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Ito Y, Ishida T, Matsumoto H, Yamaguchi S, Suenaga N, Oizumi N, Yoshioka C, Yamane S, Hisada Y, Matsuhashi T. Passive shoulder abduction range of motion at 3 months postoperatively is the most important prognostic factor for achieving full recovery of range of motion at 6 months after arthroscopic rotator cuff repair. JSES Int 2024; 8:806-814. [PMID: 39035660 PMCID: PMC11258824 DOI: 10.1016/j.jseint.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background After arthroscopic rotator cuff repair (ARCR), it is crucial for clinicians to predict the functional recovery in the early postoperative period for considering rehabilitation strategies. The aim of this study was to identify the prognostic factors in the early postoperative period for achieving full recovery of range of motion (ROM) at 6 months after ARCR. Methods This study included 184 patients who underwent ARCR. Patients were divided into the full recovery and nonrecovery groups using the Constant ROM score at 6 months postoperatively. The area under the curve for predicting the full recovery group was calculated for all independent variables such as demographic data, ROM, shoulder functional scores at preoperative and 3 months postoperative using receiver operating characteristic curve analysis. Multivariable logistic regression analysis was then performed using candidate variables with an area under the curve of 0.7 or greater to determine prognostic factors for full recovery at 6 months postoperatively. The same analysis as above was also performed by dividing the patients into groups according to their preoperative ROM. Results Multivariable logistic regression analysis revealed that preoperative active flexion, 3 months postoperative passive abduction, and internal rotation at 90° abduction ROM were significant prognostic factors of achieving full ROM recovery at 6 months postoperatively. Only passive abduction ROM at 3 months postoperatively was significantly extracted in the preoperative ROM limitation group. Conclusion This study demonstrated that passive abduction ROM at 3 months postoperatively was a significant prognostic factor of achieving full recovery of ROM at 6 months after ARCR.
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Affiliation(s)
- Yu Ito
- Department of Rehabilitation, Orthopedic Hokushin Hospital, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hisashi Matsumoto
- Department of Rehabilitation, Orthopedic Hokushin Hospital, Sapporo, Japan
| | - Shota Yamaguchi
- Department of Rehabilitation, Orthopedic Hokushin Hospital, Sapporo, Japan
| | - Naoki Suenaga
- Upper Extremity Center of Joint Replacement & Endoscopy, Orthopaedic Hokushin Hospital, Sapporo, Japan
| | - Naomi Oizumi
- Upper Extremity Center of Joint Replacement & Endoscopy, Orthopaedic Hokushin Hospital, Sapporo, Japan
| | - Chika Yoshioka
- Upper Extremity Center of Joint Replacement & Endoscopy, Orthopaedic Hokushin Hospital, Sapporo, Japan
| | - Shintaro Yamane
- Upper Extremity Center of Joint Replacement & Endoscopy, Orthopaedic Hokushin Hospital, Sapporo, Japan
| | - Yukiyoshi Hisada
- Upper Extremity Center of Joint Replacement & Endoscopy, Orthopaedic Hokushin Hospital, Sapporo, Japan
| | - Tomoya Matsuhashi
- Upper Extremity Center of Joint Replacement & Endoscopy, Orthopaedic Hokushin Hospital, Sapporo, Japan
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2
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Iio R, Ueda D, Matsumoto T, Manaka T, Nakazawa K, Ito Y, Hirakawa Y, Yamamoto A, Shiba M, Nakamura H. Deep learning-based screening tool for rotator cuff tears on shoulder radiography. J Orthop Sci 2024; 29:828-834. [PMID: 37236873 DOI: 10.1016/j.jos.2023.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Early diagnosis of rotator cuff tears is essential for appropriate and timely treatment. Although radiography is the most used technique in clinical practice, it is difficult to accurately rule out rotator cuff tears as an initial imaging diagnostic modality. Deep learning-based artificial intelligence has recently been applied in medicine, especially diagnostic imaging. This study aimed to develop a deep learning algorithm as a screening tool for rotator cuff tears based on radiography. METHODS We used 2803 shoulder radiographs of the true anteroposterior view to develop the deep learning algorithm. Radiographs were labeled 0 and 1 as intact or low-grade partial-thickness rotator cuff tears and high-grade partial or full-thickness rotator cuff tears, respectively. The diagnosis of rotator cuff tears was determined based on arthroscopic findings. The diagnostic performance of the deep learning algorithm was assessed by calculating the area under the curve (AUC), sensitivity, negative predictive value (NPV), and negative likelihood ratio (LR-) of test datasets with a cutoff value of expected high sensitivity determination based on validation datasets. Furthermore, the diagnostic performance for each rotator cuff tear size was evaluated. RESULTS The AUC, sensitivity, NPV, and LR- with expected high sensitivity determination were 0.82, 84/92 (91.3%), 102/110 (92.7%), and 0.16, respectively. The sensitivity, NPV, and LR- for full-thickness rotator cuff tears were 69/73 (94.5%), 102/106 (96.2%), and 0.10, respectively, while the diagnostic performance for partial-thickness rotator cuff tears was low at 15/19 (78.9%), NPV of 102/106 (96.2%) and LR- of 0.39. CONCLUSIONS Our algorithm had a high diagnostic performance for full-thickness rotator cuff tears. The deep learning algorithm based on shoulder radiography helps screen rotator cuff tears by setting an appropriate cutoff value. LEVEL OF EVIDENCE Level III: Diagnostic Study.
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Affiliation(s)
- Ryosuke Iio
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daiju Ueda
- Smart Life Science Lab, Center for Health Science Innovation, Osaka Metropolitan University, Osaka, Japan; Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Toshimasa Matsumoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoichi Ito
- Ito Clinic, Osaka Shoulder Center, Osaka, Japan
| | - Yoshihiro Hirakawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masatsugu Shiba
- Smart Life Science Lab, Center for Health Science Innovation, Osaka Metropolitan University, Osaka, Japan; Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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3
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Menekse S. Comparison of Outcomes between Open and Arthroscopic Rotator Cuff Repair. Adv Orthop 2024; 2024:5575404. [PMID: 38249956 PMCID: PMC10796185 DOI: 10.1155/2024/5575404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Objective The objective of this retrospective cohort study is to evaluate the long-term clinical and functional outcomes of two surgical techniques for rotator cuff repair, namely, open and arthroscopic methods. Methods A total of 100 patients diagnosed with rotator cuff tears and treated at Seyhan State Hospital in the past five years were enrolled, considering the same inclusion criteria for both groups. The study groups consisted of 50 patients who underwent open rotator cuff repair and 50 patients who underwent arthroscopic rotator cuff repair. We used the SPSS programme to analyse the data, focusing on parameters such as postoperative recovery time, functional capacity scores, pain levels measured by the VAS scale, quality of life evaluated by the SF-36 scores, and complication rates. Results Both methods resulted in similar recovery times and functional capacity scores, but patients treated with the open method reported slightly lower pain levels (average VAS score: 2.8) compared to those treated with the arthroscopic method (average VAS score: 3.1). The study also found slightly better quality of life scores in the arthroscopic group (average SF-36 score: 71.4) compared to the open surgery group (average SF-36 score: 68.7). The complications rates were lower in the arthroscopic group (2%) than in the open surgery group (4%), but these differences were not statistically significant. Conclusions The study suggests that, while there are no significant differences in terms of clinical outcomes between the two surgical methods, short-term pain levels may be influenced by the more frequent application of acromioplasty in arthroscopic methods. Therefore, the choice of the surgical method should be made based on the unique characteristics, including the location and size, the patient's overall health status, and the surgeon's experience. These findings should be used as a guide and not as absolute results.
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Affiliation(s)
- Serdar Menekse
- Orthopaedic Department, Adana Seyhan State Hospital, Seyhan, Adana, Türkiye
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4
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Kuo SJ, Su YH, Hsu SC, Huang PH, Hsia CC, Liao CY, Chen SH, Wu RW, Hsu CC, Lai YC, Liu DY, Ku NE, Chen JF, Ko JY. Effects of Adding Extracorporeal Shockwave Therapy (ESWT) to Platelet-Rich Plasma (PRP) among Patients with Rotator Cuff Partial Tear: A Prospective Randomized Comparative Study. J Pers Med 2024; 14:83. [PMID: 38248784 PMCID: PMC10820784 DOI: 10.3390/jpm14010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
A rotator cuff tear is a prevalent ailment affecting the shoulder joint. The clinical efficacy of combined therapy remains uncertain for partial rotator cuff tears. In this study, we integrated extracorporeal shockwave therapy (ESWT) with platelet-rich plasma (PRP) injection, juxtaposed with PRP in isolation. Both cohorts exhibited significant improvements in visual analogue scale (VAS), Constant-Murley score (CMS), degrees of forward flexion, abduction, internal rotation, and external rotation, and the sum of range of motion (SROM) over the six-month assessment period. The application of ESWT in conjunction with PRP exhibited notable additional enhancements in both forward flexion (p = 0.033) and abduction (p = 0.015) after one month. Furthermore, a substantial augmentation in the range of shoulder motion (SROM) (p < 0.001) was observed after six months. We employed isobaric tag for relative and absolute quantitation (iTRAQ) to analyze the differential plasma protein expression in serum samples procured from the two groups after one month. The concentrations of S100A8 (p = 0.042) and S100A9 (p = 0.034), known to modulate local inflammation, were both lower in the ESWT + PRP cohort. These findings not only underscore the advantages of combined therapy but also illuminate the associated molecular changes.
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Affiliation(s)
- Shu-Jui Kuo
- School of Medicine, China Medical University, Taichung 404328, Taiwan; (S.-J.K.); (S.-C.H.); (D.-Y.L.); (N.-E.K.); (J.-F.C.)
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan
| | - Yu-Hsiang Su
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan; (Y.-H.S.); (C.-C.H.)
| | - Shih-Chan Hsu
- School of Medicine, China Medical University, Taichung 404328, Taiwan; (S.-J.K.); (S.-C.H.); (D.-Y.L.); (N.-E.K.); (J.-F.C.)
| | - Po-Hua Huang
- Department of Orthopedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan; (P.-H.H.); (C.-Y.L.); (S.-H.C.); (R.-W.W.); (C.-C.H.)
| | - Chia-Chun Hsia
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan; (Y.-H.S.); (C.-C.H.)
| | - Chin-Yi Liao
- Department of Orthopedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan; (P.-H.H.); (C.-Y.L.); (S.-H.C.); (R.-W.W.); (C.-C.H.)
| | - Sung-Hsiung Chen
- Department of Orthopedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan; (P.-H.H.); (C.-Y.L.); (S.-H.C.); (R.-W.W.); (C.-C.H.)
| | - Re-Wen Wu
- Department of Orthopedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan; (P.-H.H.); (C.-Y.L.); (S.-H.C.); (R.-W.W.); (C.-C.H.)
| | - Chieh-Cheng Hsu
- Department of Orthopedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan; (P.-H.H.); (C.-Y.L.); (S.-H.C.); (R.-W.W.); (C.-C.H.)
| | - Yen-Chun Lai
- School of Medicine, National Taiwan University, Taipei 100233, Taiwan;
| | - De-Yi Liu
- School of Medicine, China Medical University, Taichung 404328, Taiwan; (S.-J.K.); (S.-C.H.); (D.-Y.L.); (N.-E.K.); (J.-F.C.)
| | - Nien-En Ku
- School of Medicine, China Medical University, Taichung 404328, Taiwan; (S.-J.K.); (S.-C.H.); (D.-Y.L.); (N.-E.K.); (J.-F.C.)
| | - Jui-Feng Chen
- School of Medicine, China Medical University, Taichung 404328, Taiwan; (S.-J.K.); (S.-C.H.); (D.-Y.L.); (N.-E.K.); (J.-F.C.)
| | - Jih-Yang Ko
- Department of Orthopedic Surgery, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan; (P.-H.H.); (C.-Y.L.); (S.-H.C.); (R.-W.W.); (C.-C.H.)
