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Kantanavar R, Lee IE, Rhee SM, Rhee YG. Outcomes of arthroscopic single-row repair alone vs. repair with human dermal allograft patch augmentation in patients with large to massive, posterosuperior rotator cuff tears: a retrospective comparative study. J Shoulder Elbow Surg 2024; 33:823-831. [PMID: 37689106 DOI: 10.1016/j.jse.2023.08.002] [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: 03/14/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Large to massive rotator cuff tears (RCTs) affect shoulder functions profoundly with unmanageable disability without intervention. The retear rates with arthroscopic rotator cuff repair (ARCR) in these patients are abysmal. Patch augmentation has been credited for preventing retears, improving functions by increasing the strength, and acting as a bioconductive scaffold. This study aimed to assess the retear rates and compare the clinical and radiological outcomes between the ARCR with and without acellular human dermal allograft (HDA) augmentation. METHODS This is a retrospective comparative study among patients diagnosed with large to massive, posterosuperior RCTs, operated between January 2020 and December 2021, including 36 patients (group I) with and 131 patients (group II) without HDA augmentation, with a mean follow-up of 20 (range, 12-35) months. The average age was 64 (range, 49-80) and 66 (range, 41-81) years in groups I and II, respectively. In group I, there were 16 male and 20 female patients, whereas in group II, there were 58 male and 73 female patients. RESULTS The visual analog scale score improved to 1.1 ± 1.7 in group I and 2.1 ± 1.7 in group II (P = .005). There was a greater improvement in the University of California, Los Angeles shoulder score to 30.1 ± 4.2 in group I compared with 23.2 ± 3.9 in group II (P = .046). Forward flexion (degrees) improved from a mean of 103.2 ± 18.6 to 138.9 ± 23.5 in group I and from 106.4 ± 21.3 to 127.0 ± 19.5 in group II (P = .004). The acromiohumeral interval (mm) measured in anteroposterior radiographs increased to 8.4 ± 1.8 in group I and 8.2 ± 2.0 in group II (P = .006). The satisfaction after the procedure was 4.4 ± 0.6 in group I and 3.1 ± 1.1 in group II (P = .044). The retear rate in the HDA-augmented group was 5.6% as compared with 29.1% in the nonaugmented group, which was statistically significant (P = .007). There were no complications or adverse tissue reactions against HDA seen in any patients. CONCLUSION In patients with large to massive, posterosuperior RCTs, patch augmentation with acellular HDA significantly averted the retears after ARCR without any graft-related complications. The augmentation also resulted in improved shoulder function and greater range of motion compared with the nonaugmented group.
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Affiliation(s)
- Radhakrishna Kantanavar
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, Myongji Hospital, Goyang-si, Kyunggi Gyeonggi-do, Republic of Korea
| | - In El Lee
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, Myongji Hospital, Goyang-si, Kyunggi Gyeonggi-do, Republic of Korea
| | - Sung Min Rhee
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, College of Medicine, KyungHee University Hospital, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, Myongji Hospital, Goyang-si, Kyunggi Gyeonggi-do, Republic of Korea.
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Rhee SM, Youn SM, Park JH, Rhee YG. Biceps Rerouting for Semirigid Large-to-Massive Rotator Cuff Tears. Arthroscopy 2021; 37:2769-2779. [PMID: 33892075 DOI: 10.1016/j.arthro.2021.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical and radiographic results of arthroscopic rotator cuff repair (ARCR) with biceps rerouting (BR) and those of conventional repair for semirigid, large-to-massive rotator cuff tear. METHODS We prospectively collected data of 111 patients who underwent either ARCR + BR (n = 59, group 1) or only ARCR (n = 52, group 2) for semirigid, large-to-massive rotator cuff tear between January 2016 and December 2018. We comparatively analyzed both groups with respect to preoperative factors including concomitant lesions of the long head of the biceps tendon (LHBT). Univariate logistic regression analysis was performed to identify predictive variables for occurrence of retear after ARCR + BR. RESULTS Mean age of groups 1 and 2 were 62.8 and 63.7 years, respectively (P = .484). Mean follow-up period in groups 1 and 2 were 15.1 and 25.1 months, respectively (P = .102). Mean range of motion and functional scores improved significantly (P < .05) and comparably (P > .05) in both groups. In total, 11 (18.6%) and 25 (48.1%) patients from groups 1 and 2, respectively, showed retear of the repaired rotator cuff at final follow-up (P < .01). Of 45 group 1 patients who showed less than 50% partial tearing of the LHBT preoperatively, 6 (13.3%) experienced retear. Comparatively, of 14 patients with partial tearing involving more than 50% of the LHBT, 5 (35.7%) suffered postoperative retear. If the patients had partial tear involving more than 50% of LHBT preoperatively, the odds ratio (OR) to have retear was 4.222 (P = .037). Wider (OR, 1.445, P = .047) and thinner (OR, 0.166, P = .019) LHBT were the prognostic factors to have retear. Three (5.1%) group 1 patients showed the Popeye deformity at final follow-up. CONCLUSIONS ARCR + BR for semirigid, large-to-massive rotator cuff tears effectively improved clinical and structural outcomes as also shown in the conventional repairs. However, the retear rate was significantly lower in patients who underwent ARCR + BR than those treated conventionally. Partial tearing involving more than 50% of the LHBT and wide and/or thin tendon morphology were significant risk factors for postoperative occurrence of retear. LEVEL OF EVIDENCE Level III, retrospective therapeutic comparative trial.
