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Pastor PCS, Ramos MIP, Roig AG, Safont JA. Superior capsular reconstruction with the long head of the biceps tendon achieves excellent clinical results and low rotator cuff rerupture rates one year after cuff repair surgery. INTERNATIONAL ORTHOPAEDICS 2024; 48:2121-2128. [PMID: 38796811 DOI: 10.1007/s00264-024-06223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To analyze the clinical one-year evolution of healed and rerupture lesions in patients who received a rotator cuff repair plus Superior Capsular Reconstruction (SCR) with the long head of the biceps (LHB). Moreover, to compare this evolution between men and women. METHODS A pilot study was conducted on patients who underwent a rotator cuff repair plus SCR with LHB between February 2021 and June 2022. All patients completed pre-operative and one-year post-operative evaluations for tendon type of tear and tendon integrity using Magnetic Resonance Imaging (MRI)after one year of the surgery. Besides, functionality was evaluated with the American Shoulder and Elbow Surgeons (ASES) score; the visual analog scale for pain (VAS); and the Constant score. RESULTS A total of 38 patients completed the one-year final evaluation, they presented an increased functionality score to 83 and 86 in Constant and ASES scales (p < .001), respectively. Besides, 84% of the patients presented a healed cuff, while rerupture occurred in 16% of the patients. There were differences between the healed and rerupture patients in the total Constant score, with a remarkable increase in the strength subscale, almost double for patients with healed cuff (p < .001); in the same way, daily life activity score, and balance subscale increased, while pain score decreased in the healed cuff group (p < .05). There was no difference in functionality between men and women (p > .05). Besides, almost all patients achieved the MCID in both ASES and Constant total scores, irrespectively of the healing group. CONCLUSION The cuff repair using SCR with the LHB achieved a low percentage of rerupture and a functional improvement after one year of follow-up. Patients who healed the lesion presented more strength and better performance in daily life activities than those with cuff repurture. Thus, SCR + LHB procedure can be considered an efficient technique for rotator cuff repair surgery for both men and women. Although a comparison with a control group is needed to confirm these findings.
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Affiliation(s)
- Pablo Cañete San Pastor
- Universidad Católica de Valencia San Vicente Mártir. Escuela de Doctorado, Valencia, Spain.
- Hospital de Manises, Manises, Spain.
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Ducasse M, Collin P. Hawkins award 2023: clinical outcome and tendon healing after arthroscopic repair of isolated supraspinatus tears: a retrospective comparative study in patients older than 70 years vs. patients younger than 50 years. JSES Int 2024; 8:673-680. [PMID: 39035654 PMCID: PMC11258851 DOI: 10.1016/j.jseint.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background The purpose of this study was to evaluate and compare the clinical and structural outcomes after arthroscopic repair of isolated supraspinatus tears in patients older than 70 years vs. patients younger than 50 years to determine whether age influences the treatment of these tears. Methods We conducted a retrospective, comparative study of 87 shoulders of 86 patients older than 70 years who underwent rotator cuff repair after isolated full-thickness supraspinatus tear between January 2010 and December 2020. A control group of 87 patients younger than 50 years was matched for sex, body mass index, smoking habits, tendon retraction according to Patte and fatty infiltration according to Goutallier. Clinical assessment used Constant-Murley Score (CMS), age- and sex-matched Constant Scores and Subjective Shoulder Value at 6 months. Cuff integrity was evaluated using ultrasonography based on the Sugaya criteria, types I-II-III being considered as healed. Results The CMS significantly improved by +17.91 points in elderly patients compared with +7.47 points in controls (P < .1) and activity (P = .2), mobility (P < .1), and strength (P < .1). The adjusted CMS significantly improved by +24.94 in elderly patients compared with +8.49 points in controls (P < .1). The Subjective Shoulder Value improved by +29.48 points in elderly patients compared with +23.47 points in controls. The improvement was similar in both groups. (P < .10). Satisfaction was similar in both groups (P = .31). Regarding structural outcomes, patients younger than 50 years presented better results in terms of healing than patients older than 70 years, as the healing rate was 73.7% in the elderly group and 88.5% in the control group (P = .1). The clinical outcomes were not significantly associated with the tendon healing (P = .1). Conclusion Functional gain for patients older than 70 years is better than their younger peers despite their low-grade healing. Arthroscopic repair after isolated supraspinatus tears should be considered as a valuable treatment regardless the age.