- Center for Shockwave Medicine and Tissue Engineering, College of Medicine, Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan
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Du C, Wu R, Yan W, Fang J, Dai W, Wang Y, Cheng J, Hu X, Ao Y, Liang X, Liu Z. Ultrasound-Controlled Delivery of Growth Factor-Loaded Cerasomes Combined with Polycaprolactone Scaffolds Seeded with Bone Marrow Mesenchymal Stem Cells for Biomimetic Tendon-to-Bone Interface Engineering. ACS APPLIED MATERIALS & INTERFACES 2024; 16:292-304. [PMID: 38133932 PMCID: PMC10789257 DOI: 10.1021/acsami.3c14959] [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: 10/07/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Rotator cuff tear (RCT) is a prevalent shoulder injury that poses challenges for achieving continuous and functional regeneration of the tendon-to-bone interface (TBI). In this study, we controlled the delivery of growth factors (GFs) from liposomal nanohybrid cerasomes by ultrasound and implanted three-dimensional printed polycaprolactone (PCL) scaffolds modified with polydopamine loaded with bone marrow mesenchymal stem cells (BMSCs) to repair tears of the infraspinatus tendon in a lapine model. Direct suturing (control, CTL) was used as a control. The PCL/BMSC/cerasome (PBC) devices are sutured with the enthesis of the infraspinatus tendon. The cerasomes and PCL scaffolds are highly stable with excellent biocompatibility. The roles of GFs BMP2, TGFβ1, and FGF2 in tissue-specific differentiation are validated. Compared with the CTL group, the PBC group had significantly greater proteoglycan deposition (P = 0.0218), collagen volume fraction (P = 0.0078), and proportions of collagen I (P = 0.0085) and collagen III (P = 0.0048). Biotin-labeled in situ hybridization revealed a high rate of survival for transplanted BMSCs. Collagen type co-staining at the TBI is consistent with multiple collagen regeneration. Our studies demonstrate the validity of biomimetic scaffolds of TBI with BMSC-seeded PCL scaffolds and GF-loaded cerasomes to enhance the treatment outcomes for RCTs.
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Affiliation(s)
- Cancan Du
- Department
of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing 100191, China
- Beijing
Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering
Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
| | - Ruiqi Wu
- Department
of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Wenqiang Yan
- Department
of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing 100191, China
- Beijing
Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering
Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
| | - Jingchao Fang
- Department
of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Wenli Dai
- Department
of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing 100191, China
- Beijing
Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering
Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
| | - Yiqun Wang
- Department
of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing 100191, China
- Beijing
Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering
Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
| | - Jin Cheng
- Department
of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing 100191, China
- Beijing
Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering
Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
| | - Xiaoqing Hu
- Department
of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing 100191, China
- Beijing
Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering
Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
| | - Yingfang Ao
- Department
of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing 100191, China
- Beijing
Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering
Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
| | - Xiaolong Liang
- Department
of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Zhenlong Liu
- Department
of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing 100191, China
- Beijing
Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering
Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
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6
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Ji JH, Choi C, You H, Parikh D, Oh S. Effects of Arthroscopic Atelocollagen Insertion in High-Grade Partial Articular Supraspinatus Tendon Avulsion Lesions: A Retrospective Cohort Study With Propensity Score Matching. Orthop J Sports Med 2023; 11:23259671231212882. [PMID: 38035219 PMCID: PMC10683401 DOI: 10.1177/23259671231212882] [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: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 12/02/2023] Open
Abstract
Background This study sought to evaluate the effect of atelocollagen insertion into the bone-tendon interface of the repaired tendon after arthroscopic rotator cuff repair for high-grade partial articular supraspinatus tendon avulsion (PASTA) lesions. Purpose To compare clinical and radiological outcomes of atelocollagen-inserted rotator cuff repair and atelocollagen-noninserted rotator cuff repair in the high-grade PASTA lesions. Study Design Cohort study; Level of evidence, 3. Methods The data from 301 consecutive patients who underwent arthroscopic rotator cuff repair of PASTA lesions between January 2017 and June 2020 were retrospectively reviewed. Patients with minimum 2-year follow-up data were included and divided into 2 groups: those treated with transtendon suture-bridge repair without additional augmentation (group 1) and those with atelocollagen-inserted transtendon suture-bridge repair (group 2). Patients in group 2 were matched 1:1 to patients in group 1 using propensity score matching (n = 68 per group); and pain visual analog scale, American Shoulder and Elbow Surgeons, University of California, Los Angeles, Korean Shoulder Scoring System, Simple Shoulder Test, and range of motion scores were compared between these groups. Also, repaired tendon integrity and thickness were compared immediately, 6 months, and 1 year after surgery on magnetic resonance imaging (MRI) using the vertical distance from the midpoint footprint of the greater tuberosity. Results In most comparisons, there were no significant differences in outcome measures and range of motion between groups. However, less residual discomfort at the final follow-up was also documented in group 2 (P = .043). Also, the difference in forward flexion was 3.7° at 1 year and 5.4° at final follow-up, and the difference in abduction was 2.2° at final follow-up, which were all significantly greater in the experimental group. Group 2 showed significant greater tendon thickness of the repaired tendon immediately, 6 months, and 1 year after surgery on MRI (P≤ .001). Conclusion Addition of atelocollagen did not improve outcome scores. However, there was slightly greater flexion and abduction at final follow-up. Also, there was less residual discomfort at final follow-up.
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Affiliation(s)
- Jong-Hun Ji
- Department of Orthopaedic Surgery, Deajeon St Mary's Hospital, Catholic University of Korea, Deajeon, Republic of Korea
| | - Changrak Choi
- Department of Orthopaedic Surgery, St Vincent's Hospital, Catholic University of Korea, Suwon, Republic of Korea
| | - Hwangyong You
- Department of Orthopaedic Surgery, Deajeon St Mary's Hospital, Catholic University of Korea, Deajeon, Republic of Korea
| | - Darshil Parikh
- Department of Orthopaedic Surgery, Deajeon St Mary's Hospital, Catholic University of Korea, Deajeon, Republic of Korea
| | - Seungbae Oh
- Department of Orthopaedic Surgery, St Vincent's Hospital, Catholic University of Korea, Suwon, Republic of Korea
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7
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Su-Bao D, Zhang B, Luo H, Liu Y, Chen-Li R, Zou Y, Qiang-Zeng S, Fu S, Liu G. Single knotless-anchor with two ethicon 2# for Ellman grade III bursal-side partial thickness rotator cuff tears: a cadaveric biomechanical study and short-term clinical evaluation. BMC Musculoskelet Disord 2023; 24:701. [PMID: 37658346 PMCID: PMC10474714 DOI: 10.1186/s12891-023-06841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Several surgical techniques are used to treat bursal-side partial thickness rotator cuff tears (PTRCTs). However, use of single knotless-anchor with two Ethicon 2# repair technique for PTRCTs has not been reported. MATERIALS AND METHODS Bursal-side PTRCTs (Ellman grade III, 75% thickness of tears) were created in the supraspinatus tendon in 16 fresh-frozen cadaveric shoulders. The specimens were randomly assigned to two equal groups: (1) Group A (Transtendon repair), a single knotless-anchor repair with two Ethicon 2#; (2) Group B, Conversion repair (Double-row, DR). Post-repair, each specimen was subjected to cyclic loading test from 5 to 100 N (50 cycles), followed by an ultimate failure test. The displacement of greater tuberosity (mm) and ultimate (N) were recorded. In the clinical study, 12 patients diagnosed with Ellman grade III Bursal-side PTRCTs (using a single knotless anchor with two Ethicon 2# repair techniques) were operated on and analyzed. Visual analog scale (VAS), American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley Score (CMS), and range of motion (ROM) were assessed before surgery and at final minimum follow-up (>1year). RESULTS There was no significant between-group difference with respect to load-to-failure test (Group A, 359.25 ± 17.91 N; Group B, 374.38 ± 13.75 N, P > 0.05). There were no significant differences with respect to rotator cuff displacement of 10 mm (Group A, 190.50 ± 8.52 N; Group B, 197.25 ± 6.84 N, P > 0.05) and 15 mm (Group A, 282.25 ± 12.20 N; Group B, 291.13 ± 14.74 N, P > 0.05). However, there was significant between-group difference with respect to displacement of 3 and 5 mm (P < 0.05). In the clinical trial, all patients were followed up for an average of 20.4 months (12-29 months). At the last follow-up after surgery(minimum>1year), the VAS score was 0.50 ± 0.67 (0-2), the ASES score was 86.50 ± 3.96 (79-92), the CMS score was 85.08 ± 5.65 (74-93), the mean Forward flexion ROM was 154.00°± 12.48° (131°-169°), and the abduction ROM was 165.00°±13.26° (138°-173°). There was a statistically significant difference between the results of the preoperative and the last postoperative follow-up. The results of the last postoperative follow-up were statistically different from those of the preoperative follow-up (P < 0.05). Regarding complications, stiffness (2 cases) and shoulder impingement (1 case) occurred in 3 cases (25%). CONCLUSION A single knotless anchor with two Ethicon 2# may provide a biomechanically and clinically feasible option for the treatment of bursal-side Ellman grade III PTRCTs, particularly in resource-constrained settings. MESH KEYWORDS Bursal-side Ellman Grade III; Single Knotless-anchor; Double-row repair; Biomechanical study; Short-term clinical evaluation.
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Affiliation(s)
- Ding Su-Bao
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Baolu- Zhang
- School of Nursing, Southwest Medical University, Lu Zhou Sichuan, Lu Zhou Sichuan, China
| | - Hong- Luo
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Yang- Liu
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Rui Chen-Li
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Yiyuan- Zou
- No.1 Orthopedic hospital of Chengdu,, Chengdu, Sichuan, China
| | - Sheng Qiang-Zeng
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Shijie- Fu
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China
| | - Gang Liu
- Department of Orthopedics and Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China.
- Academician Workstation, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China.
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Lu Zhou, China.
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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8
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Zhang Y, Zhou M, Hou J, Zhang J, Zhou C, Long Y, Ke M, Tang Y, Yang R. Arthroscopic Autologous Coracoacromial Ligament Augment Technique for Particle Thickness of Rotator Cuff with at Least Two Years Follow-Up. Orthop Surg 2023; 15:2157-2166. [PMID: 36905294 PMCID: PMC10432468 DOI: 10.1111/os.13697] [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: 12/13/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE Patch technology has been the new technique in the treatment of partial thickness of the rotator cuff tear (PTRCTs) to address the limitation of traditional techniques. Compared with allogeneic patches and artificial materials, coracoacromial ligament is obviously closer to their own biology. The purpose of the study was to evaluate the functional and radiographic outcomes following arthroscopic autologous coracoacromial ligament augment technique for treatment of PTRCTs. METHOD This study included three female patients with PTRCTs who underwent arthroscopy operation in 2017 with an average age of 51 years (range from 50 to 52 years). The coracoacromial ligament implant was attached to the bursal side surface of the tendon. The clinical results were evaluated by American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), acromiohumeral distance (AHD) and muscle strength before and 12 months after operation. Magnetic resonance imaging (MRI) was performed 24 months after operation to assess the integrity of the anatomical structure of the original tear site. RESULT The average ASES score improved significantly from 57.3 preoperatively to 95.0 at 1-year follow-up. The strength improved significantly from grade 3 preoperatively to grade 5 at 1 year. Two of three patients underwent the MRI at 2-year follow-up. Radiographic released the complete healing of rotator cuff tear. No implant-related serious adverse events were reported. CONCLUSION The new technique of using autogenous coracoacromial ligament patch augment provides good clinical results on patients with PTRCTs.
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Affiliation(s)
- Yuanhao Zhang
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Min Zhou
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jingyi Hou
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jinming Zhang
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chuanhai Zhou
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yi Long
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Meng Ke
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yiyong Tang
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Rui Yang
- Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
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9
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Zhan J, Liu S, Dong C, Ge Y, Xia X, Tian N, Xu Q, Jiang G, Xu W, Cui J. Shoulder MRI-based radiomics for diagnosis and severity staging assessment of surgically treated supraspinatus tendon tears. Eur Radiol 2023; 33:5587-5593. [PMID: 36856840 DOI: 10.1007/s00330-023-09523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/05/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To develop and validate MRI-based radiomics models capable of evaluating supraspinatus tendon tears within the shoulder joints by using arthroscopy as the reference standard. METHODS A total of 432 patients (332 in the training set and 100 in the external validation set) with intact supraspinatus tendon (n = 202) and supraspinatus tendon tear (n = 230, 130 full-thickness tears and 100 partial-thickness tears) were enrolled. Radiomics features were extracted from fat-saturated T2-weighted coronal images. Two radiomics signature models for detecting supraspinatus tendon abnormalities (tear or not), and stage lesion severity (full- or partial-thickness tear) and radiomics scores (Rad-score), were constructed and calculated using multivariate logistic regression analysis. The diagnostic performance of the two models was validated using ROC curves on the training and validation datasets. RESULTS For the radiomics model of no tears or tears, thirteen features from MR images were used to build the radiomics signature with an AUC value of 0.98 in the training set, 0.97 in the internal validation set, and 0.98 in the external validation set. For the radiomics model of full- or partial-thickness tears, thirteen features from MR images were used to build the radiomics signature with an AUC value of 0.79 in the training set, 0.69 in the internal validation set, and 0.77 in the external validation set. CONCLUSION The proposed radiomics models in this study can accurately rule out supraspinatus tendon tears and are capable of assessing the severity staging of tears with moderate accuracy based on shoulder MR images. KEY POINTS • The radiomics model of no tears or tears achieved a high overall accuracy of 93.6%, sensitivity of 91.6%, and specificity of 95.2% for supraspinatus tendon tears. • The radiomics model of full- or partial-thickness tears displayed moderate performance with an accuracy of 76.4%, a sensitivity of 79.2%, and a specificity of 74.3% for supraspinatus tendon tears severity staging.
