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Jin H, Gao Y, Ji Y, Xu R, Zuo H, Wang Z. Case report: pulsed radiofrequency surgery combined with platelet-rich plasma injection in the treatment of supraspinatus injury. Medicine (Baltimore) 2021; 100:e27797. [PMID: 34941031 PMCID: PMC8701732 DOI: 10.1097/md.0000000000027797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The shoulder joint is the most movable joint of the human body, and the incidence of aseptic inflammation of the muscles and tendons around the shoulder joint and acute and chronic muscle injuries is relatively high. Pulsed radiofrequency neuromodulation technology is gradually being used in shoulder joint diseases. Platelet-rich plasma (PRP) is a high-power platelet plasma solution obtained by centrifugation of autologous blood. Platelet cells contain many growth factors that promote tissue repair. PATIENT CONCERNS Shoulder soreness, limited movement of the shoulder joint, abduction of the upper limbs, and aggravation of pain during flat lifting. The pain radiates to the deltoid muscle stop and forearm. INTERVENTIONS In this study, radiofrequency pulses combined with PRP were used to treat supraspinatus muscle injury and explore new methods for the treatment of shoulder joint muscle and tendon injuries represented by supraspinatus muscle injury. DIAGNOSIS We reported 4 patients with supraspinatus injury who received radiofrequency pulse combined with PRP treatment in our hospital. OUTCOMES After treatment, the patients were followed up at the first month, the third month, and the sixth month, and the Constant-Murley shoulder score and visual analog scale were used to comprehensively evaluate the postoperative improvement of the patients. There was no significant increase in postoperative pain, the Constant-Murley shoulder Score was significantly increased, the range of movement of the shoulder joint was significantly improved, and there were no postoperative complications. LESSONS The combined application of the 2 treatments can make full use of the analgesic effect of pulsed radiofrequency technology and the repairing effect of PRP, and can maximize the advantages of the 2 more advanced treatment methods in the field of minimally invasive.
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Affiliation(s)
- Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, PR China
| | - Yao Gao
- Department of Pain, The Second Hospital of Jilin University, Changchun, PR China
| | - Youbo Ji
- Department of Pain, The Second Hospital of Jilin University, Changchun, PR China
| | - Rui Xu
- Department of Endocrinology, Shanghai National Research Center for Endocrine and Metabolic Disease, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Metabolic Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Hao Zuo
- Department of Pain, The Second Hospital of Jilin University, Changchun, PR China
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, PR China
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Greiner F, Trnka HJ, Chraim M, Neunteufel E, Bock P. Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation. Foot Ankle Int 2021; 42:1115-1120. [PMID: 33843294 PMCID: PMC8446883 DOI: 10.1177/10711007211002814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Insertional Achilles tendinopathy (IAT) is a painful pathology in which the strongest and thickest tendon of the human body is affected. Different conservative and operative treatments have been described to address this pathology. This study aimed to evaluate the medium-term clinical and radiological outcomes of patients who underwent a surgical therapy via a longitudinal tendon-splitting approach with debridement and double-row refixation. METHODS All patients were assessed pre- and postoperatively using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score, the Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI). Additionally, a lateral radiograph of the foot was performed to assess the postoperative result. Forty-two patients with confirmed IAT who underwent surgery between 2013 and 2017 with a longitudinal tendon-splitting approach and tendon refixation using a double-row refixation system were evaluated. The average follow-up was 32.8 (range, 18-52) months. We included 26 female and 16 male patients with an average age of 56.8 (range, 27-73) years. RESULTS The mean VAS improved from 8.91 ± 1.0 preoperatively to 1.47 ± 2.5 postoperatively (P< .01). AOFAS scores improved significantly from 51.0 ± 12.5 preoperatively to 91.3 ± 14.3 postoperatively (P< .01). All total and subscores of the FFI and FAOS saw a significant improvement at follow-up (P< .01). Lateral radiographs showed recurrent calcification in 30 patients (71.4%). CONCLUSION We found that, at an average of 33 months posttreatment, insertional Achilles tendinopathy via a longitudinal tendon-splitting approach resulted in good outcomes for patients after failure of initial conservative therapy. Recurrent calcification seems to be very common but shows no association with inferior outcomes or the return of symptoms. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Fabian Greiner
- Department of Orthopaedics and
Trauma-Surgery, Medical University of Vienna, Vienna, Austria,Department of Paediatric Orthopaedics,
Adult Foot and Ankle Surgery, Speising Orthopaedic Hospital, Vienna, Austria,Fabian Greiner, MD, Department of
Orthopaedics and Trauma-Surgery, Medical University of Vienna, Waehringer
Guertel 18-20, Vienna, 1090, Austria.
