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Rupp MC, Geissbuhler AR, Rutledge JC, Horan MP, Ganokroj P, Chang P, Provencher MT, Millett PJ. Predictors of Clinical Outcomes and Quality of Life After Sternoclavicular Joint Reconstruction With Hamstring Tendon Autograft. Am J Sports Med 2024:3635465241273940. [PMID: 39272217 DOI: 10.1177/03635465241273940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Anterior instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathological condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet to date results are limited to small case series. Studies on baseline, preoperative factors and their association with postoperative outcome are limited. PURPOSE To assess the midterm clinical outcomes and survivorship after SCJ reconstruction using hamstring tendon autograft in patients experiencing anterior SCJ instability and to determine whether baseline patient or causative factors are associated with postoperative outcomes or patient satisfaction. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent SCJ reconstruction with a hamstring tendon autograft for anterior SCJ instability between October 2005 and October 2020 were included in this retrospective single-center study. At a minimum of 2 years postoperatively, clinical outcomes were collected, including the following patient-reported outcomes (PROs): the 12-Item Short Form Survey (SF-12) score; American Shoulder and Elbow Surgeons (ASES) score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Single Assessment Numeric Evaluation (SANE) score; and visual analog scale (VAS) pain score. Subjective postoperative satisfaction with the procedure was quantified on a scale from 0 (very unsatisfied) to 10 (very satisfied). The predictive role of patient factors, including age, sex, and injury in dominant arm, on postoperative PROs and satisfaction at short-term follow-up was evaluated using multiple linear regression. RESULTS A total of 49 patients (mean age, 29.6 ± 16.2 years; range 13.8-67.1 years; 27 females) were included in the final analysis. At a mean follow-up of 3.9 ± 2.1 years, all PROs had significantly improved, including the mean SF-12 Physical Component Summary score (40.4 ± 6.8 to 52.6 ± 6.9; P < .001), ASES score (54.9 ± 20.4 to 91.0 ± 11.3; P < .001), QuickDASH score (41.2 ± 18.5 to 10.2 ± 9.1; P < .001); SANE score (50.2 ± 21.1 to 88.3 ± 8.8; P < .001), VAS pain score (4.4 ± 2.6 to 0.8 ± 1.4; P < .001), and VAS pain score at its worst (7.4 ± 2.5 to 3.3 ± 2.6; P < .001). The median postoperative satisfaction score was 9 (range, 1-10). Revision-free survivorship was 95.9%. Male patients had a significantly lower VAS pain score at its worst compared with female patients (2.6 ± 2.6 vs 4.1 ± 2.4; P = .045); higher age was significantly correlated with a worse QuickDASH score (correlation coefficient, 0.314; P = .036). Overhead athletes had a significantly lower propensity to return to sport compared with nonoverhead athletes (P = .043), with only 45% of the overhead athletes returning to a level similar to their preinjury level, whereas 81% of the nonoverhead athletes were able to do so. CONCLUSION The significant improvements in clinical and sport-specific outcomes and high patient satisfaction after SCJ reconstruction with a hamstring tendon autograft demonstrate the success of this procedure in treating anterior SCJ instability. Male sex and younger patient age are associated with superior outcomes, while overhead athletes have to be counseled about difficulties of returning to preinjury level of sport postoperatively.
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Affiliation(s)
- Marco-Christopher Rupp
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | | | | | - Phob Ganokroj
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peter Chang
- Department of Orthopaedic Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Ilyas G, Ipci FB, Gokalp O, Egeli E. The relationship between the duration and the retraction and atrophy grades in traumatic isolated full-thickness supraspinatus tears in young patients. BMC Musculoskelet Disord 2024; 25:535. [PMID: 38997654 PMCID: PMC11241912 DOI: 10.1186/s12891-024-07659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The study aimed to determine the grade of retraction and atrophy according to the time elapsed in traumatic isolated full-thickness supraspinatus (SS) tears in young patients. METHODS One thousand twenty-six patients, who underwent arthroscopic shoulder surgery, were retrospectively reviewed. Pre-operative magnetic resonance imaging (MRI) of 69 patients aged 18 to 40 years with isolated traumatic full-thickness SS lesions remaining after exclusion criteria were evaluated for tendon retraction and atrophy grades. SS retraction was determined from a T2-weighted oblique coronal MRI slice, and the atrophy grade was determined from the T1-weighted oblique sagittal MRI slice. The patients were divided into four groups 0-1 month, 1-3 months, 3-6 months, and 6-12 months according to the time between trauma and MRI. The relationship of tendon retraction and muscle atrophy with elapsed time was evaluated, in addition, comparisons between groups were made. RESULTS Thirty-one (45%) of the patients were female and their mean age was 30 ± 7.3 (18-40) years. The mean age of men was 30.5 ± 6.9 (18-39) years (p = 0.880). The time between rupture and MRI was moderately correlated with retraction and strongly correlated with atrophy grades (r = 0.599, 0.751, respectively). It was observed that there was a statistically significant difference between the 1st (0-1 month) and 2nd (1-3 months) groups (p = 0.003, 0.001, respectively), and between the 2nd and 3rd (3-6 months) groups (p = 0.032, 0.002, respectively), but there was no significant difference between the 3rd and 4th (6-12 months) groups (p = 0.118, 0.057, respectively). In addition, there was a moderate correlation between tendon retraction and atrophy grades (r = 0.668). Power (1- b) in post hoc analysis was calculated as 0.826. CONCLUSIONS The current study, supported by arthroscopy, showed that there is a moderate and strong positive correlation between the time elapsed after trauma and the level of retraction and degree of atrophy in traumatic full-thickness SS tears, and demonstrated the importance of early surgical intervention in young patients.
