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Darbandi A, Credille K, Darbandi A, Hevesi M, Dandu N, Bodendorfer BM, Wang Z, Garrigues G, Verma N, Yanke A. Fatty Infiltration, Tear Size, and Retraction Size Are Significant Risk Factors for Retear following Arthroscopic Rotator Cuff Repair: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00488-2. [PMID: 38986851 DOI: 10.1016/j.arthro.2024.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To assess the consistency and quality of risk factor reporting for rotator cuff repair (RCR) retear and identify risk factors most frequently associated with retear. METHODS A systematic review with PRISMA guidelines was performed. Of the initial 3,158 titles, a total of 31 studies met the following inclusion criteria: (1) clinical studies regarding RCR failure, (2) arthroscopic procedures involving RCR, (3) reporting clinical outcomes (4) performed within 5 years (5) and studies investigating pre-operative risk factors for retear. After full-text review, 18 risk factors were analyzed. RESULTS The most consistently significant risk factors were acromiohumeral distance (AHD) (80%), critical shoulder angle (CSA) (67%), tear size (63%), anterior/posterior (AP) dimension (60%), fatty infiltration (FI, 58%), and retraction size (56%). FI was analyzed using different methods between studies with 63% finding significant results and 50% of all studies performing ordinal analysis. Tear size was inconsistently analyzed quantitatively or qualitatively, with 58% finding significant results and 63% of all studies analyzing quantitatively. Risk factors consistently found to be non-significant included age, sex, diabetes mellitus (DM), symptom duration, hand dominance, repair technique, smoking and body mass index (BMI). CONCLUSIONS Tear size, fatty infiltration, and retraction size were found to be significant risk factors in the majority of included studies evaluating rotator cuff retear. Risk factors less likely reported as predictive included repair technique, age, sex, DM, symptom duration, hand dominance, repair technique, smoking, and BMI. Risk factors that require further investigation include CSA, AHD, and AP tear dimension. Level III, systematic review of Level III-V studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Adam Yanke
- Midwest Orthopedics at Rush, Chicago, IL.
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Yau WP. Differences in Clinical Outcomes Between Patients With Retear After Supraspinatus Tendon Repair and Those With Intact Repair at 5-Year Follow-up. Am J Sports Med 2024; 52:1040-1052. [PMID: 38385212 DOI: 10.1177/03635465241227643] [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: 02/23/2024]
Abstract
BACKGROUND It is well known that rotator cuff repair is associated with an overall retear rate of 21% to 26%. However, a cuff retear may not necessarily be associated with poor clinical outcomes. HYPOTHESIS There would be no difference in clinical outcomes between patients with a cuff retear and those with an intact repair at a midterm follow-up of 5 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective study was conducted involving patients who received arthroscopic complete repair of the supraspinatus tendon between January 2009 and December 2017. Patients who did not have a postoperative magnetic resonance imaging (MRI) scan or who had a follow-up of <5 years were excluded. Clinical outcomes, including the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion (FF) of the involved shoulder were assessed at the 2-year and 5-year follow-up points. RESULTS The study group included 105 patients with a mean follow-up of 85 months. MRI scans were performed at a mean of 20 months. Fourteen full-thickness cuff retears and 91 intact repairs were identified using postoperative MRI scans. Significant improvement in VAS score, ASES score, and FF were found between the preoperative assessment and the 2 designated follow-up points (2 years and 5 years) in both the cuff retear and the intact repair groups (P < .001). The VAS and ASES scores at the 2-year follow-up for the intact repair group were 1.8 ± 2.0 and 80.7 ± 18.1, respectively. The corresponding values for the retear group were 2.3 ± 2.2 and 71.9 ± 19.5, respectively. No significant difference was found between the 2 groups in the VAS and ASES scores at the 2-year follow-up. However, patients with an intact repair had a better VAS score (1.4 ± 1.8; P = .049) and ASES score (81.7 ± 17; P = .019) than those with a cuff retear at the 5-year assessment (3.0 ± 2.8 and 67.1 ± 22.9, respectively). In the intact repair group, 91% of patients achieved the minimal clinically important difference for the 5-year VAS score, compared with 54% in the cuff retear group (P < .001). The corresponding values for the 5-year ASES score were 80% and 54%, respectively (P = .044). FF measurements at the 5-year follow-up in patients with intact repair and those with a cuff retear were 161°± 23° and 144°± 37°, respectively (P = .059). Continuous improvement in VAS score and FF between the 2-year and 5-year follow-up was observed in the intact repair group (P = .005 and P = .04, respectively). CONCLUSION The patients with an intact repair had better VAS and ASES scores compared with those who had a cuff retear at a midterm follow-up of 5 years. Between the 2-year and the 5-year follow-up, some further improvement was observed in the VAS score and FF in the intact repair group.
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Affiliation(s)
- W P Yau
- Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of the People's Republic of China
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Hirakawa Y, Manaka T, Ito Y, Nakazawa K, Iio R, Kubota N, Nakamura H. Comparison of cost, surgical time, and clinical results between arthroscopic transosseous rotator cuff repair with lateral cortical augmentation and arthroscopic transosseous equivalent suture bridge: A propensity score-matched analysis. J Orthop Sci 2024; 29:529-536. [PMID: 36822948 DOI: 10.1016/j.jos.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/15/2023] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND To reduce the healthcare burden, the clinical results of arthroscopic rotator cuff repair and the cost of the implants used have recently been focused upon. This study compared implant cost, surgical time, short-term clinical results, and cuff repair integrity 2 years postoperatively between arthroscopic transosseous rotator cuff repair using lateral cortical augmentation (TOA) and arthroscopic transosseous-equivalent suture bridge (TOE). METHODS This study included 220 patients with rotator cuff repairs performed by a single surgeon between December 2013 and December 2018. Overall, 70 TOA and 68 TOE cases met the inclusion criteria. The same surgeon performed the procedures at two different hospitals, and the techniques differed between the facilities. A total of 42 TOA patients were matched with 42 TOE patients. The patients were matched using a propensity score analysis by gender, age, and cuff tear size. The minimum follow-up period was 2 years. Implant cost and surgical time were compared between the two methods. The range of motion, clinical outcomes, and visual analog scale were evaluated. Magnetic resonance imaging was performed to examine cuff repair integrity 2 years postoperatively. RESULTS The follow-up rate was 81% (112/138 patients). Implant cost was significantly lower with TOA ($1,396 vs. $2,165; p < 0.001) than with TOE. The average surgical time in the TOA method was significantly shorter than that in the TOE method (82 vs. 109 min; p = 0.001). At a minimum 2-year follow-up, the mean active elevation, abduction, and clinical outcomes improved with both methods, although no improvements in external and internal rotations were observed with either method. There were no significant differences in the postoperative variables and retear rate (TOA, 12%; TOE, 19%; p = 0.548) between the two methods. CONCLUSIONS TOA and TOE achieved comparable clinical results; however, TOA was more cost-effective and had a shorter surgical time than TOE. LEVEL OF EVIDENCE Level Ⅲ, retrospective matched control study.
