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Smith KM, Clinker CE, Cutshall ZA, Lu CC, Joyce CD, Chalmers PN, Tashjian RZ. Progression of symptomatic bilateral rotator cuff disease. JSES Int 2023; 7:586-591. [PMID: 37426927 PMCID: PMC10328764 DOI: 10.1016/j.jseint.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Prior studies have demonstrated that conservatively treated rotator cuff tears and rotator cuff tendinopathy may continue to progress. It is unclear whether that rate of progression differs between sides in patients with bilateral disease. This study evaluated the likelihood of progression of rotator cuff disease as confirmed via magnetic resonance imaging (MRI) in individuals with symptomatic bilateral pathology, treated conservatively for a minimum of 1 year. Methods We identified patients with bilateral rotator cuff disease confirmed via MRI within the Veteran's Health Administration electronic database. A retrospective chart review via the Veteran's Affairs electronic medical record was performed. Progression was determined using 2 separate MRIs with a minimum of 1 year apart. We defined progression as (1) a progression from tendinopathy to tearing, (2) an increase from partial-thickness to full-thickness tearing, or (3) an increase in tear retraction or tear width of at least 5 mm. Results Four hundred eighty MRI studies from 120 Veteran's Affair patients with bilateral, conservatively treated rotator cuff disease were evaluated. Overall, 42% (100/240) of rotator cuff disease had progressed. No significant difference was found between progression of right vs. left rotator cuff pathology, with right shoulder pathology progressing at a rate of 39% (47/120), while left shoulder disease progressed at a rate of 44% (53/120). The likelihood of disease progression was associated with less initial tendon retraction (P value = .016) and older age (P value = .025). Conclusions Rotator cuff tears are no more likely to progress on the right, as compared to the left side. Older age and less initial tendon retraction were found to be predictors of disease progression. These suggest that higher activity level may not associate with greater progression of rotator cuff disease. Future prospective studies evaluating progression rates between dominant vs. nondominant shoulders are warranted.
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Affiliation(s)
- Karch M. Smith
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Zachary A. Cutshall
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Chao-Chin Lu
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Peter N. Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z. Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Yuan T, Yang S, Qian H, Lai C, Jiang H, Meng J, Zhao J, Bao N. All-inside technique versus in situ transtendon repair for Ellman Ⅲ partial articular supraspinatus tendon avulsion. J Shoulder Elbow Surg 2023; 32:24-32. [PMID: 35948188 DOI: 10.1016/j.jse.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The current surgical techniques for repairing Ellman Ⅲ partial articular supraspinatus tendon avulsion (PASTA) is mainly tear completion followed by repair and in situ transtendon repair, and both techniques have been proven to have good clinical effects. In situ transtendon repair is more widely used because of its high performance in preserving the integrity of the bursal side supraspinatus tendon. However, there is still some scope for improvement. Our purpose was to compare the clinical outcomes of the all-inside repair technique and in situ transtendon repair for Ellman III PASTA. METHODS A retrospective comparative study was conducted on 56 patients who suffered from Ellman Ⅲ PASTA and underwent rotator cuff repair; 28 patients were treated with the all-inside technique (group A), and 28 patients were treated with the transtendinous technique (group B). All patients were followed up for at least 2 years. The visual analog scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were used to evaluate the patient's shoulder joint function before surgery, 1 month and 3 months after surgery, and at the last time of follow-up. RESULTS Group A showed superiority in pain and functional improvement 1 month after the operation: the VAS score, 2.8 ± 0.3 in group A vs. 4.7 ± 0.4 in group B (P = .042); Constant score, 73 ± 5 in group A vs. 60 ± 6 in group B (P = .038); and ASES score, 75 ± 5 in group A vs. 58 ± 7 in group B (P = .043), whereas there was no statistical difference in group B. However, 3 months after surgery and at the last follow-up, the VAS, Constant, and ASES scores in both groups were significantly improved (P < .01), and there was no significant statistical difference between the groups (P > .05). Magnetic resonance imaging showed that the repaired rotator cuff tendon-bone healed well; at the last follow-up, all patients were in good function, the pain was completely relieved, and no revision was performed in both groups. CONCLUSION Arthroscopic repair of Ellman Ⅲ PASTA provided satisfactory functional improvements and pain relief regardless of the all-inside and in situ transtendon repair techniques. However, the all-inside repair technique is more beneficial due to its dual function in preserving the intact bursa and avoidance of uneven tension of the articular side, which is advantageous to early postoperative rehabilitation.
