1
|
Yau WP. Differences in Clinical Outcomes Between Patients With Retear After Supraspinatus Tendon Repair and Those With Intact Repair at 5-Year Follow-up. Am J Sports Med 2024; 52:1040-1052. [PMID: 38385212 DOI: 10.1177/03635465241227643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND It is well known that rotator cuff repair is associated with an overall retear rate of 21% to 26%. However, a cuff retear may not necessarily be associated with poor clinical outcomes. HYPOTHESIS There would be no difference in clinical outcomes between patients with a cuff retear and those with an intact repair at a midterm follow-up of 5 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective study was conducted involving patients who received arthroscopic complete repair of the supraspinatus tendon between January 2009 and December 2017. Patients who did not have a postoperative magnetic resonance imaging (MRI) scan or who had a follow-up of <5 years were excluded. Clinical outcomes, including the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion (FF) of the involved shoulder were assessed at the 2-year and 5-year follow-up points. RESULTS The study group included 105 patients with a mean follow-up of 85 months. MRI scans were performed at a mean of 20 months. Fourteen full-thickness cuff retears and 91 intact repairs were identified using postoperative MRI scans. Significant improvement in VAS score, ASES score, and FF were found between the preoperative assessment and the 2 designated follow-up points (2 years and 5 years) in both the cuff retear and the intact repair groups (P < .001). The VAS and ASES scores at the 2-year follow-up for the intact repair group were 1.8 ± 2.0 and 80.7 ± 18.1, respectively. The corresponding values for the retear group were 2.3 ± 2.2 and 71.9 ± 19.5, respectively. No significant difference was found between the 2 groups in the VAS and ASES scores at the 2-year follow-up. However, patients with an intact repair had a better VAS score (1.4 ± 1.8; P = .049) and ASES score (81.7 ± 17; P = .019) than those with a cuff retear at the 5-year assessment (3.0 ± 2.8 and 67.1 ± 22.9, respectively). In the intact repair group, 91% of patients achieved the minimal clinically important difference for the 5-year VAS score, compared with 54% in the cuff retear group (P < .001). The corresponding values for the 5-year ASES score were 80% and 54%, respectively (P = .044). FF measurements at the 5-year follow-up in patients with intact repair and those with a cuff retear were 161°± 23° and 144°± 37°, respectively (P = .059). Continuous improvement in VAS score and FF between the 2-year and 5-year follow-up was observed in the intact repair group (P = .005 and P = .04, respectively). CONCLUSION The patients with an intact repair had better VAS and ASES scores compared with those who had a cuff retear at a midterm follow-up of 5 years. Between the 2-year and the 5-year follow-up, some further improvement was observed in the VAS score and FF in the intact repair group.
Collapse
Affiliation(s)
- W P Yau
- Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of the People's Republic of China
| |
Collapse
|
2
|
Rinaldi VG, La Verde M, Coliva F, Cammisa E, Lullini G, Caravelli S, Mosca M, Zaffagnini S, Marcheggiani Muccioli GM. Arthroscopic approach does not yield better results than open surgery after subscapularis repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07403-1. [PMID: 37004531 DOI: 10.1007/s00167-023-07403-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE This study aimed to compare the long-term outcomes of arthroscopic versus mini-open repair in patients with isolated subscapularis tendon tears. METHODS Google Scholar, PubMed, and Embase databases were searched for studies evaluating isolated subscapularis tears subsequently treated by arthroscopic or mini-open repair. The inclusion criteria were clinical studies reporting isolated subscapularis lesions treated by arthroscopic or mini-open repair, a minimum follow-up of 12 months, and clinical and functional outcomes reported in the study results. Articles not reporting functional outcomes or studies that reported results for anterosuperior rotator cuff tears without a separate analysis of subscapularis tendon tears were excluded. Studies older than 20 years and studies with a minimum follow-up of less than 12 months were also excluded. RESULTS A total of 12 studies met the inclusion criteria; 8 papers were included in the arthroscopic repair group, and 6 were included in the mini-open repair group (2 studies reported results for both techniques). The mean age reported was 49.3 years, and 85.1% of patients were male. The dominant limb was involved in 77.6% of the patients, and a traumatic onset of symptoms was verified in 76.3%. The mean time to surgery was 9.6 months. The Constant-Murley score showed positive results for the arthroscopic and mini-open groups, with mean postoperative values of 84.6 and 82.1, respectively. Promising results were also observed for pain, with a mean of 13.2 (out of 15) points for the arthroscopic group and 11.7 for the mini-open group. The long head of the biceps was involved in 78% of the patients, and LHB tenodesis or tenotomy were the most common concomitant procedures performed. CONCLUSIONS There was no significant difference in clinical and functional outcomes between open and arthroscopic repair. Moreover, the same complication rates were reported in both treatments, but arthroscopic repair led to less postoperative pain. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Vito Gaetano Rinaldi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy.
