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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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2
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Fieseler G, Laudner K, Cornelius J, Schulze S, Delank KS, Schwesig R. Longitudinal Analysis of the ASES and Constant-Murley Scores, and the Internal Rotation/Shift and Jobe Tests Following Arthroscopic Repair of Supraspinatus Lesions. J Pers Med 2023; 13:1304. [PMID: 37763072 PMCID: PMC10533080 DOI: 10.3390/jpm13091304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
It is essential to investigate patients post-surgery using functional surveys like the American Shoulder and Elbow Surgeons Shoulder (ASES) and the Constant-Murley shoulder (CMS) scores, as well as clinical tests, such as the Internal Rotation and Shift (IRO/Shift) and Jobe tests. In this study, 51 out of an initial 87 patients underwent an arthroscopic supraspinatus repair (22 single-row, 16 double-row, 13 debridement). Testing occurred pre-surgery, and 3 and 6 months post-surgery. Both surveys showed significant improvements over time among all 87 patients, but there were no differences between groups (lesion/no lesion) (p > 0.815) or time × group (p > 0.895). The IRO/Shift test showed a stronger ability to distinguish between both groups (positive vs. negative) with respect to the ASES and CMS scores over time, but the Jobe test did not (p > 0.100). Improvements in the CMS scores and the Jobe test were lower following repair compared to the ASES and IRO/Shift test. Most patients returned to adequate levels of functional abilities at 6 months post-surgery. The time required to return to activities of daily living and negative clinical tests was longer for the double-row repair patients compared to the single-row and debridement groups. In conclusion, both the functional surveys and the clinical tests demonstrated improvements following surgery.
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Affiliation(s)
- George Fieseler
- Clinic for Hand, Trauma and Orthopedic Surgery, Sports Medicine, Clinic Hann, Münden, 34346 Hannoversch Münden, Germany
| | - Kevin Laudner
- Department of Health Sciences, Hybl Sports Medicine and Performance Center, University of Colorado, Colorado Springs, CO 80918, USA
| | - Jakob Cornelius
- Clinic for Hand, Trauma and Orthopedic Surgery, Sports Medicine, Clinic Hann, Münden, 34346 Hannoversch Münden, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Stephan Schulze
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
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3
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Velasquez Garcia A, Ingala Martini L, Franco Abache A, Abdo G. Role of platelet-rich plasma in the treatment of rotator cuff tendinopathy. World J Orthop 2023; 14:505-515. [PMID: 37485430 PMCID: PMC10359750 DOI: 10.5312/wjo.v14.i7.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/11/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023] Open
Abstract
Shoulder pain is a common musculoskeletal complaint, and rotator cuff (RC) pathologies are one of the main causes. The RC undergoes various tendinopathic and avascular changes during the aging process. Other degenerative changes affecting its healing potential make it an appealing target for biological agents. Platelet-rich plasma (PRP) has demonstrated the potential to deliver a high concentration of several growth factors and anti-inflammatory mediators, and its clinical use is mainly supported by experiments that demonstrated its positive effect on muscle, ligaments, and tendinous cells. This review aimed to specify the role of PRP and its future applications in RC tendinopathies based on the current clinical evidence. Due to the different characteristics and conflicting outcomes, clinicians should use PRP with moderate expectations until more consistent evidence is available. However, it is reasonable to consider PRP in patients with contraindications to corticosteroid injections or those with risk factors for inadequate healing. Its autologous origin makes it a safe treatment, and its characteristics make it a promising option for treating RC tendinopathy, but the efficacy has yet to be established.
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Affiliation(s)
| | - Liborio Ingala Martini
- Department of Orthopedic Surgery, Hospital IVSS Dr. Luis Ortega, Porlamar 6301, Venezuela
- Department of Orthopedic Surgery, Hospital Clinicas del Este, Los Robles 6301, Venezuela
| | - Andres Franco Abache
- Department of Orthopedic Surgery, Hospital de Especialidades Guayaquil MSP, Guayaquil 090101, Ecuador
| | - Glen Abdo
- Department of Graduate Medical Education, Internal Medicine Residence Program, New York Medical College at St. Mary’s and St. Clare’s, Passaic, NJ 07055, United States
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Desai V, Stambulic T, Daneshvar P, Bicknell RT. Lower trapezius tendon transfer for irreparable rotator cuff injuries: a scoping review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:1-9. [PMID: 37588064 PMCID: PMC10426520 DOI: 10.1016/j.xrrt.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Rotator cuff tears are a common source of shoulder pain and dysfunction. An irreparable rotator cuff tear poses a particular treatment challenge. There have been few studies reporting the outcomes of lower trapezius tendon (LTT) transfer for irreparable rotator cuff injuries. Therefore, the purpose of this review is to summarize the postoperative functional outcomes and complications of patients undergoing a LTT transfer for massive irreparable rotator cuff injuries. Methods A scoping review was performed using the Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases with the search terms "trapezius" AND "transfer." Of 362 studies included for initial screening, 37 full-text citations were reviewed, with 5 studies meeting all the inclusion criteria to be included in the review. Two reviewers extracted data on study design, patient demographics, surgical technique, functional outcomes, range of motion (ROM), and complications for each study according to the predefined criteria. Results Improvements in the preoperative to postoperative functional status, identified using the Disabilities of the Arm, Shoulder, and Hand (50.34 to 18), The American Shoulder and Elbow Surgeons Score (48.56 to 80.24), Visual Analog Scale (5.8 to 1.89), Single Assessment Numeric Evaluation (34.22 to 69.86), and Subjective Shoulder Value (52.24 to 77.66), were evident across all 5 studies. Preoperative to postoperative increases in ROM were seen for flexion (85 to 135), external rotation (18 to 52), and abduction (50 to 98). The overall complication rate was 18%, with seroma formation (8%) as the most common postoperative complication. Discussion/Conclusion Our analysis showed that LTT transfer improved postoperative function, ROM, and pain for patients with irreparable rotator cuff tears with an overall complication rate of 18%. Future controlled studies are required to directly compare LTT transfer to other tendon transfers and other surgical techniques for irreparable rotator cuff tears.
