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Savarese E, Aicale R, Torsiello E, Bernardini G, Maffulli N. Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved. Knee Surg Sports Traumatol Arthrosc 2024; 32:1843-1853. [PMID: 38651602 DOI: 10.1002/ksa.12184] [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: 10/29/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Management of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1-year follow-up, considering different type of tears, demographic data and number of torn tendons. METHODS Patients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3-6 months and 1-year follow-up. RESULTS A total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow-up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow-up (p < 0.05). CONCLUSIONS The use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidity and is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Eugenio Savarese
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Rocco Aicale
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Ernesto Torsiello
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giulio Bernardini
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Nicola Maffulli
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, UK
- School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Keele University, Stoke-on-Trent, UK
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Roma, Italy
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Kim HG, Kim SC, Park JH, Kim JS, Kim DY, Lee SM, Yoo JC. Atelocollagen Injection During Arthroscopic Rotator Cuff Repair for Small- to Medium-Sized Subacute or Chronic Rotator Cuff Tears Enhances Radiographic Tendon Integrity: A Propensity Score-Matched Comparative Study. Arthroscopy 2024:S0749-8063(24)00233-0. [PMID: 38513879 DOI: 10.1016/j.arthro.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To evaluate the clinical and structural outcomes of using injectable atelocollagen during arthroscopic rotator cuff repair (ARCR) for small- to medium-sized rotator cuff tears. METHODS This retrospective study reviewed patients with small- to medium-sized full-thickness tears who underwent ARCR from 2016 to 2022 with a minimum 1-year follow-up. Propensity score (PS) matching was used to reduce bias. Tendon integrity was evaluated using magnetic resonance imaging (MRI) at postoperative 6 months. Clinical and structural outcomes were compared between the 2 groups. RESULTS After PS matching, this study included 181 pairs of patients comparing ARCR with atelocollagen injection and without atelocollagen injection. Range of motion, muscle strength, and functional outcomes were significantly improved in both the atelocollagen group and the control group. Forward elevation and external rotation were significantly worse in the atelocollagen group compared with the control group at 2, 6, and 12 months postoperatively and at the final follow-up. In total, 125 patients (69.1%) in the atelocollagen group and 130 patients (71.8%) in the control group exceeded the minimal clinically important difference in the American Shoulder and Elbow Surgeons score without a significant difference between the 2 groups (P = .509). The mean value of Sugaya grade on postoperative MRI evaluation was 2.03 ± 0.81 for the atelocollagen group and 2.24 ± 0.97 for the control group, with a significant difference between the 2 groups (P = .027). Tendon healing failure was observed in 12 patients (6.6%) in the atelocollagen group and 19 patients (10.5%) in the control group, with no statistical difference between the 2 groups (P = .189). CONCLUSIONS Atelocollagen injection during ARCR for small- to medium-sized subacute or chronic rotator cuff tears did not show a benefit in clinical outcomes. However, postoperative MRI showed significantly lower Sugaya grade compared with the control group, with no significant difference in retear rate. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Hyun Gon Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Su Cheol Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Soo Kim
- Department of Orthopedic Surgery, Chung-ang University College of Medicine, Chung-ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Dae Yeung Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Kokubu T, Mifune Y, Inui A. Clinical outcomes of medialized single-row repair with fascia lata graft augmentation for large and massive rotator cuff tears. J Shoulder Elbow Surg 2024; 33:e153-e161. [PMID: 37619927 DOI: 10.1016/j.jse.2023.07.020] [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: 11/26/2022] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND A high postoperative retear rate after arthroscopic rotator cuff repair (ARCR) of large and massive tears remains a problem. This study evaluated rotator cuff integrity after ARCR with fascia lata graft augmentation for large and massive rotator cuff tears and compared clinical outcomes between patients with intact repairs and retears. METHODS Forty-five patients with rotator cuff tears who could not undergo primary repair due to tendon retraction underwent arthroscopic medialized single-row repair with fascia lata graft augmentation. The patients' minimum follow-up was 2 (2-9) years. Supraspinatus cuff integrity was evaluated postoperatively by magnetic resonance imaging. We compared the clinical outcomes of patients with intact repairs vs. retears based on the University of California-Los Angeles (UCLA), Constant, and Japanese Orthopaedic Association (JOA) scores. We also evaluated their range of motion (ROM) and muscle strength. RESULTS Retears were observed in 11 of 45 patients. UCLA, Constant, and JOA scores significantly improved postoperatively compared to preoperatively in the intact repair (all P < .001) and retear (all P < .036) groups. The intact repair group had significantly higher Constant (75.6 [mean] ± 9.9 [SD] vs. 69.8 ± 7.9; P = .026) and JOA (94.4 ± 6.9 vs. 89.8 ± 5.9; P = .041) scores than the retear group. Forward elevation, abduction, and the strengths of abduction and external rotation significantly improved in the intact repair group (all P < .003) but not in the retear group (all P > .05). The intact repair group had significantly higher postoperative forward flexion (165° ± 15° vs. 154° ± 23°; P = .036), abduction (164° ± 17° vs. 151° ± 26°; P = .029), and abduction strength (3.5 ± 2.2 kg vs. 2.3 ± 1.2 kg; P = .017) than the retear group. In the intact repair group (n = 34), Sugaya type I:II ratio differed significantly between postoperative 3 months (2:32) and 24 months (24:10) (P < .001). Repaired tendon thickness did not decrease significantly between 3 months (7.1 mm) and 2 years (6.9 mm) (P = .543). CONCLUSIONS ARCR with fascia lata graft augmentation of large and massive rotator cuff tears showed a 24.4% retear rate but significantly improved the clinical scores, ROMs, and muscle strength with excellent cuff integrity in the intact repair group. However, the differences in the Constant and UCLA scores between the intact repair and retear groups were under the minimal clinically important difference, and their clinical significance is uncertain. Our results confirm that ARCR with fascia lata graft augmentation improves patients' postoperative outcomes if the repair site is maintained postoperatively.
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Affiliation(s)
- Takeshi Kokubu
- Department of Orthopaedic Surgery, Kobe Medical Center, Kobe, Japan.
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Shin KH, Jang IT, Han SB. Outcomes of Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon in Large to Massive Rotator Cuff Tears: A Meta-Analysis and Systematic Review. J Clin Med 2024; 13:1052. [PMID: 38398365 PMCID: PMC10889218 DOI: 10.3390/jcm13041052] [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: 01/04/2024] [Revised: 01/26/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Addressing large to massive rotator cuff tears (LMRCTs) poses complex challenges. This systematic review investigated outcomes of superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) compared to conventional rotator cuff repair (RCR) for LMRCTs. (2) Methods: A systematic search across the MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus databases until 1 October 2023 identified studies that directly compared SCR with LHBT with conventional RCR in patients with LMRCTs and included a minimum of a 12-month follow-up period. The assessed outcome measures encompassed retear rates, functional outcomes, range of motion (ROM), and acromiohumeral interval (AHI). Risk of bias assessment was conducted via the Robins-I tool. (3) Results: In six studies with 456 cases (210 SCR using LHBT and 246 using RCR), SCR with LHBT significantly reduced retear rates (OR = 0.21; 95% CI, 0.12-0.36; p < 0.01; I2 = 0%). Furthermore, SCR with LHBT showed significant improvement in range of forward flexion (SMD 0.32, 95% CI: 0.09-0.55, p < 0.01, I2 = 39%) and AHI (SMD 0.61, 95% CI: 0.31-0.92, p < 0.01, I2 = 0%) postoperatively. (4) Conclusion: SCR with LHBT is a safe and effective treatment for LMRCTs, reducing retear rates, maintaining greater postoperative AHI, and improving ROM compared to conventional RCR. Additional high-quality interventional studies are needed to confirm these results.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon-si 14555, Republic of Korea
| | - Il-Tae Jang
- Nanoori Medical Research Institute, Seoul 06048, Republic of Korea;
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea;
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Kim SH, Shin SJ. No Difference In Clinical Outcomes Following Repair of Large Retracted Anterior Rotator Cuff Tears Using Patch Augmentation With Human Dermal Allograft Versus Anterior Cable Reconstruction With Biceps Tendon Autograft. Arthroscopy 2024; 40:294-302. [PMID: 37716630 DOI: 10.1016/j.arthro.2023.08.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To compare the clinical outcomes and tendon integrity after rotator cuff repair combined with anterior cable reconstruction (ACR) using the proximal biceps tendon and patch augmentation (PA) using a human dermal allograft (HDA) in a large retracted anterior rotator cuff tear. METHODS Patients who underwent arthroscopic rotator cuff repair with 2 different augmentation procedures between January 2017 and December 2020 were enrolled. The inclusion criteria were patients who were treated by arthroscopic rotator cuff repair with ACR using the proximal biceps tendon (ACR group) or patch augmentation using a an HDA (PA group) and follow-up for at least 2 years. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) score, Constant score, and the number of patients who achieved minimal clinically important differences (MCID). Magnetic resonance imaging was performed to evaluate tendon integrity after surgery. RESULTS A total of 92 patients were enrolled (ACR group = 55 patients and PA group = 37 patients). The mean ASES and Constant scores significantly improved in the ACR group (68.8 ± 15.3 and 58.4 ± 16.9 before surgery vs 91.4 ± 6.3 and 87.8 ± 6.0 after surgery, P < .001) and in the PA group (63.7 ± 16.7 and 57.9 ± 15.4 before surgery vs 93.1 ± 6.3 and 88.3 ± 6.2 after surgery, P < .001). Overall, 78 patients (84.8%) achieved the MCID with 81.8% in the ACR group and 89.2% in the PA group, with no significant differences between the 2 groups (P = .638). Ten patients (18.2%) had retear in the ACR group, and three patients (8.1%) had retear in the PA group (P = .174). CONCLUSIONS In large retracted anterior rotator cuff tears, both augmentation techniques using biceps tendon autograft and HDA provided satisfactory clinical outcomes that achieved the MCID in 84.8%, range of motion restoration, and lower retear rates with no significant differences between the two groups. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Seong Hun Kim
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Gyeonggi, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
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Park HS, Ham KH, Kim YS. The Arthroscopic Biceps Rerouting Technique Shows Better Early Clinical Outcomes within 1 Year Than Partial Repair in Large to Massive Rotator Cuff Tears. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:240. [PMID: 38399528 PMCID: PMC10890027 DOI: 10.3390/medicina60020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The arthroscopic biceps rerouting (BR) technique was introduced as a novel technique for large-to-massive rotator cuff tears (LMRCTs). This method can restore shoulder stability, and its biomechanical effect was verified in a cadaver experiment. Recent reports have shown favorable clinical outcomes. This study aimed to compare the clinical outcomes of partial repair with those of the BR technique in LMRCTs. Materials and Methods: We included 72 patients who had undergone LMRCTs. Arthroscopic partial repair was performed in 31 patients (group I), while repair with the BR technique was performed in 41 patients (group II). Functional and imaging outcomes were evaluated and compared using a visual analog scale for pain, range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Korean Shoulder Score (KSS) before the surgery and at 3, 6, and 12 months after the surgery and at the last follow-up. Tendon integrity was investigated using magnetic resonance in all the patients at 12 months postoperative. Results: The mean follow-up period was 22.11 ± 10.47 months (range, 12-53 months). Forward flexion (p = 0.02) and external rotation at the side (p = 0.04) were significantly higher in group II than in group I on postoperative day (POD) 12 months. For internal rotation, group II showed significant improvement compared to group I on POD 3 months (p = 0.002) and at 6 months postoperative (p = 0.01). On POD 12 months, the ASES (p = 0.047) and KSS (p = 0.048) were better in group II. Significant improvements in pain and clinical scores were observed in both groups at the last follow-up. However, the two groups had no significant differences in pain, clinical scores, or ROM at the last follow-up. Retear of the repaired tendon was observed in nine patients in group I (29.03%) and eight in group II (19.51%, p = 0.35). Conclusions: Partial repair and repair using the BR technique effectively improved clinical and radiologic outcomes. The BR technique revealed early recovery of ROM and better clinical results than partial repair at one year postoperative. This could be a useful method in treating LMRCTs.
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Affiliation(s)
- Hyung-Seok Park
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea; (H.-S.P.); (K.-H.H.)
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| | - Kwon-Hyoung Ham
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea; (H.-S.P.); (K.-H.H.)