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Affiliation(s)
- Mehdi Ducasse
- Department of Orthopedics and Traumatology, Caen Normandy University Hospital Center, Caen, France
| | - Philippe Collin
- CHP Saint-Grégoire, Saint-Grégoire, France
- American Hospital of Paris, Neuilly-sur-Seine, France
- Clinique Victor Hugo, Paris, France
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Minarro JC, Bassi C, Boltuch A, Urbano-Luque M, Buijze GA, Lafosse L, Lafosse T. Subacromial Balloon Spacer Does Not Reduce the Retear Rate for Massive Rotator Cuff Tears: A Comparative Study. Arthroscopy 2024; 40:242-248. [PMID: 37394148 DOI: 10.1016/j.arthro.2023.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To determine whether a subacromial spacer decreases the recurrent rotator cuff tear rate in arthroscopically managed massive rotator cuff tears (MRCTs) with 1 year of follow-up. METHODS We selected all patients who met the following criteria: (1) an MRCT excluding Collin type A, (2) Goutallier stage equal or less than 2, and (3) complete arthroscopic repair of the MRCT. Patients were allocated into 2 groups: A (without subacromial spacer) or B (with subacromial spacer) for a prospective evaluation 1 year after surgery. The primary outcome was the retear rate, determined with magnetic resonance imaging (MRI) according to the classification of Sugaya. Secondary outcome measures were the functional outcomes using visual analog score, Shoulder Subjective Value, and Constant-Murley Score. Preoperative rotator cuff characteristics such as number of tendons involved and the tear retraction also were evaluated. Patient-related data such as sex, age, laterality, history of smoking, and diabetes mellitus were analyzed. RESULTS In total, 31 patients were included in group A and 33 in group B. Preoperatively, only 2 differences were found between both groups: a significant (but not clinical) greater Constant score in group A (P = .034) and a slightly greater retraction of the supraspinatus in group B (P = .0025). The overall retear rate between the 2 groups was similar regarding the number of patients (P = .746) and the total number of tendons involved in the recurrent tear (P = .112). At 1-year follow-up, no differences were found in VAS (P = .397), SSV (P = .309), and Constant score (P = .105). CONCLUSIONS In reparable massive rotator cuff tears (excluding Collin type A), the augmentation of repair with a subacromial spacer did not significantly reduce the number of patients with recurrent rotator cuff tears identified by MRI. It was also ineffective in reducing the number of re-ruptured tendons in these patients. No patient-reported or clinically significant findings were noted in Constant, SSV, and VAS scores at 1-year postoperative follow-up. Patients with MRI findings of a healed rotator cuff (Sugaya 1-3) had better clinical outcomes compared with those without. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- José Carlos Minarro
- Upper Limb Department, Alps Surgery Institute, Annecy, France; Hospital Universitario Reina Sofía, Córdoba, Spain.
| | - Cristina Bassi
- Upper Limb Department, Alps Surgery Institute, Annecy, France
| | - Andrew Boltuch
- Upper Limb Department, Alps Surgery Institute, Annecy, France
| | | | | | - Laurent Lafosse
- Upper Limb Department, Alps Surgery Institute, Annecy, France
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Lee JB, Kholinne E, Yeom JW, So SP, Ben H, Alsaqri H, Koh KH, Jeon IH. Evaluation of a New MRI-Based Classification of Graft Status After Superior Capsule Reconstruction. Orthop J Sports Med 2023; 11:23259671231193315. [PMID: 37781637 PMCID: PMC10536853 DOI: 10.1177/23259671231193315] [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: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 10/03/2023] Open
Abstract
Background A classification system for the graft state after superior capsule reconstruction (SCR) using magnetic resonance imaging (MRI) has not been described previously. Purpose To introduce a new, MRI-based classification system for graft integrity after SCR and to evaluate the system according to postoperative outcomes. Study Design Cohort study (diagnosis); Level of evidence, 3. Method Included were 62 consecutive patients who underwent SCR using autologous fascia lata graft between January 2013 and April 2021. Postoperative outcomes were assessed (American Shoulder and Elbow Surgeons [ASES] score, Constant score, pain visual analog scale [pVAS], range of motion [ROM], acromiohumeral distance [AHD], Hamada grade). Graft status was classified by 2 orthopaedic surgeons on postoperative MRI in accordance with the signal intensity and the presence or extent of the tear, as follows: type 1 (hypointense signal without tear), type 2 (hyperintense signal without tear), type 3 (partial-thickness tear), type 4 (full-thickness tear with partial continuity), and type 5 (full-thickness tear with complete discontinuity). Intra- and interobserver agreement were assessed using Cohen kappa. The correlation between postoperative outcomes (ASES score, Constant score, pVAS, ROM, AHD, and Hamada grade) and the SCR graft classification system was assessed with the Pearson correlation coefficient, and the outcomes were compared according to classification type. Results Patients were classified according to the new system as follows: type 1 (n = 15), type 2 (n = 20), type 3 (n = 7), type 4 (n = 8), and type 5 (n = 12). There was excellent interobserver agreement (κ = 0.819) and intraobserver agreement (κ = 0.937 and 0.919). The classification system showed a moderate to high correlation with the ASES score (r = -0.451; P = .001), pVAS (r = 0.359; P = .005), AHD (r = -0.642; P < .001), and Hamada grade (r = 0.414; P < .001). Patients classified as having types 1 and 2 showed better outcomes in terms of ASES score, pVAS, ROM, and AHD compared with type 5 patients (P ≤ .021 for all). Conclusion The new classification system was highly reproducible and showed clinical utility for both radiological and clinical evaluation after SCR.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Ji Woong Yeom
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Williams TG, Hackett LM, Lam PH, Stitz DJ, Al-Housni H, Murrell DF, Murrell GAC. Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) vs. Global: A comparison of 2 scales developed to assess ultrasound images post rotator cuff repair. J Shoulder Elbow Surg 2023; 32:713-728. [PMID: 36481456 DOI: 10.1016/j.jse.2022.10.035] [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: 05/01/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ultrasound is commonly used to assess rotator cuff repair (RCR), but no standardized criterion exists to characterize the tendon. PURPOSE The aims of this study were to (1) develop content validity for ultrasound specific criteria to grade the postoperative appearance of a tendon after RCR, (2) assess the reliability of the criteria, and (3) assess the feasibility to use these assessments. METHODOLOGY Following expert consultation and literature review for content validity, 2 scales were created: 1) the Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) scale and 2) the Rotator Cuff Repair-Investigator Global Assessment (RCR-IGA). A prospective cohort study was undertaken on patients who had received a RCR and serial B-mode ultrasound images. Four raters assessed the 64-ultrasound images using the scales created in a blinded fashion using intraclass correlation coefficients. RESULTS The FECTS scale was a composite score with 5 key parameters and the RCR-IGA scale was a 5-point global score. The intrarater reliability for the FECTS scale was excellent for the most experienced rater (0.92) and fair for the rater with no experience (0.72). The intrarater reliability for the RCR-IGA scale was excellent for 3 of the 4 raters (0.80-0.87) and fair when used by the least experienced rater (0.56). Inter-rater testing for all the FECTS scale parameters had excellent reliability (0.82-0.92) except for Fibrillar matrix (0.73). The average time to complete the FECTS scale per image was 23 seconds and 11 seconds for the RCR-IGA scale. CONCLUSION The FECTS scale and the RCR-IGA scale are reliable tools to assess the ultrasonic appearance of the repaired rotator cuff tendon. The FECTS scale was more reliable for less experienced assessors. The RCR-IGA scale was easier, more time efficient and reliable for those with experience.