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Affiliation(s)
- Jinfeng Zhan
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Song Liu
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Cheng Dong
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Yaqiong Ge
- GE Healthcare China, Pudong New Town, No. 1, Huatuo Road, Shanghai, 210000, China
| | - Xiaona Xia
- Department of Radiology, Shandong University, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Qingdao, 266034, China
| | - Na Tian
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Qi Xu
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Gang Jiang
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Wenjian Xu
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Jiufa Cui
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China.
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10
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Dey Hazra RO, Dey Hazra ME, Hanson JA, Rutledge JC, Doan KC, Horan MP, Millett PJ. Minimum 10-Year Outcomes After Arthroscopic Repair of Partial-Thickness Supraspinatus Rotator Cuff Tears. Am J Sports Med 2023; 51:2404-2410. [PMID: 37306068 DOI: 10.1177/03635465231176557] [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: 06/13/2023]
Abstract
BACKGROUND The prevalence of partial-thickness rotator cuff tears (PTRCTs) has been reported to be 13% to 40% within the adult population, accounting for 70% of all rotator cuff tears. Approximately 29% of PTRCTs will progress to full-thickness tears if left untreated. The long-term clinical course after arthroscopic repair of PTRCTs is not well known. PURPOSE To investigate minimum 10-year patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (RCR) of the supraspinatus tendon and to report reoperation and complication rates. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients were included who underwent arthroscopic RCR of a PTRCT performed by a single surgeon between October 2005 and October 2011. Arthroscopic RCR was performed with a transtendon repair of partial, articular-sided supraspinatus tendon avulsions, bursal-sided repair, or conversion into a full-thickness tear and repair. PRO data were collected preoperatively and at a minimum 10 years postoperatively. PRO measures included the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, the shortened version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH), the 12-Item Short Form Health Survey Physical Component Summary, and patient satisfaction. Subanalyses were performed to determine if tear location or age was associated with outcomes. Retears, revision surgery, and surgical complications were recorded. RESULTS In total, 33 patients (21 men, 12 women) at a mean age of 50 years (range, 23-68) met criteria for inclusion. Follow-up was obtained in 28 (87.5%) of the 32 eligible patients ≥10 years out from surgery (mean, 12 years; range, 10-15 years). Of the 33 PTCRTs, 21 were articular sided and 12 were bursal sided. Of the 33 patients, 26 underwent concomitant biceps tenodesis. At follow-up, the mean PROs were significantly improved when compared with preoperative levels: American Shoulder and Elbow Surgeons score from 67.3 to 93.7 (P < .001), Single Assessment Numeric Evaluation from 70.9 to 91.2 (P = .004), QuickDASH from 22.3 to 6.6 (P < .004), and 12-Item Short Form Health Survey Physical Component Summary from 44.8 to 54.2 (P < .001). Median postoperative satisfaction was 10 (range, 5-10). No patient underwent revision surgery. CONCLUSION Arthroscopic repair of PTRCTs results in excellent clinical outcomes and high patient satisfaction at minimum 10-year follow-up. Furthermore, the procedure is highly durable, with a clinical survivorship rate of 100% at 10 years.
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Affiliation(s)
- Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, 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
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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11
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Liu J, Dai S, Deng H, Qiu D, Liu L, Li M, Chen Z, Kang J, Tao J. Evaluation of the prognostic value of the anatomical characteristics of the bony structures in the shoulder in bursal-sided partial-thickness rotator cuff tears. Front Public Health 2023; 11:1189003. [PMID: 37304102 PMCID: PMC10250604 DOI: 10.3389/fpubh.2023.1189003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Background In recent studies, individual scapular anatomy has been found to be related to degenerative full-thickness rotator cuff tears. However, research on the relationship between the anatomical characteristics of shoulder radiographs and bursal-sided partial-thickness rotator cuff tears (PTRCTs) is limited, and the risk factors for this pathology still need to be determined. Methods The bursal-sided PTRCTs group included 102 patients without a history of shoulder trauma who underwent arthroscopy between January 2021 and October 2022. A total of 102 demographically matched outpatients with intact rotator cuffs were selected as the control group. Radiographs were used to measure the lateral acromial angle (LAA), critical shoulder angle (CSA), greater tuberosity angle (GTA), β-angle, acromion index (AI), acromiohumeral distance (AHD), acromial tilt (AT), acromial slope (AS), acromial type, and acromial spur by two independent observers. Multivariate analyses of these data were used to identify potential risk factors for bursal-sided PTRCTs. Receiver operating characteristic (ROC) analysis was performed to assess the sensitivity and specificity of CSA, GTA, and AI for this type of pathology. Result The β-angle, AHD, AS and acromion type showed no difference between bursal-sided PTRCTs and controls (p = 0.009, 0.200, 0.747 and 0.078, respectively). CSA, GTA and AI were significantly higher in bursal-sided PTRCTs (p < 0.001). LAA, β-angle and AT were significantly lower in bursal-sided PTRCTs. Multivariate logistic regression analysis demonstrated significant correlations between the acromial spur (p = 0.024), GTA (p = 0.004), CSA (p = 0.003) and AI (p = 0.048) and bursal-sided PTRCTs. The areas under the ROC curves for AI, CSA, and GTA were 0.655 (95% CI 0.580-0.729), 0.714 (95% CI 0.644-0.784), and 0.695 (95% CI 0.622-0.767), respectively. Conclusion Acromial spur, GTA, CSA, and AI were independent risk factors for bursal-sided PTRCTs. Furthermore, CSA was the most powerful predictor of bursal-sided PTRCTs compared to GTA and AI.
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Affiliation(s)
- Jun Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Simin Dai
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hui Deng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Dewei Qiu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Li Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mingzhang Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhijun Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiawei Kang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jun Tao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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12
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Yang Y, Hu D, Chen S, Guan S, Shang X. Transtendon technique versus repair after completion of the tear for articular-sided partial rotator cuff tear: a meta-analysis of comparative studies. J Orthop Surg Res 2023; 18:378. [PMID: 37217901 DOI: 10.1186/s13018-023-03831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Transtendon repair and repair after completion of the tear have been widely used to treat partial-thickness rotator cuff tears (PT-RCTs). The present study was aimed to compare the clinical outcomes and tendon integrity following arthroscopic repair of articular PT-RCTs using transtendon repair or repair after completion of the tear. METHODS We performed a systematic electronic database search on Cochrane Central Register of Controlled Trials, PubMed and Embase to identify articles equating articular-sided PT-RCTs repair. The randomized controlled clinical trials that met our criteria were evaluated for quality of methodology. The results obtained were further analyzed and correlated to present the benefits and drawbacks comparing the two surgical procedures. RESULT According to our inclusion and exclusion criteria, six articles were included in the present study. A total of 501 patients were analyzed as part of this study. The results indicated that both the surgical treatments provided excellent functional improvements and tendon integrity. However, no significant differences for the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, constant score, range of motion, postoperative adhesive capsulitis, tendon integrity and patient satisfaction were found between the two cohorts (p > 0.05). CONCLUSIONS Both transtendon technique and repair after completion of the tear for articular-sided partial rotator cuff tear provide improvements in clinical outcome with a low complication rate and a high rate of healing.
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Affiliation(s)
- Yimeng Yang
- Department of Sports Medicine, Huashan Hospital, No. 12, Wulumuqi Zhong Road, Shanghai, 200040, China
- State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, China
| | - Dan Hu
- Department of Orthopedics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215008, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, No. 12, Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Shibing Guan
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
| | - Xiliang Shang
- Department of Sports Medicine, Huashan Hospital, No. 12, Wulumuqi Zhong Road, Shanghai, 200040, China.
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13
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Diabetes Mellitus and Obesity as Prognostic Factors in Arthroscopic Repair of Chronic Rotator Cuff Tears. J Clin Med 2023; 12:jcm12020627. [PMID: 36675554 PMCID: PMC9866981 DOI: 10.3390/jcm12020627] [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: 11/30/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Metabolic diseases such as obesity and diabetes mellitus seem to have an influence on reoperation and long-term functional outcomes after arthroscopic repair of chronic rotator cuff tears. High prevalence of these pathologies can be found in the Canary Islands. A retrospective cohort study was carried out, in which 80 patients undergoing shoulder arthroscopic surgery for the repair of chronic rotator cuff tears were included, with a minimum follow up of 5 years, to study the occurrence of complications, reoperation, and functional outcomes. Functionality after surgery improved in 75% of patients with diabetes and remained the same or worsened in 25% (OR = 1.444). In the group of non-diabetic patients, 83.9% had improved function after surgery while it remained the same or worsened in 16.1% (OR = 0.830). Functionality after surgery improved in 76.6% of obese patients and remained the same or worsened in 23.4% (OR = 1.324). In the non-obese group, 87.9% had improved function after surgery, while it remained the same or worsened in 12.1% (OR = 0.598). Despite not obtaining statistically significant differences, the analysis of the results obtained suggests that obesity and diabetes could act by decreasing the subjective improvement in functionality after surgery, and, in the case of obesity, also increase the risk of reoperation.
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14
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Chen C, Shi Q, Li M, Chen Y, Zhang T, Xu Y, Liao Y, Ding S, Wang Z, Li X, Zhao C, Sun L, Hu J, Lu H. Engineering an enthesis-like graft for rotator cuff repair: An approach to fabricate highly biomimetic scaffold capable of zone-specifically releasing stem cell differentiation inducers. Bioact Mater 2022; 16:451-471. [PMID: 35386315 PMCID: PMC8965727 DOI: 10.1016/j.bioactmat.2021.12.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/29/2021] [Accepted: 12/19/2021] [Indexed: 02/09/2023] Open
Abstract
Rotator cuff (RC) attaches to humerus across a triphasic yet continuous tissue zones (bone-fibrocartilage-tendon), termed "enthesis". Regrettably, rapid and functional enthesis regeneration is challenging after RC tear. The existing grafts bioengineered for RC repair are insufficient, as they were engineered by a scaffold that did not mimic normal enthesis in morphology, composition, and tensile property, meanwhile cannot simultaneously stimulate the formation of bone-fibrocartilage-tendon tissues. Herein, an optimized decellularization approach based on a vacuum aspiration device (VAD) was developed to fabricate a book-shaped decellularized enthesis matrix (O-BDEM). Then, three recombinant growth factors (CBP-GFs) capable of binding collagen were synthesized by fusing a collagen-binding peptide (CBP) into the N-terminal of BMP-2, TGF-β3, or GDF-7, and zone-specifically tethered to the collagen of O-BDEM to fabricate a novel scaffold (CBP-GFs/O-BDEM) satisfying the above-mentioned requirements. After ensuring the low immunogenicity of CBP-GFs/O-BDEM by a novel single-cell mass cytometry in a mouse model, we interleaved urine-derived stem cell-sheets into this CBP-GFs/O-BDEM to bioengineer an enthesis-like graft. Its high-performance on regenerating enthesis was determined in a canine model. These findings indicate this CBP-GFs/O-BDEM may be an excellent scaffold for constructing enthesis-like graft to patch large/massive RC tears, and provide breakthroughs in fabricating graded interfacial tissue.
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Affiliation(s)
- Can Chen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Qiang Shi
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Muzhi Li
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Rehabilitation, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Yang Chen
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Tao Zhang
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Yan Xu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Yunjie Liao
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Shulin Ding
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Zhanwen Wang
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Xing Li
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Chunfeng Zhao
- Division of Orthopedic Research and Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, 55905, United States
| | - Lunquan Sun
- Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jianzhong Hu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Corresponding author. Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, Hunan, China.
| | - Hongbin Lu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
- Hunan Engineering Research Center of Sports and Health, Changsha, 410008, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, 410008, China
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Corresponding author. Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, Hunan, China.