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 14662, Republic of Korea
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Shin KH, Kim JU, Jang IT, Han SB. Effect of Bone Marrow Stimulation on Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671231224482. [PMID: 38282788 PMCID: PMC10812110 DOI: 10.1177/23259671231224482] [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: 06/29/2023] [Accepted: 08/16/2023] [Indexed: 01/30/2024] Open
Abstract
Background Arthroscopic rotator cuff repair (RCR) is a common orthopaedic procedure, but it has a high rate of retears that can negatively affect the functional outcomes. Bone marrow stimulation (BMS) has been suggested as an additional treatment to improve the outcomes of RCR. Purpose To compare the effectiveness of the BMS procedure during RCR with conventional RCR. Study Design Systematic review; Level of evidence, 2. Methods A systematic literature search was conducted in MEDLINE/PubMed, Embase, Cochrane Library, and Scopus, on March 1, 2023, for studies comparing postoperative retear rates and functional outcomes between patients who underwent primary arthroscopic RCR with and without the BMS procedure. Only level 1 and 2 randomized controlled trials with a minimum 12-month follow-up were included. The primary outcomes were retear rates and functional outcomes as measured by the Constant; American Shoulder and Elbow Surgeons (ASES); and University of California, Los Angeles (UCLA) scores and by postoperative range of motion. Subgroup analyses were performed based on repair technique (single-row repair vs double-row or suture-bridge repair). The standardized mean difference (SMD) and odds ratio (OR) were utilized to synthesize continuous and dichotomous outcomes, respectively. Homogeneity was evaluated using the chi-square test and I2 statistic. Results The literature search yielded 661 articles, of which 6 studies (522 patients; 261 with BMS, 261 without BMS) met the eligibility criteria. The combined analysis showed no significant decrease in retear rates with the utilization of the BMS procedure during RCR (OR, 0.60; 95% CI, 0.35 to 1.03; P = .07; I2 = 24%). There was no significant intergroup difference in functional outcomes (Constant score: SMD, 0.13; 95% CI, -0.04 to 0.31; P = .13; I2 = 0%; ASES score: SMD, 0.04; 95% CI, -0.20 to 0.28; P = .73; I2 = 0%; UCLA score: SMD, -0.13; 95% CI, -0.50 to 0.23; P = .47; I2 = 0%). Subgroup analyses revealed no significant differences in postoperative retear risk or total Constant score according to the repair technique. Conclusion Based on the available evidence, this systematic review did not find a significant benefit of the BMS procedure at the footprint during arthroscopic RCR compared with conventional RCR in terms of retear rates and functional outcomes at short-term follow-up.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopedic Surgery, Incheon Nanoori Hospital, Incheon, South Korea
| | - Jin-Uk Kim
- Department of Orthopedic Surgery, Incheon Nanoori Hospital, Incheon, South Korea
| | - Il-Tae Jang
- Nanoori Medical Research Institute, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Kim JS, Kim SC, Park JH, Kim HG, Kim BT, Kim DY, Yoo JC. Arthroscopic Incomplete Rotator Cuff Repair With Patch Augmentation Using Acellular Dermal Matrix Allograft. Arthrosc Tech 2023; 12:e2203-e2209. [PMID: 38196869 PMCID: PMC10772997 DOI: 10.1016/j.eats.2023.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/29/2023] [Indexed: 01/11/2024] Open
Abstract
Arthroscopic rotator cuff repair has been shown promising clinical outcomes. However, large to massive rotator cuff tears are difficult to completely repair with appropriate tension because of their size or poor tissue quality. An incomplete repair using the "hybrid technique" is one of way to solve this problem by maximizing the contact area between the tendon and the footprint of greater tuberosity. Additionally, the acellular dermal matrix patch augmentation has emerged as an adjuvant technique to enhance the biomechanical properties to promote healing of the repaired construct. This Technical Note describes arthroscopic incomplete rotator cuff repair using the "hybrid technique" with acellular dermal matrix patch augmentation.
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Affiliation(s)
- Jae Soo Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Su Cheol Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Gon Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Taek Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Yeung Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Patel D, Roy G, Endres N, Ziino C. Preoperative vitamin D supplementation is a cost-effective intervention in arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2023; 32:2473-2482. [PMID: 37308074 DOI: 10.1016/j.jse.2023.05.007] [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: 12/02/2022] [Revised: 04/16/2023] [Accepted: 05/06/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study investigates the potential role of preoperative 25(OH)D supplementation as a cost-effective strategy to decrease revision rotator cuff repair (RCR) rates and lower the total health care burden from patients undergoing primary arthroscopic RCR. Previous literature has emphasized the importance of vitamin D on bone health maintenance, soft tissue healing, and outcomes in RCR. Inadequate preoperative vitamin D levels may increase revision RCR rates following primary arthroscopic RCR. Although 25(OH)D deficiency is common in RCR patients, serum screening is not routinely performed. METHODS A cost-estimation model was developed to determine the cost-effectiveness of both preoperative selective and nonselective 25(OH)D supplementation in RCR patients in order to reduce revision RCR rates. Prevalence and surgical cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean and lower and upper bounds of 1-year cost savings were calculated for both the selective and nonselective supplementation scenarios. RESULTS Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost savings of $6,099,341 (range: -$2,993,000 to $15,191,683) per 250,000 primary arthroscopic RCR cases. Nonselective 25(OH)D supplementation of all arthroscopic RCR patients was calculated to result in a mean cost savings of $11,584,742 (range: $2,492,401-$20,677,085) per 250,000 primary arthroscopic RCR cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where the cost of revision RCR exceeds $14,824.69 and prevalence of 25(OH)D deficiency exceeds 6.67%. Additionally, nonselective supplementation is a cost-effective strategy in clinical scenarios where revision RCR cost is ≥$4216.06 and prevalence of 25(OH)D deficiency is ≥1.93%. CONCLUSIONS This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce revision RCR rates and lower the overall health care burden from arthroscopic RCR. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the lower cost of 25(OH)D supplementation compared to serum assays.
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Affiliation(s)
- Dhiraj Patel
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Gregory Roy
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Nathan Endres
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Chason Ziino
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA.
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Şahin K, Albayrak MO, Şentürk F, Ersin M, Erşen A. Gender and degree of tendon healing are independent predictive factors for clinical outcome in successfully healed rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2023; 31:4585-4593. [PMID: 37453965 DOI: 10.1007/s00167-023-07508-7] [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: 03/30/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Arthroscopic rotator cuff repair (aRCR) is a commonly performed procedure and has been reported to be a successful treatment. Successful healing has traditionally been considered to be associated with good outcome; however, knowledge on predictive factors affecting final outcome other than tendon healing is limited. This study aims to investigate predictive factors influencing clinical outcome following aRCR in patients with successfully healed tears. METHODS This retrospective case-control study was conducted in a single center with 135 patients who had successfully healed tendons based on Sugaya classification (grades I-III) on postoperative magnetic resonance imaging (MRI) scans following aRCR. Clinical outcome measures included Constant-Murley score (CMS), range of motion (ROM), pain score. Various preoperative, intraoperative factors and degree of postoperative tendon healing were assessed to identify independent predictive factors for final clinical outcome. RESULTS Mean age of patients was 55.9 ± 9.0 years and mean follow-up duration was 46.8 ± 14.9 months. There were 50 (37%) male and 85 (63.0%) female patients. At final follow-up, mean CMS was 85.7 ± 12.0. Considering mean postoperative CMS and the minimal clinically important difference (MCID) of 10 points for CMS, a cutoff level of 75 points for CMS was set (85-10 = 75) and study population was divided into two study groups (group I, poor outcome, CMS ≤ ;75, and group II, good outcome, CMS > 75). There were 24 (17.8%) patients in group I and 111 (82.2%) patients in group II. Univariate analysis revealed that gender, body mass index (BMI) and degree of tendon healing (Sugaya classification) differed significantly between two groups (p < 0.05). Multivariate logistic regression analysis which was conducted with these variables showed that female gender (odds ratio 3.65) and Sugaya grade III (odds ratio 8.19) were independent predictive factors which were significantly associated with poor outcome (p < 0.05). CONCLUSIONS This study showed that despite achieving a successful healing, considerable amount of patients (17.8%) have ended up with poor outcome. Female gender and degree of tendon healing were identified as independent predictive factors for poor outcome. These data would help surgeons during decision-making, risk assessment and patient counseling. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Koray Şahin
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
| | - Muhammed Oğuzhan Albayrak
- Department of Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fatih Şentürk
- Department of Orthopedics and Traumatology, Hendek State Hospital, Sakarya, Turkey
| | - Mehmet Ersin
- Department of Orthopedics and Traumatology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ali Erşen
- Department of Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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11
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Ardebol J, Ghayyad K, Hwang S, Pak T, Menendez ME, Denard PJ. Patient-reported outcome tools and baseline scores vary by country and region for arthroscopic repair of massive rotator cuff tears: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:312-317. [PMID: 37588489 PMCID: PMC10426575 DOI: 10.1016/j.xrrt.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Different patient-reported outcome (PRO) tools are used in patients with arthroscopic rotator cuff repair (ARCR) which complicates outcome comparisons. The purpose of this systematic review was to compare PRO usage and baseline scores across world regions and countries in patients with ARCR of massive rotator cuff tears (MRCT). Methods A systematic review was performed on ARCR for MRCT. The search was conducted from September to November of 2022 using the MEDLINE database for articles published in the last 15 years. Thirty-seven articles were included after initial screening and full-text review. In each article, PRO usage, baseline scores, and country of origin were collected. PRO usage was reported in percentages and baseline scores were normalized for each region to facilitate comparisons. Normalization was performed using the PRO means from each article. These averages were converted to fractions using the worst and best possible scores. These were combined into a single numerical value, expressed as a decimal from 0 to 1, using the total sample size for each tool per region. Values closer to 0 represent worse functional outcomes. Results Thirty-two percent (n = 12) of articles were from Asia, 43.2% (n = 16) from Europe, 5.4% (n = 2) from the Middle East, and 18.9% (n = 7) from North America. The most commonly reported PRO tools were American Shoulder and Elbow Surgeons (ASES) in 19 papers, Constant-Murley Score (CMS) in 26 papers, Visual Analog Scale for pain (VAS) in 19 papers, and University of California in Los Angeles (UCLA) in 11 papers. ASES was reported in 51% of articles with 63% being from Asia (n = 12) compared to 21% from North America (n = 4). CMS was reported in 70% of studies with 58% being from Europe. Upon normalization, the preoperative score ranged from 0.30 to 0.44. Europe (0.39), and North America (0.40) showed similar scores. The lowest and highest scores were seen in the Middle East (0.3) and Asia (0.44) respectively. Conclusion There is no standardized method to report outcomes in patients undergoing ARCR for MRCT. Great variation in usage exists in PROs which complicates data comparison between world regions. With normalization, baseline scores where similar among Asia, North America, and Europe, and lowest in the Middle East.
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Affiliation(s)
- Javier Ardebol
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Kassem Ghayyad
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Simon Hwang
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Theresa Pak
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
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12
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Thangarajah T, Tsuchiya S, Lukenchuk J, Lo IK. Arthroscopic superior capsular reconstruction with dermal allograft for primary and recurrent rotator cuff tears. JSES Int 2023; 7:574-580. [PMID: 37426916 PMCID: PMC10328778 DOI: 10.1016/j.jseint.2023.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background The aim of this study was to compare the clinical outcomes and retear rate of arthroscopic superior capsular reconstruction (SCR) with dermal allograft following structural failure of a previous rotator cuff repair, with a cohort of primary SCRs. Methods This was a retrospective comparative study with a study group comprising 22 patients who were followed up at a minimum of 24 (mean, 41; range, 27-65) months after SCR with dermal allograft performed for structural failure of a previous rotator cuff repair. The control group included 13 patients who previously underwent a primary SCR using dermal allograft and were followed up for 24 months. Clinical outcome measures comprised range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Rotator Cuff (WORC) Index. Radiological outcomes included the acromiohumeral interval and graft integrity on magnetic resonance imaging at one year. Logistic regression was used to determine whether SCR being undertaken as either a primary or revision procedure influenced functional outcomes or retear rate. Results The mean age at the time of surgery was 58 (range, 39-74) years for the study group and 60 (range, 48-70) years for the control group. Forward flexion improved from a mean of 117° (range, 7°-180°) preoperatively to 140° (range, 45°-170°) postoperatively (P = .11), and external rotation increased from a mean of 31° (range, 0°-70°) preoperatively to 36° (range, 0°-60°) postoperatively (P = .23). The American Shoulder and Elbow Surgeons score improved (P = 0) from a mean of 38 (range, 12-68) to 73 (range, 17-95), and the WORC Index improved (P = 0) from a mean of 29 (range, 7-58) to 59 (range, 30-97). Following SCR, there was no significant change in the acromiohumeral interval. The graft was intact in 42% of cases on magnetic resonance imaging and none of the retears underwent further surgery. Compared to revision SCR, primary SCR resulted in a significant improvement in forward flexion (P = .001), external rotation (P = 0), and WORC Index (P = .019). Logistic regression demonstrated that SCR performed as a revision procedure was associated with a higher retear rate (P = .006) and worse forward flexion (P = .009) and external rotation (P = .008). Conclusion SCR using human dermal allograft following structural failure of a previous rotator cuff repair can lead to an improvement in clinical outcomes but the results are inferior to primary procedures.
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Affiliation(s)
- Tanujan Thangarajah
- Corresponding author: Tanujan Thangarajah, MB ChB (hons), MSc, PhD, FRCS (Tr&Orth), MAcadMEd, Department of Trauma and Orthopaedic Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4 Canada.