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Affiliation(s)
- Tiffany G Williams
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Lisa M Hackett
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Daniel J Stitz
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Hilal Al-Housni
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Dedee F Murrell
- Department of Dermatology, St. George Hospital, Sydney, NSW, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
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Zampeli F, Kazum E, Fadhel BW, Gomez AJ, Valenti P. Medialized rotator cuff repair for retracted, massive, postero superior tears: Clinical and radiological outcomes. Orthop Traumatol Surg Res 2023; 109:103296. [PMID: 35537680 DOI: 10.1016/j.otsr.2022.103296] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/08/2022] [Accepted: 03/03/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The footprint medialization allows a tension free repair in severely retracted rotator cuff tears (RCT), thereby de-creasing the rate of retear. The purpose of the study was to evaluate the clinical and radiological results in a cohort of chronic RCT treated with medialized repair. Secondary purpose was to analyze the impact of medialization length on shoulder function and tendon healing. HYPOTHESIS It was hypothesized that the medialization length would have an impact on clinical and radiological outcome. MATERIAL AND METHODS A consecutive series of thirty patients that underwent arthroscopic repair of a massive posterosuperior RCT at a single institution were retrospectively studied at mean follow-up 18.4months (SD 15.3; range 9-58). The medialization of the medial footprint was measured intraoperatively. Preoperative and postoperative examination included active range of motion, abduction strength, pain assessment, and functional scores. The postoperative rotator cuff integrity was evaluated according to the Sugaya's classification. Types IV-V were categorized as absence of healing. RESULTS At final follow-up the clinical outcomes were significantly improved in all patients (p≤0.001) with the exception of external rotation that displayed no significant improvement (p=0.05). In group 1 (n=8) medialization length was≤10mm (mean 8, SD 1.9) and in group 2 (n=14)>10mm (mean 12.6, SD 1.7). There were no significant differences regarding preoperative and postoperative clinical outcomes (p>0.05) between two groups. Group 2 demonstrated moderate correlation between length of medialization and Sugaya stage of tendon healing (r=0.53, p=0.049). Absence of healing was noted in 4/22 patients, 1/8 in group 1 and 3/14 in group 2. DISCUSSION Medialized repair is an effective technique for treating chronic, massive and retracted posterosuperior RCT. A medialization of the footprint less than or equal to 10mm is recommended, as it was associated with good clinical and radiological results. The rate of tendon healing decreases when medialization exceeds 10mm. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Frantzeska Zampeli
- Paris shoulder unit, Clinique Bizet, Paris, France; Hand-Upper Limb-Microsurgery Department, KAT Attica General Hospital, Kifissia, Greece.
| | - Efi Kazum
- Paris shoulder unit, Clinique Bizet, Paris, France; Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tuphé P, Regas I, Sakek F, Haight H, Pluvy I, Lascar T, Obert L, Loisel F. Intra- and Inter-rater Reliability of Postoperative Radiographic Analysis of Reverse Shoulder Arthroplasty in 49 Shoulders After Proximal Humerus Fracture. Indian J Orthop 2022; 56:2013-2021. [PMID: 36310564 PMCID: PMC9561354 DOI: 10.1007/s43465-022-00716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
Introduction The lateralization shoulder angle (LSA), the distalization shoulder angle (DSA) and the new "pentagon" concept are tools used in scheduled shoulder surgery to evaluate the positioning of reverse shoulder arthroplasty (RSA) implants. There is no information on the intra- and inter-rater reliability of these tools in the context of RSA for a proximal humerus fracture. The first hypothesis was the high reliability of the intra- and inter-rater analysis of the LSA and DSA angles. The second hypothesis was the reproductibility of the pentagon based on LSA and DSA analysis. Methods Forty-nine patients were evaluated retrospectively with a minimum of 2 years radiological follow-up after RSA surgery. Tuberosity healing was evaluated using an AP radiograph of the shoulder and their location analyzed within the said "pentagon" defined by the LSA/DSA angles and the maximum lengthening recommended. Results The intra-rater analysis found strong to an almost perfect agreement for the LSA and DSA. The agreement was moderate to strong for the pentagon. The inter-rater analysis found a fair agreement for the LSA and moderate agreement for the DSA and pentagon. Conclusion The LSA/DSA is used in patients undergoing RSA for glenohumeral OA. In this context, the tuberosities were intact and certain complications inherent to RSA for humeral fracture were not present. The population studied here (RSA after fracture) creates an interpretation bias due to the difficulty in analyzing tuberosity position. Level of Evidence 4, retrospective study.