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Affiliation(s)
- Veeral Desai
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Thomas Stambulic
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Parham Daneshvar
- Department of Othopaedic Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Ryan T. Bicknell
- Department of Othopaedic Surgery, Queen’s University, Kingston, Ontario, Canada
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Kim MS, Rhee SM, Cho NS. Perianchor cyst formation in all-suture anchor after rotator cuff repair: an evaluation of anchor insertion angle. J Shoulder Elbow Surg 2022; 31:1831-1839. [PMID: 35367621 DOI: 10.1016/j.jse.2022.02.028] [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: 11/23/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies reported that micromotion after all-suture anchor implantation can lead to perianchor cyst formation (PCF), leading to risk of retear. Modifying anchor insertion angle (AIA) is known to be one of the various ways to increase anchor stability. However, there currently are few studies that assess the correlation between PCF, AIA, and retear. PURPOSE To find the correlation of PCF and the repaired rotator cuff integrity with AIA after arthroscopic double-row suture-bridge rotator cuff repair (RCR) using an all-suture anchor in the medial row. METHODS A total of 218 patients who underwent arthroscopic double-row suture-bridge RCR were retrospectively reviewed. All patients underwent RCR using all-suture anchors and polyether ketone anchors in the medial and lateral rows, respectively. Magnetic resonance imaging was conducted 6 months after the surgery to evaluate PCF, AIA, and integrity of the repaired cuff. The all-suture anchor insertion angle in the medial row was measured with reference to the greater tuberosity to assess the relationship between the AIA and PCF. The correlations between PCF, AIA, and post-RCR integrity were evaluated including various demographic and radiologic factors. RESULTS Perianchor cysts were formed in 93 patients (42.7%). Mediolateral tear size (2.1 ± 1.2 cm vs. 1.7 ± 0.9 cm, P = .034) and AIA (61.9° ± 15.2° vs. 68.4° ± 13.0°, P = .001) were significantly different between patient groups with and without perianchor cysts. Multivariate logistic regression analysis showed that mediolateral tear size (odds ratio [OR] 1.318, 95% confidence interval [CI] 1.008-1.724; P = .043) and AIA (OR 0.967, 95% CI 0.947-0.988; P = .002) were independent risk factors for PCF. In addition, PCF was observed more frequently (69.6% vs. 32.1%, P < .001) and the AIA was lower (59.4° ± 13.7° vs. 67.8° ± 13.8°, P < .001) in the retear group than in the healed group. CONCLUSIONS Perianchor cysts were formed in approximately 40% of patients who underwent arthroscopic double-row suture-bridge RCR using all-suture anchors. Low AIA and large mediolateral tear size were risk factors for PCF. Moreover, perianchor cyst and AIA were correlated with post-RCR integrity. Therefore, a high AIA must be carefully considered when all-suture anchors are inserted into the medial row when performing RCR.
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Affiliation(s)
- 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
| | - Sung Min Rhee
- College of Medicine, Kyung Hee University, Seoul, Republic of Korea; Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Nam Su Cho
- Department of Orthopedic Surgery, Cheil Orthopedic Hospital, Seoul, Republic of Korea.
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6
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Tanpowpong T, Itthipanichpong T, Limskul D, Tantimethanon T, Jenvorapoj S. How to Decrease Suture Tangling When Performing Supraspinatus Repair With a Single-Working Portal Technique. Arthrosc Tech 2022; 11:e1219-e1222. [PMID: 35936841 PMCID: PMC9353274 DOI: 10.1016/j.eats.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/02/2022] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic rotator cuff repair is one of the most common procedures in shoulder surgery. Some complications occur related to portal incisions, such as infection, bleeding, increased surgical time, and surgical scar. By using 1 lateral working portal with decreased suture tangling, surgical complications can be reduced and rehabilitation and patient satisfaction can be enhanced.
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Affiliation(s)
| | | | | | | | - Somjet Jenvorapoj
- Address correspondence to Somjet Jenvorapoj, M.D., Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
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7
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Randelli PS, Cucchi D, Fossati C, Boerci L, Nocerino E, Ambrogi F, Menon A. Arthroscopic Rotator Cuff Repair Augmentation With Autologous Microfragmented Lipoaspirate Tissue Is Safe and Effectively Improves Short-term Clinical and Functional Results: A Prospective Randomized Controlled Trial With 24-Month Follow-up. Am J Sports Med 2022; 50:1344-1357. [PMID: 35302901 DOI: 10.1177/03635465221083324] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous microfragmented lipoaspirate tissue has been recently introduced in orthopaedics as an easily available source of nonexpanded adipose-derived mesenchymal stem cells. Autologous microfragmented lipoaspirate tissue is expected to create a suitable microenvironment for tendon repair and regeneration. Rotator cuff tears show a high incidence of rerupture and represent an ideal target for nonexpanded mesenchymal stem cells. PURPOSE To evaluate the safety and efficacy of autologous lipoaspirate tissue in arthroscopic rotator cuff repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Consecutive patients referring to the investigation center for surgical treatment of magnetic resonance imaging-confirmed degenerative posterosuperior rotator cuff tears were assessed for eligibility. Those who were included were randomized to receive a single-row arthroscopic rotator cuff repair, followed by intraoperative injection of autologous microfragmented adipose tissue processed with an enzyme-free technology (treatment group) or not (control group). Clinical follow-up was conducted at 3, 6, 12, 18, and 24 months; at 18 months after surgery, magnetic resonance imaging of the operated shoulder was obtained to assess tendon integrity and rerupture rate. RESULTS An overall 177 patients were screened, and 44 (22 per group) completed the 24-month follow-up. A statistically significant difference in favor of the treatment group in terms of Constant-Murley score emerged at the primary endpoint at 6-month follow-up (mean ± SD; control group, 76.66 ± 10.77 points; treatment group, 82.78 ± 7.00 points; P = .0050). No significant differences in clinical outcome measures were encountered at any of the other follow-up points. No significant differences emerged between the groups in terms of rerupture rate, complication rate, and number of adverse events. CONCLUSION This prospective randomized controlled trial demonstrated that the intraoperative injection of autologous microfragmented adipose tissue is safe and effective in improving short-term clinical and functional results after single-row arthroscopic rotator cuff repair. REGISTRATION NCT02783352 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Pietro S Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy.,REsearch Center for Adult and Pediatric Rheumatic Diseases, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Davide Cucchi
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy
| | - Linda Boerci
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Milan, Italy
| | - Elisabetta Nocerino
- Department of Diagnostic and Interventional Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccaro," Università degli Studi di Milano, Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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8
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Peng Y, Wu W, Li X, Shangguan H, Diao L, Ma H, Wang G, Jia S, Zheng C. Effects of leukocyte-rich platelet-rich plasma and leukocyte-poor platelet-rich plasma on the healing of bone-tendon interface of rotator cuff in a mice model. Platelets 2022; 33:1075-1082. [PMID: 35257633 DOI: 10.1080/09537104.2022.2044462] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Platelet-rich plasma (PRP) is widely used clinically to treat tendon injuries, and often contains leukocytes. However, the debate regarding the concentration of leukocytes in PRP is still ongoing. This study aimed to evaluate the therapeutic effects of leukocyte-rich platelet-rich plasma (LR-PRP) and leukocyte-poor platelet-rich plasma (LP-PRP) on the healing of the bone-tendon interface (BTI) of the rotator cuff. A total of 102 C57BL/6 mice were used. Thirty mice were used to prepare the PRP, while 72 underwent acute supraspinatus tendon injury repair. The animals were then randomly assigned to three groups: LR-PRP, LP-PRP and control groups. The mice were euthanized at 4 and 8 weeks postoperatively, and histological, immunological and biomechanical analyses were performed. The histological results showed that the fusion effect at the bone-tendon interface at 4 and 8 weeks after surgery was greater in the PRP groups and significantly increased at 4 weeks; however, at 8 weeks, the area of the fibrocartilage layer in the LP-PRP group increased significantly. M2 macrophages were observed at the repaired insertion for all the groups at 4 weeks. At 8 weeks, M2 macrophages withdrew back to the tendon in the control group, but some M2 macrophages were retained at the repaired site in the LR-PRP and LP-PRP groups. Enzyme-linked immunoassay results showed that the concentrations of IL-1β and TNF-α in the LR-PRP group were significantly higher than those in the other groups at 4 and 8 weeks, while the concentrations of IL-1β and TNF-α in the LP-PRP group were significantly lower than those in the control group. The biomechanical properties of the BTI were significantly improved in the PRP group. Significantly higher failure load and ultimate strength were seen in the LR-PRP and LP-PRP groups than in the control group at 4 and 8 weeks postoperatively. Thus, LR-RPR can effectively enhance the early stage of bone-tendon interface healing after rotator cuff repair, and LP-PRP could enhance the later stages of healing after rotator cuff injury.
