double-row repair. The second meta-analysis and subgroup analysis were performed for evidence Levels I, II, and III. RESULTS The primary analysis of studies providing 6 Level I randomized controlled trials showed no clinically significant differences in Constant scores, University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores between double-row and single-row rotator cuff repair. The overall odds ratio (OR) of intact rotator cuff tendon healing was 1.93 in patients treated with double-row versus single-row repair, and the difference was significant. The results of the second meta-analysis including evidence Levels I, II, and III were similar to those of the primary analysis. In the subgroup with tears less than 3 cm, there was no statistically significant difference between the groups with regard to shoulder functional score and structure integrity. A statistically significant benefit of double-row repair in the ASES and UCLA scores was observed in the subgroup with tears greater than 3 cm; however, these differences were not clinically significant. The OR for tendon healing was found to be more favorable for double-row repair than for single-row repair in the subgroup with tears greater than 3 cm. CONCLUSIONS Double-row repair provides a significantly higher rate of intact tendon healing than does single-row repair, and this advantage was mainly reflected in patients with large or massive tears. However, this benefit did not translate into clinically confirmed functional improvement. Thus, the double-row technique should be used only in carefully selected patients. LEVEL OF EVIDENCE Level III, systematic review of Levels I, II, and III studies.
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Affiliation(s)
- Ming Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Melean P, Lichtenberg S, Montoya F, Riedmann S, Magosch P, Habermeyer P. The acromial index is not predictive for failed rotator cuff repair. INTERNATIONAL ORTHOPAEDICS 2013; 37:2173-9. [PMID: 23793462 DOI: 10.1007/s00264-013-1963-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 05/30/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The main objective of this study was to evaluate the association between the acromial index (AI) and the incidence of recurrent tears of the rotator cuff (RC) in a cohort of patients with full thickness tears who underwent arthroscopic primary repair. METHODS A prognostic study of a prospective case series of 103 patients with full thickness RC tears was undertaken. The average age was 59.5 years (39-74) and follow-up was 30.81 months (12-72). True anterior-posterior X-rays were obtained during the pre-operative evaluation. Pre and post-operative magnetic resonance imaging (MRI) were recorded. RESULTS Eighteen cases with recurrent tears (17.4%) were seen on post-operative MRI. The average AI for patients with recurrent tears was 0.711 ± 0.065 and for patients without recurrent tears 0.710 ± 0.064 (p < 0.05). A positive association between age and recurrent tears of the RC was noted (average ages: recurrent tears group 63 ± 5.9 years; group without recurrent tears 58.8 ± 7.5 years) (r = -0.216; p = 0.029). We did not find an association between size of the primary tear and recurrent tears (r = -0.075; p < 0.05) or between degrees of retraction of the primary and recurrent tears of the cuff (r = -0.073; p < 0.05). We observed that 38.9% of the recurrent tears cases presented with more than one tendon affected before the arthroscopy. At follow-up, none of these recurrent tears showed more than one tendon affected on MRI evaluation. CONCLUSION In this study, we found that the AI radiological measurement is not a predictor for recurrent tears of the RC after primary arthroscopic repair.
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Affiliation(s)
- Patricio Melean
- Orthopaedics Department, Hospital del Trabajador, Santiago, Chile,
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Kukkonen J, Joukainen A, Lehtinen J, Aärimaa V. The effect of glenohumeral osteoarthritis on the outcome of isolated operatively treated supraspinatus tears. J Orthop Sci 2013; 18:405-9. [PMID: 23512014 DOI: 10.1007/s00776-013-0369-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/13/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rotator cuff tear is considered to be a common source of shoulder pain and dysfunction. Osteoarthritis of the glenohumeral joint (OAG) may coexist with rotator cuff tear, especially in elderly patients. The aim of the study was to evaluate the effect of associated OAG on the treatment outcome of rotator cuff repair. METHODS A total of 85 consecutive shoulders with an arthroscopically repaired isolated full-thickness supraspinatus tendon tear in males were included in this study. The grade of OAG was estimated preoperatively from shoulder radiographs using the Kellgren-Lawrence (K-L) classification, and peroperatively using the Outerbridge classification. Supraspinatus tendon tear was re-inserted anatomically to the native footprint in all cases. The Constant score was used as an outcome measure and was measured preoperatively and 1 year after the operation. The effect of OAG on the Constant score was analyzed statistically. RESULTS 82 shoulders (96.5 %) were available for the 1-year follow-up. Preoperative OAG was detected in 22/82 patients (26.8 %). Any OAG above K-L grade 0 was associated with a lower Constant score preoperatively [49.9 (SD 17.6) vs. 60.1 (SD 16.7) (p = 0.0185)] and also at the 1-year follow-up [73.9 (SD 17.5) vs. 82.8 (SD 10.9) (p = 0.0074)]. 16/60 patients (26.7 %) with K-L grade 0 radiographs had peroperatively detected OAG. Furthermore, any peroperatively detected OAG was associated with a lower Constant score preoperatively [53.2 (SD 19.0) vs. 60.9 (SD 15.2) (p = 0.0445)] and at the 1-year follow-up 76.8 [(SD 14.8) vs. 83.5 (SD 11.4) (p = 0.0223)]. CONCLUSION OAG is a relatively common finding in operated supraspinatus tear patients. Pre- and peroperatively detected OAG during rotator cuff reconstruction is predictive for lower pre- and postoperative Constant scores.