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13
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Dey Hazra RO, Dey Hazra ME, Hanson JA, Rutledge JC, Doan KC, Ganokroj P, Horan MP, Dornan GJ, Millett PJ. Minimum 5-Year Clinical Outcomes of Arthroscopically Repaired Massive Rotator Cuff Tears: Effect of Age on Clinical Outcomes. Am J Sports Med 2023; 51:1979-1987. [PMID: 37259961 DOI: 10.1177/03635465231174430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Massive rotator cuff tears (MRCTs) can be challenging to treat, and the efficacy of repair of MRCTs in older patients has been debated. PURPOSE To report minimum 5-year outcomes after primary arthroscopic rotator cuff repair of MRCT and determine whether age affects outcomes. STUDY DESIGN Case series; Level of evidence 4. METHODS The study included consecutive patients with MRCTs who were treated with arthroscopic rotator cuff repair by a single surgeon between February 2006 and October 2016. MRCTs were defined as ≥2 affected tendons with tendon retraction to the glenoid rim and/or a minimum exposed greater tuberosity of ≥67. Patient-reported outcome (PRO) data collected preoperatively and at a minimum of 5 years included the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numeric Evaluation (SANE) score; the shortened version of the Disabilities of the Arm, Shoulder and Hand score (QuickDASH); the 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS); and patient satisfaction. Surgical failure was defined as subsequent revision rotator cuff surgery or conversion to reverse total shoulder arthroplasty. Regression analysis was performed to determine whether age had an effect on clinical outcomes. RESULTS A total of 53 shoulders in 51 patients (mean age, 59.7 years; range, 39.6-73.8 years; 34 male, 19 female) met inclusion criteria with a mean follow-up of 8.1 years (range, 5.0-12.1 years). Three shoulders (5.7%) failed at 2.4, 6.0, and 7.1 years. Minimum 5-year follow-up was obtained in 45 of the remaining 50 shoulders (90%). Mean PROs improved as follows: ASES from 58.8 to 96.9 (P < .001), SANE from 60.5 to 88.5 (P < .001), QuickDASH from 34.2 to 6.8 (P < .001), and SF-12 PCS from 41.1 to 52.2 (P < .001). Patient satisfaction was a median of 10 (on a scale of 1-10). Age was not associated with any PRO measures postoperatively (P > .05). CONCLUSION This study demonstrated significantly improved clinical scores, decreased pain, and increased return to activity for patients with MRCT at midterm follow-up (mean, 8.1 years; range, 5.0-12.1 years). In this patient cohort, no association was found between age and clinical outcomes.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Jared A Hanson
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Kent C Doan
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | - Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Hsieh YC, Kuo LT, Hsu WH, Tsai YH, Peng KT. Comparison of Outcomes after Arthroscopic Rotator Cuff Repair between Elderly and Younger Patient Groups: A Systematic Review and Meta-Analysis of Comparative Studies. Diagnostics (Basel) 2023; 13:1770. [PMID: 37238254 PMCID: PMC10217625 DOI: 10.3390/diagnostics13101770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to compare the outcomes of arthroscopic rotator cuff repair (ARCR) surgery between younger and older patients. We performed this systematic review and meta-analysis of cohort studies comparing outcomes between patients older than 65 to 70 years and a younger group following arthroscopic rotator cuff repair surgery. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and other sources for relevant studies up to 13 September 2022, and then assessed the quality of included studies using the Newcastle-Ottawa Scale (NOS). We used random-effects meta-analysis for data synthesis. The primary outcomes were pain and shoulder functions, while secondary outcomes included re-tear rate, shoulder range of motion (ROM), abduction muscle power, quality of life, and complications. Five non-randomized controlled trials, with 671 participants (197 older and 474 younger patients), were included. The quality of the studies was all fairly good, with NOS scores ≥ 7. The results showed no significant differences between the older and younger groups in terms of Constant score improvement, re-tear rate, or other outcomes such as pain level improvement, muscle power, and shoulder ROM. These findings suggest that ARCR surgery in older patients can achieve a non-inferior healing rate and shoulder function compared to younger patients.
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Affiliation(s)
- Yu-Chieh Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (Y.-C.H.); (Y.-H.T.); (K.-T.P.)
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yao-Hung Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (Y.-C.H.); (Y.-H.T.); (K.-T.P.)
| | - Kuo-Ti Peng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (Y.-C.H.); (Y.-H.T.); (K.-T.P.)
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Hu D, Li X, Li J, Tong P, Li Z, Lin G, Sun Y, Wang J. The preclinical and clinical progress of cell sheet engineering in regenerative medicine. Stem Cell Res Ther 2023; 14:112. [PMID: 37106373 PMCID: PMC10136407 DOI: 10.1186/s13287-023-03340-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Cell therapy is an accessible method for curing damaged organs or tissues. Yet, this approach is limited by the delivery efficiency of cell suspension injection. Over recent years, biological scaffolds have emerged as carriers of delivering therapeutic cells to the target sites. Although they can be regarded as revolutionary research output and promote the development of tissue engineering, the defect of biological scaffolds in repairing cell-dense tissues is apparent. Cell sheet engineering (CSE) is a novel technique that supports enzyme-free cell detachment in the shape of a sheet-like structure. Compared with the traditional method of enzymatic digestion, products harvested by this technique retain extracellular matrix (ECM) secreted by cells as well as cell-matrix and intercellular junctions established during in vitro culture. Herein, we discussed the current status and recent progress of CSE in basic research and clinical application by reviewing relevant articles that have been published, hoping to provide a reference for the development of CSE in the field of stem cells and regenerative medicine.
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Affiliation(s)
- Danping Hu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
- HANGZHOU CHEXMED TECHNOLOGY CO., LTD, Hangzhou, 310000, China
| | - Xinyu Li
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
| | - Jie Li
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
| | - Pei Tong
- Hospital of Hunan Guangxiu, Medical College of Hunan Normal University, Hunan Normal University, Changsha, 410008, China
| | - Zhe Li
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China
- National Engineering and Research Center of Human Stem Cells, Changsha, 410008, China
- Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, 410008, China
| | - Yi Sun
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, 410008, China.
- National Engineering and Research Center of Human Stem Cells, Changsha, 410008, China.
- Key Laboratory of Stem Cells and Reproductive Engineering, Ministry of Health, Changsha, 410008, China.
| | - Juan Wang
- Shanghai Biomass Pharmaceutical Product Evaluation Professional Public Service Platform, Center for Pharmacological Evaluation and Research, China State Institute of Pharmaceutical Industry, Shanghai, 200437, China.
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Zhong Y, Jin W, Gao H, Sun L, Wang P, Zhang J, Ong MTY, Sai Chuen Bruma F, Chen S, Chen J. A Knitted PET Patch Enhances the Maturation of Regenerated Tendons in Bridging Reconstruction of Massive Rotator Cuff Tears in a Rabbit Model. Am J Sports Med 2023; 51:901-911. [PMID: 36802867 DOI: 10.1177/03635465231152186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Although nondegradable synthetic grafts for bridging reconstruction of massive rotator cuff tears (MRCTs) have shown satisfactory clinical outcomes, their function and details on graft-tendon healing and enthesis regeneration have not been fully studied. HYPOTHESIS The knitted polyethylene terephthalate (PET) patch as a nondegradable synthetic graft could provide sustained mechanical support, facilitating enthesis and tendon regeneration in the treatment of MRCTs. STUDY DESIGN Controlled laboratory study. METHODS A knitted PET patch was fabricated for bridging reconstruction (PET group) in a New Zealand White rabbit model of MRCTs (negative control group), and an autologous Achilles tendon was used as a control (autograft group). The animals were sacrificed, and tissue samples were harvested for gross observation as well as histological and biomechanical analyses at 4, 8, and 12 weeks postoperatively. RESULTS Histological analysis showed no significant difference in the graft-bone interface score between the PET and autograft groups at 4, 8, and 12 weeks postoperatively. Interestingly, in the PET group, Sharpey-like fibers were observed at 8 weeks, while fibrocartilage formation and the ingrowth of chondrocytes were recognized at 12 weeks. Meanwhile, the tendon maturing score was significantly higher in the PET group than in the autograft group (19.7 ± 1.5 vs 15.3 ± 1.2, respectively; P = .008) at 12 weeks, with parallel-oriented collagen fibers around the knitted PET patch. Moreover, the ultimate failure load of the PET group was similar to that of a healthy rabbit tendon at 8 weeks (125.6 ± 13.6 vs 130.8 ± 28.6 N, respectively; P > .05) and no different from that of the autograft group at 4, 8, and 12 weeks. CONCLUSION The knitted PET patch could not only immediately reconstruct the mechanical support for the torn tendon postoperatively in the rabbit model of MRCTs but also enhanced maturation of the regenerated tendon by fibrocartilage formation and improved the organization of collagen fibers. Herein, the knitted PET patch could be a promising candidate graft adopted in bridging reconstruction of MRCTs. CLINICAL RELEVANCE A nondegradable knitted PET patch can safely bridge MRCTs with satisfactory mechanical strength and the promotion of tissue regeneration.
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Affiliation(s)
- Yuting Zhong
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhe Jin
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Han Gao
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyi Sun
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Peng Wang
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Zhang
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Michael Tim Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Fu Sai Chuen Bruma
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Shiyi Chen
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Institute of Sports Medicine of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Chen P, Yeh HW, Lu Y, Chen ACY, Chan YS, Lädermann A, Chiu JCH. Comparison of suture-bridge and independent double-row techniques for medium to massive posterosuperior cuff tears: a two-year retrospective study. BMC Musculoskelet Disord 2023; 24:154. [PMID: 36855071 PMCID: PMC9972682 DOI: 10.1186/s12891-023-06256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Transosseous-equivalent suture-bridge (TOE-SB) and independent double-row (IDR) repair techniques were developed to treat rotator cuff tears. The study was designed to prove that both TOE-SB and IDR techniques provided comparable clinical results and retear rate for medium to massive posterosuperior rotator cuff tears, while the surgical time and number of suture anchor used were less in the IDR group. STUDY DESIGN Level of evidence: level III, Retrospective comparative study. METHODS Patients with medium to massive posterosuperior rotator cuff tears receiving arthroscopic TOE-SB and IDR between November 2016 to October 2019 were retrospectively enrolled. All patients were confirmed to have grade ≤ 2 fatty infiltration in the muscles of the torn tendons. Revision, concomitant subscapularis tear, acromiohumeral distance < 7 mm, glenohumeral osteoarthritis, partial repair, incomplete repair, partial thickness, or irreparable posterosuperior cuff tear were excluded. Surgical time, number of suture anchor used for the surgery, pre-operative, and post-operative clinical scores such as Constant-Murley score, subjective shoulder value (SSV), and visual analog scale (VAS) were compared. The retear rates between groups were evaluated by ultrasound. RESULTS Thirty-five IDR and thirty-five TOE-SB repairs were enrolled. The IDR technique required much fewer anchors than TOE-SB did to complete the cuff repair. The mean operation time in IDR and TOE-SB group were 86(18.23), and 114(18.7) (min), respectively (P < 0.01). The mean number of anchors used to complete the cuff repair was 2(0.17) in IDR and 3(0.61) in TOE-SB (P < 0.01). The Constant-Murley score improved from 34.9 ± 6.6 to 80.6 ± 9.4 in the IDR group, and 37.4 ± 6 to 81.9 ± 4.6 in the TOE-SB group (both P < 0.001). SSV improved from 24.6 ± 9.6 to 79.3 ± 10.6 in the IDR, and 27.9 ± 9 to 82.9 ± 6.9 in the TOE-SB group (both P < 0.001). VAS improved from 7.9 ± 0.6 to 1.5 ± 0.7 in the IDR, and 8 ± 0.5 to 1.3 ± 0.6 in the TOE-SB group (both P < 0.001) at final follow-up. No significant difference was found between the retear rates (14.3% in the IDR vs. 17.1% in the TOE-SB, respectively) in the 2-year follow-up. CONCLUSIONS Both IDR and TOE-SB group provided comparable clinical results and retear rates for medium to massive posterosuperior rotator cuff tears. The surgical time and number of anchors used were less in the IDR group than in the TOE-SB group.