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Affiliation(s)
- Yundong Peng
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Wenxia Wu
- College of Health Science, Wuhan Sports University, Wuhan, China.,Department of Rehabilitation Therapy, Jinci College of Shanxi Medical University, Jinzhong, China
| | - Xiaomei Li
- College of Health Science, Wuhan Sports University, Wuhan, China.,Medical College, Huainan Union University, Anhui, China
| | - Hengyi Shangguan
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Luyu Diao
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Haozhe Ma
- College of International Education, Wuhan Sports University, Wuhan, China
| | - Guanglan Wang
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- College of Health Science, Hubei Provincial Collaborative Innovation Center for Exercise and Health Promotion, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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Yamauchi S, Tsukada H, Sasaki E, Sasaki S, Kimura Y, Yamamoto Y, Tsuda E, Ishibashi Y. Biomechanical analysis of bioabsorbable suture anchors for rotator cuff repair using osteoporotic and normal bone models. J Orthop Sci 2022; 27:115-121. [PMID: 33461858 DOI: 10.1016/j.jos.2020.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study aimed to compare the failure load of suture anchors used in rotator cuff repair between normal and osteoporotic bone models. METHODS A total of 16 anchors made from metal (TwinFix Ti 5.0 or 6.5 mm, Corkscrew FT 4.5, 5.5, or 6.5 mm), polyether ether ketone (HEALICOIL PK [HC-PK] 4.5 or 5.5 mm, SwiveLock PK 4.75 or 5.5 mm), or bioabsorbable material (HEALICOIL RG [HC-RG] 4.75 or 5.5 mm, Corkscrew Bio 4.75, 5.5, or 6.5 mm, SwiveLock BC 4.75 or 5.5 mm) were included. Moreover, 10- and 5-pounds per cubic foot (pcf) Sawbone® models were set as normal and osteoporotic cancellous bone models, respectively. Pullout testing was performed in parallel to the insertion axis at a displacement rate of 12.5 mm/s using a universal testing machine. To evaluate the change in failure load between the two Sawbone® models with different densities, the remaining failure load ratio (RFLR) was defined as the ratio of the failure load in 10 pcf to that in 5 pcf. RESULTS In the 10-pcf Sawbone®, TwinFix Ti 6.5 mm showed the highest mean failure load (304.0 ± 15.2 N). In the 5-pcf Sawbone® model, HC-PK 5.5 mm showed the highest failure load (146.3 ± 5.8 N). Among anchors with the same diameter, HC-PK and HC-RG showed a significantly higher failure load than other anchors in the 10- and 5-pcf Sawbone® models. HC-PK 5.5 mm (62.1%) and HC-PK 4.5 mm (51.1%) have the highest RFLR among anchors with the same diameter. CONCLUSIONS HC-PK and HC-RG showed higher failure load than the other anchors in both normal and osteoporotic bone models, except for TwinFix Ti 6.5 mm in the 10-pcf Sawbone® model. Based on our results, bioabsorbable anchors had sufficient failure load for rotator cuff repair in addition to bioabsorbability.
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Affiliation(s)
- Shohei Yamauchi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Harehiko Tsukada
- Department of Orthopaedic Surgery, Aomori City Hospital, 1-14-20 Katsuta, Aomori, 030-0821, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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10
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Day Hazra RO, Ernat JJ, Rakowski DR, Boykin RE, Millett PJ. The Evolution of Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2021; 9:23259671211050899. [PMID: 34901288 PMCID: PMC8652190 DOI: 10.1177/23259671211050899] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.
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Affiliation(s)
- Rony-Orijit Day Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Justin J Ernat
- Steadman Philippon Research Institute, Vail, Colorado, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | | | - Robert E Boykin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,EmergeOrtho, Asheville, North Carolina, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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11
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Lee HY, Cheon SJ, Seo H, Lee BY, Nam JH, Lee DY. Periimplant osteolysis does not affect the outcome of rotator cuff repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3910-3920. [PMID: 33090240 DOI: 10.1007/s00167-020-06328-3] [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] [Received: 05/21/2020] [Accepted: 10/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The goal of this study was to perform a systematic review and meta-analysis to compare the clinical and radiologic outcomes of rotator cuff repair, depending on the presence of developed periimplant osteolysis (PIO) after using suture anchors. METHODS The electronic databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for articles published up until October 2019 to find relevant articles comparing the outcomes of rotator cuff repair between the periimplant osteolysis group and non-periimplant osteolysis group. Data searching, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. The results are presented as risk ratio (RR) for binary outcomes and standardised mean difference (SMD) for continuous outcomes with 95% confidence intervals (CI). RESULTS Six clinical studies were included. No significant differences were found between the group with periimplant osteolysis and the group without periimplant osteolysis regarding retear rate (RR = 1.34; 95% CI 0.93-1.94; I2 = 28%), postoperative clinical scores (SMD = 0.29; 95% CI - 0.26 to 0.83; I2 = 80%) and range of motion (ROM); forward flexion (SMD = 0.39; 95% CI - 0.16 to 0.93; I2 = 0%), external rotation (SMD = - 0.10; 95% CI - 0.64 to 0.45; I2 = 0%) and internal rotation (SMD = - 0.37; 95% CI - 0.92 to 0.17; I2 = 0%). CONCLUSION The presence of periimplant osteolysis after rotator cuff repair with suture anchor does not affect the clinical outcomes such as retear rate, clinical scoring, and ROM. However, as there was no standard consensus on the criteria for evaluating periimplant osteolysis, this result may not fully reflect the effect of periimplant osteolysis depending on its severity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hyo Yeol Lee
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea
| | - Sang Jin Cheon
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Haneol Seo
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Beom Yeol Lee
- Faculty of Nanotechnology Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Jun Ho Nam
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea.,Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Dong-Yeong Lee
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea. .,Department of Orthopaedic Surgery, Barun Hospital, Jinju, 52725, Republic of Korea.
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12
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Gathen M, Cucchi D, Jansen T, Goost H, Schildberg FA, Burger C, Wirtz DC, Kabir K, Welle K. Practicability of a Virtual Consultation to Evaluate the Shoulder Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 161:195-200. [PMID: 34544165 DOI: 10.1055/a-1522-9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the course of the corona pandemic, resource conservation and the protection of further infections have made it necessary to break new ground in the organisation of orthopaedic and trauma surgery consultations. One solution is consistent digitisation and the offer of video consultation hours. In this study, non-contact examination of patients with shoulder disorders is described and critically examined. METHODS Thirty patients who presented with pathologies of the shoulder joint in a university outpatient clinic were subjected to a physical examination in a conventional and contactless manner. The data obtained on mobility, function and provocation test of both examinations were compared to draw conclusions about the virtual feasibility. RESULTS 46% of the patients suffered from a traumatic shoulder lesion, and 54% showed degenerative lesions. The assessment of mobility showed a high correlation of 70 - 90% between the two examinations. Common tests to evaluate the supraspinatus, infraspinatus, subscapularis and the long head of the biceps could be adequately performed in a contactless version by more than three quarters of the patients, but with low-to-moderate performance values. CONCLUSION Contact-less examination is particularly disadvantageous when evaluating stability criteria. For the medical history and functional test, there were no significant differences between the classic consultation and contactless consultation. Although virtual consultation is a widespread and valuable addition in pandemic times, it cannot replace a safe assessment and indication by personal examination.