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Affiliation(s)
- Tao Yuan
- Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shaoqiang Yang
- Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hong Qian
- Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chengteng Lai
- Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hui Jiang
- Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jia Meng
- Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianning Zhao
- Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Nirong Bao
- Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
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Wang C, Tan J, Zhang Y, Chen D, He Y. In Situ-Forming Fibrin Gel Encapsulation of MSC-Exosomes for Partial-Thickness Rotator Cuff Tears in a Rabbit Model: Effectiveness Shown in Preventing Tear Progression and Promoting Healing. J Bone Joint Surg Am 2022; 104:1492-1502. [PMID: 35726973 DOI: 10.2106/jbjs.21.01157] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current nonoperative treatments for partial-thickness rotator cuff tears (PTRCTs) have limited effectiveness in preventing tear progression or promoting tendon healing. This study aimed to establish a rabbit model using in situ-forming fibrin gel containing adipose stem cell-derived exosomes (ASC-Exos/fibrin) to treat PTRCTs. METHODS Fifty-six rabbits (112 shoulders) were included in this study and assigned to 4 groups: the control group (32 shoulders; PTRCTs without treatment), the fibrin group (32 shoulders; PTRCTs treated with fibrin gel), the ASC-Exo/fibrin group (32 shoulders; PTRCTs treated with ASC-Exos/fibrin), and the sham group (16 shoulders; sham surgery). Bilateral, 50%-thickness, bursal-side PTRCTs of 1 mm (depth) × 3 mm (width) × 5 mm (length) on the supraspinatus tendon were established by a number-11 scalpel blade, with accuracy of the measurement ensured by a digital vernier caliper. At 6 and 12 weeks postoperatively, gross observation, measurement of the thickness of residual supraspinatus tendons, and histological and biomechanical analyses were performed to analyze tendon repair. RESULTS At 12 weeks postoperatively, the tendon thickness in the ASC-Exos/fibrin group (mean and standard deviation, 1.63 ± 0.19 mm) was significantly greater than in the control group (0.85 ± 0.09 mm) (p < 0.0001) and fibrin group (1.16 ± 0.17 mm) (p < 0.0001). The histological score in the ASC-Exos/fibrin group (6.25 ± 0.53) was significantly better than in the control group (11.38 ± 0.72) (p < 0.0001) and fibrin group (9.00 ± 0.54) (p < 0.0001). Overall, immunohistochemical staining of types-I and III collagen and biomechanical testing also showed ASC-Exos/fibrin to be more effective in repairing PTRCTs than fibrin alone and no treatment. CONCLUSIONS Local administration of in situ-forming ASC-Exos/fibrin effectively facilitated the healing of bursal-side PTRCTs in rabbits. This approach may be a candidate for the nonoperative management of PTRCTs. CLINICAL RELEVANCE Ultrasound-guided injection of ASC-Exos/fibrin may be a novel nonoperative strategy to treat PTRCTs.
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Affiliation(s)
- Chongyang Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jiaqi Tan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yao Zhang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Daoyun Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yaohua He
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Department of Orthopedic Surgery, Jinshan Branch of Shanghai Sixth People's Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, People's Republic of China
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Conservatively Treated Symptomatic Rotator Cuff Tendinopathy May Progress to a Tear. Arthrosc Sports Med Rehabil 2022; 4:e1449-e1455. [PMID: 36033187 PMCID: PMC9402454 DOI: 10.1016/j.asmr.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the likelihood of, and risk factors for, progression of rotator cuff tendinopathy to tear on magnetic resonance imaging (MRI) in patients treated conservatively for minimum 1 year. Methods Patients in the Veterans Health Administration (VHA) Corporate Data Warehouse with a diagnosis of rotator cuff injury and sequential MRI of the same shoulder at least 1 year apart were identified. Presenting MRIs were reviewed to select patients with tendinopathy, while excluding those with a normal appearing cuff, tear, or prior repair. Tear progression was defined as development of a partial or full-thickness tear on follow-up MRI. Chart review was performed for demographic and clinical data. Descriptive statistics and inter-observer and intra-observer reliability were calculated. Discrete and continuous variables were compared between patients who progressed and those who did not using chi-square, Fisher’s Exact, Student’s t, and Mann-Whitney U-test. Results In the VHA database, 135 patients had an initial MRI demonstrating rotator cuff tendinopathy. On subsequent MRI at mean 3.4 year follow-up, 39% of patients had progressed to a tear. When grouped on the basis of time between scans as 1 to 2 years, 2 to 5 years, or over 5 years, the rate of progression was 32%, 37%, and 54% respectively. No factors were associated with progression. Conclusions Among patients with symptomatic rotator cuff tendinopathy that remained symptomatic at a minimum of 1 year and obtained a follow-up MRI, 39% progressed to a partial or full-thickness tear. None of the factors evaluated in this study correlated with progression from tendinopathy to tear. When patients were grouped based on time between scans as 1 to 2 years, 2 to 5 years, or more than 5 years, the rate of progression from tendinopathy to tear was 32%, 37%, and 54%, respectively.