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Affiliation(s)
- Poyu Chen
- grid.454211.70000 0004 1756 999XDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan ,grid.145695.a0000 0004 1798 0922Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Wei Yeh
- grid.454211.70000 0004 1756 999XLinkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi Lu
- grid.454211.70000 0004 1756 999XDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan
| | - Alvin Chao-Yu Chen
- grid.454211.70000 0004 1756 999XDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan ,grid.413801.f0000 0001 0711 0593Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan ,grid.413801.f0000 0001 0711 0593Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Sheng Chan
- grid.413801.f0000 0001 0711 0593Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan ,grid.413801.f0000 0001 0711 0593Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan ,grid.454209.e0000 0004 0639 2551Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Alexandre Lädermann
- grid.413934.80000 0004 0512 0589Division of orthopedics and Trauma Surgery, Hôpital de la Tour, Meyrin, Switzerland ,grid.8591.50000 0001 2322 4988Faculty of Medicine, University of Geneva, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Joe Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Hasegawa A, Mihata T, Fukunishi K, Itami Y, Uchida A, Neo M. Structural and clinical outcomes after superior capsule reconstruction using an at least 6-mm-thick fascia lata autograft including the intermuscular septum. J Shoulder Elbow Surg 2023; 32:e48-e59. [PMID: 35998778 DOI: 10.1016/j.jse.2022.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsule reconstruction (SCR) is a viable treatment option for irreparable rotator cuff tears. However, graft tear rate is highly variable in the previous studies, and the impact of graft tears on clinical outcomes after arthroscopic SCR remains controversial. We aimed to investigate the graft tear rate, timing of graft tear, and the impact of graft tears on clinical outcomes after arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum. METHODS This retrospective multi-institutional study included 154 patients (79 women and 75 men; mean age, 69.9 yr; age range, 49-87 yr) with irreparable rotator cuff tears who underwent arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum and completed a minimum 2-year follow-up. Postoperative graft integrity was evaluated by magnetic resonance imaging examinations performed at 3, 6, 12, and 24 mo after surgery. The presence of a full-thickness defect within the graft was diagnosed as a graft tear. In contrast, a graft without a full-thickness defect was diagnosed as a healed graft. We compared the following data between patients with and without graft tears: (1) baseline characteristics, (2) visual analog scale pain score, (3) Japanese Orthopaedic Association score, (4) American Shoulder and Elbow Surgeons shoulder score, and (5) active range of motion. RESULTS The overall graft tear rate was 11.7% (18 of 154 patients). Of 18 graft tears, 14 (77.8%) occurred within 6 mo after SCR. Two additional graft tears were diagnosed at 12 mo postoperatively and another 2 at 24 mo after SCR. The visual analog scale, American Shoulder and Elbow Surgeons, and Japanese Orthopaedic Association scores improved significantly after SCR in both patients with and without graft tears (all P < .0001). However, patients with graft tears showed significantly inferior postoperative visual analog scale, American Shoulder and Elbow Surgeons, and Japanese Orthopaedic Association scores (1.9, 75.2, and 77.4, respectively) than those without graft tears (0.5, 93.1, and 92.3, respectively; all P < .01). CONCLUSIONS The overall graft tear rate after arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum was low (11.7%), relatively to that reported in previous studies. The majority of graft tears (77.8%) occurred within 6 mo after SCR. Graft healing was associated with more favorable clinical outcomes after SCR.
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Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Kunimoto Fukunishi
- Department of Orthopedic Surgery, Rakusai Shimizu Hospital, Kyoto, Japan
| | - Yasuo Itami
- Department of Orthopedic Surgery, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Akihiro Uchida
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Sun K, Li Y. Study of arthroscopic superior capsule reconstruction in the treatment of irreparable rotator cuff tears. Front Surg 2023; 9:895571. [PMID: 36684146 PMCID: PMC9852769 DOI: 10.3389/fsurg.2022.895571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Background The objective of this study was to investigate the clinical outcome and radiographic findings after arthroscopic superior capsule reconstruction (ASCR) with a new augmented autograft technique for irreparable rotator cuff tears. Methods Between 2018 and 2020, 11 patients whose shoulders had irreparable rotator cuff tears underwent ASCR using a fascia lata weaving mesh. Physical examination, radiography, and magnetic resonance imaging (MRI) were performed before surgery and the average follow-up was 20 months (18-24 months) after surgery. Clinical outcome scores were recorded. Results Average clinical outcome scores improved significantly at the final follow-up, with 94.7 points scored on the American Shoulder and Elbow Surgeons scale (range, 85-100 points) and 34.5 points on the University of California, Los Angeles scale (33-35 points) (P < 0.05). Mean active elevation increased significantly from 30.1° to 150° (P < 0.05) and external rotation increased from 30° to 59.2° (P < 0.05). The acromiohumeral distance (AHD) increased from 3.9 ± 0.6 mm preoperatively to 10.1 ± 0.7 mm postoperatively (P < 0.05). No patient had graft tear or tendon retear during follow-up. Conclusions ASCR with a new augmented autograft can restore the function of the shoulder joint with irreparable rotator cuff tears. Our results suggest that this reconstruction technique can help obtain good clinical and radiographic outcomes, which can provide a reliable method for the treatment of irreparable rotator cuff tears. Level of Evidence Level IV, therapeutic case series.
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20
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Park JH, Park KT, Kim SC, Bukhary HA, Lee SM, Yoo JC. Arthroscopic biceps augmentation does not improve clinical outcomes during incomplete repair of large to massive rotator cuff tears. Bone Joint J 2022; 104-B:1234-1241. [PMID: 36317346 DOI: 10.1302/0301-620x.104b11.bjj-2022-0422.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIMS This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon augmentation. We aimed to evaluate the additional benefit on clinical outcomes and the capacity to lower the re-tear rate. METHODS We retrospectively reviewed 1,115 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between October 2011 and May 2019. From this series, we identified 77 patients (28 male, 49 female) with a mean age of 64.1 years (50 to 80). Patients were classified into groups A (n = 47 incomplete) and B (n = 30 with biceps augmentation) according to the nature of their reconstruction. Clinical scores were checked preoperatively and at six months, one year, and two years postoperatively. In preoperative MRI, we measured the tear size, the degree of fatty infiltration, and muscle volume ratio of the supraspinatus. In postoperative MRI, the integrity of the repaired rotator cuff tendon was assessed using the Sugaya classification. Tendon thickness at the footprint was evaluated on T2-weighted oblique coronal view. RESULTS There were no significant differences in the initial preoperative demographic characteristics. In both groups, there were significant improvements in postoperative clinical scores (p < 0.001). However, most clinical outcomes, including range of motion measurements (forward elevation, external rotation, internal rotation, and abduction), showed no differences between the pre- and postoperative values. Comparing the postoperative outcomes of both groups, no further improvement from biceps augmentation was found. Group B, although not reaching statistical significance, had more re-tears than group A (30% vs 15%; p = 0.117). CONCLUSION In LMRCTs, biceps augmentation provided no significant improvement of an incomplete repair. Therefore, biceps augmentation is not recommended in the treatment of LMRCTs.Cite this article: Bone Joint J 2022;104-B(11):1234-1241.
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Affiliation(s)
- Jong H Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Seoul, South Korea
| | - Kun T Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Seoul, South Korea
| | - Su C Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Seoul, South Korea
| | - Hashem A Bukhary
- Department of Orthopaedic Surgery, Samsung Medical Center, Seoul, South Korea
- Department of Orthopaedic Division, Taif University Faculty of Medicine, Taif, Saudi Arabia
| | - Sang M Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Seoul, South Korea
| | - Jae C Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Seoul, South Korea
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21
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Liu B, Kim JU, Kim YK, Jeong HJ, Oh JH. Clinical outcomes of reverse shoulder arthroplasty and rotator cuff repair in patients with massive rotator cuff tears without osteoarthritis: comparison using propensity score matching. J Shoulder Elbow Surg 2022; 31:2096-2105. [PMID: 35429633 DOI: 10.1016/j.jse.2022.02.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/12/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal management for massive rotator cuff tears (MRCTs) without osteoarthritis (OA) remains controversial. The purpose of this study was to evaluate and compare the clinical outcomes of reverse shoulder arthroplasty (RSA) vs. rotator cuff repair (RCR) in patients with MRCTs without OA. METHODS We conducted a retrospective data analysis of 68 patients treated for MRCTs via RSA and 215 patients treated for MRCTs via arthroscopic RCR between January 2014 and April 2019. Through propensity score matching, patients were matched for sex, age, tear size, and global fatty degeneration index. Thirty-nine patients in each group were included, and all patients had completed minimal 2-year follow-up. Postoperative radiologic evaluations of healing failure were performed. The visual analog scale score for pain, range of motion, and functional outcome measures including the American Shoulder and Elbow Surgeons score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Simple Shoulder Test score, and Constant score were assessed and compared between the 2 groups. RESULTS Healing failure was observed in 10 patients in the RCR group (32.3%). No statistically significant differences in preoperative range of motion and functional scores were found between the RCR and RSA groups. Both groups showed significant pain relief and functional improvement at final follow-up. Patients in the RCR group showed significantly greater forward elevation (156.4° ± 23.8° vs. 139.7° ± 22.4°, P < .001) and internal rotation (thoracic vertebra, T8.2 ± 1.2 vs. T9.7 ± 2.6, P = .001). The average American Shoulder and Elbow Surgeons score was 88.3 ± 12.2 in the RCR group and 81.8 ± 16.1 in the RSA group (P = .045). The QuickDASH score was significantly higher in the RCR group (P = .019). A significantly higher Simple Shoulder Test score (9.7 ± 2.8 vs. 8.1 ± 3.0, P = .01) and a significantly higher Constant score (67.2 ± 6.5 vs. 63.2 ± 7.1, P = .011) were seen in the RCR group. CONCLUSION Both RSA and RCR are effective and reliable treatment options for MRCTs without OA. However, the RCR group showed better shoulder function improvement than the RSA group. Considering the possible implications of RSA, RCR should be referred to as a first-line treatment option for patients with MRCTs without OA with proper indications.
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Affiliation(s)
- Bei Liu
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Un Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Young Kyu Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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22
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Kim DS, Jang Y. Can “infraspinatus rotational transfer” be a surgical option for severe rotator cuff tears? Clin Shoulder Elb 2022; 25:171-172. [PMID: 36102049 PMCID: PMC9471817 DOI: 10.5397/cise.2022.01200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
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Jeong JH, Yoon EJ, Kim BS, Ji JH. Biceps-incorporating rotator cuff repair with footprint medialization in large-to-massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2022; 30:2113-2122. [PMID: 34988632 DOI: 10.1007/s00167-021-06829-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In large-to-massive rotator cuff tears (MRCTs), incorporating the long head of the biceps tendon (LHBT) with arthroscopic partial rotator cuff and margin convergence can improve clinical outcomes and preserve the acromio-humeral interval (AHI) during mid-term follow-up. The purpose of this study was to evaluate mid-term clinical and radiological outcomes of arthroscopic biceps-incorporating rotator cuff repair with partial release of the LHBT and footprint medialization through the Neviaser portal in MRCTs. METHODS This study enrolled 107 patients (38 males and 69 females, mean age: 64.9 ± 8.6 years) with MRCTs. A novel arthroscopic biceps-incorporating repair was performed by footprint medialization, with a partially released biceps tendon covering central defects. Clinical outcomes such as pain VAS, KSS, ASES, UCLA, SST and CS scores and ROM were evaluated at a mean follow-up time of 35 months (range 12-132 months). Serial radiographs with a mean postoperative MRI follow-up duration of 33 months were used to evaluate AHI, tendon integrity, fatty infiltration (FI) and muscle hypotrophy. RESULTS Postoperative pain VAS, KSS, ASES, UCLA, SST, and CS scores and ROM (except external rotation) were improved significantly. AHI also improved significantly from 8.6 to 9.3 mm. According to Sugaya's classification, type I, II, III, IV, or V healing status was found in 30 (28.0%), 29 (27.1%), 26 (24.3%), 14 (13.1%), and 8 (7.5%) patients, respectively. The retear rate was 22 (20.6%). CONCLUSIONS Novel biceps-incorporating cuff repair with footprint medialization yielded satisfactory outcomes in MRCT patients at the 3-year follow-up. A partially released, repaired biceps tendon provided superior stability with preserved AHI similar to that of anterior cable reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jin Hwa Jeong
- Joint Center, Department of Orthopedic Surgery, Shinsegae Seoul Hospital, 841, Gyeongin-ro, Yeongdeungpo-gu, Seoul, 07305, Republic of Korea
| | - Eun Ji Yoon
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Bo Seoung Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea.
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24
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Shah NS, Suriel Peguero E, Umeda Y, Crawford ZT, Grawe BM. Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review. HSS J 2022; 18:130-137. [PMID: 35087343 PMCID: PMC8753535 DOI: 10.1177/15563316211008137] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. QUESTIONS/PURPOSE The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. METHODS We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. RESULTS Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. CONCLUSIONS The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.