| | | | - Michel Chraim
- Department of Paediatric Orthopaedics,
Adult Foot and Ankle Surgery, Speising Orthopaedic Hospital, Vienna, Austria,Fusszentrum Vienna, Vienna,
Austria
| | - Elena Neunteufel
- Department of Paediatric Orthopaedics,
Adult Foot and Ankle Surgery, Speising Orthopaedic Hospital, Vienna, Austria
| | - Peter Bock
- Department of Paediatric Orthopaedics,
Adult Foot and Ankle Surgery, Speising Orthopaedic Hospital, Vienna, Austria,Orthopoint Vienna, Vienna,
Austria
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Longstaffe R, Adams K, Thigpen C, Pill S, Rush L, Alexander R, Hall TM, Siffri P, Kwapisz A, Hawkins R, Tokish JM, Kissenberth M, Tolan S. Is residual tendon a predictor of outcome following arthroscopic rotator cuff repair? A preliminary outlook at short-term follow-up. J Shoulder Elbow Surg 2020; 29:S53-S58. [PMID: 32284306 DOI: 10.1016/j.jse.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple factors including muscle atrophy, fatty infiltration, smoking, advanced patient age, and increasing tear size have been identified as risk factors for retear after rotator cuff repair. However, little is known about what effect the length of the residual rotator cuff tendon has on the success of repair and patient outcomes. METHODS This study included 64 patients. Patients were stratified based on a residual tendon length of greater than 15 mm (group 1, residual tendon) or 15 mm or less (group 2, no residual tendon). Rotator cuff tendon integrity was then evaluated using ultrasound imaging at 6 months. Outcome measures included the Single Assessment Numeric Evaluation score, visual analog scale score, EQ5D Index score, Global Rating of Change score, and Penn Shoulder Score. RESULTS No differences were found between groups regarding demographic data or repair configuration. Assessment of tendon healing demonstrated an increased rate of tendons that had "not healed" in group 2 (19.3% [n = 5] vs. 13.2% [n = 5]), but this difference was not statistically significant (P = .55). Functional outcome scores improved significantly from preoperatively to final follow-up in both groups and displayed no differences at 6-month follow-up. CONCLUSION A smaller residual tendon length was not a negative predictor of clinical outcomes following arthroscopic rotator cuff repair in patients with short-term follow-up. Although there was a trend toward a decreased rate of healing in patients with smaller residual tendons, this was not significant.
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Affiliation(s)
- Robert Longstaffe
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; Pan Am Clinic, Winnipeg, MB, Canada.
| | - Kyle Adams
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Charles Thigpen
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; ATI Physical Therapy, Greenville, SC, USA
| | - Stephan Pill
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Lane Rush
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; Lane Rush Medical Group, Meridian, MS, USA
| | - Ryan Alexander
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Taylor M Hall
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Paul Siffri
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Adam Kwapisz
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; Clinic of Orthopaedics and Pediatric Orthopaedics, Medical University of Lodz, Lodz, Poland
| | - Richard Hawkins
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | | | - Michael Kissenberth
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Stefan Tolan
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
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Easley J, Puttlitz C, Hackett E, Broomfield C, Nakamura L, Hawes M, Getz C, Frankle M, St Pierre P, Tashjian R, Cummings PD, Abboud J, Harper D, McGilvray K. A prospective study comparing tendon-to-bone interface healing using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair in sheep. J Shoulder Elbow Surg 2020; 29:157-166. [PMID: 31401128 DOI: 10.1016/j.jse.2019.05.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/03/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the biomechanical and histologic properties of rotator cuff repairs using a vented anchor attached to a bioresorbable interpositional scaffold composed of aligned PLGA (poly(l-lactide-co-glycoside)) microfibers in an animal model compared to standard anchors in an ovine model. METHODS Fifty-six (n = 56) skeletally mature sheep were randomly assigned to a repair of an acute infraspinatus tendon detachment using a innovative anchor-PLGA scaffold device (Treatment) or a similar anchor without the scaffold (Control). Animals were humanely euthanized at 7 and 12 weeks post repair. Histologic and biomechanical properties of the repairs were evaluated and compared. RESULTS The Treatment group had a significantly higher fibroblast count at 7 weeks compared to the Control group. The tendon bone repair distance, percentage perpendicular fibers, new bone formation at the tendon-bone interface, and collagen type III deposition was significantly greater for the Treatment group compared with the Control group at 12 weeks (P ≤ .05). A positive correlation was identified in the Treatment group between increased failure loads at 12 weeks and the following parameters: tendon-bone integration, new bone formation, and collagen type III. No statistically significant differences in biomechanical properties were identified between Treatment and Control Groups (P > .05). CONCLUSIONS Use of a vented anchor attached to a bioresorbable interpositional scaffold composed of aligned PLGA microfibers improves the histologic properties of rotator cuff repairs in a sheep model. Improved histology was correlated with improved final construct strength at the 12-week time point.
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Affiliation(s)
- Jeremiah Easley
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Christian Puttlitz
- Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Eileen Hackett
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Cecily Broomfield
- Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | - Lucas Nakamura
- Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA
| | | | - Charles Getz
- Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Frankle
- Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA; Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Patrick St Pierre
- Shoulder and Elbow Service, Desert Orthopedic Center, Eisenhower Health, Rancho Mirage, CA, USA
| | - Robert Tashjian
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Joseph Abboud
- The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Kirk McGilvray
- Orthopedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, CO, USA.