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Ko SH, Jeon YD, Kim MS. Progression of Symptomatic Partial-Thickness Rotator Cuff Tears: Association With Initial Tear Involvement and Work Level. Orthop J Sports Med 2022; 10:23259671221105471. [PMID: 35783470 PMCID: PMC9247374 DOI: 10.1177/23259671221105471] [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: 02/26/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Partial-thickness rotator cuff tears (PTRCTs) often progress to full-thickness rotator cuff tears (FTRCTs). Thus, it is important to analyze the risk factors for tear progression to determine the proper timing of repair. Purpose To identify the risk factors associated with progression of PTRCT. Study Design Case-control study; Level of evidence, 3. Methods Included were 89 patients diagnosed with PTRCT on magnetic resonance imaging (MRI) scans who underwent nonoperative treatment at the authors' institution between August 2012 and August 2019. Patient characteristics, shoulder stiffness (compared with the contralateral shoulder); work level (classified as high [heavy manual labor], medium [manual labor with less activity], and low [sedentary activity]); and radiological factors including initial tear size, acromion type (flat, curved, hooked, or heel-shaped), and initial tear involvement (as a percentage of the rotator cuff tendon footprint length) were analyzed to assess their association with tear progression, defined as >20% increase in tear involvement. Results The mean MRI follow-up period was 22.3 ± 17.2 months (median, 16.1 months; range, 6.4-89.5 months), and tear progression was observed in 12 patients (13.5%). In these 12 patients, tear involvement increased by 60% of the rotator cuff footprint, while mediolateral (ML) and anteroposterior (AP) tear sizes progressed by 1.1 and 1.8 mm, respectively. Univariate regression analysis showed that shoulder stiffness (P = .031), work level (P = .001), initial tear involvement (P < .001), ML and AP tear sizes (P < .001 and P = .005, respectively), and acromion type (P = .003) were significantly associated with tear progression. Multivariate regression analysis showed that initial tear involvement (odds ratio [OR], 1.053; 95% CI, 1.006-1.102; P = .026) and high work level (OR, 15.831; 95% CI, 1.150-217.856; P = .039) were independent risk factors for tear progression. The cutoff value for initial tear involvement was 47.5% (sensitivity, 81.8%; specificity, 85.7%). Conclusion Tear progression was observed in 14% of patients with PTRCT in this study. To predict tear progression, evaluating the tear involvement during initial MRI is essential. The risk of tear progression increased with initial tear involvement >47.5% and a heavy work level.
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Affiliation(s)
- Sang-Hun Ko
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Young-Dae Jeon
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Myung-Seo Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Frandsen JJ, Quinlan NJ, Smith KM, Lu CC, Chalmers PN, Tashjian RZ. Symptomatic Rotator Cuff Tear Progression: Conservatively Treated Full- and Partial-Thickness Tears Continue to Progress. Arthrosc Sports Med Rehabil 2022; 4:e1091-e1096. [PMID: 35747654 PMCID: PMC9210491 DOI: 10.1016/j.asmr.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/15/2022] [Indexed: 11/03/2022] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
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7
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Diagnosis and Management of Partial Thickness Rotator Cuff Tears: A Comprehensive Review. J Am Acad Orthop Surg 2021; 29:1031-1043. [PMID: 34520444 DOI: 10.5435/jaaos-d-20-01092] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/10/2021] [Indexed: 02/01/2023] Open
Abstract
Partial thickness rotator cuff tears (PRCTs) are a challenging disease entity. Optimal management of PRCTs continues to be controversial. Although advances in magnetic resonance imaging and ultrasonography have aided in early diagnosis, arthroscopic evaluation remains the benchmark for diagnosis. Conservative treatment is often the first line of management for most patients; however, evidence suggests that surgical intervention may limit tear progression and the long-term sequelae. Surgical decision making is driven by factors such as age, arm dominance, etiology, activity level, tear thickness, and tear location. Many surgical options have been described in the literature to treat PRCTs including arthroscopic débridement, transosseous, in situ repair techniques, and tear completion and repair. Biologic supplements have also become an attractive alternative to aid in healing; however, the long-term efficacy of these modalities is largely unknown. This article will provide a detailed review of the etiology and natural history of PRCTs, as well as diagnosis, and current management to guide clinical decision-making and formulate an algorithm for management of PRCTs for the orthopaedic surgeon.