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Affiliation(s)
- Yoshihiro Hirakawa
- Ishikiriseiki Hospital, 18-28, Yayoi-town, Higashi-Osaka City 579-8026, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
| | - Yoichi Ito
- Osaka Shoulder Center, Ito Clinic, 1-10-12, Ueda, Matsubara-city, Osaka, 580-0016 Japan
| | - Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Ryosuke Iio
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Naoya Kubota
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
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Kilbasanli S, Kaçmaz M. General anesthesia versus combined interscalene nerve/superficial cervical plexus block in arthroscopic rotator cuff repair: A randomized prospective control trial. Medicine (Baltimore) 2023; 102:e35522. [PMID: 37861492 PMCID: PMC10589582 DOI: 10.1097/md.0000000000035522] [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: 06/18/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In this study, interscalene brachial plexus block (ISB) with superficial cervical plexus block added and general anesthesia (GA) application were evaluated in terms of intraoperative hemodynamics, operative time and postoperative analgesia need in patients who underwent rotator cuff tear repair. METHODS 70 patients aged between 18 and 75 years were included in this prospective study. Arthroscopic rotator cuff tear repair surgery was performed in all patients. The patients were randomized into 2 groups, namely Group ISB who received a combination of superficial cervical plexus block added to the Interscalene Nerve Block, and Group GA, for those who received GA. Duration of operation, waiting times, intraoperative hemodynamic data, postoperative visual analog scale (VAS), analgesic requirement, as well as patient and surgeon satisfaction levels, were compared between the 2 groups. RESULTS While VAS values at the post-anesthesia care unit were lower in ISB group at 2 and 24 hours (P < .05), there was no significant difference between VAS values measured at 6th and 12th hours (P ≥ .05). In the GA group, postoperative morphine and diclofenac consumption was higher, and rescue analgesia was needed earlier (P < .05). The hospital stay was shorter (P < .05), and surgeon and patient satisfaction were higher in the ISB group (P < .05). CONCLUSION SUBSECTIONS In rotator cuff tear repair anesthesia, ISB with superficial cervical plexus block provides adequate intraoperative anesthesia, low postoperative VAS level, reduced and deferred consumption of opioids and nonsteroidal anti-inflammatory drugs, higher patient and surgeon satisfaction and early discharge.
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Affiliation(s)
- Seval Kilbasanli
- Department of Anesthesiology, Training and Research Hospital, Nigde, Turkey
| | - Mustafa Kaçmaz
- Department of Anesthesiology, Ömer Halisdemir University Faculty of Medicine, Nigde, Turkey
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Longo UG, De Salvatore S, Zollo G, Calabrese G, Piergentili I, Loppini M, Denaro V. Magnetic resonance imaging could precisely define the mean value of tendon thickness in partial rotator cuff tears. BMC Musculoskelet Disord 2023; 24:718. [PMID: 37689653 PMCID: PMC10492299 DOI: 10.1186/s12891-023-06756-5] [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: 01/16/2023] [Accepted: 07/25/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Rotator Cuff (RC) lesions are classified in full-thickness and partial-thickness tears (PTRCTs). To our knowledge, no studies investigated the mean size of shoulder tendons in healthy and PTRCT patients using MRI scans. The aim of the study was to provide data to obtain and compare the mean value of tendon sizes in healthy and PTRCTs groups. METHODS From 2014 to 2020, 500 were included in the study. They were divided into two groups: Group 1 (100 subjects) was composed of people positive for partial-thickness rotator cuff tears (PTRCTs), while the 400 subjects in Group 2 were negative for PTRCTs. RESULTS Overall, of the patients included in the study, 231 were females and 269 were males. The mean age of the patients was 49 ± 12.7 years. The mean thickness of the supraspinatus tendon (SSP) was 5.7 ± 0.6 mm in Group 1, 5.9 ± 0.6 mm in Group 2 (p < 0.001). The mean length of the ISP tendon was 27.4 ± 3.2 mm in Group 1, 28.3 ± 3.8 mm in Group 2 (p = 0.004). The mean width of the SSP tendon was 17 ± 1.6 mm in Group 1, 17.6 ± 2 mm in Group 2 (p = 0.004). The mean width of the infraspinatus tendon (ISP) tendon was 17.7 ± 1.4 mm in Group 1, 18.3 ± 2.1 mm in Group 2 (p = 0.02). CONCLUSION The anatomical data present in this paper may serve as a tool for surgeons to properly manage PTRCTs. The findings of the present study aimed to set the first step towards reaching unanimity to establish international cut-off values to perform surgery. Additionally, they could widely increase diagnostic accuracy, improving both conservative and surgical approaches. Lastly, further clinical trials using more accurate diagnostic MRI tools are required to better define the anatomical differences between PTRCT and healthy patients. LEVEL OF EVIDENCE Level II, Retrospective Comparative Trial.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
- Department of Orthopedics, Children’s Hospital Bambino Gesù, Palidoro, Rome, 00165 Italy
| | - Giuliano Zollo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Giovanni Calabrese
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
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Horan MP, Hanson JA, Rakowski DR, Patel RB, Vidal LB, Millett PJ. Outcomes and Survivorship 5 Years After Arthroscopic Rotator Cuff Repair in Active Patients 70 Years and Older. Orthop J Sports Med 2023; 11:23259671231168888. [PMID: 37250743 PMCID: PMC10214071 DOI: 10.1177/23259671231168888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 05/31/2023] Open
Abstract
Background Rotator cuff tears are common in the elderly population and are associated with increased pain, decreased function, and decreased enjoyment of recreational activities. Purpose To evaluate clinical outcomes at a minimum of 5 years after arthroscopic repair of full-thickness rotator cuff tears in recreational athletes aged ≥70 years at the time of surgery. Study Design Case series; Level of evidence, 4. Methods Included were recreational athletes aged ≥70 years who underwent arthroscopic rotator cuff repair (RCR) from December 2005 to January 2016. Patient and surgery characteristics were collected prospectively and retrospectively reviewed. Patient-reported outcome (PRO) scores utilized were the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), the shortened version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH), 12-Item Short Form Health survey (SF-12) questionnaire (Physical Component Summary and Mental Component Summary), and patient satisfaction. Kaplan Meier survivorship analysis was performed, with failure defined as revision RCR or retear on magnetic resonance imaging (MRI). Results Overall, 71 shoulders (n = 67 patients [44 men, 23 women]; mean age, 73.4 years [range, 70.1-81.3 years]) were included in this study. Follow-up data was obtained for 65 of the 69 available shoulders (94%) at a mean of 7.8 years (range, 5-15.3 years). Mean age at follow-up was 81.2 years (range, 75.7-91.0). One RCR was revised after a traumatic accident, and another had a symptomatic, MRI-confirmed retear. One patient had lysis of adhesions for stiffness 3 months postoperatively. All PRO scores improved from pre- to postoperatively-ASES, from 55.3 to 93.6; SANE, from 62 to 89.6; QuickDASH, from 32.9 to 7.3; and SF-12 Physical Component Summary, from 43.3 to 53 (P < .001 for all)-and the median satisfaction score was 10 out of 10. Postoperatively, 63% of the patients returned to their original fitness program and 33% of patients modified their recreational activity. Survivorship analysis showed a 98% survival rate at 5 years and a 92% rate at 10 years. Conclusion Sustained improvement in function, reduced pain, and return to activities was seen after arthroscopic RCR in active patients ≥70 years old. Despite one-third of patients modifying their recreational activity, the cohort reported high levels of satisfaction and general health.
