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Shibata T, Doi N, Shibata Y, Minokawa S, Miyake S, Izaki T. Application of indocyanine green fluorescence angiography in evaluating blood flow in rotator cuff tears: a preliminary study. J Shoulder Elbow Surg 2024; 33:2149-2158. [PMID: 38909639 DOI: 10.1016/j.jse.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND The relationship between the degree of vascularization at the edge of a torn rotator cuff tendon and cuff healing remains unclear. The purpose of this study was to employ indocyanine green (ICG) fluorescence angiography to evaluate the blood flow at the edge of a torn rotator cuff tendon under the subacromial view. METHODS Thirteen shoulders of 13 patients who underwent arthroscopic repair of full-thickness rotator cuff tears were included in this prospective study. Viewing from the posterolateral portal, ICG at 0.2 mg/kg body weight was intravenously administered, and the blood flow was recorded. After resecting the poorly vascularized torn edge of the tendon, ICG administration was repeated at the same volume. The fluorescence intensity and perfusion time of the tendon blood flow were evaluated using video analysis and modeling tools. Cuff integrity was evaluated using magnetic resonance imaging at 6 months postoperatively. Patients were divided into healed and retear groups, and the differences in the degree of blood flow were evaluated. RESULTS ICG fluorescence angiography could visualize the blood flow in the rotator cuff tendon, and the torn edge of the tendon with poor blood flow was resected. The overall retear rate was 23.1% (3/13). Based on quantitative analysis, the fluorescence intensity factors were significantly lower in the retear group than in the healed group before tendon débridement. The retear rate in the high blood flow group was 0% (0/7), while that in the low blood flow group was 50.0% (3/6). CONCLUSIONS ICG fluorescence angiography may play a role in the future of shoulder arthroscopy. Further study is needed to determine the effect of blood flow on tendon healing.
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Affiliation(s)
- Terufumi Shibata
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan; Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan.
| | - Nobunao Doi
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Yozo Shibata
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - So Minokawa
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Satoshi Miyake
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Teruaki Izaki
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
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Da Silva AZ, Moverman MM, Joyce C, Tashjian R, Chalmers PN. Patient, imaging, and surgical factors associated with supraspinatus re-tear pattern after rotator cuff repair. JSES Int 2024; 8:1045-1050. [PMID: 39280155 PMCID: PMC11401561 DOI: 10.1016/j.jseint.2024.06.007] [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: 09/18/2024] Open
Abstract
Background This study aimed to characterize patient, imaging, and surgical factors associated with re-tear patterns after rotator cuff repair, as well as to identify predictors of type 2 failure in a large patient cohort. Methods A retrospective case-control study was performed at a single urban academic institution. All patients who underwent an arthroscopic rotator cuff repair by 2 fellowship-trained shoulder and elbow surgeons between 2005 and 2022 and were subsequently found to have a symptomatic re-tear on magnetic resonance imaging were included. Patients were characterized as either a type 1 (failure at bone-tendon interface) or type 2 (failure medial to the bone-tendon junction) re-tear based on the Cho classification. Chart review was performed to collect demographic, imaging, and intraoperative surgical factors. Multivariable analysis was performed to determine patient and imaging factors associated with type 2 failure. Results Fifty-seven patients were included in the study. Overall, 33 (57.9%) patients were classified as a Cho 1 re-tear and 24 (42.1%) were classified as Cho 2 re-tear. No differences in preoperative tear characteristics (tear width, tear retraction, and tendon length) or fatty infiltration were found between Cho 1 and Cho 2 re-tears. Bivariate analysis comparing Cho 1 vs. Cho 2 found male sex was associated with a higher incidence of a Cho 2 re-tear (79.2% vs. 20.8%; P = .033). No significant differences in repair construct (single row vs. double row) (P = .816), biceps treatment (P = .552), concomitant subscapularis repair (P = .306), number of medial anchors (P = .533), or number of lateral anchors (P = .776) were noted between re-tear types. After controlling for potential confounding factors, multivariable regression analysis demonstrated that male sex was predictive of developing a Cho 2 re-tear (odds ratio 3.8; 95% confidence interval 1.1-13.3; P = .039). Repair construct was not found to be predictive of re-tear pattern (P = .580). Conclusion Repair construct used during rotator cuff repair does not appear to influence re-tear pattern. Male sex was associated with a higher rate of type 2 failure.