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Effect of affective temperament on outcome of rotator cuff surgery. Orthop Traumatol Surg Res 2019; 105:1549-1553. [PMID: 31732399 DOI: 10.1016/j.otsr.2019.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 07/25/2019] [Accepted: 09/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although numerous risk factors have been described, the effects of temperament, which is defined as a risk factor for certain disorders, on the outcome of patients undergoing rotator cuff surgery have not been investigated. HYPOTHESIS We investigated whether a relationship exists between affective temperament and the outcome of patients undergoing rotator cuff surgery. MATERIAL AND METHODS The outcomes of 176 patients undergoing rotator cuff surgery were examined using the Oxford and Constant questionnaires as well as visual analog scale values preoperatively and postoperatively. Inclusion criteria were defined as 1) dissatisfaction with pain despite 6 months of nonoperative treatment; 2) rotator cuff defects with full-thickness, small- to large-sized defects; 3) presence of a single dominant temperament or nondominant temperament; 4) no history of a diagnosed psychiatric disorder; and 5) a minimum of greater than 1 year of follow-up after surgery. Exclusion criteria were 1) other comorbid shoulder pathology; 2) irreparable or partial rotator cuff rupture; 3) grade 3 retractions; 4) grade 3-4 fatty infiltration; 5) other comorbid diseases such as diabetes, thyroid disorders, or inflammatory diseases; 6) history of shoulder surgery; 7) infection of the shoulder joint; 8) neurologic deficit in muscles around the shoulder; 9) two or more dominant temperaments; and 10) history of acromioclavicular joint resection and/or biceps tenodesis with cuff repair. All patient temperaments were evaluated according to the Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto questionnaire version. RESULTS The mean follow-up time was 45.5 months. The outcomes of patients with depressive temperament were worse than of patients with a nondominant temperament. This situation was observed both preoperatively and postoperatively. However, a similar relationship between nondominant and anxious temperament groups was observed only postoperatively. CONCLUSION We noticed that depressive and anxious temperaments had a negative effect on patient outcomes after rotator cuff surgery; however, nondominant temperaments had a positive effect on patient outcomes. LEVEL OF EVIDENCE Level III; Retrospective Comparative Study.
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Do functional outcomes and cuff integrity correlate after single- versus double-row rotator cuff repair? A systematic review and meta-analysis study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:593-605. [PMID: 29442181 DOI: 10.1007/s00590-018-2145-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to perform a systematic review and meta-analysis of all available level I prospective randomized controlled trials comparing arthroscopic single-row (SR) with double-row (DR) rotator cuff repairs by both clinical outcomes and radiological re-tear rates. METHODS PubMed, EMBASE, Google Scholar, and Cochrane databases search was done for level I RCTs comparing clinical and radiological outcomes after SR versus DR rotator cuff repair. Clinical outcomes included UCLA, ASES, Constant, WORC, and SANE scores; structural outcomes included MRI, MRA, or US. RESULTS Seven level I studies were included (5 mid-term and 2 short-term). Postoperative ASES, Constant, WORC, and SANE scores showed nonsignificant slightly better function of DR groups. Only, UCLA score showed significantly better scores with DR repair (p = 0.007). Full-thickness re-tear incidence was reported in 15/174 (8.6%) in DR group and 20/175 (11.4%) in SR group (p = 0.44). Partial-thickness re-tear rate was reported in 18/174 patients (10.3%) in DR group and 41/175 patients (23.4%) in SR group (p = 0.009). CONCLUSION Within the domain of level I mid-term and short-term studies, DR repair showed significant better UCLA score only. (ASES, Constant, WORC, and SANE scores showed no significance.) This may correlate weakly with the significant lower partial-thickness re-tear rates of DR repairs. In contrary, long-term level III studies showed a direct correlation of both functional outcomes and cuff structural integrity, with significant superiority of DR over SR repair techniques. LEVEL OF EVIDENCE Level 1, systematic review and meta-analysis.
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Cho NS, Cha SW, Shim HS, Juh HS, Rhee YG. Comparison of Clinical and Structural Outcomes of Open and Arthroscopic Repair for Massive Rotator Cuff Tear. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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A 3D finite element model for geometrical and mechanical comparison of different supraspinatus repair techniques. J Shoulder Elbow Surg 2016; 25:557-63. [PMID: 26652702 DOI: 10.1016/j.jse.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Contact pressure and contact area are among the most important mechanical factors studied to predict the effectiveness of a rotator cuff repair. The suture configurations can strongly affect these factors but are rarely correlated with each other. For example, there is a significant difference between the single-row technique and the transosseous or transosseous-like approaches in terms of footprint contact area coverage. A finite element model-based approach is presented and applied to account for various parameters (eg, suture pretension, geometry of the repair, effect of the sutures, geometry of the lesion) and to compare the efficacy of different repair techniques in covering the original footprint. METHODS The model allows us to evaluate the effect of parameters such as suture configuration and position and suture pretension. The validity of such an approach was assessed in comparing 3 different repair techniques: single row, transosseous equivalent, and double row. RESULTS Results from the application of the models show that the double-row and transosseous-equivalent techniques lead to progressive increase of the contact area compared with the single-row approach, supporting the conclusion that transosseous-equivalent fixation leads to an increase of the contact area and a better distribution of the pressure coverage. CONCLUSION The 3-dimensional finite element model approach allows multiple variables to be assessed singularly, weighing the specific influence. Moreover, the approach presented in this study could be a valid tool to predict and to reproduce different configurations, identifying how to reduce the stress over the tendon and when a repair could be effective or not.