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Affiliation(s)
| | | | | | - Ravi B. Patel
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
| | - Leslie B. Vidal
- 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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Polce EM, Vadhera AS, Fu MC, Singh H, Haunschild ED, Garrigues GE, Yanke AB, Forsythe B, Cole BJ, Verma NN. Determining the Time Required to Achieve Clinically Significant Outcomes on the PROMIS Upper Extremity Questionnaire After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2023; 11:23259671231157038. [PMID: 37051286 PMCID: PMC10084545 DOI: 10.1177/23259671231157038] [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: 11/28/2022] [Accepted: 01/01/2023] [Indexed: 04/14/2023] Open
Abstract
Background Clinically significant outcome (CSO) thresholds for the Patient-Reported Outcome Measurement Information System-Upper Extremity (PROMIS-UE) score have been previously defined after arthroscopic rotator cuff repair (RCR). However, the time required to achieve CSOs for the PROMIS-UE score is unknown. Purpose To (1) determine the time required to achieve the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) score thresholds after RCR for the PROMIS-UE questionnaire and (2) identify patient factors associated with earlier or delayed achievement of these clinical benchmarks. Study Design Case-control study; Level of evidence, 3. Methods A prospectively maintained institutional database was retrospectively reviewed for consecutive patients who underwent RCR between January 2018 and January 2019. Patients were included if they completed the PROMIS-UE questionnaire both preoperatively and at standardized postoperative time intervals: 5 to 7 months (6-month time point), 11 to 13 months (1-year time point), and ≥23 months (2-year time point). Kaplan-Meier survival curves with interval censoring were used to define the cumulative percentage of patients who achieved the MCID, SCB, and PASS. Patient variables associated with earlier or delayed achievement of the MCID, SCB, and PASS were determined using Weibull parametric survival regression analysis. Results Included were 105 patients undergoing RCR (age, 57.3 ± 10.3 years; body mass index, 31.5 ± 6.1 kg/m2). By 2-year follow-up, the cumulative percentage of patients achieving the MCID, SCB, and PASS was 86.7%, 76.2%, and 74.3%, respectively. The mean time required to reach the MCID, SCB, and PASS score thresholds was 9.5 ± 3.8, 10.3 ± 4.4, and 9.8 ± 4.6 months, respectively. Factors associated with delayed achievement of CSOs included greater baseline PROMIS-UE score (MCID and SCB) and workers' compensation insurance (PASS). Greater baseline PROMIS-UE scores were associated with earlier achievement of the PASS. Conclusion Most patients achieved CSOs for the PROMIS-UE within 12 months of RCR. Patient-specific factors found to be associated with earlier or delayed achievement of CSOs can be used to inform patient discussions on the expected timeline for recovery after RCR.
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Affiliation(s)
- Evan M. Polce
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
- Evan M. Polce, BS, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI 53703, USA () (Twitter: @EvanPolce)
| | - Amar S. Vadhera
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C. Fu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Harsh Singh
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Eric D. Haunschild
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Grant E. Garrigues
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B. Yanke
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J. Cole
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review. Arthroscopy 2023; 39:452-458. [PMID: 36604006 DOI: 10.1016/j.arthro.2022.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/05/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To study the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following arthroscopic rotator cuff repair (ARCR) at a minimum of 10-years follow-up. METHODS Two independent reviewers performed a literature search of PubMed, Embase, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only studies reporting on outcomes of ARCR with a minimum 10-year follow-up were considered for inclusion. Patient demographics, satisfaction, and clinical, radiologic, and surgical outcomes were evaluated. RESULTS Our search found 9 studies including 455 shoulders in 448 patients (51.6% male patients), with age at time of surgery ranging from 45 to 90 years met our inclusion criteria. Overall follow-up ranged from 10 to 18 years. At final follow-up, the ranges of American Shoulder & Elbow Surgeons, age- and sex-adjusted Constant-Morley, and University of California Los Angeles scores were reported in 5, 6, and 3 studies, respectively, as 79.4 to 93.2, 73.2 to 94, and 26.5 to 33, respectively. Of the included studies, satisfaction rates varied in 6 studies from 85.7% to 100% in the long-term. Additionally, the overall radiologic retear rate ranged from 9.5% to 63.2%. The overall surgical revision rates ranged in 6 studies from 3.8% to 15.4%, with from 0% to 6.7% requiring revision ARCR and from 1.0% to 3.6% requiring revision subacromial decompression in 6 and 2 studies, respectively, at minimum 10-years' follow-up. CONCLUSIONS In this study, we found that ARCR results in high rates of patient satisfaction, satisfactory clinical outcomes with respect to patient-reported functional outcomes and range of motion, and low revision rates at minimum 10-years' follow-up. However, an overall 30% retear rate was observed in asymptomatic patients. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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9
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Mancini MR, Horinek JL, Phillips CJ, Denard PJ. Arthroscopic Rotator Cuff Repair. Clin Sports Med 2023; 42:81-94. [DOI: 10.1016/j.csm.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Baumgarten KM. Can the Single Assessment Numeric Evaluation be used as a stand-alone subjective outcome instrument in patients undergoing rotator cuff repair? J Shoulder Elbow Surg 2022; 31:2542-2553. [PMID: 35750155 DOI: 10.1016/j.jse.2022.05.017] [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: 03/20/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND/HYPOTHESIS There is no consensus to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. The Single Assessment Numeric (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis was that SANE will correlate with and be comparable in responsiveness to other subjective outcome measures that have been used in a stand-alone fashion in patients undergoing rotator cuff repair (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], Western Ontario Rotator Cuff Index [WORC], and the Simple Shoulder Test [SST]). In addition, the SANE will be more relevant to each patient compared to the ASES, further supporting its use as a stand-alone shoulder-specific outcomes measure. METHODS A retrospective review of a database of patients undergoing rotator cuff repair was reviewed where the SANE was recorded with the ASES, WORC, and/or SST. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine if correlations differed in (1) preoperative and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean (SRM) and the effect size (ES) of all scores. Relevance and precision of the SANE and ASES were examined using 150 consecutive patients to determine the number of questions in each score that were not answered. RESULTS Correlation was excellent for the SANE and the ASES (n = 1838, r = 0.81, P < .0001), the WORC (n = 1793, r = 0.82, P < .0001), and the SST (n = 1836, r = 0.76, P < .0001). Correlation of preoperative scores was moderate and postoperative scores were excellent when comparing the SANE with all 3 scores. All scores were highly responsive, with the SRM of the SANE = 2.1, ASES = 2.2, WORC = 2.4, and the SST = 1.8. The ES of the SANE = 2.4, ASES = 2.7, WORC = 3.0, and the SST = 2.1. One hundred percent of the SANE scores were answered completely compared with 57% (P < .0001) of the ASES, with significant variability found in the answers to the "work" and "score" questions. CONCLUSION In patients undergoing rotator cuff repair, the SANE highly correlated and has equivalent responsiveness with the WORC, ASES, and SST, which have been used as stand-alone shoulder-specific outcomes measures. The SANE may provide the same information as the WORC, ASES, and SST regarding outcome with significant reduction in responder burden. This study supports that the SANE can be used as a subjective, stand-alone instrument for patients undergoing rotator cuff repair.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Green A, Loyd K, Molino J, Evangelista P, Gallacher S, Adkins J. Long-term functional and structural outcome of rotator cuff repair in patients 60 years old or less. JSES Int 2022; 7:58-66. [PMID: 36820436 PMCID: PMC9937847 DOI: 10.1016/j.jseint.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background The long-term outcomes of rotator cuff repair (RCR) have not been well studied. The purpose of this study was to evaluate long-term functional and structural outcomes after RCR in younger patients. Methods A total of 49 patients (34 [69%] male) with a mean age of 51 ± 6 years were evaluated preoperatively, and at short- and long-term follow-ups (minimum 15 years). There were 13 (27%) small, 17 (35%) medium, 14 (29%) large, and 5 (10%) massive tears. 15 (31%) had an acute repair of a traumatic tear. Long-term evaluation included physical examination, plain radiographs, ultrasound, and patient reported outcome measures (PROMs) (visual analog scale pain, Disability of Arm, Shoulder and Hand, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form-36). Statistical analysis was performed to determine associations between preoperative and intraoperative factors and long-term functional and structural outcome. Results There were significant improvements in the mean short- and long-term PROMs compared to preoperatively that exceeded reported minimal clinically important differences and substantial clinical benefits. There was a slight decrease in the PROMs from the short-term to long-term follow-up. Male sex and traumatic rotator cuff tears were associated with better long-term outcomes. The number of medical co-morbidities was associated with worse long-term outcomes. Smaller initial tear size was associated with better long-term outcomes. There were 15 (31%) full thickness and 9 (18%) partial thickness recurrent rotator cuff tears, 17 (35%) had rotator cuff tear arthropathy (2 Hamada grade 1, 15 Hamada grade 2), 5 (10%) had revision surgery (2 revision RCR, 2 anatomic total shoulder, and 1 reverse total shoulder), and 13 (26%) had subsequent contralateral RCR. There were weak correlations between the presence of arthropathy and DASH (r = 0.34; P = .02) and visual analog scale pain (r = 0.29; P = .049). There were no significant correlations between the structural outcomes (recurrent rotator cuff tear, recurrent full thickness tear, acromiohumeral space, and critical shoulder angle,) and the PROMs. Discussion and Conclusion Long-term follow-up of RCR in this relatively young patient cohort demonstrated substantial and durable patient reported functional outcome and improvement despite considerable structural deterioration. This suggests that while RCR does not arrest the progression of rotator cuff disease it may delay this progression and that patients adapt to the structural changes as they age.
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Affiliation(s)
- Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA,Corresponding author: Andrew Green, MD, Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA.
| | - Kelsey Loyd
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Peter Evangelista
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Stacey Gallacher
- Advanced Orthopedics and Sports Medicine Institute, Freehold, NJ, USA
| | - Jacob Adkins
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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Aydın M, Veizi E, Çepni Ş, Şahin A, Fırat A. Transosseous repair with a cortical implant for greater tubercle cyst-related rotator cuff tear results in good clinical outcomes, but significant implant migration. Knee Surg Sports Traumatol Arthrosc 2022; 30:3499-3507. [PMID: 35366077 DOI: 10.1007/s00167-022-06958-9] [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: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate whether an arthroscopic transosseous technique (ATO) with cortical implants is effective for rotator cuff tear (RCT) repair in patients with cysts of the greater tuberosity (GTC). METHODS Patients treated with the ATO technique between January 2013 and October 2017 were evaluated. Inclusion criteria were patients treated for both cyst-related and non-cyst-related RCTs and patients with a moderate-sized tear (1-3 cm) according to the DeOrio and Cofield classification. A total of 39 patients were separated into two groups: Group 1 (n = 16) patients with cyst-associated RCT, and Group 2 (n = 23) patients with no cyst. Implant pull-out and migration were evaluated radiologically on standard antero-posterior shoulder radiographs and rotator cuff re-tear was assessed on magnetic resonance images at the final follow-up examination. Group 1 patients were separated into two subgroups according to cyst size (cyst < 5 mm and cyst ≥ 5 mm) and subgroup analysis was performed. Clinical assessment was performed using a visual analog scale, the Constant score and Oxford shoulder score. RESULTS The mean follow-up time was 33.7 ± 11.7 months. The mean cyst size was 5.4 ± 1.5 mm. There was no significant difference in re-tear rates between the cystic and non-cystic groups. The mean implant migration distance was 3.0 ± 2.2 mm in patients with a RCT -related cyst and 0.7 ± 0.8 mm in those without a cyst. A statistically significant difference was found between the groups (p = 0.002). There was no statistically significant difference between the groups in respect of clinical scores. No implant failure was observed. CONCLUSION The ATO method performed with a cortical implant in RCTs resulted in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates. While no implant failures were observed, implant migration was associated with cyst presence. Therefore, judicious use is advocated in the choice of transosseous fixation for cyst-related RCTs and patients should be informed of the possibility of implant migration. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mustafa Aydın
- Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, 06000, Ankara, Turkey
| | - Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey.