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Affiliation(s)
- Adrik Z Da Silva
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Christopher Joyce
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Robert Tashjian
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Ruiz Ibán MÁ, García Navlet M, Moros Marco S, Diaz Heredia J, Hernando Sánchez A, Ruiz Díaz R, Vaquero Comino C, Rosas Ojeda ML, Del Monte Bello G, Ávila Lafuente JL. Augmentation of a Transosseous-Equivalent Repair in Posterosuperior Nonacute Rotator Cuff Tears With a Bioinductive Collagen Implant Decreases the Retear Rate at 1 Year: A Randomized Controlled Trial. Arthroscopy 2024; 40:1760-1773. [PMID: 38158165 DOI: 10.1016/j.arthro.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/25/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To determine whether the addition of a bioinductive collagen implant (BCI) over a transosseous equivalent (TOE) repair of medium-to-large posterosuperior rotator cuff tears improves the healing rate determined by magnetic resonance imaging (MRI) at 12-month follow-up. METHODS A Level I randomized controlled trial was performed in 124 subjects with isolated, symptomatic, reparable, full-thickness, medium-to-large posterosuperior nonacute rotator cuff tears, with fatty infiltration ≤2. These were randomized to 2 groups in which an arthroscopic posterosuperior rotator cuff tear TOE repair was performed alone (Control group) or with BCI applied over the TOE repair (BCI group). The primary outcome was the retear rate (defined as Sugaya 4-5) determined by MRI at 12 months of follow-up. Secondary outcomes were characteristics of the tendon (Sugaya grade and thickness of the healed tendon) and clinical outcomes (pain levels, EQ-5D-5L, American Shoulder and Elbow Surgeons, and Constant-Murley scores) at 12 months of follow-up. RESULTS Of the 124 randomized patients, 122 (60 in the BCI group and 62 in the Control group) were available for MRI evaluation 12.2 ± 1.02 months after the intervention. There were no relevant differences in preoperative characteristics. Adding the BCI reduced the retear rate (8.3% [5/60] in the BCI group vs 25.8% [16/62] in the Control group, P = .010; relative risk of retear of 0.32 [95% confidence interval 0.13-0.83]). Sugaya grade was also better in the BCI group (P = .030). There were no differences between groups in the percentage of subjects who reached the MCID for CMS (76.7% vs 81.7%, P = .654) or American Shoulder and Elbow Surgeons (75% vs 80%, P = .829), in other clinical outcomes or in complication rates at 12.4 ± 0.73 (range 11.5-17) months of follow-up. CONCLUSIONS Augmentation with a BCI of a TOE repair in a medium-to-large posterosuperior rotator cuff tear reduces the retear rate at 12-month follow-up by two-thirds, yielding similar improvements in clinical outcomes and without increased complication rates. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Miguel Ángel Ruiz Ibán
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Madrid, Spain; Departamento de de Cirugía, Ciencias Sanitarias Y Medicosociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain; Área De Traumatología y Ortopedia, Universidad CEU San Pablo, Madrid, Spain.
| | - Miguel García Navlet
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Asepeyo Coslada, Madrid, Spain
| | - Santos Moros Marco
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Maz Zaragoza, Zaragoza, Spain
| | - Jorge Diaz Heredia
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Madrid, Spain; Departamento de de Cirugía, Ciencias Sanitarias Y Medicosociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Arántzazu Hernando Sánchez
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Asepeyo Coslada, Madrid, Spain
| | - Raquel Ruiz Díaz
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Madrid, Spain; Departamento de de Cirugía, Ciencias Sanitarias Y Medicosociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Carlos Vaquero Comino
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Asepeyo Coslada, Madrid, Spain
| | - Maria Luisa Rosas Ojeda
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Gabriel Del Monte Bello
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Fraternidad-Muprespa Habana, Madrid, Spain
| | - Jose Luis Ávila Lafuente
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Maz Zaragoza, Zaragoza, Spain
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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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Kawamata J, Suenaga N, Oizumi N. Relationship between hematoma-like tissue on the footprint and structural outcome of arthroscopic rotator cuff repair with a transosseous technique. JSES Int 2023; 7:324-330. [PMID: 36911767 PMCID: PMC9998884 DOI: 10.1016/j.jseint.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background We have tried to create hematoma over the footprint site at the end of arthroscopic rotator cuff repair (ARCR) surgery, expecting to apply biochemical effects of the platelet-related factors. The purpose of this study was to investigate the presence of hematoma-like tissue (HLT) on postoperative magnetic resonance imaging, and to evaluate the relationship between the HLT and the structural outcomes of ARCR. Materials and methods Twenty-five patients were reviewed with a mean age at surgery of 69.8 years (range, 52-85 years). Postoperative magnetic resonance imaging was performed at 1 week, 6-8 weeks, and >6 months postoperatively. Structural outcomes for the repaired cuff and thickness of HLT were evaluated on coronal T2-weighted images. Signal intensity of HLT was evaluated on coronal T2-weighted fat-suppressed images as the ratio compared to supraspinatus tendon intensity (HLT/SSP ratio). Results Structural outcomes showed Sugaya type 1 in 12 shoulders, type 2 in 4, and type 3 in 9. HLT thickness was significantly thicker at 1 week and 6-8 weeks postoperatively in Sugaya type 1 patients than in type 3 patients (1 week; P = .014, 6-8 weeks; P < .001). HLT/SSP ratio gradually decreased (at 1 week; 1.9 ± 0.7, 6-8 weeks; 1.6 ± 0.6, >6 months; 1.2 ± 0.5), and differed significantly between >6 months and both 1 week and 6-8 weeks (P < .001 each).