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Ettinger S, Razzaq R, Waizy H, Claassen L, Daniilidis K, Stukenborg-Colsman C, Plaass C. Operative Treatment of the Insertional Achilles Tendinopathy Through a Transtendinous Approach. Foot Ankle Int 2016; 37:288-93. [PMID: 26443697 DOI: 10.1177/1071100715609921] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Different operative techniques have been proposed for the treatment of insertional Achilles tendinopathy (IAT), with often disappointing results. The aim of this study was to evaluate the outcome of the transtendinous approach in IAT. METHODS Forty patients operated with an IAT between 2010 and 2011 were included in this retrospective study. The mean follow-up was 15.6 (±3.7, 12-27) months. Indication for surgery was IAT with failed conservative therapy. Using a transtendinous approach, the Achilles tendon (AT) was partially detached and all pathologic tissues were debrided. The AT was reinserted using different anchor techniques. Clinical data were recorded using examination and clinical scores (American Orthopaedic Foot & Ankle Society [AOFAS], Foot and Ankle Outcome Score [FAOS], Numerical Rating Scale [NRS], and Short Form-36 [SF-36]). RESULTS The mean AOFAS hindfoot score improved from 59.4 preoperatively to 86.5 postoperatively (P < .05). All FAOS subscales, NRS pain scores, and pain and function subscales of SF-36 improved significantly. The median time of return to work and sports was 14.5 (±17.6; 2-82) and 22.7 (±13.4; 7-58) weeks. Three patients had superficial wound healing difficulties but required no revision. One patient had to be revised due to a hematoma. Patients treated with 2 suture anchors or double-row fixation technique improved significantly (P < .05) compared to those with single anchor fixation, regarding AOFAS score (79.6 and 90.2) and FAOS subscale scores. Eighty-three percent of the patients showed good to excellent results. CONCLUSION The transtendinous approach allowed access to all associated pathologies in IAT. It had relatively few complications and lead to good clinical results. LEVEL OF CLINICAL EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Sarah Ettinger
- Department of Orthopedic Surgery, Hannover Medical School, Germany
| | - Rameez Razzaq
- Department of Trauma Surgery, Helios Clinic, Hildesheim, Germany
| | - Hazibullah Waizy
- Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany
| | - Leif Claassen
- Department of Orthopedic Surgery, Hannover Medical School, Germany
| | | | | | - Christian Plaass
- Department of Orthopedic Surgery, Hannover Medical School, Germany
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Vieira FA, Olawa PJ, Belangero PS, Arliani GG, Figueiredo EA, Ejnisman B. Lesão do manguito rotador: tratamento e reabilitação. Perspectivas e tendências atuais. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Vieira FA, Olawa PJ, Belangero PS, Arliani GG, Figueiredo EA, Ejnisman B. Rotator cuff injuries: current perspectives and trends for treatment and rehabilitation. Rev Bras Ortop 2015; 50:647-51. [PMID: 27218075 PMCID: PMC4866939 DOI: 10.1016/j.rboe.2015.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/21/2014] [Indexed: 12/17/2022] Open
Abstract
Objective To map out the approaches used by Brazilian orthopedists in treating complete tears of the rotator cuff. Methods A multiple-choice questionnaire was handed out to 232 orthopedists at the 45th Brazilian Congress of Orthopedics and Traumatology. Of these, 207 were returned but five were incomplete and were excluded. Thus, 202 questionnaires were used. Results Among the orthopedists who answered the questionnaires, around 60% were from the southeastern region and 46% were shoulder and elbow surgeons. There was a significant association (p < 0.05) between length of experience and number of rotator cuff repairs performed per year. There was also a significant association (p < 0.05) between shoulder specialty and the following variables: arthroscopic technique, use of anchors in a single-row configuration, mean time taken for an indication for surgery to be made in cases of traumatic and degenerative lesions, use of a specific protocol for postsurgical rehabilitation, return to sport and indication of irreparable injuries. Conclusions Brazilian shoulder surgeons have well-established approaches toward treating rotator cuff injuries. Most of these approaches differ significantly from those of other specialties. This shows the importance of placing value on training in preparing shoulder specialists in this country.