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Ali Şahin
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
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Furuhata R, Matsumura N, Matsuo T, Kimura H, Suzuki T, Nakamura M, Iwamoto T. Evaluation of Radiographic Changes 5 Years After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2022; 10:23259671221126095. [PMID: 36199829 PMCID: PMC9528035 DOI: 10.1177/23259671221126095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Radiographic changes in the glenohumeral joint often occur after rotator cuff repair; however, the details of the progression and underlying causes remain unknown. Purpose: To retrospectively evaluate the timing and frequency of radiographic changes after arthroscopic rotator cuff repair and to clarify the predictive factors that affect the onset of such changes using multivariate analysis. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 100 patients with 5 years of follow-up after arthroscopic rotator cuff repair and evaluated the postoperative shift in radiographic findings on plain radiographs every year during follow-up. Factors related to osteoarthritis, acromial spur re-formation, and greater tuberosity resorption at 5 years after surgery were evaluated using logistic regression analyses. Explanatory variables included preoperative factors, intraoperative factors, and postoperative retear. Baseline variables significant in the univariate analyses were included in the multivariate models. Results: Of the 100 patients, 12 developed osteoarthritis, 26 developed acromial spur formation, and 16 developed greater tuberosity resorption at 5 years after surgery. The incidence and grade of osteoarthritis and acromial spur gradually increased over time postoperatively. On the other hand, greater tuberosity resorption developed within 2 years after surgery but did not progress later. Multivariate analysis showed that a larger anteroposterior tear size (odds ratio [OR], 1.09; 95% CI, 1.01-1.17; P = .037) was a risk factor for postoperative osteoarthritis. Early retear (OR, 10.26; 95% CI, 1.03-102.40; P = .047) was a risk factor for acromial spur re-formation. Roughness of the greater tuberosity (OR, 9.07; 95% CI, 1.13-72.82; P = .038) and larger number of suture anchors (OR, 3.34; 95% CI, 1.66-6.74; P = .001) were risk factors for greater tuberosity resorption. Conclusion: Our study showed that radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. While the osteoarthritic changes and acromial spur re-formation gradually progressed postoperatively, the greater tuberosity resorption stopped within 2 years after surgery. Tear size, morphology of the greater tuberosity, and the number of suture anchors can affect radiographic changes. Furthermore, this study suggested that acromial spur re-formation may be an indicator of early retears.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tomoki Matsuo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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14
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Quigley R, Verma N, Evuarherhe A, Cole BJ. Rotator Cuff Repair with Graft Augmentation Improves Function, Decreases Revisions, and Is Cost-Effective. Arthroscopy 2022; 38:2166-2174. [PMID: 35066111 DOI: 10.1016/j.arthro.2022.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the cost effectiveness of the use of extracellular matrix (ECM) augment at the time of primary rotator cuff repair utilizing a decision tree analysis. METHODS A decision tree model was created utilizing the existing literature for retear rates with and without dermal graft augmentation. Costs for rotator cuff repair (hospital and surgeon fees) were based on published studies and the cost for graft augmentation was based on institutional data. Utility measures were based upon EQ-5D (European Quality of Life 5 Dimension) scores to assess for improvement in quality adjusted life years (QALY) over a 10-year postoperative period with and without graft augmentation. Cost effectiveness was assessed using the incremental cost effectiveness ratio (ICER), or the incremental cost for per QALY with graft augmentation. Cost effectiveness is based on previous literature whereby an intervention is considered cost effective if the ICER is less than $50,000/QALY. RESULTS On the basis of our decision tree analysis, total cost for rotator cuff tear without augmentation was $12,763, while the cost increased to $16,039 with ECM augmentation. With graft augmentation there was an improvement in 2.29 QALY, while there was an improvement of 2.05 without graft augmentation. The ICER of graft augmentation is $14,000/QALY, well below the cost effectiveness cut-off of $50,000/QALY. Sensitivity analysis showed the maximum cost of the ECM augment to be cost effective is $11,921. CONCLUSION Graft augmentation does come with a significant upfront cost; however, on the basis of our decision-tree analysis, it may represent a cost-effective procedure. There is evidence to potentially consider more routine use in rotator cuff repairs, while being cost effective. LEVEL OF EVIDENCE Economic: Level IV: computer simulation model (Monte Carlo simulation, Markov model) with inputs derived from Level IV studies.
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Affiliation(s)
- Ryan Quigley
- Kaiser Permanente, Sacramento, California, U.S.A
| | - Nikhil Verma
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Aghogho Evuarherhe
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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15
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Plachel F, Jo OI, Rüttershoff K, Andronic O, Ernstbrunner L. A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs. Am J Sports Med 2022:3635465211073332. [PMID: 35179393 DOI: 10.1177/03635465211073332] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (aRCR) has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair (oRCR). A pooled analysis of long-term results of both techniques is yet missing. PURPOSE To evaluate the long-term results of aRCR and oRCR for full-thickness rotator cuff tears. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases were searched for studies that reported on long-term clinical and radiographic outcomes of full-thickness aRCR and oRCR with a minimum follow-up of 9 years. RESULTS Eleven studies were included: 5 studies on aRCR and 6 studies on oRCR. Studies were based on 550 shoulders (539 patients) with a mean patient age of 56.3 years (range, 25-77). After a mean follow-up of 14.0 years (range, 9-20), the mean preoperative absolute Constant score (CS) and American Shoulder and Elbow Surgeons (ASES) shoulder score were significantly improved postoperatively (CS, 44 to 78 points; ASES, 52% to 91%; both comparisons, P < .001). The retear rate was 41% (141 of 342 shoulders) without a significant difference between groups (aRCR, 43%; oRCR, 39%) (P = .364). A retear was associated with significantly reduced CS as compared with a healed repair (P = .004). No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups. CONCLUSION Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other. REGISTRATION CRD42020180448 (PROSPERO).
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Affiliation(s)
- Fabian Plachel
- Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Olivia Imkyeong Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Katja Rüttershoff
- Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Octavian Andronic
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.,Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.,Melbourne Orthopaedic Group, Windsor, Victoria 3181, Australia
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16
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Day Hazra RO, Ernat JJ, Rakowski DR, Boykin RE, Millett PJ. The Evolution of Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2021; 9:23259671211050899. [PMID: 34901288 PMCID: PMC8652190 DOI: 10.1177/23259671211050899] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.
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Affiliation(s)
- Rony-Orijit Day Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Justin J Ernat
- Steadman Philippon Research Institute, Vail, Colorado, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | | | - Robert E Boykin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,EmergeOrtho, Asheville, North Carolina, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Buyukdogan K, Aslan L, Koyuncu Ö, Eren İ, Birsel O, Fox MA, Demirhan M. Long-term outcomes after arthroscopic transosseous-equivalent repair: clinical and magnetic resonance imaging results of rotator cuff tears at a minimum follow-up of 10 years. J Shoulder Elbow Surg 2021; 30:2767-2777. [PMID: 33991652 DOI: 10.1016/j.jse.2021.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE The objective of this study was to evaluate the long-term functional outcomes and structural integrity of medium to massive rotator cuff tears at 10-12 years of follow-up after arthroscopic transosseous-equivalent (TOE) repair. METHODS This was a retrospective study of a consecutive series of patients who underwent primary arthroscopic TOE repair of medium- to massive-sized degenerative rotator cuff tears performed by a single surgeon between January 2007 and August 2009. Patients were examined at a minimum follow-up of 10 years, and magnetic resonance imaging (MRI) was performed to assess tendon integrity. The Constant score (CS), American Shoulder and Elbow Surgeons score, and pain level documented using a visual analog scale were compared between intact repairs and recurrent defects. Univariate analysis was performed to identify factors related to recurrent defects. RESULTS A total of 102 patients met the inclusion criteria, and 79 shoulders in 76 patients (74.5% of eligible patients) with a mean age at surgery of 55 ± 8 years (range, 40-72 years) were available for clinical evaluation at a mean follow-up time of 10.9 years (range, 10-12 years). The mean anteroposterior tear size was 3.1 ± 1.1 cm, and there were 41 medium (52%), 26 large (33%), and 12 massive (15%) tears. MRI was performed in 72 shoulders in 69 patients (91% of available shoulders) and revealed that 13 shoulders had recurrent defects (Sugaya stages 4 and 5). During the follow-up period, 3 patients underwent revision surgery, and the overall recurrent defect rate was 21.3%. A clinically meaningful improvement was observed in all outcome measures at the final follow-up regardless of tendon integrity. Patients with intact repairs showed superior outcomes compared with those with recurrent defects; however, only the overall CS met the threshold for clinical relevance. A significant linear correlation was observed between the Sugaya classification and all outcome scores except the CS pain subscale; however, the strength of correlation was weak. The presence of diabetes (odds ratio [OR], 8.6; 95% confidence interval [CI], 2.25-33.2; P = .002), tear size (OR, 2.08; 95% CI, 1.16-3.46; P = .012), and tear retraction (OR, 4.07; 95% CI, 1.11-14.83; P = .033) were associated with recurrent defects in the univariate analysis. CONCLUSION Arthroscopic TOE repair of rotator cuff tears provided improved clinical outcomes with a recurrent defect rate of 21.3% at 10-12 years after surgery. Future research focusing on tendon healing is needed as repair integrity on MRI correlates with clinical outcomes.
