1
|
Wang JT, Li CB, Zhang JT, An MY, Zhao G, Liu YJ. Interposition of acellular amniotic membrane at the tendon to bone interface would be better for healing than overlaying above the tendon to bone junction in the repair of rotator cuff injury. Chin J Traumatol 2024:S1008-1275(24)00039-7. [PMID: 38688817 DOI: 10.1016/j.cjtee.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
PURPOSE The retear rate of rotator cuff (RC) after surgery is high, and the rapid and functional enthesis regeneration remains a challenge. Whether acellular amniotic membrane (AAM) helps to promote the healing of tendon to bone and which treatment is better are both unclear. The study aims to investigate the effect of AAM on the healing of RC and the best treatment for RC repair. METHODS Thirty-three Sprague Dawley rats underwent RC transection and repair using microsurgical techniques and were randomly divided into the suturing repair only (SRO) group (n = 11), the AAM overlaying (AOL) group (n = 11), and the AAM interposition (AIP) group (n = 11), respectively. Rats were sacrificed at 4 weeks, then examined by subsequent micro-CT, and evaluated by histologic and biomechanical tests. The statistical analyses of one-way ANOVA or Kruskal-Wallis test were performed using with SPSS 23.0. A p < 0.05 was considered a significant difference. RESULTS AAM being intervened between tendon and bone (AIP group) or overlaid over tendon to bone junction (AOL group) in a rat model, promoted enthesis regeneration, increased new bone and cartilage generation, and improved collagen arrangement and biomechanical properties in comparison with suturing repair only (SRO group) (AOL vs. SRO, p < 0.001, p = 0.004, p = 0.003; AIP vs. SRO, p < 0.001, p < 0.001, p < 0.001). Compared with the AOL group, the AIP group had better results in micro-CT evaluation, histological score, and biomechanical testing (p = 0 0.039, p = 0.011, p = 0.003, respectively). CONCLUSION In the RC repair model, AAM enhanced regeneration of the tendon to bone junction. This regeneration was more effective when the AAM was intervened at the tendon to bone interface than overlaid above the tendon to bone junction.
Collapse
Affiliation(s)
- Jiang-Tao Wang
- Chinese PLA Medical School, Beijing, 100039, China; Department of Orthopedics, The 980th Hospital of PLA Joint Logistics Support Forces, Shijiazhuang, 050082, China
| | - Chun-Bao Li
- Department of Orthopedics, The Forth Medical Center of Chinese PLA General Hospital, Beijing, 100089, China
| | | | - Ming-Yang An
- Chinese PLA Medical School, Beijing, 100039, China
| | - Gang Zhao
- Chinese PLA Medical School, Beijing, 100039, China
| | - Yu-Jie Liu
- Department of Orthopedics, The Forth Medical Center of Chinese PLA General Hospital, Beijing, 100089, China; Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China.
| |
Collapse
|
2
|
Zeng S, Sun J, Qin B, Liu Y, Liu G, Deng K, Yin Y, Bao D. Semi-Bone Tunnel Technique Using Double-Row Suture Bridge Combined With Platelet-Rich Plasma Hydrogel for Rotator Cuff Repair in a Rabbit Model. Am J Sports Med 2024; 52:1308-1318. [PMID: 38523475 DOI: 10.1177/03635465241235146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND The approach to managing the footprint area and reconstructing the tendon-bone interface (TBI) is critical for optimal healing. PURPOSE To evaluate the outcomes of the semi-bone tunnel (SBT) technique using a double-row suture bridge combined with platelet-rich plasma (PRP) hydrogel for rotator cuff repair in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS A total of 48 New Zealand White rabbits were divided into 4 groups. The supraspinatus tendons were severed at the footprint to create a rotator cuff tear model in the surgical groups. Rabbits were treated with the traditional onto-surface repair (control group), SBT technique (SBT group), and SBT technique combined with PRP hydrogel implantation (SBT+PRP group). The rabbits without surgery were the normal group. At 8 weeks after surgery, macroscopic observation, magnetic resonance imaging (MRI) and micro-computed tomography (μCT) examinations, histological evaluations, and biomechanical tests were performed to assess the curative effects of the given treatments. RESULTS The MRI results showed that the repaired supraspinatus tendon presented a uniform signal, minimal inflammatory response, and the lowest signal-to-noise quotient value in the SBT+PRP group. The μCT results suggested that the SBT technique did not reduce the local bone mineral density in the TBI area compared with the onto-surface repair technique. The histological staining results showed that the regenerated TBI in the SBT+PRP group had a 4-layer structure similar to the natural tissue. The highest values for biomechanical properties were observed in the SBT+PRP group, and there was no significant difference between the SBT+PRP group and normal group. CONCLUSION The SBT technique presented a better tendon-bone healing effect for rotator cuff tear in the rabbit model compared with the traditional onto-surface repair technique. The specimens in the SBT+PRP group had a similar TBI structure and biomechanical properties to the natural tissue. CLINICAL RELEVANCE The SBT technique can be an alternative surgical approach for rotator cuff repair, especially for moderate to large tears and cases requiring scaffold implantation.
Collapse
Affiliation(s)
- Shengqiang Zeng
- Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Jiacheng Sun
- The Center of Joint and Sports Medicine, Orthopedics Department, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Bo Qin
- Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Yang Liu
- Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Gang Liu
- Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Kai Deng
- Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Yiran Yin
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Dingsu Bao
- Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
- Department of Orthopaedics, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| |
Collapse
|
3
|
Núñez JH, Montenegro JD, Surroca M, Ocrospoma-Flores B, Guerra-Farfán E, Mendez-Sanchez G, Fraguas A, Gómez O. Arthroscopic rotator cuff repair using a single or double row technique: A meta-analysis of randomized clinical trial. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00256-4. [PMID: 38040196 DOI: 10.1016/j.recot.2023.11.023] [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: 04/01/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE To compare the double row technique versus the single row technique for arthroscopic rotator cuff repair, in order to assess whether there are clinical differences. METHODS Systematic review of randomized clinical trials comparing the clinical results of the double-row technique versus the single-row technique in arthroscopic rotator cuff repair. Demographic, clinical, and surgical variables were analyzed, including functional scores, tendon healing rate, and re-tear rate. RESULTS Thirteen randomized clinical trials were selected. 437 patients in the single row group (50.7%) and 424 patients in the double row group (49.3%) were analyzed. No significant differences were found between the two groups in terms of age (P=.84), sex (P=.23) and loss to follow-up (P=.52). Significant differences were found for the better results of the double row technique at the UCLA level (P=.01). No significant differences were found on the Constant-Murley scale (P=.87) or on the ASES scale (P=.56). Similarly, there was a higher healing rate (P=.006) and less risk of rotator cuff re-tears with the double row technique (P=.006). CONCLUSIONS In rotator cuff repair, the double row technique was found to be superior to the single row technique in terms of better UCLA score, better tendon healing rate, and lower re-tear rate. No clinically significant differences were found on the Constant-Murley scale or on the ASES scale.
Collapse
Affiliation(s)
- J H Núñez
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España; Cirugía Ortopédica y Traumatología, Universitat de Barcelona; Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España.
| | - J D Montenegro
- Cirugía Ortopédica y Traumatología, Universitat de Barcelona; Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - M Surroca
- Cirugía Ortopédica y Traumatología, Universitat de Barcelona; Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - B Ocrospoma-Flores
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| | - E Guerra-Farfán
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| | - G Mendez-Sanchez
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| | - A Fraguas
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| | - O Gómez
- Arthoesport, Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Grupo Quirón Salud, Barcelona, España
| |
Collapse
|
4
|
Assunção JH, Silveira EC, Takayanagi OM, de Andrade E Silva FB, Malavolta EA, Ferreira Neto AA. Rotator cuff repair in patients 50 years of age or younger: A comparative study of functional outcomes in relation to older patients. Orthop Traumatol Surg Res 2023; 109:103660. [PMID: 37453677 DOI: 10.1016/j.otsr.2023.103660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 04/26/2023] [Accepted: 05/17/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Few studies have evaluated the clinical results of surgical treatment of rotator cuff tears in young patients and most of the publications are only case series and with a small number of evaluated individuals. The aim of this study is to compare the clinical outcomes of patients undergoing arthroscopic rotator cuff repair according to age at the time of the procedure. HYPOTHESIS Patients with 50 years of age or younger undergoing surgical treatment of rotator cuff tear have similar clinical outcomes to older patients. MATERIALS AND METHODS Retrospective cohort study comparing results obtained after surgical treatment of rotator cuff tears between patients aged 50 years or younger and the older patients by the ASES and UCLA functional scales. Patients undergoing arthroscopy full-thickness rotator cuff repair were included. RESULTS We evaluated 390 shoulders (377 patients), 94 aged 50 years or younger (median=46.5 years) and 296 aged over 50 years (median=60 years). Both groups significantly improved with the procedure after 24 months of follow-up, according to the ASES and UCLA scales (p<0.001). The groups did not differ in the scores obtained in the preoperative assessments and at 24 months of follow-up. The score obtained on the ASES scale at 24 months of follow-up had a median of 87.2 (IQR=38) among patients aged 50 years or younger and 90 points (IQR=26.4) among older patients (p=0.253). The scores obtained by the UCLA scale were 31 points (IQR=9) and 33 points (IQR =7) respectively (p=0.156). DISCUSSION Our results showed that, after 24 months, the functional results of arthroscopic full-thickness rotator cuff repair did not differ between patients younger than 50 years and older patients. These results are similar to those found by other authors. Both groups of patients achieved significant improvement after the surgical procedure, achieving approximately 90 points on the ASES scale and 32 points on the UCLA scale. LEVEL OF EVIDENCE III Retrospective cohort study.