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Affiliation(s)
- Martin Gathen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Davide Cucchi
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Tom Jansen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Hans Goost
- Department of Orthopaedics and Trauma Surgery, Krankenhaus Wermelskirchen, Germany
| | | | - Christof Burger
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | | | - Koroush Kabir
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Kristian Welle
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
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13
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Adam JR, Nanjayan SK, Monga P. Management of rotator cuff tears - Key historical landmarks. J Clin Orthop Trauma 2021; 18:6-12. [PMID: 33954084 PMCID: PMC8080522 DOI: 10.1016/j.jcot.2021.03.019] [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] [Received: 02/28/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 02/04/2023] Open
Abstract
The management of rotator cuff pathology has developed over hundreds of years. In this article, we take a journey from the early days, in order to understand how we have reached our modern-day practice. Initially our understanding of rotator cuff pathology was based on cadaveric anatomical findings and this has enhanced over the years by the development of radiological and surgical techniques. We discuss the historical debates over the pathogenesis of cuff dysfunction. This work describes the landmark publications by several clinicians who have made important contributions to our understanding of rotator cuff pathology and its management. We follow the trends of surgical management of rotator cuff tears, traditionally performed via an open technique, to an exponential rise in arthroscopic surgery in recent years. As new techniques emerge, a review of the historical rise and fall of techniques is a reminder for us to remain vigilant of surgical indications and rigorous outcome analysis.
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Affiliation(s)
- John R. Adam
- The James Cook University Hospital, Middlesbrough, UK
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14
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Sakha S, Erdogan S, Shanmugaraj A, Betsch M, Leroux T, Khan M. Update on all-arthroscopic vs. mini-open rotator cuff repair: A systematic review and meta-analysis. J Orthop 2021; 24:254-263. [PMID: 33867750 DOI: 10.1016/j.jor.2021.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/23/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose To provide an updated comparison between modern arthroscopic and mini-open repairs for treating rotator cuff tears. Methods Multiple online databases were searched from 2010 to October 1st, 2020. A meta-analysis was conducted for patient-reported outcomes and complications. Results Eleven studies were included. Majority of patients underwent mini-open repair (MOR) compared to arthroscopic repair (AR) (57.4% vs 42.6%). A meta-analysis found statistically significant differences (p < 0.05) in patient-reported outcomes favouring AR. While retear rates were higher in AR (p = 0.03) analysis of retear rates for arthroscopic double row and mini-open repairs, yielded no differences between groups (p = 0.48). Conclusion Patients undergoing AR for rotator cuff tears had improved post-operative clinical outcomes in some functional outcomes compared to MOR. Modern arthroscopic double row repair result in similar failure rates to open repair techniques. Level of evidence Level III, Systematic Review of Level I-III studies.
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Affiliation(s)
- Seaher Sakha
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Safiya Erdogan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marcel Betsch
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Center of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty University Heidelberg, Mannheim, Germany
| | - Timothy Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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15
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Hasan SS. Editorial Commentary: Biology and Biomechanics Must Be Carefully Balanced for a Durable Rotator Cuff Repair. Arthroscopy 2021; 37:38-41. [PMID: 33384094 DOI: 10.1016/j.arthro.2020.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023]
Abstract
Arthroscopic rotator cuff repair strategies have evolved over 3 decades, but suture anchor design, anchor configuration, and stitches have been largely driven by repair biomechanics. In recent years there has been a shift toward repair strategies that enhance the biology of tendon repair. Double-row and transosseous equivalent suture anchor repair constructs demonstrate excellent time zero mechanical properties, but the resulting increased repair tension and tendon compression may compromise tendon healing. Modern single-row repairs employing medialized triple-loaded suture anchors, simple stitches, and lateral marrow venting avoid some of the problems associated with double-row repairs and demonstrate excellent short-term healing and clinical results. The most robust repair fails if the tendon does not heal. Biology and biomechanics must be carefully balanced.
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16
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Cucchi D, Menon A, Feroldi FM, Boerci L, Randelli PS. The presence of gastroesophageal reflux disease increases the risk of developing postoperative shoulder stiffness after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2020; 29:2505-2513. [PMID: 32711105 DOI: 10.1016/j.jse.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative shoulder stiffness (SS) after arthroscopic rotator cuff (RC) repair has been reported with a variable incidence, and numerous preoperative risk factors have been described. This prospective study aimed to document the incidence of postoperative SS and to evaluate the role of preoperative risk factors in the development of this complication, with a special focus on the role of gastroesophageal reflux disease (GERD). METHODS Preoperative risk factors for SS were prospectively evaluated in 237 consecutive patients undergoing arthroscopic single-row RC repair. The presence of GERD was evaluated with the GerdQ diagnostic tool. Postoperative SS was diagnosed according to the criteria described by Brislin et al in 2007. RESULTS The incidence of postoperative SS was 8.02%. The presence of GERD was significantly associated with the development of postoperative SS (odds ratio [OR], 5.265; 95% confidence interval [CI], 1.657-1.731; P = .005). Older age (OR, 0.896; 95% CI, 0.847-0.949; P < .001), male sex (OR, 0.126; 95% CI, 0.0252-0.632; P = .012), and number of pregnancies (OR, 0.47; 95% CI, 0.228-0.967; P = .040) emerged as protective factors. CONCLUSIONS The presence of GERD significantly influences the development of postoperative SS after arthroscopic single-row RC repair. An underlying aspecific proinflammatory condition, characterized by increased expression of tumor necrosis factor α and transforming growth factor β, and disorders in retinoid metabolism are hypotheses that could explain this previously unknown association. The documented incidence of postoperative SS falls within previously reported ranges, with women being significantly more affected than men.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany.
| | - Alessandra Menon
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Research Center for Adult and Pediatric Rheumatic Diseases, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Linda Boerci
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Milan, Italy
| | - Pietro Simone Randelli
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Research Center for Adult and Pediatric Rheumatic Diseases, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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17
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Jin S, Chun YM. Peri-anchor cyst formation after arthroscopic bankart repair: comparison between biocomposite suture anchor and all-suture anchor. Clin Shoulder Elb 2020; 23:178-182. [PMID: 33330255 PMCID: PMC7726366 DOI: 10.5397/cise.2020.00290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study is to investigate clinical outcomes and radiological findings of cyst formation in the glenoid around suture anchors after arthroscopic Bankart repair with either biocomposite suture anchor or all-suture anchor in traumatic anterior shoulder instability. We hypothesized that there would be no significant difference in clinical and radiological outcomes between the two suture materials. Methods This retrospective study reviewed 162 patients (69 in group A, biocomposite anchor; 93 in group B, all-suture anchor) who underwent arthroscopic Bankart repair of traumatic recurrent anterior shoulder instability with less than 20% glenoid defect on preoperative en-face view three-dimensional computed tomography. Patient assignment was not randomized. Results At final follow-up, the mean subjective shoulder value, Rowe score, and University of California, Los Angeles shoulder score improved significantly in both groups. However, there were no significant differences in functional shoulder scores and recurrence rate (6%, 4/69 in group A; 5%, 5/93 in group B) between the two groups. On follow-up magnetic resonance arthrography/computed tomography arthrography, the incidence of peri-anchor cyst formation was 5.7% (4/69) in group A and 3.2% (3/93) in group B, which was not a significant difference. Conclusions Considering the low incidence of peri-anchor cyst formation in the glenoid after Bankart repair with one of two anchor systems and the lack of association with recurrence instability, biocomposite and all-suture anchors in Bankart repair yield satisfactory outcomes with no significant difference.