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Affiliation(s)
- Jun Kawamata
- Department of Orthopaedic Surgery, Kaisei Hospital, Hokkaido, Japan
| | - Naoki Suenaga
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Hokkaido, Japan
| | - Naomi Oizumi
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Hokkaido, Japan
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Lv M, Xu Q, He F, Guo J, Zheng Z, Xie J, Wang W. Transosseous-Equivalent/Suture Bridge Technique in Combination With Platelet-Rich Plasma Application Yield Optimal Clinical Outcomes in Arthroscopic Rotator Cuff Repair: A Bayesian Network Analysis of Randomized Controlled Trials. Arthroscopy 2023; 39:425-437.e1. [PMID: 36343767 DOI: 10.1016/j.arthro.2022.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To assess the clinical evidence defining the optimal combination of arthroscopic suture technique and platelet-rich products (PRP), and application for arthroscopic rotator cuff repair (ARCR). METHODS All level of evidence (LOE) I randomized controlled trials (RCT) focusing on arthroscopic suture technique and/or PRP application in ARCR were included. The exclusion criteria were LOE II or worse, studies with other interventions, studies reported none of the predetermined clinical outcomes; studies unable to extract any precise data; studies from the same patient group of included studies. A pair-wise meta-analysis and Bayesian network analysis were performed on each comparison. The intervention options were ranked by Bayesian network analysis. RESULTS 27 studies comprising 1,947 individuals met the inclusion criteria. The application of transosseous equivalent/suture bridge repair (SB) with PRP (SB+PRP) significantly reduced retear rate (risk ratio [RR], 0.29; 95% confidence interval [CI], [0.15, 0.55].) and increased Constant-Murley score (mean difference, 1.90; 95% CI, [0.14, 3.74]), compared to SB repair. Single-row repair (SR) with PRP usage (SR+PRP) significantly reduced retear rate (RR, 0.27; 95% CI, [0.12, 0.55]) and pain visual analog scale (VAS) (mean difference: -0.84; 95% CI [-1.39, -0.46].), increased University of California, Los Angeles (UCLA) shoulder score (mean difference: 1.48; 95% CI [0.50, 2.58]) and Constant-Murley score (mean difference: 4.53; 95% CI [2.65, 6.38]), compared to SR repair. The ranking for outcomes demonstrated SB+PRP resulted in the best retear rate, UCLA shoulder score, with the second-best postoperative pain, Constant-Murley score, while SR+PRP resulted in the best postoperative pain, Constant-Murley score, with the second-best retear rate and UCLA score. CONCLUSION Arthroscopic rotator cuff repair utilizing SB+PRP yields optimal retear rate and UCLA shoulder score, with the second-best postoperative pain and Constant-Murley shoulder outcome score, while SR+PRP yields the best in these two parameters. LEVEL OF EVIDENCE Level I, Bayesian network analysis of level I RCT.
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Affiliation(s)
- Minchao Lv
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Qingxin Xu
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feixiong He
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Jinku Guo
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Zhenxin Zheng
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Jun Xie
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Wei Wang
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China.
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Maia Dias C, Gonçalves SB, Completo A, da Silva MR, de Campos Azevedo C, Mineiro J, Ferreira F, Folgado J. Mechanical consequences at the tendon-bone interface of different medial row knotless configurations and lateral row tension in a simulated rotator cuff repair. J Exp Orthop 2022; 9:94. [PMID: 36117186 PMCID: PMC9482894 DOI: 10.1186/s40634-022-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Little is known about the direct influence of different technical options at the rotator cuff tendon-bone interface (TBI) and, more specifically, at the medial bearing row (MBR), regarding local contact force, area and pressure. We evaluated the mechanical repercussions of different medial row anchor configurations for that setting using different values of tension in the lateral row anchors. Methods Knotless transosseous equivalent (TOE) rotator cuff repairs with locked versus nonlocked medial anchors and single versus double-hole suture passage were tested in a synthetic rotator cuff mechanical model, using 2 different values of lateral row tension. Contact force, area, pressure, peak force and MBR force were compared at the simulated TBI using a pressure mapping sensor. Results When compared to locked anchors, medial row sliding configurations generate lower values for all the above-mentioned parameters. The use of double-hole suture passage in the medial cuff generated slightly higher values contact area regardless of lateral row tension. At higher lateral row tension values, lower values of the remaining parameters, including MBR force, were found when compared to single-hole suture passage. Lateral row anchor tension increase induced an increase of all parameters regardless of the medial row configuration and TBI contact force and MBR force were the most susceptible parameters, regardless of the medial row pattern. Conclusion Medial row mechanism, suture configuration and lateral row tension interfere with the mechanical force, area and pressure at by TBI. Lateral row tension increase is a major influencer in those parameters. These results can help surgeons choose the right technique considering its mechanical effect at the TBI. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00536-1.
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Affiliation(s)
- Carlos Maia Dias
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal. .,Hospital CUF Tejo, Shoulder and Elbow Unit, Lisbon, Portugal.
| | - Sérgio B Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - António Completo
- TEMA, Department of Mechanical Engineering, University of Aveiro (UA), Aveiro, Portugal
| | | | - Clara de Campos Azevedo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Hospital CUF Tejo, Elbow and Shoulder Unit, Lisbon, PT, Portugal.,Hospital Dos SAMS de Lisboa, Lisbon, Portugal
| | | | - Frederico Ferreira
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Knotted and knotless double row transosseous equivalent repair techniques for arthroscopic rotator cuff repair demonstrate comparable post-operative outcomes. Knee Surg Sports Traumatol Arthrosc 2022; 31:1919-1924. [PMID: 35996032 DOI: 10.1007/s00167-022-07121-0] [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: 06/28/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To compare failure rates and outcomes after transosseous equivalent (TOE) double row (DR) knotted suture bridge versus knotless suture tape bridge repair techniques for rotator cuff tears. METHODS A consecutive series of 272 shoulders in 256 patients who underwent arthroscopic, double row, TOE repair for full-thickness tears of the supraspinatus tendon were reviewed. Eighty-four shoulders were repaired using knotted suture bridge (KSB) technique, and 188 shoulders were repaired using all knotless suture tape bridge (KTB) technique. Revision procedures and concomitant subscapularis tendon repairs were excluded from analysis. The minimum follow-up was 12 months. Primary outcome was failure of surgical repair, defined as either confirmed retear on MRI and/or need for revision surgery. Secondary clinical outcome measures were assessed including range of motion, strength, visual analog scale (VAS), operative time, subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) mental and physical health, American Shoulder and Elbow Surgeons Shoulder Score (ASES), Brophy shoulder activity scores, and need for manipulation under anesthesia (MUA). RESULTS A total of 127 shoulders (38 KSB and 89 KTB) met inclusion criteria for the study. No significant difference in demographic variables were present between the groups at baseline. Supraspinatus tear size and average follow-up time did not differ significantly between groups. Failure rates were similar between the KSB and KTB repairs (13.1 vs 7.9%, n.s.). There was no significant difference in functional outcomes including strength, range of motion in forward flexion and external rotation, as well as patient reported outcomes including VAS, SSV, PROMIS, ASES, and Brophy scores between the groups. There was also no difference in post-operative stiffness requiring MUA. CONCLUSION Both KSB and KTB repair techniques demonstrate low retear rates with excellent functional outcomes when compared to pre-operative examination. Both KSB and KTB techniques are viable options for achieving a successful rotator cuff repair. LEVEL OF EVIDENCE Level III.