| | - Matteo La Verde
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
| | - Federico Coliva
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
| | | | - Giada Lullini
- UOC Medicina Riabilitativa e Neuroriabilitazione, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Silvio Caravelli
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
| | - Massimiliano Mosca
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
- DIBINEM, University of Bologna, Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10 - c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
- DIBINEM, University of Bologna, Bologna, Italy
| |
Collapse
|
3
|
Baumgarten KM. Can the Single Assessment Numeric Evaluation be used as a stand-alone subjective outcome instrument in patients undergoing rotator cuff repair? J Shoulder Elbow Surg 2022; 31:2542-2553. [PMID: 35750155 DOI: 10.1016/j.jse.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND/HYPOTHESIS There is no consensus to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. The Single Assessment Numeric (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis was that SANE will correlate with and be comparable in responsiveness to other subjective outcome measures that have been used in a stand-alone fashion in patients undergoing rotator cuff repair (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], Western Ontario Rotator Cuff Index [WORC], and the Simple Shoulder Test [SST]). In addition, the SANE will be more relevant to each patient compared to the ASES, further supporting its use as a stand-alone shoulder-specific outcomes measure. METHODS A retrospective review of a database of patients undergoing rotator cuff repair was reviewed where the SANE was recorded with the ASES, WORC, and/or SST. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine if correlations differed in (1) preoperative and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean (SRM) and the effect size (ES) of all scores. Relevance and precision of the SANE and ASES were examined using 150 consecutive patients to determine the number of questions in each score that were not answered. RESULTS Correlation was excellent for the SANE and the ASES (n = 1838, r = 0.81, P < .0001), the WORC (n = 1793, r = 0.82, P < .0001), and the SST (n = 1836, r = 0.76, P < .0001). Correlation of preoperative scores was moderate and postoperative scores were excellent when comparing the SANE with all 3 scores. All scores were highly responsive, with the SRM of the SANE = 2.1, ASES = 2.2, WORC = 2.4, and the SST = 1.8. The ES of the SANE = 2.4, ASES = 2.7, WORC = 3.0, and the SST = 2.1. One hundred percent of the SANE scores were answered completely compared with 57% (P < .0001) of the ASES, with significant variability found in the answers to the "work" and "score" questions. CONCLUSION In patients undergoing rotator cuff repair, the SANE highly correlated and has equivalent responsiveness with the WORC, ASES, and SST, which have been used as stand-alone shoulder-specific outcomes measures. The SANE may provide the same information as the WORC, ASES, and SST regarding outcome with significant reduction in responder burden. This study supports that the SANE can be used as a subjective, stand-alone instrument for patients undergoing rotator cuff repair.
Collapse
Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
| |
Collapse
|
4
|
Macciacchera M, Siddiqui S, Ravichandiran K, Khan M, Sheth U, Abouali J. Risk factors for the development of degenerative changes among patients undergoing rotator cuff repair: A systematic review. Shoulder Elbow 2022; 14:352-359. [PMID: 35846400 PMCID: PMC9284300 DOI: 10.1177/17585732211047225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Osteoarthritis (OA) of the glenohumeral joint results in significant pain and functional limitations. It is unclear which risk factors increase the risk of developing glenohumeral OA amongst Rotator Cuff Repair (RCR) patients. The purpose of this systematic review was to examine the risk factors which may contribute to the development of osteoarthritic changes post-operatively. METHODS MEDLINE, Embase, and PubMed databases were searched to identify studies reporting on demographics of patients who develop OA following RCR. RESULTS Seventeen articles were identified investigating a total of 1292 patients. The overall quality of evidence was low. Pooled assessment of OA incidence following RCR at minimum 5 years follow-up found 26% of patients developed OA. Patients requiring revision surgery following retears developed OA at a rate of 29%. Surgical technique and patient demographics may also contribute to degenerative changes. DISCUSSION This review found correlations between the aforementioned risk factors and glenohumeral joint degeneration at long-term follow-up after RCR. These findings suggest that future long-term studies should aim to identify prognostic factors that may place a patient at increased risk of developing OA. Such data can be used to counsel patients with respect to long-term outcomes following surgical intervention.
Collapse
Affiliation(s)
| | | | | | - Moin Khan
- McMaster University, Hamilton, Canada
| | | | - Jihad Abouali
- University of Toronto, Toronto, Canada,Jihad Abouali, Division of Orthopaedic
Surgery, University of Toronto, Toronto, 304-840 Coxwell Ave, Ontario, Canada,
M4C5T2.