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Affiliation(s)
- Gokhan Ilyas
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Usak University, Usak, Turkey.
| | - Fikri Burak Ipci
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Usak University, Usak, Turkey
| | - Oguzhan Gokalp
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Usak University, Usak, Turkey
| | - Ercument Egeli
- Orthopaedics and Traumatology Clinic, Usak Esme State Hospital, Usak, Turkey
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Rupp MC, Chang P, Horan MP, Hussain ZB, Godin JA, Pogorzelski J, Millett PJ. Arthroscopic rotator cuff repair in active patients younger than 45 Years: a prospective analysis with a mean 5-year follow-up. JSES Int 2024; 8:798-805. [PMID: 39035645 PMCID: PMC11258837 DOI: 10.1016/j.jseint.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background To report clinical and activity-specific outcomes after arthroscopic rotator cuff repair (ARCR) for full-thickness supraspinatus tears in active individuals aged less than or equal to 45 years. The pre hoc hypothesis was that patients in this age group would demonstrate significant improvements in clinical outcomes following ARCR along with a significant improvement of athletic abilities. Methods Patients were included in this study if they were (1) active individuals aged between 18 and 45 years at the time of surgery, (2) had a full-thickness rotator cuff tear of the supraspinatus tendon with or without anterior or posterior extension, and (3) underwent ARCR. Preoperative and postoperative patient-reported outcomes scores including the American Shoulder and Elbow Surgeons (ASES) score; Disabilities of Arm, Shoulder and Hand; Single Assessment Numeric Evaluation; and Short Form-12 Physical Component Summary were prospectively collected and postoperative patient satisfaction (scale of 1-10) was recorded at a minimum of 2 years postoperatively. Attainment of the minimal clinically important difference and patient acceptable symptom state for the ASES was calculated. Athletic activity-specific outcomes and return to activity were investigated prospectively via a custom-made comprehensive questionnaire. Results Between November 2005 and June 2020, of 1149 RCRs performed by the senior author, 54 patients (mean age 40.9 years, 13 female; follow-up 69.7 ± 35.2 months in a range of 24.6-179.6 months) were included into the outcomes analysis. Of those, 4 patients (7.4%) had progressed to revision RCR. At a follow-up of 5.8 years, outcome scores had significantly improved compared to preoperative baselines (ASES 55.6 ± 13.8 to 90.1 + 15.8; P < .001; Disabilities of Arm, Shoulder and Hand 38.9 ± 18.4 to 11.9 ± 17.1; P < .001, Single Assessment Numeric Evaluation 60.7 ± 22.7 to 79.3 ± 27.6; P = .001, Short Form-12 Physical Component Summary 41.6 ± 8.3 to 51.9 ± 9.0; P ≤ .001). Ninety three point six percent of the patients reached the minimal clinically important difference and 72.6% reached the patient acceptable symptom state. Median satisfaction was 9.5/10. Eighty six percent of the patients returned to sports, while 67% of the patients returned to a similar level compared to preoperatively. All sport-specific metrics such as shoulder strength and endurance (P < .001), intensity (P < .001), and impairments from pain affecting speed (P = .002), endurance (P = .002), and competition (P < .001) significantly improved postoperatively. Conclusion ARCR of full-thickness rotator cuff tear in active individuals aged 45 years or less results in a clinically relevant improvement of outcomes, function, and quality of life at a minimum of 2 years and mean 5.8-year follow-up with a low rate of revision. While 86% of patients were able to return to activity and sport-specific outcome metrics significantly and substantially improved compared to preoperatively, a return to preinjury levels was not reliably achieved in all patients, with particular limitations observed in overhead active individuals. The data support the hypothesis that patients in this age group demonstrate significant improvements in clinical outcomes following ARCR along with significant improvements in athletic abilities.