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Chen SY, Xiao ZH, Wang JK. Efficacy of threading lasso fixation in repairing partial articular supraspinatus tendon avulsion lesions: a retrospective study. BMC Musculoskelet Disord 2021; 22:847. [PMID: 34610812 PMCID: PMC8493669 DOI: 10.1186/s12891-021-04739-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: 04/05/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background The partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function. Methods Twenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery. Results There were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01). Conclusions Arthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.
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Affiliation(s)
- Sun-Yu Chen
- Department of Sports Injury, Fuzhou Second Hospital Affiliated to Xiamen University, No. 47, Shangteng Road, Cangshan District, Fuzhou, Fujian Province, 350007, P.R. China.
| | - Zhan-Hao Xiao
- Department of Sports Injury, Fuzhou Second Hospital Affiliated to Xiamen University, No. 47, Shangteng Road, Cangshan District, Fuzhou, Fujian Province, 350007, P.R. China
| | - Jian-Kun Wang
- Department of Sports Injury, Fuzhou Second Hospital Affiliated to Xiamen University, No. 47, Shangteng Road, Cangshan District, Fuzhou, Fujian Province, 350007, P.R. China
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Suh D, Park SE, Han YH, Kim ES, Ji JH. Transtendon Suture Bridge Repair of Both-Sided Partial-Thickness Rotator Cuff Tears: Midterm Outcomes. Am J Sports Med 2021; 49:3202-3211. [PMID: 34520255 DOI: 10.1177/03635465211034503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Among symptomatic partial-thickness rotator cuff tears (PTRCT) indicated for surgery, both-sided (concurrent articular and bursal side) PTRCT are rarely reported and discussed in the literature. Without clinical data on and definite guidelines for treating these rare partial tears, appropriate management cannot be expected. PURPOSE To calculate the prevalence of both-sided PTRCT and to evaluate clinical outcomes after arthroscopic transtendon suture bridge repair of both-sided PTRCT at a minimum 3-year follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS Among symptomatic PTRCT that required arthroscopic surgery (765 patients) between March 2008 and December 2014, 178 both-sided partial tears were confirmed arthroscopically, and arthroscopic transtendon suture bridge repair was performed in 100 patients enrolled in our study after exclusion criteria were applied. The presence of concurrent articular and bursal side partial tears was confirmed via arthroscopy, with Ellman grade >2 on either the bursal or the articular side of these both-sided partial tears. Without tear completion, transtendon suture bridge repair was performed in all cases. Clinical outcomes including clinical scores and range of motion were evaluated at a mean of 5.3 ± 1.4 years (range, 3-8 years). Follow-up magnetic resonance imaging (MRI) was performed at 6 to 12 months (mean ± SD, 11 ± 5.20 months) after surgery to evaluate the tendon integrity (Sugaya classification) of the repaired rotator cuff. RESULTS The mean age was 57.5 ± 7.8 years, and 65% of patients were women. Mean preoperative American Shoulder and Elbow Surgeons, University of California Los Angeles, Simple Shoulder Test, and Constant-Murley outcome scores of 52 ± 14, 19 ± 4, 6 ± 2, and 69 ± 10 significantly improved postoperatively to 94 ± 5, 33 ± 2, 11 ± 1, and 93 ± 5, respectively (P < .001). Mean forward flexion, abduction, external rotation, and internal rotation improved significantly from 148°± 31°, 134°± 39°, 22°± 13°, and L2 preoperatively to 154°± 17°, 151°± 60°, 29°± 14°, and T10 postoperatively, respectively (P < .001). The retear rate on follow-up MRI scans was 2%. As per Sugaya classification on postoperative MRI scans, type 1 healing was found in 29%; type 2, in 60%; type 3, in 9%; and type 4, in 2%. CONCLUSION Among all symptomatic PTRCT that required surgery, both-sided PTRCT were more common than expected. Arthroscopic transtendon suture bridge repair of these both-sided PTRCT showed satisfactory clinical outcomes at a minimum 3-year follow-up.