Collapse
Affiliation(s)
- Jorge Henrique Assunção
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Eric Curi Silveira
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Oscar Makoto Takayanagi
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Eduardo Angeli Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
5
|
Aagaard KE, Lunsjö K, Adolfsson L, Frobell R, Björnsson Hallgren H. Factors associated with healing failure after early repair of acute, trauma-related rotator cuff tears. J Shoulder Elbow Surg 2023; 32:2074-2081. [PMID: 37178969 DOI: 10.1016/j.jse.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair. METHODS This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging-verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed. RESULTS Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63). CONCLUSION Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.
Collapse
Affiliation(s)
- Knut E Aagaard
- Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences Lund/Clinical Sciences Helsingborg, Lund University, Lund, Sweden
| | - Karl Lunsjö
- Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences Lund/Clinical Sciences Helsingborg, Lund University, Lund, Sweden
| | - Lars Adolfsson
- Department of Orthopaedics in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Richard Frobell
- Department of Clinical Sciences Lund/Clinical Sciences Helsingborg, Lund University, Lund, Sweden
| | - Hanna Björnsson Hallgren
- Department of Orthopaedics in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| |
Collapse
|
6
|
Hsu JC, Wilhelm CV. Endoscopic Proximal Hamstring Tendon Repair With Knotless Suture-Bridge Technique. Arthrosc Tech 2023; 12:e1737-e1745. [PMID: 37942091 PMCID: PMC10627846 DOI: 10.1016/j.eats.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/28/2023] [Indexed: 11/10/2023] Open
Abstract
Symptomatic proximal hamstring tendon tears are typically repaired surgically, with open incision and knot-tying technique. An endoscopic, knotless, suture-bridge repair technique is presented. Potential advantages include knotless simplicity, compression over a broad zone to improve tendon-bone healing, and decreased pain secondary to elimination of knots and the open incision and approach.
Collapse
Affiliation(s)
- Jim C. Hsu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Christopher V. Wilhelm
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| |
Collapse
|
7
|
Carbonel Bueno I, Hernando Sacristán J, García Pérez R, Navarro López P, Hernández Fernández I, Ripalda Marín J. [Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears. A systematic review.]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:252-274. [PMID: 37773337 PMCID: PMC10594983 DOI: 10.31053/1853.0605.v80.n3.41161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 10/01/2023] Open
Abstract
Purpose The purpose of this study is to perform a systematic review of the scientific literature to compare single and double row techniques for rotator cuff tears in terms of functional, pain improvement and structural healing of the tendon. Methods In order to carry out the research, a systematic selection of scientific articles has been made by consulting PubMed and The Cochrane Library databases. The articles included in the present study compare the single-row and double-row techniques, with publication date between 2016 and 2021. Results Diverse results are observed in the UCLA, SST, Constant and ASES assessment scales and in the range of mobility, therefore, the superiority of one technique in terms of functional results is not established. The double row technique may show superiority in the strength variable, although there is a methodological variability in its measurement. The double-row technique may be related to more intense postoperative pain, while the single-row technique to residual shoulder pain. However, the variables strength and pain show non-homogeneous or coincident data. The superiority of the double row repair in the structural healing of the tendon and a lower re-tear rate than the single row technique is established with statistically significant results, being the most homogeneous and coincident studies.
Collapse
|
8
|
Rhee SM, Youn SM, Kim CH, Chang GW, Kim SY, Ham HJ, Rhee YG. Rotator cuff repairs with all-suture tape anchors: no difference in outcomes between with or without all-suture tape anchors. Knee Surg Sports Traumatol Arthrosc 2023; 31:4060-4067. [PMID: 37226010 DOI: 10.1007/s00167-023-07454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE This study aimed at comparing the outcomes of medium- to large-sized rotator cuff repairs performed using the suture bridge technique either with or without tape-like sutures, and single row techniques with conventional sutures. METHODS A total of 135 eligible patients with medium to large rotator cuff tears were identified and analyzed retrospectively, from 2017 to 2019. Only repairs using all-suture anchors were included in the study. Patients were divided into the following three groups: single-row (SR) repair (N = 50), standard double-row suture bridge (DRSB) repair with conventional sutures (N = 35), and DRSB with tape-like sutures (N = 50). The average postoperative follow-up period was 26.3 ± 9.8 months (range, 18-37). RESULTS DRSB with tapes had the highest re-tear rate of 16% (8/50), but there was no significant difference with the re-tear rates observed in SR (8%, 4/50) and DRSB with conventional sutures (11.4%, 4/35) (n.s.). DRSB with tapes demonstrated higher rate of type 2 re-tears (10%) compared to type 1 re-tears (6%), but the other two groups showed either similar or higher rates of type 1 re-tears compared to that of type 2. Post-operative functional scores of the three groups improved significantly (all p < 0.05), but the differences between the groups were not statistically significant. CONCLUSIONS No clinical difference in functional outcomes and re-tear rates were observed in DRSB with tapes when compared with SR and DRSB using the conventional sutures. Tape-like DRSB suture which was expected to be superior by its biomechanical advantage was clinically non-superior to conventional DRSB suture. There were no significant differences in VAS scores and UCLA scores. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seung-Min Youn
- The Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, Australia
| | - Cheol Hwan Kim
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea
| | - Geun-Wu Chang
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea
| | - Se Yeon Kim
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea
| | - Hyun Joo Ham
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea.
| |
Collapse
|
9
|
You T, Wu S, Ou X, Liu Y, Wang X. A network meta-analysis of arthroscopic rotator cuff repair. BMC Surg 2023; 23:201. [PMID: 37443010 DOI: 10.1186/s12893-023-02078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE Rotator cuff tear is a common shoulder injury that often leads to serious limitations in daily life. Herein, a network Meta-analysis using frequency theory was performed to evaluate the clinical outcomes of five rotator cuff repair techniques, including single-row repair, double-row repair, suture bridge repair, platelet-rich plasma therapy, and bone marrow stimulation, thus guiding clinical decision-making on rotator cuff repair. METHODS PubMed, EMbase, The Cochrane Library, and Web of Science were searched for randomized controlled trials and cohort studies comparing rotator cuff repair techniques published from inception to May 2022. Combined analysis and quality assessment were performed using software STATA15.1 and Review Manager5.3. RESULTS A total of 51 articles were finally included, including 27 randomized controlled trials and 24 cohort studies. Results from the network Meta-analysis showed that: (1) In terms of the American Shoulder and Elbow Surgeons score, platelet-rich plasma therapy, double-row repair, bone marrow stimulation, and single-row repair were significantly better than suture bridge repair. (2) In terms of Constant score, bone marrow stimulation was significantly better than double-row repair, single-row repair, and suture bridge repair. (3) In terms of visual analog scale score, platelet-rich plasma therapy was significantly better than double-row repair and suture bridge repair. (4) In terms of the Shoulder Rating Scale of the University of California at Los Angeles score, platelet-rich plasma therapy and double-row repair were relatively better but not significantly different from the other treatments. (5) In terms of the risk of re-tear, the re-tear rate of platelet-rich plasma therapy and double-row repair was significantly lower than that of single-row repair and suture bridge repair. CONCLUSION Based on the results of network Meta-analysis and surface under the cumulative ranking, platelet-rich plasma therapy, bone marrow stimulation, and double-row repair have good overall rehabilitation effects. It is recommended to choose appropriate repair techniques as per the actual clinical situation.
Collapse
Affiliation(s)
- Tianshu You
- School of Electrical Engineering and Computer, Jilin Jianzhu University, Changchun, Jilin Province, China
| | - Siyu Wu
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiaolan Ou
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ying Liu
- Department of Cardiology, Jilin Province Hospital, Changchun, Jilin Province, China
| | - Xu Wang
- School of Electrical Engineering and Computer, Jilin Jianzhu University, Changchun, Jilin Province, China.
| |
Collapse
|
10
|
Gumina S, Mezzaqui L, Aimino R, Rionero M, Spagnoli A, Campagna V, Candela V. Aetiopathogenesis of Rotator Cuff Tear in Patients Younger than 50 Years: Medical Conditions Play a Relevant Role. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050998. [PMID: 37241230 DOI: 10.3390/medicina59050998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Studies on rotator cuff tears (RCT) in patients younger than 50 years have focused on the post-operative outcomes. Little is known about cuff tear etiopathogenesis, although it is a common belief that most tears are due to trauma. We have retrospectively verified the prevalence of medical conditions, whose role in tendon degeneration development have been widely demonstrated, in a group of patients younger than 50 years with postero-superior RCT. Materials and Methods: 64 patients [44M-20F; mean age (SD): 46.90 (2.80)] were enrolled. Personal data, BMI, smoking habit, diseases (diabetes, arterial hypertension, hypercholesterolaemia, thyroid diseases, and chronic obstructive pulmonary disease) were registered. The possible triggering cause and the affected side and tear dimensions were recorded, and statistical analysis was then performed. Results: 75% of patients had one or more diseases and/or a smoking habit for more than 10 years. In the remaining 25%, only four patients referred had had a traumatic event, while in the other eight patients, both medical condition and trauma were registered. The presence of two or more diseases did not affect RCT size. Conclusions: In our series, three quarters of patients with RCT had a smoking habit or medical conditions predisposing them to a tendon tear; therefore, the role of trauma in RCT onset in patients younger than 50 years is markedly resized. It is plausible that in the remaining 25%, RCT may be due to trauma or to genetic or acquired degeneration. Level of Evidence: IV.
