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Adorno GR, Timmer KB, Chang RASH, Shi J, Rogers SA, Harley BAC. Shaping the mechanical properties of a gelatin hydrogel interface via amination. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.10.14.618299. [PMID: 39464090 PMCID: PMC11507719 DOI: 10.1101/2024.10.14.618299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
Injuries to musculoskeletal interfaces, such as the tendon-to-bone insertion of the rotator cuff, present significant physiological and clinical challenges for repair due to complex gradients of structure, composition, and cellularity. Advances in interface tissue engineering require stratified biomaterials able to both provide local instructive signals to support multiple tissue phenotypes while also reducing the risk of strain concentrations and failure at the transition between dissimilar materials. Here, we describe adaptation of a thiolated gelatin (Gel-SH) hydrogel via selective amination of carboxylic acid subunits on the gelatin backbone. The magnitude and kinetics of HRP-mediated primary crosslinking and carbodiimide-mediated secondary crosslinking reactions can be tuned through amination and thiolation of carboxylic acid subunits on the gelatin backbone. We also show that a stratified biomaterial comprised of mineralized (bone-mimetic) and non-mineralized (tendon-mimetic) collagen scaffold compartments linked by an aminated Gel-SH hydrogel demonstrate improved mechanical performance and reduced strain concentrations. Together, these results highlight significant mechanical advantages that can be derived from modifying the gelatin macromer via controlled amination and thiolation and suggest an avenue for tuning the mechanical performance of hydrogel interfaces within stratified biomaterials.
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Rosenblum J, Madi R, Lee H, Pei YA, Du S, Farooqi AS, Lee A, Kelly JD. Primary Arthroscopic Repair for Massive Rotator Cuff Tears Results in Good Shoulder Function, Low Pain, and Satisfactory Outcomes at 2-Year Minimum Follow-Up. Arthroscopy 2024; 40:2353-2360. [PMID: 38428700 DOI: 10.1016/j.arthro.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE To evaluate outcomes of patients who underwent primary arthroscopic repair for massive rotator cuff tears (MRCTs). METHODS Patients with MRCTs (full-thickness tear of 2 or more tendons or full-thickness tear ≥5 cm) who underwent arthroscopic repair with a minimum follow-up of 2 years were retrospectively reviewed (n = 51). All patients had preoperative magnetic resonance imaging used to characterize pattern of tear, degree of fatty degeneration (Goutallier classification), and degree of rotator cuff arthropathy (Hamada classification). Outcomes were determined by American Shoulder and Elbow Surgeons (ASES) scores and Penn Shoulder Scores (PSS). RESULTS A total of 51 patients with a minimum 2.3-year follow-up (mean, 5.4 years; range, 2.3-9.7 years) were included in this study. Mean ASES score was 46.1 ± 7.8 (95% CI, 43.9-48.3) for pain and 39.4 ± 12.1 (95% CI, 36.0-42.8) for function. Total ASES score averaged 85.5 ± 18.4 (95% CI, 80.4-90.7). PSS had a mean pain score of 26.8 ± 4.4 (95% CI, 25.4-28.1), a mean satisfaction score of 7.9 ± 2.9 (95% CI, 7.0-8.2), and a mean function score of 48.5 ± 13.5 (95% CI, 44.7-52.3). Total PSS averaged 83.2 ± 19.6 (95% CI, 77.7-87.7). No correlation was found between Goutallier grade and ASES/PSS scores or between Hamada grade and ASES/PSS scores. Three patients underwent reoperation after primary arthroscopic repair of an MRCT (5.9%). CONCLUSIONS Patients with MRCTs who undergo primary arthroscopic repair have postoperative outcome scores indicative of good shoulder function, low pain, and high satisfaction. The rate of reoperation for individuals who underwent primary arthroscopic repair with MRCTs was low at 6%. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jessica Rosenblum
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A..