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Affiliation(s)
- Marco-Christopher Rupp
- The Steadman Philippon Research Institute, Vail, CO, USA
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, München, Germany
| | | | | | | | | | - Jonas Pogorzelski
- The Steadman Philippon Research Institute, Vail, CO, USA
- Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, München, Germany
| | - Peter J. Millett
- The Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
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Baum C, Audigé L, Stojanov T, Müller SA, Candrian C, Müller AM, Rosso C, Fankhauser L, Willscheid G, Moroder P, Akgün D, Danzinger V, Gebauer H, Imiolczyk JP, Karpinski K, Lacheta L, Minkus M, Paksoy A, Samaniego E, Thiele K, Weiss I, Suter T, Müller-Lebschi J, Mueller S, Saner M, Haag-Schumacher C, Tamborrini-Schütz G, Trong MLD, Buitrago-Tellez C, Hasler J, Riede U, Weber S, Moor B, Biner M, Fournier S, Gallusser N, Marietan D, Pawlak S, Spormann C, Hansen B, Mamisch N, Durchholz H, Bräm J, Cunningham G, Kourhani A, Ossipow S, Simao P, Lädermann A, Egli R, Erdbrink S, Flückiger R, Lombardo P, Pinworasarn T, Scacchi P, Weihs J, Zumstein M, Flury M, Berther R, Ehrmann C, Hübscher L, Schwappach D, Eid K, Bensler S, Fritz Y, Grünberger N, Kriechling P, Langthaler D, Niehaus R, Nobs R, Benninger E, de Groot Q, Doert A, Ebert S, Grimm P, Mottier F, Pisan M, Schätz J, Schwank A, Wiedenbach J, Scheibel M, Audigé L, Bellmann F, Brune D, de Jong M, Diermayr S, Endell D, Etter M, Freislederer F, Gkikopoulos N, Glanzmann M, Grobet C, Jung C, Moro F, Moroder P, Ringer R, Schätz J, Schwyzer HK, Weber B, Wehrli M, Wirth B, Nötzli M, Franz A, Oswald J, Steiger B, Ameziane Y, Child C, Spagna G, Candrian C, Del Grande F, Feltri P, Filardo G, Marbach F, Schönweger F, Jost B, Badulescu M, Lüscher S, Napieralski F, Öhrström L, Olach M, Rechsteiner J, Scheler J, Spross C, Zdravkovic V, Zumstein MA, Chlasta A, Gerber K, Hayoz A, Müller-Lebschi J, Schuster F, Wieser K, Borbas P, Bouaicha S, Camenzind R, Catanzaro S, Gerber C, Grubhofer F, Hasler A, Hochreiter B, Marcus R, Selman F, Sutter R, Wyss S, Appenzeller-Herzog C, Aghlmandi S, Ahlborn I, Baum C, Eckers F, Grezda K, Hatz S, Hunziker S, Stojanov T, Taha M, Tamborrini-Schütz G, Mueller AM. Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon. Am J Sports Med 2024; 52:441-450. [PMID: 38259113 PMCID: PMC10838469 DOI: 10.1177/03635465231219253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/02/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. PURPOSE To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. RESULTS From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. CONCLUSION Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.
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Affiliation(s)
- Cornelia Baum
- Investigation performed at University Hospital Basel, Basel and the Schulthess Klinik, Zurich, Switzerland
| | - Laurent Audigé
- Surgical Outcome Research Center, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Thomas Stojanov
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Sebastian A. Müller
- Department of Orthopaedic and Trauma Surgery, Shoulder and Elbow, Cantonal Hospital Baselland, Bruderholz, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Candrian
- Trauma and Ortho Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Andreas M. Müller
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sandra Weber
- Hôpital du Valais–Centre Hospitalier du Valais Romand, Martigny, CH
| | | | | | | | | | | | | | | | | | | | | | - Jakob Bräm
- Hirslanden Clinique la Colline, Geneva, CH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Larissa Hübscher
- Institute of Social and Preventive Medicine, University of Bern, Bern, CH
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- University Library Basel, University of Basel, Basel, CH
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Nunna B, Parihar P, Wanjari M, Shetty N, Bora N. High-Resolution Imaging Insights into Shoulder Joint Pain: A Comprehensive Review of Ultrasound and Magnetic Resonance Imaging (MRI). Cureus 2023; 15:e48974. [PMID: 38111406 PMCID: PMC10725840 DOI: 10.7759/cureus.48974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Shoulder joint pain is a complex and prevalent clinical concern affecting individuals across various ages and lifestyles. This review delves into the pivotal role of high-resolution imaging techniques, namely ultrasound and magnetic resonance imaging (MRI), in the comprehensive assessment and management of shoulder joint pain. We explore the anatomical foundations of the shoulder, common etiologies of pain, and the significance of precise diagnosis. High-resolution imaging facilitates the identification of various shoulder pathologies and is crucial in treatment planning, surgical interventions, and long-term prognosis assessment. We examine emerging technologies, discuss challenges and limitations, and chart potential future developments, emphasizing the ongoing evolution of imaging in this critical healthcare domain. In conclusion, high-resolution imaging is an indispensable tool, continually advancing to meet the diagnostic and therapeutic needs of individuals grappling with shoulder joint pain.