Collapse
Affiliation(s)
- Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy
- Icot Latina, 00100 Latina, Italy
| | | | | | | | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00100 Rome, Italy
| | - Vincenzo Campagna
- Orthopaedics and Traumatology Unit, Celio Military Hospital, 00100 Rome, Italy
| | - Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy
| |
Collapse
|
11
|
Liu Q, Qi J, Zhu W, Thoreson AR, An KN, Steinmann SP, Zhao C. The Effect of Pulling Angle on Rotator Cuff Mechanical Properties in a Canine In Vitro Model. Bioengineering (Basel) 2023; 10:bioengineering10050599. [PMID: 37237669 DOI: 10.3390/bioengineering10050599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
The objective of this study was to examine the effect of pulling angle on time-zero mechanical properties of intact infraspinatus tendon or infraspinatus tendon repaired with the modified Mason-Allen technique in a canine model in vitro. Thirty-six canine shoulder samples were used. Twenty intact samples were randomly allocated into functional pull (135°) and anatomic pull (70°) groups (n = 10 per group). The remaining sixteen infraspinatus tendons were transected from the insertion and repaired using the modified Mason-Allen technique before being randomly allocated into functional pull or anatomic pull groups (n = 8 per group). Load to failure testing was performed on all specimens. The ultimate failure load and ultimate stress of the functional pulled intact tendons were significantly lower compared with anatomic pulled tendons (1310.2 ± 167.6 N vs. 1687.4 ± 228.2 N, p = 0.0005: 55.6 ± 8.4 MPa vs. 67.1 ± 13.3 MPa, p = 0.0334). For the tendons repaired with the modified Mason-Allen technique, no significant differences were observed in ultimate failure load, ultimate stress or stiffness between functional pull and anatomic pull groups. The variance of pulling angle had a significant influence on the biomechanical properties of the rotator cuff tendon in a canine shoulder model in vitro. Load to failure of the intact infraspinatus tendon was lower at the functional pulling position compared to the anatomic pulling position. This result indicates that uneven load distribution across tendon fibers under functional pull may predispose the tendon to tear. However, this mechanical character is not presented after rotator cuff repair using the modified Mason-Allen technique.
Collapse
Affiliation(s)
- Qian Liu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jun Qi
- Department of Orthopedics, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Weihong Zhu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Andrew R Thoreson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kai-Nan An
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Scott P Steinmann
- Department of Orthopedic Surgery, University of Tennessee Health Science Center College of Medicine, Chattanooga, TN 37450, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
12
|
Themessl A, Wagner T, Rupp MC, Degenhardt H, Woertler K, Hatter KA, Imhoff AB, Siebenlist S, Pogorzelski J. "Functional outcomes and MRI-based tendon healing after (antero-) superior rotator cuff repair among patients under 50 years: retrospective analysis of traumatic versus non-traumatic rotator cuff tears". BMC Musculoskelet Disord 2023; 24:52. [PMID: 36670374 PMCID: PMC9862981 DOI: 10.1186/s12891-023-06174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Rotator cuff tears among patients under 50 years either result from an adequate trauma or are considered non-traumatic due to work-related or athletic overuse. The impact of these different mechanisms on postoperative functional outcomes and tendon healing has not yet been fully understood. Therefore, it was the purpose of this study to investigate the influence of etiology of (antero-)superior rotator cuff tears on postoperative outcomes and the healing rates after arthroscopic rotator cuff repair in a young patient population. METHODS Patients under 50 years who underwent arthroscopic rotator cuff repair between 2006-2017 for an anterosuperior rotator cuff tear with a minimum follow up of 24 months were included in this study. Revision surgeries or reconstructive concomitant procedures other than long head of the biceps tenodesis were excluded. Patients were divided into two groups according to the etiology of their rotator cuff tear (traumatic vs. non-traumatic). Demographic and outcome scores including the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score (CS), bilateral strength measurements and postoperative tendon integrity evaluated on magnetic resonance imaging (MRI) were assessed and compared between both groups. RESULTS The mean follow up for this study was 55.6 months (24 - 158). Twenty-one patients (50.0%) had a traumatic RCT and 21 patients (50.0%) had a non-traumatic tear. Outcome scores did not differ significantly between groups. Strength measurements of the supraspinatus revealed significantly decreased force of the affected side as opposed to the contralateral side (p = 0.001), regardless of etiology. Retear rates were similar in both groups (37.5% and 33.3%, p = n.s.). Cuff integrity at follow-up was not predictive of superior scores or strength. CONCLUSION Surgical treatment of traumatic and non-traumatic RCT yields good clinical results in patients under the age of 50. The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates. About one third of the patients suffered from a retear postoperatively, however retears were not predictive of inferior outcomes at midterm follow-up. STUDY DESIGN Level III. TRIAL REGISTRATION Retrospectively registered.
Collapse
Affiliation(s)
- Alexander Themessl
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Timon Wagner
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Hannes Degenhardt
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Klaus Woertler
- grid.6936.a0000000123222966Department of Radiology, Technical University of Munich, Munich, Germany
| | - Kate A. Hatter
- grid.189509.c0000000100241216Department of Surgery/ Emergency Medicine, Duke University Hospital, Durham, NC USA
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| |
Collapse
|
13
|
Meng C, Jiang B, Liu M, Kang F, Kong L, Zhang T, Wang C, Wang J, Han C, Ren Y. Repair of rotator cuff tears in patients aged 75 years and older: Does it make sense? A systematic review. Front Public Health 2023; 10:1060700. [PMID: 36733288 PMCID: PMC9887178 DOI: 10.3389/fpubh.2022.1060700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Background Rotator cuff injuries are common, and morbidity increases with age. The asymptomatic full-thickness tear rate is 40% in the over 75-year-old population. Purpose This study aimed to systematically review the literature on the outcomes of rotator cuff repair among >75 years old patients. Study design Systematic review. Methods A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was performed in the electronic databases of PubMed, Medline, Embase, and The Cochrane Library. Studies in English evaluating repair of full-thickness rotator cuff tears in patients aged >75 years were included. Results Six studies were reviewed, including 311 patients (313 shoulders) treated with arthroscopic and/or open rotator cuff repair. Sixty-one patients were lost to follow-up, leaving 252 shoulders with outcome data. Patients in this age group demonstrated a significant improvement in the clinical and functional scores after rotator cuff repair, with a high satisfaction rate. The mean American Shoulder and Elbow Surgeons scores improved from 43.8 (range, 42.0-45.5) preoperatively to 85.3 (range, 84.0 to 86.5) postoperatively, and the mean Constant scores improved from 45.4 (range, 34.7-55.5) to 78.6 (range, 67.0-91.6). Pain, evaluated in all studies by the visual analog scale for pain, showed a significant improvement at the last follow-up compared with the mean preoperative score. Furthermore, range of motion and return to daily activities and sports gained marked improvements. Conclusion Rotator cuff repair in patients aged >75 years could achieve high clinical success rates with good outcomes and pain relief. Although patients in this age group are at a high risk of retear, rotator cuff repair may offer a good option with significant functional and clinical improvement.
Collapse
Affiliation(s)
- Chenyang Meng
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Boyong Jiang
- Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Ming Liu
- Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Fujia Kang
- Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Lingyue Kong
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Ting Zhang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Caixia Wang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Jingjuan Wang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Changxu Han
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China,*Correspondence: Changxu Han ✉
| | - Yizhong Ren
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China,Yizhong Ren ✉
| |
Collapse
|
14
|
Bushnell BD, Connor PM, Harris HW, Ho CP, Trenhaile SW, Abrams JS. Two-year outcomes with a bioinductive collagen implant used in augmentation of arthroscopic repair of full-thickness rotator cuff tears: final results of a prospective multicenter study. J Shoulder Elbow Surg 2022; 31:2532-2541. [PMID: 35788057 DOI: 10.1016/j.jse.2022.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Full-thickness rotator cuff tears (FTRCTs) represent a common shoulder injury that, if untreated, can progress in size, become increasingly painful, and inhibit function. These lesions are often surgically repaired, with double-row arthroscopic repair often preferred for larger tears. Biological augmentation technologies have been developed to improve rates of postoperative radiographic retear and enhance patient-reported outcomes after surgical FTRCT repair. This study sought to confirm that augmented repair with a bioinductive bovine collagen implant results in favorable retear rates and patient outcomes with follow-up to 2 years. METHODS A prospective multicenter cohort study was undertaken to determine the efficacy and safety of augmenting single- or double-row arthroscopic repair of FTRCTs with a bioinductive bovine collagen implant. Of 115 adult patients participating, 66 (57.4%) had medium (1-3-cm) tears and 49 (42.6%) had large (3-5-cm) tears. Magnetic resonance imaging and patient-reported outcomes (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Constant-Murley Score [CMS]) were performed and recorded at baseline, 3 months, 1 year, and 2 years. RESULTS Mean duration of follow-up was 2.1 years (range, 1.5-2.9 years). Between baseline and 2-year follow-up, mean total thickness of the supraspinatus tendon increased by 12.5% for medium tears and by 17.1% for large tears. Radiographic retear was noted in 7 of 61 available patients (11.5%) with medium tears, and in 14 of 40 patients (35.0%) with large tears. In both groups, these tears primarily occurred before the 3-month follow-up visit (13 of 21 [61.9%]). Radiographic retear with the supplemented double-row (DR) repair technique was 13.2% overall (12 of 91 DR patients; 11.3% for medium tears and 15.8% for large tears). The minimal clinically important difference was achieved by >90% of patients with both medium and large tears for both ASES and CMS. There were 2 serious adverse events classified by the treating surgeon as being possibly related to the device and/or procedure (1 case of swelling/drainage and 1 case of intermittent pain). Nine patients (7.8%; 4 medium tears and 5 large tears) required reoperation of the index rotator cuff surgery. CONCLUSION Final 2-year data from this study confirm that using this implant in augmentation of arthroscopic double-row repair of FTRCTs provides favorable rates of radiographic retear and substantial functional recovery. The relative safety of the device is also further supported.