| | - Rashad Madi
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Hannah Lee
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Yixuan Amy Pei
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Steven Du
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ali S Farooqi
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Alexander Lee
- Department of Orthopedic Surgery, Ohio State University, Columbus, Ohio, U.S.A
| | - John D Kelly
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Baumann AN, Fiorentino A, Sidloski K, Lee HA, Anastasio AT, Walley KC, Kelly JD. Clinical Outcomes and Re-Tear Rates for Partial Arthroscopic Rotator Cuff Repair With or Without Biceps Augmentation for Large-to-Massive Tears: A Systematic Review and Meta-analysis. Orthopedics 2024; 47:e217-e224. [PMID: 39163602 DOI: 10.3928/01477447-20240809-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
BACKGROUND The recent addition of biceps tendon augmentation to partial arthroscopic rotator cuff repair (ARCR) for the treatment of large-to-massive rotator cuff tears is proposed to improve clinical outcomes and reduce re-tears. MATERIALS AND METHODS The purpose of this systematic review and meta-analysis (5 studies) was to compare outcomes between partial ARCR with (142 patients) and without (149 patients) biceps augmentation. RESULTS Partial ARCR with and without biceps augmentation were comparable in pain, function, and range of motion. However, biceps augmentation vs no augmentation at all during ARCR may lower re-tear rates for irreparable large-to-massive rotator cuff tears (42.9% vs 72.5%, P=.007). CONCLUSION More research is needed to investigate this technique and guide surgical decision-making. [Orthopedics. 2024;47(5):e217-e224.].
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Spicer SJ, Soliman S, Malek R, Kaplan M, Clark J, Averell N, Goodwin B, Jermyn R. A Comparison of Functional Outcomes in Rotator Cuff Repairs Using Adjunctive Bone Marrow Aspirate Concentrate vs. Bone Marrow Aspirate Concentrate With Platelet-Rich Plasma: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e67594. [PMID: 39310448 PMCID: PMC11416799 DOI: 10.7759/cureus.67594] [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] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
Regenerative medicine, specifically bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), has become a novel adjunct that orthopedic surgeons have started to use with surgical rotator cuff repairs (RCR). Thus, we are conducting this systematic review to determine if either RCRs with BMAC alone or with BMAC and PRP result in superior functional outcomes. We conducted a comprehensive search using five databases including PubMed, Web of Science, Embase, Scopus, and Cochrane. After duplicates were removed, 1205 studies were screened by title and abstract using Rayyan, resulting in three included studies (one BMAC with PRP and two BMAC only). Only studies that reported functional outcomes using the American Shoulder and Elbow Surgeons Shoulder Score and the University of California Los Angeles Shoulder Score were included. Changes in assessment scores from baseline to follow-up evaluation were quantified using the effect size and used in the meta-analysis for each group. Interpretation of treatment efficacy was represented using Cohen's d. The effect size of BMAC with PRP (Cohen's d = 2.19) was not significantly different (p = 0.76) from that of BMAC alone (Cohen's d = 2.35). Between-group differences in functional outcomes were Cohen's d = 0.16, which was not significant. Given the lack of superiority and the small sample size, more research is required before a conclusion can be drawn as to the benefits of combining PRP with BMAC for RCR. If functional outcomes are the same, using BMAC alone as an adjunct may be optimal to reduce resources used and cost. Future studies should be conducted with a larger pool as our primary limitation is that only three studies were included.
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Affiliation(s)
- Seth J Spicer
- School of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
- Research, Futures Forward Research Institute, Toms River, USA
| | - Sara Soliman
- Surgery, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
- Research, Futures Forward Research Institute, Toms River, USA
| | - Robert Malek
- Internal Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
- Research, Futures Forward Research Institute, Toms River, USA
| | - Mitchell Kaplan
- Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
- Research, Futures Forward Research Institute, Toms River, USA
| | - Jensen Clark
- Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Nicholas Averell
- Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
- Research, Futures Forward Research Institute, Toms River, USA
| | - Brandon Goodwin
- Pain Management, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
- Research, Futures Forward Research Institute, Toms River, USA
| | - Richard Jermyn
- Physical Medicine and Rehabilitation, NeuroMusculoskeletal Institute, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