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CENGİZ B. The effect of the number of anchors used in the medial row on clinical outcomes in arthroscopic double row repair of rotator cuff tears: retrospective evaluation of patients with 3 to 7 years of follow-up. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1035358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Transosseous-Equivalent/Suture Bridge Arthroscopic Rotator Cuff Repair in Combination With Late Postoperative Mobilization Yield Optimal Outcomes and Retear Rate: A Network Meta-analysis of Randomized Controlled Trials. Arthroscopy 2022; 38:148-158.e6. [PMID: 34082023 DOI: 10.1016/j.arthro.2021.05.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to perform a network meta-analysis of the randomized controlled trials (RCTs) in the literature in order to assess the evidence defining the optimal combination of surgical technique single-row repair (SRR), double-row repair (DRR), or transosseous-equivalent/suture bridge (TOE/SB) arthroscopic rotator cuff repair (ARCR) and postoperative rehabilitation (early or late) protocol for ARCR. METHODS The literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized SSR-early trials (RCTs) comparing SRR vs DRR vs TOE/SB ARCR techniques were included, as well as early vs late postoperative range of motion. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score. RESULTS Twenty-eight studies comprising 2,181 total shoulders met the inclusion criteria. TOE/SB-late (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.08-0.46) and DRR-late (OR, 0.25; 95% CI, 0.12-0.52) were found to significantly reduce the rate of retear, with TOE/SB-late resulting in the highest P-score for the American Shoulder and Elbow Surgeons (P-score: 0.7911) score and retear rate (P-score: 0.8725). DRR-early did not result in any significant improvements over the SRR-early group, except in internal rotation. There was no significant difference in forward flexion between groups, with almost equivalent P-scores. Furthermore, TOE/SB-early and TOE/SB-late trended toward worsening external rotation compared with the control. CONCLUSIONS The current study suggests that rotator cuff repair using the TOE/SB technique and late postoperative mobilization yields the highest functional outcomes and lowest retear rate in the arthroscopic management of symptomatic rotator cuff tears. LEVEL OF EVIDENCE Level I, meta-analysis of Level I studies.
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11
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Modified double-pulley suture-bridge techniques with or without medial knot tying show comparable clinical and radiological outcomes in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:3997-4003. [PMID: 34417658 DOI: 10.1007/s00167-021-06708-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The optimal technique for arthroscopic rotator cuff repair is still controversial. The aim of this study was to compare modified arthroscopic double-pulley suture-bridge (DPSB) technique with medial knot tying to those without tying, considering clinical and radiological outcomes. METHODS This study included 292 patients with large full-thickness rotator cuff tears treated with modified DPSB technique. The patients were divided into 158 cases with medial knot tying (knot-tying group) and 134 without tying (knotless group). At follow-up, clinical outcome was assessed by the Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score. The assessment of tendon healing was performed with magnetic resonance imaging (MRI) at a minimum of 12 months postoperatively. RESULTS The Constant score, ASES score and UCLA score in the knot-tying and knotless groups all improved significantly from before surgery to 12 months postoperatively (P < 0.05, respectively). No significant differences were observed between groups for each phase evaluated (n.s.). Tendon healing was categorised according to Sugaya's classification. The retearing rate was 27/158 (17.0%) in the knot-tying group and 20/134 (14.9%) in the knotless group, with no statistically significant difference between groups (n.s.). Additionally, the retear was classified using the Cho's classification. When comparing the retear rates of different types independently, no statistically significant differences were found between groups (n.s.). CONCLUSIONS The knotless modified DPSB technique showed comparable short-term functional outcomes to those of the knot tying method in large full-thickness rotator cuff tears. Additionally, no significant differences in repair integrity were observed between the two methods. Both techniques can be considered effective treatments for patients with large-sized full-thickness rotator cuff tears. LEVEL OF EVIDENCE III.