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Affiliation(s)
- Fabio Antonio Vieira
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paul Juma Olawa
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paulo Santoro Belangero
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | - Benno Ejnisman
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Ying ZM, Lin T, Yan SG. Arthroscopic single-row versus double-row technique for repairing rotator cuff tears: a systematic review and meta-analysis. Orthop Surg 2015; 6:300-12. [PMID: 25430714 DOI: 10.1111/os.12139] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/31/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The purpose of this study was to systematically review published reports that compare the outcomes of single-row and double-row suture anchor fixation in arthroscopic rotator cuff repair. METHODS Combined data regarding relevant patient characteristics, rotator cuff pathology, surgical techniques, postoperative rehabilitation regimens, University of California at Los Angeles (UCLA) Scores, Constant scores, American Shoulder and Elbow Society (ASES) scores, tendon healing, incidence of recurrent rotator cuff defects, shoulder muscle strength, range of motion, surgical time and patient satisfaction were assessed. RESULTS Seven eligible randomized controlled studies and four prospective cohort studies were identified. There were no significant differences between the single-row and double-row groups in terms of Constant or ASES scores. However, UCLA scores, tendon healing, abduction shoulder strength index (SSI), external rotation SSI and internal rotation SSI were significantly better for double-row technique than for single-row technique. A statistically significant advantage for double-row repair according to UCLA score and external rotation SSI was found in the subgroup with tears greater than 3 cm. CONCLUSION No definite conclusion could be drawn about differences in overall outcomes of double- and single-row techniques for repairing for small to medium (<3 cm) or large to massive (>3 cm) rotator cuff tears, even though some measures of clinical outcome showed significant differences between these two techniques.
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Affiliation(s)
- Zhi-min Ying
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Schmidt CC, Jarrett CD, Brown BT. Management of rotator cuff tears. J Hand Surg Am 2015; 40:399-408. [PMID: 25557775 DOI: 10.1016/j.jhsa.2014.06.122] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/13/2014] [Accepted: 06/22/2014] [Indexed: 02/02/2023]
Abstract
Every year approximately 18 million Americans report shoulder pain, a large percentage of which are a result of rotator cuff disease. Rotator cuff tear progression can be difficult to predict. Factors associated with tear enlargement include increasing symptoms, advanced age, involvement of 2 or more tendons, and rotator cable lesion. Nonsurgical treatment can be effective for patients with full-thickness tears. When conservative treatment fails, surgical repair provides a reliable treatment alternative. Recurrent tears after surgery can compromise outcomes, particularly for younger patients with physically demanding occupations. Revision surgery provides satisfactory results for those with symptomatic re-tears. If the tear is deemed irreparable, addressing concomitant biceps pathology or performing partial repairs can reliably improve pain and potentially reverse pseudoparalysis. The reverse shoulder arthroplasty has limited indications in the setting of rotator cuff tears and should be reserved for patients with painful pseudoparalysis and associated arthropathy.
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Affiliation(s)
- Christopher C Schmidt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical School, Pittsburgh, PA; Department of Orthopaedic Surgery, Emory Orthopaedic Center, Emory University of Hospitals, Atlanta, GA; Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA.
| | - Claudius D Jarrett
- Department of Orthopaedic Surgery, University of Pittsburgh Medical School, Pittsburgh, PA; Department of Orthopaedic Surgery, Emory Orthopaedic Center, Emory University of Hospitals, Atlanta, GA; Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
| | - Brandon T Brown
- Department of Orthopaedic Surgery, University of Pittsburgh Medical School, Pittsburgh, PA; Department of Orthopaedic Surgery, Emory Orthopaedic Center, Emory University of Hospitals, Atlanta, GA; Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
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Awwad GE, Eng K, Bain GI, McGuire D, Jones CF. Medial grasping sutures significantly improve load to failure of the rotator cuff suture bridge repair. J Shoulder Elbow Surg 2014; 23:720-8. [PMID: 24291046 DOI: 10.1016/j.jse.2013.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/02/2013] [Accepted: 08/13/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The suture bridge (SB) transosseous-equivalent rotator cuff repair reduces re-tear rates compared with single-row or other double-row constructs. However, failure rates continue to be high, especially in large and massive tears. The aim of this study was to assess the biomechanical performance of a new SB repair with use of a medial grasping suture compared with the traditional SB repair. METHODS Seven matched pairs of sheep infraspinatus tendons were randomly assigned to either SB or suture bridge with grasping suture (SBGS) repair. Each construct was subjected to cyclic loading and then loaded until failure under displacement control in a materials testing machine. Footprint displacement, ultimate load to failure, and mode of failure were assessed. RESULTS The rotator cuff footprint displacement was less during tensile loading with the addition of the medial grasping suture. The ultimate load to failure was significantly greater for the SBGS repair group than for the SB repair group (334.0 N vs 79.8 N). The mode of failure was the tendon pulling off the footprint in all cases (type 1 tear). There were no failures in which the tendon tore at the medial row of anchors, leaving part of the tendon still on the footprint (type 2 tear). CONCLUSION The addition of a medial grasping suture significantly improved the ultimate load to failure and reduced the footprint displacement of the SB rotator cuff repair in a biomechanical model.