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Affiliation(s)
- Nihar S. Shah
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA,Nihar S. Shah, MD, Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH 45267-0212, USA.
| | | | - Yuta Umeda
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Zachary T. Crawford
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Clinical and structural outcome of intra-articular steroid injection for early stiffness after arthroscopic rotator cuff repair. INTERNATIONAL ORTHOPAEDICS 2022; 46:563-571. [DOI: 10.1007/s00264-021-05288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/12/2021] [Indexed: 11/26/2022]
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26
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Nabergoj M, Bagheri N, Bonnevialle N, Gallinet D, Barth J, Labattut L, Metais P, Godeneche A, Garret J, Clavert P, Collin P. Arthroscopic rotator cuff repair: Is healing enough? Orthop Traumatol Surg Res 2021; 107:103100. [PMID: 34628088 DOI: 10.1016/j.otsr.2021.103100] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/19/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023]
Abstract
HYPOTHESIS/BACKGROUND Arthroscopic rotator cuff repair most commonly results in good clinical outcomes, however understanding of predictive factors influencing the final clinical outcome is limited. AIM The purpose of our study was to evaluate clinical outcomes of patients with healed supraspinatus tendon after arthroscopic rotator cuff repair and to identify its pre- and peri-operative predictive factors of good clinical results. METHODS A multi-center prospective study followed up 188 patients, who had a healed tendon after an arthroscopic repair of isolated supraspinatus tear. Inclusion criteria were: age under 70 years old, isolated supraspinatus tear, stage 0 or I of fatty infiltration, healed supraspinatus tendon at one year postoperatively and the same arthroscopic double row rotator cuff repair used in all patients. Clinical assessment used Constant Murley Score (CMS) and Subjective Shoulder Value (SSV) preoperatively and at one year postoperatively. Ultrasound (US) control checked tendon repair quality based on Sugaya classification. Types I-II-III were considered as healed. RESULTS The average age of our cohort was 57.57 (range; 41 to 70) years and the female to male ratio was 1.14 (range; 100 to 87). The average preoperative CMS was 53.75±13.50 (mean±SD; range; 16 to 83). At final follow up, the average postoperative CMS was 79.95±12.05 (mean±SD; range; 28 to 100). 12.22% (23/188) of patients, who had a CMS score below 70, had a clinically significant difference compared to the average CMS, due to the fact that the minimal clinically significant difference (MCID) in CMS is 10. A statistical analysis has shown that in patients with lower scores there was only a significant dominance of females (p-value=0.001). No difference was found in regards to age, preoperative CMS, fatty degeneration and other factors. CONCLUSION Our study showed that despite all patients had a healed repair of supraspinatus, not all of them experienced a good final clinical outcome. The only factor negatively influencing the final clinical outcome was a female gender. No other structural factors seemed to influence the final clinical results. Futures studies should focus more on analyzing which personality traits and other psychosocial factors play an important role in determining the final outcome after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI 1000 Ljubljana, Slovenia
| | - Nima Bagheri
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicolas Bonnevialle
- Hôpital Pierre-Paul-Riquet, CHRU de Toulouse, place Baylac, 31059 Toulouse cedex 09, France
| | - David Gallinet
- Centre épaule main Besançon, 16, rue Madeleine-Brès, 25000 Besançon, France
| | - Johannes Barth
- Centre osteo-articulaire des Cèdres, parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France
| | - Ludovic Labattut
- Service de chirurgie orthopédique et traumatologique, hôpital François-Mitterrand, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - Pierre Metais
- Elsan Hôpital Privé la Châtaigneraie, 63110 Beaumont, France
| | - Arnaud Godeneche
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Jérôme Garret
- Clinique du parc, 155, boulevard Stalingrad, 69006 Lyon, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, Haut Pierre 2, CHRU Strasbourg, avenue Molière, 67200 Strasbourg, France
| | - Philippe Collin
- Clinique Victor-Hugo, 5, Bis rue du Dôme, 75116 Paris, France.
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Ciccotti M, Horan MP, Nolte PC, Elrick BP, Millett PJ. Outcomes After Arthroscopic Rotator Cuff Repair Using Margin Convergence Versus Superior Capsular Reconstruction: Should Candidates for Margin Convergence Be Treated With Superior Capsular Reconstruction? Orthop J Sports Med 2021; 9:23259671211050624. [PMID: 34778478 PMCID: PMC8573497 DOI: 10.1177/23259671211050624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Both margin convergence rotator cuff repair (MC-RCR) and superior capsular reconstruction (SCR) result in improved clinical outcomes in the treatment of massive rotator cuff tears (RCTs). The question remains whether it is better to perform MC-RCR using native, albeit occasionally deficient, tissues or to perform primary SCR. Purpose/Hypothesis To compare the clinical results of MC-RCR versus SCR for the treatment of massive RCTs. It was hypothesized that SCR would yield better outcomes. Study Design Cohort study; Level of evidence, 3. Methods Included were patients who underwent arthroscopic MC-RCR or SCR for massive RCTs performed by a single surgeon between 2014 and 2019. MC-RCR was performed if it was technically possible to close the defect; otherwise, SCR was performed. Outcomes were assessed at 6 months and then annually using American Shoulder and Elbow Surgeons; Single Assessment Numerical Evaluation; shortened version of Disabilities of the Arm, Shoulder and Hand; 12-Item Short Form Health Survey Physical Component Summary; and patient satisfaction scores. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) were compared between groups. Revision surgeries and complications were reported. Results Included were 46 patients in the MC-RCR group (mean age, 59 ± 8 years) and 46 patients in the SCR group (mean age, 57 ± 7 years); 29 patients in each group were available at 2-year follow-up. Preoperative outcome scores were not significantly different between groups. Within groups, all outcome scores improved from pre- to postoperatively (P < .05), with no significant differences in postoperative scores or patient satisfaction between groups. No significant between-group differences were noted in the percentage of patients who reached the MCID, SCB, and PASS (MCID, 92.3% vs 84.6%; SCB, 80.8% vs 80.8%; and PASS, 66.7% vs 66.7%). SCR had a significantly lower survivorship rate compared with MC-RCR (84.7% vs 100%) (P = .026). Conclusion Both MC-RCR and SCR provided similar improvement in outcomes; however, SCR resulted in a significantly lower survivorship rate at 2 years postoperatively. If an RCT is technically repairable, we recommend that it be repaired primarily, even if MC techniques are needed to close the defect. SCR remains a good option for massive RCTs that are not technically repairable.
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Affiliation(s)
- Michael Ciccotti
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Philip-C Nolte
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
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Tanaka S, Gotoh M, Tanaka K, Mitsui Y, Nakamura H, Ozono H, Okawa T, Shiba N. Functional and Structural Outcomes After Retears of Arthroscopically Repaired Large and Massive Rotator Cuff Tears. Orthop J Sports Med 2021; 9:23259671211035752. [PMID: 34631904 PMCID: PMC8493310 DOI: 10.1177/23259671211035752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Most studies have shown acceptable clinical results in patients with large or massive tears treated by arthroscopic rotator cuff repair (ARCR); however, the effects of retears after surgery in these patients remain unknown. Purpose: To evaluate functional and structural outcomes after retears of large and massive rotator cuff tears treated by ARCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 196 consecutive patients with large to massive rotator cuff tears underwent physical examination and magnetic resonance imaging before and after ARCR at 6, 12, and 24 months. Of these, 9 patients were lost at 6 months after surgery. Therefore, 187 patients were followed up for 24 months after surgery; 148 patients showed no postsurgical ruptures. Consequently, the remaining 39 patients with postsurgical ruptures were included in this study (mean age at surgery, 64.2 ± 8.7 years). Functional outcome measures comprised the University of California, Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. Structural outcome measures consisted of the global fatty degeneration index (GFDI), mediolateral tear size, and residual tendon attachment area as evaluated by our own scoring system. Results: The mean UCLA and JOA scores significantly improved from 16.3 ± 3.9 and 63.2 ± 10.7 preoperatively to 27.9 ± 5.5 (P < .0001) and 84.5 ± 9.4 (P < .0001) at final follow-up, respectively. The mean mediolateral tear size (P = .03, .02, and .02, respectively) and residual tendon attachment area (P = .04, .03, and .04, respectively) significantly improved from preoperatively to 6, 12, and 24 months postoperatively. The correlation analysis between the functional and structural variables confirmed significant associations between the residual tendon attachment area, the JOA and UCLA scores at 24 months postoperatively, and the preoperative GFDI (r = –0.81 to 0.78). Conclusion: The residual tendon attachment area after a retear was significantly larger at 24 months after surgery than before surgery. In addition, significant associations were confirmed between preoperative fatty degeneration, the residual tendon attachment area, and functional outcomes after a retear. These results may explain why functional outcomes significantly improved even after retears in this series.
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Affiliation(s)
- Suguru Tanaka
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Koji Tanaka
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yasuhiro Mitsui
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hidehiro Nakamura
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hiroki Ozono
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Japan
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Nocera NL, Burke CJ, Gyftopoulos S, Adler RS. Ultrasound-MRI Correlation for Healing of Rotator Cuff Repairs Using Power Doppler, Sonographic Shear Wave Elastography and MR Signal Characteristics: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2055-2068. [PMID: 33258512 DOI: 10.1002/jum.15583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine whether the healing response in rotator cuff repairs can be quantitatively characterized using a multimodality imaging approach with MR signal intensity, power Doppler and shear wave elastography (SWE). MATERIALS AND METHODS Patients scheduled for rotator cuff repair were prospectively enrolled between September 2013 and June 2016. A 12 patient cohort with unilateral, full-thickness, supraspinatus tendon tears underwent MRI and ultrasound both preoperatively and postoperatively (at 3 and 6 months post-surgery). The MR signal intensity ratio of tendon-to-deltoid muscle (TMR), vascularity score by power Doppler (PD) and shear wave velocity (SWV) were measured. Repaired and asymptomatic control shoulders were compared over time and between modalities. RESULTS TMR and vascularity of the tendon repair initially increased and then decreased postoperatively. Although not achieving statistical significance, postoperative SWV initially decreased and later increased, which negatively correlated with the TMR at 3 months (r = -0.73, p = 0.005). PD demonstrated a statistically significant change in tendon vascularity over time compared to the contralateral control (p = 0.009 at 3 months; p = 0.036 at 6 months). No significant correlation occurred between TMR and SWE at 6 months, or with PD at any time point. CONCLUSION Despite a small patient cohort, this prospective pilot study suggests a temporal relationship of MRI and ultrasound parameters that parallels the expected phases of healing in the repaired rotator cuff.
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Affiliation(s)
- Nicole L Nocera
- New York University Langone Orthopedic Center, New York, NY, USA
| | | | | | - Ronald S Adler
- New York University Langone Orthopedic Center, New York, NY, USA
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Morikawa D, LeVasseur MR, Luczak SB, Mancini MR, Bellas N, McCarthy MBR, Cote MP, Berthold DP, Muench LN, Mazzocca AD. Decreased Colony-Forming Ability of Subacromial Bursa-Derived Cells During Revision Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e1047-e1054. [PMID: 34430884 PMCID: PMC8365201 DOI: 10.1016/j.asmr.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/14/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To compare the cellular viability and differentiation potential of subacromial bursa-derived cells (SBDCs) located over the rotator cuff muscle and tendon of patients undergoing primary versus revision arthroscopic rotator cuff repair (ARCR). Methods Subacromial bursa was harvested from 18 primary (57.1 ± 4.6 years) and 12 revision ARCRs (57.3 ± 6.7 years). Bursa was collected from 2 sites (over rotator cuff tendon and muscle), digested with collagenase, and grown in culture. The number of nucleated cells, colony-forming units (CFUs), differentiation potential, and mesenchymal stem cell surface markers were compared in primary and revision cases. Results There was no difference in the number of nucleated cells between primary and revision ARCR harvested from the subacromial bursa overlying the tendon (3019.3 ± 1420.6 cells/mg and 3541.7 ± 2244.2 cells/mg, respectively; P = .912) or muscle (2753.5 ± 1547.1 cells/mg and 2989.0 ± 2231.4 cells/mg, respectively; P = .777). There was no difference in the number of CFUs between primary and revision ARCR over the rotator cuff tendon (81.5 ± 49.5 CFUs and 53.0 ± 36.9 CFUs, respectively; P = .138), but there were significantly fewer CFUs over the muscle in revision cases (28.1 ± 22.7 CFUs) compared with primary cases (55.7 ± 34.5 CFUs) (P = .031). SBDCs from revision ARCR expressed characteristic mesenchymal stem cell surface epitopes and had multidifferentiation potentials for chondrogenesis, osteogenesis, and adipogenesis. Conclusions SBDCs harvested over the rotator cuff muscle demonstrated significantly decreased colony-forming abilities in revision arthroscopic rotator cuff repairs compared with primary repairs. However, the subacromial bursa retains its pluripotent differentiation potential for chondrogenic, osteogenic, and adipogenic lineages in the revision setting. Clinical Relevance The subacromial bursa may play a role in the healing response of the repaired rotator cuff. This capacity is not necessarily diminished in the revision setting and may be harnessed as an orthobiologic.