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Affiliation(s)
- Seokhwan Jin
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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18
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Walter SG, Cucchi D, Thomas W, Friedrich MJ, Jansen T. ARoCuS Web application promotes standardized treatment and documentation of rotator cuff tears. Musculoskelet Surg 2020; 105:289-294. [PMID: 32314304 PMCID: PMC8578089 DOI: 10.1007/s12306-020-00658-8] [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] [Received: 09/01/2019] [Accepted: 04/11/2020] [Indexed: 11/11/2022]
Abstract
Purpose To program a Web application for simplified calculation of the Advanced Rotator Cuff tear Score (ARoCuS), which is a 5-part, 18-item treatment-oriented intraoperative scoring system for intraoperative evaluation of rotator cuff tears. Methods ARoCuS characteristics (torn tendon, tear size, tissue quality and tear pattern) were assessed intraoperatively on 40 consecutive patients with rotator cuff tears for calculation of defect category ΔV. Video recordings were used to re-calculate the ARoCuS after surgery and to assess inter-observer reliability. Results The Web application “ARoCuS App” was built using Angular and transformed to a native iOS application. The intraoperative use of the app proved to be simple and intuitive. There were inter-/intra-observer differences neither in ARoCuS defect categories ΔV nor in ARoCuS characteristics (p > 0.05). Conclusion The ARoCuS app is a supportive tool for integration of standardized treatment procedures and documentation of rotator cuff tears in clinical routine.
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Affiliation(s)
- S G Walter
- Department for Orthopedic Surgery, University Hospital, Siegmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - D Cucchi
- Department for Orthopedic Surgery, University Hospital, Siegmund-Freud-Str. 25, 53127, Bonn, Germany
| | - W Thomas
- Clinic for Orthopedic Surgery, Karol Wojtyla Hospital, Viale Africa 32, 00144, Rome, Italy
| | - M J Friedrich
- Department for Orthopedic Surgery, University Hospital, Siegmund-Freud-Str. 25, 53127, Bonn, Germany
| | - T Jansen
- Department for Orthopedic Surgery, University Hospital, Siegmund-Freud-Str. 25, 53127, Bonn, Germany
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19
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Ro K, Rhee SM, Kim JY, Kim MS, Kim JD, Lee H, Rhee YG. All-Suture Anchor Settling After Arthroscopic Repair of Small and Medium Rotator Cuff Tears. Am J Sports Med 2019; 47:3483-3490. [PMID: 31718248 DOI: 10.1177/0363546519886547] [Citation(s) in RCA: 5] [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 All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors. PURPOSE To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm2; n = 31), group B (BMD, 0.4-0.6 g/cm2; n = 32), and group C (BMD, >0.6 g/cm2; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21). RESULTS On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) (P = .001). The DA was deeper in patients with a higher BMD at time zero (r = 0.374; P = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA (r = 0.769; P < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) (P = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) (P = .550). CONCLUSION In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.
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Affiliation(s)
- Kyunghan Ro
- Shoulder and Elbow Clinic, Bonbridge Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Myung Seo Kim
- Department of Orthopaedic Surgery, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Jong Dae Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hojin Lee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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21
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Randelli PS, Menon A, Nocerino E, Aliprandi A, Feroldi FM, Mazzoleni MG, Boveri S, Ambrogi F, Cucchi D. Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years. Am J Sports Med 2019; 47:2659-2669. [PMID: 31411899 DOI: 10.1177/0363546519865529] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic techniques are now considered the gold standard for treatment of most rotator cuff (RC) tears; however, no consensus exists on the maintenance of results over time, and long-term follow-up data have been reported for few cohorts of patients. PURPOSE To present the long-term results associated with the arthroscopic treatment of RC tears and to evaluate associations between preoperative factors and RC integrity at final follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 169 patients were contacted at least 10 years after arthroscopic RC surgery and were invited to a clinical evaluation. Information on preoperative conditions, tear size, subjective satisfaction, and functional scores was collected; isometric strength and range of motion were also measured; and each patient underwent an ultrasound examination to evaluate supraspinatus integrity and a shoulder radiograph to evaluate osteoarthritis. RESULTS A total of 149 patients (88.2% of the eligible patients) were available for a complete telephonic interview, and 102 patients were available for the final evaluation. Ultrasound revealed an intact supraspinatus in 54 patients (53.47%). By adding the 10 patients who underwent revision surgery to the nonintact group, this percentage would drop to 48.65%. Tear size was associated with supraspinatus integrity in univariate analysis (hazard ratio, 3.04; 95% CI, 1.63-5.69; P = .001) and multivariable analysis (hazard ratio, 2.18; 95% CI, 1.03-4.62; P = .04). However, no significant differences were encountered in the subjective and functional scores collected, with the exception of the Constant-Murley Score, which was significantly higher in patients with smaller tears at the index procedure. Strength testing also revealed significantly superior abduction and flexion strength in this group, and radiographs showed a significantly higher acromion-humeral distance and lower grades of osteoarthritis. Patients with an intact supraspinatus at final follow-up showed superior results in all functional scores, greater satisfaction, superior abduction and flexion strength, higher acromion-humeral distance, and lower grades of osteoarthritis. CONCLUSION RC tear size at the time of surgery significantly affects supraspinatus integrity at a minimum follow-up of 10 years. However, a larger tear is not associated with an inferior subjective result, although it negatively influences abduction and flexion strength, range of motion, and osteoarthritis progression. Intraoperative efforts to obtain a durable RC repair are encouraged, since supraspinatus integrity at final follow-up influences clinical and functional outcomes, patient satisfaction, and osteoarthritis progression.