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Affiliation(s)
- Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung-Min Youn
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Korea
| | - Joon Hong Park
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Korea.
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Ro K, Rhee SM, Kim JY, Kim MS, Kim JD, Lee H, Rhee YG. All-Suture Anchor Settling After Arthroscopic Repair of Small and Medium Rotator Cuff Tears. Am J Sports Med 2019; 47:3483-3490. [PMID: 31718248 DOI: 10.1177/0363546519886547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors. PURPOSE To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm2; n = 31), group B (BMD, 0.4-0.6 g/cm2; n = 32), and group C (BMD, >0.6 g/cm2; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21). RESULTS On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) (P = .001). The DA was deeper in patients with a higher BMD at time zero (r = 0.374; P = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA (r = 0.769; P < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) (P = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) (P = .550). CONCLUSION In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.
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Affiliation(s)
- Kyunghan Ro
- Shoulder and Elbow Clinic, Bonbridge Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Myung Seo Kim
- Department of Orthopaedic Surgery, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Jong Dae Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hojin Lee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Kim JD, Rhee SM, Kim MS, Ro K, Rhee YG. Arthroscopic Side-to-side Repair for Large U-shaped Full-Thickness Rotator Cuff Tears: Is the Repair Integrity Actually Maintained? Arthroscopy 2019; 35:3211-3218. [PMID: 31708353 DOI: 10.1016/j.arthro.2019.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and structural outcomes of arthroscopic side-to-side repair of large U-shaped full-thickness rotator cuff tears (FTRCTs) by assessing the functional score of the patients and the integrity of the tendon repair using magnetic resonance imaging with a minimum follow-up duration of 2 years. METHODS In this case series, 59 consecutive patients who underwent arthroscopic side-to-side repair of large U-shaped FTRCTs, with a minimum follow-up duration of 2 years (range 25 to 72 months), were retrospectively enrolled. The mean patient age was 58.6 years. Patients' functional scores and integrity of the tendon repairs were evaluated. RESULTS The mean visual analog scale score improved from 5.7 ± 2.1 preoperatively to 2.4 ± 1.3 postoperatively (P < .001). The mean range of motion (forward flexion) improved from 152.7° ± 11.4° to 164.5° ± 9.5° (P < .001). The mean Constant-Murley score improved from 57.3 ± 7.2 preoperatively to 77.8 ± 6.9 postoperatively (P < .001). Postoperative magnetic resonance imaging examinations demonstrated cuff integrity with a retear rate of 54.2%. The retear rate of patients who underwent anchor fixation to the medial row (45%) was significantly lower than that of patients who underwent simple side-to-side repair (73.7%) (P = .039). The University of California at Los Angeles shoulder rating and Constant-Murley scores were not significantly different between the healed and retear groups (P = .639 and P = .863, respectively). CONCLUSIONS Arthroscopic side-to-side repair of large U-shaped FTRCTs demonstrated satisfactory clinical outcomes. However, the retear rate was higher than expected when simple side-to-side fixation was performed without footprint fixation. Therefore, medial row fixation is recommended if arthroscopic side-to-side repair is performed. LEVEL OF EVIDENCE III, comparative therapeutic trial.