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15
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Fanelli MG, Field LD. The Arthroscopic "Bellows" Sign Identifies Hidden Rotator Cuff Tears. Arthrosc Tech 2022; 11:e723-e725. [PMID: 35646583 PMCID: PMC9134251 DOI: 10.1016/j.eats.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/17/2022] [Indexed: 02/03/2023] Open
Abstract
The intraoperative recognition of rotator cuff tears continues to be a challenge in some cases, despite clinical suspicion, a physical examination suggesting a rotator cuff tear, and detection on preoperative imaging studies. Intraoperative identification can be elusive in partial tears including intratendinous tears and obscured full-thickness tears. The purpose of this Technical Note, and the associated technique video, is to discuss a visual sign for the detection of various rotator cuff tear pathologies. Derived from the dynamic fluid expansion and contraction of the affected tissues, this indicator is termed the arthroscopic "bellows" sign.
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Affiliation(s)
| | - Larry D. Field
- Address correspondence to Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 E. Fortification St., Jackson, MS 39202.
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16
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Xu J, Li Y, Ye Z, Wu C, Han K, Zheng T, Jiang J, Yan X, Su W, Zhao J. Biceps Augmentation Outperforms Tear Completion Repair or In Situ Repair for Bursal-Sided Partial-Thickness Rotator Cuff Tears in a Rabbit Model. Am J Sports Med 2022; 50:195-207. [PMID: 34779674 DOI: 10.1177/03635465211053334] [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: 01/31/2023]
Abstract
BACKGROUND There is an ongoing debate on the treatment of bursal-sided partial-thickness rotator cuff tears (PTRCTs), including ideal repair techniques. Augmentation using a collagen patch has been introduced as a new surgical approach to treat PTRCTs, while the effect of autogenous biceps augmentation (BA) has not been investigated. PURPOSE To analyze the effects of BA on bursal-sided PTRCTs and compare its histological and biomechanical results with those of tear completion followed by repair and in situ repair (ISR). STUDY DESIGN Controlled laboratory study. METHODS Unilateral chronic PTRCTs were created in 96 mature New Zealand White rabbits, which were randomly divided into 4 groups: no repair, tear completion repair (TCR), ISR, and BA. A new bicipital groove was fabricated in BA for the biceps tendon that was transferred to augment the bursal-sided PTRCT repair. In each group, we sacrificed 6 rabbits for biomechanical testing of the whole tendon-to-bone complex (WTBC) and 6 for histological evaluation of bursal- and articular-sided layers at 6 and 12 weeks postoperatively. Healing responses between the biceps and new bicipital groove in the BA group were determined using histological analysis, and final groove morphologies were evaluated using micro-computed tomography. RESULTS The remaining tendon and enthesis in bursal-sided PTRCTs progressively degenerated over time. WTBCs of ISR exhibited a larger failure load than those of TCR, although better healing properties in the bursal-sided repaired site were achieved using TCR based on histological scores and superior articular-sided histological scores were observed using ISR. However, WTBCs of BA displayed the best biomechanical results and superior histological scores for bursal- and articular-sided regions. The new bicipital groove in BA remodeled over time and formed similar morphologies to a native groove, which provided a mature bone bed for transferred biceps tendon healing to augment bursal-sided PTRCTs. CONCLUSION BA achieved better biomechanical and histological results for repairing bursal-sided PTRCTs as compared with TCR and ISR. When compared with that of TCR, the WTBC of ISR exhibited a higher failure load, showing histological superiority in the articular-sided repair and inferiority in the bursal-sided repair. CLINICAL RELEVANCE BA may be an approach to improve bursal-sided PTRCT repair in humans, which warrants further clinical investigation.
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Affiliation(s)
- Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yufeng Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ting Zheng
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaoyu Yan
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Griffith JF. How to Report: Shoulder MRI. Semin Musculoskelet Radiol 2021; 25:652-660. [PMID: 34861710 DOI: 10.1055/s-0041-1736586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Magnetic resonance imaging of the shoulder is a commonly performed investigation. This article discusses the common shoulder pathologies encountered, emphasizes the key features to report, and provides examples of terminology used to describe these pathologies.
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Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
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18
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Song S, Lee SK, Kim JY. [Partial-Thickness Tear of Supraspinatus and Infraspinatus Tendon Revisited: Based on MR Findings]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1366-1387. [PMID: 36238879 PMCID: PMC9431970 DOI: 10.3348/jksr.2021.0124] [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] [Received: 06/30/2021] [Revised: 10/03/2021] [Accepted: 10/18/2021] [Indexed: 12/05/2022]
Abstract
The interpretation of MRI of partial-thickness rotator cuff tears can be challenging. This review describes the anatomic considerations for diagnosing partial-thickness tears, especially supraspinatus and infraspinatus tendon and summarizes the classification of partial-thickness rotator cuff tears, as well as provides an overview on partial-thickness tears with delamination.
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Wang T, Ren Z, Zhang Y, Zhao X, Liu X, Yu T, Zhang Y. Comparison of Arthroscopic Debridement and Repair in the Treatment of Ellman Grade II Bursal-side Partial-thickness Rotator Cuff Tears: A Prospective Randomized Controlled Trial. Orthop Surg 2021; 13:2070-2080. [PMID: 34596965 PMCID: PMC8528987 DOI: 10.1111/os.13130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the effects of arthroscopic debridement and repair in treating Ellman grade II bursal‐side partial‐thickness rotator cuff tears. Methods This is a single‐center, prospective, randomized controlled trial. From September 2017 to April 2019, 78 patients underwent arthroscopic debridement (35 patients) or repair (43 patients) due to Ellman grade II bursal‐side partial‐thickness rotator cuff tears. Twenty‐six men and 52 women were included in the study, with an average age of 56.31 years (range, 42 to 74 years). After the acromioplasty was formed, the debridement group only performed stump refreshing and surrounding soft tissue cleaning, while the repair group converted the partial tears into full‐thickness tears and then sutured them by single row or suture bridge technique. The visual analogue scale (VAS), Constant‐Murley shoulder (CMS), American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) scores were used to evaluate clinical results preoperatively and at 6, 12, and 18 months postoperatively. Magnetic resonance imaging was used to assess the integrity of the rotator cuff, muscle atrophy, and fat infiltration. Results A total of 85 patients met the inclusion criteria and were randomly divided into the debridement group (41 patients) and the repair group (43 patients). During the 18‐month follow‐up period, a total of seven patients were lost to follow‐up. The functional scores of both groups were significantly improved: the VAS score decreased 5.06 and 4.63 in the debridement group (5.77 preoperative to 0.71 postoperative) and the repair group (5.49 to 0.86) (P < 0.05). Moreover, the CMS, ASES, UCLA scores increased 51.63, 58.24, 20.57 in debridement group (39.46 to 91.09, 34.14 to 92.38, 13.29 to 33.86), and increased 48.14, 60.53, 20.93 in repair group (43.63 to 91.77, 33.10 to 93.63, 12.58 to 33.51) (P < 0.05). No significant differences were found in functional scores between the two groups at 6, 12, and 18 months postoperatively (P > 0.05). The magnetic resonance imaging showed no re‐tears, and no difference was observed in the degree of muscle atrophy and fat infiltration between the two groups (P > 0.05). Except for four cases of shoulder stiffness, no other obvious surgery‐related complications were found. Conclusion For Ellman grade II bursal‐side partial‐thickness rotator cuff tears, both the debridement and repair groups achieved good results during 18‐month follow‐ups, with no difference between the two groups.
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Affiliation(s)
- Teng Wang
- Qingdao University, Qingdao, China.,Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhongkai Ren
- Qingdao University, Qingdao, China.,Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xia Zhao
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaomeng Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tengbo Yu
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
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Bushnell BD, Bishai SK, Krupp RJ, McMillan S, Schofield BA, Trenhaile SW, McIntyre LF. Treatment of Partial-Thickness Rotator Cuff Tears With a Resorbable Bioinductive Bovine Collagen Implant: 1-Year Results From a Prospective Multicenter Registry. Orthop J Sports Med 2021; 9:23259671211027850. [PMID: 34409115 PMCID: PMC8366148 DOI: 10.1177/23259671211027850] [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: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Surgical treatment of partial-thickness rotator cuff tears remains challenging and controversial, with several traditional options including debridement with acromioplasty, transtendon or in situ repair, and take-down and repair. A resorbable bioinductive bovine collagen implant has shown promise as an alternative treatment option for partial-thickness tears. Purpose: Data from a registry were analyzed to further establish that the implant contributes to improved patient-reported outcome (PRO) scores across a large number of patients treated for partial-thickness rotator cuff tears. Study Design: Case series; Level of evidence, 4. Methods: A total of 19 centers in the United States enrolled patients >21 years old with partial-thickness tears of the rotator cuff in a comprehensive prospective multicenter registry. PRO scores were recorded preoperatively and postoperatively at 2 and 6 weeks, 3 and 6 months, and 1 year: American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, Veterans RAND 12-Item Health Survey (physical and mental component scores), and Western Ontario Rotator Cuff scores. Revisions were reported throughout the study. Results: The registry included 272 patients with partial-thickness tears (49 grade 1 tears, 101 grade 2 tears, and 122 grade 3 tears), 241 who underwent isolated bioinductive repair (IBR; collagen implant placed after bursectomy without a traditional rotator cuff repair), and 31 who had take-down and repair with bioinductive augmentation. Patients experienced statistically significant and sustained improvement from baseline for all PRO scores beginning at 3 months. Among patients with grade ≥2 tears, those with take-down and repair had significantly inferior scores at 2 and 6 weeks for most PRO scores as compared with those who underwent IBR, but the difference was no longer significant at 1 year for all but the physical component score of the Veterans RAND 12-Item Health Survey. There were 11 revisions, which occurred at a mean ± SD of 188.7 ± 88.0 days after the index surgery. There were no infections. Conclusion: This registry analysis further establishes across a large data set that this resorbable bioinductive bovine collagen implant improves PROs in all grades of partial-thickness tears, whether used as IBR or in conjunction with take-down and repair. IBR may offer improved early clinical outcomes (≤6 weeks) and comparable outcomes at 1 year when compared with a more invasive “take-down and repair” approach.
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Affiliation(s)
| | | | - Ryan J Krupp
- Norton Orthopedic Institute, Louisville, Kentucky, USA
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21
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Does Preoperative Conservative Management Affect the Success of Arthroscopic Repair of Partial Rotator Cuff Tear? Indian J Orthop 2021; 56:289-294. [PMID: 35140860 PMCID: PMC8790001 DOI: 10.1007/s43465-021-00479-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study is to examine the effect of preoperative conservative treatment on the success of high-grade bursal/articular-sided partial rotator cuff repair. METHODS Patients who had undergone shoulder arthroscopy in institution for Ellman Stage 3 bursal-side or articular-side partial tears between January 2008 and April 2018 were investigated retrospectively. This study assessed 201 patients diagnosed with isolated partial rotator cuff tears with a history of failed conservative management and persistent shoulder pain who underwent arthroscopic surgery. The demographic data of patients and pre- and postoperative The American Shoulder and Elbow Surgeons Shoulder Scores (ASES) that were recorded in the archive were evaluated. RESULTS While 55 of the patients with Ellman grade 3 bursal-sided partial tears received preoperative conservative management for at least 6 months (Group 1), 62 of them could not tolerate conservative management and early arthroscopic repair was performed (Group 2). On the other hand, 42 of the patients with Ellman grade 3 articular-sided tears received preoperative conservative management (Group 3), 42 of them could not tolerate preoperative conservative management (Group 4). The mean ASES score improvement was 52.33 ± 8.55 for Group 1, 54.68 ± 11.29 for Group 2, 48.4 ± 7.77 for Group 3 and 49.33 ± 10.05 for Group 4. A statistically significant difference was found between the groups with one-way ANOVA test (p = 0.05). With the Tukey test, this difference was seen to be caused by Group 2. CONCLUSION Although there are many factors affecting its success, conservative management should be the first option in the treatment of partial rotator cuff tears. However, we think that it should not be insisted especially in patients with bursal-sided tears (> 50% of the tendon thickness) that cannot tolerate conservative management due to severe pain since the results of early arthroscopic repair of bursal-sided tears were found to be better. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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22
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Ezell DJ, Malcarney HL. Rotator cuff repair rehabilitation considerations and respective guidelines: a narrative review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:179-185. [PMID: 37588949 PMCID: PMC10426574 DOI: 10.1016/j.xrrt.2021.04.009] [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
Current rotator cuff repair rehabilitation protocols focus on multiple areas, including protecting the healing tissue, optimizing range of motion and strength, and returning the individual to labor demanding and sport-specific tasks. Post-operative rehabilitation timelines with consideration of the tear size remain variable among practitioners. Prognostic factors, healing rates, range of motion timeline, exercise progressions, and guidance on return to sport and work activity are the many factors that can help guide rotator cuff repair rehabilitation and ultimately may reduce failure rates and improve outcomes. The purpose of this narrative review is to outline the multi-factorial nature of rotator cuff pathology and guide treatment based on a multitude of factors.