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Affiliation(s)
- Pietro Simone Randelli
- Prima Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Menon
- Prima Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Elisabetta Nocerino
- Department of Diagnostic and Interventional Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federico Ambrogi
- Laboratory of Medical Statistics and Biometry "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Davide Cucchi
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
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Ro K, Pancholi S, Son HS, Rhee YG. Perianchor Cyst Formation After Arthroscopic Rotator Cuff Repair Using All-Suture-Type, Bioabsorbable-Type, and PEEK-Type Anchors. Arthroscopy 2019; 35:2284-2292. [PMID: 31350085 DOI: 10.1016/j.arthro.2019.03.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to identify the difference in postoperative perianchor bone reactions in different groups of patients who underwent rotator cuff tear repairs with all-suture-, bioabsorbable screw-, and PEEK (polyether ether ketone)-type suture anchors. Furthermore, the rate of rotator cuff retear and its association with perianchor bone reactions based on the different anchors used were investigated. Moreover, their impact on the clinical outcome of patients was examined. METHODS The study included 213 patients who underwent arthroscopic single-row repair and were divided into 3 groups according to the suture anchor used: all-suture (n = 137), biodegradable (n = 36), and PEEK (n = 40) anchor groups. The clinical outcomes and magnetic resonance imaging findings were evaluated at a mean follow-up of 9.6 months. The perianchor bone reaction at the anchor site was categorized according to grades. Patients were classified based on repair integrity into the healed and retear groups with Sugaya type I to III and Sugaya type IV to V, respectively. RESULTS No statistically significant differences in Constant scores and retear rates were observed between the groups (P = .934 and P = .548, respectively). Magnetic resonance imaging showed that the total number of perianchor cysts formed postoperatively was 23 (10.8% [23 of 213 patients]). Moreover, the proportions of perianchor cysts were 8.8%, 16.7%, and 12.5% in the all-suture-type, bioabsorbable-, and PEEK-type anchor groups, respectively (P = .485). In the retear group, the incidence rate was significantly increased with higher grades of perianchor bone reaction (P = .001). The tear size and perianchor bone reaction were found to be independent factors that affected the incidence of retear. CONCLUSIONS Perianchor cyst formation was observed in 10.8% of cases after the use of suture anchors for arthroscopic rotator cuff repair. No significant differences were observed among all-suture-type, bioabsorbable-type, and PEEK-type anchors in terms of visual analog scale and Constant scores, retear rates, and perianchor bone reactions. However, the retear rate was associated with a greater perianchor cystic reaction and larger tear size. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Affiliation(s)
- Kyunghan Ro
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Samyak Pancholi
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyuck Sung Son
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Shi BY, Diaz M, Binkley M, McFarland EG, Srikumaran U. Biomechanical Strength of Rotator Cuff Repairs: A Systematic Review and Meta-regression Analysis of Cadaveric Studies. Am J Sports Med 2019; 47:1984-1993. [PMID: 29975549 DOI: 10.1177/0363546518780928] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical cadaveric studies of rotator cuff repair (RCR) have shown that transosseous equivalent and double-row anchored repairs are stronger than other repair constructs. PURPOSE To identify technical and procedural parameters that most reliably predict biomechanical performance of RCR constructs. STUDY DESIGN Systematic review. METHODS The authors systematically searched the EMBASE and PubMed databases for biomechanical studies that measured RCR performance in cadaveric specimens. The authors performed a meta-regression on the pooled data set with study outcomes (gap formation, failure mode, and ultimate failure load) as dependent variables and procedural parameters (eg, construct type, number of suture limbs) as covariates. Stratification by covariates was performed. An alpha level of .05 was used. RESULTS Data from 40 eligible studies were included. Higher number of suture limbs correlated with higher ultimate failure load (β = 38 N per limb; 95% CI, 28 to 49 N) and less gap formation (β = -0.6 mm per limb; 95% CI, -1 to -0.2 mm). Other positive predictors of ultimate failure load were number of sutures, number of mattress stitches, and use of wide suture versus standard suture. When controlling for number of suture limbs, we found no significant differences among single-row anchored, double-row anchored, transosseous equivalent, and transosseous repairs. Higher number of suture limbs and transosseous equivalent repair both increased the probability of catastrophic construct failure. CONCLUSION This study suggests that the number of sutures, suture limbs, and mattress stitches in a RCR construct are stronger predictors of overall strength than is construct type. There is a need to balance increased construct strength with higher risk of type 2 failure.
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Affiliation(s)
- Brendan Y Shi
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miguel Diaz
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Binkley
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Edward G McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Uma Srikumaran
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
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Determination of Threshold Scores for Treatment Success After Arthroscopic Rotator Cuff Repair Using Oxford, Constant, and University of California, Los Angeles Shoulder Scores. Arthroscopy 2019; 35:304-311. [PMID: 30473455 DOI: 10.1016/j.arthro.2018.07.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the threshold scores for the Constant-Murley score (CMS); University of California, Los Angeles (UCLA) shoulder score; and Oxford Shoulder Score (OSS) that determine treatment success after arthroscopic rotator cuff (RC) repair. METHODS Patients who underwent unilateral arthroscopic double-row RC repair by a single surgeon between 2010 and 2015 were prospectively followed up and assessed preoperatively and at 6, 12, and 24 months postoperatively. Perceived pain was measured with a visual analog scale, and functional outcome was assessed by the CMS, UCLA score, and OSS. Treatment success was defined as simultaneous fulfillment of 3 criteria: improvement in pain, expectations for surgery met, and patient satisfied with surgery. Threshold scores were determined by receiver operating characteristic (ROC) analyses, using the various scores as predictors and the defined treatment success as the criterion. RESULTS The study included a total of 214 patients (96 male and 118 female patients) with a mean age of 60.1 ± 10 years. Most patients showed improvement in pain (≥88%) and high satisfaction (≥93%) and expectation fulfillment (≥80%) postoperatively. Of the patients, 73% had treatment success at 6 months; 85%, at 12 months; and 80%, at 24 months. ROC analyses showed good prediction of treatment success using the CMS, UCLA score, and OSS at all 3 follow-up time points (area under the ROC curve [AUC] > 0.70), with excellent prediction using the UCLA score at 12 months and 24 months (AUC, 0.811 and 0.805, respectively) and the OSS at 12 months (AUC, 0.820). The following threshold scores were identified: CMS of 59, UCLA score of 21, and OSS of 42 at 6 months; CMS of 61, UCLA score of 26, and OSS of 43 at 12 months; and CMS of 65, UCLA score of 30, and OSS of 46 at 24 months. CONCLUSIONS The CMS, UCLA score, and OSS have good predictive value in defining treatment success after arthroscopic RC repair. The cutoff scores are time dependent. LEVEL OF EVIDENCE Level II, development of diagnostic criteria.
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Increasing the deltoid muscle volume positively affects functional outcomes after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2019; 27:259-266. [PMID: 30196437 DOI: 10.1007/s00167-018-5135-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to determine the effect of changes in deltoid muscle volume (DMV) on the clinical outcomes of patients who underwent arthroscopic repair due to chronic rotator cuff rupture. METHODS A total of 54 patients (35 females, 19 males) between 40 and 70 years of age who underwent single-row arthroscopic repair due to chronic rotator cuff tears were compared via preoperative (preop) and postoperative (postop) (6-12 months) magnetic resonance imaging (MRI) to determine the total DMV (tDMV). A clinical evaluation was performed with American Shoulder and Elbow Surgeons (ASES) and Constant scores in both the preop and postop groups. tDMV values were also measured in a randomly selected control group (50 patients). A standardized rehabilitation program was recommended for all patients. RESULTS Positive correlations were found between the change in tDMV (ΔtDMV) and ASES and Constant scores (p < 0.03 and p < 0.032, respectively). The preop tDMV value was significantly lower in the patient group than in the control group (p < 0.02). Significantly lower ΔtDMV and body mass index (BMI)-adjusted tDMV values [Δ(tDMV/BMI)] were observed in patients who had rerupture at the postop MRI. CONCLUSIONS According to the present study, changes in DMV impact clinical outcomes after rotator cuff repair. Rehabilitation of the DMV or increasing the preop DMV values positively affects postop clinical outcomes. In addition, if the DMV is below the cutoff value during the preop period, there is insufficient improvement in clinical scores. The clinical relevance of this study is the finding that in patients with a chronic rotator cuff tear and a hypotrophic deltoid muscle, increasing the preop DMV could help achieve better functional outcomes. LEVEL OF EVIDENCE Prognostic, Level 3, case-control study.