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Affiliation(s)
- Juha Kukkonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, P.O. Box 28, 20701, Turku, Finland.
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Mall NA, Lee AS, Chahal J, Sherman SL, Romeo AA, Verma NN, Cole BJ. An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears. Arthroscopy 2013; 29:366-76. [PMID: 23290186 DOI: 10.1016/j.arthro.2012.06.024] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/24/2012] [Accepted: 06/25/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to systematically review the literature to better define the epidemiology, mechanism of injury, tear characteristics, outcomes, and healing of traumatic rotator cuff tears. A secondary goal was to determine if sufficient evidence exists to recommend early surgical repair in traumatic rotator cuff tears. METHODS An independent systematic review was conducted of evidence Levels I to IV. A literature search of PubMed, Medline, Embase, and Cochrane Collaboration of Systematic Reviews was conducted, with 3 reviewers assessing studies for inclusion, methodology of individual study, and extracted data. RESULTS Nine studies met the inclusion and exclusion criteria. Average patient age was 54.7 (34 to 61) years, and reported mean time to surgical intervention, 66 days (3 to 48 weeks) from the time of injury. The most common mechanism of injury was fall onto an outstretched arm. Supraspinatus was involved in 84% of tears, and infraspinatus was torn in 39% of shoulders. Subscapularis tears were present in 78% of injuries. Tear size was <3 cm in 22%, 3 to 5 cm in 36%, and >5 cm in 42%. Average active forward elevation improved from 81° to 150° postoperatively. The weighted mean postoperative UCLA score was 30, and the Constant score was 77. CONCLUSIONS Traumatic rotator cuff tears are more likely to occur in relatively young (age 54.7), largely male patients who suffer a fall or trauma to an abducted, externally rotated arm. These tears are typically large and involve the subscapularis, and repair results in acceptable results. However, insufficient data prevent a firm recommendation for early surgical repair. LEVEL OF EVIDENCE Level IV, systematic review Levels III and IV studies.
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Affiliation(s)
- Nathan A Mall
- Sports Medicine Program, Rush University Medical Center, Chicago, Illinois 60612, USA
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Pietschmann MF, Frankewycz B, Schmitz P, Docheva D, Sievers B, Jansson V, Schieker M, Müller PE. Comparison of tenocytes and mesenchymal stem cells seeded on biodegradable scaffolds in a full-size tendon defect model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:211-220. [PMID: 23090834 DOI: 10.1007/s10856-012-4791-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 10/08/2012] [Indexed: 06/01/2023]
Abstract
In order to investigate cell-based tendon regeneration, a tendon rupture was simulated by utilizing a critical full-size model in female rat achilles tendons. For bridging the defect, polyglycol acid (PGA) and collagen type I scaffolds were used and fixed with a frame suture to ensure postoperatively a functional continuity. Scaffolds were seeded with mesenchymal stem cells (MSC) or tenocytes derived from male animals, while control groups were left without cells. After a healing period of 16 weeks, biomechanical, PCR, histologic, and electron microscopic analyses of the regenerates were performed. Genomic PCR for male-specific gene was used to detect transplanted cells in the regenerates. After 16 weeks, central ossification and tendon-like tissue in the superficial tendon layers were observed in all study groups. Biomechanical test showed that samples loaded with tenocytes had significantly better failure strength/cross-section ratio (P < 0.01) compared to MSC and the control groups whereas maximum failure strength was similar in all groups. Thus, we concluded that the application of tenocytes improves the outcome in this model concerning the grade of ossification and the mechanical properties in comparison to the use of MSC or just scaffold materials.
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Affiliation(s)
- M F Pietschmann
- Department of Orthopaedics, Ludwig-Maximilians-University (LMU), Munich, Germany.