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Affiliation(s)
- Kadir Buyukdogan
- Department of Orthopedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Lercan Aslan
- Department of Orthopedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Özgür Koyuncu
- Department of Orthopedics and Traumatology, Vehbi Koc Vakfı American Hospital, Istanbul, Turkey
| | - İlker Eren
- Department of Orthopedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Michael A Fox
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mehmet Demirhan
- Department of Orthopedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey.
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Beauchamp JÉ, Beauchamp M. Functional outcomes of arthroscopic transosseous rotator cuff repair using a 2-mm tape suture in a 137-patient cohort. JSES Int 2021; 5:1105-1110. [PMID: 34766091 PMCID: PMC8568820 DOI: 10.1016/j.jseint.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Although being the historical gold standard for rotator cuff repair, open transosseous (TO) repair was largely replaced by anchor-based methods with the advent of arthroscopic surgery owing to their comparative ease of use. However, suture anchors are at risk of dislodgement, especially among older patients, who have more osteopenic bone or those presenting large tears. Considering the ever-increasing active life expectancy and associated increased quality of life expectations by older generations, the need to offer safe and efficient surgical treatments to these patients imposes itself. Arthroscopic TO repairs would combine the best of both worlds and be well adapted to these populations. The primary objective of this study was to evaluate the functional outcome and complication rate of the TO arthroscopic repair technique when using a 2-mm braided suture tape. The secondary objective of this study was to assess functional outcome of TO repair in older patients and patients with >3-cm tears. Methods One hundred thirty-seven consecutive patients with full-thickness rotator cuff tear who underwent arthroscopic TO (anchorless) rotator cuff repair between January 2011 and December 2013 were reviewed. The surgery was performed by a single surgeon with a reusable curved suture passer and 2-mm braided tape suture. Follow-up was 3 to 5 years (mean = 50 months). All patients underwent preoperative and postoperative functional assessments (American Shoulder and Elbow Surgeons and Quick Dash) and were questioned with their overall satisfaction. Results Thirty-eight (28%) of the 137 patients were 65 years and older, and 62 (45%) had a large or massive tear. One patient (0.7%) had early retear at the suture-tendon interface after trauma 3 weeks postoperatively. The average Quick Dash score improved by 55.6 points and the average American Shoulder and Elbow Surgeons score improved by 69.7 points 3.5 and 6.3 times their minimal clinically important differences, respectively. There was no significant difference in final functional outcomes between patients 65 years and older and younger patients or between patients with large and massive (>3 cm) and smaller tears (≤3 cm). Mean operative time was 68 min ± 16. Conclusions Arthroscopic TO repair using a 2-mm tape material has achieved significant mid-term functional improvement, with results statistically unaffected by larger tear size (>3 cm) or older age (≥65 years).
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Affiliation(s)
| | - Marc Beauchamp
- Hôpital du Sacré-Cœur de Montréal Research Center, Montréal, Québec, Canada
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Comparison of Occurrence of Bone Tunnel Laceration, Clinical Results, and Cuff Repair Integrity of Transosseous Arthroscopic Rotator Cuff Repair With and Without Lateral Cortical Augmentation. Arthrosc Sports Med Rehabil 2021; 3:e981-e988. [PMID: 34430876 PMCID: PMC8365204 DOI: 10.1016/j.asmr.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To compare the occurrence of bone tunnel laceration, the short-term clinical results, and cuff repair integrity of transosseous arthroscopic rotator cuff repair (ARCR) using a tunneling device, with and without lateral cortical augmentation. Methods A retrospective review of patients who underwent transosseous ARCR from May 2012 to December 2017 was conducted. The inclusion criterion was repairable medium- to massive-sized full-thickness rotator cuff tear. This study included 2 consecutive series of patients undergoing transosseous ARCR with and without lateral cortical augmentation, called the ITO method and AT method, respectively. The incidence of bone tunnel laceration was evaluated intraoperatively. Patients were assessed through a range of motion and Constant scores preoperatively and at final follow-up. Further, magnetic resonance imaging was performed at 24 months postoperatively to examine the repaired rotator cuff integrity. Results A total of 121 subjects were included: 33 in the AT group and 88 in the ITO group. The intraoperative bone tunnel laceration occurrence rate was 67% and 4% for the AT and ITO methods, respectively; the difference was significant (P = .001). Anatomic failure rate (Sugaya Ⅲ, Ⅳ, and Ⅴ) rate for medium- to large-sized tears was significantly lower for the ITO than for the AT method (29% vs 65%, P = .004), but not for massive tears (61% vs 69%, P = .515). The mean forward elevation, abduction, external rotation, internal rotation, and Constant score were significantly improved at final follow-up from preoperative values. There were no significant differences between the 2 methods. Conclusions Transosseous ARCR using a tunneling device with and without lateral cortical augmentation is a reliable method of improving clinical results at a minimum follow-up of 2 years. The intraoperative occurrence rate of bone tunnel laceration occurrence rate and the anatomic failure rate of medium- to large-sized cuff tear were lower with lateral cortical augmentation than without it. Level of Evidence Level Ⅳ, therapeutic cases series.
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Johannsen AM, Arner JW, Elrick BP, Nolte PC, Rakowski DR, Horan MP, Millett PJ. Minimum 10-Year Outcomes of Primary Arthroscopic Transosseous-Equivalent Double-Row Rotator Cuff Repair. Am J Sports Med 2021; 49:2035-2041. [PMID: 34101516 DOI: 10.1177/03635465211015419] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Modern rotator cuff repair techniques demonstrate favorable early and midterm outcomes, but long-term results have yet to be reported. PURPOSE To determine 10-year outcomes and survivorship after arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair. STUDY DESIGN Case series; Level of evidence 4. METHODS The primary TOE rotator cuff repair procedure was performed using either a knotted suture bridge or knotless tape bridge technique on a series of patients with 1 to 3 tendon full-thickness rotator cuff tears involving the supraspinatus. Only patients who were 10 years postsurgery were included. Patient-reported outcomes were collected pre- and postoperatively, including American Shoulder and Elbow Surgeons (ASES), 12-Item Short Form Health Survey (SF-12), Single Assessment Numeric Evaluation (SANE), shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and satisfaction. Kaplan-Meier survivorship analysis was performed. Failure was defined as progression to revision surgery. RESULTS A total of 91 shoulders (56 men, 31 women) were included between October 2005 and December 2009. Mean follow-up was 11.5 years (range, 10.0-14.1 years). Of 91 shoulders, 5 (5.5%) failed and required revision surgery. Patient-reported outcomes for patients who survived were known for 80% (69/86). Outcomes scores at final follow-up were as follows: ASES, 93.1 ± 10.8; SANE, 87.5 ± 14.2; QuickDASH, 11.1 ± 13.5; and SF-12 physical component summary (PCS), 49.2 ± 10.1. There were statistically significant declines in ASES, SANE, and SF-12 PCS from the 5-year to 10-year follow-up, but none of these changes met the minimally clinically important difference threshold. Median satisfaction at final follow-up was 10 (range, 3-10). From this cohort, Kaplan-Meier survivorship demonstrated a 94.4% survival rate at a minimum of 10 years. CONCLUSION Arthroscopic TOE rotator cuff repair demonstrates high patient satisfaction and low revision rates at a mean follow-up of 11.5 years. This information may be directly utilized in surgical decision making and preoperative patient counseling regarding the longevity of modern double-row rotator cuff repair.