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Affiliation(s)
- Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - S Brandon Luczak
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Nicholas Bellas
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mary Beth R McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
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Significance of the acromiohumeral distance on stress radiography for predicting healing and function after arthroscopic repair of massive rotator cuff tears. J Shoulder Elbow Surg 2021; 30:e471-e481. [PMID: 33271320 DOI: 10.1016/j.jse.2020.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A decreased acromiohumeral distance (AHD) is commonly detected in patients with massive rotator cuff tears (mRCTs). Most studies evaluating fixed humeral elevation have used preoperative or postoperative standardized radiography and not stress radiography. This study aimed to evaluate the predictive role of the preoperative AHD measured using stress radiography (AHD_stress) in rotator cuff healing and function after arthroscopic repair of mRCTs. METHODS The data of 113 patients who underwent arthroscopic repair of mRCTs were analyzed. Postoperative cuff integrity was evaluated using magnetic resonance imaging at 1 year, and shoulder function was evaluated at a mean of 34.9 ± 17.8 months (range, 24-92 months) postoperatively. Forty-seven patients showed healing failure. Propensity score matching (1-1) was performed between the healed group and healing failure group. Thirty-eight patients in each group were matched in the final analysis. The AHD and AHD_stress were defined as the shortest distances from the inferior acromion to the superior humerus on standard anteroposterior radiography and stress radiography (5.4-kg weight applied inferiorly in a neutral position), respectively. The AHD difference (AHD_diff) was defined as the difference between the AHD and AHD_stress values. Receiver operating characteristic curve analysis was performed to determine cutoff values for significant variables. RESULTS No difference in the mean preoperative AHD was found between the healed group (7.5 ± 2.0 mm) and healing failure group (6.9 ± 2.2 mm, P = .234). The AHD_diff value was significantly higher in the healed group (4.4 ± 2.1 mm) than in the healing failure group (3.0 ± 2.0 mm, P = .002; cutoff, 3.2 mm). Patients with an AHD_diff value ≥ 3.2 mm showed a lower healing failure rate (28.9% vs. 71.1%, P < .001) and higher functional scores than patients with an AHD_diff value < 3.2 mm. The AHD_diff value was higher in patients with an American Shoulder and Elbow Surgeons (ASES) score ≥ 80 (4.9 ± 1.9 mm) than in those with an ASES score < 80 (3.1 ± 2.1 mm, P = .024). Among patients with healing failure, only the postoperative AHD showed a significant difference between those with an ASES score ≥ 80 (7.0 ± 2.5 mm) and those with an ASES score < 80 (4.8 ± 2.1 mm, P = .009; cutoff, 4.8 mm). CONCLUSION A reducible AHD, which increased by ≥ 3.2 mm under stress radiography, can be a favorable predictor of rotator cuff healing and function after arthroscopic repair of mRCTs. Our findings suggest that this new and simple radiologic parameter should be considered preoperatively and would be helpful to determine appropriate treatment strategies.
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32
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Haleem A, Gohal C, Leroux T, Henry P, Alolabi B, Khan M. Primary arthroscopic repair of massive rotator cuff tears results in significant improvements with low rate of re-tear. Knee Surg Sports Traumatol Arthrosc 2021; 29:2134-2142. [PMID: 32748233 DOI: 10.1007/s00167-020-06190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE To conduct a systematic review of outcomes following primary arthroscopic repair of chronic massive rotator cuff tears (RCTs) and to assess clinical outcomes and rates of repair failure. The authors' preferred treatment algorithm is also provided. METHODS Medline, Embase and PubMed were searched identifying articles pertaining to primary arthroscopic repair of chronic massive RCTs without the use of augmentation. Primary outcomes were patient-reported outcomes and the secondary outcome was the rate of repair failure. Outcome data were pooled and presented as well as assessment of study methodological quality. Data from studies reporting similar outcome measures were pooled when possible, and mean differences alongside confidence intervals and p values were reported, where appropriate. RESULTS Twenty-six studies (1405 participants) were included, with mean age of 62 years (range 52-69). The mean duration of symptoms pre-operatively was 31 months (range 6-40), and the mean follow-up time was 39 months (range 12-111). Complete repair was performed in 78% of patients and partial repair was performed in 22%. Both complete and partial repairs resulted in significant improvements with respect to pain, range of motion and functional outcome scores. The rate of repair failure for the total cohort was 36% at a mean follow-up of 31 months, and for the complete and partial repair subgroups the failure rate was 35% and 40%, respectively. CONCLUSIONS Arthroscopic repairs of chronic, massive RCTs, whether complete or partial, are associated with significant improvements in pain, function and objective outcome scores. The rate of repair failure is lower than previously reported, however, still high at 36%. The present paper finds that arthroscopic repair is still a viable treatment option for massive RCTs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ahmed Haleem
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Chetan Gohal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy Leroux
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Patrick Henry
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Bashar Alolabi
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada.
- St. Joseph's Healthcare Hamilton, 50 Charlton Ave E., Mary Grace Wing, Room G807, Hamilton, ON, L8N 4A6, Canada.
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Anterior Cable Reconstruction of the Superior Capsule Using Semitendinosus Allograft for Large Rotator Cuff Defects Limits Superior Migration and Subacromial Contact Without Inhibiting Range of Motion: A Biomechanical Analysis. Arthroscopy 2021; 37:1400-1410. [PMID: 33359853 DOI: 10.1016/j.arthro.2020.12.183] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To biomechanically assess translation, contact pressures, and range of motion for anterior cable reconstruction (ACR) using hamstring allograft for large to massive rotator cuff tears. METHODS Eight cadaveric shoulders (mean age, 68 years) were tested with a custom testing system. Range of motion (ROM), superior translation of the humeral head, and subacromial contact pressure were measured at 0°, 30°, 60°, and 90° of external rotation (ER) with 0°, 20°, and 40° of glenohumeral abduction. Three conditions were tested: intact, stage III tear (supraspinatus + anterior half of infraspinatus), and stage III tear + allograft ACR (involving 2 supraglenoid anchors for semitendinosus tendon allograft fixation. Allograft ACR included loop-around fixation using 3 side-to-side sutures and an anchor at the articular margin to restore capsular anatomy along the anterior edge of the cuff defect. RESULTS ACR with allograft for stage III tears showed significantly higher total ROM compared with intact at all angles (P ≤ .028). Augmentation significantly decreased superior translation for stage III tears at 0°, 30°, and 60° ER for both 0° and 20° abduction, and at 0° and 30° ER for 40° abduction (P ≤ .043). Augmentation for stage III tears significantly reduced overall subacromial contact pressure at 30° ER with 0° and 40° abduction, and at 60° ER with 0° and 20° abduction (P ≤ .016). CONCLUSION Anterior cable reconstruction using cord-like allograft semitendinosus tendon can biomechanically improve superior migration and subacromial contact pressure (primarily in the lower combined abduction and rotation positions), without limiting range of motion for large rotator cuff tendon defects or tears. CLINICAL RELEVANCE In patients with superior glenohumeral instability, using hamstring allograft for ACR may improve rotator cuff tendon defect longevity by providing basic static ligamentous support to the dynamic tendon while helping to limit superior migration, without restricting glenohumeral kinematics.
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34
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Moriyama H, Gotoh M, Tanaka K, Mitsui Y, Nakamura H, Ozono H, Okawa T, Shiba N. Midterm Functional and Structural Outcomes of Large/Massive Cuff Tears Treated by Arthroscopic Partial Repair. Orthop J Sports Med 2021; 9:2325967120988795. [PMID: 34250157 PMCID: PMC8226377 DOI: 10.1177/2325967120988795] [Citation(s) in RCA: 3] [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: 09/06/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Previous studies have shown good clinical outcomes in patients with
irreparable large or massive rotator cuff tears treated using arthroscopic
partial repair (APR); however, few studies have evaluated both functional
and structural outcomes in these patients. Purpose: To evaluate both functional and structural outcomes in patients with large or
massive rotator cuff tears treated using APR. Study Design: Case series; Level of evidence, 4. Methods: Between March 2009 and November 2016, a total of 30 patients underwent APR
because of the irreparability of their large or massive rotator cuff tears
during surgery. Of these patients, 24 completed the minimum 24-month
follow-up (mean, 61.8 ± 27.1 months; range, 24-112 months) and were included
in this study. Functional outcome measures included the Japanese Orthopaedic
Association (JOA) and University of California Los Angeles (UCLA) scores and
the visual analog scale for pain. Structural outcome measures comprised
preoperative fatty degeneration, mediolateral tear size, residual tendon
attachment area, and glenohumeral (GH) arthritic changes evaluated on
magnetic resonance imaging scans or plain radiographs before and after
surgery. Functional and structural outcomes were evaluated preoperatively,
at 3 months postoperatively, and at the final follow-up. Results: The JOA scores for all patients significantly improved from 67.9 ± 11.3
preoperatively to 85.4 ± 15.6 postoperatively (P <
.0001). Similarly, the UCLA scores significantly improved from 15.8 ± 4.20
preoperatively to 29 ± 6.69 at final follow-up postoperatively
(P < .0001). The mediolateral tear size were
significantly decreased at 3 months postoperatively (P <
.001) and at the final follow-up (P < .001). Compared
with preoperative scores, the novel score evaluating the residual tendon
attachment area improved from 3.08 ± 0.46 to 3.54 ± 0.41 (P
< .001) after surgery overall, although it significantly deteriorated
from 3 months postoperatively to the final follow-up. GH osteoarthritis
progressed in 6 patients (25%). Patients who developed osteoarthritis had
lower JOA and UCLA scores than did those who did not (JOA,
P = .010; UCLA, P = .037). Conclusion: In irreparable large or massive rotator cuff tears treated using APR,
functional outcome improved after surgery. Although the residual tendon
attachment area improved, functional outcome after APR corresponded to the
GH alterations at the midterm follow-up. Longer-term follow-up is needed to
further elucidate the effect of APR on clinical outcomes in these
patients.
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Affiliation(s)
- Hiroaki Moriyama
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Koji Tanaka
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
| | - Yashuhiro Mitsui
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
| | - Hidehiro Nakamura
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Hiroki Ozono
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
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De Giacomo AF, Park MC, Lee TQ. Anterior Cable Reconstruction Using the Proximal Biceps Tendon for Large Rotator Cuff Defects. Arthrosc Tech 2021; 10:e807-e813. [PMID: 33738218 PMCID: PMC7953232 DOI: 10.1016/j.eats.2020.10.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/29/2020] [Indexed: 02/03/2023] Open
Abstract
Tears of the rotator cuff tendons can occur that do not allow anatomic footprint restoration yet may not be large enough to require a superior capsular reconstruction technique. Typically, these intermediate-sized tears are addressed with a medialized repair or partial repair technique. A partially repaired rotator cuff tendon, however, can lead to a high retear rate, as the repaired tendon is required to serve as both a dynamic tendon and a static ligamentous stabilizer. One potential static support, as a nearby autologous graft donor, is the proximal long head biceps tendon. The purpose of this Technical Note is to describe a surgical technique for an anterior cable reconstruction using the proximal biceps tendon for large rotator cuff defects.
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Affiliation(s)
- Anthony F. De Giacomo
- Southern California Permamente Medical Group, Woodland Hills,Address correspondence to Anthony F. De Giacomo, M.D., 5601 De Soto Ave., Woodland Hills, CA 91365.
| | - Maxwell C. Park
- Southern California Permamente Medical Group, Woodland Hills
| | - Thay Q. Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
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36
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Seo JB, Kwak KY, Park B, Yoo JS. Anterior cable reconstruction using the proximal biceps tendon for reinforcement of arthroscopic rotator cuff repair prevent retear and increase acromiohumeral distance. J Orthop 2021; 23:246-249. [PMID: 33664556 DOI: 10.1016/j.jor.2021.02.003] [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: 12/20/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Anterior cable reconstruction (ACR) using the long head of the biceps tendon (LHBT) was developed to place at the native superior capsule attachment site for large to massive rotator cuff tears (LMRCTs) with anterior cable disruption. In this study, we investigated whether ACR for reinforcement before ARCR prevented retear after arthroscopic rotator cuff repair (ARCR), especially in cases of LMRCTs with anterior cable disruption. A total of 125 patients who underwent arthroscopic rotator cuff repair (ARCR) for LMRCTs were retrospectively enrolled. To assess the benefit of ACR with LHBT, all data were compared with those after ARCR alone. As a result, ACR with LHBT showed satisfactory clinical and radiologic outcomes in comparison with conventional ARCR only technique. ACR with LHBT prevented retear after ARCR and improved the AHD, although There was no difference of clinical outcomes between two groups.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Kwon-Young Kwak
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Byeonghun Park
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Sung Yoo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
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Merlet MC, Guinet V, Rousseau T, van Rooij F, Saffarini M, Dujardin F, Courage O. Arthroscopic Side-to-Side Repair of Massive Rotator Cuff Tears Maintains Adequate Functional Improvement at 12 to 14 Years' Follow-up. Am J Sports Med 2021; 49:298-304. [PMID: 33523752 DOI: 10.1177/0363546520985224] [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 Rotator cuff tears are common shoulder injuries that often cause pain and loss of function. Nonanatomic side-to-side techniques facilitate repair by minimizing tensions within tendons to improve healing and optimize the thickness of sutured tissues. PURPOSE/HYPOTHESIS The purpose was to evaluate long-term clinical and radiographic outcomes of arthroscopic side-to-side repair of massive rotator cuff tears (mRCTs). The hypothesis was that, at a minimum follow-up of 12 years, arthroscopic side-to-side repair maintains clinically important improvements. STUDY DESIGN Case series; Level of evidence, 4. METHODS The authors reviewed records of all patients who underwent arthroscopic repair of mRCTs over 2 consecutive years. A total of 30 adult patients met the eligibility criteria and underwent side-to-side repair. Patients were evaluated clinically using the Constant score (CS) and ultrasound to assess retears at 3 timepoints after surgery: 2 to 4 years, 5 to 7 years, and 12 to 14 years. RESULTS At first follow-up (3.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 13 retears (43%). At second follow-up (6.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 2 new retears (total 50%). At final follow-up (13.0 ± 0.7 years), only 21 patients had clinical assessment (1 died and 8 could not be reached), and only 19 patients had ultrasound assessment, which revealed 6 new retears (total 79%). Both absolute CS and age-/sex-adjusted CS improved significantly from baseline values at first follow-up (73.5 and 96.6, respectively), and remained stable at second follow-up (69.0 and 91.9, respectively), and final follow-up (64.4 and 87.0, respectively). Compared to shoulders with intact repairs, those with retears tended to have lower absolute CS at all follow-up visits, although differences were not statistically significant. CONCLUSION Patients with mRCTs maintain satisfactory clinical scores at 12 to 14 years after arthroscopic side-to-side repair despite a high incidence of retears. Repair is a safe and effective treatment for mRCTs, providing a less invasive and less complex alternative to reverse shoulder arthroplasty and tendon transfer procedures.