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Zhang X, Song W, Liu Y, Han K, Wu Y, Cho E, Fang Z, Jiang L, Hu Y, Zhu X, Jiang J, Huangfu X, Zhao J. Healthy Tendon Stem Cell-Derived Exosomes Promote Tendon-To-Bone Healing of Aged Chronic Rotator Cuff Tears by Breaking the Positive-Feedback Cross-Talk between Senescent Tendon Stem Cells and Macrophages through the Modulation of Macrophage Polarization. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2311033. [PMID: 38459643 DOI: 10.1002/smll.202311033] [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: 11/28/2023] [Revised: 02/03/2024] [Indexed: 03/10/2024]
Abstract
The re-tear rate of rotator cuff tears (RCT) after surgical repair is high, especially in aged patients with chronic tears. Senescent tendon stem cells (s-TSCs) generally exist in aged and chronically torn rotator cuff tendons and are closely associated with impaired tendon-to-bone healing results. The present study found a positive feedback cross-talk between s-TSCs and macrophages. The conditioned medium (CM) from s-STCs can promote macrophage polarization mainly toward the M1 phenotype, whose CM reciprocally accelerated further s-TSC senescence. Additional healthy tendon stem-cells derived exosomes (h-TSC-Exos) can break this positive feedback cross-talk by skewing macrophage polarization from the M1 phenotype to the M2 phenotype, attenuating s-TSCs senescence. S-TSC senescence acceleration or attenuation effects induced by M1 or M2 macrophages are associated with the inhibition or activation of the bone morphogenetic protein 4 signaling pathway following RNA sequencing analysis. Using an aged-chronic rotator cuff tear rat model, it is found that h-TSC-Exos can shift the microenvironment in the tendon-to-bone interface from a pro-inflammatory to an anti-inflammatory type at the acute postoperative stage and improve the tendon-to-bone healing results, which are associated with the rejuvenated s-TSCs. Therefore, this study proposed a potential strategy to improve the healing of aged chronic RCT.
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Affiliation(s)
- Xuancheng Zhang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Wei Song
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yang Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, 215006, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yuxu Wu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Eunshinae Cho
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zhaoyi Fang
- Biodynamics Lab, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Lianghua Jiang
- Department of Orthopedic Trauma, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, 215300, China
| | - Yihe Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Xuesong Zhu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, 215006, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Xiaoqiao Huangfu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
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Akdemir M, Kılıç Aİ, Kurt C, Çapkın S. Better short-term outcomes of mini-open rotator cuff repair compared to full arthroscopic repair. Clin Shoulder Elb 2024; 27:212-218. [PMID: 38738322 PMCID: PMC11181071 DOI: 10.5397/cise.2023.00745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Rotator cuff tears commonly cause shoulder pain and functional impairment, prompting surgical intervention such as miniopen and arthroscopic methods, each with distinct benefits. This study aimed to compare the clinical outcomes and complications of these two approaches. METHODS A retrospective analysis was conducted on 165 patients who underwent rotator cuff repair using either arthroscopic-assisted mini-open or full arthroscopic approaches. Patient demographics, tear characteristics, clinical outcomes, and complications were assessed, with statistical analyses conducted to discern differences between the groups. RESULTS Among the patients, 74 (53.2%) received the mini-open approach, while 65 (46.8%) underwent arthroscopic repair, with a mean follow-up of 19.91 months. The mini-open group exhibited significantly higher postoperative American Shoulder and Elbow Surgeons (ASES) scores compared to the arthroscopic group (P=0.002). Additionally, the mini-open group demonstrated a more significant improvement in ASES scores from preoperative to postoperative assessments (P=0.001). However, the arthroscopic method had a significantly longer operative time (P<0.001). Complications, including anchor placement issues, frozen shoulder, infection, and re-rupture, occurred in 17.3% of patients overall. Re-rupture rates were 13.5% for mini-open and 6.2% for full arthroscopic repair, with no significant difference between the two methods (P=0.317). CONCLUSIONS Both the mini-open and arthroscopic methods yielded favorable clinical outcomes for rotator cuff tear treatment, but the mini-open group exhibited superior results. Surgeons should consider patient characteristics, tear attributes, and surgical expertise when selecting the appropriate technique. Level of evidence: III.