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Affiliation(s)
- Dongwhan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Eun Park
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hun Han
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eung-Sic Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Schlegel TF, Abrams JS, Angelo RL, Getelman MH, Ho CP, Bushnell BD. Isolated bioinductive repair of partial-thickness rotator cuff tears using a resorbable bovine collagen implant: two-year radiologic and clinical outcomes from a prospective multicenter study. J Shoulder Elbow Surg 2021; 30:1938-1948. [PMID: 33220413 DOI: 10.1016/j.jse.2020.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current surgical treatment options for partial-thickness tears (eg, takedown and repair, in situ repair) are limited by the degenerative nature of the underlying tendon and may require extensive intervention that can alter the anatomic footprint. The complexity of available techniques to address these issues led to the development of a resorbable collagen implant, which can be used to create a bioinductive repair of partial-thickness tears. METHODS We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12), or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. After arthroscopic subacromial decompression without a traditional rotator cuff repair, a bioinductive implant was secured over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores (CMS) preoperatively and at 3 months, 1 year, and 2 years postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site. RESULTS At 2-year follow-up, mean ASES and CMS scores improved both clinically and statistically at 1 and 2 years, compared with baseline, for intermediate- and high-grade tears. There was magnetic resonance imaging evidence of new tissue fill-in within the original baseline tear in 100% of the intermediate-grade tears and 95% of the high-grade tears. In 90.9% of the intermediate-grade tears and 84.2% of the high-grade tears, this new tissue fill-in represented at least an additional 50% of the volume of the initial lesion. From baseline to 2-year follow-up, the mean tendon thickness increased by 1.2 mm (standard deviation, 1.3; P = .012) and 1.8 mm (standard deviation, 2.2; P = .003) in the intermediate- and high-grade tears, respectively. The analysis of tear grade and location revealed no statistically significant difference in the change in mean tendon thickness at any time point. One patient with a high-grade articular lesion demonstrated progression to a full-thickness tear; however, the patient was noncompliant and the injury occurred while shoveling snow 1 month after surgery. Neither tear location nor treatment of bicep pathology affected the ASES or CMS scores at any follow-up point. No serious adverse events related to the implant were reported. CONCLUSION Final results from this 2-year prospective study indicate that the use of this resorbable bovine collagen implant for isolated bioinductive repair of intermediate- and high-grade partial-thickness rotator cuff tears of the supraspinatus is safe and effective, regardless of tear grade and location.
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Affiliation(s)
- Theodore F Schlegel
- University of Colorado Health Steadman Hawkins Clinic Denver, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
| | | | | | | | - Charles P Ho
- Department of Musculoskeletal Radiology, University of Colorado School of Medicine, Aurora, CO, USA
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Brockmeyer M, Haupert A, Lausch AL, Wagenpfeil G, Stroeder J, Schneider G, Kohn D, Lorbach O. Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up. Orthop J Sports Med 2021; 9:2325967120985106. [PMID: 33738311 PMCID: PMC7934052 DOI: 10.1177/2325967120985106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/04/2022] Open
Abstract
Background: The best surgical treatment option for symptomatic moderate- to high-grade articular-sided partial-thickness rotator cuff tears (PTRCTs) is still controversial. Purpose/Hypothesis: The purpose of this study was to evaluate patient-reported and clinical outcomes and tendon integrity after arthroscopic debridement or repair for PTRCTs at a minimum of 2 years postoperatively. We hypothesized that the overall outcomes would be positive, showing pain relief, good shoulder function, and high tendon integrity. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 30 patients (16 men, 14 women; mean age, 51 years) who underwent arthroscopic treatment for symptomatic PTRCTs (Ellman grades 2 and 3). Debridement was performed in 15 patients, and arthroscopic tendon repair was performed in the remaining 15 patients. Patients completed the Constant score; American Shoulder and Elbow Surgeons (ASES) shoulder score; Western Ontario Rotator Cuff Index; Simple Shoulder Test; and visual analog scale (VAS) for pain, function, and satisfaction. In addition, patients were examined clinically (range of motion, impingement tests, rotator cuff tests, and tests for the long head of the biceps tendon), and morphologic assessment of rotator cuff integrity was performed using direct magnetic resonance arthrography and was classified according to Sugaya. Results: The mean follow-up period was 55 months. The patient-reported outcome measures showed high patient satisfaction, reduction in persistent pain, and good shoulder function. Linear regression analysis showed that the debridement group had significantly better results on the Constant (bias-corrected and accelerated [BCa] 95% CI, 4.20-26.30), ASES (BCa 95% CI, 5.24-39.26), and VAS (pain: BCa 95% CI, 0.13-3.62; function: BCa 95% CI, 1.04-4.84; satisfaction: BCa 95% CI, 0.14-6.28) scores than did the repair group. At follow-up, there was no significant difference between the groups in clinical testing results. Good supraspinatus tendon integrity was seen in most patients: Sugaya classification grade 1 in 13 patients, grade 2 in 11 patients, and grade 3 in 6 patients. Conclusion: Midterm results after arthroscopic debridement and repair for PTRCTs showed high patient satisfaction, good shoulder function, and high tendon integrity for both procedures. Patients who underwent arthroscopic debridement had higher Constant, ASES, and VAS scores compared with patients who underwent tendon repair.