Collapse
Affiliation(s)
| | | | | | - Charles P Ho
- The Steadman Philippon Research Institute, Vail, CO, USA
| | | | | |
Collapse
|
15
|
Fackler NP, Ehlers CB, Callan KT, Amirhekmat A, Smith EJ, Parisien RL, Wang D. Statistical Fragility of Single-Row Versus Double-Row Anchoring for Rotator Cuff Repair: A Systematic Review of Comparative Studies. Orthop J Sports Med 2022; 10:23259671221093391. [PMID: 35571970 PMCID: PMC9096204 DOI: 10.1177/23259671221093391] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Comparative studies and randomized controlled trials (RCTs) often use the P (probability) value to convey the statistical significance of their findings. P values are an imperfect measure, however, and are vulnerable to a small number of outcome reversals to alter statistical significance. The inclusion of a fragility index (FI) and fragility quotient (FQ) may aid in the interpretation of a study’s statistical strength. Purpose/Hypothesis: The purpose of this study was to examine the statistical stability of studies comparing single-row to double-row rotator cuff repair. It was hypothesized that the findings of these studies would be vulnerable to a small number of outcome event reversals, often fewer than the number of patients lost to follow-up. Study Design: Systematic review; Level of evidence, 3. Methods: We analyzed comparative studies and RCTs on primary single-row versus double-row rotator cuff repair that were published between 2000 and 2021 in 10 leading orthopaedic journals. Statistical significance was defined as a P < .05. The FI for each outcome was determined by the number of event reversals necessary to alter significance. The FQ was calculated by dividing the FI by the respective sample size. Results: Of 4896 studies screened, 22 comparative studies, 10 of which were RCTs, were ultimately included for analysis. A total of 74 outcomes were examined. Overall, the median FI was 2 (interquartile range [IQR], 1-3), and the median FQ was 0.035 (IQR, 0.020-0.057). The mean FI was 2.55 ± 1.29, and the mean FQ was 0.043 ± 0.027. In 64% of outcomes, the FI was less than the number of patients lost to follow-up.) Additionally, 81% of significant outcomes needed just a single outcome reversal to lose their significance. Conclusion: Over half of the studies currently used to guide clinical practice have a number of patients lost to follow-up greater than their FI. The results of these studies should be interpreted within the context of these limitations. Future analyses may benefit from the inclusion of the FI and the FQ in their statistical analyses.
Collapse
Affiliation(s)
- Nathan P. Fackler
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Cooper B. Ehlers
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Kylie T. Callan
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| | - Arya Amirhekmat
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| | - Eric J. Smith
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| | | | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| |
Collapse
|
16
|
Ma M, Pan Z, Lu L. Clinical effect of arthroscopic long head of biceps transfer and tenodesis on irreparable rotator cuff tear. J Orthop Surg Res 2022; 17:220. [PMID: 35399092 PMCID: PMC8996574 DOI: 10.1186/s13018-022-03121-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To explore the clinical effect of arthroscopic long head of biceps transfer and tenodesis for on irreparable rotator cuff tear.
Methods
A total of 18 patients with irreparable rotator cuff tear who were treated in the Dongfang Hospital Affiliated to Tongji University School of Medicine from April 2018 to March 2020 were included in this study. They all underwent arthroscopic long head of biceps transfer and tenodesis. Shoulder joint motions (forward flexion, abduction, and external rotation angle) and magnetic resonance imaging (MRI) were performed. Moreover, visual analogue scale (VAS) and university of California Los Angeles (UCLA) score were conducted during follow-up.
Results
Preoperative symptoms lasted from 3 to 16 months, with an average duration of 10 months. All patients healed in the first stage without obvious complications were included. All patients were followed up for 4 to 14 months after the surgery, with an average duration of 11.1 months. The range of shoulder joint motions, including forward flexion (80.52° ± 31.19° vs. 149.47° ± 28.36°), abduction (65.13° ± 37.59° vs. 152.46° ± 28.64°) and lateral rotation (30.17° ± 15.15° vs. 71.49° ± 11.42°) was significantly improved after operation (P < 0.05). The VAS score was notably decreased after operation (8.46 ± 0.80 vs. 1.55 ± 0.70), but the UCLA score was markedly increased (15.27 ± 2.89 vs. 31.17 ± 2.36). MRI imaging showed that 15 patients had good tissue healing, with a healing rate of 83.3% (15/18).
Conclusion
Arthroscopy of the biceps long head tendon transposition can significantly relieve pain in patients with large rotator cuff tears, improve joint mobility, and restore joint function.
Collapse
|
17
|
Transosseous-Equivalent/Suture Bridge Arthroscopic Rotator Cuff Repair in Combination With Late Postoperative Mobilization Yield Optimal Outcomes and Retear Rate: A Network Meta-analysis of Randomized Controlled Trials. Arthroscopy 2022; 38:148-158.e6. [PMID: 34082023 DOI: 10.1016/j.arthro.2021.05.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to perform a network meta-analysis of the randomized controlled trials (RCTs) in the literature in order to assess the evidence defining the optimal combination of surgical technique single-row repair (SRR), double-row repair (DRR), or transosseous-equivalent/suture bridge (TOE/SB) arthroscopic rotator cuff repair (ARCR) and postoperative rehabilitation (early or late) protocol for ARCR. METHODS The literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized SSR-early trials (RCTs) comparing SRR vs DRR vs TOE/SB ARCR techniques were included, as well as early vs late postoperative range of motion. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score. RESULTS Twenty-eight studies comprising 2,181 total shoulders met the inclusion criteria. TOE/SB-late (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.08-0.46) and DRR-late (OR, 0.25; 95% CI, 0.12-0.52) were found to significantly reduce the rate of retear, with TOE/SB-late resulting in the highest P-score for the American Shoulder and Elbow Surgeons (P-score: 0.7911) score and retear rate (P-score: 0.8725). DRR-early did not result in any significant improvements over the SRR-early group, except in internal rotation. There was no significant difference in forward flexion between groups, with almost equivalent P-scores. Furthermore, TOE/SB-early and TOE/SB-late trended toward worsening external rotation compared with the control. CONCLUSIONS The current study suggests that rotator cuff repair using the TOE/SB technique and late postoperative mobilization yields the highest functional outcomes and lowest retear rate in the arthroscopic management of symptomatic rotator cuff tears. LEVEL OF EVIDENCE Level I, meta-analysis of Level I studies.
Collapse
|
18
|
No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears. Knee Surg Sports Traumatol Arthrosc 2022; 30:2521-2527. [PMID: 35133449 PMCID: PMC9206597 DOI: 10.1007/s00167-022-06884-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/12/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE Acute trauma-related rotator cuff tears are believed to have better healing potential than chronic tears due to less degenerative changes of the tendons. However, the histopathological condition of tendons from trauma-related tears is not well investigated. The purpose of this study was to explore specific histopathological features in tendons from acute trauma-related full-thickness rotator cuff tears and to compare them to findings in tendons from nontraumatic, chronic tears. METHODS In a prospective cohort study, 62 previously asymptomatic patients [14 women, median age 61 years (range 42-75)] with trauma-related full-thickness rotator cuff tears were consecutively included. Arthroscopic repair was performed within 30 (median, IQR 25-37) days after the injury. During surgery, tissue biopsies were harvested from the supraspinatus tendons in 53 (86%) of the patients. In addition, similar biopsies were harvested from 10 patients undergoing surgery for chronic tears without history of trauma. All tissue samples were examined by a well-experienced pathologist under light microscope. Tendon degeneration was determined using the Bonar score whereas immunostaining was used for proliferation (Ki67), inflammation (CD45), apoptosis (p53) and haemosiderin staining to study traces of bleeding. RESULTS The median (IQR) Bonar score for the acute trauma-related biopsies was 10.5 (7.5-14.5) compared to 11 (5-12.8) for the control group with no statistically significant difference between the groups. No statistically significant between-group difference was found for the inflammatory index whereas tendons from patients with trauma-related full-thickness rotator cuff tears had statistically significantly higher apoptosis [3.1 (0.5-8.9) vs. 0.1 (0-1.5), p = 0.003] and proliferation [4.0 (1.8-6.9) vs. 0.4 (0-2.0), p = 0.001) indices than those undergoing surgery for chronic tears. Positive haemosiderin staining was found in 34% of tissue samples from patients with trauma-related tears compared to 10% in the control group (n.s). CONCLUSION This study suggests that there is no difference with regard to degenerative changes between supraspinatus tendons harvested from patients with acute, trauma-related rotator cuff tears and patients with nontraumatic, chronic tears. LEVEL OF EVIDENCE II.