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Affiliation(s)
- Pierre Tuphé
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Ines Regas
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Fiona Sakek
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Harrison Haight
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Isabelle Pluvy
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - Tristan Lascar
- Orthopedic, Traumatology, and Hand Surgery Unit, Princesse Grace de Monaco Hospital, Principality of Monaco, Monaco, France
| | - Laurent Obert
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
| | - François Loisel
- Department of Orthopaedics, Traumatology, Plastic, Reconstructive and Hand Surgery, Faculty of Medicine and Pharmacy, University of Franche Comté, CIC IT 808, C.H.U Besançon, 25033 Besançon, France
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Functional and radiologic results of the crimson duvet procedure in rotator cuff treatment: a randomized controlled clinical trial. J Shoulder Elbow Surg 2022; 31:1200-1207. [PMID: 35007748 DOI: 10.1016/j.jse.2021.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/25/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears are one of the more frequent pathologies of the shoulder. Arthroscopic techniques and biologic augmentation have been developed to improve the rate and quality of healing. The crimson duvet procedure (CDP) theoretically provides mesenchymal stem cells through microfracture treatment of the footprint. The aim of this research was to evaluate the effect of CDP in patients who had undergone arthroscopic surgery for complete rotator cuff repair. METHODS A prospective randomized clinical trial was performed in a total of 123 patients, consisting of 59 women and 64 men, with a mean age of 58 years. We included patients with a clinical and radiologic diagnosis of a complete rotator cuff tear. All patients were treated with arthroscopic rotator cuff repair. In group 1, the surface of the footprint was débrided; in group 2, the footprint underwent microfracture. The primary outcome was the nonhealing rate, which was detected by magnetic resonance imaging (MRI) or ultrasonography, and the secondary outcome was the functional result. A Sugaya classification of I to III was considered to indicate healing. For clinical evaluation, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Constant scores were evaluated, along with the range of motion. The functional evaluation was performed preoperatively and at 6 months and 1 year postoperatively. The radiologic (MRI or ultrasonography) evaluation was performed at 6 months. Neither the patients nor the radiologists and physical therapists who performed the postoperative evaluations were informed of the random selection. RESULTS We observed a healing rate of 85.11% in the control group and 93.7% in the CDP group, which was not significant (P = .19). However, a significant improvement in function was observed in all patients. The ASES score improved from 68.9 (SD 13.8) preoperatively to 92.2 at 6 months and to 96.4 (SD 6.2) at 12 months (P < .05), but no difference was observed between the groups. A similar level of improvement was observed in the Constant score. CONCLUSION The arthroscopic repair of complete rotator cuff tears presents good and excellent clinical results in most patients. Nevertheless, nonhealing occurs at a rate that depends mainly on the age of the patient and the size of the tear. The addition of CDP did not improve the functional results or the healing rate.
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Preoperative rotator cuff tendon integrity, tear size, and muscle atrophy and fatty infiltration are associated with structural outcomes of arthroscopic revision rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2022; 30:2029-2038. [PMID: 34636949 DOI: 10.1007/s00167-021-06732-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A few studies have focused on factors predisposing to retear after arthroscopic revision rotator cuff repair (ARRCR). This study aimed to retrospectively evaluate (1) the structural and clinical outcomes of ARRCR and (2) pre- and intraoperative factors affecting the integrity of the rotator cuff (RC) tendon by focusing on preoperative RC tendon integrity, tear size, muscle hypotrophy and fatty infiltration. METHODS Patients who underwent ARRCR between 2006 and 2016 were reviewed. Preoperative variables included demographic data, RC tendon integrity, tear size, and muscle hypotrophy and fatty infiltration on preoperative magnetic resonance imaging (MRI). Intraoperative variables included repair technique and completeness of repair. The visual analog scale for pain (PVAS), functional VAS (FVAS), American Shoulder and Elbow Surgeons scores, and shoulder range of motion (ROM) were assessed. Postoperative tendon integrity was evaluated using over 6-month follow-up MRI. Patients were classified into groups A (healed) and B (retear), and their variables were compared. RESULTS Overall 65 patients with a mean follow-up of 49.5 ± 30.2 (range, 24.0-148.9) months were analyzed. Fifty-six of 65 (86.2%) patients underwent MRI at 9.1 ± 9.7 (range, 4.4-40.2) months after ARRCR, and 20 of 56 (35.7%) patients (group B) exhibited retear. Group A (36/56, 64.3%) showed higher functional scores and ROMs than group B at the final follow-up, with significant differences in the FVAS scores (Group A versus B: FVAS, 7.6 ± 1.8 versus 6.4 ± 1.9, p = 0.036). Intraoperative variables, including preoperative tendon integrity (p = 0.021), tear size (p = 0.007), supraspinatus and infraspinatus muscle hypotrophy and fatty infiltration (p < 0.001 and p = 0.046), and completeness of repair (p = 0.030), differed significantly between the groups. Multivariate analysis revealed that preoperative supraspinatus muscle hypotrophy and fatty infiltration were independent predisposing factors for retear after ARRCR [odds ratio = 7.5, 95% confidence interval (CI) 1.1-55.8, p = 0.048]. CONCLUSION The retear was found in 20/56 patients (35.7%) after ARRCR for less than massive rotator cuff tears in this limited study population. Preoperative tendon integrity, tear size, supraspinatus and infraspinatus muscle hypotrophy and fatty infiltration, and completeness of repair was revealed to be associated with tendon integrity following ARRCR. Among them, preoperative supraspinatus muscle atrophy and fatty infiltration were the independent factors for retear after ARRCR, although generalization is limited. LEVEL OF EVIDENCE IV.