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Affiliation(s)
- Matthias Brockmeyer
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Alexander Haupert
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Anna-Lena Lausch
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jonas Stroeder
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Guenther Schneider
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Dieter Kohn
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Olaf Lorbach
- Department of Shoulder Surgery and Sports Traumatology, Schön Klinik Lorsch, Lorsch, Germany
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Tsuchiya S, Davison EM, Rashid MS, Bois AJ, LeBlanc J, More KD, Lo IKY. Determining the rate of full-thickness progression in partial-thickness rotator cuff tears: a systematic review. J Shoulder Elbow Surg 2021; 30:449-455. [PMID: 32920110 DOI: 10.1016/j.jse.2020.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Partial-thickness rotator cuff tears are likely at least as common as full-thickness rotator cuff tears, and it is critical for surgeons to have knowledge of the tear progression rate of partial-thickness rotator cuff tears when determining surgical or nonsurgical treatment. However, a systematic review investigating the rate of tear progression of partial-thickness rotator cuff tears has not been performed. Therefore, the purpose of this study was to systematically review the literature and determine the rate of full-thickness progression in nonoperatively treated partial-thickness rotator cuff tears. METHODS A systematic review of the literature was performed following the PRISMA guidelines and checklist using the PubMed, MEDLINE, and Cochrane Library databases. English-language studies of Level I through IV evidence examining partial-thickness rotator cuff tears with description of the change in tear size were included. Studies using imaging modalities other than magnetic resonance imaging (MRI) or ultrasonography (US) for serial imaging and studies without description of the number of tears that progressed to full-thickness tears were excluded. The primary outcome was to determine the per-month progression rate from a partial-thickness tear to a full-thickness tear confirmed on either MRI or US. The progression rates, which were divided into 3 groups-symptomatic, asymptomatic and combined (asymptomatic + symptomatic)-were calculated using a random effects model with binomial within-study variance. RESULTS Four studies were included, and 257 tears were analyzed statistically for tear progression. The average follow-up was 34 months (standard deviation, 19 months). The overall rate of progression to a full-thickness tear was 0.26% per month (95% confidence interval [CI], 0.15%-0.36% per month). In the symptomatic and asymptomatic groups, the rates were 0.22% per month (95% CI, 0.09%-0.34% per month) and 0.32% per month (95% CI, 0.15%-0.49% per month), respectively, which showed no significant difference (P =.341). CONCLUSIONS This study demonstrated that partial-thickness tears progress to full-thickness tears over time but at a relatively low rate at short- to intermediate-term follow-up. There was no significant difference in the per-month rates of full-thickness progression between symptomatic and asymptomatic tears.
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Affiliation(s)
- Saho Tsuchiya
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Erin M Davison
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Mustafa S Rashid
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Aaron J Bois
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Justin LeBlanc
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Kristie D More
- University of Calgary Sport Medicine Centre, University of Calgary, Calgary, AB, Canada
| | - Ian K Y Lo
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada.