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Abstract
Rotator cuff disease accounts for more than 4.5 million annual visits to a physician, and more than 75,000 surgical repairs are performed a year. Surgical techniques have evolved from all open repairs to all arthroscopic repairs being the most commonly used. The purpose of this article is to review the current evidence regarding the outcomes of surgical techniques in rotator cuff surgery. Reported outcomes have been favorable with open, mini-open, and arthroscopic repairs. Recently, a committee sponsored by the AAOS published a clinical practice guideline summary regarding the management of rotator cuff tears. The guidelines touched aspects of both nonoperative and operative repair. In regard to operative repair, the committee could not recommend a modality of surgical repair (eg, arthroscopic vs open) as a superior method, citing a lack of comparative studies. The theoretical advantage of arthroscopic surgery lies in smaller soft tissue dissection and the ability to evaluate and treat the glenohumeral joint. However, no study using patient-based outcomes has shown superiority compared with open or mini-open repairs. With the method of surgical repair not changing outcomes, investigation has recently focused on optimizing bone-tendon healing in rotator cuff repair. Double-row fixation allows for a more anatomic reapproximation of the rotator cuff footprint on the greater tuberosity versus single-row and has been shown to be biomechanically superior. Despite this, no clinical studies have shown superiority of one type of repair versus the other. The AAOS committee citing similar evidence gave a weak recommendation for the use of achieving tendon-to-bone healing with double-row fixation. Transosseous-equivalent repair, which provides a high compressive force on the tendon-to-bone interface of repair, is the newest fixation method under investigation to optimize healing. The use of collagen and biologic augmentation has gained interest as researchers are attempting to optimize rotator cuff healing. There is moderate evidence against the use of porcine small intestine submucosa xenograft patches. Other commercially available collagen augments have yet to be proven as either beneficial or detrimental. Other than PRP, which has not shown to have any benefit augmenting repair, no biologic augment has been investigated clinically. Overall, rotator cuff surgery portends a good outcome for appropriately selected patients. However, there is not much high-quality evidence-based research that can be used to conclude what surgical treatments are superior or appropriate for a given patient. Future research should be aimed at identifying whether and in whom rotator cuff healing is appropriate to better identify surgical candidates as well as to determine the best surgical repair strategy.
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Kukkonen J, Kauko T, Virolainen P, Äärimaa V. Smoking and operative treatment of rotator cuff tear. Scand J Med Sci Sports 2012. [PMID: 23206267 DOI: 10.1111/sms.12020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This registry study was set up to evaluate the effect of smoking on the pre-operative status, intraoperative findings, and post-operative status after rotator cuff reconstruction. Five hundred seventy-six consecutive shoulders with primarily arthroscopically repaired penetrating rotator cuff tear were followed up. Tobacco consumption was recorded as pack-years. Age-adjusted Constant score was used as an outcome measure. Five hundred sixty-four patients were available for 1-year follow-up (dropout rate 2%). One hundred fourteen (20%) and 450 (80%) patients were pre-operatively recorded to be smokers and non-smokers, respectively. The gender distribution did not differ between the groups (P = 0.286). The mean age of all patients was 55 years in smokers (SD 9.1) and 61 years in non-smokers (SD 9.4) (P < 0.001). There was no statistically significant difference in pre-operative Constant score (P = 0.075) or mean size of intraoperatively measured tendon tear (P = 0.290) between the groups. At final follow-up, there was a statistically significant difference in Constant scores between smokers [71 (SE 1.4)] and non-smokers [75 (SE 0.7)] (P = 0.017). The pack-years of smoking correlated with neither the Constant score (P = 0.815) nor the size of the tear (P = 0.786). We conclude that operatively treated rotator cuff tear patients who smoked were significantly younger than non-smokers, and that smoking was associated with lower post-operative Constant score.