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Affiliation(s)
- Marie Caroline Merlet
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | - Virginie Guinet
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | - Thomas Rousseau
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | | | | | - Franck Dujardin
- Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
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Lobo-Escolar L, Ramazzini-Castro R, Codina-Grañó D, Lobo E, Minguell-Monyart J, Ardèvol J. Risk factors for symptomatic retears after arthroscopic repair of full-thickness rotator cuff tears. J Shoulder Elbow Surg 2021; 30:27-33. [PMID: 32862994 DOI: 10.1016/j.jse.2020.05.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Factors affecting a rotator cuff symptomatic retear after arthroscopic repair have yet to be clearly identified, since they usually influence the surgical decisions. METHODS Consecutive patients with full-thickness tear of the supraspinatus who underwent arthroscopic repair were retrospectively analyzed. Cases of symptomatic retear, defined as Sugaya type IV and V on magnetic resonance imaging, associated with intensive pain and/or functional impairment were identified at follow-up. The patients with no symptomatic retear were selected as the control group. Information from potential risk factors of symptomatic retear, including depression and subacromial corticosteroid injections, was extracted from the medical records. The statistical analysis included multivariant logistic regression. RESULTS The symptomatic retear rate was 9.5% in 158 patients. Patients in the symptomatic retear group were more likely to be smoking, to have massive tears, a short acromiohumeral distance, and moderate to severe fatty infiltration. They also had had more frequently subacromial corticosteroid injections and depression. However, following the multiple logistic regression analysis, only massive tears and moderate to severe fatty infiltration remained significantly associated. Similarly, in relation to the study hypothesis, both corticosteroid injections (odds ratio [OR] 6.66, 95% confidence interval [CI] 1.49, 29.81; P = .013) and depression (OR 8.26, IC 1.04, 65.62; P = .046) were significantly associated with symptomatic retear risk. CONCLUSIONS This study found support for the hypothesis that both depression and corticosteroid infiltration before surgery are independent risk factors for symptomatic retear after arthroscopic repair of rotator cuff.
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Affiliation(s)
- Luis Lobo-Escolar
- Department of Orthopaedics & Traumatology Surgery, Hospital ASEPEYO Sant Cugat, Sant Cugat del Vallès, Barcelona, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Rodrigo Ramazzini-Castro
- Department of Orthopaedics & Traumatology Surgery, Hospital Nacional de San Marcos-Guatemala, Guatemala
| | - David Codina-Grañó
- Department of Orthopaedics & Traumatology Surgery, Hospital ASEPEYO Sant Cugat, Sant Cugat del Vallès, Barcelona, Spain
| | - Elena Lobo
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - Joan Minguell-Monyart
- Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Orthopaedics & Traumatology Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Jordi Ardèvol
- Department of Orthopaedics & Traumatology Surgery, Hospital ASEPEYO Sant Cugat, Sant Cugat del Vallès, Barcelona, Spain
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Kim C, Lee YJ, Kim SJ, Yoon TH, Chun YM. Bone Marrow Stimulation in Arthroscopic Repair for Large to Massive Rotator Cuff Tears With Incomplete Footprint Coverage. Am J Sports Med 2020; 48:3322-3327. [PMID: 32976717 DOI: 10.1177/0363546520959314] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is no research on incomplete footprint coverage with single-row repair related to bone marrow stimulation (BMS) in large to massive rotator cuff tears (RCTs). PURPOSE/HYPOTHESIS The purpose was to compare the clinical results and structural integrity between BMS and non-BMS groups that underwent arthroscopic repair of large to massive rotator cuff tears with <50% footprint coverage. It was hypothesized that both groups would exhibit improved clinical outcomes at 2 years after surgery but the BMS group would have significantly better clinical outcomes and structural integrity. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study included 98 patients who underwent arthroscopic repair with <50% footprint coverage for large to massive RCTs with (BMS group; n = 56) or without (non-BMS group; n = 42) BMS. Functional outcomes at the 2-year follow-up were assessed using the visual analog scale for pain score, subjective shoulder value; American Shoulder and Elbow Surgeons score; University of California, Los Angeles, shoulder score; and active range of motion. Structural integrity was evaluated using magnetic resonance arthrography or computed tomography arthrography results at 6 months postoperatively. RESULTS At the 2-year follow-up, all functional outcomes significantly improved in both groups compared with preoperative values (P < .001). However, there were no significant postoperative differences between groups. On follow-up magnetic resonance arthrography or computed tomography arthrography, the overall retear rate was not significantly different between the BMS group (30.3%; 17/56) and the non-BMS group (35.7%; 15/42). CONCLUSION While both groups exhibited functional improvement after single-row repair with <50% footprint coverage for large to massive RCTs, BMS did not produce better clinical outcomes or structural integrity.
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Affiliation(s)
- Chul Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Jae Lee
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lee KW, Lee GS, Yang DS, Park SH, Chun YS, Choy WS. Clinical Outcome of Arthroscopic Partial Repair of Large to Massive Posterosuperior Rotator Cuff Tears: Medialization of the Attachment Site of the Rotator Cuff Tendon. Clin Orthop Surg 2020; 12:353-363. [PMID: 32904088 PMCID: PMC7449848 DOI: 10.4055/cios19126] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022] Open
Abstract
Backgroud The goal of this study was to evaluate the clinical and radiological outcomes of arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon and to identify prognostic factors affecting rotator cuff healing in patients with irreparable large to massive posterosuperior rotator cuff tears. Methods Between July 2012 and March 2016, 42 patients with irreparable large to massive posterosuperior rotator cuff tears underwent an arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon. All patients had a minimum of 2-year follow-up (mean, 35.4 ± 7.3 months). Clinical evaluation was performed using the visual analog scale, the University of California, Los Angeles shoulder rating scale, Constant score, and active range of motion. Radiological evaluation was performed using magnetic resonance imaging and simple radiography. Results Clinical outcomes at the final follow-up improved significantly compared with the preoperative values (all p < 0.001). The failure rate was 23.8% (10/42); however, clinical outcomes significantly improved regardless of cuff healing (all p < 0.001). The mean acromiohumeral distance was 6.5 ± 1.7 mm (range, 3.2-9.7 mm) before surgery and 6.3 ± 1.6 mm (range, 2.8-9.5 mm) at the final follow-up. Preoperative acromiohumeral distance was associated with failure of cuff healing in the univariate analysis (p = 0.043) and multivariate analysis (p = 0.048). A receiver operating characteristic curve was used to determine the predictive cutoff value for the smallest preoperative acromiohumeral distance for successful healing, which was calculated as 5.3 mm. Conclusions Despite healing failure, arthroscopic partial repair with medialization can be a possible treatment option for irreparable large to massive posterosuperior rotator cuff tears because of the improvement in clinical outcome. The shorter preoperative acromiohumeral distance was the single most important factor negatively affecting cuff healing, and the likelihood of success of healing might be improved if a repair is performed when the preoperative acromiohumeral distance is < 5.3 mm.
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Affiliation(s)
- Kwang Won Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Gyu Sang Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Ho Park
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Young Sub Chun
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
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Jeong JY, Shim SB, Hong JH, Im W, Lee SM, Yoo JC. Effect of Preoperative Frozen Shoulder on Clinical Outcomes After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2020; 8:2325967120934449. [PMID: 32782902 PMCID: PMC7383686 DOI: 10.1177/2325967120934449] [Citation(s) in RCA: 4] [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] [Indexed: 01/23/2023] Open
Abstract
Background: A concomitant rotator cuff tear (RCT) with frozen shoulder is a common but challenging clinical scenario. The effect of frozen shoulder on clinical outcomes is open to discussion. Purpose/Hypothesis: This study aimed to evaluate the effect of preoperative frozen shoulder on postoperative clinical outcomes of an RCT. We hypothesized that the treatment results of an RCT concomitant with preoperative frozen shoulder would be comparable with those of an isolated RCT. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 212 patients were divided into 2 groups: 154 in the non–frozen shoulder (NFS) group and 58 in the preoperative frozen shoulder (FS) group. All patients underwent a thorough preoperative evaluation that included range of motion (ROM) and the pain visual analog scale, functional visual analog scale, Constant score, and American Shoulder and Elbow Surgeons (ASES) score. The same evaluation was performed at 6 months and 1 and 2 years postoperatively. The healing status of the repaired RCT of all patients was evaluated by postoperative magnetic resonance imaging. Results: The FS group showed statistically significantly worse functional outcomes than the NFS group at 6 months and 1 year postoperatively (P < .05). At 2 years postoperatively, active assisted ROM was equivalent between the groups, although the ASES and Constant scores were significantly lower for the FS group (P < .033 and P < .001, respectively). The retear rates were 5.3% and 12.3% for the FS and NFS groups, respectively (P = .013). Conclusion: Preoperative frozen shoulder positively affected rotator cuff healing but negatively affected most functional outcomes, including ROM, at 6 months and 1 year postoperatively. At 2 years after surgery, there was no significant difference in active motion, but outcome scores remained lower in the FS group. For patients with preoperative frozen shoulder, a delay in surgery for additional physical therapy might not be necessary. The retear rate for the NFS group was more than double that for the FS group in the current study, which indicates that surgery for an RCT combined with frozen shoulder might provide better results in the long term because of an intact, healed rotator cuff.
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Affiliation(s)
- Jeung Yeol Jeong
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Seung Bo Shim
- Department of Orthopedic Surgery, Seoul Barun Hospital, Seoul, Republic of Korea
| | - Jin Ho Hong
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Wooyoung Im
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sang Min Lee
- Division of Sports Medicine, Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kholinne E, Kwak JM, Sun Y, Kim H, Koh KH, Jeon IH. Evaluation of Deltoid Origin Status Following Open and Arthroscopic Repair of Large Rotator Cuff Tears: A Propensity-Matched Case-Control Study. Clin Shoulder Elb 2020; 23:11-19. [PMID: 33330228 PMCID: PMC7714323 DOI: 10.5397/cise.2020.00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/15/2020] [Indexed: 01/08/2023] Open
Abstract
Background The purpose of this study was to evaluate and compare deltoid origin status following large rotator cuff repair carried out using either an open or an arthroscopic method with a propensity score matching technique. Methods A retrospective review of 112 patients treated for full-thickness, large rotator cuff tear via either a classic open repair (open group) or an arthroscopic repair (arthroscopic group) was conducted. All patients included in the study had undergone postoperative magnetic resonance imaging (MRI) and clinical follow-up for at least 12 and 18 months after surgery, respectively. Propensity score matching was used to select controls matched for age, sex, body mass index, and affected site. There were 56 patients in each group, with a mean age of 63.3 years (range, 50-77 years). The postoperative functional and radiologic outcomes for both groups were compared. Radiologic evaluation for postoperative rotator cuff integrity and deltoid origin status was performed with 3-Tesla MRI. Results The deltoid origin thickness was significantly greater in the arthroscopic group when measured at the anterior acromion (P=0.006), anterior third (P=0.005), and middle third of the lateral border of the acromion level (P=0.005). The deltoid origin thickness at the posterior third of the lateral acromion was not significantly different between the arthroscopic and open groups. The arthroscopic group had significantly higher intact deltoid integrity with less scarring (P=0.04). There were no full-thickness deltoid tears in either the open or arthroscopic group. Conclusions Open rotator cuff repair resulted in a thinner deltoid origin, especially from the anterior acromion to the middle third of the lateral border of the acromion, at the 1-year postoperative MRI evaluation. Meticulous reattachment of the deltoid origin is as essential as rotator cuff repair when an open approach is selected.