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13
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Jung W, Lee S, Hoon Kim S. The natural course of and risk factors for tear progression in conservatively treated full-thickness rotator cuff tears. J Shoulder Elbow Surg 2020; 29:1168-1176. [PMID: 32044254 DOI: 10.1016/j.jse.2019.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/19/2019] [Accepted: 10/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The natural course of and risk factors for tear progression in full-thickness rotator cuff tears (FTRCTs) have not been clarified yet. The study's purpose was to retrospectively evaluate tear progression in FTRCTs by using magnetic resonance imaging (MRI) and to identify risk factors that are relevant to such tear progression. METHODS Between June 2010 and September 2019, a total of 345 patients with FTRCTs who had been diagnosed via MRI were treated conservatively. Of these, 48 patients who underwent post-treatment follow-up MRI were retrospectively enrolled. Tear progression was defined as significant when the tear size increased by >5 mm. RESULTS The mean MRI follow-up duration was 22 ± 14 months (range, 12-65 months). Among the 48 patients (mean age, 69 years; range, 53-81), 26 (54%) and 20 (41%) showed medial-lateral (M-L) and anterior-posterior (A-P) tear progression on MRI follow-up. Multivariate analysis revealed that MRI follow-up duration (P = .011), diabetes mellitus (P = .017), and infraspinatus muscle atrophy (P = .011) were independent risk factors for tear progression in the A-P plane. A high critical shoulder angle (P = .011) and supraspinatus (P = .024) and infraspinatus (P = .020) muscle atrophy were risk factors associated with M-L tear progression. CONCLUSION Among the assessed patients, a considerable number of FTRCTs increased in size during the follow-up period. Severe infraspinatus muscle atrophy was the independent risk factor for exacerbation of A-P and M-L tear progression.
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Affiliation(s)
- Whanik Jung
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sanguk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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14
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Long-term results after arthroscopic treatment of symptomatic Ellman grade 2 PASTA lesions. J Shoulder Elbow Surg 2019; 28:1356-1362. [PMID: 30904238 DOI: 10.1016/j.jse.2018.12.002] [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] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this retrospective study was to evaluate the clinical and radiologic long-term results of medium-sized (Ellman grade 2) partial-thickness articular-sided supraspinatus tendon avulsion (PASTA) lesions treated arthroscopically. METHODS Of 22 patients, 18 (82%) were available for follow-up evaluation after a mean of 15 ± 2 years (range, 12-17 years). The mean age at time of surgery was 55 ± 9 years (range, 35-66 years). The Constant score was used as the primary outcome instrument to evaluate shoulder function. Furthermore, the University of California-Los Angeles shoulder score, the American Shoulder and Elbow Surgeons score, and the Subjective Shoulder Value were collected. The patients' satisfaction with the outcome was investigated. Tendon integrity of the affected shoulder at final follow-up was assessed with magnetic resonance imaging or ultrasound in 89% of the cohort. RESULTS Overall, 94% of the patients were very satisfied or satisfied with the outcome. The average Constant score of the affected shoulder was 78 ± 21 points; the University of California-Los Angeles score, 31 ± 7 points; the American Shoulder and Elbow Surgeons score, 85 ± 24 points; and the Subjective Shoulder Value, 83% ± 21%. Radiologic evaluation showed progression to a full-thickness rotator cuff tear in 6% (1/16), and 60% of the patients (6/10) showed persistent signs of partial tearing evaluated by magnetic resonance imaging. CONCLUSION At long-term follow-up, arthroscopic treatment of medium-sized PASTA lesions resulted in good clinical results together with a high satisfaction level of the patients.
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15
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Camurcu Y, Ucpunar H, Ari H, Duman S, Cobden A, Sofu H. Predictors of allocation to surgery in patients older than 50 years with partial-thickness rotator cuff tear. J Shoulder Elbow Surg 2019; 28:828-832. [PMID: 30885549 DOI: 10.1016/j.jse.2018.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the predictive factors for allocation to surgery in patients older than 50 years with symptomatic chronic partial-thickness rotator cuff tear (PTRCT). METHODS Patients older than 50 years with a confirmed diagnosis of unilateral isolated PTRCT were included in this retrospective study. In the minimum follow-up of 2 years, eventual allocation to surgical or nonsurgical treatment was determined individually. Patients who underwent surgery were defined as failed conservative management and allocation to surgery. Data pertaining to patients' demographics, functional comorbidity index values, duration of symptoms, and American Shoulder and Elbow Surgeons scores were collected from our medical records. Tear side and Ellman classification, subacromial spur, and acromiohumeral intervals were also noted. A regression analysis was performed to determine the major predictors of allocation to surgery. RESULTS There were 202 patients with a mean age of 62 years in group I (no-surgery group) and 70 patients with a mean age of 57 years in group II (surgery group). The mean age and functional comorbidity index values were significantly higher in group I than in group II (P < .001 and P < .001, respectively). Bursal-sided tears were significantly more common in group II (P = .026). According to the findings of regression analysis, tear side and functional comorbidity index were the major predictors of allocation to surgery (P = .015 and P < .001, respectively). CONCLUSION Our study results indicate that in patients older than 50 years with PTRCTs, those with fewer comorbidities and bursal-sided PTRCTs were significantly more likely to undergo surgery.