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Affiliation(s)
- Jong Dae Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Seo Kim
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyunghan Ro
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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Ro K, Pancholi S, Son HS, Rhee YG. Perianchor Cyst Formation After Arthroscopic Rotator Cuff Repair Using All-Suture-Type, Bioabsorbable-Type, and PEEK-Type Anchors. Arthroscopy 2019; 35:2284-2292. [PMID: 31350085 DOI: 10.1016/j.arthro.2019.03.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to identify the difference in postoperative perianchor bone reactions in different groups of patients who underwent rotator cuff tear repairs with all-suture-, bioabsorbable screw-, and PEEK (polyether ether ketone)-type suture anchors. Furthermore, the rate of rotator cuff retear and its association with perianchor bone reactions based on the different anchors used were investigated. Moreover, their impact on the clinical outcome of patients was examined. METHODS The study included 213 patients who underwent arthroscopic single-row repair and were divided into 3 groups according to the suture anchor used: all-suture (n = 137), biodegradable (n = 36), and PEEK (n = 40) anchor groups. The clinical outcomes and magnetic resonance imaging findings were evaluated at a mean follow-up of 9.6 months. The perianchor bone reaction at the anchor site was categorized according to grades. Patients were classified based on repair integrity into the healed and retear groups with Sugaya type I to III and Sugaya type IV to V, respectively. RESULTS No statistically significant differences in Constant scores and retear rates were observed between the groups (P = .934 and P = .548, respectively). Magnetic resonance imaging showed that the total number of perianchor cysts formed postoperatively was 23 (10.8% [23 of 213 patients]). Moreover, the proportions of perianchor cysts were 8.8%, 16.7%, and 12.5% in the all-suture-type, bioabsorbable-, and PEEK-type anchor groups, respectively (P = .485). In the retear group, the incidence rate was significantly increased with higher grades of perianchor bone reaction (P = .001). The tear size and perianchor bone reaction were found to be independent factors that affected the incidence of retear. CONCLUSIONS Perianchor cyst formation was observed in 10.8% of cases after the use of suture anchors for arthroscopic rotator cuff repair. No significant differences were observed among all-suture-type, bioabsorbable-type, and PEEK-type anchors in terms of visual analog scale and Constant scores, retear rates, and perianchor bone reactions. However, the retear rate was associated with a greater perianchor cystic reaction and larger tear size. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Affiliation(s)
- Kyunghan Ro
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Samyak Pancholi
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyuck Sung Son
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Abstract
BACKGROUND One potential advantage of arthroscopic shoulder surgery over open approaches is accelerated recovery; however, the functional recovery period of daily activities for specific movements after arthroscopic rotator cuff repair has not yet been reported, to our knowledge. QUESTIONS/PURPOSES (1) After arthroscopic rotator cuff repair, when are patients able to perform low-level and high-level front-of-body motion, low-level and high-level behind-the-back motion, strength-related activities, and sports/leisure activities? (2) How do tear size, arm dominance, and retear affect performance of these activities? (3) When does the UCLA score cross above 80% in each UCLA score component (28 points)? METHODS A 2-year prospective study of 135 patients who underwent arthroscopic rotator cuff repair was performed (45 in small-sized, 45 in medium-sized, and 45 in large-to-massive-sized groups). The mean age was 60 years. Thirty-one and 104 shoulders were nondominant and dominant shoulders, respectively. Twenty-seven shoulders showed retear on MRI taken 9 months after surgery. We evaluated the functional recovery periods using the questionnaire and the UCLA scores and assessed influencing factors such as tear size, arm dominance, and retear. The patients were asked to fill out a questionnaire at 1, 2, 3, 6, 9, 12, 15, 18, and 24 months after surgery. The questionnaire evaluated front-of-the-body, behind-the-back, general, simple strength-related, and sports/leisure activities. Based on the UCLA evaluation, the functional recovery period was defined as the time required to achieve a score > 80% in each UCLA score component. RESULTS Patients experienced recovery of low-level and high-level ROM front-of-the-body, high-level ROM behind-the-back, simple strength-related, and sports/leisure activities within 2 ± 1, 3 ± 2, 9 ± 0, 10 ± 2, and 14 ± 3 months, respectively, after surgery. Two patients with large-to-massive tears did not gain the recovery of high-level ROM behind-the-back, simple strength-related, and sports/leisure activities. Patients with large-to-massive tears were delayed from some activities compared with patients with small tears (10 ± 0 versus 7 ± 1 for washing back, p = 0.010; 11 ± 0 versus 10 ± 0 for lifting 5 kg, p = 0.020; 15 ± 0 versus 13 ± 0 for sports/leisure). Arm dominance was not associated with functional recovery. Patients with retears, compared with intact healing, had a longer time to return to washing hair (3 ± 2 versus 3 ± 1, p = 0.007), combing (4 ± 3 versus 2 ± 1, p = 0.002), washing the back (10 ± 3 versus 8 ± 3, p = 0.034), and sports/leisure (15 ± 3 versus 14 ± 3, p = 0.010). UCLA score in 134 patients reached 28 points, corresponding to the functional recovery period at 6 ± 3 months. One patient did not reach > 28 points on the UCLA score. CONCLUSIONS It took patients an average of 14 months to recover their daily motion after surgery. Tear size and retear affected only the recovery period of high-level motion activities and sports/leisure. This study was believed to serve as a guideline to inform patients about functional recovery after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Level III, therapeutic study.
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Kim HJ, Park JS, Kim JY, Kee YM, Rhee YG. Interstitial tears of the rotator cuff: difficulty in preoperative diagnosis. J Shoulder Elbow Surg 2018; 27:487-492. [PMID: 29122450 DOI: 10.1016/j.jse.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have investigated the characteristic findings of preoperative magnetic resonance imaging (MRI) and the clinical and radiologic outcomes of interstitial tear of the rotator cuff treated with arthroscopic repair after tear completion. METHODS Forty-one patients (14 men and 27 women; mean age, 56.5 years) with arthroscopically confirmed interstitial tears underwent single-row repair after tear completion. The minimum follow-up period was 2 years. RESULTS Twenty-eight patients (68.3%) were properly evaluated with MRI before surgery. Seven cases (17.1%) were misdiagnosed as bursal-sided tears and 5 cases (12.2%) were misdiagnosed as articular-sided tears on the basis of presurgical MRI findings. Arthroscopy revealed fibrillation and dimpling of the tendon surface in all cases and congestion within the defect in 36 cases (87.8%). At the final follow-up, the visual analog scale score for pain during motion decreased to 0.8 from a preoperative mean of 6.1 (P <.001). Moreover, at the final follow-up, the mean University of California-Los Angeles score and Constant score improved from 15.7 and 51.8 to 32.1 and 83.8, respectively (P <.001 for all). At 9 months after surgery, MRI revealed no cases of retear. CONCLUSION Interstitial tears are difficult to diagnose before surgery because MRI findings may lead to the misdiagnosis of interstitial tears as articular- or bursal-sided tears. If MRI-based diagnosis is indicative of articular- or bursal-sided tears but arthroscopy reveals fibrillation and dimpling of the tendon surface, interstitial tears should be suspected. The defective sites in interstitial tears are usually accompanied by congestion.