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Affiliation(s)
- Adam M Johannsen
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Justin W Arner
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Philip-C Nolte
- Steadman Philippon Research Institute, Vail, Colorado, USA.,BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen, Germany
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21
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Guevara JA, Entezari V, Ho JC, Derwin KA, Iannotti JP, Ricchetti ET. An Update on Surgical Management of the Repairable Large-to-Massive Rotator Cuff Tear. J Bone Joint Surg Am 2020; 102:1742-1754. [PMID: 32740266 DOI: 10.2106/jbjs.20.00177] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jonathan A Guevara
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jason C Ho
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Schanda JE, Keibl C, Heimel P, Monforte X, Tangl S, Feichtinger X, Teuschl AH, Baierl A, Muschitz C, Redl H, Fialka C, Mittermayr R. Zoledronic Acid Substantially Improves Bone Microarchitecture and Biomechanical Properties After Rotator Cuff Repair in a Rodent Chronic Defect Model. Am J Sports Med 2020; 48:2151-2160. [PMID: 32543880 DOI: 10.1177/0363546520926471] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone mineral density at the humeral head is reduced in patients with chronic rotator cuff tears. Bone loss in the humeral head is associated with repair failure after rotator cuff reconstruction. Bisphosphonates (eg, zoledronic acid) increase bone mineral density. HYPOTHESIS Zoledronic acid improves bone mineral density of the humeral head and biomechanical properties of the enthesis after reconstruction of chronic rotator cuff tears in rats. STUDY DESIGN Controlled laboratory study. METHODS A total of 32 male Sprague-Dawley rats underwent unilateral (left) supraspinatus tenotomy with delayed transosseous rotator cuff reconstruction after 3 weeks. All rats were sacrificed 8 weeks after rotator cuff repair. Animals were randomly assigned to 1 of 2 groups. At 1 day after rotator cuff reconstruction, the intervention group was treated with a single subcutaneous dose of zoledronic acid at 100 µg/kg bodyweight, and the control group received 1 mL of subcutaneous saline solution. In 12 animals of each group, micro-computed tomography scans of both shoulders were performed as well as biomechanical testing of the supraspinatus enthesis of both sides. In 4 animals of each group, histological analyses were conducted. RESULTS In the intervention group, bone volume fraction (bone volume/total volume [BV/TV]) of the operated side was higher at the lateral humeral head (P = .005) and the medial humeral head (P = .010) compared with the control group. Trabecular number on the operated side was higher at the lateral humeral head (P = .004) and the medial humeral head (P = .001) in the intervention group. Maximum load to failure rates on the operated side were higher in the intervention group (P < .001). Cortical thickness positively correlated with higher maximum load to failure rates in the intervention group (r = 0.69; P = .026). Histological assessment revealed increased bone formation in the intervention group. CONCLUSION Single-dose therapy of zoledronic acid provided an improvement of bone microarchitecture at the humeral head as well as an increase of maximum load to failure rates after transosseous reconstruction of chronic rotator cuff lesions in rats. CLINICAL RELEVANCE Zoledronic acid improves bone microarchitecture as well as biomechanical properties after reconstruction of chronic rotator cuff tears in rodents. These results need to be verified in clinical investigations.
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Affiliation(s)
- Jakob E Schanda
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Medical University of Vienna, Department of Oral Surgery, Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Vienna, Austria
| | - Xavier Monforte
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,University of Applied Sciences Technikum Wien, Department of Life Science Engineering, Vienna, Austria
| | - Stefan Tangl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Medical University of Vienna, Department of Oral Surgery, Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Vienna, Austria
| | - Xaver Feichtinger
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas H Teuschl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,University of Applied Sciences Technikum Wien, Department of Life Science Engineering, Vienna, Austria
| | - Andreas Baierl
- University of Vienna, Department of Statistics and Operations Research, Vienna, Austria
| | - Christian Muschitz
- St Vincent Hospital Vienna, II. Medical Department, Metabolic Bone Disease Unit, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria.,Sigmund Freud University, Medical Faculty, Center for the Musculoskeletal System, Vienna, Austria
| | - Rainer Mittermayr
- AUVA Trauma Center Vienna-Meidling, Department for Trauma Surgery, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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23
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Plachel F, Siegert P, Rüttershoff K, Thiele K, Akgün D, Moroder P, Scheibel M, Gerhardt C. Long-term Results of Arthroscopic Rotator Cuff Repair: A Follow-up Study Comparing Single-Row Versus Double-Row Fixation Techniques. Am J Sports Med 2020; 48:1568-1574. [PMID: 32391732 DOI: 10.1177/0363546520919120] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (RCR) with suture anchor-based fixation techniques has replaced former open and mini-open approaches. Nevertheless, long-term studies are scarce, and lack of knowledge exists about whether single-row (SR) or double-row (DR) methods are superior in clinical and anatomic results. PURPOSE To analyze long-term results after arthroscopic RCR in patients with symptomatic rotator cuff tears and to compare functional and radiographic outcomes between SR and DR repair techniques at least 10 years after surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Between 2005 and 2006, 40 patients with a symptomatic full-thickness rotator cuff tear (supraspinatus tendon tear with or without a tear of the infraspinatus tendon) underwent arthroscopic RCR with either an SR repair with a modified Mason-Allen suture-grasping technique (n = 20) or a DR repair with a suture bridge fixation technique (n = 20). All patients were enrolled in a long-term clinical evaluation, with the Constant score (CS) as the primary outcome measure. Furthermore, an ultrasound examination was performed to assess tendon integrity and conventional radiographs to evaluate secondary glenohumeral osteoarthritis. RESULTS A total of 27 patients, of whom 16 were treated with an SR repair and 11 with a DR repair, were followed up after a mean ± SD period of 12 ± 1 years (range, 11-14 years). Five patients underwent revision surgery on the affected shoulder during follow-up period, which led to 22 patients being included. The overall CS remained stable at final follow-up when compared with short-term follow-up (81 ± 8 vs 83 ± 19 points; P = .600). An increasing number of full-thickness retears were found: 6 of 22 (27%) at 2 years and 9 of 20 (45%) at 12 years after surgery. While repair failure negatively affected clinical results as shown by the CS (P < .05), no significant difference was found between the fixation techniques (P = .456). In general, progressive osteoarthritic changes were observed, with tendon integrity as a key determinant. CONCLUSION Arthroscopic RCR with either an SR or a DR fixation technique provided good clinical long-term results. Repair failure was high, with negative effects on clinical results and the progression of secondary glenohumeral osteoarthritis. While DR repair slightly enhanced tendon integrity at long-term follow-up, no clinical superiority to SR repair was found.