Collapse
|
19
|
Ponugoti N, Raghu A, Colaco HB, Magill H. A comparison of simple and complex single-row versus transosseous-equivalent double-row repair techniques for full-thickness rotator cuff tears: a systematic review and meta-analysis. JSES Int 2022; 6:70-78. [PMID: 35141679 PMCID: PMC8811406 DOI: 10.1016/j.jseint.2021.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Methods Conclusion
Collapse
Affiliation(s)
- Nikhil Ponugoti
- Orthopaedic Registrar, Hampshire Hospital NHS Foundation Trust, Basingstoke, Hampshire, UK
- Corresponding author: Nikhil Ponugoti, MBBS, DNB Ortho, MRCS, Registrar Office, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, RG24 9NA, United Kingdom.
| | - Aashish Raghu
- Orthopaedic Registrar, East & North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Henry B. Colaco
- Consultant Orthopaedic Surgeon, Hampshire Hospital NHS Foundation Trust, Winchester, Hampshire, UK
| | - Henry Magill
- Orthopaedic Registrar, Chelsea and Westminster Hospital, London, UK
| |
Collapse
|
20
|
Wang W, Kang H, Li H, Li J, Meng Y, Li P. Comparative efficacy of 5 suture configurations for arthroscopic rotator cuff tear repair: a network meta-analysis. J Orthop Surg Res 2021; 16:714. [PMID: 34895286 PMCID: PMC8665484 DOI: 10.1186/s13018-021-02847-y] [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: 08/26/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason-Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO. METHODS A systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com , and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software. RESULTS Thirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle-Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR. CONCLUSION Based on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.
Collapse
Affiliation(s)
- Wei Wang
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Hui Kang
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Hongchuan Li
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Jian Li
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Yibin Meng
- Departments of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xian City, 710054, Shanxi Province, China
| | - Peng Li
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, 76 Guo Road, Beilin South District, Xian City, 710054, Shanxi Province, China.
| |
Collapse
|
21
|
Zhao J, Luo M, Pan J, Liang G, Feng W, Zeng L, Yang W, Liu J. Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review. J Shoulder Elbow Surg 2021; 30:2660-2670. [PMID: 34089878 DOI: 10.1016/j.jse.2021.05.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Retear after arthroscopic rotator cuff repair (ARCR) consistently challenges medical staff and patients, and the incidence of retear after surgery is 10%-94%. The purpose of this study was to identify the risk factors that cause retear after ARCR and provide theoretical guidance for clinical intervention to reduce the occurrence of postoperative rotator cuff retear. METHODS The protocol for this meta-analysis was registered with PROSPERO (CRD42021225088). PubMed, Web of Science, and Embase were searched for observational studies on risk factors for rotator cuff retear after arthroscopic repair. Meta-analytical methods were used to determine the odds ratio or weighted mean difference of potential risk factors related to postoperative rotator cuff retear. Stata 15.1 was used to quantitatively evaluate the publication bias of the statistical results. RESULTS Fourteen studies from 6 countries with a total of 5693 patients were included. The meta-analysis revealed that the risk factors for retear after rotator cuff repair were age, body mass index, diabetes, subscapularis and infraspinatus fatty infiltration, symptom duration, bone mineral density, tear length, tear width, tear size area, amount of retraction, critical shoulder angle, acromiohumeral interval, distance from the musculotendinous junction to the glenoid, operative duration, biceps procedure, and postoperative University of California Los Angeles shoulder score. CONCLUSION These findings can help clinical medical staff identify patients who are prone to retear early after arthroscopic repair and develop targeted prevention and treatment strategies for modifiable risk factors, which are of great significance for reducing the occurrence of rotator cuff retear after ARCR.
Collapse
Affiliation(s)
- Jinlong Zhao
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China; Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Guihong Liang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Wenxuan Feng
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Lingfeng Zeng
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Weiyi Yang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jun Liu
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China.
| |
Collapse
|
22
|
Park JY, Lee JH, Oh KS, Chung SW, Choi Y, Yoon WY, Kim DW. Rotator cuff retear after repair surgery: comparison between experienced and inexperienced surgeons. Clin Shoulder Elb 2021; 24:135-140. [PMID: 34488293 PMCID: PMC8423529 DOI: 10.5397/cise.2021.00073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background We hypothesized in this study that the characteristics of retear cases vary according to surgeon volume and that surgical outcomes differ between primary and revision arthroscopic rotator cuff repair (revisional ARCR). Methods Surgeons performing more than 12 rotator cuff repairs (RCRs) per year were defined as high-volume surgeons, and those performing fewer than 12 RCRs were considered low-volume surgeons. Of the 47 patients who underwent revisional ARCR at our clinic enrolled in this study, 21 cases were treated by high-volume surgeons and 26 cases by low-volume surgeons. In all cases, the interval between primary surgery and revisional ARCR, degree of “acromial scuffing,” number of anchors, RCR technique, retear pattern, fatty infiltration, retear size, operating time, and clinical outcome were recorded. Results During primary surgery, significantly more lateral anchors (p=0.004) were used, and the rate of use of the double-row repair technique was significantly higher (p<0.001) in the high- versus low-volume surgeon group. Moreover, the “cut-through pattern” was observed significantly more frequently among the cases treated by high- versus low-volume surgeons (p=0.008). The clinical outcomes after revisional ARCR were not different between the two groups. Conclusions Double-row repair during primary surgery and the cut-through pattern during revisional ARCR were more frequent in the high- versus low-volume surgeon groups. However, no differences in retear site or size, fatty infiltration grade, or outcomes were observed between the groups.
Collapse
Affiliation(s)
- Jin-Young Park
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| | - Jae-Hyung Lee
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Yunseong Choi
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| | - Won-Yong Yoon
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| | - Dong-Wook Kim
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| |
Collapse
|
23
|
GÜNAY M, EKEN G. The effect of row number on clinical and life quality outcomes of patients who underwent arthroscopic rotator cuff repair. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.957621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Arthroscopic release combined with single-row fixation or double-row suture bridge fixation in patients with traumatic supraspinatus tear and adhesive capsulitis non-responsive to conservative management: A prospective randomized trial. Orthop Traumatol Surg Res 2021; 107:102828. [PMID: 33524627 DOI: 10.1016/j.otsr.2021.102828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/27/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are few previous studies on traumatic supraspinatus tear with adhesive capsulitis. This study used arthroscopic release with single-row fixation or double-row suture bridge fixation to treat adhesive capsulitis of the shoulder with rotator cuff tears. Further, the clinical efficacy of arthroscopic release with single-row fixation and double-row suture bridge fixation was compared. HYPOTHESES Arthroscopic release combined with single-row fixation or double-row suture bridge fixation showed good clinical outcomes in patients with traumatic supraspinatus tear with adhesive capsulitis. METHODS A single-center prospective randomized trial was performed from June 2013 to June 2017. Of the 68 patients with traumatic supraspinatus tear and adhesive capsulitis who underwent arthroscopic release, 34 (22 with tear measuring≤3cm and 12 with tear measuring>3cm) were included in the single-row fixation group and 34 (20 with tear measuring≤3cm and 14 with tear measuring>3cm) were included in the double-row suture bridge fixation group. The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) shoulder scores, range of motion, time to achieve satisfactory scores, and rotator cuff re-tear rate were compared between the groups. RESULTS The range of motion, VAS score, UCLA and ASES shoulder scores significantly improved after surgery in both groups. There was a significant difference in the UCLA and ASES shoulder scores, time to achieve satisfactory scores, and rotator cuff re-tear rates in patients with tears measuring>3cm between the groups. CONCLUSIONS Arthroscopic release combined with single-row fixation or double-row suture bridge fixation showed good clinical outcomes in patients with traumatic supraspinatus tear with adhesive capsulitis. Therefore, the capsule of the shoulder should be thoroughly released to achieve such outcomes. For patients with rotator cuff tears measuring>3cm, double-row suture bridge fixation was superior to single-row fixation and the rotator cuff re-tear rate was low. LEVEL OF EVIDENCE I; prospective, randomized trial, treatment study.