| |
Collapse
|
5
|
Yoon JY, Park JH, Rhee SM, Jeong HJ, Han J, Lee JH, Jeon S, Oh JH. Safety and Efficacy of Autologous Dermal Fibroblast Injection to Enhance Healing After Full-Thickness Rotator Cuff Repair: First-in-Human Pilot Study. Orthop J Sports Med 2021; 9:23259671211052996. [PMID: 34778485 PMCID: PMC8586194 DOI: 10.1177/23259671211052996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/04/2021] [Indexed: 01/08/2023] Open
Abstract
Background: There is growing interest in various biological supplements to improve tendon healing in patients after arthroscopic rotator cuff repair. The ideal biological supplement to strengthen rotator cuff remains unknown. Purpose: To assess the safety and efficacy of autologous cultured dermal fibroblast (ADF) injection on tendon-to-bone healing in patients after arthroscopic rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: Included were 6 patients who underwent arthroscopic rotator cuff repair between June 2018 and March 2020; all patients had a full-thickness rotator cuff tear (>2 cm) involving the supraspinatus and infraspinatus tendons. The patients were injected with ADF between the repaired tendon and footprint during arthroscopic rotator cuff repair using the suture bridge technique. The safety of ADFs and the procedure was evaluated at 5 weeks postoperatively, and the anatomical healing of the repaired tendon was accessed at 6 months postoperatively using magnetic resonance imaging and at 12 months using ultrasonography. Outcomes including shoulder range of motion (ROM), visual analog scale (VAS) for pain, and functional scores were measured at 6 and 12 months postoperatively. Results: Adverse reactions to ADF injection were not observed at 6 months after surgery. VAS and functional scores at 6 and 12 months postoperatively were significantly improved compared with preoperative scores (all P < .05). However, there was no significant difference on any ROM variable between preoperative and postoperative measurements at 6 and 12 months (all P > .05). No healing failure was found at 6 and 12 months postoperatively. Conclusion: There was no adverse reaction to ADF injection, and all patients had successful healing after rotator cuff repair. A simple and easily accessible ADF injection may be a novel treatment option for increasing the healing capacity of torn rotator cuff tendons. Further clinical research is needed to verify the study results.
Collapse
Affiliation(s)
- Ji Young Yoon
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Joo Hyun Park
- Department of Orthopaedic Surgery, Bundang Jesaeng General Hospital, Seongnam, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jikhyon Han
- Cutigen Research Institute, Tego Science Inc, Seoul, Republic of Korea
| | - Ji-Hye Lee
- Cutigen Research Institute, Tego Science Inc, Seoul, Republic of Korea
| | - Saewha Jeon
- Cutigen Research Institute, Tego Science Inc, Seoul, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| |
Collapse
|
6
|
Lee WY, Kim YM, Hwang DS, Shin HD, Joo YB, Cha SM, Kim KH, Jeon YS, Lee SY. Does Demineralized Bone Matrix Enhance Tendon-to-Bone Healing after Rotator Cuff Repair in a Rabbit Model? Clin Orthop Surg 2021; 13:216-222. [PMID: 34094012 PMCID: PMC8173240 DOI: 10.4055/cios20099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
Backgroud The purpose of this study was to compare the histologic outcomes of rotator cuff (RC) repair with demineralized bone matrix (DBM) augmentation and those without DBM augmentation and to evaluate the role of DBM for tendon-to-bone (TB) healing in a rabbit model. Methods Twenty-six adult male New Zealand white rabbits were randomly allocated to the control group (n = 13) or the DBM group (n = 13). Repair was performed 8 weeks after complete transection of the right supraspinatus tendon of all rabbits. In the control group, RC repair was achieved by a standard transosseous technique. In the DBM group, RC repair was achieved using the same technique, and DBM was interposed between the cuff and bone. After 8 weeks, the RC tendon entheses from all rabbits were processed for gross and histologic examination. Results On gross TB healing, 2 of 11 specimens in the control group were unhealed and no specimen was grossly unhealed in the DBM group (p = 0.421). In the control group, the tendon midsubstance was disorganized with randomly and loosely arranged collagen fibers and rounded fibroblastic nuclei. The TB interface was predominantly fibrous with small regions of fibrocartilage, especially mineralized fibrocartilage. In the DBM group, the tendon midsubstance appeared normal and comprised densely arranged collagen fibers, with orientated crimped collagen fibers running in the longitudinal direction of the tendon. These fibers were interspersed with elongated fibroblast nuclei. The TB interface consisted of organized collagen fibers with large quantities of fibrocartilage and mineralized fibrocartilage. Conclusions The use of DBM for TB interface healing in rabbit experiments showed good results in gross and histologic analysis. However, it is difficult to draw a solid conclusion because the sample size is small. Further evaluation in the in vivo setting is necessary to determine clinical recommendations.
Collapse
Affiliation(s)
- Woo-Yong Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young-Mo Kim
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Deuk-Soo Hwang
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun-Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yong-Bum Joo
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Soo-Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyung-Hee Kim
- Department of Pathology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yoo-Sun Jeon
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun-Yeul Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| |
Collapse
|
7
|
Hurley-Novatny A, Arumugasaamy N, Kimicata M, Baker H, Mikos AG, Fisher JP. Concurrent multi-lineage differentiation of mesenchymal stem cells through spatial presentation of growth factors. Biomed Mater 2020; 15:055035. [PMID: 32526725 PMCID: PMC7648258 DOI: 10.1088/1748-605x/ab9bb0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Severe tendon and ligament injuries are estimated to affect between 300 000 and 400 000 people annually. Surgical repairs of these injuries often have poor long-term clinical outcomes because of resection of the interfacial tissue-the enthesis-and subsequent stress concentration at the attachment site. A healthy enthesis consists of distinct regions of bone, fibrocartilage, and tendon, each with distinct cell types, extracellular matrix components, and architecture, which are important for tissue function. Tissue engineering, which has been proposed as a potential strategy for replacing this tissue, is currently limited by its inability to differentiate multiple lineages of cells from a single stem cell population within a single engineered construct. In this study, we develop a multi-phasic gelatin methacrylate hydrogel construct system for spatial presentation of proteins, which is then validated for multi-lineage differentiation towards the cell types of the bone-tendon enthesis. This study determines growth factor concentrations for differentiation of mesenchymal stem cells towards osteoblasts, chondrocytes/fibrochondrocytes, and tenocytes, which maintain similar differentiation profiles in 3D hydrogel culture as assessed by qPCR and immunofluorescence staining. Finally, it is shown that this method is able to guide heterogeneous and spatially confined changes in mesenchymal stem cell genes and protein expressions with the tendency to result in osteoblast-, fibrochondrocyte-, and tenocyte-like expression profiles. Overall, we demonstrate the utility of the culture technique for engineering other musculoskeletal tissue interfaces and provide a biochemical approach for recapitulating the bone-tendon enthesis in vitro.
