Atelocollagen Injection During Arthroscopic Rotator Cuff Repair for Small- to Medium-Sized Subacute or Chronic Rotator Cuff Tears Enhances Radiographic Tendon Integrity: A Propensity Score-Matched Comparative Study

Injection of an allodermal matrix and leukocyte-rich platelet-rich plasma mixture improved the tendon integrity in cases of full-thickness common extensor tendon tears of the elbow: Two case reports

RATIONALE

Lateral epicondylitis, commonly known as tennis elbow, is a chronic condition characterized by tendinosis at the insertion site of the lateral epicondyle. Various treatment methods are available, ranging from conservative to surgical options for refractory lateral epicondylitis. Recently, platelet-rich plasma (PRP) injections have shown effectiveness for treating this condition. This study aimed to evaluate the effectiveness of injecting a mixture of allodermal matrix (ADM) and leukocyte-rich PRP (LRPRP) for tendon regeneration.

PATIENT CONCERNS

A 59-year-old man and a 62-year-old man, both with full-thickness tears in the common extensor tendon, presented persistent elbow pain despite undergoing several conservative treatments, including steroid injections, extracorporeal shock wave therapy, physical therapy, and medication previously.

DIAGNOSES

The patients were diagnosed with refractory lateral epicondylitis using ultrasonography and magnetic resonance imaging (MRI).

INTERVENTIONS

We performed injections of a mixture of ADM and LRPRP into the full-thickness tear of the common extensor tendon.

OUTCOMES

One year after the procedure, visual analogue scale pain scores, patient-rated tennis elbow evaluation scores, quick disabilities of the arm, shoulder, and hand scores, and Nirschl scores had all improved significantly from baseline. In case 1, MRI scans obtained at 6 and 12 months postinjection demonstrated improved tendon integrity in full-thickness tear of the common extensor tendon. In case 2, similar improvements were observed on the 6-month postinjection MRI.

LESSONS

Injection of a mixture of ADM and LRPRP at the site of full-thickness tears in the common extensor tendon of the elbow can enhance tendon integrity. This treatment also improves functional status in cases of recalcitrant lateral epicondylitis.

The Incidence of Popeye Deformity After Soft-Tissue Biceps Tenodesis Is Comparable to Biceps Anchor Tenodesis and Lower Than Biceps Tenotomy During Arthroscopic Rotator Cuff Repair

PURPOSE

To compare clinical and radiologic outcomes between biceps anchor tenodesis (AT), biceps soft-tissue tenodesis (ST), and biceps tenotomy (TT) for patients with concomitant rotator cuff repair (RCR).

METHODS

This retrospective study reviewed patients who underwent arthroscopic RCR for full-thickness rotator cuff tears with AT, ST, or TT with minimum 2-year follow-up. All biceps procedures were performed arthroscopically, and ST consisted of fixation to the transverse humeral ligament. We excluded massive rotator cuff tears, additional biceps procedures, and revisions. Patient-reported outcome measures (PROMs) (visual analog scale [VAS] pain score, VAS functional score, American Shoulder and Elbow Surgeons score, and Constant score) and elbow flexion (EF) strength were evaluated preoperatively and at final follow-up.

RESULTS

A total of 155 patients (50 AT, 52 ST, and 53 TT patients) were included in this study. The AT group was younger (mean age, 58.7 ± 6.3 years in AT group, 67.6 ± 5.0 years in ST group, and 66.1 ± 5.3 years in TT group) and had a lower proportion of female patients (13 [26.0%] in AT group, 31 [59.6%] in ST group, 39 [73.6%] in TT group) than the ST and TT groups (all P < .001). At final follow-up, PROM scores were significantly improved in all 3 groups (all P < .001). The VAS pain score (P = .134), VAS functional score (P = .616), and American Shoulder and Elbow Surgeons score (P = .093) at final follow-up showed no significant differences between the 3 groups. The Constant score and EF strength were significantly higher in the AT group than in the ST and TT groups preoperatively (P = .009 for Constant score, P = .033 for EF strength) and at final follow-up (P < .001 for Constant score, P < .001 for EF strength). There was no significant difference in mean improvement in PROM scores and EF strength or in the proportion of achievement of the minimal clinically important difference. The incidence of Popeye deformity was significantly higher in the TT group (n = 11, 20.8%) than in the AT group (n = 3, 5.8%) and ST group (n = 4, 8.0%) (P = .035). Regression analysis showed that TT (odds ratio, 15.6; P < .001) and male sex (odds ratio, 103.9; P < .001) were associated with Popeye deformity and that ST (coefficient, -0.51; P = .035) was associated with bicipital groove pain.

CONCLUSIONS

Biceps AT, ST, and TT during arthroscopic RCR showed good clinical outcomes. Although there was a possibility of selection bias, there was no significant difference in mean improvement in clinical outcomes between the 3 long head of the biceps tendon procedures. The incidence of Popeye deformity was higher in the TT group, and that of biceps groove pain was higher in the ST group.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Editorial Commentary: Biologic Augmentation of Rotator Cuff Repair: Platelet-Rich Plasma May Be of Significant Benefit, Whereas Atelocollagen Cannot Be Recommended

The field of orthobiologics continues to advance at a rapid pace and theoretically holds some promise to augment the biologic healing response in rotator cuff repair (RCR). However, the clinical evidence for use of substances such as platelet-rich plasma (PRP) for RCR remains inconclusive. Atelocollagen, as a synthetic collagen substitute, has been proposed as another alternative to provide more collagen substrate for healing, but outcomes data with this technique is lacking. In contrast, (biologic) PRP has been well studied, does not show adverse outcomes, and has been shown to improve healing of large to massive tears, as well as RCR outcomes. As biologic augmentation options continue to push the envelope on indications, due diligence is required to carefully examine options for safety and efficacy. Evolutions in RCR should also continue to motivate sports medicine surgeons and researchers to seek out further innovations to improve patient outcomes. That said, PRP outcome improvement for RCR is not definitive and requires further study. RCR can humble even the best of surgeons and demands that we continue to look for ways to improve outcomes.