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Affiliation(s)
- Yalkin Camurcu
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey.
| | - Hanifi Ucpunar
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Hamza Ari
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Serda Duman
- Department of Orthopaedics and Traumatology, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Adem Cobden
- Department of Orthopaedics and Traumatology, Sivas Numune Hospital, Sivas, Turkey
| | - Hakan Sofu
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
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Jain NB, Schneider BJ, Murrell WB, Hettrich CM, Archer KR. What's New in Orthopaedic Rehabilitation. J Bone Joint Surg Am 2018; 100:1993-1999. [PMID: 30480605 DOI: 10.2106/jbjs.18.00828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Nitin B Jain
- Departments of Physical Medicine and Rehabilitation (N.B.J., B.J.S., and K.R.A.) and Orthopaedics (N.B.J. and K.R.A.) and Division of Epidemiology (N.B.J.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Byron J Schneider
- Departments of Physical Medicine and Rehabilitation (N.B.J., B.J.S., and K.R.A.) and Orthopaedics (N.B.J. and K.R.A.) and Division of Epidemiology (N.B.J.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - William B Murrell
- Emirates Hospitals Group, Integra Medical and Surgical Center, Dubai, United Arab Emirates.,Department of Orthopaedics, Rehabilitation, and Podiatry, Ft. Belvoir Community Hospital, Ft. Belvoir, Virginia
| | | | - Kristin R Archer
- Departments of Physical Medicine and Rehabilitation (N.B.J., B.J.S., and K.R.A.) and Orthopaedics (N.B.J. and K.R.A.) and Division of Epidemiology (N.B.J.), Vanderbilt University Medical Center, Nashville, Tennessee
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Lemmon EA, Locke RC, Szostek AK, Ganji E, Killian ML. Partial-width injuries of the rat rotator cuff heal with fibrosis. Connect Tissue Res 2018; 59:437-446. [PMID: 29874950 PMCID: PMC6324170 DOI: 10.1080/03008207.2018.1485666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Identify the healing outcomes following a partial-width, full-thickness injury to the rotator cuff tendon-bone attachment and establish if the adult attachment can regenerate the morphology of the healthy attachment. HYPOTHESIS We hypothesized that a partial-width injury to the attachment would heal via fibrosis and bone remodeling, resulting in increased cellularity and extra-cellular matrix deposition, reduced bone volume (BV), osteoclast presence, and decreased collagen organization compared to shams. MATERIALS AND METHODS A partial-width injury was made using a biopsy punch at the center one-third of the rat infraspinatus attachment. Contralateral limbs underwent a sham operation. Rats were sacrificed at 3 and 8 weeks after injury for analyses. Analyses performed at each time point included cellularity (Hematoxylin & Eosin), ECM deposition (Masson's Trichrome), BV (micro-computed tomography; microCT), osteoclast activity (Tartrate Resistant Acid Phosphatase; TRAP), and collagen fibril organization (Picrosirius Red). Injured and sham shoulders were compared at both 3 and 8 weeks using paired, two-way ANOVAs with repeated measures (Sidak's correction for multiple comparisons). RESULTS Cellularity and ECM deposition increased at both 3 and 8 weeks compared to sham contralateral attachments. BV decreased and osteoclast presence increased at both 3 and 8 weeks compared to sham contralateral limbs. Collagen fibril organization was reduced at 3 weeks after injury compared to 3-week sham attachments. CONCLUSIONS These findings suggest that a partial-width injury to the rotator cuff attachment does not fully regenerate the native structure of the healthy attachment. The injury model healed via scar-like fibrosis and did not propagate into a full-width tear after 8 weeks of healing.
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Affiliation(s)
- Elisabeth A. Lemmon
- Department of Animal and Food Sciences and Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Ryan C. Locke
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Adrianna K. Szostek
- Department of Animal and Food Sciences and Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Elahe Ganji
- Department of Mechanical Engineering and Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Megan L. Killian
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
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