Collapse
Affiliation(s)
- Amelia Hurley-Novatny
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States of America. Center for Engineering Complex Tissues, University of Maryland and Rice University, College Park, MD 20742, United States of America
| | | | | | | | | | | |
Collapse
|
8
|
Kunz P, Mick P, Gross S, Schmidmaier G, Zeifang F, Weber MA, Fischer C. Contrast-Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair. J Orthop Res 2020; 38:1150-1158. [PMID: 31769543 DOI: 10.1002/jor.24535] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/19/2019] [Indexed: 02/04/2023]
Abstract
Supraspinatus (SSP) tendon tears represent a common indication for shoulder surgery. Yet, prediction of postoperative function and tendon retear remains challenging and primarily relies on morphologic magnetic resonance imaging (MRI)-based parameters, supported by patients' demographic data like age, gender, and comorbidities. Considering continuously high retear rates, especially in patients with larger tears and negative prognostic factors, improved outcome prediction could be of high clinical value. Contrast-enhanced ultrasound (CEUS) enables an assessment of dynamic perfusion of the SSP muscle. As a potential surrogate for muscle vitality, CEUS might reflect functional properties of the SSP and support improved outcome prediction after tendon repair. Fifty patients with isolated SSP tendon tears were prospectively enrolled. Preoperatively, SSP muscle perfusion was quantified by CEUS and conventional morphologic parameters like tear size, fatty infiltration, and tendon retraction were assessed by MRI. At six months follow-up, shoulder function, tendon integrity, and muscle perfusion were reassessed. The predictive value of preoperative CEUS for postoperative shoulder function and tendon integrity was evaluated. 35 patients entered the statistical analysis. Preoperative CEUS-based assessment of SSP perfusion significantly correlated with early postoperative shoulder function (Constant, r = 0.48, p < 0.018) and tendon retear (r = 0.67, p < 0.001). CEUS-based subgroup analysis identified patients with exceptionally high, respectively low risk for tendon retear. CEUS-based assessment of the SSP seemed to predict early shoulder function and tendon retear after SSP repair and allowed to identify patient subgroups with exceptionally high or low risk for tendon retear. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:1150-1158, 2020.
Collapse
Affiliation(s)
- Pierre Kunz
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.,Clinic for Shoulder and Elbow Surgery, Catholic Hospital Mainz, An der Goldgrube 11, 55131, Mainz, Germany
| | - Paul Mick
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Sascha Gross
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Felix Zeifang
- Ethianum Klinik Heidelberg, Voßstraße 6, 69115, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| |
Collapse
|
9
|
Aguado G, Obando DV, Herrera GA, Ramirez A, Llinás PJ. Retears of the Rotator Cuff: An Ultrasonographic Assessment During the First Postoperative Year. Orthop J Sports Med 2019; 7:2325967119889049. [PMID: 31903401 PMCID: PMC6927200 DOI: 10.1177/2325967119889049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Surgical repair of rotator cuff (RC) tears is an effective treatment option. However, the prevalence of recurrent ruptures is high. Hypothesis Recurrent tears are a frequent complication of surgical repair of RC tears. Their incidence might be influenced by factors such as the patient's age and size of the initial tear. Study Design Case series; Level of evidence, 4. Methods Data from 90 adult patients who underwent arthroscopic RC repair between 2014 and 2017 and underwent an ultrasound examination 6 to 12 months after surgery were analyzed retrospectively. Massive tears were repaired using a double-row technique, and nonmassive tears were repaired with a single-row technique. Clinical records were reviewed for demographic information. Results All patients (57.8% women; 42.2% men) were older than 18 years (mean, 58.9 years). Of these patients, 30.0% (27/90) had massive tears, which were primarily found in patients ≥60 years (74.1%; 20/27). Complete healing was seen in 74.5% of all repairs during follow-up. A total of 23 patients (25.5%) had retears (13 complete; 10 partial), which were diagnosed by ultrasound imaging 6 to 12 months after the initial surgery. The occurrence of retears was more prevalent in patients with massive tears than in patients with nonmassive tears (40.7% vs 19.0%, respectively); the difference was statistically significant (P = .03). Reruptures occurred in 50.0% of patients older than 60 years with massive tears. Although patients older than 60 years had more recurrent tears (32.6%) compared with younger patients (18.2%), the difference was not statistically significant (P = .12). Conclusion One-quarter of the patients who had undergone surgical repair of an RC tear had recurrent ruptures. There was a statistically significant association between the initial massive tear and a retear. Patients older than 60 years showed a higher recurrence rate, but this difference lacked statistical significance. Reruptures occurred in 50.0% of patients older than 60 years with massive tears.