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Affiliation(s)
- Bhagyasri Nunna
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratap Parihar
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neha Shetty
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Bora
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Zhou Y, She H, Liu X, Wang R, Bai F. Outcomes After Combined Remnant Preservation and Bone Marrow Stimulation for Acute Rotator Cuff Tears. Orthop J Sports Med 2023; 11:23259671231152233. [PMID: 36814767 PMCID: PMC9940193 DOI: 10.1177/23259671231152233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background Both remnant preservation (RP) and bone marrow stimulation (BMS) enhance the healing potential of the repaired rotator cuff by improving the biological milieu of the tendon-bone interface. Purpose To evaluate the clinical and imaging outcomes of arthroscopic rotator cuff repair using a combined RP-BMS technique in patients with acute rotator cuff tears. Study Design Cohort study; Level of evidence, 3. Methods Between January 2016 and June 2019, a total of 56 patients were diagnosed with acute rotator cuff tears; 29 patients underwent conventional repair (group 1), and 27 patients underwent RP-BMS (group 2). At a minimum follow-up period of 2 years, the authors compared clinical outcomes with the University of California-Los Angeles; Constant; American Shoulder and Elbow Surgeons; and pain visual analog scale scores as well as shoulder range of motion. Tendon integrity and retear were assessed on magnetic resonance imaging according to the Sugaya classification (intact, grades 1-3; retear, grades 4-5). Between-group comparisons were conducted using the Student t test or Mann-Whitney U test for continuous variables and the Pearson chi-square test or Fisher exact test for categorical variables. Results In both groups, patients had significant preoperative to postoperative improvement on all clinical outcome measures (P = .001 for all). Shoulder abduction in group 2 was significantly greater compared with group 1 at the postoperative 3-month (107.37° ± 8.32° vs 95.44° ± 8.78°; P = .001), 6-month (155.25° ± 10.02° vs 144.72° ± 9.28°; P = .001), and final (165.15° ± 9.17° vs 158.31° ± 8.01°; P = .021) follow-ups. At the final follow-up, significantly more patients in group 2 had intact tendons (Sugaya grades 1-3) compared with group 1 (P = .015), and the tendon retear rate was lower in group 2 (1/27; 3.70%) than in group 1 (7/29; 24.14%) (P = .033). Conclusion Both surgical techniques led to satisfactory clinical outcomes, but shoulder abduction was greater after the RP-BMS technique compared with conventional repair. RP-BMS may be an alternative surgical technique to improve tendon integrity and retear rates after the repair of acute rotator cuff tears.