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Hackl M, Nacov J, Kammerlohr S, Staat M, Buess E, Leschinger T, Müller LP, Wegmann K. Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure. Am J Sports Med 2021; 49:1847-1853. [PMID: 33872064 DOI: 10.1177/03635465211006138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-row (DR) and transosseous-equivalent (TOE) techniques for rotator cuff repair offer more stability and promote better tendon healing compared with single-row (SR) repairs and are preferred by many surgeons. However, they can lead to more disastrous retear patterns with failure at the medial anchor row or the musculotendinous junction. The biomechanics of medial cuff failure have not been thoroughly investigated thus far. PURPOSE To investigate the intratendinous strain distribution within the supraspinatus tendon depending on repair technique. STUDY DESIGN Controlled laboratory study. METHODS Twelve fresh-frozen cadaveric shoulders were used. The intratendinous strain within the supraspinatus tendon was analyzed in 2 regions-(1) at the footprint at the greater tuberosity and (2) medial to the footprint up to the musculotendinous junction-using a high-resolution 3-dimensional camera system. Testing was performed at submaximal loads of 40 N, 60 N, and 80 N for intact tendons, after SR repair, after DR repair, and after TOE repair. RESULTS The tendon strain of the SR group differed significantly in both regions from that of the intact tendons and the TOE group at 40 N (P≤ .043) and from the intact tendons, the DR group, and the TOE group at 60 N and 80 N (P≤ .048). SR repairs showed more tendon elongation at the footprint and less elongation medial to the footprint. DR and TOE repairs did not provide significant differences in tendon strain when compared with the intact tendons. However, the increase in tendon strain medial to the footprint from 40 N to 80 N was significantly more pronounced in the DR and TOE group (P≤ .029). CONCLUSION While DR and TOE repair techniques more closely reproduced the strains of the supraspinatus tendon than did SR repair in a cadaveric model, they showed a significantly increased tendon strain at the musculotendinous junction with higher loads in comparison with the intact tendon. CLINICAL RELEVANCE DR and TOE rotator cuff reconstructions lead to a more anatomic tendon repair. However, their use has to be carefully evaluated whenever tendon quality is diminished, as they lead to a more drastic increase in tendon strain medial to the footprint, putting these repairs at risk of medial cuff failure.
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Affiliation(s)
- Michael Hackl
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Julia Nacov
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Sandra Kammerlohr
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Manfred Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Jülich, Germany
| | | | - Tim Leschinger
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Lars P Müller
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Kilian Wegmann
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
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Şahin K, Şentürk F, Ersin M, Arzu U, Chodza M, Erşen A. Repair Integrity and Functional Outcomes Between Knot-Tying and Knotless Suture-Bridge Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial. Orthop J Sports Med 2021; 9:23259671211002482. [PMID: 33954223 PMCID: PMC8058806 DOI: 10.1177/23259671211002482] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Knot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates. Purpose: To compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial). Results: Overall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03). Conclusion: Both techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique. Registration: NCT03982108 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Koray Şahin
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Şentürk
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Ersin
- Haseki Education Research Hospital, Istanbul, Turkey
| | - Ufuk Arzu
- Dr Yaşar Eryılmaz Doğubeyazıt State Hospital, Ağrı, Turkey
| | | | - Ali Erşen
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Matache BA, Hurley ET, Kanakamedala AC, Jazrawi LM, Virk M, Strauss EJ, Campbell KA. Knotted Versus Knotless Anchors for Labral Repair in the Shoulder: A Systematic Review. Arthroscopy 2021; 37:1314-1321. [PMID: 33307150 DOI: 10.1016/j.arthro.2020.11.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare biomechanical and clinical outcomes between knotless and knotted anchors in arthroscopic labral repair, specifically in (1) Bankart repair, (2) SLAP repair, (3) posterior labral repair, and (4) remplissage augmentation of Bankart repair. METHODS MEDLINE, EMBASE, and the Cochrane Library were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to find biomechanical and clinical studies comparing knotted and knotless anchors using the search term "knotless anchor." RESULTS Overall, 17 studies met inclusion criteria. There were 7 studies evaluating the biomechanical outcomes, of which 5 found mixed results between knotted and knotless anchors for arthroscopic Bankart repair, 1 demonstrated a difference for SLAP repair favoring knotless anchors, and 2 showed no significant difference for Remplissage in terms of ultimate load-to-failure. Four studies evaluated knotless labral anchors compared with knotted anchors in patients undergoing arthroscopic Bankart repair with no significant differences in outcomes reported between the 2 anchor types, except in one study that found an improved visual analog scale score and a lower recurrence and revision rate with knotted anchors. Five studies evaluated knotless anchors compared with knotted anchors in patients undergoing SLAP repair, and none of the included studies found any significant differences in the patient reported outcome measures or revision rates. Of the 5 studies comparing operative time, 4 found a reduced time with knotless anchors. CONCLUSIONS The clinical results show no significant differences in outcomes between knotless and knotted anchors for labral repair in the shoulder, including Bankart repair, SLAP repair, and posterior labral repair. However, there was conflicting evidence supporting knotless or knotted anchors in the biomechanical studies. However, operative times may be reduced with the use of knotless anchors. LEVEL OF EVIDENCE III, A Systematic Review of Level II and III studies.
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Affiliation(s)
- Bogdan A Matache
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A..
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Ajay C Kanakamedala
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Mandeep Virk
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
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Abstract
» Regardless of recent advances in rotator cuff repair techniques, the rate of unhealed or recurrent rotator cuff tears remains high, with most recurrent rotator cuff tears occurring within the first 6 months after surgery.
» Factors that can negatively affect tendon healing include older age, greater tear size, tendon retraction, and fatty infiltration. However, several clinical features that are often underestimated, including osteoporosis, diabetes, smoking, and hyperlipidemia, have proven to have an important influence on rotator cuff healing.
» Recent meta-analyses that evaluated studies with Level-I and Level-II evidence have shown an overall increase in retear rates after single-row repair compared with double-row repair. However, to our knowledge, there are no Level-I clinical studies comparing different double-row configurations and, to date, no double-row repair technique has proven to be superior to the others.