Collapse
Affiliation(s)
| | | | - Gilberto A Herrera
- Icesi University, Cali, Colombia.,Orthopedics Department, Fundación Valle del Lili, Cali, Colombia
| | | | - Paulo J Llinás
- Icesi University, Cali, Colombia.,Orthopedics Department, Fundación Valle del Lili, Cali, Colombia.,Fellowship Program in Arthroscopic and Reconstructive Surgery of the Shoulder and Knee, Fundación Valle del Lili, Cali, Colombia
| |
Collapse
|
10
|
Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty? INTERNATIONAL ORTHOPAEDICS 2019; 44:275-282. [DOI: 10.1007/s00264-019-04468-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023]
|
11
|
Oh SB, Jeong JJ, Ji JH, Patel K, Hwang WH, Cho JH. Medialization of medial row anchor via the Nevasier portal yield enhanced footprint and outcomes in medium-to-large rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2019; 27:3989-3996. [PMID: 31375876 DOI: 10.1007/s00167-019-05641-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate clinical and radiological outcomes of medial row anchor insertion between 90° or 45° (deadman) angle in the suture-bridge rotator cuff repair of medium-to-large rotator cuff tears. METHODS This retrospective analysis included 113 consecutive patients undergoing arthroscopic suture-bridge repair for medium-to-large rotator cuff tears (mean tear size: 2.8 × 2.3 cm) between 2010 and 2013. The patients were divided into two groups: group I (53 patients) and group II (60 patients) involving 90° and 45° medial row anchors, respectively. The conventional lateral row anchors were inserted in the suture-bridge repair. The clinical outcomes at 2 years and radiological outcomes including re-tear or footprint coverage (anteroposterior length and mediolateral width) of the repaired tendon using postoperative MRI were evaluated. RESULTS Clinical outcome scores were significantly improved in both groups. However, Group I (90° anchor insertion group) showed better clinical scores without the difference of range of motion. The postoperative MRI revealed enlarged footprint coverage with 90° medial row anchor. The repaired footprint cuff size (mediolateral width) in the coronal plane MRI showed a statistically significant difference (45°: 19 mm vs. 90°: 24 mm) (p < 0.05). CONCLUSIONS Enhanced clinical outcomes and additional anatomical footprint coverage (coronal width of repaired tendon) in the suture-bridge repair are obtained with the 90° medial row anchors compared with the 45° medial row anchors. These findings would guide clinical application of 90° medial row anchor insertion for further medialization in the medium-to-large rotator cuff tears. LEVEL OF EVIDENCE Level III (retrospective comparative trial).
Collapse
Affiliation(s)
- Seung-Bae Oh
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Jung Jeong
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kaushal Patel
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Ha Hwang
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Hyung Cho
- Department of Orthopaedic Surgery, Daejeon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
12
|
Matsuba T, Hata Y, Ishigaki N, Nakamura K, Kato H. Osteoarthritis progression of the shoulder: A long-term follow-up after mini-open rotator cuff repair. J Orthop Surg (Hong Kong) 2019; 26:2309499018768106. [PMID: 29635956 DOI: 10.1177/2309499018768106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate whether (1) the primary repair of rotator cuff tears can prevent the progression of osteoarthritis (OA) and (2) the quality of postoperative cuff integrity affects the incidence of osteoarthritic changes. METHODS A total of 86 patients treated with mini-open repair for rotator cuff tears over a minimum of 10 years of follow-up (mean ± standard deviation 11.1 ± 1.0 years) were retrospectively analyzed. Preoperative and postoperative radiographs of the affected and unaffected sides were compared, and the degree of OA was evaluated using the Samilson and Prieto classification. Magnetic resonance imaging was used to evaluate cuff integrity, classify patients into good and poor cuff integrity groups, and compare the degree of OA between the two groups. RESULTS OA deteriorated either significantly or to a similar degree on both sides postoperatively. However, OA progressed in significantly more cases on the affected side. A comparison between the aforementioned cuff integrity groups showed that the postoperative OA of the poor cuff integrity group was significantly worse than that of the good cuff integrity group on the affected side. CONCLUSION Our study showed that even if rotator cuff tears are repaired, the progression of osteoarthritic changes cannot be halted. The progression of OA was affected by cuff integrity. Rotator cuff dysfunction due to poor cuff integrity was a risk factor for shoulder arthritis.