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Affiliation(s)
- J Kukkonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
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Gerhardt C, Hug K, Pauly S, Marnitz T, Scheibel M. Arthroscopic single-row modified mason-allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched-pair analysis. Am J Sports Med 2012; 40:2777-85. [PMID: 23104608 DOI: 10.1177/0363546512462123] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic double-row fixation of supraspinatus tendon tears compared with single-row techniques is still a matter of debate. HYPOTHESIS Arthroscopic double-row rotator cuff repair using the suture bridge technique provides better clinical results and lower retear rates than does single-row repair using a modified Mason-Allen stitch technique. STUDY DESIGN Cohort study; Level of evidence 3. METHODS Forty patients underwent either an arthroscopic single-row modified Mason-Allen stitch (SR) (n = 20; mean age ± SD, 61.5 ± 7.4 y) or a modified suture bridge double-row repair (DR) (n = 20; age, 61.2 ± 7.5 y). The anteroposterior extension was classified as Bateman I in 10% and Bateman II in 90% of patients in the SR group and as Bateman II in 80% and Bateman III in 20% of patients in the DR group. Patients were matched for sex and age. The subjective shoulder value (SSV), Constant-Murley score (CS), and Western Ontario Rotator Cuff Index (WORC) were used for clinical follow-up. Furthermore, MRI scans were conducted for analysis of tendon integrity, muscle atrophy, and fatty infiltration via semiquantitative signal intensity analysis. In addition, re-defect patterns were evaluated. RESULTS The mean follow-up time in the SR group was 16.8 ± 4.6 months. The mean SSV was 91.0% ± 8.8%, mean CS was 82.2 ± 8.1 (contralateral side, 88.8 ± 5.3), and mean WORC score was 96.5% ± 3.2%. The mean follow-up time in the DR group was 23.4 ± 2.9 months, with patients achieving scores of 92.9% ± 9.6% for the SSV, 77.0 ± 8.6 for the CS (contralateral side, 76.7 ± 17.1), and 90.7% ± 12.6% for the WORC (P > .05). No significant differences were detected in the clinical outcome between groups. Tendon integrity was as follows. Type 1, none in either group; type 2, 4 SR and 5 DR; type 3, 9 SR and 10 DR; type 4, 3 SR and 3 DR; and type 5, 3 SR and 2 DR. The failure rate was 31.6% (n = 6) in the SR group and 25% (n = 5) in the DR group (P > .05). No significant differences were obtained for muscular atrophy or fatty degeneration (SR group, 0.94 ± 0.16; DR group, 1.15 ± 0.5) (P > .05). Re-defects revealed lateral cuff failure in 83.3% of SR patients in contrast to patients treated with DR techniques. The re-defect pattern was medial cuff failure in 80% of the patients. CONCLUSION The clinical results after modified Mason-Allen single-row versus double-mattress suture bridge technique did not demonstrate significant differences in a matched patient cohort. Concerning the failure mode, single- and double-row techniques seem to demonstrate different re-defect patterns.
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Affiliation(s)
- Christian Gerhardt
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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Khazzam M, Kuhn JE, Mulligan E, Abboud JA, Baumgarten KM, Brophy RH, Jones GL, Miller B, Smith M, Wright RW. Magnetic resonance imaging identification of rotator cuff retears after repair: interobserver and intraobserver agreement. Am J Sports Med 2012; 40:1722-7. [PMID: 22707747 DOI: 10.1177/0363546512449424] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the most commonly used imaging modality to assess the rotator cuff. Currently, there are a limited number of studies assessing the interobserver and intraobserver reliability of MRI after rotator cuff repair. HYPOTHESIS Fellowship-trained orthopaedic shoulder surgeons will have good inter- and intraobserver agreement with regard to features of the repaired rotator cuff (repair integrity, fat content, muscle volume, number of tendons involved, tear size, and retract) on MRI. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Seven fellowship-trained orthopaedic shoulder surgeons reviewed 31 MRI scans from 31 shoulders from patients who had previous rotator cuff repair. The scans were evaluated for the following characteristics: rotator cuff repair status (full-thickness retear vs intact repair), tear location, tendon thickness, fatty infiltration, atrophy, number of tendons involved in retear, tendon retraction, status of the long head of the biceps tendon, and bone marrow edema in the humeral head. Surgeons were asked to review images at 2 separate time points approximately 9 months apart and complete an evaluation form for each scan at each time point. Multirater kappa (κ) statistics were used to assess inter- and intraobserver reliability. RESULTS The interobserver agreement was highest (80%, κ = 0.60) for identifying full-thickness retears, tendon retear retraction (64%, κ = 0.45), and cysts in the greater tuberosity (72%, κ = 0.43). All other variables were found to have fair to poor agreement. The worst interobserver agreement was associated with identifying rotator cuff footprint coverage (47%, κ = -0.21) and tendon signal intensity (29%, κ = -0.01). The mean intraobserver reproducibility was also highest (77%-90%, κ = 0.71) for full-thickness retears, quality of the supraspinatus (47%-83%, κ = 0.52), tears of the long head of the biceps tendon (58%-94%, κ = 0.49), presence of bone marrow edema in the humeral head (63%-87%, κ = 0.48), cysts in the greater tuberosity (70%-83%, κ = 0.47), signal in the long head of the biceps tendon (60%-80%, κ = 0.43), and quality of the infraspinatus (37-90%, κ = 0.43). The worst intraobserver reproducibility was found in identification of the location of bone marrow edema (22%-83%, κ = -0.03). CONCLUSION The results of this study indicate that there is substantial variability when evaluating MRI scans after rotator cuff repair. Intact rotator cuff repairs or full-thickness retears can be identified with moderate reliability. These findings indicate that additional imaging modalities may be needed for accurate assessment of the repaired rotator cuff.