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Affiliation(s)
- Mehmet Akdemir
- Department of Orthopedics and Traumatology, İzmir Ekol Hospital, İzmir, Türkiye
| | - Ali İhsan Kılıç
- Department of Orthopedics and Traumatology, İzmir Bakırçay University, İzmir, Türkiye
| | - Cengizhan Kurt
- Department of Orthopedics and Traumatology, İzmir Bakırçay University, İzmir, Türkiye
| | - Sercan Çapkın
- Department of Orthopedics and Traumatology, İzmir Bakırçay University, İzmir, Türkiye
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Chan E, Remedios S, Wong I. My Approach to Failed Rotator Cuff Repair. Sports Med Arthrosc Rev 2023; 31:120-128. [PMID: 38109164 DOI: 10.1097/jsa.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Failed rotator cuff repairs pose several challenges due to the high incidence rate, complexity, and range of symptoms. We propose an overview for assessing and treating failed rotator cuff repairs. For active young patients, attempt revision repair with patch augmentation if possible. When anatomic revision is not viable, but muscle is retained, consider partial repair with interposition bridging. Isolated, irreparable supraspinatus tears may benefit from superior capsule reconstruction. Tendon transfer is suitable for patients with significant atrophy and multiple irreparable cuff tears. Low-demand elderly patients or those with substantial glenohumeral arthritis may consider reverse total shoulder arthroplasty if conservative management fails. There are a variety of reported outcomes in the literature but long-term studies with larger cohorts are needed to improve the management of failed rotator cuff repair.
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Affiliation(s)
| | - Sarah Remedios
- Faculty of Health, Dalhousie University
- Division of Orthopaedic Surgery, Nova Scotia Health, Halifax, NS
| | - Ivan Wong
- Faculty of Medicine
- Faculty of Health, Dalhousie University
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Patel D, Roy G, Endres N, Ziino C. Preoperative vitamin D supplementation is a cost-effective intervention in arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2023; 32:2473-2482. [PMID: 37308074 DOI: 10.1016/j.jse.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/16/2023] [Accepted: 05/06/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study investigates the potential role of preoperative 25(OH)D supplementation as a cost-effective strategy to decrease revision rotator cuff repair (RCR) rates and lower the total health care burden from patients undergoing primary arthroscopic RCR. Previous literature has emphasized the importance of vitamin D on bone health maintenance, soft tissue healing, and outcomes in RCR. Inadequate preoperative vitamin D levels may increase revision RCR rates following primary arthroscopic RCR. Although 25(OH)D deficiency is common in RCR patients, serum screening is not routinely performed. METHODS A cost-estimation model was developed to determine the cost-effectiveness of both preoperative selective and nonselective 25(OH)D supplementation in RCR patients in order to reduce revision RCR rates. Prevalence and surgical cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean and lower and upper bounds of 1-year cost savings were calculated for both the selective and nonselective supplementation scenarios. RESULTS Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost savings of $6,099,341 (range: -$2,993,000 to $15,191,683) per 250,000 primary arthroscopic RCR cases. Nonselective 25(OH)D supplementation of all arthroscopic RCR patients was calculated to result in a mean cost savings of $11,584,742 (range: $2,492,401-$20,677,085) per 250,000 primary arthroscopic RCR cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where the cost of revision RCR exceeds $14,824.69 and prevalence of 25(OH)D deficiency exceeds 6.67%. Additionally, nonselective supplementation is a cost-effective strategy in clinical scenarios where revision RCR cost is ≥$4216.06 and prevalence of 25(OH)D deficiency is ≥1.93%. CONCLUSIONS This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce revision RCR rates and lower the overall health care burden from arthroscopic RCR. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the lower cost of 25(OH)D supplementation compared to serum assays.
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Affiliation(s)
- Dhiraj Patel
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Gregory Roy
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Nathan Endres
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Chason Ziino
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA.
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Sun Y, Ben H, Zhou Y, Jeon IH, Tan J. Cancellous bone should not be exposed during medialized rotator cuff repair based on bone-to-tendon healing in a rat mode. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07395-y. [PMID: 37014419 DOI: 10.1007/s00167-023-07395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE To compare the biological bone-to-tendon healing using three different medialized bone bed preparation techniques (i.e. cortical bone exposure, cancellous bone exposure, and no cartilage removal) in a rat model of medialized rotator cuff repair. METHODS Twenty-one male Sprague-Dawley rats with 42 shoulders were subjected to bilateral supraspinatus tenotomy from the greater tuberosity. The rotator cuff was repaired using medialized anchoring with the cortical bone exposed, the cancellous bone exposed, or no cartilage removed. Four and three rats in each group were killed for biomechanical testing and histological evaluation, respectively, at postoperative 6 weeks. RESULTS All rats survived until the end of the study, but one infected shoulder in the cancellous bone exposure group was excluded from further analysis. Compared with the cortical bone exposure and no cartilage removal groups, the rotator cuff healing of the cancellous bone exposure group showed significantly lower maximum load (cancellous bone exposure group: 26.2 ± 2.3 N, cortical bone exposure group: 37.6 ± 7.9 N, no cartilage removal group: 34.6 ± 7.2 N, P = 0.005 and 0.029) and less stiffness (cancellous bone exposure group: 10.5 ± 2.4 N/mm, cortical bone exposure group: 17.4 ± 6.7 N, no cartilage removal group: 16.0 ± 3.9 N, P = 0.015 and 0.050) at postoperative 6 weeks. In all three groups, the repaired supraspinatus tendon healed towards the original insertion rather than the medialized insertion. The cancellous bone exposure group showed inferior fibrocartilage formation and insertion healing. CONCLUSIONS The medialized bone-to-tendon repair strategy does not guarantee complete histological healing, and the removal of excessive bony structure impairs bone-to-tendon healing. This study concludes that surgeons should not expose the cancellous bone during the medialized rotator cuff repair.