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23
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Rosinski A, Chen JL, McGahan PJ. A partial articular-sided supraspinatus tear caused by the biceps tendon: A novel etiology of internal impingement. Clin Case Rep 2021; 9:CCR34044. [PMID: 34194749 PMCID: PMC8223686 DOI: 10.1002/ccr3.4044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Impingement of the LHB can directly lead to articular-sided supraspinatus tears. When pain persists despite arthroscopic debridement, we recommend taking the arm out of traction intraoperatively and placing it in the 90-90 position.
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Affiliation(s)
| | - James L. Chen
- Advanced Orthopaedics and Sports MedicineSan FranciscoCAUSA
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24
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Yi D, Lim H, Yim J. Effect of Microcurrent Stimulation on Pain, Shoulder Function, and Grip Strength in Early Post-Operative Phase after Rotator Cuff Repair. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050491. [PMID: 34067980 PMCID: PMC8152281 DOI: 10.3390/medicina57050491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 01/27/2023]
Abstract
Background and Objectives: The purpose of this study was to investigate the effects of microcurrent stimulation on pain, shoulder function, and grip strength in patients with rotator cuff repair. Materials and Methods: This randomized single-blind controlled trial was conducted on inpatients of the rehabilitation department, and included 28 patients who underwent rotator cuff repair. Participants were randomly assigned to the experimental group (n = 14), treated with microcurrent stimulation, and the control group (n = 14), treated with false microcurrent stimulation. The microcurrent stimulation administered to the experimental group underwent general physical therapy and microcurrent stimulation three times a week for 4 weeks. Results: Changes in pain, range of motion in shoulder, simple shoulder test, and grip strength were assessed before and after the intervention. Both groups showed a significant decrease in pain and shoulder function (t = 27.412, 22.079, 19.079, and 18.561; p < 0.001), and grip strength showed a significant increase (t = −8.251 and −9.946; p < 0.001). The experimental group that underwent microcurrent stimulation exhibited a significant effect on pain, shoulder function, and grip strength compared with the control group that underwent false microcurrent stimulation (t = −2.17, −2.22, and 2.213; p = 0.039, 0.035, and 0.036). Conclusions: This study confirmed that microcurrent stimulation is effective for the treatment of rotator cuff repair patients.
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Affiliation(s)
- Donghyun Yi
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul 01795, Korea; (D.Y.); (H.L.)
| | - Hwanyong Lim
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul 01795, Korea; (D.Y.); (H.L.)
| | - Jongeun Yim
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea
- Correspondence: ; Tel.: +82-2-3399-1635
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No Difference in Outcome Between Articular-Sided and Bursal-Sided Tears: Comparative Study With Minimum 2-Year Follow-Up of Arthroscopic Repairs in 104 Patients in a Single-Surgeon Series. Arthroscopy 2021; 37:1449-1454. [PMID: 33429031 DOI: 10.1016/j.arthro.2020.12.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and compare the functional outcomes after arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tears. METHODS We conducted a retrospective analysis of patients who had undergone arthroscopic tear completion and subsequent repair of symptomatic partial-thickness rotator cuff tears in a single institution from 2010 to 2015. Range of motion (ROM) (forward flexion and abduction), the pain score as measured on the Numeric Pain Rating Scale, and outcome scores (Constant-Murley score, University of California, Los Angeles shoulder score, and Oxford Shoulder Score) were calculated preoperatively and at 1 year and 2 years postoperatively. The delta difference was calculated for each outcome parameter at the respective follow-up points as the difference from the preoperative baseline score. RESULTS A total of 104 patients were included. All tears involved the supraspinatus tendon and did not exceed 2 cm. Of the patients, 65 had an articular-sided tear (AST) whereas 39 had a bursal-sided tear (BST). The mean age of the patients was 53.4 years in the AST group and 55.8 years in the BST group. The AST and BST groups did not differ preoperatively in terms of age, sex, and the measured outcome parameters. Postoperatively, the patients in both groups achieved statistically significant improvement in pain relief and functional outcomes at 2 years. No statistically significant difference was observed between the 2 groups in terms of the delta-difference outcomes in ROM in forward flexion (P = .781) or abduction (P = .348), pain score (P = .187), Constant-Murley score (P = .186), University of California, Los Angeles shoulder score (P = .911), and Oxford Shoulder Score (P = .186) at 2 years. CONCLUSIONS Partial-thickness rotator cuff tears treated with arthroscopic tear completion and subsequent repair achieved good outcomes in terms of ROM, functional outcomes, and pain relief at 2 years. There was no difference in outcomes regardless of whether the location of the tear was articular sided or bursal sided. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Tokish JM, Hawkins RJ. Current concepts in the evolution of arthroscopic rotator cuff repair. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:75-83. [PMID: 37588146 PMCID: PMC10426701 DOI: 10.1016/j.xrrt.2021.01.004] [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
Arthroscopic rotator cuff repair has become one of the most common and successful surgeries performed in orthopedics. It represents the culmination of advances in many diverse fields such as optics, fluid dynamics, mechanical engineering, and most recently, orthobiologics. This article reviews the current state of the art of arthroscopic rotator cuff repair, through the lens of its historical context and evolution to our present understanding. We review the limitations in the current approach, and glance toward the future of rotator cuff regeneration with emerging technologies.
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Gu J, Dai B, Shi X, He Z. Clinical short-term outcomes of articular-sided and bursal-sided partial-thickness rotator cuff tears of less than 50% in a single surgeon series: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e24965. [PMID: 33725860 PMCID: PMC7969290 DOI: 10.1097/md.0000000000024965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There have been no published randomized clinical trial to assess the clinical outcomes between the articular-sided and bursal-sided tears. Therefore, a comparative analysis of evaluating and comparing the functional outcomes following arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tearsis essential. METHODS This study is a present randomized controlled trial which is conducted in our hospital. Consecutive patients with symptomatic articular-sided or bursal-sided partial-thickness rotator cuff tears underwent arthroscopic repair between June 2020 and January 2022. The institutional review board approved the study proposal (with number 10012030), and informed consent was obtained from all patients. Inclusion criteria were existence of an articular- or bursal-sided tear involving <50% of the tendon thickness-confirmed intraoperatively and treated with arthroscopic debridement with or without other decompression surgery (acromioplasty/distal clavicle resection)-and a minimum follow-up of 2 years. All patients followed the same postoperative rehabilitation program. The patients were assessed at baseline preoperatively, and at 1 year and 2 years postoperatively. Outcome parameters were measured at each respective follow-up, which included active range of motion in forward flexion and abduction of the affected shoulder, pain score as measured on the Numeric Pain Rating Scale, as well as outcome scores in terms of the Constant-Murley Score, and Oxford Shoulder Score. RESULTS Table 1 and Table 2 describe the data indicators that this article wants to evaluate and collect. CONCLUSIONS We hypothesize that both groups of patients will show improvement in range of motion, functional outcome scores, and pain at 2 years, and that results would be similar between the two groups. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6496).
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Brockmeyer M, Haupert A, Lausch AL, Wagenpfeil G, Stroeder J, Schneider G, Kohn D, Lorbach O. Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up. Orthop J Sports Med 2021; 9:2325967120985106. [PMID: 33738311 PMCID: PMC7934052 DOI: 10.1177/2325967120985106] [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: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/04/2022] Open
Abstract
Background: The best surgical treatment option for symptomatic moderate- to high-grade articular-sided partial-thickness rotator cuff tears (PTRCTs) is still controversial. Purpose/Hypothesis: The purpose of this study was to evaluate patient-reported and clinical outcomes and tendon integrity after arthroscopic debridement or repair for PTRCTs at a minimum of 2 years postoperatively. We hypothesized that the overall outcomes would be positive, showing pain relief, good shoulder function, and high tendon integrity. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 30 patients (16 men, 14 women; mean age, 51 years) who underwent arthroscopic treatment for symptomatic PTRCTs (Ellman grades 2 and 3). Debridement was performed in 15 patients, and arthroscopic tendon repair was performed in the remaining 15 patients. Patients completed the Constant score; American Shoulder and Elbow Surgeons (ASES) shoulder score; Western Ontario Rotator Cuff Index; Simple Shoulder Test; and visual analog scale (VAS) for pain, function, and satisfaction. In addition, patients were examined clinically (range of motion, impingement tests, rotator cuff tests, and tests for the long head of the biceps tendon), and morphologic assessment of rotator cuff integrity was performed using direct magnetic resonance arthrography and was classified according to Sugaya. Results: The mean follow-up period was 55 months. The patient-reported outcome measures showed high patient satisfaction, reduction in persistent pain, and good shoulder function. Linear regression analysis showed that the debridement group had significantly better results on the Constant (bias-corrected and accelerated [BCa] 95% CI, 4.20-26.30), ASES (BCa 95% CI, 5.24-39.26), and VAS (pain: BCa 95% CI, 0.13-3.62; function: BCa 95% CI, 1.04-4.84; satisfaction: BCa 95% CI, 0.14-6.28) scores than did the repair group. At follow-up, there was no significant difference between the groups in clinical testing results. Good supraspinatus tendon integrity was seen in most patients: Sugaya classification grade 1 in 13 patients, grade 2 in 11 patients, and grade 3 in 6 patients. Conclusion: Midterm results after arthroscopic debridement and repair for PTRCTs showed high patient satisfaction, good shoulder function, and high tendon integrity for both procedures. Patients who underwent arthroscopic debridement had higher Constant, ASES, and VAS scores compared with patients who underwent tendon repair.
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Affiliation(s)
- Matthias Brockmeyer
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Alexander Haupert
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Anna-Lena Lausch
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jonas Stroeder
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Guenther Schneider
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Dieter Kohn
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Olaf Lorbach
- Department of Shoulder Surgery and Sports Traumatology, Schön Klinik Lorsch, Lorsch, Germany
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Moorthy V, Chen JY, Lee M, Ang BFH, Lie DTT. The UCLA Shoulder Score Is a Better Predictor of Treatment Success Than the Constant and Oxford Shoulder Scores After Arthroscopic Rotator Cuff Repair: A 2-Year Follow-Up Study. Arthrosc Sports Med Rehabil 2021; 3:e485-e490. [PMID: 34027459 PMCID: PMC8129435 DOI: 10.1016/j.asmr.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to determine the correlation between functional outcome scores and treatment success after arthroscopic rotator cuff repair. Methods We conducted a retrospective cohort study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2010 and 2015. University of California at Los Angeles Shoulder Score (UCLASS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) were measured before and at 6, 12, and 24 months after surgery. Patients were divided into 2 groups at each follow-up: (1) those with successful treatment and (2) those with unsuccessful treatment. Treatment success was defined as simultaneous fulfilment of 3 criteria: clinically significant improvement in pain, expectations for surgery met, and patient satisfied with surgery. Results A total of 214 subjects met the inclusion criteria. UCLASS was a consistent significant predictor of treatment success at 6 months (odds ratio [OR] 1.192, P = .005, 95% confidence interval [CI] 1.054-1.348), 12 months (OR 1.274, P < .001, 95% CI 1.153-1.406), and 24 months (OR 1.266, P < .001, 95% CI 1.162-1.380). Lower preoperative CSS was significant in predicting treatment success at 6 months (OR 0.952, P = .001, 95% CI 0.926-0.979), while larger tear size was significant in predicting treatment success at 24 months (OR 1.773, P = .043, 95% CI 1.019-3.083). Conclusion UCLASS is a better tool for predicting treatment success than CSS and OSS in patients undergoing arthroscopic rotator cuff repair, up to a minimum of 24 months’ follow-up. A holistic assessment of shoulder function, taking into account both subjective and objective evaluation of function, as well as patient-reported satisfaction, is important in determining treatment success after arthroscopic rotator cuff repair. Level of Evidence III, retrospective comparative study.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | | | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Ravenscroft M, Barnes MW, Muench LN, Mazzocca AD, Berthold DP. Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft as a Surgical Solution for the Treatment of Massive Irreparable Rotator Cuff Tears. Arthrosc Tech 2021; 10:e877-e885. [PMID: 33738228 PMCID: PMC7953327 DOI: 10.1016/j.eats.2020.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/01/2020] [Indexed: 02/03/2023] Open
Abstract
Massive, irreparable rotator cuff tears in patients without severe signs of osteoarthritis remains a major challenge for orthopaedic surgeons. These can be a source of significant pain and functional loss occurring most commonly in a relatively frail, elderly patient population. A plethora of surgical techniques covering minimally invasive, arthroscopic techniques and open, salvage procedures have been described for this challenging patient cohort. Continuous evolvement of arthroscopic techniques has led to all-arthroscopic superior capsular reconstruction techniques using allografts, thereby reducing donor side morbidity along with decreased soft tissue dissection. However, conventional superior capsular reconstruction is noted to be a technically complex, time-consuming, and high-cost surgery, which may put this technique beyond the confidence of many shoulder surgeons. The subacromial balloon spacer has emerged as a potential solution in these patients, providing interposition between the humeral head and acromion. However, the subacromial balloon biodegrades rapidly and its effect is only temporary. Thus this technique article presents using an acellular human dermal allograft to reconstruct the bursal layer, which is normally interposed between the humeral head and the acromion. The proposed technique provides a permanent interposition graft preventing humeral acromial contact, which does not undergo rapid biodegradation. The surgical technique is technically feasible, both minimizing surgical time and therefore operative risk to the patient.