Collapse
|
26
|
Wang Z, Long Z, Li H, Lu H, Gingery A, Amadio PC, Moran SL, Zhao C. A biomechanical comparison of a mesh suture to a polyblend suture in a porcine tendon model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:450. [PMID: 33850847 PMCID: PMC8039690 DOI: 10.21037/atm-20-1065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The suture-tendon interface turned out to be the weak point of a repaired rotator cuff. A double rip-stop (DRS) technique was developed to enhance the strength of the suture-tendon interface. The first aim of this study was to compare the suture-tendon interface strength between mesh suture and the No. 2 FiberWire (FW), which is commonly used in the clinic. The second aim was to compare the biomechanical properties of rotator cuff repair between mesh suture and No. 2 FiberWire using a typical suture-bridge (SB) and DRS techniques. Methods Eighteen porcine subscapularis tendon (SST) was randomly assigned to the Mesh-tendon group and FiberWire-tendon group. A single suture loop was passed through the SST with a Mesh suture or FiberWire. Thirty-two infraspinatus tendons (ISTs) were randomly assigned to four groups: SB-Mesh group: SB technique with Mesh suture, SB-FW group: SB technique with FiberWire, DRS-Mesh group: DRS technique with Mesh suture, and DRS-FW group: DRS technique with FiberWire. All repaired specimens were underwent failure testing. Failure modes, load to create a 3-mm gap, failure load, and stiffness were compared. Results There were no significant differences between the Mesh-tendon group and FiberWire-tendon group regarding the failure load, stiffness, and ultimate stress. When the same technique was used, the rotator cuff repaired with a mesh suture had the similar load to create a 3-mm gap, failure load, and stiffness compared with FiberWire. When the same suture was used, the DRS technique had a significantly higher load to create a 3-mm gap formation and failure load compared with the SB technique. Conclusions The repair failure strength and stiffness using the mesh suture were similar to the FiberWire suture regardless of the repair techniques. However, the repair strength in the DRS technique was significantly stronger than the SB technique when the same suture material was used.
Collapse
Affiliation(s)
- Zhanwen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Zeling Long
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hong Li
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Anne Gingery
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
27
|
Pogorzelski J, Erber B, Themessl A, Rupp MC, Feucht MJ, Imhoff AB, Degenhardt H, Irger M. Definition of the terms "acute" and "traumatic" in rotator cuff injuries: a systematic review and call for standardization in nomenclature. Arch Orthop Trauma Surg 2021; 141:75-91. [PMID: 33130936 PMCID: PMC7815591 DOI: 10.1007/s00402-020-03656-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although of high relevance for clinical decision making, there exists no consensus throughout the literature of the terms "acute" and "traumatic" used in the classification of rotator cuff tears. With differing definitions, the comparability of outcome studies may be limited. The aim was to provide a detailed systematic review of the definitions used in the literature and present a suggestion for a standardization in nomenclature based on the findings. METHODS Four different internet databases were searched in February 2020 using the terms ("acute" OR "traumatic" OR "trauma" OR "athlete" OR "young") AND ("rotator cuff tears" OR "rotator cuff tear" OR "rotator cuff" OR "rotator cuff rupture" OR "supraspinatus" OR "infraspinatus" OR "subscapularis" OR "teres minor"). Prospective, retrospective, cohort and case-control studies as well as case series were included. Systematic reviews, cadaveric or laboratory studies and studies on non-traumatic or non-acute rotator cuff tears were excluded. RESULTS The literature search conducted 10,349 articles of which 10,151 were excluded based on the title, 119 based on the abstract and 33 based on the manuscript. A total of 46 studies were finally included for review and subsequently analyzed. Overall, there exists no consensus neither on the term "acute" nor on "traumatic" in the context of rotator cuff tears in the literature. The time span for acute injuries ranged between 2 weeks and 6 months. For traumatic injuries, only 20% of the selected studies described a specific and adequate injury mechanism in combination with adequate imaging. CONCLUSION The term "acute" should be reserved for RCT showing muscle edema, wavelike appearance of the central part of the torn tendon and joint effusion, which typically requires adequate imaging within 2 weeks from trauma. Repair of acute tears should occur within 8 weeks from trauma to benefit from possibly superior biological healing capacities. The term "traumatic" should be used for a sudden onset of symptoms in a previously asymptomatic patient, triggered by an adequate trauma, e.g., a fall on the retroverted arm with an axial cranioventral force or a traumatic shoulder dislocation.
Collapse
Affiliation(s)
- Jonas Pogorzelski
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany.
| | - Bernd Erber
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Alexander Themessl
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Hannes Degenhardt
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Markus Irger
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| |
Collapse
|
28
|
Imam M, Sallam A, Ernstbrunner L, Boyce G, Bardakos N, Abdelkafy A, Moussa M, Ghazal MA. Three-year functional outcome of transosseous-equivalent double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded randomized controlled trial. J Shoulder Elbow Surg 2020; 29:2015-2026. [PMID: 32951642 DOI: 10.1016/j.jse.2020.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The trial aimed to prospectively compare the functional outcomes of patients undergoing arthroscopic rotator cuff repair using transosseous-equivalent double-row (TEDR) or single-row (SR) suture anchor techniques at 3 years postoperatively for both large (>3 cm) and small (<3 cm) tears. METHODS Eighty patients with a symptomatic and magnetic resonance imaging (MRI)-proven full-thickness rotator cuff tear, who had failed conservative management of at least 6 months' duration and who had a complete passive range of motion of the affected shoulder, were enrolled in the trial. Patients were randomized to TEDR repair (n = 40) or SR repair (n = 40). Subgroup analysis was conducted for tears <3 cm (TEDR n = 17, SR n = 19) and tears >3 cm (TEDR n = 23, SR n = 21). Primary outcomes included the Oxford Shoulder Score (OSS), the University of California, Los Angeles (UCLA) score, and the Constant-Murley score (CMS). The secondary outcomes included a 0-100-mm visual analog scale (VAS) score for pain, range of motion (ROM), and EQ-5D scores. All patients completed a follow-up of 3 years. RESULTS There was a significant difference in the mean OSS postoperative score for tears >3 cm (P = .01) and mean improvement from baseline in the TEDR group (P = .001). For tears >3 cm, mean postoperative scores were also significantly higher in the TEDR group for UCLA (P = .015) and CMS (P = .001). Post hoc testing showed that the differences between these groups was statistically significant (P < .05). For tears <3 cm, a significant postoperative difference in favor of SR repair was seen in the mean CMSs (P = .011), and post hoc testing showed that the difference was statistically significant (P = .015). No significant difference was seen with mean postoperative OSS or UCLA, and post hoc testing did not show a statistically significant difference between groups. CONCLUSIONS TEDR repair showed improved functional outcomes for tears >3 cm compared with SR repair. For tears <3 cm, no clear benefit was seen with either technique.
Collapse
Affiliation(s)
- Mohamed Imam
- Norfolk and Norwich University Hospitals, Norfolk, England; Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Asser Sallam
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt.
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Glenn Boyce
- Bendigo Orthopaedic and Sports Medicine, and University Hospital Geelong, Ryrie and Bellarine Street Geelong, Geelong, VIC, Australia
| | | | - Ashraf Abdelkafy
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Moussa Moussa
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Mohamed-Adel Ghazal
- Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| |
Collapse
|
29
|
Chen X, Jones IA, Togashi R, Park C, Vangsness CT. Use of Platelet-Rich Plasma for the Improvement of Pain and Function in Rotator Cuff Tears: A Systematic Review and Meta-analysis With Bias Assessment. Am J Sports Med 2020; 48:2028-2041. [PMID: 31743037 PMCID: PMC7234896 DOI: 10.1177/0363546519881423] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many clinical trials have investigated the use of platelet-rich plasma (PRP) to treat rotator cuff-related abnormalities. Several meta-analyses have been published, but none have focused exclusively on level 1 randomized controlled trials. PURPOSE To assess the efficacy of PRP for rotator cuff-related abnormalities and evaluate how specific tendon involvement, the inclusion of leukocytes, and the use of gel/nongel formulations affect pain and functional outcomes. STUDY DESIGN Systematic review and meta-analysis. METHODS The literature was screened following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Baseline, short-term, and long-term data were extracted for the Constant score, University of California, Los Angeles (UCLA) score, visual analog scale (VAS) for pain, retear rate, Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) score. The 100-point modified Coleman Methodology Score (CMS) was used to assess methodological quality. Funnel plots and the Egger test were used to screen for publication bias, and sensitivity analysis was performed to evaluate the effect of potential outliers. RESULTS A total of 18 level 1 studies were included in this review, 17 (1116 patients) of which could be included in quantitative analysis. The mean modified CMS was 79.4 ± 10.39. The Constant scores of patients who received PRP were significantly better short term (weighted mean difference [WMD], 2.89 [95% CI, 0.89-4.90]; P < .01) and long term (WMD, 2.66 [95% CI, 1.13-4.19]; P < .01). The VAS scores were significantly improved short term (WMD, -0.45 [95% CI, -0.75 to -0.15]; P < .01). Sugaya grade IV and V retears in PRP-treated patients were significantly reduced long term (odds ratio [OR], 0.34 [95% CI, 0.20-0.57]; P < .01). In PRP-treated patients with multiple tendons torn, there were reduced odds of retears (OR, 0.28 [95% CI, 0.13-0.60]; P < .01). Patients who received leukocyte-rich PRP had significantly better Constant scores compared with the leukocyte-poor PRP group, but there was no difference in VAS scores. Patients receiving PRP gel reported higher Constant scores compared with the controls, whereas those receiving nongel PRP treatments did not, although there was no difference in VAS scores. Long-term odds of retears were decreased, regardless of leukocyte content (leukocyte-poor PRP: OR, 0.36 [95% CI, 0.16-0.82]; leukocyte-rich PRP: OR, 0.32 [95% CI, 0.16-0.65]; all P < .05) or usage of gel (nongel: OR, 0.42 [95% CI, 0.23-0.76]; gel: OR, 0.17 [95% CI, 0.05-0.51]; all P < .01). CONCLUSION Long-term retear rates were significantly decreased in patients with rotator cuff-related abnormalities who received PRP. Significant improvements in PRP-treated patients were noted for multiple functional outcomes, but none reached their respective minimal clinically important differences. Overall, our results suggest that PRP may positively affect clinical outcomes, but limited data, study heterogeneity, and poor methodological quality hinder firm conclusions.