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Affiliation(s)
- Yi Zhou
- Department of Orthopaedics, Jian Yang Hospital of Traditional Chinese Medicine, Jian Yang, China
| | - Hongjiang She
- Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Zunyi, China
| | - Xiaoyan Liu
- Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Zunyi, China
| | - Rui Wang
- Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Zunyi, China
| | - Fan Bai
- Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Zunyi, China.,Fan Bai, MD, Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Fenghuang Road No. 98, Huichuan District, Zunyi 563000, China ()
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Themessl A, Wagner T, Rupp MC, Degenhardt H, Woertler K, Hatter KA, Imhoff AB, Siebenlist S, Pogorzelski J. "Functional outcomes and MRI-based tendon healing after (antero-) superior rotator cuff repair among patients under 50 years: retrospective analysis of traumatic versus non-traumatic rotator cuff tears". BMC Musculoskelet Disord 2023; 24:52. [PMID: 36670374 PMCID: PMC9862981 DOI: 10.1186/s12891-023-06174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Rotator cuff tears among patients under 50 years either result from an adequate trauma or are considered non-traumatic due to work-related or athletic overuse. The impact of these different mechanisms on postoperative functional outcomes and tendon healing has not yet been fully understood. Therefore, it was the purpose of this study to investigate the influence of etiology of (antero-)superior rotator cuff tears on postoperative outcomes and the healing rates after arthroscopic rotator cuff repair in a young patient population. METHODS Patients under 50 years who underwent arthroscopic rotator cuff repair between 2006-2017 for an anterosuperior rotator cuff tear with a minimum follow up of 24 months were included in this study. Revision surgeries or reconstructive concomitant procedures other than long head of the biceps tenodesis were excluded. Patients were divided into two groups according to the etiology of their rotator cuff tear (traumatic vs. non-traumatic). Demographic and outcome scores including the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score (CS), bilateral strength measurements and postoperative tendon integrity evaluated on magnetic resonance imaging (MRI) were assessed and compared between both groups. RESULTS The mean follow up for this study was 55.6 months (24 - 158). Twenty-one patients (50.0%) had a traumatic RCT and 21 patients (50.0%) had a non-traumatic tear. Outcome scores did not differ significantly between groups. Strength measurements of the supraspinatus revealed significantly decreased force of the affected side as opposed to the contralateral side (p = 0.001), regardless of etiology. Retear rates were similar in both groups (37.5% and 33.3%, p = n.s.). Cuff integrity at follow-up was not predictive of superior scores or strength. CONCLUSION Surgical treatment of traumatic and non-traumatic RCT yields good clinical results in patients under the age of 50. The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates. About one third of the patients suffered from a retear postoperatively, however retears were not predictive of inferior outcomes at midterm follow-up. STUDY DESIGN Level III. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Alexander Themessl
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Timon Wagner
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Hannes Degenhardt
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Klaus Woertler
- grid.6936.a0000000123222966Department of Radiology, Technical University of Munich, Munich, Germany
| | - Kate A. Hatter
- grid.189509.c0000000100241216Department of Surgery/ Emergency Medicine, Duke University Hospital, Durham, NC USA
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Surgery and Rotator Cuff Disease. Clin Sports Med 2023; 42:1-24. [DOI: 10.1016/j.csm.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tendon Transfers, Balloon Spacers, and Bursal Acromial Reconstruction for Massive Rotator Cuff Tears. Clin Sports Med 2023; 42:125-140. [DOI: 10.1016/j.csm.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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No difference in clinical outcome after rotator cuff repair performed within or later than 3 months after trauma: a retrospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:672-680. [PMID: 36287225 PMCID: PMC9898400 DOI: 10.1007/s00167-022-07193-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Rotator cuff (RC) tear is one of the most common injuries of the shoulder. Patients with RC tears often report a trauma initiating shoulder pain and impaired function. The aim of this retrospective analysis of a prospectively registered cohort was to elucidate whether the time interval between the trauma and RC repair, using a cut off of 3 months, affects the functional outcome after 2 years. METHODS In a single orthopedic unit, 819 consecutive patients were treated with rotator cuff repair during the period from 2010 to 2014 and 733 of the patients completed the Western Ontario Rotator Cuff (WORC) index preoperatively and at 2-year follow-up. The Constant-Murley (CM) score was completed by trained physiotherapists after a clinical examination both preoperatively and at 2-year follow-up. Preoperative magnetic resonance imaging (MRI) was performed in all patients and postoperatively in 65% of the included patients. Re-tears and partial repairs were excluded, as were patients with pseudoparalysis who were given high priority and underwent surgery during the first 3 weeks after trauma. RESULTS Of the 733 treated patients, 437 (60%) reported having had a shoulder trauma in their medical history initiating their shoulder symptoms, and of these, 358 met the inclusion criteria. 296 patients with non-traumatic tears, 9 repairs done within 3 weeks after trauma, 25 partial repairs, 33 re-tears and 12 others were excluded. At 2-year follow-up there was no significant difference in WORC index (n.s.) or CM score (n.s.) between patients who had their RC repaired within or more than 3 months after trauma. In patients where RC repair was performed within 3 months, the WORC index improved by 42.9%, and in the group of patients operated later than 3 months, the increase was 38.7%. This difference between the groups was neither statistically significant (n.s.) nor clinically relevant. On postoperative MRI, 80% of the repairs were healed in both groups. CONCLUSION In this retrospective cohort study, no differences in clinical outcome were found when RC repair was performed between 3 weeks and 3 months or later than 3 months after injury in patients describing their onset of symptoms as traumatic. LEVEL OF EVIDENCE III.