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Learn GD, McClellan PE, Knapik DM, Cumsky JL, Webster-Wood V, Anderson JM, Gillespie RJ, Akkus O. Woven collagen biotextiles enable mechanically functional rotator cuff tendon regeneration during repair of segmental tendon defects in vivo. J Biomed Mater Res B Appl Biomater 2018; 107:1864-1876. [PMID: 30485649 DOI: 10.1002/jbm.b.34279] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/04/2018] [Accepted: 10/19/2018] [Indexed: 12/15/2022]
Abstract
Despite advancements in surgical techniques and materials for rotator cuff repair procedures, primary repair failures remain common. This study examines the use of electrochemically aligned collagen (ELAC) threads woven into biotextile scaffolds as grafts to repair critical infraspinatus tendon defects in New Zealand White rabbits. Three surgical treatment groups were evaluated: rabbits undergoing direct repair as operative controls, rabbits receiving ELAC scaffolds alone, and rabbits treated with mesenchymal stem cell (MSC)-seeded ELAC scaffolds. In each animal, the intact, contralateral infraspinatus served as an internal positive control. Tendon-bone constructs were harvested after 3 months in vivo and outcome measures included biomechanical testing, histological staining, and immunohistochemical staining. Biomechanical testing revealed that maximum load-bearing capacity was comparable between all groups, while MSC-seeded scaffold repairs exhibited increased stiffness relative to non-seeded scaffold repairs. Histological staining revealed robust collagen deposition around ELAC fibers and increased cellularity within the continuum of woven scaffolds as compared to native tendon. Immunohistochemical staining revealed presence of collagens I and III in all groups, but procollagen I and the tendon-specific marker tenomodulin were only observed in seeded and non-seeded ELAC scaffold repairs. Findings of this pilot study warrant continued investigation of ELAC biotextile scaffolds for repair of critically-sized rotator cuff tendon defects. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1864-1876, 2019.
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Affiliation(s)
- Greg D Learn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Phillip E McClellan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, Ohio
| | - Jameson L Cumsky
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Victoria Webster-Wood
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - James M Anderson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.,Department of Pathology, Case Western Reserve University, Cleveland, Ohio.,Department of Macromolecular Science, Case Western Reserve University, Cleveland, Ohio
| | - Robert J Gillespie
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, Ohio
| | - Ozan Akkus
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.,Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio.,Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, Ohio
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Van der Bracht H, Van den Langenbergh T, Pouillon M, Verhasselt S, Verniers P, Stoffelen D. Rotator cuff repair with all-suture anchors: a midterm magnetic resonance imaging evaluation of repair integrity and cyst formation. J Shoulder Elbow Surg 2018; 27:2006-2012. [PMID: 29802062 DOI: 10.1016/j.jse.2018.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 03/01/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study investigated the feasibility and safety of all-suture anchors in arthroscopic rotator cuff repair. METHODS All patients were diagnosed with a rotator cuff tear by ultrasound or magnetic resonance imaging (MRI). Patients with partial tears, massive tears, subscapularis tears, or previous shoulder surgery, were excluded. MRI and clinical outcome were investigated in all patients at 1.58 years (range, 1.0-2.0 years) after rotator cuff repair with all-suture anchors (prospective case series). Integrity of the cuff repair, cyst formation (encapsulated fluid signal around the anchor), ingrowth of the bone into the anchor, and integrity of the bone tunnel border were evaluated for 47 anchors. Clinical results were evaluated using the Constant-Murley score. RESULTS An MRI evaluation was performed in 20 patients at 1.58 years (range, 1.0-2.0 years) after rotator cuff repair with all-suture anchors. MRI evaluation showed a very small rim of fluid around 10% of the anchors. None of the anchors showed cyst formation with fluid diameter more than twice the anchor diameter. In approximately 90% of the anchors, no fluid could be detected between the anchors and the edge of the bony tunnel. Full rotator cuff integrity was seen in 19 patients. Only 1 patient sustained a retear. Clinical results comparable with an arthroscopic rotator cuff repair using classic anchors were seen. CONCLUSIONS This prospective clinical cohort study shows promising early radiographic and clinical results after arthroscopic rotator cuff repair using all-suture anchors.
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Affiliation(s)
- Hans Van der Bracht
- Department of Orthopaedic Surgery and Traumatology, Algemeen Ziekenhuis St-Lucas, Gent, Belgium.
| | - Tom Van den Langenbergh
- Department of Orthopaedic Surgery and Traumatology, University Hospital Antwerp, Antwerp, Belgium
| | - Marc Pouillon
- Department of Radiology, GasthuisZusters Antwerpen Hospitals, Wilrijk, Belgium
| | - Skrallan Verhasselt
- Department of Orthopaedic Surgery and Traumatology, University Hospital Leuven, Leuven, Belgium
| | - Philippe Verniers
- Department of Orthopaedic Surgery and Traumatology, Algemeen Ziekenhuis St-Lucas, Gent, Belgium
| | - Danny Stoffelen
- Department of Orthopaedic Surgery and Traumatology, GasthuisZusters Antwerpen Hospitals, Wilrijk, Belgium
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TÜRKMEN İSMAİL. Comparison of Belt and Suspenders Technique With Simple Double Row Rotator Cuff Repair in the Patients with Chronic Rotator Cuff Tear. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.459636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ono Y, Joly DA, Thornton GM, Lo IKY. Mechanical and imaging evaluation of the effect of sutures on tendons: tape sutures are protective to suture pulling through tendon. J Shoulder Elbow Surg 2018; 27:1705-1710. [PMID: 29759907 DOI: 10.1016/j.jse.2018.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/01/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND High-strength sutures, including #2 and tape-type, are popular when performing arthroscopic rotator cuff repair. Although the most common mechanism of anatomic failure of rotator cuff repair is suture pulling through tendon, the effect of sutures on the suture-tendon interface has rarely been investigated. We evaluated the effect of commercially available modern high-strength standard #2 and tape-type sutures on tendon. METHODS Isolated sutures (FiberTape, #2 FiberWire [Arthrex Inc., Naples, FL, USA], Ultratape, and #2 Ultrabraid [Smith & Nephew, Andover, MA, USA]) and suture-tendon constructs using sheep infraspinatus tendons were evaluated using mechanical testing and imaging (microcomputed tomography) techniques. RESULTS For the 4 suture-tendon constructs evaluated, maximum and residual displacements were all less than 3 mm. Whether evaluating isolated sutures or suture-tendon constructs, tape-type sutures had smaller displacements than standard #2 sutures when products from the same company were compared. On initial suture passing and after mechanical testing, hole volume was larger in constructs with tape-type rather than standard #2 sutures comparing within the same company. Collectively, constructs with larger hole volumes after mechanical testing had stiffer sutures. The percentage difference in hole volume was larger for standard #2 than tape-type sutures: FiberWire (43%), Ultrabraid (17%), FiberTape (11%), and Ultratape (9%). CONCLUSIONS Tape-type sutures created larger final holes than standard #2 sutures from the same company. When initially passed through the tendon, tape-type sutures produced larger holes than standard #2 sutures; however, standard #2 sutures enlarged their initially smaller holes more and displaced more than tape-type sutures during cyclic loading, which suggests that tape-type sutures may be protective to suture pulling through tendon.