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Affiliation(s)
- George E Awwad
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kevin Eng
- Discipline of Orthopaedics and Trauma, School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Modbury Public Hospital, Modbury, SA, Australia
| | - Gregory I Bain
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia; Discipline of Orthopaedics and Trauma, School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Modbury Public Hospital, Modbury, SA, Australia.
| | - Duncan McGuire
- Discipline of Orthopaedics and Trauma, School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Modbury Public Hospital, Modbury, SA, Australia
| | - Claire F Jones
- Discipline of Orthopaedics and Trauma, School of Medicine, University of Adelaide, Adelaide, SA, Australia; Adelaide Centre for Spinal Research, SA Pathology, Adelaide, SA, Australia; School of Mechanical Engineering, University of Adelaide, Adelaide, SA, Australia
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Abstract
CONTEXT The mature athlete's shoulder remains a challenging clinical condition to manage. A normal natural history of the shoulder includes stiffness, rotator cuff tears, and osteoarthritis, all of which can become increasingly more symptomatic as an athlete ages. EVIDENCE ACQUISITION PubMed (1978-2013). STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3-4. RESULTS Rotator cuff pathology increases with age and activity level. Partial tears rarely heal, and debridement of significant partial tears results in poorer outcomes than those of repair. Repair of partial-thickness tears can be accomplished with completion and subsequent repair or in situ repair. The most successful result for treatment of osteoarthritis in the shoulder remains total shoulder arthroplasty, with more than 80% survival at 20 years and high rates of return to sport. Caution should be taken in patients younger than 60 years, as they show much worse results with this treatment. Adhesive capsulitis of the shoulder can be successfully treated with nonoperative management in 90% of cases. CONCLUSION Mature athletes tend to have rotator cuff pathology, osteoarthritis, and stiffness, which may limit their participation in athletic events. Age is a significant consideration, even within the "mature athlete" population, as patients younger than 50 years should be approached differently than those older than 65 years with regard to treatment regimens and postoperative restriction.
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Kim YK, Moon SH, Cho SH. Treatment outcomes of single- versus double-row repair for larger than medium-sized rotator cuff tears: the effect of preoperative remnant tendon length. Am J Sports Med 2013; 41:2270-7. [PMID: 23942285 DOI: 10.1177/0363546513499000] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [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 In rotator cuff repair, no practical guidelines exist for deciding which technique is the most beneficial to outcomes. PURPOSE To determine which of 2 repair techniques, the single-row (SR) and double-row suture bridge (DR-SB) methods, leads to better therapeutic outcomes in terms of remnant tendon length in patients with larger than medium-sized cuff tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Remnant tendon length, muscle atrophy, and fatty degeneration were measured on preoperative magnetic resonance imaging (MRI) in 78 patients with larger than medium-sized rotator cuff tears who were available for follow-up MRI. There were 30 patients with remnant tendons <10 mm in length (group 1) and 48 with remnant tendons ≥10 mm in length (group 2). In group 1, the SR technique was performed on 17 patients and the DR-SB technique on 13 patients. In group 2, the SR technique was performed on 16 patients and the DR-SB technique on 32 patients. The mean follow-up period for all patients was 26.6 months (range, 24-42 months). Clinical outcomes were evaluated using the University of California, Los Angeles (UCLA), Constant, and American Shoulder and Elbow Surgeons (ASES) scores. RESULTS In group 1, there was 1 retear (6%) with the SR repair and 6 (46%) with the DR-SB repair. In group 2, there were 3 retears (19%) with the SR repair and 2 (6%) with the DR-SB repair. The retear rate was significantly higher in patients with the DR-SB repair in group 1 (P = .025), while there was no significant difference between the 2 techniques in group 2 (P = .316). The UCLA and Constant scores were significantly higher in patients with the SR repair in group 1 (P = .02 and P = .029, respectively), and the UCLA and ASES scores were significantly higher in patients with the DR-SB repair in group 2 (P < .001 and P = .001, respectively). CONCLUSION Remnant tendon length should be considered to improve repair integrity. The SR technique may provide superior rotator cuff integrity when remnant tendons are <10 mm in length.
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Affiliation(s)
- Young Kyu Kim
- Sung Hoon Moon, Department of Orthopaedic Surgery, Kangwon National University Hospital, 17-1 Hyoja 3-dong, Chuncheon 200-722, South Korea.