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Degan TJ, Hartzler RU, Rahal A, DeBerardino TM, Burkhart SS. Prospective 1-Year Outcomes Are Maintained at Short-Term Final Follow-Up After Superior Capsular Reconstruction Augmentation of Complete Rotator Cuff Repair. Arthroscopy 2022; 38:1411-1419. [PMID: 34785296 DOI: 10.1016/j.arthro.2021.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcomes of arthroscopic superior capsular reconstruction (SCR) augmentation of complete, massive rotator cuff repair (RCR). METHODS A retrospective study of dermal allograft SCR-augmented RCRs performed by a single surgeon from June 2016 through December 2017 was performed with the following inclusion criteria: massive rotator cuff tear amenable to complete repair but with poor-quality native rotator cuff tissue. Radiographic follow-up was performed at 1 year, and clinical follow-up was performed at both 1 year and a minimum 2 years after surgery. Clinical follow-up included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, Subjective Shoulder Value score, active forward elevation, and external rotation. Radiographs and magnetic resonance imaging (MRI) scans were assessed for muscle quality using the Goutallier classification, and graft and cuff integrity was assessed according to the Sugaya classification. RESULTS The inclusion criteria were met by 24 patients at 1 year and by 18 (75%) at a minimum of 2 years postoperatively. Patient-reported outcomes were improved compared with preoperative data and were maintained at minimum 2-year follow-up, with median American Shoulder and Elbow Surgeons scores of 42.5 (interquartile range [IQR], 30.8-58.7) versus 93.9 (IQR, 82.4-100) (P < .001); median Subjective Shoulder Value scores of 30 (IQR, 20-50) versus 90 (IQR, 86.2-97.2) (P < .001); and median visual analog scale pain scores of 5.5 (IQR, 1-9) versus 0 (IQR, 0-0.8) (P = .001). Evaluation of graft and tendon healing on postoperative MRI revealed poor interobserver agreement and showed 10 completely healed grafts (42%), 9 partially healed grafts (38%), and 5 completely disrupted grafts (21%), with 42% of supraspinatus tendons and 54% of infraspinatus tendons healed. CONCLUSIONS SCR with dermal allograft augmentation of complete RCR with poor-quality tissue shows very good clinical outcomes at minimum 2-year follow-up. Poor interobserver agreement regarding postoperative graft and rotator cuff integrity by MRI was found. The healing rate for the SCR grafts was 79%. The rates of healing of the native supraspinatus and infraspinatus tendons were 42% and 54%, respectively. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Timothy J Degan
- Department of Orthopedics, Baylor College of Medicine, Houston, Texas, U.S.A.; The CORE Institute, Phoenix, Arizona, U.S.A
| | - Robert U Hartzler
- Department of Orthopedics, Baylor College of Medicine, Houston, Texas, U.S.A.; Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A.; TSAOG Orthopaedics, San Antonio, Texas, U.S.A..