Collapse
Affiliation(s)
- Xiao Chen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ian A. Jones
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ryan Togashi
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Caron Park
- Southern California Clinical and Translational Science Institute, Los Angeles, California, USA
| | - C. Thomas Vangsness
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
30
|
Oh JH, Park JS, Rhee SM, Park JH. Maximum Bridging Suture Tension Provides Better Clinical Outcomes in Transosseous-Equivalent Rotator Cuff Repair: A Clinical, Prospective Randomized Comparative Study. Am J Sports Med 2020; 48:2129-2136. [PMID: 32551868 DOI: 10.1177/0363546520930425] [Citation(s) in RCA: 4] [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 Some studies reporting clinical outcomes after transosseous-equivalent (TOE) repair have attributed type II rotator cuff failure to excessive bridging suture tension, as it can cause overloading on the medial row. In a previous biomechanical cadaveric study, increasing bridging suture tension over 90 N did not improve the contact area and ultimate failure load of the TOE construct, despite increasing the contact force and contact pressure. PURPOSE To compare the clinical outcomes of different bridging suture tensions after TOE rotator cuff repair based on the results of a previous biomechanical study. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 78 patients who underwent arthroscopic rotator cuff repair for medium- to large-sized tears were prospectively enrolled and randomly divided into 2 groups according to the applied bridging suture tension: optimum tension group (96.3 ± 4.9 N) and maximum tension group (199.0 ± 20.3 N). Bridging suture tension was measured with a customized tensiometer, as used in the previous biomechanical study. The functional outcome was measured at the final follow-up (27.4 ± 5.9 months [range, 24-45 months]) using the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and Constant score, and the anatomic outcome was evaluated using magnetic resonance imaging or ultrasonography at least 12 months after surgery. RESULTS Overall, 64 patients (32 in each group) were analyzed. The functional outcomes improved significantly compared with preoperative values (all P < .05) but did not show significant differences between the 2 groups (all P > .05). Regarding the anatomic outcomes, the maximum tension group (n = 1; 3.1%) had a significantly lower healing failure rate than the optimum tension group (n = 9; 28.1%) (P = .013). One patient in the maximum tension group had a type II failure. CONCLUSION Maximum bridging suture tension in TOE repair for medium- to large-sized rotator cuff tears provided better anatomic healing with less risk of medial rotator cuff failure, which differs from the results of a previous time-zero biomechanical study.
Collapse
Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | | | - Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Joo Hyun Park
- Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Republic of Korea
| |
Collapse
|
31
|
Rashid M, Dudhia J, Dakin SG, Snelling S, Lach A, De Godoy R, Mouthuy PA, Smith R, Morrey M, Carr AJ. Histological evaluation of cellular response to a multifilament electrospun suture for tendon repair. PLoS One 2020; 15:e0234982. [PMID: 32589672 PMCID: PMC7319602 DOI: 10.1371/journal.pone.0234982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/05/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Rotator cuff tendon repair in humans is a commonly performed procedure aimed at restoring the tendon-bone interface. Despite significant innovation of surgical techniques and suture anchor implants, only 60% of repairs heal successfully. One strategy to enhance repair is the use of bioactive sutures that provide the native tendon with biophysical cues for healing. We investigated the tissue response to a multifilament electrospun polydioxanone (PDO) suture in a sheep tendon injury model characterised by a natural history of failure of healing. METHODOLOGY AND RESULTS Eight skeletally mature English Mule sheep underwent repair with electrospun sutures. Monofilament sutures were used as a control. Three months after surgery, all tendon repairs healed, without systemic features of inflammation, signs of tumour or infection at necropsy. A mild local inflammatory reaction was seen. On histology the electrospun sutures were densely infiltrated with predominantly tendon fibroblast-like cells. In comparison, no cellular infiltration was observed in the control suture. Neovascularisation was observed within the electrospun suture, whilst none was seen in the control. Foreign body giant cells were rarely seen with either sutures. CONCLUSION This study demonstrates that a tissue response can be induced in tendon with a multifilament electrospun suture with no safety concerns.
Collapse
Affiliation(s)
- Mustafa Rashid
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - Jayesh Dudhia
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, North Mymms, United Kingdom
| | - Stephanie G. Dakin
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - Sarah Snelling
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - Antonina Lach
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - Roberta De Godoy
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, North Mymms, United Kingdom
| | - Pierre-Alexis Mouthuy
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - Roger Smith
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, North Mymms, United Kingdom
| | - Mark Morrey
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Oxford, United Kingdom
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Andrew J. Carr
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- NIHR Biomedical Research Centre, Oxford, United Kingdom
| |
Collapse
|
32
|
Maassen NH, Somerson JS. A Majority of Single Versus Double-Row Rotator Cuff Repair Comparisons Fail to Consider Modern Single-Row Techniques. JBJS Rev 2020; 8:e0203. [DOI: 10.2106/jbjs.rvw.19.00203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
33
|
Chen Y, Jiang F, Li H, Chen S, Qiao Y, Li Y, Hua Y, Chen J, Ge Y. Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor. Am J Sports Med 2020; 48:931-938. [PMID: 32040348 DOI: 10.1177/0363546519900897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most patients return successfully to shoulder involving sports or activity after rotator cuff repairs. It has not been decided yet whether postoperative participation in shoulder activity adds to the risk of retear. PURPOSE/HYPOTHESIS The purpose was to verify whether patients who participate in shoulder activities after rotator cuff repair have a higher risk of structural failure than nonactive patients and to investigate the relationship between postoperative shoulder function and tendon integrity in active and nonactive patients. The hypotheses were that (1) active patients have a higher retear rate than nonactive patients and (2) structural failure is associated with worse functional outcomes in active patients. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A cohort study was performed using 145 patients who underwent arthroscopic rotator cuff repair from 2015 to 2017. Functional assessments and magnetic resonance imaging were performed at least 24 months postoperatively. Shoulder activities since 6 months after surgery were rated in 4 categories (sports, job, activities of daily life, and weight of general lifting) as sedentary, light, moderate, or strenuous. The activity level of each patient was defined by the highest rated category. Patients who were involved in light, moderate, and strenuous activity were identified as active for the present study, and the rest were defined as sedentary. The proportion of retears between groups and the functional conditions between retorn and intact tendons were compared. RESULTS A total of 48 patients were enrolled in the active group, and 97 were enrolled in the sedentary group. The active group demonstrated a significantly higher retear rate than the sedentary group (27.1% vs 11.3%, respectively; P = .016; risk ratio, 2.39 [95% CI, 1.16-4.93]). In the active group, patients with retears showed higher visual analog scale scores for pain, decreased abduction strength, and lower shoulder functional scores (American Shoulder and Elbow Surgeons score, Fudan University Shoulder Score, and Constant-Murley score) than those with healed tendons, whereas in the sedentary group, functional outcomes were generally similar across patients with and without retears. CONCLUSION Shoulder activity after the early postoperative period was associated with a high risk of retears in patients who underwent rotator cuff repair. A correlation between inhibited function and structural failure was detected but only in active patients, while sedentary patients with retears retained functional improvements similar to those with intact tendons.
Collapse
Affiliation(s)
- Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yang Qiao
- Department of Radiology, Huashan Hospital, Shanghai, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yunshen Ge
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| |
Collapse
|
34
|
Altintas B, Anderson NL, Pitta R, Buckley PS, Bhatia S, Provencher MT, Millett PJ. Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review. Am J Sports Med 2020; 48:744-753. [PMID: 31038992 DOI: 10.1177/0363546519834574] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years. PURPOSE To systematically review the literature on the outcomes of RCR among patients ≥70 years old. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included. RESULTS Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs (P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively. CONCLUSION RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.
Collapse
Affiliation(s)
- Burak Altintas
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA.,Department of Orthopaedic Surgery, School of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | | | - Rafael Pitta
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Patrick S Buckley
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Sanjeev Bhatia
- Department of Orthopaedics, Northwestern Medicine, Warrenville, Illinois, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Yoon JS, Kim SJ, Choi YR, Kim SH, Chun YM. Arthroscopic Repair of the Isolated Subscapularis Full-Thickness Tear: Single- Versus Double-Row Suture-Bridge Technique. Am J Sports Med 2019; 47:1427-1433. [PMID: 31042439 DOI: 10.1177/0363546519838281] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No clinical comparative study has addressed isolated subscapularis tears after arthroscopic repair with either single-row or double-row suture-bridge technique. PURPOSE/HYPOTHESIS The purpose of this study is to compare clinical outcomes and structural integrity after arthroscopic repair of an isolated subscapularis full-thickness tear with either the single-row technique or the double-row suture-bridge technique. The authors hypothesized that there would be no significant differences in clinical outcomes and structural integrity between approaches. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study included 56 patients who underwent arthroscopic repair of an isolated subscapularis full-thickness tear with grade II or less fatty infiltration in the subscapularis muscle with either a single-row technique (n = 31) or a double-row suture-bridge technique (n = 25). Functional outcomes were assessed with the visual analog scale (VAS) for pain, Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) shoulder score, and active range of motion. Magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed 6 months after surgery to assess the structural integrity of the repaired tendon. RESULTS At the 2-year follow-up, all scoring parameters applied (VAS, SSV, ASES, and UCLA), subscapularis strength, and active range of motion improved significantly in both groups as compared with preoperative values ( P < .001). However, there were no significant differences between groups in any of these clinical outcome measurements (VAS, 1.2 vs 1.1; SSV, 91.3 vs 91.8; ASES, 91.0 vs 91.4; UCLA, 31.9 vs 32.1). On follow-up MRA or CTA, the overall retear rate did not differ significantly between the single-row group (13%, 4 of 31) and the double-row group (12%, 3 of 25). CONCLUSION Arthroscopic single-row repair and double-row suture-bridge repair of isolated full-thickness subscapularis tears both yielded satisfactory clinical outcomes and structural integrity with no significant differences among patients with good muscle quality.