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Greenhagen RM, Shinabarger AB, Pearson KT, Burns PR. Intermediate and long-term outcomes of the suture bridge technique for the management of insertional achilles tendinopathy. Foot Ankle Spec 2013; 6:185-90. [PMID: 23349381 DOI: 10.1177/1938640012473150] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Insertional Achilles tendinopathy is a problem frequently encountered by the foot and ankle surgeon. Conservative care yields mixed results, and this condition is often treated surgically. Our hypothesis is that the suture bridge technique through a central posterior incision allows adequate visualization for thorough debridement and exostectomy and provides a stable tendon-to-bone interface for healing. MATERIAL AND METHODS The medical records of 35 patients who underwent surgical treatment for insertional Achilles tendinopathy with the suture bridge technique, by a single surgeon, between 2006 and 2012 were retrospectively reviewed. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instruments as well as a subjective questionnaire were utilized. RESULTS In all, 30 individuals who met the inclusion criteria for the treatment of insertional Achilles tendinopathy were evaluated at a mean follow-up of 28.93 ± 16.99 months. We included 10 men and 20 women, with a mean age of 49.1 ± 9.2 years. The mean preoperative AOFAS score was 56.6 ± 14.0. The average postoperative AOFAS score significantly increased to 91.7 ± 10.4 (P < .0001). One participant required revisional surgery, consisting of a flexor hallucis longus transfer performed by another physician. There were no wound complications or infections. Overall, there was a 97% (28/29) satisfaction rate. CONCLUSION The central incision with complete detachment of the Achilles tendon and reattachment with the suture bridge technique for the treatment of insertional Achilles tendinopathy provides an effective treatment with good to excellent clinical outcomes in 97% of patients, with a mean follow-up of 29 months.
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Zhang AL, Montgomery SR, Ngo SS, Hame SL, Wang JC, Gamradt SC. Analysis of rotator cuff repair trends in a large private insurance population. Arthroscopy 2013; 29:623-9. [PMID: 23375667 DOI: 10.1016/j.arthro.2012.11.004] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 10/31/2012] [Accepted: 11/02/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to identify current trends in open and arthroscopic surgical treatment of rotator cuff tears across sex, age, and region in the United States. METHODS Using the PearlDiver Patient Record Database (PearlDiver, Fort Wayne, IN), a publicly available national database of insurance records, patients who underwent rotator cuff repair from 2004 through 2009 were identified. The number of open (CPT codes 23410, 23412, 23420) and arthroscopic (CPT code 29827) rotator cuff repairs were quantified in isolation and in combination with acromioplasty (CPT codes 23415, 29826). The type of procedure, date, sex, and region of the country was identified for each patient. Trend tests (χ(2) and Cochran-Armitage) were used to determine statistical significance. RESULTS There were 151,866 rotator cuff repair procedures identified in the database from 2004 through 2009, which represented an incidence of 13.6 for every 1,000 patients assigned an orthopaedic International Classification of Diseases, Ninth Revision (ICD-9) or Current Procedural Terminology (CPT) code. Male patients accounted for 60% of the repairs and female patients for 40%. There were 98,174 arthroscopic cuff repairs (65%) and 53,692 open repairs (35%). The annual percentage of arthroscopic cases increased from 48.8% in 2004 to 74.3% in 2009, whereas the percentage of open cases decreased from 51.2% in 2004 to 25.7% in 2009 (P < .0001). Acromioplasty was also performed in 47.3% of cases, and the rate showed only a slight increase (from 46.6% to 47.8%) between 2004 and 2009 (P < .01). All regions of the United States showed similar surgical trends and trends for sex and age distributions. CONCLUSIONS Our analysis shows that the majority of rotator cuff repairs in the United States are now performed arthroscopically (>74%) and there has been a recent steady decline in performance of open rotator cuff repair. Concomitant acromioplasty is performed approximately half the time, and this trend is increasing slightly. These findings were consistent across age, sex, and region in the United States. LEVEL OF EVIDENCE IV, cross-sectional study.
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Affiliation(s)
- Alan L Zhang
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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Salata MJ, Sherman SL, Lin EC, Sershon RA, Gupta A, Shewman E, Wang VM, Cole BJ, Romeo AA, Verma NN. Biomechanical evaluation of transosseous rotator cuff repair: do anchors really matter? Am J Sports Med 2013; 41:283-90. [PMID: 23239668 DOI: 10.1177/0363546512469092] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Suture anchor fixation has become the preferred method for arthroscopic repairs of rotator cuff tears. Recently, newer arthroscopic repair techniques including transosseous-equivalent repairs with anchors or arthroscopic transosseous suture passage have been developed. PURPOSE To compare the initial biomechanical performance including ultimate load to failure and localized cyclic elongation between transosseous-equivalent repair with anchors (TOE), traditional transosseous repair with a curved bone tunnel (TO), and an arthroscopic transosseous repair technique utilizing a simple (AT) or X-box suture configuration (ATX). STUDY DESIGN Controlled laboratory study. METHODS Twenty-eight human cadaveric shoulders were dissected to create an isolated supraspinatus tear and randomized into 1 of 4 repair groups (TOE, TO, AT, ATX). Tensile testing was conducted to simulate the anatomic position of the supraspinatus with the arm in 60° of abduction and involved an initial preload, cyclic loading, and pull to failure. Localized elongation during testing was measured using optical tracking. Data were statistically assessed using analysis of variance with a Tukey post hoc test for multiple comparisons. RESULTS The TOE repair demonstrated a significantly higher mean ± SD failure load (558.4 ± 122.9 N) compared with the TO (325.3 ± 79.9 N), AT (291.7 ± 57.9 N), and ATX (388.5 ± 92.6 N) repairs (P < .05). There was also a significantly larger amount of first-cycle excursion in the AT group (8.19 ± 1.85 mm) compared with the TOE group (5.10 ± 0.89 mm). There was no significant difference between repair groups in stiffness during maximum load to failure or in normalized cyclic elongation. Failure modes were as follows: TOE, tendon (n = 4) and bone (n = 3); TO, suture (n = 6) and bone (n = 1); AT, tendon (n = 2) and bone (n = 3) and suture (n = 1); ATX, tendon (n = 7). CONCLUSION This study demonstrates that anchorless repair techniques using transosseous sutures result in significantly lower failure loads than a repair model utilizing anchors in a TOE construct. CLINICAL RELEVANCE Suture anchor repair appears to offer superior biomechanical properties to transosseous repairs regardless of tunnel or suture configuration.