| | - Andres Rahal
- Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A.; TSAOG Orthopaedics, San Antonio, Texas, U.S.A
| | - Thomas M DeBerardino
- Department of Orthopedics, Baylor College of Medicine, Houston, Texas, U.S.A.; Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A.; TSAOG Orthopaedics, San Antonio, Texas, U.S.A
| | - Stephen S Burkhart
- Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A.; TSAOG Orthopaedics, San Antonio, Texas, U.S.A
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11
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Ma J, Sahoo S, Imrey PB, Jin Y, Baker AR, Entezari V, Ho JC, Iannotti JP, Ricchetti ET, Polster JM, Winalski CS, Derwin KA. Inter-rater agreement of rotator cuff tendon and muscle magnetic resonance imaging parameters evaluated preoperatively and during the first postoperative year following rotator cuff repair. J Shoulder Elbow Surg 2021; 30:e741-e752. [PMID: 33930556 PMCID: PMC8551316 DOI: 10.1016/j.jse.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is standard of care for rotator cuff evaluation, with clinical interpretation usually limited to qualitative judgments. The reliability of MRI-based measurements and scoring systems has been evaluated only preoperatively or ≥6 months following rotator cuff repair, when repairs are in the later stages of healing. This study describes the MRI assessments and inter-rater agreement of various rotator cuff tendon and muscle parameters evaluated preoperatively and 4 times during the first postoperative year. METHODS Two musculoskeletal radiologists independently assessed MRI scans of 42 patients preoperatively and 3, 12, 26, and 52 weeks after rotator cuff repair. Using standardized reading rules, readers assessed tendon integrity (5-point Sugaya classification), tear dimensions, muscle fat (5-point Goutallier classification) and atrophy (4-point Warner classification), muscle cross-sectional areas, and myotendinous junction distance. Raw exact agreement proportions, κ statistics, and correlation coefficients were used to quantify inter-rater agreement. RESULTS Readers showed moderate to substantial above-chance agreement in scoring rotator cuff tendon integrity and supraspinatus muscle atrophy and good to excellent agreement on tear dimensions and muscle cross-sectional areas but only fair to moderate agreement for fatty infiltration and myotendinous junction distance. Only fatty infiltration grades evidenced observer bias. Inter-rater agreement did not appear time dependent. CONCLUSION By use of defined reading rules in a research setting, MRI evaluations of rotator cuff tendon integrity, tear dimensions, muscle atrophy, and cross-sectional areas have reasonable reliability at all time points in the first postoperative year. However, the presence of clinically significant disagreements, even in such favorable circumstances, indicates the need for improved imaging tools for precise rotator cuff evaluation.
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Affiliation(s)
- Jinjin Ma
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Sambit Sahoo
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Peter B. Imrey
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew R. Baker
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jason C. Ho
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Joshua M. Polster
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Carl S. Winalski
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Kathleen A. Derwin
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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12
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Significance of the acromiohumeral distance on stress radiography for predicting healing and function after arthroscopic repair of massive rotator cuff tears. J Shoulder Elbow Surg 2021; 30:e471-e481. [PMID: 33271320 DOI: 10.1016/j.jse.2020.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A decreased acromiohumeral distance (AHD) is commonly detected in patients with massive rotator cuff tears (mRCTs). Most studies evaluating fixed humeral elevation have used preoperative or postoperative standardized radiography and not stress radiography. This study aimed to evaluate the predictive role of the preoperative AHD measured using stress radiography (AHD_stress) in rotator cuff healing and function after arthroscopic repair of mRCTs. METHODS The data of 113 patients who underwent arthroscopic repair of mRCTs were analyzed. Postoperative cuff integrity was evaluated using magnetic resonance imaging at 1 year, and shoulder function was evaluated at a mean of 34.9 ± 17.8 months (range, 24-92 months) postoperatively. Forty-seven patients showed healing failure. Propensity score matching (1-1) was performed between the healed group and healing failure group. Thirty-eight patients in each group were matched in the final analysis. The AHD and AHD_stress were defined as the shortest distances from the inferior acromion to the superior humerus on standard anteroposterior radiography and stress radiography (5.4-kg weight applied inferiorly in a neutral position), respectively. The AHD difference (AHD_diff) was defined as the difference between the AHD and AHD_stress values. Receiver operating characteristic curve analysis was performed to determine cutoff values for significant variables. RESULTS No difference in the mean preoperative AHD was found between the healed group (7.5 ± 2.0 mm) and healing failure group (6.9 ± 2.2 mm, P = .234). The AHD_diff value was significantly higher in the healed group (4.4 ± 2.1 mm) than in the healing failure group (3.0 ± 2.0 mm, P = .002; cutoff, 3.2 mm). Patients with an AHD_diff value ≥ 3.2 mm showed a lower healing failure rate (28.9% vs. 71.1%, P < .001) and higher functional scores than patients with an AHD_diff value < 3.2 mm. The AHD_diff value was higher in patients with an American Shoulder and Elbow Surgeons (ASES) score ≥ 80 (4.9 ± 1.9 mm) than in those with an ASES score < 80 (3.1 ± 2.1 mm, P = .024). Among patients with healing failure, only the postoperative AHD showed a significant difference between those with an ASES score ≥ 80 (7.0 ± 2.5 mm) and those with an ASES score < 80 (4.8 ± 2.1 mm, P = .009; cutoff, 4.8 mm). CONCLUSION A reducible AHD, which increased by ≥ 3.2 mm under stress radiography, can be a favorable predictor of rotator cuff healing and function after arthroscopic repair of mRCTs. Our findings suggest that this new and simple radiologic parameter should be considered preoperatively and would be helpful to determine appropriate treatment strategies.