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Affiliation(s)
- Michael Khazzam
- UT Southwestern Medical Center at Dallas, 1801 Inwood Rd, Dallas, TX 75390-8883.
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Jost PW, Khair MM, Chen DX, Wright TM, Kelly AM, Rodeo SA. Suture number determines strength of rotator cuff repair. J Bone Joint Surg Am 2012; 94:e100. [PMID: 22810407 DOI: 10.2106/jbjs.k.00117] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Failure of surgical repair of a rotator cuff tear continues to be a clinical problem. For other tendon repairs, increasing the number of sutures improves both biomechanical performance and clinical outcomes. Several investigators have shown biomechanical advantages of double-row techniques but have used many more sutures than were used with the single-row techniques with which the double-row techniques were compared. The purposes of our study were to establish whether using a greater number of sutures would improve the biomechanical properties of a rotator cuff repair model, and whether using equal numbers of sutures would lead to equivalent results between single and double-row configurations. METHODS Fresh-frozen sheep infraspinatus tendons underwent single-row repair with two, four, or six mattress sutures and double-row repair with use of four mattress sutures. Specimens were pretensioned at 10 N for one minute, then cycled from 10 to 180 N for 200 cycles at 0.2 Hz; this was followed by load to failure. Cyclic gap formation, failure load, and failure type were recorded. RESULTS The four-suture single-row and four-suture double-row repairs had similar gap formation during cyclic testing, with no significant differences between them. Cyclic gap formation in the two-suture single-row group was 6.7 and 7.1 mm (97% and 109%) greater than that in the four and six-suture single-row groups after 200 cycles (p < 0.001). The average loads to failure of the two, four, and six-suture single-row groups were 274, 362, and 572 N (p < 0.0001). The average load to failure of the four-suture double-row group was 386 N, which was similar to the value in the four-suture single-row group (p = 0.58). CONCLUSIONS In an ovine rotator cuff tendon repair model, increasing the number of sutures decreased cyclic gap formation and increased load to failure. Single and double-row repairs are biomechanically equivalent when the number of sutures is kept constant. CLINICAL RELEVANCE The results of this study support the use of greater numbers of sutures in rotator cuff repair and disagree with the assertion that double-row repairs are biomechanically superior to single-row repairs.
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Affiliation(s)
- Patrick W Jost
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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DeHaan AM, Axelrad TW, Kaye E, Silvestri L, Puskas B, Foster TE. Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review. Am J Sports Med 2012; 40:1176-85. [PMID: 22156169 DOI: 10.1177/0363546511428866] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The advantage of single-row versus double-row arthroscopic rotator cuff repair techniques has been a controversial issue in sports medicine and shoulder surgery. There is biomechanical evidence that double-row techniques are superior to single-row techniques; however, there is no clinical evidence that the double-row technique provides an improved functional outcome. HYPOTHESIS When compared with single-row rotator cuff repair, double-row fixation, although biomechanically superior, has no clinical benefit with respect to retear rate or improved functional outcome. STUDY DESIGN Systematic review. METHODS The authors reviewed prospective studies of level I or II clinical evidence that compared the efficacy of single- and double-row rotator cuff repairs. Functional outcome scores included the American Shoulder and Elbow Surgeons (ASES) shoulder scale, the Constant shoulder score, and the University of California, Los Angeles (UCLA) shoulder rating scale. Radiographic failures and complications were also analyzed. A test of heterogeneity for patient demographics was also performed to determine if there were differences in the patient profiles across the included studies. RESULTS Seven studies fulfilled our inclusion criteria. The test of heterogeneity across these studies showed no differences. The functional ASES, Constant, and UCLA outcome scores revealed no difference between single- and double-row rotator cuff repairs. The total retear rate, which included both complete and partial retears, was 43.1% for the single-row repair and 27.2% for the double-row repair (P = .057), representing a trend toward higher failures in the single-row group. CONCLUSION Through a comprehensive literature search and meta-analysis of current arthroscopic rotator cuff repairs, we found that the single-row repairs did not differ from the double-row repairs in functional outcome scores. The double-row repairs revealed a trend toward a lower radiographic proven retear rate, although the data did not reach statistical significance. There may be a concerning trend toward higher retear rates in patients undergoing a single-row repair, but further studies are required.
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Affiliation(s)
- Alexander M DeHaan
- Department of Orthopaedic Surgery and Sports Medicine, Boston University School of Medicine, Boston, MA, USA
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