Collapse
Affiliation(s)
- Tomoyuki Matsuba
- 1 Shoulder Medical Center, North Alps Medical Center Azumi Hospital, Nagano, Japan
| | - Yukihiko Hata
- 1 Shoulder Medical Center, North Alps Medical Center Azumi Hospital, Nagano, Japan
| | - Norio Ishigaki
- 1 Shoulder Medical Center, North Alps Medical Center Azumi Hospital, Nagano, Japan
| | - Koichi Nakamura
- 1 Shoulder Medical Center, North Alps Medical Center Azumi Hospital, Nagano, Japan
| | - Hiroyuki Kato
- 2 Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| |
Collapse
|
13
|
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: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND 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.
Collapse
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
| |
Collapse
|
14
|
Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, Pripp AH, Smith HJ. At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears. J Bone Joint Surg Am 2019; 101:1050-1060. [PMID: 31220021 DOI: 10.2106/jbjs.18.01373] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tendon repair and physiotherapy are frequently used treatment methods for small and medium-sized rotator cuff tears. In 2 previous publications of the 1 and 5-year results of this study, we reported significant but small between-group differences in favor of tendon repair. Long-term results are needed to assess whether the results in both groups remain stable over time. METHODS In this study, 103 patients with a rotator cuff tear not exceeding 3 cm were randomly assigned to primary tendon repair or physiotherapy with optional secondary repair. Blinded follow-up was performed after 6 months and 1, 2, 5, and 10 years. Outcome measures included the Constant score; the self-report section of the American Shoulder and Elbow Surgeons score; the measurement of shoulder pain, motion, and strength; and patient satisfaction. Magnetic resonance imaging (MRI) was performed on surgically treated shoulders after 1 year, and ultrasound was performed on all shoulders after 5 and 10 years. The main analysis was by 1-way analysis of covariance and by intention to treat. RESULTS Ninety-one of 103 patients attended the last follow-up. After 10 years, the results were better for primary tendon repair, by 9.6 points on the Constant score (p = 0.002), 15.7 points on the American Shoulder and Elbow Surgeons score (p < 0.001), 1.8 cm on a 10-cm visual analog scale for pain (p < 0.001), 19.6° for pain-free abduction (p = 0.007), and 14.3° for pain-free flexion (p = 0.01). Fourteen patients had crossed over from physiotherapy to secondary surgery and had an outcome on the Constant score that was 10.0 points inferior compared with that of the primary tendon repair group (p = 0.03). CONCLUSIONS At 10 years, the differences in outcome between primary tendon repair and physiotherapy for small and medium-sized rotator cuff tears had increased, with better results for primary tendon repair. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Stefan Moosmayer
- Departments of Orthopaedic Surgery (S.M.), Physiotherapy (G.L., U.S.S., B.H., and I.C.S.), and Occupational Therapy (T.H.), Martina Hansen's Hospital, Sandvika, Norway
| | - Gerty Lund
- Departments of Orthopaedic Surgery (S.M.), Physiotherapy (G.L., U.S.S., B.H., and I.C.S.), and Occupational Therapy (T.H.), Martina Hansen's Hospital, Sandvika, Norway
| | - Unni S Seljom
- Departments of Orthopaedic Surgery (S.M.), Physiotherapy (G.L., U.S.S., B.H., and I.C.S.), and Occupational Therapy (T.H.), Martina Hansen's Hospital, Sandvika, Norway
| | - Benjamin Haldorsen
- Departments of Orthopaedic Surgery (S.M.), Physiotherapy (G.L., U.S.S., B.H., and I.C.S.), and Occupational Therapy (T.H.), Martina Hansen's Hospital, Sandvika, Norway
| | - Ida C Svege
- Departments of Orthopaedic Surgery (S.M.), Physiotherapy (G.L., U.S.S., B.H., and I.C.S.), and Occupational Therapy (T.H.), Martina Hansen's Hospital, Sandvika, Norway
| | - Toril Hennig
- Departments of Orthopaedic Surgery (S.M.), Physiotherapy (G.L., U.S.S., B.H., and I.C.S.), and Occupational Therapy (T.H.), Martina Hansen's Hospital, Sandvika, Norway
| | - Are H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Hans-Jørgen Smith
- Division of Radiology and Nuclear Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
15
|
Plachel F, Traweger A, Vasvary I, Schanda JE, Resch H, Moroder P. Long-term results after arthroscopic transosseous rotator cuff repair. J Shoulder Elbow Surg 2019; 28:706-714. [PMID: 30573430 DOI: 10.1016/j.jse.2018.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/30/2018] [Accepted: 09/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the long-term clinical and radiologic results after arthroscopic transosseous rotator cuff repair (TORCR). METHODS A total of 69 patients with full-thickness supraspinatus tendon tears with or without infraspinatus tendon tears treated with arthroscopic TORCR by a single surgeon between 1998 and 2003 were included. Among them, 56 patients (81%) with a mean age of 58 ± 5 years (range, 42-70 years) were available for final follow-up examination after an average of 15 ± 2 years (range, 12-18 years). The Subjective Shoulder Value, Constant score (CS), University of California at Los Angeles score, and American Shoulder and Elbow Surgeons score were recorded. Magnetic resonance imaging (MRI) was performed to visualize tendon integrity in 66% of patients. RESULTS At final follow-up, the mean CS was 84 ± 8 points; mean University of California at Los Angeles score, 33 ± 2 points; mean American Shoulder and Elbow Surgeons score, 92 ± 10 points; and mean Subjective Shoulder Value, 89% ± 17%. MRI revealed asymptomatic repair failure in 9 patients (27%). Moreover, 4 patients (7%) underwent revision surgery because of a symptomatic rerupture, resulting in an overall retear rate of 33%. Patients with intact repairs at final follow-up showed a significantly higher CS (P = .019) and abduction strength (P = .016) than patients with retears. CONCLUSION Arthroscopic TORCR for the treatment of full-thickness rotator cuff tears provided good clinical results 12 to 18 years after surgery. Cuff integrity on follow-up MRI scans had a positive effect on the clinical outcome.