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Affiliation(s)
- Yohei Ono
- Section of Orthopaedic Surgery, Department of Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Denis A Joly
- Section of Orthopaedic Surgery, Department of Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Gail M Thornton
- Section of Orthopaedic Surgery, Department of Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Ian K Y Lo
- Section of Orthopaedic Surgery, Department of Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
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Growth factor delivery strategies for rotator cuff repair and regeneration. Int J Pharm 2018; 544:358-371. [PMID: 29317260 DOI: 10.1016/j.ijpharm.2018.01.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/21/2017] [Accepted: 01/01/2018] [Indexed: 12/21/2022]
Abstract
The high incidence of degenerative tears and prevalence of retears (20-95%) after surgical repair makes rotator cuff injuries a significant health problem. This high retear rate is attributed to the failure of the repaired tissue to regenerate the native tendon-to-bone insertion (enthesis). Biological augmentation of surgical repair such as autografts, allografts, and xenografts are confounded by donor site morbidity, immunogenicity, and disease transmission, respectively. In contrast, these risks may be alleviated via growth factor therapy, which can actively influence the healing environment to promote functional repair. Several challenges have to be overcome before growth factor delivery can translate into clinical practice such as the selection of optimal growth factor(s) or combination, identification of the most efficient stage and duration of delivery, and the design considerations for the delivery device. Emerging insight into the injury-repair microenvironment and our understanding of growth factor mechanisms in healing are informing the design of advanced delivery scaffolds to effectively treat rotator cuff tears. Here, we review potential growth factor candidates, design parameters and material selection for growth factor delivery, innovative and dynamic delivery scaffolds, and novel therapeutic targets from tendon and developmental biology for the structural and functional healing of rotator cuff repair.
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Cucchi D, Marmotti A, De Giorgi S, Costa A, D'Apolito R, Conca M, Russo A, Saccomanno MF, de Girolamo L. Risk Factors for Shoulder Stiffness: Current Concepts. JOINTS 2017; 5:217-223. [PMID: 29270559 PMCID: PMC5738468 DOI: 10.1055/s-0037-1608951] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Shoulder stiffness is a condition of painful restriction of the glenohumeral range of motion. Numerous risk factors for primary and postoperative shoulder stiffness have been described. This article summarizes the known aspects of the pathophysiology of shoulder stiffness, with special attention to elements of molecular biology and genetics, which could influence the risk of developing shoulder stiffness. Furthermore, the role of hormonal and metabolic factors, medical disorders, drugs, and of other published risk factors for primary and postoperative shoulder stiffness is reviewed and discussed. Finally, aspects related to shoulder surgery and postoperative rehabilitation protocols, which could influence the development of postoperative stiffness are presented.
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Affiliation(s)
- Davide Cucchi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | | | - Silvana De Giorgi
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Bari, Italy
| | - Alberto Costa
- Departemnt of Orthopaedics and Traumatology, Orlandi Hospital, Bussolengo, Verona, Italy
| | - Rocco D'Apolito
- Department of Orthopaedics, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Marco Conca
- UO Ortopedia Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - Alessandro Russo
- Laboratorio di Biomeccanica e Innovazione Tecnologica-Clinica II, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maristella F Saccomanno
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Rome, Italy
| | - Laura de Girolamo
- Laboratorio di Biotecnologie applicate all'Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Thomas W, Thomas TS, Tafuro L, Walter S. Treating Rotator Cuff Tears Through a Coracoacromial Mini-Open Approach. Arthrosc Tech 2016; 5:e1023-e1027. [PMID: 27909670 PMCID: PMC5124062 DOI: 10.1016/j.eats.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/17/2016] [Indexed: 02/03/2023] Open
Abstract
The purpose of this study is to present a "smart," open, minimally invasive surgical technique for rotator cuff repair of the shoulder. On the basis of an anatomic study by Tichy, we use a coracoacromial mobile window: We split-not detach-the deltoid muscle by respecting its fibers' orientation and resect the coracoacromial ligament before repairing the torn rotator cuff tendons with anchors. The described approach is fast, is technically uncomplicated, and can be carried out with a standard set of instruments. In cases of rotator cuff tears for which arthroscopic treatment would be very demanding, as well as in situations in which there are technical problems and/or limited access to arthroscopic equipment, this approach may serve as a backup strategy.
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Affiliation(s)
| | | | | | - Sebastian Walter
- Address correspondence to Sebastian Walter, M.D., M.Sc., European Hospital, Via Portuense 700, 00149 Rome, Italy.European HospitalVia Portuense 70000149 RomeItaly
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Ono Y, Woodmass JM, Nelson AA, Boorman RS, Thornton GM, Lo IKY. Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone. Bone Joint Res 2016; 5:269-75. [PMID: 27357383 PMCID: PMC4957181 DOI: 10.1302/2046-3758.56.2000535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/09/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P). METHODS Using standard suture loops pulled in-line with the rotator cuff (approximately 60°), anchors were tested in cadaveric bone and foam blocks representing normal to osteopenic bone. Mechanical testing included preloading to 10 N and cyclic loading for 500 cycles from 10 N to 60 N at 60 mm/min. The parameters evaluated were initial displacement, cyclic displacement and number of cycles and load at 3 mm displacement relative to preload. Video recording throughout testing documented the predominant source of suture displacement and the distance of 'suture cutting through bone'. RESULTS In cadaveric bone and foam blocks, MultiFIX P anchors had significantly greater initial displacement, and lower number of cycles and lower load at 3 mm displacement than SpeedScrew anchors. Video analysis revealed 'suture cutting through bone' as the predominant source of suture displacement in cadaveric bone (qualitative) and greater 'suture cutting through bone' comparing MultiFIX P with SpeedScrew anchors in foam blocks (quantitative). The greater suture displacement in MultiFIX P anchors was predominantly from suture cutting through bone, which was enhanced in an osteopenic bone model. CONCLUSIONS Anchors with sutures external to the anchor body are at risk for suture cutting through bone since the suture eyelet is at the distal tip of the implant and the suture directly abrades against the bone edge during cyclic loading. Suture cutting through bone may be a significant source of fixation failure, particularly in osteopenic bone.Cite this article: Y. Ono, J. M. Woodmass, A. A. Nelson, R. S. Boorman, G. M. Thornton, I. K. Y. Lo. Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone. Bone Joint Res 2016;5:269-275. DOI: 10.1302/2046-3758.56.2000535.
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Affiliation(s)
- Y Ono
- McCaig Institute for Bone and Joint Health, Department of Surgery, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - J M Woodmass
- McCaig Institute for Bone and Joint Health, Department of Surgery, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - A A Nelson
- McCaig Institute for Bone and Joint Health, Department of Surgery, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - R S Boorman
- McCaig Institute for Bone and Joint Health, Department of Surgery, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - G M Thornton
- McCaig Institute for Bone and Joint Health, Department of Surgery, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - I K Y Lo
- McCaig Institute for Bone and Joint Health, Department of Surgery, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
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A novel suture anchor constructed of cortical bone for rotator cuff repair: a biomechanical study on sheep humerus specimens. INTERNATIONAL ORTHOPAEDICS 2016; 40:1913-8. [DOI: 10.1007/s00264-016-3185-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/27/2016] [Indexed: 02/03/2023]
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Abstract
PURPOSE The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions. METHODS A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. RESULTS The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions. CONCLUSIONS The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed. LEVEL OF EVIDENCE IV.
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Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop 2015; 6:902-918. [PMID: 26716086 PMCID: PMC4686437 DOI: 10.5312/wjo.v6.i11.902] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/04/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.
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