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Affiliation(s)
- Hwan Jin Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young Moon Kee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Abstract
BACKGROUND No studies have focused on the everted type of bursal-sided partial-thickness rotator cuff tears (PTRCTs). PURPOSE To evaluate the radiological characteristics, arthroscopic findings, and clinical and structural outcomes after arthroscopic repair of the everted type of bursal-sided PTRCTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Two groups of patients with bursal-sided PTRCTs (simple type, 25 shoulders; everted type, 25 shoulders) were enrolled. The mean age was 59.6 years (range, 47-73 years) and 60.8 years (range, 48-72 years) among patients with the simple and everted type, respectively. The mean follow-up period was 2.7 years (range, 2.0-5.1 years). RESULTS The everted type always exhibited an acromial spur (hat-shaped, 52%; heel-shaped, 48%) and bony changes in the greater tuberosity (bony spur, 52%; sclerotic changes, 48%). Hat-shaped spurs of the acromion were not observed in the simple type. The everted type showed significantly thicker tendon on magnetic resonance imaging (MRI), as the stump was retracted superomedially (mean thickness: 8.1 ± 1.2 mm vs 5.5 ± 1.1 mm for the everted and simple type, respectively). During arthroscopic repair, additional sutures were needed more often for the everted type than for the simple type (64% vs 16%, respectively). After repair, the tendon margin was uneven and ragged in 16% of shoulders with the everted type. Preoperatively, the visual analog scale (VAS) score for pain during motion and range of motion (ROM) were significantly worse in patients with the everted type than in those with the simple type (VAS score, 7.2 vs 5.6, respectively; ROM for forward flexion, 146.8° vs 156.4°, respectively). Postoperatively, no significant differences in the VAS score, ROM, or clinical outcomes were observed between the 2 groups, with no retears on follow-up MRI in either group. CONCLUSION The everted type of bursal-sided PTRCTs showed a characteristic hat-shaped acromion, often with bony spurs of the greater tuberosity. On MRI, the tendon stump appeared thickened because of the everted flap. The everted type was more likely to require additional sutures because of an uneven or ragged tendon margin. However, satisfactory clinical and structural outcomes were observed for both the simple and everted types.
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Affiliation(s)
- Hwan Jin Kim
- Department of Orthopaedic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Young Moon Kee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Cho NS, Moon SC, Hong SJ, Bae SH, Rhee YG. Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable. Am J Sports Med 2017. [PMID: 28622022 DOI: 10.1177/0363546517709772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. PURPOSE To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively. RESULTS There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P < .001, respectively). At final follow-up, the mean visual analog scale (VAS) for pain score during motion was 1.31 ± 0.98 and 1.24 ± 0.90 in groups A and B, respectively ( P = .587). The mean Constant score was 77.5 ± 11.2 and 78.0 ± 11.9 points in groups A and B, respectively ( P = .875). The mean University of California, Los Angeles score was 30.5 ± 4.1 and 31.0 ± 3.0 points in groups A and B, respectively ( P = .652). In assessing the repair integrity on postoperative MRI, the retear rate was 23.9% and 14.7% in groups A and B, respectively ( P = .029). CONCLUSION Irrespective of involvement in the anterior attachment of the rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.