» The influence of postoperative rotator cuff healing on clinical outcomes is controversial. Although clinical differences may not be apparent in the short term, healed tendons have had better functional outcomes and greater strength in the midterm.
» In general, a period of immobilization for 2 to 4 weeks, depending on tear size, is recommended. Graded supervised rehabilitation has proven to facilitate tendon healing without associated stiffness compared with early unprotected range of motion.
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Affiliation(s)
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois
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16
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Maia Dias C, Gonçalves SB, Completo A, Tognini M, da Silva MR, Mineiro J, Curate F, Ferreira F, Folgado J. Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model. J Exp Orthop 2021; 8:9. [PMID: 33537914 PMCID: PMC7859138 DOI: 10.1186/s40634-020-00321-y] [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: 11/16/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Knotless repairs have demonstrated encouraging performance regarding retear rate reduction, but literature aiming at identifying the specific variables responsible for these results is scarce and conflictive. The purpose of this paper was to evaluate the effect of the material (tape or wire suture) and medial tendon passage (single or double passage) on the contact force, pressure and area at the tendon bone interface in order to identify the key factors responsible for this repairs´ success. METHODS A specific knotless transosseous equivalent cuff repair was simulated using 2 tape or suture wire loaded medial anchors and 2 lateral anchors, with controlled lateral suture limb tension. The repair was performed in a previously validated sawbones® mechanical model. Testing analyzed force, pressure and area in a predetermined and constant size "repair box" using a Tekscan® sensor, as well as peak force and pressure, force applied by specific sutures and force variation along the repair box. RESULTS Tapes generate lower contact force and pressure and double medial passage at the medial tendon is associated with higher contact area. Suture wires generate higher peak force and pressure on the repair and higher mean force in their tendon path and at the medial bearing row. Force values decrease from medial to lateral and from posterior to anterior independently of the material or medial passage. CONCLUSION Contrary to most biomechanical literature, suture tape use lowers the pressure and force applied at the tendon bone junction, while higher number of suture passage points medially increases the area of contact. These findings may explain the superior clinical results obtained with the use uf suture tapes because its smaller compressive effect over the tendon may create a better perfusion environment healing while maintaining adequate biomechanical stability.
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Affiliation(s)
- Carlos Maia Dias
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
| | - Sérgio B Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - António Completo
- TEMA, Department of Mechanical Engineering, University of Aveiro (UA), Aveiro, Portugal
| | | | | | | | - Francisco Curate
- Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Frederico Ferreira
- Department of Bioengineering, and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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17
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Harada N, Gotoh M, Ishitani E, Kakuma T, Yano Y, Tatara D, Kawakami J, Imai T, Karasuyama M, Kudoh Y, Shiba N. Combination of risk factors affecting retear after arthroscopic rotator cuff repair: a decision tree analysis. J Shoulder Elbow Surg 2021; 30:9-15. [PMID: 32838953 DOI: 10.1016/j.jse.2020.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several risk factors for postoperative retear after arthroscopic rotator cuff repair (ARCR) have been cited in a large number of reports; various combinations of these seem to be present in the clinical setting. PURPOSE Using a combination model for decision tree analysis, we aimed to investigate the combination of risk factors that affect postoperative retear the most. METHODS A total of 286 patients who underwent magnetic resonance (MR) imaging at 6 months after surgery were included in this study. Based on the structural integrity of the MR images taken 6 months after surgery, the patients were divided into a healed group (intact tendon, 254 patients) and a retear group (ruptured tendon, 32 patients). Using univariate and decision tree analyses, we selected a combination of 11 risk factors that drastically affected postoperative retear. RESULTS The mean age was 64.9 ± 7.1 years, and the mean symptom duration was 9.7 ± 11.6 months. The tear was small/medium in 177 patients and large/massive in 109 patients. The technique for surgical repair was single row in 42 patients, double row in 60 patients, and suture bridging in 216 patients. On univariate analysis, both groups had significant differences in the anteroposterior (AP) tear size (P < .0001), mediolateral tear size (P < .0001), hyperlipidemia (P = .0178), global fatty degeneration index (P < .0001), supraspinatus fatty degeneration stage (P < .0001), and critical shoulder angle (CSA) (P = .0015). All of these 5 risk factors, except for mediolateral tear size, were selected as candidates for the decision tree analysis. Eight combination patterns were determined to have prediction probabilities that ranged from 4.3% to 86.1%. In particular, the combination of an AP tear size of ≥40 mm, hyperlipidemia, and a CSA of ≥37° affected retear after ARCR the most. CONCLUSIONS Decision tree analysis lead to the extraction of different retear factor combinations, which were divided into 5 retear groups. The worst combination was of AP tear size ≥40 mm, hyperlipidemia, and CSA ≥37°, and the prediction probability of this combination was 86.2%. Therefore, our data may offer a new index for the prediction of retear after ARCR.