Collapse
Affiliation(s)
- Fabian Plachel
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria; Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria.
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Imre Vasvary
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Jakob E Schanda
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Vienna, Austria
| | - Herbert Resch
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Philipp Moroder
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria; Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| |
Collapse
|
16
|
Editorial Commentary: Steroid Injections Prior to Arthroscopic Rotator Cuff Repair-Is It Time to Rethink a Conservative Treatment Paradigm? Arthroscopy 2019; 35:714-716. [PMID: 30827425 DOI: 10.1016/j.arthro.2018.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
The standard of care for most rotator cuff conditions over the past half century or longer has been a trial of nonoperative treatment including nonsteroidal anti-inflammatory agents, physiotherapy, and steroid injections prior to surgery. There is compelling basic science data to suggest a negative effect of corticosteroids on tissue quality. Chronicity of the tear is a risk factor for unsuccessful repair, but other factors including use of tobacco products, repair technique, and postoperative management all have an impact. Evidence either in favor of or against use of steroid injections as a treatment option is limited or weak at best. Given advances in rotator cuff repair techniques and successful long-term outcomes, treating surgeons should be mindful of how injections might affect surgical outcomes owing to either delayed surgical intervention or a direct effect on tissue quality.
Collapse
|
17
|
Malavolta EA, Gracitelli MEC, Assunção JH, Ferreira Neto AA, Bordalo-Rodrigues M, de Camargo OP. Clinical and Structural Evaluations of Rotator Cuff Repair With and Without Added Platelet-Rich Plasma at 5-Year Follow-up: A Prospective Randomized Study. Am J Sports Med 2018; 46:3134-3141. [PMID: 30234999 DOI: 10.1177/0363546518795895] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been studied with the objective of reducing the retear rate and improving functional outcomes after rotator cuff repair. Only one study to date has reported its midterm effect. HYPOTHESIS PRP promotes better functional and structural results in arthroscopic rotator cuff repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS All patients underwent arthroscopic single-row repair of small to medium supraspinatus tears. At the end of the surgical procedure, liquid PRP prepared by apheresis with autologous thrombin was applied in the tendon-to-bone interface in the PRP group. The outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scales and the visual analog scale (VAS) for pain at 6, 12, 24, and 60 months after surgery and magnetic resonance imaging at 12 and 60 months. RESULTS Of 54 patients initially randomized, we analyzed the clinical outcomes in 51 (25 control, 26 PRP) and the structural outcomes in 44 (22 each group). At 60-month follow-up, the mean UCLA scores were 32.5 ± 3.8 and 32.1 ± 4.6 in the control and PRP groups, respectively ( P = .992). The mean Constant scores were 82.0 ± 9.5 in the control group and 82.1 ± 11.0 in the PRP group ( P = .699). The mean VAS scores were 1.4 ± 1.8 and 1.5 ± 2.1 in the control and PRP groups, respectively ( P = .910). None of the clinical assessments at 6, 12, and 24 months in either group produced statistically significant differences, and both groups showed significant improvements throughout the follow-up time in the 3 evaluations ( P < .001). The control group exhibited 1 full-thickness retear (Sugaya type IV) and 11 partial-thickness retears (Sugaya type III), while the PRP group had 7 partial-thickness retears (Sugaya type III). The overall number of retears did not differ between groups ( P = .203). CONCLUSION PRP obtained by apheresis and applied in liquid form with the addition of thrombin at the end of single-row repair of supraspinatus tears did not promote better clinical or structural results at 60-month follow-up. REGISTRATION NCT01029574 ( ClinicalTrials.gov identifier).