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Affiliation(s)
- Nam Su Cho
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seong Cheol Moon
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Se Jung Hong
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seong Hae Bae
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Kim JY, Park JS, Rhee YG. Can Preoperative Magnetic Resonance Imaging Predict the Reparability of Massive Rotator Cuff Tears? Am J Sports Med 2017; 45:1654-1663. [PMID: 28273425 DOI: 10.1177/0363546517694160] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous studies have shown preoperative fatty infiltration of rotator cuff muscles to be strongly negatively correlated with the successful repair of massive rotator cuff tears (RCTs). PURPOSE To assess the association between factors identified on preoperative magnetic resonance imaging (MRI), especially infraspinatus fatty infiltration, and the reparability of massive RCTs. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We analyzed a total of 105 patients with massive RCTs for whom MRI was performed ≤6 months before arthroscopic procedures. The mean age of the patients was 62.7 years (range, 46-83 years), and 46 were men. Among them, complete repair was possible in 50 patients (48%) and not possible in 55 patients (52%). The tangent sign, fatty infiltration of the rotator cuff, and Patte classification were evaluated as predictors of reparability. Using the receiver operating characteristic curve and the area under the curve (AUC), the prediction accuracy of each variable and combinations of variables were measured. RESULTS Reparability was associated with fatty infiltration of the supraspinatus ( P = .0045) and infraspinatus ( P < .001) muscles, the tangent sign ( P = .0033), and the Patte classification ( P < .001) but not with fatty infiltration of the subscapularis and teres minor ( P = .425 and .132, respectively). The cut-off values for supraspinatus and infraspinatus fatty infiltration were grade >3 and grade >2, respectively. The examination of single variables revealed that infraspinatus fatty infiltration showed the highest AUC value (0.812; sensitivity: 0.86; specificity: 0.76), while the tangent sign showed the lowest AUC value (0.626; sensitivity: 0.38; specificity: 0.87). Among 2-variable combinations, the combination of infraspinatus fatty infiltration and the Patte classification showed the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96). The combination of 4 variables, that is, infraspinatus and supraspinatus fatty infiltration, the tangent sign, and the Patte classification, had an AUC of 0.866 (sensitivity: 0.28; specificity: 0.98), which was lower than the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96) among the 2-variable combinations. CONCLUSION The tangent sign or Patte classification alone was not a predictive indicator of the reparability of massive RCTs. Among single variables, infraspinatus fatty infiltration was the most effective in predicting reparability, while the combination of Goutallier classification <3 of the infraspinatus and Patte classification ≤2 of the rotator cuff muscles was the most predictive among the combinations of variables. This information may help predict the reparability of massive RCTs.
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Affiliation(s)
- Jung Youn Kim
- Department of Orthopaedic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Cho NS, Cha SW, Shim HS, Juh HS, Rhee YG. Comparison of Clinical and Structural Outcomes of Open and Arthroscopic Repair for Massive Rotator Cuff Tear. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cho NS, Cha SW, Rhee YG. Alterations of the Deltoid Muscle After Open Versus Arthroscopic Rotator Cuff Repair. Am J Sports Med 2015; 43:2927-34. [PMID: 26394890 DOI: 10.1177/0363546515603063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Open repair can be more useful than arthroscopic repair for immobile and severely retracted, large to massive rotator cuff tears. However, it is not known whether the deltoid muscle is altered after open repair or to what extent the deltoid origin remains detached after surgery. PURPOSE To compare postoperative alterations of the deltoid muscle in open versus arthroscopic repair for severely retracted, large to massive rotator cuff tears. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Enrolled in this study were 135 patients who underwent surgical repair for severely retracted, large to massive rotator cuff tears and who had routine follow-up MRIs at least 6 months after surgery. Open repairs were performed in 56 cases and arthroscopic repairs in 79 cases. The detachment and thickness of the deltoid muscle at its proximal origin were recorded in 5 zones on MRI. The alterations of the deltoid muscle and postoperative integrity of the repaired rotator cuff were evaluated. RESULTS Partial detachment of the deltoid occurred in 1 patient (1.8%) in the open group and in 2 patients (2.5%) in the arthroscopic group (P = .80). All the partial detachments occurred in zones 2 and 3. Attenuation of the proximal origin of the deltoid was found in 3 patients (5.4%) in the open group and in 4 patients (5.1%) in the arthroscopic group (P = .87). Atrophy of the deltoid muscle was shown in 3 patients (5.4%) in the open group and 4 patients (5.1%) in the arthroscopic group (P = .61). The retear rate of the repaired cuff was 30.4% (17/56) in the open group and 38.0% (30/79) in the arthroscopic group (P = .74). CONCLUSION Between open and arthroscopic repair for severely retracted, large to massive rotator cuff tears, there was no significant difference in detachment of the deltoid origin and alterations of the deltoid muscle after repair. Postoperative alterations of the deltoid occurred in arthroscopic surgery as well as in open surgery. For immobile massive rotator cuff tear, open repair is an acceptable technique as long as the deltoid muscle is meticulously reattached after surgery.