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Affiliation(s)
- Nobuya Harada
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan; Kurume University School of Medicine Graduate School, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan.
| | - Eiichi Ishitani
- Department of Orthopedic Surgery, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatistics, Kurume University School of Medicine, Fukuoka, Japan
| | - Yuka Yano
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Daisuke Tatara
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Junichi Kawakami
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Takaki Imai
- Department of Rehabilitation, Keishinkai Hopital, Saga, Japan
| | - Masaki Karasuyama
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Yu Kudoh
- Kurume University School of Medicine Graduate School, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan
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Kunze KN, Rossi LA, Beletsky A, Chahla J. Does the Use of Knotted Versus Knotless Transosseous Equivalent Rotator Cuff Repair Technique Influence the Incidence of Retears? A Systematic Review. Arthroscopy 2020; 36:1738-1746. [PMID: 32057983 DOI: 10.1016/j.arthro.2020.01.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/17/2019] [Accepted: 01/31/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare knotted and knotless transosseous equivalent (TOE) rotator cuff repair (RCR) techniques and evaluate their imaging-diagnosed retear rates. METHODS The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008 to 2019), EMBASE (2008 to 2019), and Medline (2008 to 2019) were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, with the following search terms: rotator cuff repair AND (knotless OR knotted) AND transosseous; rotator cuff repair AND (knotless OR knotted or transosseous); rotator cuff repair AND ("suture bridge" OR "suture bridging"). Data pertaining to demographic characteristics, surgical techniques, retears, and patient-reported outcomes were extracted from each study. Rates and locations of retear were reported using ranges, and risks of bias and heterogeneity for each study were assessed. RESULTS A total of 7 studies (552 shoulders) were included. Patients had a weighted mean (± standard deviation) age of 60.5 ± 2.4 years with 27.8 ± 7.9-month follow-up. The incidence of retears ranged from 5.1% to 33.3% in patients treated with knotless TOE RCR, and the incidence for patients treated with knotted TOE RCR ranged from 7.5% to 25%. The incidence of type I retears ranged from 42.9% to 100% for patients treated with knotless TOE RCR and 20% to 100% for patients treated with knotted TOE RCR. The incidence of type II retears ranged from 0% to 57.1% in patients treated with knotless TOE RCR and 0% to 100% in patients treated with knotted TOE RCR. CONCLUSIONS The incidence and location of retears after knotless and knotted TOE RCR appear to be similar.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Luciano A Rossi
- Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alexander Beletsky
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Kim J, Ryu Y, Kim SH. Surgical Options for Failed Rotator Cuff Repair, except Arthroplasty: Review of Current Methods. Clin Shoulder Elb 2020; 23:48-58. [PMID: 33330234 PMCID: PMC7714325 DOI: 10.5397/cise.2019.00416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 12/30/2022] Open
Abstract
Although the prevalence of rotator cuff tears is dependent on the size, 11% to 94% of patients experience retear or healing failure after rotator cuff repair. Treatment of patients with failed rotator cuff repair ranges widely, from conservative treatment to arthroplasty. This review article attempts to summarize the most recent and relevant surgical options for failed rotator cuff repair patients, and the outcomes of each treatment, except arthroplasty.
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Affiliation(s)
- Jangwoo Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yunki Ryu
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Khoschnau S, Milosavjevic J, Sahlstedt B, Rylance R, Rahme H, Kadum B. High prevalence of rotator cuff tears in a population who never sought for shoulder problems: a clinical, ultrasonographic and radiographic screening study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:457-463. [DOI: 10.1007/s00590-019-02593-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
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A Prospective Randomized Trial Comparing Suture Bridge and Medially Based Single-Row Rotator Cuff Repair in Medium-Sized Supraspinatus Tears. Arthroscopy 2019; 35:2803-2813. [PMID: 31604496 DOI: 10.1016/j.arthro.2019.05.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/12/2019] [Accepted: 05/12/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical and imaging outcomes between the suture bridge technique (SB) and the medially based single-row technique (medSR) in patients with 1- to 3-cm tear sizes. METHODS All patients were evaluated preoperatively and postoperatively (at 12 and 24 months) using the modified University of California, Los Angeles scoring system; active range of motion (flexion and external rotation); and a visual analog scale for pain. Healing status was examined by postoperative magnetic resonance imaging. RESULTS Clinical and imaging evaluations were completed by 92 patients at 1-year follow-up and by 74 patients at 2 years. No significant differences were found between the 2 groups across all measures at final follow-up: The University of California, Los Angeles scores were 33.4 points in SB patients and 33.0 points in medSR patients (P = .58); the visual analog scale scores were 6 mm and 7 mm, respectively (P = .38); the active flexion angles were 161° and 159°, respectively (P = .34); and the external rotation angles were 49° and 52°, respectively (P = .37). Retears were observed in 6.5% of SB patients and 2.1% of medSR patients (P = .31). Medial cuff failure was observed only in SB patients (4.3%, 2 cases), whereas incomplete healing (deep-layer retraction pattern) was observed only in medSR patients (8.7%, 4 cases). Neo-tendon regeneration in the medSR group was observed in 93% of patients. CONCLUSIONS This study did not show any significant differences in the clinical outcomes and cuff integrity between the 2 treatment groups at final follow-up; however, medial cuff failure was observed only in the SB group, and incomplete healing was more frequent in the medSR group. One should consider the risk of medial cuff failure and incomplete healing of the repaired cuff before choosing the repair technique for medium-sized supraspinatus tears. LEVEL OF EVIDENCE Level I, therapeutic, prospective, randomized trial.