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Godshaw BM, Hughes JD, Boden SA, Lin A, Lesniak BP. Comparison of Functional Outcomes After Arthroscopic Rotator Cuff Repair Between Patients With Traumatic and Atraumatic Tears. Orthop J Sports Med 2022; 10:23259671221126551. [PMID: 36313008 PMCID: PMC9608059 DOI: 10.1177/23259671221126551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The role of tear etiology in outcomes after rotator cuff repair is not well understood. Purpose/Hypothesis: The purpose of this study was to determine the difference in outcomes after rotator cuff repair based on tear etiology. We hypothesized that traumatic rotator cuff tears will have greater improvements in functional outcome measures and range of motion (ROM) than atraumatic tears. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a chart review of 221 consecutive patients who underwent arthroscopic rotator cuff repair; prospectively collected preoperative and minimum 2-year postoperative data were evaluated. Shoulder ROM, strength, and standard shoulder physical examination findings were recorded pre- and postoperatively. Outcome measures included visual analog scale for pain, Subjective Shoulder Value (SSV), 10-item Patient-Reported Outcomes Measurement Information System (PROMIS-10; physical and mental components), and American Shoulder and Elbow Surgeons (ASES) form. Results: Of the 221 patients, 73 had traumatic tears and 148 had atraumatic/degenerative tears. There were no differences in age, body mass index, or Charlson Comorbidity Index between groups. Patients in the atraumatic cohort had significantly longer duration of symptoms before presentation (18 vs 7 months; P < .01). Preoperatively, the traumatic cohort had less motion to forward flexion (mean ± SD; 138° ± 43.7° vs 152° ± 29.8°; P = .02). Postoperatively, both groups experienced significant improvements in visual analog scale and SSV scores (P < .001 each). However, only the traumatic cohort demonstrated improvements in ASES and PROMIS-10 physical component scores. Patients with traumatic rotator cuff tears had lower preoperative SSV and less motion than those with atraumatic tears, but they had greater improvements in SSV (40.6% ± 39.0% vs 29.2% ± 39.7%; P = .005) and forward flexion (21.6° ± 48.6° vs 2.3° ± 48.2°; P < .001), as well as strength in forward flexion, external rotation, and internal rotation (P < .001, P = .003, and P = .002, respectively). Conclusion: Patients with traumatic rotator cuff tears have worse preoperative symptoms and more functional deficits but experience greater improvements in ROM, strength, and perceived shoulder function than those with degenerative/atraumatic tears.
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Affiliation(s)
- Brian M. Godshaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Ochsner Sports Medicine Institute, New Orleans, Louisiana, USA
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephanie Ann Boden
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Bryson P. Lesniak, MD, UPMC Rooney Sports Complex, 3200 South Water St, Pittsburgh, PA 15203, USA ()
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12
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No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears. Knee Surg Sports Traumatol Arthrosc 2022; 30:2521-2527. [PMID: 35133449 PMCID: PMC9206597 DOI: 10.1007/s00167-022-06884-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/12/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE Acute trauma-related rotator cuff tears are believed to have better healing potential than chronic tears due to less degenerative changes of the tendons. However, the histopathological condition of tendons from trauma-related tears is not well investigated. The purpose of this study was to explore specific histopathological features in tendons from acute trauma-related full-thickness rotator cuff tears and to compare them to findings in tendons from nontraumatic, chronic tears. METHODS In a prospective cohort study, 62 previously asymptomatic patients [14 women, median age 61 years (range 42-75)] with trauma-related full-thickness rotator cuff tears were consecutively included. Arthroscopic repair was performed within 30 (median, IQR 25-37) days after the injury. During surgery, tissue biopsies were harvested from the supraspinatus tendons in 53 (86%) of the patients. In addition, similar biopsies were harvested from 10 patients undergoing surgery for chronic tears without history of trauma. All tissue samples were examined by a well-experienced pathologist under light microscope. Tendon degeneration was determined using the Bonar score whereas immunostaining was used for proliferation (Ki67), inflammation (CD45), apoptosis (p53) and haemosiderin staining to study traces of bleeding. RESULTS The median (IQR) Bonar score for the acute trauma-related biopsies was 10.5 (7.5-14.5) compared to 11 (5-12.8) for the control group with no statistically significant difference between the groups. No statistically significant between-group difference was found for the inflammatory index whereas tendons from patients with trauma-related full-thickness rotator cuff tears had statistically significantly higher apoptosis [3.1 (0.5-8.9) vs. 0.1 (0-1.5), p = 0.003] and proliferation [4.0 (1.8-6.9) vs. 0.4 (0-2.0), p = 0.001) indices than those undergoing surgery for chronic tears. Positive haemosiderin staining was found in 34% of tissue samples from patients with trauma-related tears compared to 10% in the control group (n.s). CONCLUSION This study suggests that there is no difference with regard to degenerative changes between supraspinatus tendons harvested from patients with acute, trauma-related rotator cuff tears and patients with nontraumatic, chronic tears. LEVEL OF EVIDENCE II.