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Affiliation(s)
- Nam Su Cho
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Won Cha
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Rhee YG, Cho NS, Parke CS. Arthroscopic rotator cuff repair using modified Mason-Allen medial row stitch: knotless versus knot-tying suture bridge technique. Am J Sports Med 2012; 40:2440-7. [PMID: 23002202 DOI: 10.1177/0363546512459170] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND When using a method of suture bridge technique, there may be a possibility of strangulation of the rotator cuff tendon at the medial row. The style of knots chosen to secure the medial row might conceivably be a factor to reduce this possibility. PURPOSE To compare the clinical results and repair integrity of arthroscopic rotator cuff repair between a knotless and a conventional knot-tying suture bridge technique for patients with full-thickness rotator cuff tears and to evaluate retear patterns in the cases with structural failure after arthroscopic repair by magnetic resonance imaging (MRI). STUDY DESIGN Cohort study; Level of evidence, 2. METHODS After arthroscopic repair for medium-sized rotator cuff tears, 110 patients available for postoperative MRI evaluation at least 6 months were enrolled in this study. According to the repair technique, 51 shoulders were enrolled in a knotless suture bridge technique group (group A) and 59 shoulders in a conventional knot-tying suture bridge technique group (group B). The mean age at the time of the operation was 61.0 years (range, 44-68 years) in group A and 57.6 years (range, 45-70 years) in group B. The mean follow-up period was 21.2 months (range, 12-34 months) and 22.1 months (range, 13-32 months), respectively. RESULTS The Constant score of group A increased from the preoperative mean of 65.2 points to 79.1 points at the last follow-up (P < .001). The corresponding figures for group B improved from 66.6 points to 76.3 points (P < .001). The preoperative Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score was 21.1 points in group A and 18.3 points in group B. The UCLA score at the last follow-up was 31.0 points in group A and 27.9 points in group B (P < .001, P < .001). Retear rate was significantly lower in group A (5.9%) than group B (18.6%) (P < .001). In group B, retear occurred at the musculotendinous junction in 72.7%, but group A had no medial cuff failure. CONCLUSION In arthroscopic suture bridge repair of full-thickness rotator cuff tears, clinical results of both a knotless and a conventional knot-tying group showed improvement without significant difference between the 2 groups. However, the knotless group had a significantly lower retear rate compared with the conventional knot-tying group. A knotless suture bridge technique could be a new supplementary repair technique to conventional technique.
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Affiliation(s)
- Yong Girl Rhee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Korea.
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Lee BG, Cho NS, Rhee YG. Modified Mason-Allen suture bridge technique: a new suture bridge technique with improved tissue holding by the modified Mason-Allen stitch. Clin Orthop Surg 2012; 4:242-5. [PMID: 22949957 PMCID: PMC3425656 DOI: 10.4055/cios.2012.4.3.242] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 04/26/2011] [Indexed: 11/26/2022] Open
Abstract
We present a new method of suture bridge technique for medial row fixation using a modified Mason-Allen stitch instead of a horizontal mattress. Medial row configuration of the technique is composed of the simple stitch limb and the modified Mason-Allen stitch limb. The limbs are passed through the tendon by a shuttle relay. The simple stitch limb passes the cuff once and the modified Mason-Allen stitch limb passes three times which creates a rip stop that prevents tendon pull-out. In addition, the Mason-Allen suture bridge configuration is basically a knotless technique which has an advantage of reducing a possibility of strangulation of the rotator cuff tendon, impingement or irritation that may be caused by knot.
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Affiliation(s)
- Bong Gun Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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Lee BG, Cho NS, Rhee YG. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises. Arthroscopy 2012; 28:34-42. [PMID: 22014477 DOI: 10.1016/j.arthro.2011.07.012] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 07/10/2011] [Accepted: 07/19/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare range of motion and healing rates between 2 different rehabilitation protocols after arthroscopic single-row repair for full-thickness rotator cuff tear. METHODS Sixty-four shoulders available for postoperative magnetic resonance imaging (MRI) evaluation after arthroscopic rotator cuff repair were enrolled in this study. Aggressive early passive rehabilitation (manual therapy [2 times per day] and unlimited self-passive stretching exercise) was performed in 30 shoulders (group A) and limited early passive rehabilitation (limited continuous passive motion exercise and limited self-passive exercise) in 34 shoulders (group B). A postoperative MRI scan was performed at a mean of 7.6 months (range, 6 to 12 months) after surgery. RESULTS Regarding range of motion, group A improved more rapidly in forward flexion, external rotation at the side, internal and external rotation at 90° of abduction, and abduction than group B until 3 months postoperatively with significant differences. However, there were no statistically significant differences between the 2 groups at 1-year follow-up (P = .827 for forward flexion, P = .132 for external rotation at the side, P = .661 for external rotation at 90° of abduction, and P = .252 for abduction), except in internal rotation at 90° of abduction (P = .021). In assessing the repair integrity with postoperative MRI scans, 7 of 30 cases (23.3%) in group A and 3 of 34 cases (8.8%) in group B had retears, but the difference was not statistically significant (P = .106). CONCLUSIONS Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation protocols. However, aggressive early motion may increase the possibility of anatomic failure at the repaired cuff. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. LEVEL OF EVIDENCE Level II, randomized controlled trial.