Collapse
|
18
|
Gumina S, Camerota F, Celletti C, Venditto T, Candela V. The effects of rotator cuff tear on shoulder proprioception. INTERNATIONAL ORTHOPAEDICS 2018; 43:229-235. [DOI: 10.1007/s00264-018-4150-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022]
|
19
|
Kim KC, Shin HD, Lee WY, Yeon KW, Han SC. Clinical outcomes and repair integrity of arthroscopic rotator cuff repair using suture-bridge technique with or without medial tying: prospective comparative study. J Orthop Surg Res 2018; 13:212. [PMID: 30153852 PMCID: PMC6114704 DOI: 10.1186/s13018-018-0921-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 01/23/2023] Open
Abstract
Background There have been few studies comparing clinical and radiological outcomes between the conventional and knotless suture-bridge techniques. The purpose of this study was to evaluate and compare the functional outcomes and repair integrity of arthroscopic conventional and knotless suture-bridge technique for full-thickness rotator cuff tears. Methods We prospectively followed 100 consecutive patients (100 shoulders) with full-thickness rotator cuff tears treated with the arthroscopic conventional or knotless suture-bridge technique from October 2012 to July 2014. Enrolled patients returned for follow-up functional evaluations at 1 and 2 years after the operation. There were four outcome measures in this study: American Shoulder and Elbow Surgeons (ASES) scores, Shoulder Rating Scale of the University of California at Los Angeles (UCLA) scores, Constant scores, and visual analog scale (VAS) pain scores. Enrolled patients returned for follow-up magnetic resonance imaging or ultrasonography evaluation to confirm the integrity of the repaired cuff at 6 months post-operation (97% follow-up rate). Also, we investigated the preoperative cuff retraction of enrolled patients using preoperative MRI to find out correlation between the stage of cuff retraction and re-tear rate. Results At final follow-up, the average UCLA, ASES, Constant, and VAS scores had improved significantly to 32.5, 88.0, 80.4, and 1.3, respectively, in the conventional suture-bridge technique group and to 33.0, 89.7, 81.2, and 1.2, respectively, in the knotless suture-bridge technique group. The UCLA, ASES, Constant, and VAS scores improved in both groups after surgery (all p < 0.001), and there were no significant differences between the two groups at 2-year follow-up (p = 0.292, 0.359, 0.709, and 0.636, respectively). The re-tear rate of repaired rotator cuffs was 16.3% (8/49 shoulders) in the conventional suture-bridge technique group and 29.2% (14/48 shoulders) in the knotless suture-bridge technique group; this difference was not significant (p = 0.131). There were no significant differences between the re-tear rate of the two groups in the Patte stage I and II (p = 0.358 and 0.616). Conclusions The knotless suture-bridge technique showed comparable functional outcomes to those of conventional suture-bridge techniques in medium-to-large, full-thickness rotator cuff tears at short-term follow-up. The knotless suture-bridge technique had a higher re-tear rate compared with conventional suture-bridge technique, although the difference was not significant.
Collapse
Affiliation(s)
- Kyung Cheon Kim
- Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, South Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Woo-Yong Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - Kyu-Woong Yeon
- Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, South Korea
| | - Sun-Cheol Han
- Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, South Korea
| |
Collapse
|
20
|
Locke RC, Peloquin JM, Lemmon EA, Szostek A, Elliott DM, Killian ML. Strain Distribution of Intact Rat Rotator Cuff Tendon-to-Bone Attachments and Attachments With Defects. J Biomech Eng 2018; 139:2657103. [PMID: 28979985 DOI: 10.1115/1.4038111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 12/28/2022]
Abstract
This study aimed to experimentally track the tissue-scale strains of the tendon-bone attachment with and without a localized defect. We hypothesized that attachments with a localized defect would develop strain concentrations and would be weaker than intact attachments. Uniaxial tensile tests and digital image correlation were performed on rat infraspinatus tendon-to-bone attachments with defects (defect group) and without defects (intact group). Biomechanical properties were calculated, and tissue-scale strain distributions were quantified for superior and inferior fibrous and calcified regions. At the macroscale, the defect group exhibited reduced stiffness (31.3±3.7 N/mm), reduced ultimate load (24.7±3.8 N), and reduced area under the curve at ultimate stress (3.7±1.5 J/m2) compared to intact attachments (42.4±4.3 N/mm, 39.3±3.7 N, and 5.6±1.4 J/m2, respectively). Transverse strain increased with increasing axial load in the fibrous region of the defect group but did not change for the intact group. Shear strain of the superior fibrous region was significantly higher in the defect group compared to intact group near yield load. This work experimentally identified that attachments may resist failure by distributing strain across the interface and that strain concentrations develop near attachment defects. By establishing the tissue-scale deformation patterns of the attachment, we gained insight into the micromechanical behavior of this interfacial tissue and bolstered our understanding of the deformation mechanisms associated with its ability to resist failure.
Collapse
Affiliation(s)
- Ryan C Locke
- Department of Biomedical Engineering, University of Delaware, 5 Innovation Way, Newark, DE 19716 e-mail:
| | - John M Peloquin
- Department of Biomedical Engineering, University of Delaware, 161 Colburn Lab 150 Academy Street, Newark, DE 19716 e-mail:
| | - Elisabeth A Lemmon
- Departments of Animal and Food Sciences and Biomedical Engineering, University of Delaware, 5 Innovation Way, Newark, DE 19716 e-mail:
| | - Adrianna Szostek
- Departments of Animal and Food Sciences and Biomedical Engineering, University of Delaware, 5 Innovation Way, Newark, DE 19716 e-mail:
| | - Dawn M Elliott
- Mem. ASME Department of Biomedical Engineering, University of Delaware, 161 Colburn Lab 150 Academy Street, Newark, DE 19716 e-mail:
| | - Megan L Killian
- Mem. ASME Department of Biomedical Engineering, University of Delaware, 5 Innovation Way, Newark, DE 19716 e-mail:
| |
Collapse
|