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Zhao J, Luo M, Liang G, Pan J, Han Y, Zeng L, Yang W, Liu J. What Factors Are Associated with Symptomatic Rotator Cuff Tears: A Meta-analysis. Clin Orthop Relat Res 2022; 480:96-105. [PMID: 34424222 PMCID: PMC8673964 DOI: 10.1097/corr.0000000000001949] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/02/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears are common. A previous systematic review reported on factors associated with rotator cuff tears; however, it included relatively few studies and few variables, and in addition, it had considerable heterogeneity. To identify the factors associated with symptomatic rotator cuff tears and to help guide clinicians to potentially modifiable factors, we felt a broader and more inclusive meta-analysis would be useful. QUESTIONS/PURPOSES In this systematic review and meta-analysis, we asked what (1) demographic, (2) disease, and (3) imaging factors are associated with symptomatic rotator cuff tears? METHODS PubMed, Embase, and Web of Science were searched, and the search period were from the inception of each database through February 2021. The keywords included "risk factor," "rotator cuff injury," "rotator cuff tears," and "rotator cuff tendinitis." All comparative studies on symptomatic rotator cuff tears were included. We considered that the diagnosis of rotator cuff tear could be made by any imaging tool (MRI or ultrasound). We considered either partial- or full-thickness tears to be a rotator cuff tear. No language restrictions were applied. Twenty-six articles from 14 countries involving 9809 individuals, consisting of 3164 patients and 6645 controls, were included. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality (AHRQ) scale were used to evaluate the risk of bias of the included studies, and the highest scores were 9 and 11, respectively. The Newcastle-Ottawa Scale was used for retrospective comparative studies, and the AHRQ was used to evaluate prospective comparative studies. The eight retrospective comparative studies we included were scored from 4 to 9. The quality score of the 18 prospective comparative studies ranged from 6 to 9. Publication bias was explored using the Egger test. Heterogeneity was estimated using the I2 value. If there was no heterogeneity (I2 ≤ 50%), a fixed-effects model was used to determine the overall effect size; if there was heterogeneity (I2 > 50%), a random-effects model was used to merge the effect values. A meta-analysis was performed with RevMan 5.3, and the risk ratio (RR) and weighted mean difference of related factors were calculated. RESULTS Our meta-analysis identified the following demographic factors associated with an increased risk of rotator cuff tears: older age (mean difference 3.1 [95% CI 1.4 to 4.8]; p < 0.001), greater BMI (mean difference 0.77 [95% CI 0.37 to 1.17]; p < 0.001), smoking (RR 1.32 [95% CI 1.17 to 1.49]; p < 0.001), dominant arm (RR 1.15 [95% CI 1.06 to 1.24]; p < 0.001), greater height (mean difference 0.9 [95% CI 0.4 to 1.4]; p < 0.001), and heavier weight (mean difference 2.24 [95% CI 0.82 to 3.66]; p = 0.002). Regarding disease factors, we found that traumatic events (RR 1.91 [95% CI 1.40 to 2.54]; p < 0.001) and hypertension (RR 1.50 [95% CI 1.32 to 1.70]; p < 0.001) were associated with symptomatic rotator cuff tears. Regarding imaging factors, we found that the following three factors were associated with symptomatic rotator cuff tears: greater acromion index (mean difference 0.11 [95% CI 0.06 to 0.16]; p < 0.001), greater critical shoulder angle (mean difference 1.9 [95% CI 1.5 to 2.3]; p < 0.001), and smaller glenoid version angle (mean difference -1.3 [95% CI -1.9 to -0.8]; p < 0.001). We found no association between the patient's sex or the presence or absence of thyroid disease and the likelihood of a rotator cuff tear being present. CONCLUSION This study identified several factors associated with symptomatic rotator cuff tears, including blood glucose, blood pressure, weight, and smoking. Clinicians may seek to modify these factors, possibly in patients with symptomatic rotator cuff tears, but also in symptomatic patients who have not yet been diagnosed with rotator cuff tears because there would be no harm or risk associated with modifying any of the factors we identified. Future research should further study whether addressing these factors can delay the progression and size of rotator cuff tears.Level of Evidence Level III, prognostic study.