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Affiliation(s)
- Michael J Salata
- Rush University Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612, USA
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Clement ND, Nie YX, McBirnie JM. Management of degenerative rotator cuff tears: a review and treatment strategy. Sports Med Arthrosc Rehabil Ther Technol 2012; 4:48. [PMID: 23241147 PMCID: PMC3584736 DOI: 10.1186/1758-2555-4-48] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 12/05/2012] [Indexed: 06/01/2023]
Abstract
The aim of this review was to present an over view of degenerative rotator cuff tears and a suggested management protocol based upon current evidence. Degenerative rotator cuff tears are common and are a major cause of pain and shoulder dysfunction. The management of these tears is controversial, as to whether they should be managed non-operatively or operatively. In addition when operative intervention is undertaken, there is question as to what technique of repair should be used. This review describes the epidemiology and natural history of degenerative rotator cuff tears. The management options, and the evidence to support these, are reviewed. We also present our preferred management protocol and method, if applicable, for surgical fixation of degenerative rotator cuff tears.
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Affiliation(s)
- Nicholas D Clement
- Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland
| | - Yuan X Nie
- Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland
| | - Julie M McBirnie
- Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, Scotland
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Killian ML, Cavinatto L, Galatz LM, Thomopoulos S. Recent advances in shoulder research. Arthritis Res Ther 2012; 14:214. [PMID: 22709417 PMCID: PMC3446497 DOI: 10.1186/ar3846] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Shoulder pathology is a growing concern for the aging population, athletes, and laborers. Shoulder osteoarthritis and rotator cuff disease represent the two most common disorders of the shoulder leading to pain, disability, and degeneration. While research in cartilage regeneration has not yet been translated clinically, the field of shoulder arthroplasty has advanced to the point that joint replacement is an excellent and viable option for a number of pathologic conditions in the shoulder. Rotator cuff disease has been a significant focus of research activity in recent years, as clinicians face the challenge of poor tendon healing and irreversible changes associated with rotator cuff arthropathy. Future treatment modalities involving biologics and tissue engineering hold further promise to improve outcomes for patients suffering from shoulder pathologies.
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Affiliation(s)
- Megan L Killian
- Department of Orthopaedic Surgery, Washington University, St Louis, MO 63110, USA
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Hayashida K, Tanaka M, Koizumi K, Kakiuchi M. Characteristic retear patterns assessed by magnetic resonance imaging after arthroscopic double-row rotator cuff repair. Arthroscopy 2012; 28:458-64. [PMID: 22264831 DOI: 10.1016/j.arthro.2011.09.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 09/01/2011] [Accepted: 09/15/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine magnetic resonance imaging (MRI) findings and elucidate retear pattern and its characteristics after surgical repair of the rotator cuff using an arthroscopic double-row suture anchor (DRSA) method. METHODS Forty-seven patients with complete rotator cuff tears treated by the DRSA method under arthroscopy whose repair condition was assessed by MRI approximately 12 months after the procedure were included in the study. The mean age at treatment was 65 years (range, 42 to 82 years). The mean follow-up period was 26 months (range, 24 to 32 months). RESULT The repair integrity was classified into 5 groups according to MRI findings. A well-repaired tendon was seen in 34 shoulders. Partial retearing of the deep layer was observed in 2. Partial retearing of the superficial layer around the medial anchors was observed in 3. Complete retearing of the tendon around the medial anchors with a well-preserved footprint was observed in 4. Complete retearing of the tendon from the footprint was observed in 4. The retear patterns involving superficial retearing and complete retearing around the medial anchors were unexpected and unique. These types of retears seem to be characteristic of the DRSA method and were seen in cases with medium-sized tears. The incidence of characteristic retearing was 7 of 47. CONCLUSIONS Superficial-side partial tearing and complete tearing around the medial-row anchors with a well-repaired tendon on the footprint could be characteristics of the DRSA method. These retear patterns were observed in 7 of 13 retear cases and 7 of 47 cases overall. The retear rate by the characteristic retear was high. Exploring the causes of this retear and preventing it could lead to better clinical results with the DRSA method. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Kenji Hayashida
- Department of Orthopedic Surgery, Osaka Police Hospital, Osaka, Japan.
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