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13
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Muniandy M, Niglis L, Claude Dosch J, Meyer N, Kempf JF, Collin P. Postoperative rotator cuff integrity: can we consider type 3 Sugaya classification as retear? J Shoulder Elbow Surg 2021; 30:97-103. [PMID: 32778379 DOI: 10.1016/j.jse.2020.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sugaya classification is a widely accepted classification system that is used to analyze postoperative rotator cuff tendon integrity. However, there are inconsistencies in the literature as to whether type 3 Sugaya should be considered as a retear or healed tendon. PURPOSE We aimed to show that type 3 Sugaya is not a retear by comparing the long-term supraspinatus and infraspinatus muscle degeneration and the functional outcomes of type 3 with those of type 4 and 5 Sugaya. We hypothesized that the clinical course of type 3 Sugaya would be different from type 4 or 5 Sugaya. METHOD The study was a retrospective multicenter review of all the rotator cuff repair done in 2003-2004. We included all the patients who had undergone supraspinatus repair with 10-year follow-up (magnetic resonance imaging done with full functional assessment). Data collection included pre- and postoperative supraspinatus and infraspinatus fatty infiltration, supraspinatus muscle atrophy, and Constant score with a separate analysis of its Strength subsection. Supraspinatus tendon integrity at 10-year follow-up was determined according to Sugaya classification. The patients were divided into 2 groups: type 3 Sugaya and type 4 and 5 Sugaya. Statistical comparison was done between the groups. RESULTS There was no significant difference in the preoperative fatty infiltration of the supraspinatus and infraspinatus, supraspinatus muscle atrophy, and Constant score between the 2 groups. However, type 3 Sugaya patients had significantly better scores in the preoperative Strength subsection. Postoperatively, type 3 Sugaya patients showed significantly lesser fatty infiltration of the supraspinatus and infraspinatus, lesser supraspinatus muscle atrophy, and higher Constant score compared with type 4 and 5 Sugaya (P < .001). CONCLUSION Patients with type 3 Sugaya supraspinatus tendon exhibited lesser muscle degeneration in the supraspinatus and infraspinatus and performed better in functional assessment compared with type 4 and 5 Sugaya patients. We inferred that type 3 Sugaya should not be considered as a retear.
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Affiliation(s)
| | - Lucas Niglis
- Service de chirurgie orthopédique du membre supérieur, CCOM, Illkirch, France
| | | | - Nicolas Meyer
- Laboratoire de biostatistique, hôpital civil, Strasbourg, France
| | - Jean Francois Kempf
- Service de chirurgie orthopédique du membre supérieur, CCOM, Illkirch, France
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14
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Variability of glenohumeral positioning and bone-to-tendon marker length measurements in repaired rotator cuffs from longitudinal computed tomographic imaging. JSES Int 2020; 4:838-847. [PMID: 33345224 PMCID: PMC7738576 DOI: 10.1016/j.jseint.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background To address the need for more objective and quantitative measures of tendon healing in research studies, we intend to use computed tomography (CT) with implanted radiopaque markers on the repaired tendon to measure tendon retraction following rotator cuff repair. In our small prior study, retraction at 1-year follow-up averaged 16.1± 5.3 mm and exceeded 10.0 mm in 12 of 13 patients, and thus tendon retraction appears to be a common clinical phenomenon. This study's objectives were to assess, using 5 longitudinal CT scans obtained over 1 year following rotator cuff repair, the variability in glenohumeral positioning because of pragmatic variations in achieving perfect arm repositioning and to estimate the associated measurement variability in bone-to-tendon marker length measurements. Methods Forty-eight patients underwent rotator cuff repair with intraoperative placement of radiopaque tendon markers at the repair site. All patients had a CT scan with their arms at the side on the day of surgery and at 3, 12, 26, and 52 weeks postoperatively. Glenohumeral position (defined by the orientation and distance of the humerus with respect to the scapula) and bone-to-tendon marker lengths were measured from each scan. Within-patient variation in glenohumeral position measurements was described by their pooled within-patient standard deviations (SDs), and variation in bone-to-tendon marker lengths by their standard errors of measurement (SEMs) and 95% confidence level minimally detectable distances (MDD95) and changes (MDC95). Results The mean glenohumeral orientation from the 5 longitudinal CT scans averaged across the 48 patients was 12.6° abduction, 0.4° flexion, and –0.1° internal rotation. Within-patient SDs (95% confidence intervals) of glenohumeral orientation were 3.0° (2.7°-3.4°) in extension/flexion, 5.2° (4.6°-5.8°) in abduction/adduction, and 8.2° (7.3°-9.2°) in internal/external rotation. The SDs of glenohumeral distances were less than 1 mm in any direction. The estimated SEMs of bone-to-tendon lengths were consistent with a common value of 2.4 mm for any of the tendon markers placed across the repair, with MDD95 of 4.7 mm and MDC95 of 6.7 mm. Conclusion Apparent tendon retraction of 5 mm or more, when measured as the distance from a tendon marker's day of surgery location to its new location on a volumetrically registered longitudinal CT scan, may be considered above the usual range of measurement variation. Tendon retraction measured using implanted radiopaque tendon markers offers an objective and sufficiently reliable means for quantifying the commonly expected changes in structural healing following rotator cuff repair.