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Affiliation(s)
- Yucheng Sun
- Department of Hand Surgery, College of Medicine, Affiliated Hospital of Nantong University, University of Nantong, No.20 West Temple Road, Nantong, 226001, Jiangsu, China.
| | - Hui Ben
- Department of Orthopedic Surgery, College of Medicine, ASAN Medical Center, University of Ulsan, Seoul, Korea
| | - Youlang Zhou
- Department of Hand Surgery, College of Medicine, Affiliated Hospital of Nantong University, University of Nantong, No.20 West Temple Road, Nantong, 226001, Jiangsu, China
| | - In-Ho Jeon
- Department of Orthopedic Surgery, College of Medicine, ASAN Medical Center, University of Ulsan, Seoul, Korea
| | - Jun Tan
- Department of Hand Surgery, College of Medicine, Affiliated Hospital of Nantong University, University of Nantong, No.20 West Temple Road, Nantong, 226001, Jiangsu, China.
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Panchal KA, Moharana AK, Angrish S, Ts D. Assessment of Safety, Efficacy, and Functional Outcomes After Rotator Cuff Repair Using Ceptre® Titanium Screw Anchor: A Retrospective Study. Cureus 2023; 15:e38121. [PMID: 37252509 PMCID: PMC10212553 DOI: 10.7759/cureus.38121] [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] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background Rotator cuff tears (RCTs) are the most common cause of shoulder disability. RCT is characterized by progressive wear and tear of the tendon tissue over time. The incidence of cuff tears ranges from 5% to 39%. With increasing advancements in the surgical sector, an upward trend has been observed in repair surgeries where torn tendons are repaired arthroscopically by inserting surgical implants. With this background, this study aimed to assess the safety, efficacy, and functional outcomes after RCT repair using Ceptre® titanium screw anchor implants. Methodology This retrospective, observational, single-center, clinical study was conducted at Epic Hospital in Gujarat, India. Patients who underwent rotator cuff repair surgery between January 2019 and July 2022 were recruited and followed up in December 2022. Baseline characteristics and surgical and post-surgical details were collected from patient medical reports and post-surgery progress data were documented through telephonic follow-up. The functional outcomes and efficacy of the implant were assessed using the American Shoulder and Elbow Surgeons (ASES) form, Shoulder Pain and Disability Index (SPADI) score, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) score. Results The mean age of the recruited patients was 59.74 ± 8.91 years. Among the recruited patients, 64% were females and 36% were males. About 85% of patients had a right shoulder injury and 15% of patients (n = 6/39) had a left shoulder injury. Further, 64% (n = 25/39) of patients had supraspinatus tears, whereas 36% (n = 14) of patients had both supraspinatus and infraspinatus tears. The mean ASES, SPADI, SST, and SANE scores were observed to be 81.43 ± 14.20, 29.41 ± 12.6, 75.41 ± 12.96, and 94.67 ± 7.50, respectively. No adverse events, re-injuries, or re-surgeries were reported by any of the patients during the study period. Conclusions Our findings suggest that arthroscopic rotator cuff repair using Ceptre Knotted Ultra-High-Molecular-Weight Polyethylene Suture Titanium Screw Anchor resulted in favorable functional outcomes. Thus, it could be a considerable implant for a successful surgery.