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Senju T, Okada T, Takeuchi N, Kozono N, Nakanishi Y, Higaki H, Shimoto T, Nakashima Y. Biomechanical analysis of four different medial row configurations of suture bridge rotator cuff repair. Clin Biomech (Bristol, Avon) 2019; 69:191-196. [PMID: 31374486 DOI: 10.1016/j.clinbiomech.2019.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/22/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff tendon rupture after suture bridge repair occasionally occurs at the medial row, with remnant tendon tissue remaining at the footprint. While concentrated medial row stress is suspected to be involved in such tears, the optimal suture bridge technique remains controversial. METHODS This study aimed to investigate the construct strength provided by suture bridge techniques having four different medial row configurations using artificial materials (n = 10 per group): Group 1, four-hole (two stitches per hole) knotless suture bridge; Group 2, eight-hole (one stitch per hole) parallel knotless suture bridge; Group 3, eight-hole non-parallel knotless suture bridge; and Group 4, eight-hole knot-tying suture bridge. Each construct underwent cyclic loading from 5 to 30 N for 20 cycles, followed by tensile testing to failure. The ultimate failure load and linear stiffness were measured. FINDINGS Group 2 had the highest ultimate failure load (mean 160.54 N, SD 6.40) [Group 4 (mean 150.21 N, SD 9.76, p = 0.0138), Group 3 (mean 138.80 N, SD 7.18, p < 0.0001), and Group 1 (mean 129.35 N, SD 4.25, p < 0.0001)]. The linear stiffness of Group 2 (mean 9.32 N/mm, SD 0.25) and Group 4 (mean 9.72 N/mm, SD 0.40) was significantly higher (p = 0.0032) than that of Group 1 (mean 8.44 N/mm, SD 0.29) and Group 3 (mean 8.61 N/mm, SD 0.31). INTERPRETATION In conclusion, increasing the number of suture-passed holes, arranging the holes in parallel, and a knotless technique improved the failure load following suture bridge repair.
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Affiliation(s)
- Takahiro Senju
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
| | - Takamitsu Okada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan.
| | - Naohide Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
| | - Naoya Kozono
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
| | - Yoshitaka Nakanishi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1, Matsukadai, Higashi-ku, Fukuoka City, Fukuoka 813-8503, Japan
| | - Takeshi Shimoto
- Department of Information and System Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, 3-30-1, Higashi-ku, Fukuoka City, Fukuoka 811-0295, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
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23
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Rossi LA, Rodeo SA, Chahla J, Ranalletta M. Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes. Orthop J Sports Med 2019; 7:2325967119868674. [PMID: 31565664 PMCID: PMC6755640 DOI: 10.1177/2325967119868674] [Citation(s) in RCA: 24] [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] [Indexed: 12/14/2022] Open
Abstract
There is substantial evidence indicating that double-row (DR) repair restores
more of the anatomic rotator cuff footprint and is biomechanically superior to
single-row (SR) repair. Transosseous-equivalent (TOE) techniques have shown
biomechanical advantages when compared with traditional DR, including increased
contact at the rotator cuff footprint, higher pressure at the tendon-bone
interface, and increased failure strength. Several meta-analyses of evidence
level 1 and 2 studies have shown a lower rate of failed/incomplete healing when
DR repair was compared with SR repair types. There is some limited evidence that
TOE techniques improve healing rates in large and massive tears as compared with
SR and DR. Overall, most level 1 and 2 studies have failed to prove a
significant difference between SR and DR repairs in terms of clinical outcomes.
However, most studies include only short-term follow-up, minimizing the impact
that the higher rate of retears/failed healing seen with SR repairs can have in
the long term. There are no high-quality clinical studies comparing different DR
configurations, and there are currently not enough clinical data to determine
the functional advantages of various DR technique modifications over one
another. Although numerous biomechanical and clinical studies comparing
different rotator cuff repair techniques have been published in the past decade,
none has achieved universal acceptance. It is essential for the orthopaedic
surgeon to know in detail the available literature to be able to apply the most
appropriate and cost-effective technique in terms of healing and functional
outcomes. This review provides a critical analysis of the comparative
biomechanical and clinical studies among SR, DR, and TOE techniques reported in
the literature in the past decade.
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Affiliation(s)
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
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24
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Xu B, Chen L, Zou J, Gu Y, Hao L, Peng K. The Clinical Effect of Arthroscopic Rotator Cuff Repair techniques: A Network Meta-Analysis and Systematic Review. Sci Rep 2019; 9:4143. [PMID: 30858460 PMCID: PMC6411857 DOI: 10.1038/s41598-019-40641-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/20/2019] [Indexed: 12/18/2022] Open
Abstract
Rotator cuff tears are common and are associated with shoulder pain, disability, and dysfunction. Previous studies that have reported different arthroscopic techniques are controversial. A network meta-analysis with indirect and direct evidence was performed to compare the effectiveness of arthroscopic techniques for the treatment of rotator cuff tears. PUBMED, the Cochrane Register of Controlled Trials, EMBASE and Scopus were searched based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and related studies that evaluated arthroscopic techniques for the treatment of rotator cuff tears were identified in May 2018. The primary outcome measure was the retear rate. The secondary outcome measures included the constant score and the range of motion (forward flexion and external rotation). Twenty-one trials comprising 1815 shoulders were included in the study. This study indicated that single-row (SR) repair resulted in a higher retear rate than suture bridge (SB) and double-row (DR) repairs. Moreover, the SR and DR repairs resulted in higher incidences of retear than SB repair. The ranking of the treatments based on the constant score and external rotation was SB repair, SR repair and DR repair, whereas the treatment ranking according to forward flexion was SB repair, DR repair and SR repair. In summary, this network meta-analysis provides evidence that SB repairs might be the best choice to improve the postoperative recovery of function and decrease the retear rate.
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Affiliation(s)
- Binwu Xu
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Long Chen
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jun Zou
- Department of Orthopedics, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Yurong Gu
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Liang Hao
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China
| | - Kun Peng
- Department of Orthopedics, the second affiliated hospital of Nanchang university, Nanchang, Jiangxi, China.
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