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Affiliation(s)
- Matt Ravenscroft
- Orthteam Centre, Manchester, England
- Address correspondence to Matt Ravenscroft, F.R.C.S., BMI Alexandra, Mill Lane, Cheadle, England SK8 2PX.
| | | | - 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
| | - 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
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Andrews JR, Elbayar JH, Jordan SE. Partial-Rotator Cuff Tears in Throwing Athletes. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fama G, Tagliapietra J, Belluzzi E, Pozzuoli A, Biz C, Ruggieri P. Mid-Term Outcomes after Arthroscopic "Tear Completion Repair" of Partial Thickness Rotator Cuff Tears. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:74. [PMID: 33477332 PMCID: PMC7829759 DOI: 10.3390/medicina57010074] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
Background and Objectives: Different arthroscopic procedures are used for partial-thickness rotator cuff tears (PT-RCTs), but there is still no evidence on the superiority of one procedure over the other. The aim of this study was to evaluate the clinical outcomes and the rate of complications of a tear completion repair (TCR) technique. Materials and Methods: Patients who had undergone arthroscopic TCR technique for PT-RCTs with a follow-up of at least 2-years after surgery were included. The TCR technique involved the removal of the "critical zone" and creating microfractures to biologically support tendon healing. Functional outcomes were assessed prospectively by the Constant score (CS) and active and passive range of movement (ROM). Pain and patient satisfaction were measured using a visual analog scale (VAS). Complication rates were recorded, and tendon integrity was assessed with magnetic resonance imaging (MRI) or ultrasound performed at least 2-years after surgery. Results: Eighty-seven patients with a median age of 57 years were followed-up for a median of 5 years. The CS score improved from 53.5 preoperatively to 94.0 postoperatively (p < 0.001). Median VAS score decreased from 8.6 to 1.0 (p < 0.0001). Median patient satisfaction was 9.3. The overall complication rate was 14.9%. Conclusions: Patients with PT-RCTs of the supraspinatus tendon treated by the TCR technique with "critical zone" removal and biological stimulation by microfractures showed good functional results with excellent strength recovery, a high degree of patient satisfaction, and resolution of painful symptoms at mid-term follow-up.
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Affiliation(s)
- Giuseppe Fama
- Orthopaedic Clinic, UOC Azienda Ospedaliera of Padova, 35128 Padova, Italy; (G.F.); (P.R.)
| | - Jacopo Tagliapietra
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (J.T.); (A.P.)
| | - Elisa Belluzzi
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (J.T.); (A.P.)
- Musculoskeletal Pathology and Oncology Laboratory, Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Assunta Pozzuoli
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (J.T.); (A.P.)
- Musculoskeletal Pathology and Oncology Laboratory, Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Carlo Biz
- Orthopaedic Clinic, UOC Azienda Ospedaliera of Padova, 35128 Padova, Italy; (G.F.); (P.R.)
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (J.T.); (A.P.)
| | - Pietro Ruggieri
- Orthopaedic Clinic, UOC Azienda Ospedaliera of Padova, 35128 Padova, Italy; (G.F.); (P.R.)
- Orthopaedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (J.T.); (A.P.)
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Felsch Q, Mai V, Durchholz H, Flury M, Lenz M, Capellen C, Audigé L. Complications Within 6 Months After Arthroscopic Rotator Cuff Repair: Registry-Based Evaluation According to a Core Event Set and Severity Grading. Arthroscopy 2021; 37:50-58. [PMID: 32835815 DOI: 10.1016/j.arthro.2020.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To report complications after arthroscopic rotator cuff repairs (ARCRs) in a large patient cohort based on clinical application of a newly defined core event set (CES) and severity grading. METHODS Consecutive primary ARCRs documented in a local clinical registry between February 2010 and September 2016 were included. Clinicians documented adverse events (AEs) reported until the final, 6-month postoperative follow-up according to the CES. The CES is an organized list of relevant AEs sorted into 3 intraoperative event groups (device, osteochondral, and soft tissue) and 9 postoperative event groups (device, osteochondral, pain, rotator cuff, surgical-site infection, peripheral neurologic, vascular, superficial soft tissue, and deep soft tissue). Severity was determined using an adaptation of the Clavien-Dindo classification. Cumulative complication risks were calculated per event group and stratified by severity and rotator cuff tear extent. RESULTS A total of 1,661 repairs were documented in 1,594 patients (mean age, 57 years [standard deviation, 9 years]; 38% women); 21% involved partial tears. All events were recorded according to the CES. Intraoperative events occurred in 2.2% of repairs. We identified 329 postoperative events in 307 repairs (305 patients); 93% had 1 AE. The cumulative AE risk at 6 months was 18.5%; AE risks were 21.8% for partial tears, 15.8% for full-thickness single-tendon tears, 18.0% for tears with 2 ruptured tendons, and 25.6% for tears with 3 ruptured tendons. AE risks per event group were as follows: 9.4% for deep soft tissue, with shoulder stiffness (7.6%) being the most common event; 3.4% for persistent or worsening pain; 3.1% for rotator cuff defects; 1.7% for neurologic lesions; 0.8% for surgical-site infection; 0.7% for device; 0.4% for osteochondral; 0.2% for superficial soft tissue, and 0.1% for vascular. Most AEs had severity grades I (160 [49%]) and II (117 [36%]). CONCLUSIONS Comprehensive local AE documentation according to the CES and severity grading was possible and showed that about one-fifth of ARCRs were affected, mostly by one AE of low severity. Shoulder stiffness was the most frequent event. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Quinten Felsch
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Victoria Mai
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Holger Durchholz
- Research and Development, Schulthess Klinik, Zurich, Switzerland; Klinik Gut, St Moritz, Switzerland
| | - Matthias Flury
- Center for Orthopedics & Neurosurgery, In-Motion, Wallisellen, Switzerland
| | - Maximilian Lenz
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Carl Capellen
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Laurent Audigé
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland; Research and Development, Schulthess Klinik, Zurich, Switzerland; Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland.
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Arthroscopic repair of partial articular supraspinatus tendon avulsion lesions by conversion to full-thickness tears through a small incision. Chin J Traumatol 2020; 23:336-340. [PMID: 32768290 PMCID: PMC7718524 DOI: 10.1016/j.cjtee.2020.07.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/26/2020] [Accepted: 06/08/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion (PASTA) lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair. METHODS We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of (54.7 ± 11.4) years from March 2013 to July 2017. Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study. The tears were confirmed via arthroscopy, and a polydioxanone suture was placed to indicate the position of each tear. A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear. The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor. Data were analyzed using a paired Student's t-test with statistical significance defined as p <0.05. RESULTS At the final follow-up of 2 years, the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery (p < 0.001). The postoperative American Shoulder and Elbow Surgeons shoulder score was (90.6 ± 6.2), which was significantly higher than the preoperative score of (47.9 ± 8.3) (p < 0.001). The University of California at Los Angeles shoulder rating scale score increased from (14.7 ± 4.1) prior to surgery to (32.6 ± 3.4) points after surgery (p < 0.001). No patient had joint stiffness. CONCLUSION This modified tear completion repair, by conversion to full-thickness tears through a small incision, has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions. This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.
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Chen Y, Xu Y, Li M, Shi Q, Chen C. Application of Autogenous Urine-Derived Stem Cell Sheet Enhances Rotator Cuff Healing in a Canine Model. Am J Sports Med 2020; 48:3454-3466. [PMID: 33136424 DOI: 10.1177/0363546520962774] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A repaired rotator cuff (RC) often heals with interposed scar tissue, making repairs prone to failure. Urine-derived stem cells (USCs), with robust proliferation ability and multilineage differentiation, can be isolated from urine, avoiding invasive and painful surgical procedures for harvesting the cells. These advantages make it a novel cell source for autologous transplantation to enhance RC healing. HYPOTHESIS Implantation of an autogenous USC sheet to the injury site will enhance RC healing. STUDY DESIGN Controlled laboratory study. METHODS USCs isolated from urine were cultured using ascorbic acid and transforming growth factor β3 to form a cell sheet. Sixteen male mature beagles underwent bilateral shoulder surgery. The right shoulder underwent infraspinatus tendon (IT) insertion detachment and repair only, and the other was subjected to IT insertion detachment and repair, followed by autogenous USC sheet implantation. Among the animals, 3 received a Dil (1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate)- labeled USC sheet implant in the right shoulder and were sacrificed at postoperative 6 weeks for cell tracking. The other animals were sacrificed at postoperative 12 weeks, and the IT-humerus complexes were harvested for gross observation, micro-computed tomography evaluation and histological analysis (n = 5), and mechanical testing (n = 8). Additionally, 13 unpaired canine cadaveric shoulders were included as native controls. RESULTS Micro-computed tomography analysis showed that the USC sheet group had a significant increase in bone volume/total volume and trabecular thickness at the RC healing site when compared with the control group (P < .05 for all). Histologically, the Dil-labeled USC sheet was still visible at the RC healing site, which suggested that the implanted USCs remained viable at postoperative 6 weeks. Meanwhile, the healing interface in the USC sheet group regenerated significantly more enthesis-like tissue than did that of the control group (P < .05). Additionally, the healing interface in the USC sheet group presented a larger fibrocartilage area, more proteoglycan deposition, and higher collagen birefringence than did that of the control group (P < .05 for all). Biomechanically, the USC sheet group showed significantly higher failure load and stiffness versus the control group (P < .05 for all). CONCLUSION A USC sheet was able to enhance RC healing in a canine model. CLINICAL RELEVANCE The findings of the study showed that USC sheet implantation could serve as a practical application for RC healing.
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Affiliation(s)
- Yang Chen
- Department of Sport Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Xu
- Department of Sport Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Muzhi Li
- Department of Sport Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Shi
- Department of Sport Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
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A comparative study of arthroscopic débridement versus repair for Ellman grade II bursal-side partial-thickness rotator cuff tears. J Shoulder Elbow Surg 2020; 29:2072-2079. [PMID: 32499197 DOI: 10.1016/j.jse.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/22/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023]
Abstract
HYPOTHESIS We aimed to report the clinical outcomes of arthroscopic débridement vs. repair for Ellman grade II bursal-side partial-thickness rotator cuff tears. METHODS Patients who presented with Ellman grade II bursal-side partial-thickness rotator cuff tears from September 2015 to August 2017 were included. On the basis of preoperative findings and patient preference, 20 patients underwent débridement whereas 26 underwent arthroscopic repair. The visual analog scale (VAS), Constant-Murley shoulder, American Shoulder and Elbow Surgeons, and University of California-Los Angeles scores were assessed. Magnetic resonance imaging and B-mode ultrasonography were performed preoperatively and at 6, 12, and 24 months postoperatively. RESULTS All 46 patients were available throughout follow-up. At 2 years postoperatively, the VAS score had improved from 6.42 ± 1.56 to 0.65 ± 0.51 in the débridement group and from 6.26 ± 1.32 to 0.75 ± 0.42 in the repair group. The VAS score differed significantly between the 2 groups at 6 months postoperatively. All patient-reported outcomes improved in both groups. The American Shoulder and Elbow Surgeons score (P = .009), Constant-Murley shoulder score (P = .014), and University of California-Los Angeles score (P = .030) differed significantly between the 2 groups (higher in the débridement group) at 6 months postoperatively. Finally, 44 patients having intact tendon repairs with no interval worsening of partial-thickness tears underwent postoperative scheduled magnetic resonance imaging and B-mode ultrasonography examinations. CONCLUSION Arthroscopic débridement and repair of Ellman grade II bursal-side partial-thickness rotator cuff tears achieved comparable clinical scores and low retear rates during 2 years of follow-up. However, débridement achieved better results, especially within 6 months postoperatively, and achieved a favorable prognosis up to 2 years postoperatively.