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Affiliation(s)
- Bong Gun Lee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
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Results of arthroscopic decompression and tuberoplasty for irreparable massive rotator cuff tears. Arthroscopy 2011; 27:1341-50. [PMID: 21873021 DOI: 10.1016/j.arthro.2011.06.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 06/08/2011] [Accepted: 06/08/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical and radiologic results of arthroscopic tuberoplasty for symptomatic irreparable massive rotator cuff tears. METHODS This study enrolled 32 patients (32 shoulders) who underwent arthroscopic tuberoplasty for irreparable massive rotator cuff tears and were followed up for at least 24 months. The mean patient age at the time of surgery was 62.4 years (range, 43 to 76 years), and the mean duration of follow-up was 40 months (range, 24 to 63 months). The Constant score and the University of California, Los Angeles score were used for clinical evaluation. The acromiohumeral interval and inferior scapulohumeral line continuity were used for radiologic evaluation. RESULTS Twenty-six shoulders underwent arthroscopic tuberoplasty with concomitant acromioplasty, and 6 shoulders had only arthroscopic tuberoplasty. The Constant score increased from a preoperative mean of 47.6 points to 70.4 points at the last follow-up (P < .001). The University of California, Los Angeles score also improved from a preoperative mean of 15.4 points to 27.1 points at the last follow-up (P < .001), with 3 shoulders (9%) rated as excellent, 23 (72%) as good, and 6 (19%) as poor. The active range of forward flexion improved from 115.9° to 142.7° (P = .024). The final outcomes were not statistically affected by sex, age, preoperative mobility, and existence of a lesion of the long head of the biceps tendon. However, preoperative acromiohumeral interval and inferior scapulohumeral line continuity were statistically correlated with the final results (P < .001 and P = .047, respectively). CONCLUSIONS Arthroscopic tuberoplasty with concomitant acromioplasty, as well as treatment of the biceps tendon when indicated, would be an option for diminishing pain and improving active forward elevation for irreparable massive rotator cuff tears. In particular, satisfactory results during the minimum follow-up period of 24 months can be achieved in the cases with good preservation of the preoperative and postoperative acromiohumeral interval and continuity in the inferior scapulohumeral line, regardless of preoperative mobility.
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Cho NS, Lee BG, Rhee YG. Arthroscopic rotator cuff repair using a suture bridge technique: is the repair integrity actually maintained? Am J Sports Med 2011; 39:2108-16. [PMID: 21350064 DOI: 10.1177/0363546510397171] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Suture bridge repair has been recognized to have superior biomechanical characteristics, as shown in previous biomechanical studies. However, it is not clear whether the tendon heals better in vivo after suture bridge repair. PURPOSE To evaluate the clinical results and repair integrity after arthroscopic rotator cuff repair using a suture bridge technique for patients with rotator cuff tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS One hundred twenty-three shoulders (120 patients) that underwent arthroscopic suture bridge repair for full-thickness rotator cuff tear were enrolled for this study. The mean duration of follow-up was 25.2 months (range, 16-34 months). The postoperative repair integrity was analyzed with use of magnetic resonance imaging (MRI) in 87 shoulders. According to the retear patterns on postoperative MRI, the cases were divided into type 1 (failure at the original repair site) or 2 (failure around the medial row). RESULTS At the last follow-up, the University of California at Los Angeles (UCLA) score improved from the preoperative mean of 13.2 points to 29.7 points (P < .001). The rotator cuff was completely healed in 58 (66.7%) of the 87 shoulders, and there was a recurrent tear in 29 shoulders (33.3%). The incidence of retear tended to increase with age older than 60 years at the time of surgery (P = .002). When there was a larger intraoperative tear, the rate of retear was also higher (P = .002). When the severity of preoperative fatty degeneration of the cuff muscles was higher, there was a greater chance of a recurrent tear (P < .001). The retear patterns on postoperative MRI in 29 shoulders with recurrent failures were classified as type 1 in 12 shoulders (41.4%) and type 2 in 17 shoulders (58.6%). The preoperative cuff tear size did not have an influence on retear patterns (P = .236), but the percentage of type 1 retear increased with the severity of fatty degeneration or muscle atrophy (P = .041, .023). CONCLUSION Arthroscopic suture bridge repair of full-thickness rotator cuff tears led to a relatively high rate of recurrent defects. However, the mean 25-month follow-up demonstrated excellent pain relief and improvement in the ability to perform the activities of daily living, despite the structural failures. The factors affecting tendon healing were the patient's age, the size and extent of the tear, and the presence of fatty degeneration in the rotator cuff muscle. The retear in cases with a suture bridge technique tended to be more frequently at the musculotendinous junction.
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Affiliation(s)
- Nam Su Cho
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Yi JW, Cho NS, Cho SH, Rhee YG. Arthroscopic suture bridge repair technique for full thickness rotator cuff tear. Clin Orthop Surg 2010; 2:105-11. [PMID: 20514268 PMCID: PMC2867195 DOI: 10.4055/cios.2010.2.2.105] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 05/12/2009] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of our study is to evaluate the clinical results of arthroscopic suture bridge repair for patients with rotator cuff tears. Methods Between January 2007 and July 2007, fifty-one shoulders underwent arthroscopic suture bridge repair for full thickness rotator cuff tears. The average age at the time of surgery was 57.1 years old, and the mean follow-up period was 15.4 months. Results At the last follow-up, the pain at rest improved from 2.2 preoperatively to 0.23 postoperatively and the pain during motion improved from 6.3 preoperatively to 1.8 postoperatively (p < 0.001 and p < 0.001, respectively). The range of active forward flexion improved from 138.4° to 154.6°, and the muscle power improved from 4.9 kg to 6.0 kg (p = 0.04 and 0.019, respectively). The clinical results showed no significant difference according to the preoperative tear size and the extent of fatty degeneration, but imaging study showed a statistical relation between retear and fatty degeneration. The average Constant score improved from 73.2 to 83.79, and the average University of California at Los Angeles score changed from 18.2 to 29.6 with 7 excellent, 41 good and 3 poor results (p < 0.001 and p = 0.003, respectively). Conclusions The arthroscopic suture bridge repair technique for rotator cuff tears may be an operative method for which a patient can expect to achieve clinical improvement regardless of the preoperative tear size and the extent of fatty degeneration.