Collapse
Affiliation(s)
- Ji-Sang Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
37
|
Ajrawat P, Dwyer T, Almasri M, Veillette C, Romeo A, Leroux T, Theodoropoulos J, Nauth A, Henry P, Chahal J. Bone marrow stimulation decreases retear rates after primary arthroscopic rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg 2019; 28:782-791. [PMID: 30885313 DOI: 10.1016/j.jse.2018.11.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the optimization of biomechanical and patient factors in the setting of rotator cuff repair (RCR), postoperative retear rates remain high in many series reported in the literature. Preclinical studies have suggested bone marrow stimulation (BMS) at the rotator cuff footprint may reduce the rate of retear after RCR. The objective of this meta-analysis was to analyze the clinical evidence investigating the effect of arthroscopic RCR, with and without BMS, on rotator cuff healing and functional outcomes. METHODS PubMed, MEDLINE, Embase, and the Cochrane Library were searched through December 2017. Two reviewers selected studies based on the inclusion criteria and assessed methodologic quality. Pooled analyses were performed for continuous and binomial variables where appropriate. RESULTS Four studies (365 patients), including 2 Level I randomized controlled trials and 2 Level III retrospective comparative cohort studies were included. There was no statistical difference in the Disabilities of the Arm, Shoulder and Hand score, University of California Los Angeles Shoulder Rating Scale score, or the Constant score between the BMS and conventional repair groups. The pooled retear rates were 18.4% (28 of 152) and 31.8% (56 of 176) for patients treated with and without BMS, respectively. The pooled analysis of rotator cuff retear rates from the 4 studies (328 patients) showed a statistically significant difference favoring BMS over conventional repair (odds ratio, 0.42; 95% confidence interval, 0.25-0.73; P = .002; I2 = 0%). CONCLUSION BMS reduces the retear rate after RCR but shows no difference in functional outcomes compared with conventional repair. This study provides evidence for the use of BMS as a potential cost-effective biological approach toward improving rotator cuff healing.
Collapse
Affiliation(s)
- Prabjit Ajrawat
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Tim Dwyer
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Mahmoud Almasri
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Christian Veillette
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Anthony Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Timothy Leroux
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - John Theodoropoulos
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Aaron Nauth
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Patrick Henry
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada
| | - Jaskarndip Chahal
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, ON, Canada.
| |
Collapse
|
38
|
Mihata T, Lee TQ, Hasegawa A, Fukunishi K, Kawakami T, Fujisawa Y, Ohue M, Doi M, Neo M. Superior Capsule Reconstruction for Reinforcement of Arthroscopic Rotator Cuff Repair Improves Cuff Integrity. Am J Sports Med 2019; 47:379-388. [PMID: 30596519 DOI: 10.1177/0363546518816689] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Retear of repaired rotator cuff tendons worsens patient outcome and decreases patient satisfaction. Superior capsule reconstruction (SCR) was developed to center the humeral head and thus restore the force couple for patients with rotator cuff tears. PURPOSE To evaluate whether SCR for reinforcement before arthroscopic rotator cuff repair (ARCR) improves cuff integrity. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Thirty-four consecutive patients (mean age, 69.1 years) with severely degenerated but reparable rotator cuff tears underwent SCR with fascia lata autografts for reinforcement before ARCR. All tears were medium (1-3 cm) or large (3-5 cm), and the number of torn tendons was 2 (supraspinatus and infraspinatus) in 29 shoulders and 3 (supraspinatus, infraspinatus, subscapularis) in 5 shoulders. To assess the benefit of SCR for reinforcement, all data were compared with those after ARCR alone among 91 consecutive patients with medium or large rotator cuff tears (mean age, 63.6 years). The American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, active shoulder range of motion, and cuff integrity (Sugaya magnetic resonance imaging classification) were compared ( t test and chi-square test) between ARCR with and without SCR, as well as before surgery and at final follow-up. RESULTS All 34 patients who underwent SCR before ARCR had neither postoperative retear nor type III cuff integrity, whereas those treated with ARCR alone had a 4% incidence (4 of 91) of retear and 8% incidence of type III cuff integrity. ASES and JOA scores, active elevation, active external rotation, and active internal rotation increased in both treatment groups ( P < .001). Postoperative ASES score and active range of motion did not differ between groups, although the Goutallier grade of the supraspinatus was higher for ARCR with SCR (mean, 2.8) than ARCR alone (mean, 2.1; P < .0001). CONCLUSION SCR for reinforcement prevented retear at 1 year after ARCR and improved the quality of the repaired tendon on magnetic resonance imaging. Functional outcomes were similar between groups, even though degeneration of the torn tendons was greater among patients who underwent ARCR with SCR.
Collapse
Affiliation(s)
- Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.,Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA.,Department of Orthopaedic Surgery, University of California, Irvine, California, USA.,Katsuragi Hospital, Kishiwada, Japan
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA.,Department of Orthopaedic Surgery, University of California, Irvine, California, USA
| | - Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kunimoto Fukunishi
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Takeshi Kawakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yukitaka Fujisawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Munekazu Doi
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| |
Collapse
|
39
|
Aydin N, Karaismailoglu B, Gurcan M, Ozsahin MK. Arthroscopic double-row rotator cuff repair: a comprehensive review of the literature. SICOT J 2018; 4:57. [PMID: 30547879 PMCID: PMC6294008 DOI: 10.1051/sicotj/2018048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022] Open
Abstract
Rotator cuff repairs seek to achieve adequate tendon fixation and to secure the fixation during the process of biological healing. Currently, arthroscopic rotator cuff repair has become the gold standard. One of the earliest defined techniques is single-row repair but the inadequacy of single-row repair to precisely restore the anatomical footprint as well as the significant rates of retear especially in large tears have led surgeons to seek other techniques. Double-row repair techniques, which have been developed in response to these concerns, have various modifications like the number and placement of anchors and suture configurations. When the literature is reviewed, it is possible to say that double-row repairs demonstrate superior biomechanical properties. In regard to retear rates, both double row and transosseous equivalent (TOE) techniques have also yielded more favorable outcomes compared to single-row repair. But the clinical results are conflicting and more studies have to be conducted. However, it is more probable that superior structural integrity will yield better structural and functional results in the long run. TOE repair technique is regarded as promising in terms of better biomechanics and healing since it provides better footprint contact. Knotless TOE structures are believed to reduce impingement on the medial side of tendons and thus aid in tendon nutrition; however, there are not enough studies about its effectiveness. It is important to optimize the costs without endangering the treatment of the patients. We believe that the arthroscopic TOE repair technique will yield superior results in regard to both repair integrity and functionality, especially with tears larger than 3 cm. Although defining the pattern of the tear is one of the most important guiding steps when selecting the repair technique, the surgeon should not forget to evaluate every patient individually for tendon healing capacity and functional expectations.
Collapse
Affiliation(s)
- Nuri Aydin
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Mert Gurcan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | |
Collapse
|
40
|
Opsomer GJ, Gupta A, Haeni DL, Schubert T, Lejeune E, Petkin K, Maharaj J, Lafosse L. Arthroscopic Double-Layer Lasso Loop Technique to Repair Delaminated Rotator Cuff Tears. Arthroscopy 2018; 34:2943-2951. [PMID: 30292593 DOI: 10.1016/j.arthro.2018.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 05/28/2018] [Accepted: 06/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the arthroscopic double-layer lasso loop repair technique for delaminated posterosuperior rotator cuff tears. METHODS Forty-one patients underwent arthroscopic rotator cuff repair of a delaminated posterosuperior rotator cuff tear by the double-layer lasso loop technique. Their preoperative and postoperative clinical and functional scores were compared to evaluate surgical outcomes. The prerequisite for inclusion was a minimum follow-up period of 2 years. We excluded patients with a history of shoulder surgery before the double-layer lasso loop repair. RESULTS Statistically significant improvements (P < .001) were found in the Constant score (54 vs 83) and University of California, Los Angeles functional score (6.4 vs 9.5). Pain and strength improved according to the Jobe test, bear-hug test, belly-press test, Gerber lift-off test, and external rotation test (P < .001). No significant difference in strength was noted between the operated and nonoperated sides. There was only 1 complete rerupture (3.1%), whereas 5 patients (15.6%) had partial ruptures. CONCLUSIONS The arthroscopic double-layer lasso loop repair technique for delaminated posterosuperior rotator cuff tears is an effective procedure. Our series showed a low rerupture rate. At a mean follow-up of 44 months, postoperative recovery with resultant functional, pain, and patient satisfaction scores was good to excellent and was comparable with the nonoperated side. LEVEL OF EVIDENCE Level IV, case series.
Collapse
|