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Kaptan AY, Ulucaköy C, Özer M, Çetinkaya M, Ayanoğlu T, Ataoğlu MB, Kanatlı U. Partial and full-thickness rotator cuff tears in patients younger than 45 years. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:478-482. [PMID: 33155555 DOI: 10.5152/j.aott.2020.19154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age. METHODS Fifty patients (26 women and 24 men; mean age: 41.4±3.96 years; range: 31-45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems. RESULTS At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p<0.01). The mean ASES and UCLA scores improved significantly to 70.7 and 25.3, respectively, in the bursal-side group (p<0.01). The mean ASES and UCLA scores improved significantly to 75.3 and 27.1, respectively, in the joint-side group (p<0.01). There were no significant differences between the groups according to the postoperative ASES score (p>0.06) and UCLA score (p<0.37). CONCLUSION The arthroscopic repair of the joint-sided tears and bursal-sided tears has good functional outcomes as full thickness rotator cuff tears, and the surgical option should be considered in younger population if the conservative treatment fails. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Ahmet Yiğit Kaptan
- Department of Orthopaedics and Traumatology, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Coşkun Ulucaköy
- Department of Orthopaedics and Traumatology, Dr. Abdurrahman Yurtaslan Onkology Hospital, Ankara, Turkey
| | - Mustafa Özer
- Department of Orthopaedics and Traumatology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Mehmet Çetinkaya
- Spinal Unit of Orthopaedics and Traumatology, University of Stellenbosch Tygerberg Academic Hospital, Cape Town, South Africa
| | - Tacettin Ayanoğlu
- Clinic of Orthopaedics and Traumatology, Yozgat State Hospital, Yozgat, Turkey
| | - Muhammet Baybars Ataoğlu
- Department of Orthopaedics and Traumatology, Gazi University, School of Medicine, Ankara, Turkey
| | - Ulunay Kanatlı
- Department of Orthopaedics and Traumatology, Gazi University, School of Medicine, Ankara, Turkey
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Tennent D, Green G. Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence. Shoulder Elbow 2020; 12:253-264. [PMID: 32788930 PMCID: PMC7400714 DOI: 10.1177/1758573219864101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Partial articular sided rotator cuff tears are described as being a common cause of shoulder pain and to have a significant impact of patient quality of life. The natural history of partial articular supraspinatus tendon avulsion lesions is not clearly defined and there is limited evidence to determine optimal management. AIMS To perform a systematic review of the literature regarding the evidence for partial articular supraspinatus tendon avulsion repair and to determine whether there is any difference between operative and non-operatively managed patients. METHODS Conventional and grey literature were searched with defined terms to identify studies in human adults concerning management of partial articular sided supraspinatus avulsions. RESULTS Out of 86 papers identified by the search terms, 28 were deemed eligible for review including 1966 shoulders. 4/28 papers were of level I-II evidence but all were comparing techniques. 4/28 papers were biomechanical cadaveric studies, assessing strength of repair and effect on stability. The remaining 20 studies were level IV-V evidence and consisted of case series and technical notes identifying varying techniques of repair and their outcomes. CONCLUSION Current literature suggests that all techniques used to repair partial articular supraspinatus tendon avulsion lesions give increased functional scores and reduced pain. However, this represents a heterogeneous group of patients with variable degrees of tear and is not reproducible. There are limited controlled studies to determine whether partial articular supraspinatus tendon avulsion lesions require repair. Current classification systems represent a single plane and are open to user variation. No evidence exists to determine which tears are stable and which may progress.
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Affiliation(s)
- Duncan Tennent
- Duncan Tennent, St George's Hospital, Blackshaw Rd, London SW17 0QT, UK.
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Zafra M, Uceda P, Muñoz-Luna F, Muñoz-López RC, Font P. Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study. Arch Orthop Trauma Surg 2020; 140:1065-1071. [PMID: 32170453 DOI: 10.1007/s00402-020-03387-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of this prospective study was to compare the clinical and structural findings following the arthroscopic repair of partial-thickness (exceeding 50%) articular-sided rotator cuff tears using either a single-row or a double-row suture bridge fixation. MATERIALS AND METHODS Fifty patients were included in this study. The patients were randomly placed into two groups: 25 underwent the single-row (Group I) and 25 a double-row suture bridge fixation (Group II). The clinical outcomes were assessed using ASES and Constant shoulder scores, both preoperatively and at the end of follow-up. The pain level was evaluated using the visual analogue scale (VAS), preoperatively, at 6 months and at the end of follow-up. All patients underwent preoperative MRI to identify the rotator cuff tear, and postoperatively at 12 months to evaluate tendon integrity. RESULTS The average follow-up was 32.5 months. The mean ASES scores increased from 35.9 to 96.7 in Group I and from 35.3 to 93.4 in Group II; the mean Constant shoulder scores increased from 55.6 to 97.8 in Group I and from 57.5 to 97.3 in Group II. There were no significant differences between the two groups. The average preoperative pain level decreased from 7.4 to 3 at 6 months and to 0.4 at the end of the Group I; and from 7.6 to 3 at 6 months and 0.8 in Group II. There was no significant difference between the two groups. At 12 months, the MRI assessments showed two retears in Group I (8%) and one retear in Group II (4%). CONCLUSION Arthroscopic repair of partial-thickness articular rotator cuff tears that exceed 50% of tendon thickness with a single-row transtendon repair or double-row suture bridge provides functional improvement and pain relief regardless of the repair technique used. There were no differences in clinical results between both techniques. LEVEL OF EVIDENCE Level II; prospective comparative study.
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Affiliation(s)
- Manuel Zafra
- Hospital Quirón, Instituto de Traumatología, Avda. del Aeropuerto, 14005, Córdoba, Spain
| | - Pilar Uceda
- Hospital Quirón, Instituto de Traumatología, Avda. del Aeropuerto, 14005, Córdoba, Spain. .,, Isla Hierro St Number 14, 14011, Córdoba, Spain.
| | | | - Rafael C Muñoz-López
- Hospital Quirón, Instituto de Traumatología, Avda. del Aeropuerto, 14005, Córdoba, Spain
| | - Pilar Font
- IMIBIC, Universidad de Córdoba, Córdoba, Spain
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Sconfienza LM, Albano D, Messina C, Gitto S, Guarrella V, Perfetti C, Taverna E, Arrigoni P, Randelli PS. Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study. J Clin Med 2020; 9:jcm9072114. [PMID: 32635548 PMCID: PMC7408901 DOI: 10.3390/jcm9072114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background: We prospectively tested technical feasibility and clinical outcome of percutaneous ultrasound-guided tenotomy of long head of biceps tendon (LHBT). Methods: We included 11 patients (6 women; age: 73 ± 8.6 years) with symptomatic full-thickness rotator cuff tear and intact LHBT, in whom surgical repair was not possible/refused. After ultrasound-guided injection of local anesthetic, the LHBT was cut with a scalpel under continuous ultrasound monitoring until it became no longer visible. Pain was recorded before and at least six months after procedure. An eight-item questionnaire was administered to patients at follow-up. Results: A median of 4 tendon cuts were needed to ensure complete tenotomy. Mean procedure duration was 65 ± 5.7 s. Mean length of skin incision was 5.8 ± 0.6 mm. Pre-tenotomy VAS score was 8.2 ± 0.7, post-tenotomy VAS was 2.8 ± 0.6 (p < 0.001). At follow-up, 5/11 patients were very satisfied, 5/11 satisfied and 1/11 neutral. One patient experienced cramping and very minimal pain in the biceps. Six patients had still moderate shoulder pain, 1/11 minimal pain, 2/11 very minimal pain, while 2/11 had no pain. No patients had weakness in elbow flexion nor limits of daily activities due to LHBT. One patient showed Popeye deformity. All patients would undergo ultrasound-guided tenotomy again. Conclusion: ultrasound-guided percutaneous LHBT tenotomy is technically feasible and effective.
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (L.M.S.); (C.M.); (V.G.); (C.P.); (E.T.)
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy; (S.G.); (P.S.R.)
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (L.M.S.); (C.M.); (V.G.); (C.P.); (E.T.)
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127 Palermo, Italy
- Correspondence: ; Tel.: +390266214004
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (L.M.S.); (C.M.); (V.G.); (C.P.); (E.T.)
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy; (S.G.); (P.S.R.)
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy; (S.G.); (P.S.R.)
| | - Vincenzo Guarrella
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (L.M.S.); (C.M.); (V.G.); (C.P.); (E.T.)
| | - Carlo Perfetti
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (L.M.S.); (C.M.); (V.G.); (C.P.); (E.T.)
| | - Ettore Taverna
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (L.M.S.); (C.M.); (V.G.); (C.P.); (E.T.)
| | | | - Pietro Simone Randelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy; (S.G.); (P.S.R.)
- ASST Pini-CTO, 20122 Milano, Italy;
- RECAP-RD, Università degli Studi di Milano, 20133 Milano, Italy
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Abstract
After failed conservative management, operative intervention is typically indicated for patients with partial-thickness rotator cuff tears (PTRCTs) with persistent pain and disability symptoms. For PTRCTs involving < 50% of the tendon thickness, debridement with or without acromioplasty resulted in favourable outcomes in most studies. For PTRCTs involving > 50% of the tendon thickness, in situ repair has proven to significantly improve pain and functional outcomes for articular and bursal PTRCTs. The few available comparative studies in the literature showed similar functional and structural outcomes between in situ repair and repair after conversion to full-thickness tear for PTRCTs. Most non-overhead athletes return to sports at the same level as previous to the injury after in situ repair of PTRCTs. However, rates of return to preinjury level of competition for overhead athletes have been generally poor regardless of the utilized technique. During long-term follow-up, arthroscopic in situ repair of articular and bursal PTRCTs produced excellent functional outcomes in most patients, with a low rate of revision.
Cite this article: EFORT Open Rev 2020;5:138-144. DOI: 10.1302/2058-5241.5.190010
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Affiliation(s)
- Luciano A Rossi
- Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
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Kanatlı U, Ayanoğlu T, Ataoğlu MB, Özer M, Çetinkaya M, Eren TK. Midterm outcomes after arthroscopic repair of partial rotator cuff tears: A retrospective study of correlation between partial tear types and surgical technique. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:196-201. [PMID: 32254036 DOI: 10.5152/j.aott.2020.02.486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients who underwent arthroscopic repair for partial rotator cuff tears were evaluated retrospectively. This study purposed to assess the postoperative clinical results of arthroscopic treatment of intratendinous rotator cuff tears and to investigate the effect of the tear type on the postoperative clinical outcomes. METHODS Overall, 60 patients [36 women and 24 men; mean age: 48.6±12.2 years (range 33-67 years)] who underwent arthroscopic repair of Ellman stage 3 partial rotator cuff tear were evaluated retrospectively. These patients were grouped into the following three groups: articular-sided tears, bursal-sided tears, and intratendinous tears, with 20 patients included in each group. Subacromial decompression, acromioplasty, and tear repair without transforming to full-thickness tear were applied to the bursal-sided tears. The same technique was performed for intratendinous ruptures, with the only technical difference was that the capsular tissue was preserved during debridement of intratendinous tears. The articular-sided tears were transformed to complete tears and repaired arthroscopically. The preoperative and postoperative ASES scores and range of motion improvements were evaluated in all patients. The mean follow-up time was 44±6.5 months (range: 36-62 months). RESULTS No significant intergroup differences were observed concerning the age and the mean follow-up duration (p=0.524, p=0.665). A similar increase in ASES scores was observed for all three types of tears (bursal-sided tears: 31.09-82.65; articular-sided tears: 35.50--84.00; intratendinous tears: 34.01-83.49). Statistically, no significant intergroup difference was observed concerning ASES score improvement (p=0.585). An increase in mean forward flexion, abduction, and external rotation were observed, especially, a statistically significant increase in flexion (p=0.001) and abduction (p=0.001) in all three types of tears. No patient experienced any intraoperative or postoperative complications. CONCLUSION The results of arthroscopic treatment of intratendinous tears were similar to the other types of partial tears, and the results of arthroscopic treatment of grade 3 partial rotator cuff tears revealed satisfactory outcomes, regardless of the type of the tear. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Ulunay Kanatlı
- Department of Orthopedics and Traumatology, Gazi University, School of Medicine, Ankara, Turkey
| | - Tacettin Ayanoğlu
- Department of Orthopaedics and Traumatology, Abant İzzet Baysal University, School of Medicine, Bolu, Turkey
| | | | - Mustafa Özer
- Department of Orthopedics and Traumatology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Mehmet Çetinkaya
- Department of Orthopedics and Traumatology, Erzincan Mengücek Gazi Research Hospital, Erzincan, Turkey
| | - Toygun Kağan Eren
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
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Abstract
The cause of rotator cuff tears is multifactorial with both intrinsic and extrinsic contributing factors. Understanding the normal MR anatomy of the rotator cuff and using an appropriate search pattern can help readers identify common pathologic conditions. Accurate designation using classification systems for tear thickness, size, and degree of retraction and muscle fatty infiltration and atrophy are important in guiding surgical management. Knowledge of common disease locations for the rotator cuff tendons can help focus reader searches and increase sensitivity.