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Affiliation(s)
- Fabian Plachel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
| | - Paul Siegert
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
| | - Katja Rüttershoff
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
| | - Doruk Akgün
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
| | - Philipp Moroder
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany.,Department for Shoulder and Elbow Surgery, Schulthess Clinic, Zürich, Switzerland
| | - Christian Gerhardt
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
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Walter SG, Cucchi D, Thomas W, Friedrich MJ, Jansen T. ARoCuS Web application promotes standardized treatment and documentation of rotator cuff tears. Musculoskelet Surg 2020; 105:289-294. [PMID: 32314304 PMCID: PMC8578089 DOI: 10.1007/s12306-020-00658-8] [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: 09/01/2019] [Accepted: 04/11/2020] [Indexed: 11/11/2022]
Abstract
Purpose To program a Web application for simplified calculation of the Advanced Rotator Cuff tear Score (ARoCuS), which is a 5-part, 18-item treatment-oriented intraoperative scoring system for intraoperative evaluation of rotator cuff tears. Methods ARoCuS characteristics (torn tendon, tear size, tissue quality and tear pattern) were assessed intraoperatively on 40 consecutive patients with rotator cuff tears for calculation of defect category ΔV. Video recordings were used to re-calculate the ARoCuS after surgery and to assess inter-observer reliability. Results The Web application “ARoCuS App” was built using Angular and transformed to a native iOS application. The intraoperative use of the app proved to be simple and intuitive. There were inter-/intra-observer differences neither in ARoCuS defect categories ΔV nor in ARoCuS characteristics (p > 0.05). Conclusion The ARoCuS app is a supportive tool for integration of standardized treatment procedures and documentation of rotator cuff tears in clinical routine.
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Affiliation(s)
- S G Walter
- Department for Orthopedic Surgery, University Hospital, Siegmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - D Cucchi
- Department for Orthopedic Surgery, University Hospital, Siegmund-Freud-Str. 25, 53127, Bonn, Germany
| | - W Thomas
- Clinic for Orthopedic Surgery, Karol Wojtyla Hospital, Viale Africa 32, 00144, Rome, Italy
| | - M J Friedrich
- Department for Orthopedic Surgery, University Hospital, Siegmund-Freud-Str. 25, 53127, Bonn, Germany
| | - T Jansen
- Department for Orthopedic Surgery, University Hospital, Siegmund-Freud-Str. 25, 53127, Bonn, Germany
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25
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Fırat A, Aydın M, Tecimel O, Öçgüder A, Sanisoğlu Y, Uğurlu M. Comparison of the clinical and radiological outcomes of arthroscopic transosseous and transosseous-equivalent double-row rotator cuff repair techniques. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:178-185. [PMID: 32254034 DOI: 10.5152/j.aott.2020.02.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study compared the clinical and radiological results of the arthroscopic transosseous (ATO) and transosseous-equivalent (TOE) double-row rotator cuff repair techniques. METHODS Prospective data collected from patients treated with ATO (32 women and 7 men, mean age: 57.03±6.39 years) and TOE (36 women and 8 men; mean age: 57.86±7.81 years) techniques were retrospectively evaluated. The visual analog scale score, Constant score, and Oxford shoulder score were used to assess the clinical results. Anchor pullout on standard anteroposterior shoulder radiographs and rotator cuff re-tear on magnetic resonance images were examined at the final follow-up to evaluate the radiological results. Rotator cuff re-tears were graded as per the classification system described by Sugaya et al. Results: The mean follow-up duration was 33.3±11.8 months. No difference was observed in the demographic data of the two groups. Significant improvement was observed in the postoperative shoulder scores of the groups; however, no difference was observed between the groups. Re-tear was detected in 10 patients of the TOE group and 9 patients of the ATO group. Age, tear size, and retraction level could cause re-tear. CONCLUSION In the treatment of rotator cuff tears, the ATO and TOE techniques may achieve considerable improvements in shoulder functions in the short term. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Ahmet Fırat
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Aydın
- Department of Orthopedics, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Osman Tecimel
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Ali Öçgüder
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
| | - Yavuz Sanisoğlu
- Department of Biostatistics, Yıldırım Beyazıt University, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Mahmut Uğurlu
- Department of Orthopedics, Ankara City Hospital, Ankara, Turkey
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26
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Abstract
Transosseous repair has been used safely and effectively for primary and revision rotator cuff repair for decades; as a result, it is considered by many the historical gold standard of open repair techniques. Transosseous repair offers the advantage of excellent biology, double-row anatomic footprint reconstruction, and the ability to create multiple low-cost fixation points per surface area of tendon with high-strength suture, while avoiding anchor pullout, cyst formation, and imaging artifact. More recently, in arthroscopic applications, transosseous-equivalent anchor-based repairs have been introduced that have shown satisfactory clinical and biomechanical results; however, these attributes have been coupled with increased cost, nonbiologic burden to the healing interface of the tendon, and new catastrophic failure modes including tendon transection, anchor pullout, and bone voids. This article delineates a technique for arthroscopic true transosseous hybrid cuff repair that combines the use of anchors and transosseous techniques to maximize the benefits and minimize the detriments of both techniques. Level 1 (shoulder); level 2 (rotator cuff).
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Affiliation(s)
- Brett Sanders
- Address correspondence to Brett Sanders, M.D., Center for Sports Medicine, 2415 McCallie Ave, Chattanooga, TN 37404, U.S.A.
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27
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Gurger M, Ozer AB. A comparison of continuous interscalene block versus general anesthesia alone on the functional outcomes of the patients undergoing arthroscopic rotator cuff repair. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1659-1666. [PMID: 31243560 DOI: 10.1007/s00590-019-02482-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/21/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this prospective and randomized study was to compare the effects of general anesthesia to the combination of general anesthesia and continuous interscalene block on postoperative pain and functional outcomes in patients undergoing arthroscopic rotator cuff repair. METHODS This study included a total of 85 patients aged 45-74 years, who were scheduled for elective arthroscopic rotator cuff repair. One group consists of patients who underwent only general anesthesia (GA, N = 43), and the other group consists of patients who underwent a combination of continuous interscalene brachial plexus block and general anesthesia (CISB + GA, N = 42). Pain levels of the patients were evaluated postoperatively by a visual analog scale. Shoulder function was evaluated preoperatively and postoperatively using the Constant score. RESULTS Patients in the CISB + GA group had lower postoperative visual analog scores and less additional analgesic needs during the early postoperative period than those in the GA group. Constant scores of the patients in the CISB + GA group at postoperative week 6 were higher than those in the GA group. Evaluation of the functional outcomes at 6 months postoperatively showed that there were no significant differences between the two groups. CONCLUSION Although CISB significantly improved postoperative pain control and early (in the first 6 weeks) functional outcomes following arthroscopic rotator cuff repair, there was no significant difference between the CISB group and CISB + GA group at 6 months. LEVEL OF EVIDENCE Level II, Randomized Controlled Trial, Treatment Study.
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Affiliation(s)
- Murat Gurger
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University Hospital, 23190, Elazig, Turkey.
| | - Ayse Belin Ozer
- Department of Anesthesiology, Faculty of Medicine, Inonu University Hospital, 44280, Malatya, Turkey
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