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Affiliation(s)
- Jinlong Zhao
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guagnzhou, China
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Guihong Liang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Yanhong Han
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Lingfeng Zeng
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Weiyi Yang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jun Liu
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
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McIntyre LF, McMillan S, Trenhaile SW, Bishai SK, Bushnell BD. Full-Thickness Rotator Cuff Tears Can Be Safely Treated With a Resorbable Bioinductive Bovine Collagen Implant: One-Year Results of a Prospective, Multicenter Registry. Arthrosc Sports Med Rehabil 2021; 3:e1473-e1479. [PMID: 34712984 PMCID: PMC8527318 DOI: 10.1016/j.asmr.2021.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/18/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study was to prospectively collect safety and efficacy data in a large group of patients undergoing arthroscopic repair of full-thickness rotator cuff tears augmented with a resorbable bioinductive bovine collagen implant designed to promote healing. Methods Seventeen centers across the United States enrolled patients in an institutional review board-approved registry to collect outcomes data on the implant. Patients undergoing surgical management of full-thickness rotator cuff tears augmented with the implant were enrolled. Inclusion criteria were age of ≥21 years, willingness to participate and the ability to read and speak English. Exclusion criteria included hypersensitivity to bovine-derived products. Patients were assessed before and after surgery at up to 1 year with outcomes including the single-assessment numeric evaluation (SANE), Veterans RAND 12-Item (VR-12) mental components and physical components (VR-12 PCS), American Shoulder and Elbow Surgeons (ASES), and Western Ontario Rotator Cuff (WORC) outcome measures. Ad hoc analyses were performed to compare these outcomes at all time points depending on tear size (small/medium vs large/massive). Serious complications were collected. Results Of 210 patients enrolled, 192 had 1-year follow-up data available. The patients experienced statistically significant improvement between baseline and 1 year for mean SANE, VR-12 PCS, ASES, and WORC scores (40.0-82.0, 33.5-47.3, 46.2-87.8, and 36.2-81.0, respectively; P < .001 for all results). Ad-hoc analysis demonstrated that similar results were obtained at 1 year regardless of tear size. Twenty patients (10.4%) experienced serious complications (10.4%), including revision surgery (n = 18), proximal humerus fracture/partial subscapularis tear resulting from multiple falls (n = 1), and adhesive capsulitis (n = 1). Conclusions The safety and efficacy of a bioinductive implant in the surgical management of full-thickness rotator cuff tears at 1 year was shown in this study. Implant efficacy appears to be comparable regardless of the underlying tear size. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Louis F. McIntyre
- Orthopedic Partners, Nashville, Tennessee, United States
- Address correspondence to Louis F. McIntyre, M.D., 35 Avondale Rd, White Plains, NY 10605, U.S.A.
| | - Sean McMillan
- Virtua Medical Center, Burlington, New Jersey, United States
| | | | - Shariff K. Bishai
- Associated Orthopedists of Detroit, Detroit, Michigan, United States
| | - Brandon D. Bushnell
- Department of Orthopedic Surgery, Harbin Clinic, Rome, Georgia, United States
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Nyffeler RW, Schenk N, Bissig P. Can a simple fall cause a rotator cuff tear? Literature review and biomechanical considerations. INTERNATIONAL ORTHOPAEDICS 2021; 45:1573-1582. [PMID: 33774700 PMCID: PMC8178131 DOI: 10.1007/s00264-021-05012-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE A simple fall on the shoulder is often referred to as minor trauma that cannot cause a tendon tear but at best reveal a pre-existing rotator cuff pathology. We wanted to know whether this statement was true. The purpose of our study was therefore to summarize the causes of acute rotator cuff tears reported in the literature and provide a biomechanical explanation for tendon tears diagnosed after a fall. METHOD We searched PubMed and included studies reporting rotator cuff tears occurring due to a trauma. The number of cases, the tendons involved, the age of the patients, and the nature of trauma were summarized. In addition, we noted any information provided by the authors on the pathogenesis of acute tendon ruptures. RESULTS Sixty-seven articles with a total of 4061 traumatic rotator cuff tears met the inclusion criteria. A simple fall was the most common cause (725 cases) and the supraspinatus tendon was most frequently affected. The postulated pathomechanism is a sudden stretch of the tendon-muscle unit while contracting (eccentric loading). CONCLUSION A simple fall can cause an acute rotator cuff tear and fall-related tears are not restricted to young individuals. They can affect patients of any age. The stresses occurring within the rotator cuff during an attempt to cushion a fall may locally exceed the tensile strength of the tendon fibers and cause a partial or full-thickness tear.
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Affiliation(s)
- Richard W Nyffeler
- Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006, Bern, Switzerland.
- Stiftung Lindenhof, Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Freiburgstrasse 3, 3010, Bern, Switzerland.
| | - Nicholas Schenk
- Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006, Bern, Switzerland
- Praxis Integri, Hirschengraben 7, 3011, Bern, Switzerland
| | - Philipp Bissig
- Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006, Bern, Switzerland
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