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Affiliation(s)
- Erin McCrum
- Division of Musculoskeletal Imaging, Department of Radiology, Duke University Medical Center, Duke University, Box 3808, Durham, NC 27707, USA.
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Lindeman RW, Field LD. Arthroscopic Identification of Partial-Thickness Rotator Cuff Tears. Arthrosc Tech 2019; 8:e1233-e1237. [PMID: 32042578 PMCID: PMC7000315 DOI: 10.1016/j.eats.2019.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/25/2019] [Indexed: 02/03/2023] Open
Abstract
Partial-thickness rotator cuff tears are among the most common challenges faced by orthopaedic surgeons today. The ability to adequately manage these injuries depends on identifying their full extent during arthroscopic evaluation. There are many ways to fully visualize these tears, including arm positioning and gentle debridement. The purpose of this article is to highlight several tips and techniques to enable full visualization of partial-thickness rotator cuff tears to determine appropriate treatment.
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Affiliation(s)
| | - Larry D. Field
- Address correspondence to Dr. Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, Jackson, MS 39202, U.S.A.
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Heffernan JT, Wu VJ, Mulcahey MK, O'Brien MJ, Savoie FH. Double Row-Equivalent PASTA Repair Technique. Arthrosc Tech 2019; 8:e905-e910. [PMID: 31700785 PMCID: PMC6823870 DOI: 10.1016/j.eats.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/14/2019] [Indexed: 02/03/2023] Open
Abstract
Articular surface partial rotator cuff tendon tears are a common source of shoulder pain and dysfunction, and there is no consensus regarding the optimal arthroscopic treatment. Commonly accepted techniques, such as transtendinous repair or tear takedown with primary repair, may violate healthy tendon tissue and increase the suture anchor density. In this note, we describe an outside-in double row-equivalent technique for repair of partial articular-sided rotator cuff tears. A medial row of inverted horizontal mattress stitches is placed percutaneously using spinal needles to shuttle partially absorbable braided sutures into the joint. The technique may incorporate a soft tissue biceps tenodesis into the rotator cuff with a second, oblique medial row mattress stitch. Suture limbs are retrieved and tied in the subacromial space and then secured to a lateral anchor. The result is a side-to-side double row-equivalent rotator cuff repair, anatomically reproducing the footprint of the rotator cuff without removing healthy tissue. We believe this is an efficient and reproducible technique that preserves intact bursal tissue, limits implant costs, and produces reliable healing in partial articular-sided tears of the rotator cuff.
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Affiliation(s)
| | | | | | | | - Felix H. Savoie
- Address correspondence to Felix H. Savoie III, M.D., Department of Orthopedic Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, U.S.A.
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Patient-Reported Outcomes After Use of a Bioabsorbable Collagen Implant to Treat Partial and Full-Thickness Rotator Cuff Tears. Arthroscopy 2019; 35:2262-2271. [PMID: 31350082 DOI: 10.1016/j.arthro.2019.02.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/31/2019] [Accepted: 02/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To collect outcomes data on patients treated with a bioinductive collagen implant designed to induce rotator cuff healing in partial- and full-thickness cuff tears and to assess the safety and efficacy of the device. METHODS Fifteen surgeons in 15 centers in the United States enrolled patients between April 2016 and August 2017 and collected standardized outcomes data. Patients 21 years of age and older, able to read and speak English, and with partial- or full-thickness tears of the rotator cuff documented by magnetic resonance imaging were included in the study. Patients were assessed preoperatively with visual analogue scale (VAS), single-assessment numeric evaluation (SANE), Veterans RAND 12-Item (VR-12), American Shoulder and Elbow Surgeons (ASES), and Western Ontario Rotator Cuff (WORC) outcomes measures. Postoperative assessment was made at 2, 6, and 12 weeks, 6 months, and 1 year. Patients underwent a standardized operative procedure with the implant. Patient demographics, comorbidities, tear types, and concomitant operative procedures were recorded. RESULTS Patients in both groups experienced statistically significant improvement in VAS, SANE, VR-12 PCS, ASES, and WORC scores (mean values 1.1, P < .001; 86.0, P < .001; 49.7, P < .001; 85.6, P < .001; and 84.4, P < .001 for partial tears and 1.2, P < .001; 80.7, P < .001; 45.7, P < .001; 83.8, P < .0001; and 80.1, P < .001 for full-thickness tears, respectively). For the partial tear group, average times for return to driving, work, and nonoverhead athletic activity were 14.6, 37.3, and 65.6 days, and for the full-thickness group, 24.5, 50.7, and 119.2 days, respectively. In the partial-thickness group, 84% and 83% of patients reported improvement in their VAS pain and ASES scores, respectively, that met or exceeded each measure's minimal clinically important difference. In the full-thickness group, 72% and 77% of the patients met or exceeded the minimal clinically important differences for VAS pain and ASES, respectively. CONCLUSION Outcomes after repair of partial- and full-thickness rotator cuff tears using a bioinductive implant show safety and efficacy at 1-year follow-up. LEVEL OF EVIDENCE Retrospective case series, level IV evidence.
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Billaud A, Cruz-Ferreira E, Pesquer L, Abadie P, Carlier Y, Flurin PH. Does the critical shoulder angle decrease after anterior acromioplasty? Arch Orthop Trauma Surg 2019; 139:1125-1132. [PMID: 30868217 DOI: 10.1007/s00402-019-03163-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION No clinical studies to date have analyzed the critical shoulder angle (CSA) following anterior acromioplasty. Our study's main objective was to measure the change in the CSA after acromioplasty. MATERIALS AND METHODS Ninety patients were included in this retrospective series. The CSA and the type of acromion were evaluated before and after surgery. RESULTS The average CSA for patients before surgery was 35.9° (± 3.7, 26.2, 44.2) and 33° after the acromioplasty (± 3.5, 24.8, 41.4). The decrease was significant and 2.9° on average (± 2.2, - 2.2, 11.9, p = 0.000). Preoperatively, 58% of patients had a CSA ≥ 35° (n = 52) and 24% postoperatively (n = 22, p = 0.000). CONCLUSIONS Standardized anterior acromioplasty allows for a significant decrease in the CSA without lateral resection of the acromion. This study confirms the tight link between the CSA and the anterior acromion as well as the interest of this angle to quantify acromioplasty whether anterior or lateral. LEVEL OF EVIDENCE Level IV, Case Series, Retrospective design.
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Affiliation(s)
- Anselme Billaud
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France.
| | | | - Lionel Pesquer
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Pierre Abadie
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Yacine Carlier
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
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Long-term results after arthroscopic treatment of symptomatic Ellman grade 2 PASTA lesions. J Shoulder Elbow Surg 2019; 28:1356-1362. [PMID: 30904238 DOI: 10.1016/j.jse.2018.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this retrospective study was to evaluate the clinical and radiologic long-term results of medium-sized (Ellman grade 2) partial-thickness articular-sided supraspinatus tendon avulsion (PASTA) lesions treated arthroscopically. METHODS Of 22 patients, 18 (82%) were available for follow-up evaluation after a mean of 15 ± 2 years (range, 12-17 years). The mean age at time of surgery was 55 ± 9 years (range, 35-66 years). The Constant score was used as the primary outcome instrument to evaluate shoulder function. Furthermore, the University of California-Los Angeles shoulder score, the American Shoulder and Elbow Surgeons score, and the Subjective Shoulder Value were collected. The patients' satisfaction with the outcome was investigated. Tendon integrity of the affected shoulder at final follow-up was assessed with magnetic resonance imaging or ultrasound in 89% of the cohort. RESULTS Overall, 94% of the patients were very satisfied or satisfied with the outcome. The average Constant score of the affected shoulder was 78 ± 21 points; the University of California-Los Angeles score, 31 ± 7 points; the American Shoulder and Elbow Surgeons score, 85 ± 24 points; and the Subjective Shoulder Value, 83% ± 21%. Radiologic evaluation showed progression to a full-thickness rotator cuff tear in 6% (1/16), and 60% of the patients (6/10) showed persistent signs of partial tearing evaluated by magnetic resonance imaging. CONCLUSION At long-term follow-up, arthroscopic treatment of medium-sized PASTA lesions resulted in good clinical results together with a high satisfaction level of the patients.
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Rossi LA, Atala NA, Bertona A, Bongiovanni S, Tanoira I, Maignon G, Ranalletta M. Long-Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears. Arthroscopy 2019; 35:698-702. [PMID: 30638977 DOI: 10.1016/j.arthro.2018.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze clinical outcomes, return to sports, and complications in a series of patients with painful partial-thickness rotator cuff tears treated with arthroscopic in situ repair with suture anchors who had a minimum of 8 years of follow-up. METHODS Sixty-two patients who had undergone an arthroscopic in situ repair for partial-thickness rotator cuff tears were evaluated. All injuries involved the supraspinatus tendon. Clinical assessment consisted of glenohumeral range-of-motion measurement and the American Shoulder and Elbow Surgeons score. Pain was rated by using a visual analog scale. We assessed return to sports and the level of performance achieved after surgery. Postoperative complications were also assessed. RESULTS Mean age was 52.4 years (range, 32 to 67 years), and mean duration of follow-up was 10.4 years (range, 8 to 12 years). All active range-of-motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons score improved from 45.6 to 85.1; and the visual analog scale scores improved from 6.4 to 1.6 (P < .0001). Thirty patients participated in sports before injury: 21 were recreational athletes and 9 were competitive athletes. Twenty-six (87%) were able to return to sports, and 24 (80%) returned to the same level they had achieved before injury. No significant difference regarding functional outcomes or return to sports was found between patients with articular-sided tears and those with bursal-sided tears. No revision surgeries were performed. Three patients had postoperative adhesive capsulitis that responded favorably to physical therapy. CONCLUSIONS During long-term follow-up, arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, and revision rates are low. Most patients return to their chosen sport at the same level they had achieved before injury. The results are equally favorable for articular-sided and bursal-sided tears. LEVEL OF EVIDENCE IV, therapeutic case series.
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Affiliation(s)
- Luciano A Rossi
- Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina.
| | - Nicolas A Atala
- Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Agustin Bertona
- Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | | | - Ignacio Tanoira
- Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Gaston Maignon
- Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
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Determination of Threshold Scores for Treatment Success After Arthroscopic Rotator Cuff Repair Using Oxford, Constant, and University of California, Los Angeles Shoulder Scores. Arthroscopy 2019; 35:304-311. [PMID: 30473455 DOI: 10.1016/j.arthro.2018.07.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the threshold scores for the Constant-Murley score (CMS); University of California, Los Angeles (UCLA) shoulder score; and Oxford Shoulder Score (OSS) that determine treatment success after arthroscopic rotator cuff (RC) repair. METHODS Patients who underwent unilateral arthroscopic double-row RC repair by a single surgeon between 2010 and 2015 were prospectively followed up and assessed preoperatively and at 6, 12, and 24 months postoperatively. Perceived pain was measured with a visual analog scale, and functional outcome was assessed by the CMS, UCLA score, and OSS. Treatment success was defined as simultaneous fulfillment of 3 criteria: improvement in pain, expectations for surgery met, and patient satisfied with surgery. Threshold scores were determined by receiver operating characteristic (ROC) analyses, using the various scores as predictors and the defined treatment success as the criterion. RESULTS The study included a total of 214 patients (96 male and 118 female patients) with a mean age of 60.1 ± 10 years. Most patients showed improvement in pain (≥88%) and high satisfaction (≥93%) and expectation fulfillment (≥80%) postoperatively. Of the patients, 73% had treatment success at 6 months; 85%, at 12 months; and 80%, at 24 months. ROC analyses showed good prediction of treatment success using the CMS, UCLA score, and OSS at all 3 follow-up time points (area under the ROC curve [AUC] > 0.70), with excellent prediction using the UCLA score at 12 months and 24 months (AUC, 0.811 and 0.805, respectively) and the OSS at 12 months (AUC, 0.820). The following threshold scores were identified: CMS of 59, UCLA score of 21, and OSS of 42 at 6 months; CMS of 61, UCLA score of 26, and OSS of 43 at 12 months; and CMS of 65, UCLA score of 30, and OSS of 46 at 24 months. CONCLUSIONS The CMS, UCLA score, and OSS have good predictive value in defining treatment success after arthroscopic RC repair. The cutoff scores are time dependent. LEVEL OF EVIDENCE Level II, development of diagnostic criteria.
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