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Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu, China
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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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Whyte GP. Complete Repair of Massive, Retracted, and "Non-Repairable" Tears of the Rotator Cuff: The Anatomic Vector Repair. Arthrosc Tech 2020; 9:e357-e365. [PMID: 32226743 PMCID: PMC7093733 DOI: 10.1016/j.eats.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/17/2019] [Indexed: 02/03/2023] Open
Abstract
Massive and retracted tears of the supraspinatus and infraspinatus tendons of the rotator cuff are associated with great pain and disability and may be considered "non-repairable," depending on the extent of injury and the experience of the treating clinician. The technique of anatomic vector repair of the rotator cuff is a surgical treatment method that enables the surgeon to accurately characterize the injury pattern and successfully repair many of these debilitating injuries anatomically in a stepwise manner, often in cases that would have otherwise been treated with a less preferable surgical procedure that does not restore native anatomy.
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Affiliation(s)
- Graeme P. Whyte
- Address correspondence to Graeme P. Whyte, M.D., M.Sc., F.R.C.S.C., NYU Langone Orthopedic Hospital, 301 East 17th St, New York, NY, U.S.A.
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Easley J, Puttlitz C, Hackett E, Broomfield C, Nakamura L, Hawes M, Getz C, Frankle M, St Pierre P, Tashjian R, Cummings PD, Abboud J, Harper D, McGilvray K. A prospective study comparing tendon-to-bone interface healing using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair in sheep. J Shoulder Elbow Surg 2020; 29:157-166. [PMID: 31401128 DOI: 10.1016/j.jse.2019.05.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/03/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the biomechanical and histologic properties of rotator cuff repairs using a vented anchor attached to a bioresorbable interpositional scaffold composed of aligned PLGA (poly(l-lactide-co-glycoside)) microfibers in an animal model compared to standard anchors in an ovine model. METHODS Fifty-six (n = 56) skeletally mature sheep were randomly assigned to a repair of an acute infraspinatus tendon detachment using a innovative anchor-PLGA scaffold device (Treatment) or a similar anchor without the scaffold (Control). Animals were humanely euthanized at 7 and 12 weeks post repair. Histologic and biomechanical properties of the repairs were evaluated and compared. RESULTS The Treatment group had a significantly higher fibroblast count at 7 weeks compared to the Control group. The tendon bone repair distance, percentage perpendicular fibers, new bone formation at the tendon-bone interface, and collagen type III deposition was significantly greater for the Treatment group compared with the Control group at 12 weeks (P ≤ .05). A positive correlation was identified in the Treatment group between increased failure loads at 12 weeks and the following parameters: tendon-bone integration, new bone formation, and collagen type III. No statistically significant differences in biomechanical properties were identified between Treatment and Control Groups (P > .05). CONCLUSIONS Use of a vented anchor attached to a bioresorbable interpositional scaffold composed of aligned PLGA microfibers improves the histologic properties of rotator cuff repairs in a sheep model. Improved histology was correlated with improved final construct strength at the 12-week time point.
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Affiliation(s)
- Jeremiah Easley
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Christian Puttlitz
- Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Eileen Hackett
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Cecily Broomfield
- Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Lucas Nakamura
- Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | | | - Charles Getz
- Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Frankle
- Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA; Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Patrick St Pierre
- Shoulder and Elbow Service, Desert Orthopedic Center, Eisenhower Health, Rancho Mirage, CA, USA
| | - Robert Tashjian
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Joseph Abboud
- The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Kirk McGilvray
- Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA.
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Application of a new polyester patch in arthroscopic massive rotator cuff repair-a prospective cohort study. J Shoulder Elbow Surg 2020; 29:e11-e21. [PMID: 31405714 DOI: 10.1016/j.jse.2019.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Massive rotator cuff (RC) tears still present a clinically challenging problem, with reported rerupture rates in up to 94%. The study objective was to determine the impact of synthetic patch augmentation for massive RC tears. METHODS Between June 2012 and 2014, we performed 50 arthroscopic RC reconstructions augmented with a synthetic polyester patch. Pre- and postoperative imaging methods included arthrographic magnetic resonance imaging, arthrographic computed tomography, and ultrasound examination to determine tendon integrity or rerupture. Clinical outcome was evaluated using the Constant-Murley score and the subjective shoulder value. Mean clinical midterm and final follow-up was 22 months (9-35 months) and 52 months (25-74 months), respectively. RESULTS The mean Constant-Murley score increased significantly from 36.5 (±16.4 standard deviation [SD]) preoperatively to a midterm value of 81.2 (±9.6 SD; P < .0001) and further improved to a mean of 83.4 (±10.8 SD) at final follow-up. The mean subjective shoulder value increased from 40.3 (±24.3 SD) to 89.2 (±12.9 SD; P < .0001) at midterm and to 89.6 (±15.2 SD) at final follow-up. We observed 7 complete reruptures (14%). However, reruptures did not correlate with revision surgery, which was performed in 8 patients. The main reason for revision was frozen shoulder or arthrofibrosis with an intact reconstruction and patch, which was performed in 6 cases. CONCLUSIONS The retear rate of 14% compared favorably with nonaugmented RC repairs in the literature. Therefore, we conclude that patch augmentation in massive RC tears is feasible to reduce retears and to improve clinical outcome.
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Kim JD, Rhee SM, Kim MS, Ro K, Rhee YG. Arthroscopic Side-to-side Repair for Large U-shaped Full-Thickness Rotator Cuff Tears: Is the Repair Integrity Actually Maintained? Arthroscopy 2019; 35:3211-3218. [PMID: 31708353 DOI: 10.1016/j.arthro.2019.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and structural outcomes of arthroscopic side-to-side repair of large U-shaped full-thickness rotator cuff tears (FTRCTs) by assessing the functional score of the patients and the integrity of the tendon repair using magnetic resonance imaging with a minimum follow-up duration of 2 years. METHODS In this case series, 59 consecutive patients who underwent arthroscopic side-to-side repair of large U-shaped FTRCTs, with a minimum follow-up duration of 2 years (range 25 to 72 months), were retrospectively enrolled. The mean patient age was 58.6 years. Patients' functional scores and integrity of the tendon repairs were evaluated. RESULTS The mean visual analog scale score improved from 5.7 ± 2.1 preoperatively to 2.4 ± 1.3 postoperatively (P < .001). The mean range of motion (forward flexion) improved from 152.7° ± 11.4° to 164.5° ± 9.5° (P < .001). The mean Constant-Murley score improved from 57.3 ± 7.2 preoperatively to 77.8 ± 6.9 postoperatively (P < .001). Postoperative magnetic resonance imaging examinations demonstrated cuff integrity with a retear rate of 54.2%. The retear rate of patients who underwent anchor fixation to the medial row (45%) was significantly lower than that of patients who underwent simple side-to-side repair (73.7%) (P = .039). The University of California at Los Angeles shoulder rating and Constant-Murley scores were not significantly different between the healed and retear groups (P = .639 and P = .863, respectively). CONCLUSIONS Arthroscopic side-to-side repair of large U-shaped FTRCTs demonstrated satisfactory clinical outcomes. However, the retear rate was higher than expected when simple side-to-side fixation was performed without footprint fixation. Therefore, medial row fixation is recommended if arthroscopic side-to-side repair is performed. LEVEL OF EVIDENCE III, comparative therapeutic trial.
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Affiliation(s)
- Jong Dae Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Seo Kim
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyunghan Ro
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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Editorial Commentary: Dermal Allograft: A Viable Allograft for Salvage Procedures in Treating Irreparable Rotator Cuff Tears. Arthroscopy 2019; 35:3203-3204. [PMID: 31785746 DOI: 10.1016/j.arthro.2019.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/02/2023]
Abstract
Our experience with superior capsule reconstruction (SCR) has been successful in patients with isolated, irreparable, supraspinatus tears; however, we have found that bridging reconstruction may have a better role in treating patients with some cuff remnant. Our results are promising, and, although there is new evidence to show that dermal allografts can heal in the setting of rotator cuff deficiency, the basic principle of restoring anatomy should not be ignored. SCR has been accepted as a salvage procedure for irreparable cuff tears, with the precise indications being elucidated. Reconnecting viable cuff muscle to tuberosity directly or through a graft should be considered before SCR.
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Avanzi P, Giudici LD, Capone A, Cardoni G, Lunardi G, Foti G, Zorzi C. Prospective randomized controlled trial for patch augmentation in rotator cuff repair: 24-month outcomes. J Shoulder Elbow Surg 2019; 28:1918-1927. [PMID: 31540724 DOI: 10.1016/j.jse.2019.05.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND To evaluate the anatomic integrity of rotator cuff repair performed by medialized single row and augmented by a porcine dermal patch, in comparison with a nonaugmented group. METHODS We conducted a single-center, prospective, double-blinded, randomized controlled trial. The sample size was predefined, and patients were divided into a study group and a control group, assessed preoperatively and at 1, 3, 6, 12, and 24 months. The EuroQol-visual analog scale; Constant-Murley questionnaire; Disabilities of the Arm, Shoulder and Hand Score; and Simple Shoulder Test were administered. The humeral-acromial distance was calculated on radiographs. Tendon thickness, tear extension, and tendon signal intensity were all measured on magnetic resonance images (MRIs) along with an evaluation of footprint extension and a classification into one of 4 healing grades-healed, thinned, partially healed, not healed. RESULTS The study population consisted of 92 patients who were equally randomized into 2 homogenous groups. Sixty-nine patients completed the 24-month follow-up. The study group showed a healing rate of 97.6% compared with 59.5% for the standard repair group. The study group showed better results in terms of repaired tendon thickness and footprint coverage, with a P value < .05, although the tendon density was comparable. The study group showed better strength recovery and functionality with the outcome scores submitted. During the entire study, only 2 patients reported complications, calling for a biopsy during revision surgery. CONCLUSIONS Rotator cuff repairs augmented with a porcine dermal patch resulted in excellent clinical outcomes with a higher healing rate and close-to-normal MRI findings. The technique is safe and effective; in addition, it is reproducible and allows for better outcomes compared with those of standard medialized single-row repairs.
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Affiliation(s)
- Paolo Avanzi
- Department of Orthopaedics, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Luca Dei Giudici
- Orthopaedic Unit, Casa di Cura "Villa Igea" Hospital, Ancona, Italy
| | - Antonio Capone
- Department of Surgical Science, Orthopaedic Clinic, University of Cagliari, Ospedale Marino, Cagliari, Italy
| | - Gaia Cardoni
- Department of Surgical Science, Orthopaedic Clinic, University of Cagliari, Ospedale Marino, Cagliari, Italy.
| | - Gianluigi Lunardi
- Department of Medical Oncology, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Giovanni Foti
- Department of Radiology, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Claudio Zorzi
- Department of Orthopaedics, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
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Iijima Y, Matsuki K, Hoshika S, Ueda Y, Hamada H, Tokai M, Takahashi N, Sugaya H, Watanabe A. Relationship between postoperative retear and preoperative fatty degeneration in large and massive rotator cuff tears: quantitative analysis using T2 mapping. J Shoulder Elbow Surg 2019; 28:1562-1567. [PMID: 31327395 DOI: 10.1016/j.jse.2019.04.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fatty degeneration of the rotator cuff muscles is reported to be associated with retear after rotator cuff repair. The purpose of this study was to assess the relationship between retear and preoperative fatty degeneration, as quantified by T2 mapping. METHODS This prospective cohort study included 83 large and 24 massive rotator cuff tears (average age, 67 years; range, 46-82 years). All patients preoperatively underwent T2 mapping magnetic resonance imaging, and T2 values of the supraspinatus and infraspinatus muscles were quantified. Cuff integrity was evaluated with magnetic resonance imaging 1 year postoperatively. Preoperative T2 values were compared between the retear and intact groups. The preoperative Goutallier stage, Constant score, and the shoulder score of the University of California at Los Angeles were also compared between the 2 groups. RESULTS Retear was found in 32 shoulders (30%). Postoperative Constant and University of California at Los Angeles scores were significantly higher in intact shoulders than in retear shoulders (P < .001 for both). Mean preoperative T2 values of supraspinatus and infraspinatus were 77.4 ± 13.2 ms and 73.2 ± 15.3 ms in retear shoulders and 66.5 ± 11.1 ms and 58.6 ± 11.7 ms in intact shoulders, respectively; the differences were significant in both muscles (P < .001). Cutoff values for prediction of retear were 71.8 ms in supraspinatus and 63.1 ms in infraspinatus. There were no significant differences in the preoperative Goutallier stages of supraspinatus and infraspinatus between the 2 groups. CONCLUSIONS Retear shoulders demonstrated significantly higher preoperative T2 values than intact shoulders. T2 mapping can be a useful tool for predicting postoperative retears.
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Affiliation(s)
- Yuki Iijima
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan.
| | - Keisuke Matsuki
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Shota Hoshika
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Yusuke Ueda
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Hiroshige Hamada
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Morihito Tokai
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Norimasa Takahashi
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Hiroyuki Sugaya
- Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
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