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Affiliation(s)
| | | | - Sachin Angrish
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
| | - Deepak Ts
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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Routledge JC, Saber AY, Pennington N, Gupta N. Re-Tear Rates Following Rotator Cuff Repair Surgery. Cureus 2023; 15:e34426. [PMID: 36874651 PMCID: PMC9981227 DOI: 10.7759/cureus.34426] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/02/2023] Open
Abstract
Aim Re-tears following rotator cuff repair surgery are a common occurrence. Previous studies have identified several factors that have been shown to increase the risk of re-tears. The purpose of this study was to evaluate the rate of re-tear following primary rotator cuff repair and to identify the factors that may contribute to this rate. Method The authors performed a retrospective review, looking at rotator cuff repair surgeries performed between May 2017 and July 2019 performed in a hospital by three specialist surgeons. All methods of repair were included. All patients' medical data, including imaging and operation records, were reviewed. Results A total of 148 patients were identified. Ninety-three males and 55 females with a mean age of 58 years (range 33-79 years). Thirty-four patients (23%) had post-operative imaging with either magnetic resonance imaging or ultrasound, where it was found that 20 (14%) had a confirmed re-tear. Of these patients, nine went on to have further repair surgery. The average age of the re-tear patients was 59 (age range 39-73) and 55% were female. The majority of the re-tears were from chronic rotator cuff injuries. This paper did not identify any correlation between smoking status or diabetes mellitus and re-tear rates. Conclusions This study indicates that re-tear after rotator cuff repair surgery is a common complication. The majority of studies find increasing age to be the biggest risk factor; however, this was not the case in our study which found females in their 50s to have the highest rate of re-tear. Additional research is required to understand what factors can contribute towards rotator cuff re-rupture rates.
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Affiliation(s)
- Jamie C Routledge
- Trauma and Orthopedics, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, GBR
| | - Ahmed Y Saber
- Trauma and Orthopedics, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, GBR
| | - Neil Pennington
- Trauma and Orthopedics, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, GBR
| | - Neha Gupta
- Plastic Surgery, Pinderfields Hospital, Wakefield, GBR
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Knotted and knotless double row transosseous equivalent repair techniques for arthroscopic rotator cuff repair demonstrate comparable post-operative outcomes. Knee Surg Sports Traumatol Arthrosc 2022; 31:1919-1924. [PMID: 35996032 DOI: 10.1007/s00167-022-07121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To compare failure rates and outcomes after transosseous equivalent (TOE) double row (DR) knotted suture bridge versus knotless suture tape bridge repair techniques for rotator cuff tears. METHODS A consecutive series of 272 shoulders in 256 patients who underwent arthroscopic, double row, TOE repair for full-thickness tears of the supraspinatus tendon were reviewed. Eighty-four shoulders were repaired using knotted suture bridge (KSB) technique, and 188 shoulders were repaired using all knotless suture tape bridge (KTB) technique. Revision procedures and concomitant subscapularis tendon repairs were excluded from analysis. The minimum follow-up was 12 months. Primary outcome was failure of surgical repair, defined as either confirmed retear on MRI and/or need for revision surgery. Secondary clinical outcome measures were assessed including range of motion, strength, visual analog scale (VAS), operative time, subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) mental and physical health, American Shoulder and Elbow Surgeons Shoulder Score (ASES), Brophy shoulder activity scores, and need for manipulation under anesthesia (MUA). RESULTS A total of 127 shoulders (38 KSB and 89 KTB) met inclusion criteria for the study. No significant difference in demographic variables were present between the groups at baseline. Supraspinatus tear size and average follow-up time did not differ significantly between groups. Failure rates were similar between the KSB and KTB repairs (13.1 vs 7.9%, n.s.). There was no significant difference in functional outcomes including strength, range of motion in forward flexion and external rotation, as well as patient reported outcomes including VAS, SSV, PROMIS, ASES, and Brophy scores between the groups. There was also no difference in post-operative stiffness requiring MUA. CONCLUSION Both KSB and KTB repair techniques demonstrate low retear rates with excellent functional outcomes when compared to pre-operative examination. Both KSB and KTB techniques are viable options for achieving a successful rotator cuff repair. LEVEL OF EVIDENCE Level III.
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Monga P, Vaishya R. The changing landscape of rotator cuff surgery. J Clin Orthop Trauma 2021; 19:94-95. [PMID: 34046303 PMCID: PMC8144724 DOI: 10.1016/j.jcot.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Puneet Monga
- Wrightington Hospital, Appley Bridge, WN6 9EP, UK
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