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15
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Park SG, Shim BJ, Seok HG. How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity? Arthroscopy 2019; 35:2992-3000. [PMID: 31629587 DOI: 10.1016/j.arthro.2019.05.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To suggest a cutoff value of tension related to retear of a repaired chronically contracted rotator cuff and to analyze the correlation between predictive factors and integrity of repair in large to massive contracted rotator cuff tears (RCTs). METHODS We analyzed arthroscopic rotator cuff repairs for large to massive (>3 cm) contracted RCTs, not amenable to complete repair by standard means with meticulous release, with a minimum of 1 year follow-up. An intraoperative procedure was designed for the estimation of repair tension using a tensiometer. Clinical and radiological findings were compared between the healed group and the retear group, and magnetic resonance imaging was performed ∼1 year postoperatively for the evaluation of integrity of the repair site. The receiver operating characteristic curve was used to identify the cutoff value of the independent factors. Factors affecting postoperative retear were examined with multivariate analysis. RESULTS Fifty patients were enrolled in this study and divided into the healed group (31 patients) and the retear group (19 patients) according to the follow-up magnetic resonance imaging findings. Significant results showed that tension (5.13 < 95% confidence interval [CI] < 58.15, P < .001) and acromiohumeral interval (AHI) (1.13 < 95% CI < 33.10, P = .013) were important factors for the integrity of rotator cuff repair. The cutoff value of tension was 35 N, and an AHI <6.6 mm may also be considered a predictor of retear. An occupation ratio of the tension >35 N was the strongest predictor of retear, with an area under the curve of 0.799, sensitivity of 84.2%, and specificity of 67.7% (accuracy = 76.0%). CONCLUSIONS The integrity of a large to massive rotator cuff repair is strongly related to the tension to reach the articular margin of the footprint and AHI. We found that the possibility of retear increases when tension ≥35 N is required. AHI <6.6 mm may also be considered a predictor of retear. LEVEL OF EVIDENCE Level III, retrospective cohort design.
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Affiliation(s)
- Sam-Guk Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Bum-Jin Shim
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
| | - Hyun-Gyu Seok
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
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16
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Collin P, Colmar M, Thomazeau H, Mansat P, Boileau P, Valenti P, Saffarini M, Nover L, Kempf JF. Clinical and MRI Outcomes 10 Years After Repair of Massive Posterosuperior Rotator Cuff Tears. J Bone Joint Surg Am 2018; 100:1854-1863. [PMID: 30399080 DOI: 10.2106/jbjs.17.01190] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Massive rotator cuff tears are challenging to treat, with few or no studies on long-term outcomes of repair. The purpose of this study was to report 10-year outcomes following repair of massive posterosuperior rotator cuff tears, with and without extension into the subscapularis, and to determine prognostic factors that could influence clinical scores and retear rates. METHODS The records of 234 patients who underwent repair of a massive posterosuperior rotator cuff tear at a total of 15 centers were retrieved. Patients were asked to return for evaluation at 10 years; 78 patients could not be contacted, 7 had died, and 19 had undergone a reoperation. A total of 130 patients (68% men) with a mean age (and standard deviation) of 56.1 ± 7.7 years (range, 26 to 79 years) were evaluated clinically, and 102 of them were also evaluated using magnetic resonance imaging (MRI). The tear was confined to the supraspinatus and infraspinatus tendons in 94 shoulders and also involved the superior portion of the subscapularis in 36 shoulders. Univariable and multivariable regressions were performed to determine whether 10-year total Constant-Murley scores and repair integrity were associated with patient characteristics, tear patterns, or repair techniques. RESULTS In the study cohort, complications were noted in 14 shoulders (11%) (stiffness in 10 and infection in 4). For the 130 shoulders evaluated clinically, the mean total Constant-Murley score improved from 53.1 ± 15.9 (range, 14 to 83) preoperatively to 78.5 ± 11.3 (range, 36 to 98) at 10 years. Of the 102 shoulders evaluated using MRI, 32 had a retear (Sugaya type IV or V). Of the 19 shoulders that underwent a reoperation (excluded from the study cohort), 9 had a retear. The overall prevalence of retears was 34%. Multivariable regression analysis revealed a significant association between the 10-year Constant-Murley score and preoperative retraction of the infraspinatus tendon, but no association between retears and any of the variables. Involvement of the subscapularis had no significant effect on preoperative or postoperative Constant-Murley scores or retear rates. CONCLUSIONS Patients who had repair of a massive posterosuperior rotator cuff tear maintained considerable improvements in clinical and radiographic outcomes at 10 years. Partial concomitant tears of the subscapularis did not affect the total postoperative Constant-Murley scores or retear rates. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Philippe Collin
- Institut Locomoteur de l'Ouest CHP Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | | | - Hervé Thomazeau
- Université de Rennes 1, Rennes, France.,Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Rennes, France
| | | | - Pascal Boileau
- Service de Chirurgie Orthopédique et Chirurgie du Sport, Institut Universitaire Locomoteur et du Sport, CHU de Nice Hôpital Pasteur, Nice, France
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17
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Lädermann A, Collin P, Athwal GS, Scheibel M, Zumstein MA, Nourissat G. Current concepts in the primary management of irreparable posterosuperior rotator cuff tears without arthritis. EFORT Open Rev 2018; 3:200-209. [PMID: 29951257 PMCID: PMC5994621 DOI: 10.1302/2058-5241.3.180002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Various procedures exist for patients with irreparable posterosuperior rotator cuff tears (IRCT). At present, no single surgical option has demonstrated clinical superiority.There is no panacea for treatment and patients must be aware, in cases of palliative or non-prosthetic options, of an alarming rate of structural failure (around 50%) in the short term.The current review does not support the initial use of complex and expensive techniques in the management of posterosuperior IRCT.Further prospective and comparative studies with large cohort populations and long-term follow-up are necessary to establish effectiveness of expensive or complicated procedures such as superior capsular reconstruction (SCR), subacromial spacers or biological augmentation as reliable and useful alternative treatments for IRCT. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180002.
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