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Affiliation(s)
- Jin Woong Yi
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
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Cho NS, Yi JW, Lee BG, Rhee YG. Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique. Am J Sports Med 2010; 38:664-71. [PMID: 20040768 DOI: 10.1177/0363546509350081] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A subset of patients is often seen with an unusual pattern of tendon failure after arthroscopic rotator cuff repair using a suture bridge technique. PURPOSE To evaluate retear patterns in cases with structural failure after arthroscopic primary repairs of rotator cuff tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Forty-six cases revealing retear on magnetic resonance imaging performed at least 6 months after arthroscopic repair for the treatment of full-thickness rotator cuff tear were evaluated. A single-row technique had been performed in 19 cases and a suture bridge in 27 cases. According to retear patterns on postoperative magnetic resonance imaging, cases were divided into type 1 (cuff tissue repaired at the insertion site of rotator cuff was not observed remaining on the greater tuberosity) and type 2 (remnant cuff tissue remained at the insertion site in spite of retear). RESULTS In the single-row group, 14 cases (73.7%) had type 1 and 5 cases (26.3%) type 2 retear. In the suture bridge group, 7 cases (25.9%) had type 1 and 20 cases (74.1%) type 2. There were statistically significant differences between groups (P = .049). Extent of fatty degeneration of the rotator cuff did not affect retear patterns in the single-row group (P = .160). In the suture bridge group, the percentage of type 1 retear increased with severity of fatty degeneration (P = .030). Extent of muscle atrophy did not affect retear patterns of the single-row group; in the suture bridge group, the percentage of type 1 retear increased with severity of muscle atrophy (P = .904 vs .029). CONCLUSION The suture bridge technique tended to better preserve the cuff tissue repaired to the insertion site of the rotator cuff than a single-row technique did; the retear in cases with a suture bridge technique was mainly in the musculotendinous junction. Direct retear at the footprint of the rotator cuff increased with severity of fatty degeneration or muscle atrophy in cases with a suture bridge technique.
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Affiliation(s)
- Nam Su Cho
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Dongdaemun-gu, Seoul 130-702, Korea.
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Yi JW, Cho NS, Cho SH, Cho HJ, Rhee YG. Tuberoplasty for Irreparable Massive Rotator Cuff Tears. Clin Shoulder Elb 2009. [DOI: 10.5397/cise.2009.12.1.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rhee YG, Cho NS, Lim CT, Yi JW, Vishvanathan T. Bridging the gap in immobile massive rotator cuff tears: augmentation using the tenotomized biceps. Am J Sports Med 2008; 36:1511-8. [PMID: 18443279 DOI: 10.1177/0363546508316020] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous operative techniques have been described for the treatment of massive rotator cuff tears with severe retraction where anatomical repair is impossible. PURPOSE To evaluate the outcome of massive rotator cuff tears repaired using the biceps interposition technique. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between April 2000 and April 2004, 31 shoulders with irreparable massive rotator cuff tears and associated degenerative lesions of the biceps tendon were included for analysis. Open procedures were performed in 15 cases (open group), while 16 patients underwent arthroscopic procedures (arthroscopic group). The mean follow-up period was 32 months (range, 24-67 months). RESULTS The overall University of California at Los Angeles score at the last follow-up was 31.1 points (range, 21-35). The clinical outcome was excellent in 15 (48.4%) and good in 13 (41.9%) cases. Three patients (9.7%) had poor outcome. There was 1 case of reoperation in the open group for a retear. The mean preoperative Constant score, which was 44.6 points (range, 8-70) in the open group and 51.8 points (range, 24-70) in the arthroscopic group, improved to 80.7 points (range, 37-88) in the former and 83.5 points (range, 57-96) in the latter. The University of California at Los Angeles score improved from preoperative means of 11.3 points (range, 6-16) and 13.6 points (range, 6-19) to 29.5 points (range, 9-33) and 32.6 points (range, 21-35), respectively. However, the differences between the scores in both the categories were not statistically significant (P = .412 and .198, respectively). According to the postoperative repair integrity analyzed with use of magnetic resonance imaging in 14 of 16 cases with arthroscopic augmentation, 9 (64.3%) presented complete healing. CONCLUSION The biceps tendon interposition technique for massive rotator cuff tears offers a possible improvement in the clinical outcomes and is comparable to that of conventional repair. As well, the augmentation technique using the tenotomized biceps as potential graft for rotator cuff tears is particularly useful in bridging the gap in immobile massive rotator cuff tears with posterior defects and retraction.
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Affiliation(s)
- Yong Girl Rhee
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea.
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